Though this article concentrates on the SSRIs, other meds like the SNRIs can have a similar or even worse withdrawal effect. We didn't call it "Side Effexor" for nothing.
People legitimately need these drugs, including in the short term. The problem for acute stressors once they resolve is how to get them back off.
Paracompact · 2026-08-27 23:15:01 UTC
> Though this article concentrates on the SSRIs, other meds like the SNRIs can have a similar or even worse withdrawal effect.
And don't even get me started on tricyclics or MAOIs... no, seriously, don't get me started on them! The current generation of first-line antidepressants (SSRIs/SNRIs) might as well be free compared to the old school crazy pills.
SV_BubbleTime · 2026-08-27 23:49:53 UTC
> school crazy
Yep, that’s how I associate SSRIs.
sheepscreek · 2026-08-28 00:12:15 UTC
Much of medicine (especially mental health related) is rather primitive. We are literally reverse engineering discoveries that seem to work on some other animals, and then figuring out how (to the best of our limited ability).
I liken SSRIs to carpet bombing - also their mechanism to increase seratonin in the brain is by making something else not use it (reuptake inhibition). We’re guessing that other thing isn’t a big deal. But who knows. Serotonin is produced in the gut and it controls melatonin, which controls our sleep. It’s all connected in a bizarre way.
matheusmoreira · 2026-08-28 01:06:43 UTC
> I liken SSRIs to carpet bombing
It's like inserting objects into the body's event loop and hoping it produces the desired effects as it circulates, only to find that everything reacts to the event, not just the parts we want.
It's probably less "modern antidepressants are uniquely bad" and more "we got much better at starting people on safer drugs than we did at figuring out how to stop them"
KurSix · 2026-08-28 05:34:08 UTC
For something prescribed to get someone through a temporary crisis, "how and when do we get you back off this safely?" should probably be discussed at the beginning, not years later when the patient decides to stop.
sixeyes · 2026-08-28 08:46:38 UTC
for my snri i lessened the dose by 25% and that alone cost me a week of work, i was so fucked over. when i quit this i will for sure do the thing where you open the capsules and remove a little of the contents, gradually removing more each day.
i read online about people doing this and thought they were nutjobs. well, now i know.
bcjdjsndon · 2026-08-28 11:46:49 UTC
Or how about drugs won't solve anything, let's look at why you feel so shit to begin with instead of kicking the can down the road with happy drugs.
probably_wrong · 2026-08-28 12:39:39 UTC
If a fireman is trying to stop a house fire and suddenly they catch fire themselves, no one would argue that they need to focus on the house fire first.
Antidepressants are the same: they won't stop the bigger fire by themselves, but by preventing you from catching fire right now they give you the tools to deal with the larger problem more effectively that if you tried to do it while flailing around and screaming.
john_strinlai · 2026-08-28 12:53:24 UTC
man, you're all over this submission shitting on antidepressants and questioning people's experiences. it's irresponsible and really not cool.
Best way to manage the withdrawal would be to dramatically reduce them being prescribed in the first place.
The linked article says they have "small to moderate effectiveness", but this is being far too generous. The correct way to measure drug effectiveness is if the treatment meets the standard of a minimal important difference. I.e. you measure depression on various rating scales, like the 17-point HAM-D, and research suggests a minimal important difference (i.e. one patients and clinicians can actually notice) needs to be about 3-5 points. But the average effects of almost all antidepressants do not meet these thresholds, i.e. the effect actually appears practically invisible. [1]
Then you'll get waffling like "oh, but it really has a big effect for some people", but, well, no, we've looked at that too, and the placebo groups get just as miraculous "big effects", i.e. evidence supporting the idea "they really help some people" is also largely lacking [2-3]. All the other attempted saves ("oh, but eventually you find one that works for you") are also not really well supported either [4].
Like, maybe they really help some people, but it is far, far less clear than most assume, and should be balanced with concerns like withdrawal and serious side effects like emotional blunting and sexual dysfunction.
EDIT: And just to be clear to anyone doing a drive-by downvote thinking this is about recent asinine US politics, it emphatically isn't. There are serious methodological concerns here that desperately need to be communicated to the public.
On an academic level, we have reined in much of the excess enthusiasm in antidepressants that was courtesy of 90s-era pharmaceutical reps and ad men, but I don't think this revision ever occurred in the cultural consciousness at large.
D-Machine · 2026-08-27 23:21:37 UTC
Yup, I would agree. The meta-research / methodological research and awareness here is really quite impressive, even though its conclusions are a bit grim and not well-known.
jakebol · 2026-08-27 23:54:41 UTC
A good book on this is Mind Fixers: Psychiatry's Troubled Search for the Biology of Mental Illness. Describing the history of how many of these classes of drugs came about is pretty eye opening, I would say the book is pretty nuanced in its conclusions.
Because the 1 in 10 stat I find seems a bit low, at least in my circle, and those are the ones who are open about it.
And the people I know have been on them approximately a decade. What baffles me is that a fair number of them triggered their own depressive episodes, and likely did need therapy and something at the time - but have all long since move past those "moments".
See also: The Serotonin Theory of Depression: a Systematic Umbrella Review of the Evidence (2022). It's worth reading the introduction and results in full, but here are two important quotes (footnote markers removed):
> Our comprehensive review of the major strands of research on
serotonin shows there is no convincing evidence that depression
is associated with, or caused by, lower serotonin concentrations or
activity. Most studies found no evidence of reduced serotonin
activity in people with depression compared to people without,
and methods to reduce serotonin availability using tryptophan
depletion do not consistently lower mood in volunteers. High
quality, well-powered genetic studies effectively exclude an
association between genotypes related to the serotonin system
and depression, including a proposed interaction with stress.
> The chemical imbalance theory of depression is still put forward
by professionals, and the serotonin theory, in particular, has
formed the basis of a considerable research effort over the last few
decades. The general public widely believes that depression
has been convincingly demonstrated to be the result of serotonin
or other chemical abnormalities, and this belief shapes
how people understand their moods, leading to a pessimistic
outlook on the outcome of depression and negative expectancies
about the possibility of self-regulation of mood. The idea
that depression is the result of a chemical imbalance also
influences decisions about whether to take or continue anti-depressant medication and may discourage people from dis-continuing treatment, potentially leading to lifelong dependence
on these drugs.
