SSRIs-Worth the Risks?

[Nocd39]

I’ve just been listening to this podcast about SSRIs with Dr Rangan Chatterjee and Joanna Moncrieff:

https://podcasts.apple.com/gb/podcast/feel-better-live-more-with-dr-rangan-chatterjee/id1333552422?i=1000712300093

It’s a really interesting listen and they discuss research on how SSRIs work (basically we don’t know), whether they are effective, and side effects.

I think it’s pretty worrying that we still don’t understand how the drugs work when there can be serious and ongoing side effects. I wish there was more research into alternatives. And more non-medicinal support for people who are struggling.

AIBU?

I think it’s really hard for people coming off SSRIs

I’ve come off 4 SSRi’s with no issues including Paroxetine.

It’s not the same for everyone.

Short term yes they have a purpose, to get you through a difficult time like a bereavement or redundancy or break up etc. But you are just kicking the can down the road ... if it’s a long term issue for a person by far the best treatment leading to the best outcomes was therapy and making life changes. Diet and exercise

I think this is so well established, it's explained to everybody who gets an antidepressant prescription. It's also in the leaflet and on any information page you seek about your meds.

It surprises me that, with all the frequent articles, videos and programmes bewailing the widespread use of SSRIs, none of them address the fact that many of us live depressing lives. Unbearable, in many cases, with the drugs providing some much-needed support. We simply do not live in a perfect society.

I'm fortunate to have done ten years of heavy-duty therapy, to have maintained a high level of fitness until illness prevented it, to be aware of and, yes, grateful for the good little bits of each day, and my diet's nutritious. The other shit, though (illness-related) is tough to deal with. I need more help than fresh air and meditation can provide. Few other people living under intolerable strain have my advantages, and we all cope a little better with the drugs.

Put us in a paradise with no money worries, all the competent support services we need and an uplifting social environment, then perhaps this oft-repeated lecture would have some relevance.

I'll fight anyone who tries to take away my sertraline.

Just to add to the long list of things that PPs have mentioned - another issue with therapy is that a lot (and I really mean A LOT) of therapists out there are absolute shit. So as someone like myself who was crippled by anxiety and depression, I was left to fend for myself either on long NHS waiting lists until I eventually got some shitty therapy sessions - those at least were free. Or alternatively spend hundreds of pounds working with either shit or suboptimal or simply expensive therapists, to hypothetically achieve something completely non measurable. Am I making progress? Am I not?

Sertraline gave me my life back in a matter of weeks, no waiting, no side effects, and costs less than £10 a month.

Yes I agree with this. I don’t think there’s good research but clearly it’s not the majority of people who have serious withdrawal issues. When I say it’s hard for people, I mean there often isn’t any emotional support or much medical supervision, or ability to access medication in smaller doses should they need to taper off.

Sadly I don’t think a lot of the risks are explained to people. There might be best practice but GPs are rushed. Certainly in my case there was quite a paternalistic attitude towards me and almost a fear of discussing anything in case it made my OCD worse.

I agree with you that life can be hard and shitty and it’s not always about easy solutions. Having said that, I think we should push to have the best medical solutions possible and a range of different medications or treatments on offer.

@Burntt

"But if it’s a long term issue for a person by far the best treatment leading to the best outcomes was therapy and making life changes. Diet and exercise (I hate that this is bourbon out by science!"

Therapy isn't a silver bullet, especially while the field is so unregulated that so many shit therapists are out there offering nothing more than a "safe space" and some helpful nodding.

I'll just stick with my GP's advice, thanks.

Diet and exercise didn't manage to lift me from the abyss of depression, although I did get quite an impressive six pack out of my every day workouts.

Diet and exercise 🤣🤣🤣🤣

Sure, and colouring books and journalling, aye

I’ve definitely had the experience of super long NHS waiting lists. I think with OCD specifically it’s really obvious if the therapeutic treatment (CBT and exposure therapy) is working because it’ll be a dramatic decrease in the number of daily rituals a person is doing. However, for many people I have met with severe OCD they really struggle to get better. Engaging with therapy is terrifying and they don’t get many sessions or enough support.

I don’t think @Burntt was suggesting that diet and exercise or therapy is in any way a quick fix to cure MH issues. Certainly I couldn’t have dieted/exercised my way out of severe OCD. I think their point was that, due to the chemical effects on the body and the body basically getting used to the new serotonin levels, that long-term there can be real issues with SSRIs. Obviously for some people they have no side effects and feel they are life savers. It’s a mixed bag

"But if it’s a long term issue for a person by far the best treatment leading to the best outcomes was therapy and making life changes. Diet and exercise (I hate that this is bourbon out by science!"

l’ve had anxiety and depression since the age of 16, and anxiety since the age of about 6. I’m 62 now. Is that long term enough? Therapy has made no difference.

Yes there is.

My gp supervised them all. And offered syrup or other stuff should l need to taper slowly.

Im glad you had this support. I know in my case that didn’t happen and anecdotally I know this isn’t always given to others either. I had to fight with my GP to get the liquid form to taper off my first SSRI. Obviously not literally, if I’d had to go fists cuffs I’d never have won as I was so unwell 😂

No idea what they actually do internally or what they are meant to be tackling internally either.

