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 have a lot of ocd in my family - we sent my daughter private for treatment so she did not need to interrupt schooling. I opted for nhs as it was free but assumed it was the lessor option. But it turned out to be the other way around - nhs has really clear ocd treatment paths ways and I had had very little cbt and more getting to root if anxiety for best part of two years.

Sorry can I just add - the nhs started me with people who were not physiologists but trained specifically in cbt - actually they had just had training and were very good as really wanted to help. But when this didn’t work you go up to another level of more qualified talk therapy specialists. And then up again if this does not work to the next level. The third level worked for me

They have made a massive difference to me. I could barely leave the house at one point, anxiety took joy out of everything. I also have complex trauma. I'm grateful to have had the option of taking them.

I’m not trying to put people off.

However, informed consent is a very real and important part of the physician/patient contract.

There’s plenty of evidence to suggest that actually there are issues with the original trials, and there are issues with under-reporting or adverse events and issues with even believing and effectively monitoring patients who are reporting something is wrong.

When I was first affected by OCD, though not given an official diagnosis until years later, I was given fluoxetine which made things acutely worse in the short term. I don’t know if things would have settled down in the end but I couldn’t give them chance. I went back to the docs and was given amitriptyline and that really helped me.

I’ve been on citalopram for 14 years now and can’t imagine ever being able to come off them. I’ve tried before and then peri kicked in.

Do they test for this when you go to the Drs? You test your blood sugars and often. What is the normal level of serotonin? What units is it measured in? What is considered a low level and what is considered a high level? What does the test consist of and how frequently are you tested?

With diabetes you wouldn't give insulin without testing the bloods first. To give insulin when they don't need it would cause a hypo so it is imperative you test first.

Also what causes these guts during lockdown to stop serotonin? Odd that something they experienced caused their guts to change?

Also if I had a headache does that mean my paracetamol levels are low and I need to up them?

I've googled that for you, @Fetaface: https://www.healthline.com/health/serotonin-deficiency

So it says there are no tests. So if there are no tests then they have never established what a high or low is because they;ve never tested it! Great science or lack of!

So basically it is like injecting a diabetic without testing bloods first and hoping something will happen!

So if I have a pain in my head that means I just have low paracetamol levels yeah and I need to ensure my paracetamol levels are higher so take more then, right?

What made the body change during lockdown and change back again after? How did the brain or gut know about lockdown to change and make it go wrong?

If you can devise a way to measure neurotransmitters in the brain, @Fetaface, I'm sure you'll make a fortune 😎

Paracetamol's method of action is not well understood either, is that why you chose it as a comparator?

And of course your brain and gut know what you're living through! They respond to your environment all the time.

I have no doubt that SSRIs have an important role to play and are so helpful to so many people. Having been fortunate to access EMDR and CBT from an incredible clinical psychologist and having been cured of my CPTSD and health anxiety I do think it is disgraceful that this is not available on the NHS. I accessed NHS therapy with counsellors for years but the difference in quality when done by a clinical psychologist was just amazing.

I do think that everyone with mental health conditions should be able to access therapy from a clinical psychologist (appreciate the many challenges around this) and see if that enables them to live happily without medication. I had no idea that CPTSD could be cured (EMDR doesn't work for everyone unfortunately) and that you don't have to just learn how to manage it with medication, counselling and lifestyle changes.

exactly my experience as well..

Autistic people often respond poorly to CBT type interventions as the underlying aim is to get you to think differently about things.

Autistic people are no good at 'reframing' - things either are, or are not.

I had over a year of CBT with a very senior therapist, used to be nice to have a chat but at the end her report just summarised 'no progress'.

I’d anecdotally agree with this.

CHT feels very much like gaslighting.

Nope I chose it as a comparison as that was the conclusion scientists drew when they gave serotonin to animals and observed the changes and concluded that the serotonin was low and that is what we've been told ever since. So apply that to another medication and do the same and it seems a bit weird to assume that when we observe changes that occur from taking paracetamol why is it not assumed that it was because we had low paracetamol levels in the body?