Personally, I both agree that SSRI antidepressants were likely overprescribed early on, and disagree with the notion that the chemical imbalance theory is unsupported. N = 1, they can absolutely work. It took a few to find one that really did, hence I am certain it is not a placebo effect.
D-Machine · 2026-08-27 23:56:42 UTC
The idea that simple serotonin deficiency is the whole entirety of all depressions is 100% discredited and completely incoherent in the face of current evidence, but yes, for sure it remains clear and plausible that some forms or aspects of depression involve a serotonin deficiency.
However, tianeptine is serotonin reuptake enhancer and also can help with depression, so any simple deficiency hypothesis also doesn't look good either.
Broadly, the "chemical imbalance" theory, left vague and unspecified, is still basically sane (though not specific enough to be super useful).
pcrh · 2026-08-28 08:55:22 UTC
Here are a few additional reports:
>1. Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder. A systematic review with meta-analysis and Trial Sequential Analysis. Conclusions: SSRIs might have statistically significant effects on depressive symptoms, but *all trials were at high risk of bias and the clinical significance seems questionable*. SSRIs significantly increase the risk of both serious and non-serious adverse events. The potential small beneficial effects seem to be outweighed by harmful effects.
>2. The trouble with antidepressants: why the evidence overplays benefits
and underplays risks. Widespread prescribing has not reduced mental disability or suicide, raising questions about the assessment of evidence on effectiveness and safety of antidepressants
>3. In search of a dose–response relationship in SSRIs—a systematic review, meta-analysis, and network meta-analysis. Conclusions: There is no conclusive level I or level II evidence of a clinically meaningful dose–response relationship of SSRIs as a group or of single substances. High SSRI doses are not recommended as routine treatment.
>4 The serotonin theory of depression: a systematic umbrella review of the evidence "We did not identify *any* trials using ‘active placebo’ or ‘no intervention’ as control interventions. "
The "chemical imbalance" theory is objectively wrong, but still useful in that it conveys the fact that mental disorders have physical causes. It's a purposeful simplification.
Rendello · 2026-08-28 02:43:13 UTC
Many people take SSRIs and other medications because they believe the serotonin imbalance theory to be the modern scientific consensus. A doctor would be fired and ostracized for using the four humours, but can prescribe life-altering medication after five minutes to correct chemical imbalance, a theory which has never had much support within the scientific community.
Indeed, a rebuttal [1] to that paper starts with:
> Moncrieff et al. report in a review of reviews that depression is not generally linked with serotonin deficiency. This is hardly news to neuropharmacologists, which Moncrieff et al. tacitly admits, as they justify their review by citing examples of laity and general practitioners believing depression is caused by a “chemical imbalance”, i.e., in serotonin. For instance, already in 1986 did Depue and Spoont point out that serotonin deficiency may not be a general cause of depression or other psychiatric illness. Further, that increasing extracellular serotonin—e.g., with selective serotonin reuptake inhibitors (SSRIs)—treats depression does not mean decreased serotonin causes depression.
I have a lot of trust in the science of medicine, but almost none in healthcare. It seems like the research is totally divorced from the medieval treatments I see doctors give all the time. "This is hardly news to neuropharmacologists" vs "laity and general practitioners believe ..." indeed.
Note that it's not uncommon for even more widely prescribed medication to have no firmly established mechanism of action. Acetaminophen/paracetamol is probably the best example.
Ultimately medication is prescribed based on evidence from clinical trials, whether or not the mechanism of action is fully understood. SSRIs work to help with depression in clinical trials when compared to placebo, so they get prescribed.
Otterly99 · 2026-08-28 08:51:40 UTC
Thanks for the paper, it is actually quite crazy to think about when SSRI are basically the standard to treat depression.
I recently read a book about "The brain energy theory of mental illnesses"[1] which encapsulates depression and found it pretty compelling.
It seems to be a relatively new and active area of research[2], so there is hope!
So did you take them and have a bad time? Because they definitely work for me and I doubt a placebo could have such a large effect on the 48 hour stomach pains I used to get alongside my frequent panic attacks.
I find it funny that people complain about emotional blunting when that is the entire purpose of the drug. I would prefer not to live on the razors edge ever again. I’ve had chronic anxiety and depression ever since I was a child, though.
D-Machine · 2026-08-27 23:32:32 UTC
For some people the emotional blunting is desirable, especially as you said, if the problem is chronic anxiety. But for many other people, their depression is defined by a lack of positive affect and anhedonia, meaning that emotional blunting is literally making things worse.
Depression is highly heterogenous, and I am glad the medication helped you.
JoshTriplett · 2026-08-27 23:38:17 UTC
> I find it funny that people complain about emotional blunting when that is the entire purpose of the drug.
The ideal would be to blunt the negatives but not the positives. The effect of some of the older antidepressants can be to blunt both, across the board.
Some of the newer atypical antidepressants can address depression without making everything flat.
jakebol · 2026-08-28 00:07:27 UTC
SSRIs have much more clinical evidence of efficacy for addressing anxiety disorders vs a placebo than depression. The effect size is ~0.7 vs 0.2 in meta studies.
martinald · 2026-08-28 00:21:04 UTC
Totally agree, they really shouldn't be called antidepressants at all. Important to add tho that for many with depression they have comorbid anxiety and often the anxiety is harder to tolerate than depression, so removal of anxiety symptoms can be hugely beneficial.
Also, IME they are dosed completely wrong. So many people seem to be on very low doses, which has no improvement on placebo in the studies I've read.
Whereas, higher doses are _hugely_ better than placebo, especially for anxiety.
What's worse is a lot/most studies on SSRIs in general often don't adjust for dose. Which seems like an enormous oversight to me.
burnte · 2026-08-27 23:29:46 UTC
> Best way to manage the withdrawal would be to dramatically reduce them being prescribed in the first place.
No, that will just hurt more people up front for longer. The truth is antidepressants have a larger effect on mental health than actually gets reported because of how improvements are measured. If you look at a patient who doesn't get out of bed, is in trouble at work/school for performance, doesn't spend social time with friends, etc, and 6 months after starting an SSRI they're indistinguishable from other people but still have other issues, we call that a "mild impact" because they self-report other problems.