Sertraline was amazing for me when I was really struggling.

However, I’d love to know (I could just google this!) why SSRIs can have such an impact on sex drive/orgasming? I’ve been off it for 6 months now and I still have zero desire for sex - beginning to think this is me for life now.

I don’t think they know why but genital numbing seems to go alongside the emotional numbing, according to the podcast. I hope things improve for you x

I think the theory is they help to have increased serotonin in the brain, with the idea being that lie serotonin is behind MH problems. But it seems like the evidence for that theory is very contested and they don’t really know how SSRIs work. Clearly they do work for some people but it’s unclear if that’s to do with chemical charges, placebo or something else

Yeah that is what I thought was the line spun but that was debunked decades ago and serotonin is stored in the gut so that doesn't make much sense and there is neither proof that serotonin is the issue behind MH problems either when you look at things like lockdown it kind of pisses on that idea.

I mean surely they would test serotonin levels first if that was the real thing they do but they don't so I think that is just based on the animal test. It would be interesting to know what actually happens inside the body with them. I'm not sure if there is anything for them to 'work on' shall we say.

And don't you try and scare people out of taking a drug that is safe for the majority of people. Medications save lives. People need to understand their is always a small risk but on the whole these drugs are safe. Like many people I'd be dead now if it wasn't for ssris

But you keep making sweeping statements that aren’t true.

People don’t get support coming off them
People struggle to come off them

Not everyone feels like this.

And l don’t ever feel numb on them. This sounds like right bunkum. ‘Sexual numbing is related to emotional numbing😂

Except physical and one’s emotional. I’ve never had emotional or sexual numbing. And if you care to google explanations are quite clear as to why it happens.

I love this "I feel like the holiday me all the time".

Think of it this way: Would you critique a diabetic with Type 1 diabetes who needs insulin in order to be alive??? Same goes for people with depression who need to take SSRIs: their bodies don't process/produce/regulate serotonin properly. They need medication to be able to do that. There are loads of things the medical profession doesn't really understand able the drugs we use (hell, must of the drugs that are used are prescribed "off label" and were never originally tested for the uses that GPs now give them out for) the point is that people who have depression can be utterly destroyed by it. The question of whether or not SSRIs are "good for you" is utterly moot if the person will end their life or not be able to do anything but stay in bed without them.

Joanna Moncrieffs views are regarded as pretty minority in mental health circles. She makes a career out of challenging established views which is a good thing to do but it doesn’t mean she is actually correct.
https://www.kcl.ac.uk/news/a-response-to-the-serotonin-theory-of-depression-a-systematic-umbrella-review-of-the-evidence

No we don’t know how antidepressants work. We don’t know how a lot of drugs work including anaesthetics Do you reckon we should stop using those too?

Yes they have side effects so do all drugs and it’s always a risk; benefit trade off.

Antidepressants are the only option aside from ECT for people with very severe depression who are too ill for talking therapies and they work for a lot of people. The risks are pretty minimal.

I can agree with her that for mild to moderate depression they may be overused and talking therapies might be better but for severe depression they are required and for many conditions they have an additive effect with therapy

For OCD serotonergic antidepressants (which includes clomipramine) PLUS CBT with ERP are the only known effective treatment and are most effective when both are combined

TMS is well researched and is effective for depression but not established for other conditions and not available on the NHS in most areas as health boards refuse to fund mental health services. ECT is better than TMS but again not available to most people.

Im not sure why you’d be happy to have a strong magnet depolarise your brain repeatedly but not to take an SSRI and you worry about long term effects of SSRIs which have been used by many people around the world for many years vs TMS which is very new and indeed we do not know the long term effects of although it appears very safe so far.

Yes it would be lovely if more taking therapy was available on the NHS but you can see that it’s a numbers game and a money issue right? People want ‘long term’ ‘good quality’ therapy ie unlimited sessions 1:1 with a highly qualified person. It’s obvious the NHS can’t afford that for all. There are side effects of therapy too that I have seen many times; people being retraumatised by being rushed into low quality EMDR (flavour of the month and yet the theories on how that works are a while lot shakier than SSRIs) and people dependent on private therapists who are taking their money to maintain them in dependency with no discernible outcome

It is not as simple as SSRIs bad, therapy good. It’s horses for courses, a risk benefit trade off in all instances and health economics do come into what treatment is funded in a public health system unless all
the shy Tory voters suddenly decide to put their hands in their pockets.

that long-term there can be real issues with SSRIs

What long term issues? I’ve been on them 30 years. I haven’t had any long term issues and they’ve never stopped working. Another sweeping statement.

From a very personal view, i have been taking SSRIs for chronic anxiety since 2013 - albeit on and off. I can safely say that without a shadow of a doubt they have been amazing. They allow me to function like a relatively normal human being, not get horribly overwhelmed with things. Perhaps the most noticeable thing i feel is there is a distance mentally speaking between myself and my worries and they do stop this awful stomach churning feeling.

I am not sure where i would be without them...

Iv been on them over 20 years no issues and haven't stopped working