Thank you! So it is purely down to what you experience and society thinks your reaction to that is abnormal so chooses to call you abnormal and medicate to make the reaction disappear and instead of dealing with the cause of the feelings (the experience) they make you the problem.

Why not deal with the cause instead?

So there isn't any reaction to trauma that won't get you labelled abnormal then is there?

Misunderstanding. Like thousands of others, I have normal and expected feelings about my life circumstances. The circumstances cannot be changed. Most people would feel pretty miserable in the same situation: are you saying we should just fucking put up with it? Or, I don't know, maybe get drunk and stay drunk - after all, we know how alcohol affects the brain, so it's safer? 😂

You mentioned lockdown specifically, @Fetaface. Lots of people coped very poorly with the restrictions. No-one thought it abnormal, except insofar as it was an abnormal situation. Meds helped them cope.

Nope you are saying just put up with it.

You are saying that say living in an abusive household is causing you to feel bad for example. Instead of looking at how to enable people to get out of that household we just medicate them so that it enables policy makers and agents to do fuck all about it, right?

I am saying help these people with whatever is hurting them not ignoring it and saying it isn't the abuse causing you distress it is you that is the problem and here we'll call you abnormal so you feel even worse about yourself and tell you you'll never get better. On top of that the label we give you will arm your abuser to say you can't be believed which will enable them and cause you more pain. Great system we have there!

Im on 10mgs of Lexapro for anxiety and it's opened up my world, my mind and given me my life back. I didnt realise how small my world had become with anxiety until. I started this drug. Ive been on it 2 years now and it is the first anti depressant I have tried and Ive beeb lucky with it.

Im things that I never had the confidence to do before as I would talk myself out of it. Im not scared of what people think of me and I can handle life better. Therapy helped - until I had a few major things go on in my life that turned it upside down.

Im happy to continue taking it. My GP said it's a small dose but that small dose is a game changer for me. ❤️

Some circumstances can be changed, but the system makes it very dangerous to escape those circumstances - I was most certainly safer staying with my abuser. What happened when I found the courage to leave was nothing short of an abysmal failure of the system.

I don't know why recent posters have assumed I'm in an abusive relationship? I'm not in any relationships!

I'm really sorry that happened to you, @spicemaiden. So pleased you found the courage to leave - and, yes, there's a dire shortage of appropriate support

Sorry, no it was just an example.

I used to be against medication for depression, but I can honestly say they saved my life.

I'm conflicted about these drugs. I took citalopram for 15 years about 25 years ago and for the first five years they were a miracle drug for me. Pulled me out of lifelong anhedonia which had tipped into disabling depression. The potential effect of having a depressed mum on my young children at the time was what prompted me to reach out for help. I became a new person able to feel joy and take on challenges I'd found totally pointless and overwhelming before. The effects did wear off over the years though so I did decide to come off them when my doctor suggested it and had no side effects at all so they'd probably stopped working long ago.
A few years ago, when I wasn't coping well with a life event, so tearful and hopeless , I went back on them but, despite doubling the dose, they did numb the tears but I never got that euphoric zest for life I was so hoping for so I came off them. Biggest disappointment of my life! I use CBT and mindfulness now to stave off the pits of despair and as I have a pretty stress free life now and work on being kind and non judgemental to myself, I cope ok.
Why am I conflicted about them? When they work, they are life-changing but for me it wasn't a lasting change. Worst of all I did notice a reduced ability to orgasm over the years I took them but didn't put two and two together. Since my second try with them, I have been left with no ability to orgasm at all and am only finding out now this is a significantly common side effect which can be irreversible. I know it was probably buried in the arse covering list of side effects in the accompanying leaflet but I'd say this is a pretty life changing effect which doctors should have been more up front about... it's never been mentioned by any doctors I saw.
So I'd say they can be life saving in the short term, albeit with some life-changing side effects but unless you are supported to work on lifestyle changes, strategies and insights when they are working, they're not going to be the magic solution in the long term.
If they have brought you life long relief from depression, I am so envious! I would give anything to feel the way I did when I first took them.