The truth is we took someone from being passively suicidal to functioning normally, and we fail to look at the self-reported problems, we just report them. The self reported problems tend to change from "I don't care about anything" to "I'm unhappy at my job" or "I'm stressed at how much I have to do with work and my kids and home." These are actually major improvements, the patient has gone from being actually clinically depressed to significant improvement but continued unhappiness with life circumstances as opposed to unhappiness with life in general.
Antidepressants are amazing, we need to improve therapists and how they deal with medicated patients. Too many therapists dismiss meds and too many psychiatrists dismiss therapy. I've been in this space for a long time now, healthcare IT in the mental/behavioral health space. We're engaged in a long erm research study to help demonstrate the value of a tightly integrated therapy/psych team and more advanced treatments and when you get everyone in the room pulling in the same direction patient outcomes are amazing.
One actual issue that antidepressants face is that they're not the only treatment, but many doctors are reluctant to move to TMS or esketamine, despite the amaing success rates they have with patients who have not had success with two or more drugs. If two drugs failed you, the third has a 14% chance of helping. The 4th is single digits. But you pivot to TMS and you see 60-80 percent improvement rates. Esketamine is close too.
ADs aren't the problem, it's that we don't take mental health as serious as we take physical health.
D-Machine · 2026-08-27 23:37:38 UTC
> The truth is antidepressants have a larger effect on mental health than actually gets reported because of how improvements are measured.
The truth is actually exactly the opposite, and I provided very high-quality evidence demonstrating this to be the case. You have nothing but bald assertions.
tredre3 · 2026-08-27 23:55:03 UTC
> But you pivot to TMS and you see 60-80 percent improvement rates. Esketamine is close too.
I have received both rTMS and esketamine and the providers themselves told me they saw roughly a 30-40% response rate (not remission, that's even lower!). Upon researching the topic myself, I found that the meta analysis usually agreed with this 30% figure, but recent research papers mark eskatamine even lower. Both treatments can be miraculous for a few select people and it makes a good headline, but it's a total failure for the majority of people.
I agree with you that those treatments should be easier to access, though.
> Too many therapists dismiss meds and too many psychiatrists dismiss therapy.
This is the only factually true statement in your entire comment.
nabukodonozor · 2026-08-28 00:12:25 UTC
Well I think that we do not know enough about genesis of depression and other mental issues. So this is just symptomatic therapy. And as such it should be prescribed only for very short terms. Analogy: how would you perceive someone who prescribed his febrile patient paracetamol for 10 years just because it works? And in his defense he/she claims that febrile condition has well known metabolic chain and that paracetamol lowers fever mainly by interrupting the COX → PGE₂ part of the fever pathway in the brain.
jaggederest · 2026-08-28 01:13:26 UTC
The problem with the entire argument that you're making is that the natural rate of remission in uncomplicated major depressive episodes is very close to the rate that SSRIs create, individually, and very close in terms of timing. If you do something more like STAR-D you see higher rates, but that also takes so long that many people naturally remit.
elil17 · 2026-08-28 07:42:16 UTC
> You look at a patient who doesn't get out of bed, is in trouble at work/school for performance, doesn't spend social time with friends, etc, and 6 months after starting an SSRI they're indistinguishable from other people but still have other issues, we call that a "mild impact" because they self-report other problems.
This really lines up with what I've seen anecdotally. My partner literally doesn't remember how bad things were before he took antidepressants because depression impacted his ability to form memories. He self reports that antidepressants had a mild impact, but from an outside perspective nearly everything about his life changed.
googaar · 2026-08-27 23:43:39 UTC
I can’t believe we’ve normalized anti depressants as a society.
I’m about to get downvoted into oblivion for this take though.
I’m not trying to discount mental health, I just think there are better solutions than drugs to fix your state of mind.
Also think that some people are dealt a tougher hand than most, and that for a small subset of humans, anti depressants are the most fitting cure.
D-Machine · 2026-08-27 23:46:55 UTC
Agreed. They have to be significantly helping at least some, but we can't say who these people are for certain yet, or how many there really are.
And yes, in some cases, no other options are possible, so even if the evidence is pretty dismal for their effectiveness, they are still broadly safe enough to definitely be worth a try. They probably just shouldn't be the first-line approach.
wat10000 · 2026-08-28 00:02:25 UTC
I don’t get why people are so negative about drugs. They’re just a medical treatment, with pluses and minuses. If they help and they’re not too costly then what’s the big deal? Half the population is addicted to caffeine and nobody cares. A huge number of people need medical intervention for other things and we don’t get this quasi moralistic opposition to them.
D-Machine · 2026-08-28 00:10:42 UTC
Agreed. The problem is largely that the pluses of antidepressants have been quite significantly overstated, and the minuses have been understated, meaning the cost-benefit equation is unfortunately quite different than what the general public assumes.
We don't want to get rid of them, we just need to recalibrate prescribing, and also to properly assess cessation at intervals more frequently than we have been.
wat10000 · 2026-08-28 00:21:12 UTC
Yeah, I’m open to the idea that their effectiveness may have been overestimated and they’re overprescribed as a result. But this “I can’t believe we’ve normalized antidepressants” “there are better solutions than drugs” stuff is just moralizing.
D-Machine · 2026-08-28 00:36:10 UTC
I suppose it can be moralizing, and probably is in the parent comment.
For me I still feel the surprise because I've followed the evidence carefully for well over a decade, and the methodological problems and lack of evidence for meaningful effectiveness have always been clear. I.e. it is clear standardized effect sizes are meaningless, and you need to determine important differences, as this is just basic science, but only a tiny handful of papers ever bothered.
So it feels very much like "how can we have normalized something so incredibly scientifically shaky", i.e. for me the moralizing is not "drugs are bad, how are we normalizing drugs" it is "how can an entire medical field and society so recklessly adopt something so obviously weakly supported". I.e. my dismay is more about the weak epistemic standards of society than it is about drugs.
BeetleB · 2026-08-28 00:13:23 UTC
> I’m not trying to discount mental health, I just think there are better solutions than drugs to fix your state of mind.
Find one that's as effective on the general population.
I mean, sure, perhaps lifestyle changes are better. Can you get a higher percentage to change them and improve people's lives than we currently can with drugs?
As a top performer in school, I definitely think (and still point out), that you can get fantastically high results in SAT/GRE without paying any test prep service. I and many of my peers did it. There are better solutions than paying those services. But how many who don't pay do as well as those who do? I can tell them how to study as much as I can, but the reality is that statistically, people who attend will do better than if they don't.
From a medical standpoint, telling people to change how they live and think has a fairly low success rate. The best options usually don't work on the masses.
cameronh90 · 2026-08-28 00:24:35 UTC
Clothes too. If you're cold, why not just move to a tropical country where you can be naked, as nature intended?
marmarama · 2026-08-28 00:21:47 UTC
"As effective as placebo" does not mean worthless. As you point out, placebo antidepressants are fairly effective.
It's a terrible bind. Patients want a pill to fix things, but if they know it's just a sugar pill, it doesn't work. It has to have active ingredients that might work. That's why there's little desire to change the status quo on antidepressants much. Anyone who reads the medical literature knows they're statistically underwhelming, but the experienced reality is that they help people a lot.
Talking therapies, CBT, exercise are all good alternatives but they take time and effort that a depressed person might not be able to manage. An antidepressant prescription they can get in 15 minutes.
D-Machine · 2026-08-28 00:28:55 UTC
> As you point out, placebo antidepressants are fairly effective.
This is a misunderstanding of concepts like regression to the mean, and also the active placebo elements involved.
> but the experienced reality is that they help people a lot
And the evidence is that the reality people think they are experiencing is wrong, i.e, they are improving and factually experiencing improvement, but misattributing the cause to the drug.
> "As effective as placebo" does not mean worthless
In one sense of worthless, perhaps, but since drugs have larger costs relative to placebo, well, we can argue they are worse than worseless in another.
Better instead to talk about cost-benefit tradeoffs, number-needed-to-treat vs number-needed-to-harm and etc though, and try to get better at prescribing more carefully to those they clearly benefit.
odyssey7 · 2026-08-28 00:33:34 UTC
It’s unethical to prescribe a patient a placebo in a way that suggests that what they are receiving is scientifically proven.
In a clinical trial setting, you can prescribe a placebo, because the patient is fully aware and clearly consenting to the fact that they may receive a placebo. Lying to a patient, in a clinical setting, from a position of authority, is a completely different matter. The informed consent would be completely absent, the patient’s ability to make informed choices about their own healthcare would be undermined and withheld, and the provider would be deriving financial benefit from the patient and / or through insurance claims for what amounts to a scam.
The patient, who would be seeking a treatment from a trusted expert, would believe that they are receiving proven treatments in exchange for their time, patience, money, reduced quality of life due to side effects, and opportunity costs in terms of not going to a different provider or trying something else, but in reality their provider would be misleading them. Some patients would even die as a result of taking a particular placebo and depending on it—either because of side effects or due to the lack of effectiveness—when they tragically would have been better off trying a different approach or medication. How could a patient possibly give informed consent in such a scenario, for one thing? How could they meaningfully compare treatment options and make their own informed choices when the advice they receive includes lies?
Alas, some providers believe in placebo effects so much more strongly than their patients’ right to autonomy that when faced with complaints of side effects, they will just lie more and more to their patients in hopes that the side effects will go away, but that’s really just more gaslighting to people who are already in difficult situations.
aardvark92 · 2026-08-28 00:30:48 UTC
My anecdotal experience going on and off Paxil is that it does work for me, and no matter how badly I want to live Rx-free, I consistently devolve into a moody mess without them.
Xortl · 2026-08-28 01:48:05 UTC
What's your opinion of the claim that antidepressants have small impact on people with mild to moderate depression, but significantly more impact on people with severe depression [1]?
I ask as a nonexpert because this is a view I've read a few times from people I trust more than most, and I know two people who suffered from severe depression who credited SSRIs for getting them through.
Honestly, every time I look into if the "treatment by severity effect" is clearly established, I feel I come away only able to shrug. It is at least plausible, but hasn't been clearly established or refuted.
What does seem clear to me is that the whole cost-benefit considerations change in favor of anti-depressants when the depression is severe. I wouldn't say anti-depressants should be first-line treatments for ordinary depression, but for severe depression, I think they are a very reasonable first-line option.
Sure, they still might not help, but the costs / harms don't seem so bad compared to the potential costs / harms of leaving the severe major depression untreated, and the other options look all pretty terrible here too.
sandcat_ · 2026-08-27 23:19:57 UTC
To provide one additional anecdote: I came off escitalopram with no taper after taking it for about five years (10mg). I got brain zaps for a while, got very irritated at times, but largely was fine after a few weeks. Not downplaying the withdrawal effects for some people, but they’re not as catastrophic as this article suggests for many (perhaps most).
And overall I’m very glad I took it! It got me through a rough patch, and seems (in combination with therapy, and some life changes) to have rewired me a little. Symptoms I had for a decade prior have not returned. And I’m not sure I could have made those life changes without it.
Sadly my arachnophobia came back though. Oh well.
delichon · 2026-08-27 23:33:56 UTC
Good news, exposure therapy is quite effective for arachnophobia and is the first-line treatment. SSRIs do not have the same level of supporting evidence, and the effects are not as durable.
sandcat_ · 2026-08-27 23:42:19 UTC
Thanks, yeah, but if I’m honest I don’t really care enough to go through with it. I almost did once, years ago, the London Zoo have a programme.
I mentioned it though as one of the most stark changes I noticed after getting on an SSRI was pretty much immediately losing my fear of spiders. It was the first sign I had that showed it was doing something.
I used to literally, on occasion, launch my phone across the room if I was scrolling and came across a spider (sometimes drenching myself with coffee or whatever in the process!) and then one day, shortly after getting on it, I stumbled across some awful tarantula video or something and I just stared at it like “huh, why am I not freaking out”.
simiones · 2026-08-28 07:58:35 UTC
> SSRIs do not have the same level of supporting evidence, and the effects are not as durable.
To the extent that we can measure depression, SSRIs have been widely proven in gold standard phase III clinical trials to help with the treatment of major depression. What exactly is supposed to be lacking in the supported evidence?
avianlyric · 2026-08-28 10:25:15 UTC
GP is talking about using SSRIs for treating arachnophobia, not depression.
movespebp · 2026-08-28 12:36:41 UTC
Unfortunately many of the trials look like this : https://study329.org/ - the ghost written study concluded “Paroxetine is generally well tolerated and effective for major depression in adolescents.”
The reality of the actual trial data was very different - with catastrophic results for many.
pcblues · 2026-08-28 10:09:58 UTC
Exposure therapy does not work for everyone in all areas. Sometimes not at all.
Also, see the debate around discussing traumatic events in therapy immediately versus waiting a year.
Throwing people in the deep end doesn't always result in a swimmer :)
YMMV of course.
bsuvc · 2026-08-27 23:36:41 UTC
It's been years since, but I too had brain zaps coming off of it. It took a few months for those to go away.
I tried to describe it to my doctor and he seemed like he never heard of it before and sort of look at me like I was crazy, or at least that is what I sensed. But I ended up researching online and found it was a thing that happens.
zzzeek · 2026-08-28 00:54:36 UTC
Interesting is your doctor a general practitioner or a psychiatrist? A psychiatrist definitely knows about this stuff. GPs in my experience know almost nothing about anything beyond what seems like a script they operate from.
simiones · 2026-08-28 07:54:16 UTC
You are assuming a lot about the competency of some specific doctor who knows where in the world...
Aboutplants · 2026-08-28 11:16:50 UTC
Honestly, this is where chatbots and AI come into play and make an astonishing difference. I’m an AI realist/pessimist but its usefulness in general medicine is going to save millions of lives due to doctor ineptitude. They are after all just well read mechanics
clsec · 2026-08-28 12:02:34 UTC
A psychiatrist definitely does not always know these things. Mine told me there should be no Citalopram withdrawals and that I should taper by cutting my dose in half over a 2 week period.
They were absolutely wrong as I have serious withdrawal reactions to Citalopram. It took me a month of micro-dosing down to safely get off a drug I was on for 15 yrs. And even then I was having constant brain & body zaps, that feel like short circuiting, for a full month after I dosed down to nothing. 6 mos later & I still can't sleep more than 6 hrs.
How did I know this was going to happen? Going cold turkey when my script ran out. I even told my psych about it numerous times but they just brushed it off.
seri4l · 2026-08-28 09:10:39 UTC
Your psychiatrist looked at you like you were crazy?
_puk · 2026-08-28 13:19:35 UTC
These comments about brains zaps is the first time I've heard confirmation from what I've experienced.
I've had them every time I've started or stopped a *pine antidepressant.
Like, something rolls off the counter and my natural reaction would catch it.
Instead, my hand doesn't move, and a brain zap.
Physically painful.
sheepscreek · 2026-08-28 00:05:58 UTC
It can be catastrophic if one is managing family life, kids, taking them to and from activities on top of one’s own work. Then come misc stresses like tax returns, some expensive home repair, etc. Also dealing with depression without the anti-depressant. Switching mental health medication is no fun.
I am glad your experience was tolerable but it’s a whole arc and everyone’s tolerance + circumstances are unique which makes it all the more challenging (even for doctors).
sitharus · 2026-08-28 00:44:31 UTC
Withdrawal effects, like the beneficial effects, are highly individual. I had no withdrawal effects from escitalopram after being on it for a couple of years but I know people who’ve had the issues described in the article.
This isn’t a one size fits all area of medicine.
DataDaoDe · 2026-08-28 09:03:04 UTC
This. If there is one thing I've learned it is certainly not that you can generalize from yourself to others, especially for medication and its side-effects and withdrawal effects. I get so sick from taking novalgin that its a medical emergency (Agranulocytosis). Apparently, this occurs in like 1 case in a million. Conversely, I've heard of horrible side-effects or withdrawals from other medications where I experienced absolutely none of them.
OptionOfT · 2026-08-28 02:02:40 UTC
I tried to come off Trintellix. 4 weeks was fine. 5th week immense thoughts of doom. Had to take Xanax to bridge it kicking in again.
ritcgab · 2026-08-28 03:03:34 UTC
Same experience early this year but I did halve the dosage to 5mg for a month, which was of near zero difference. But the full withdrawal? Oh man it is no joke.
lachlanj · 2026-08-28 03:44:23 UTC
Is it possible for phobias to be treated with antidepressants or other medications? I need to look into this
sandcat_ · 2026-08-28 04:13:29 UTC
Sure seems like it to me, but my doctor seemed bemused when I mentioned it to him and I don't think they're routinely prescribed for them. I reckon if I'd have paired the SSRI with some exposure therapy, it would have cured me of it long-term. I do have an additional phobia however (I'd rather not say which) and it didn't make any impact on that at all, so YMMV.
Worth noting as well that I had no expectation of any changes to my arachnophobia going in. It didn't even cross my mind.
bgnn · 2026-08-28 06:35:22 UTC
Exposure seems to be the best way out.
nvarsj · 2026-08-28 08:37:32 UTC
I can believe it. They are used for general anxiety disorder which I imagine can be kind of similar - an over-reaction to some stimuli.
sixeyes · 2026-08-28 08:43:59 UTC
both my social phobia and my fear of dark almost vanished on venlafaxine. i take walks in the dark these days, what the fuck.
KurSix · 2026-08-28 05:30:48 UTC
What seems most broken is that medicine apparently didn't have a great way to predict which group you’d fall into, or much of a plan for the people who had a really bad time stopping. Also, RIP the anti-spider benefits
vermilingua · 2026-08-28 08:49:07 UTC
I also went cold turkey from escitalopram about a decade ago, and my experience was not as tame as yours; my ideation kicked into 6th gear, with paranoia, nausea, and insanely intense and vivid dreams every night. That was while on a 10mg dose.
I have been on over-max-dose venlafaxine for nearly a year now. I think it has been an enormous improvement in my life on nearly every axis, but if I miss a dose by even a few hours I get zaps, confusion, and dizziness. What happens to me now if I become unable to access my meds for more than a couple of days really keeps me up some nights.
dib258 · 2026-08-28 11:27:01 UTC
Venlafaxine has a small half-life so that might be why if you miss a dose by a few hours you'd get withdrawal symptoms. Drugs is leaving fast you body and so concentration is quickly decreasing. Apparently there's a extended-release, don't know if it's already what you have but maybe you could ask to try another SNRIs that has a longer half-life.
vermilingua · 2026-08-28 11:30:59 UTC
Yep I’m on XR, I’ve tried taking half my dose twice daily instead, which did smooth out the effects a bit but also made me much more likely to miss a dose. Not really any other solution other than tapering afaict.
dib258 · 2026-08-28 11:49:05 UTC
Yes, or you could ask your doctor to go on another one with longer half-life.
At least that would give you more room to miss by a few hours a dose and not going haywire into withdrawal. Especially when anxiety is already a problem and withdrawal symptoms kicks back the anxiety stronger...
Hope you find something that suits you!
dllrr · 2026-08-28 11:53:17 UTC
I think you are the flip side of what you mentioned about the article. I don't see the article as saying withdrawal is catastrophic, in fact I see it being well balanced when stating numbers. But you just said many or most people don't experience that.
If I were to take your approach, and make generalized statements based on my own experiences, I would say many if not most actually do experience significant withdrawal symptoms for an extended period of time.
You need to take into account: dosage, age, health, life circumstances, and I would think even more before you can suggest even the slightest correlation or "average" experience.
I get what you're saying and I'm very glad it was easier for you than others, clearly. I think though, it's dangerous to others to make claims based on one person's experience.
karthikeyankc · 2026-08-28 12:06:39 UTC
Me too. I was prescribed escitalopram along with other SSRIs when I lost my mom. Even with tapering, I had brain zaps for a while. Before I could stop it all completely, I was ramped up again after I lost my wife. I'm not sure if I'd be actually functional or even be here if it weren't for these meds.
mexicocitinluez · 2026-08-28 12:18:38 UTC
What was the tapering like for an SSRI? Do you remember over what period of time and how it was decreased?
karthikeyankc · 2026-08-28 12:35:05 UTC
It was monthly. I don't remember the order of the medications, but I remember the effects. The most prominent one were the brain zaps and some confusions, especially in the mornings. On the bright side, I had some creativity coming back to me and I started back on some of my creative outlets (mostly my wife and therapy helped me come back to reality). And my biggest relief was when my brain fog (sometimes I even forgot my colleagues' names) cleared up. But yeah, before I could stop it completely I was fast tracked back up on a different regimen of SSRI combinations after my wife's accident.
laughing_man · 2026-08-28 00:07:43 UTC
SSRIs and SNRIs just didn't work very well for me. If they had an positive effect at all, it wasn't enough to rise above the proverbial noise.
Coming off of them wasn't too bad though. I got the brain zaps, but those were easy to cope with.
More than anything the whole experience was a waste of money, and what finally fixed my problems was retirement and a greater attention to my health.
litigator · 2026-08-28 00:16:12 UTC
Have you looked into mirtazapine (tetra cyclic), vortioxetine (serotonin modulator) or atomoxetine (SNDRI). Atomoxetine has been a god send for me.
burnt-resistor · 2026-08-28 09:04:11 UTC
I've tried 20-some-odd antidepressants titrating off and on and usually back off again.
Mirtazapene (ATeCA) is the only one that could manage my depression. Unfortunately, it leads to severe weight gain that my health plan's formulary refuses to cover GLP-1 for because obesity is considered "a choice". It's the only one where the depression mostly goes away and the side-effects aren't life-threatening/-debilitating for me. If I forget a single dose at night or anytime I go to sleep without taking it first, I end up with almost exactly the feeling of an alcohol hangover. It's also a pretty powerful antihistamine. I also usually can't get to sleep if I don't take it. :/
Vortioxetine gave me horrific myoclonus and vestibular symptoms.
Atomoxetine is mostly for ADHD and gave me tachycardia, profuse sweating, uncomfortable nervousness, and anxiety. It didn't do shit for my ADHD or depression.
YMMV.
piperswe · 2026-08-28 11:12:08 UTC
Atomoxetine can cause some wild mood-related side effects, just as an FYI for anyone considering it. For me, it made me perpetually pissed off, and made me feel like I had a cold. I’m jealous of people it works well for though - seems like a great drug when it works!
api · 2026-08-28 00:19:47 UTC
They work so well for some they are miracle drugs, and for others they do nothing or have negative effects. This is typical. We still don’t fully understand why or even why they work at all.
Comments
People legitimately need these drugs, including in the short term. The problem for acute stressors once they resolve is how to get them back off.
And don't even get me started on tricyclics or MAOIs... no, seriously, don't get me started on them! The current generation of first-line antidepressants (SSRIs/SNRIs) might as well be free compared to the old school crazy pills.
Yep, that’s how I associate SSRIs.
I liken SSRIs to carpet bombing - also their mechanism to increase seratonin in the brain is by making something else not use it (reuptake inhibition). We’re guessing that other thing isn’t a big deal. But who knows. Serotonin is produced in the gut and it controls melatonin, which controls our sleep. It’s all connected in a bizarre way.
It's like inserting objects into the body's event loop and hoping it produces the desired effects as it circulates, only to find that everything reacts to the event, not just the parts we want.
https://news.ycombinator.com/item?id=37029912
i read online about people doing this and thought they were nutjobs. well, now i know.
Antidepressants are the same: they won't stop the bigger fire by themselves, but by preventing you from catching fire right now they give you the tools to deal with the larger problem more effectively that if you tried to do it while flailing around and screaming.
First. Do no harm.
https://www.benzoinfo.com/
https://asprescribedfilm.com/
The linked article says they have "small to moderate effectiveness", but this is being far too generous. The correct way to measure drug effectiveness is if the treatment meets the standard of a minimal important difference. I.e. you measure depression on various rating scales, like the 17-point HAM-D, and research suggests a minimal important difference (i.e. one patients and clinicians can actually notice) needs to be about 3-5 points. But the average effects of almost all antidepressants do not meet these thresholds, i.e. the effect actually appears practically invisible. [1]
Then you'll get waffling like "oh, but it really has a big effect for some people", but, well, no, we've looked at that too, and the placebo groups get just as miraculous "big effects", i.e. evidence supporting the idea "they really help some people" is also largely lacking [2-3]. All the other attempted saves ("oh, but eventually you find one that works for you") are also not really well supported either [4].
Like, maybe they really help some people, but it is far, far less clear than most assume, and should be balanced with concerns like withdrawal and serious side effects like emotional blunting and sexual dysfunction.
EDIT: And just to be clear to anyone doing a drive-by downvote thinking this is about recent asinine US politics, it emphatically isn't. There are serious methodological concerns here that desperately need to be communicated to the public.
[1] https://pubmed.ncbi.nlm.nih.gov/33593736/
[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC7451660/
[3] https://pubmed.ncbi.nlm.nih.gov/33175895/
[4] https://pmc.ncbi.nlm.nih.gov/articles/PMC11844611/
https://www.goodreads.com/en/book/show/40180010-mind-fixers
The title is a play on the Pulitzer prize winning article from the 80's.
https://web.archive.org/web/20041125092022/http://www.byline...
Because the 1 in 10 stat I find seems a bit low, at least in my circle, and those are the ones who are open about it.
And the people I know have been on them approximately a decade. What baffles me is that a fair number of them triggered their own depressive episodes, and likely did need therapy and something at the time - but have all long since move past those "moments".
> Our comprehensive review of the major strands of research on serotonin shows there is no convincing evidence that depression is associated with, or caused by, lower serotonin concentrations or activity. Most studies found no evidence of reduced serotonin activity in people with depression compared to people without, and methods to reduce serotonin availability using tryptophan depletion do not consistently lower mood in volunteers. High quality, well-powered genetic studies effectively exclude an association between genotypes related to the serotonin system and depression, including a proposed interaction with stress.
> The chemical imbalance theory of depression is still put forward by professionals, and the serotonin theory, in particular, has formed the basis of a considerable research effort over the last few decades. The general public widely believes that depression has been convincingly demonstrated to be the result of serotonin or other chemical abnormalities, and this belief shapes how people understand their moods, leading to a pessimistic outlook on the outcome of depression and negative expectancies about the possibility of self-regulation of mood. The idea that depression is the result of a chemical imbalance also influences decisions about whether to take or continue anti-depressant medication and may discourage people from dis-continuing treatment, potentially leading to lifelong dependence on these drugs.
https://www.nature.com/articles/s41380-022-01661-0
https://www.kcl.ac.uk/news/a-response-to-the-serotonin-theor...
Personally, I both agree that SSRI antidepressants were likely overprescribed early on, and disagree with the notion that the chemical imbalance theory is unsupported. N = 1, they can absolutely work. It took a few to find one that really did, hence I am certain it is not a placebo effect.
However, tianeptine is serotonin reuptake enhancer and also can help with depression, so any simple deficiency hypothesis also doesn't look good either.
Broadly, the "chemical imbalance" theory, left vague and unspecified, is still basically sane (though not specific enough to be super useful).
>1. Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder. A systematic review with meta-analysis and Trial Sequential Analysis. Conclusions: SSRIs might have statistically significant effects on depressive symptoms, but *all trials were at high risk of bias and the clinical significance seems questionable*. SSRIs significantly increase the risk of both serious and non-serious adverse events. The potential small beneficial effects seem to be outweighed by harmful effects.
>2. The trouble with antidepressants: why the evidence overplays benefits and underplays risks. Widespread prescribing has not reduced mental disability or suicide, raising questions about the assessment of evidence on effectiveness and safety of antidepressants
>3. In search of a dose–response relationship in SSRIs—a systematic review, meta-analysis, and network meta-analysis. Conclusions: There is no conclusive level I or level II evidence of a clinically meaningful dose–response relationship of SSRIs as a group or of single substances. High SSRI doses are not recommended as routine treatment.
>4 The serotonin theory of depression: a systematic umbrella review of the evidence "We did not identify *any* trials using ‘active placebo’ or ‘no intervention’ as control interventions. "
[1] https://pubmed.ncbi.nlm.nih.gov/28178949/
[2] https://www.bmj.com/content/370/bmj.m3200
[3] https://pubmed.ncbi.nlm.nih.gov/32970827/
[4] https://pubmed.ncbi.nlm.nih.gov/35854107/
Indeed, a rebuttal [1] to that paper starts with:
> Moncrieff et al. report in a review of reviews that depression is not generally linked with serotonin deficiency. This is hardly news to neuropharmacologists, which Moncrieff et al. tacitly admits, as they justify their review by citing examples of laity and general practitioners believing depression is caused by a “chemical imbalance”, i.e., in serotonin. For instance, already in 1986 did Depue and Spoont point out that serotonin deficiency may not be a general cause of depression or other psychiatric illness. Further, that increasing extracellular serotonin—e.g., with selective serotonin reuptake inhibitors (SSRIs)—treats depression does not mean decreased serotonin causes depression.
I have a lot of trust in the science of medicine, but almost none in healthcare. It seems like the research is totally divorced from the medieval treatments I see doctors give all the time. "This is hardly news to neuropharmacologists" vs "laity and general practitioners believe ..." indeed.
1. https://www.nature.com/articles/s41380-023-02090-3
Ultimately medication is prescribed based on evidence from clinical trials, whether or not the mechanism of action is fully understood. SSRIs work to help with depression in clinical trials when compared to placebo, so they get prescribed.
I recently read a book about "The brain energy theory of mental illnesses"[1] which encapsulates depression and found it pretty compelling.
It seems to be a relatively new and active area of research[2], so there is hope!
[1]: https://books.google.fr/books/about/Brain_Energy.html?id=GIx... [2]: https://pubmed.ncbi.nlm.nih.gov/38183680/
I find it funny that people complain about emotional blunting when that is the entire purpose of the drug. I would prefer not to live on the razors edge ever again. I’ve had chronic anxiety and depression ever since I was a child, though.
Depression is highly heterogenous, and I am glad the medication helped you.
The ideal would be to blunt the negatives but not the positives. The effect of some of the older antidepressants can be to blunt both, across the board.
Some of the newer atypical antidepressants can address depression without making everything flat.
Also, IME they are dosed completely wrong. So many people seem to be on very low doses, which has no improvement on placebo in the studies I've read.
Whereas, higher doses are _hugely_ better than placebo, especially for anxiety.
What's worse is a lot/most studies on SSRIs in general often don't adjust for dose. Which seems like an enormous oversight to me.
No, that will just hurt more people up front for longer. The truth is antidepressants have a larger effect on mental health than actually gets reported because of how improvements are measured. If you look at a patient who doesn't get out of bed, is in trouble at work/school for performance, doesn't spend social time with friends, etc, and 6 months after starting an SSRI they're indistinguishable from other people but still have other issues, we call that a "mild impact" because they self-report other problems.
The truth is we took someone from being passively suicidal to functioning normally, and we fail to look at the self-reported problems, we just report them. The self reported problems tend to change from "I don't care about anything" to "I'm unhappy at my job" or "I'm stressed at how much I have to do with work and my kids and home." These are actually major improvements, the patient has gone from being actually clinically depressed to significant improvement but continued unhappiness with life circumstances as opposed to unhappiness with life in general.
Antidepressants are amazing, we need to improve therapists and how they deal with medicated patients. Too many therapists dismiss meds and too many psychiatrists dismiss therapy. I've been in this space for a long time now, healthcare IT in the mental/behavioral health space. We're engaged in a long erm research study to help demonstrate the value of a tightly integrated therapy/psych team and more advanced treatments and when you get everyone in the room pulling in the same direction patient outcomes are amazing.
One actual issue that antidepressants face is that they're not the only treatment, but many doctors are reluctant to move to TMS or esketamine, despite the amaing success rates they have with patients who have not had success with two or more drugs. If two drugs failed you, the third has a 14% chance of helping. The 4th is single digits. But you pivot to TMS and you see 60-80 percent improvement rates. Esketamine is close too.
ADs aren't the problem, it's that we don't take mental health as serious as we take physical health.
The truth is actually exactly the opposite, and I provided very high-quality evidence demonstrating this to be the case. You have nothing but bald assertions.
I have received both rTMS and esketamine and the providers themselves told me they saw roughly a 30-40% response rate (not remission, that's even lower!). Upon researching the topic myself, I found that the meta analysis usually agreed with this 30% figure, but recent research papers mark eskatamine even lower. Both treatments can be miraculous for a few select people and it makes a good headline, but it's a total failure for the majority of people.
I agree with you that those treatments should be easier to access, though.
> Too many therapists dismiss meds and too many psychiatrists dismiss therapy.
This is the only factually true statement in your entire comment.
This really lines up with what I've seen anecdotally. My partner literally doesn't remember how bad things were before he took antidepressants because depression impacted his ability to form memories. He self reports that antidepressants had a mild impact, but from an outside perspective nearly everything about his life changed.
I’m about to get downvoted into oblivion for this take though.
I’m not trying to discount mental health, I just think there are better solutions than drugs to fix your state of mind.
Also think that some people are dealt a tougher hand than most, and that for a small subset of humans, anti depressants are the most fitting cure.
And yes, in some cases, no other options are possible, so even if the evidence is pretty dismal for their effectiveness, they are still broadly safe enough to definitely be worth a try. They probably just shouldn't be the first-line approach.
We don't want to get rid of them, we just need to recalibrate prescribing, and also to properly assess cessation at intervals more frequently than we have been.
For me I still feel the surprise because I've followed the evidence carefully for well over a decade, and the methodological problems and lack of evidence for meaningful effectiveness have always been clear. I.e. it is clear standardized effect sizes are meaningless, and you need to determine important differences, as this is just basic science, but only a tiny handful of papers ever bothered.
So it feels very much like "how can we have normalized something so incredibly scientifically shaky", i.e. for me the moralizing is not "drugs are bad, how are we normalizing drugs" it is "how can an entire medical field and society so recklessly adopt something so obviously weakly supported". I.e. my dismay is more about the weak epistemic standards of society than it is about drugs.
Find one that's as effective on the general population.
I mean, sure, perhaps lifestyle changes are better. Can you get a higher percentage to change them and improve people's lives than we currently can with drugs?
As a top performer in school, I definitely think (and still point out), that you can get fantastically high results in SAT/GRE without paying any test prep service. I and many of my peers did it. There are better solutions than paying those services. But how many who don't pay do as well as those who do? I can tell them how to study as much as I can, but the reality is that statistically, people who attend will do better than if they don't.
From a medical standpoint, telling people to change how they live and think has a fairly low success rate. The best options usually don't work on the masses.
It's a terrible bind. Patients want a pill to fix things, but if they know it's just a sugar pill, it doesn't work. It has to have active ingredients that might work. That's why there's little desire to change the status quo on antidepressants much. Anyone who reads the medical literature knows they're statistically underwhelming, but the experienced reality is that they help people a lot.
Talking therapies, CBT, exercise are all good alternatives but they take time and effort that a depressed person might not be able to manage. An antidepressant prescription they can get in 15 minutes.
This is a misunderstanding of concepts like regression to the mean, and also the active placebo elements involved.
> but the experienced reality is that they help people a lot
And the evidence is that the reality people think they are experiencing is wrong, i.e, they are improving and factually experiencing improvement, but misattributing the cause to the drug.
> "As effective as placebo" does not mean worthless
In one sense of worthless, perhaps, but since drugs have larger costs relative to placebo, well, we can argue they are worse than worseless in another.
Better instead to talk about cost-benefit tradeoffs, number-needed-to-treat vs number-needed-to-harm and etc though, and try to get better at prescribing more carefully to those they clearly benefit.
In a clinical trial setting, you can prescribe a placebo, because the patient is fully aware and clearly consenting to the fact that they may receive a placebo. Lying to a patient, in a clinical setting, from a position of authority, is a completely different matter. The informed consent would be completely absent, the patient’s ability to make informed choices about their own healthcare would be undermined and withheld, and the provider would be deriving financial benefit from the patient and / or through insurance claims for what amounts to a scam.
The patient, who would be seeking a treatment from a trusted expert, would believe that they are receiving proven treatments in exchange for their time, patience, money, reduced quality of life due to side effects, and opportunity costs in terms of not going to a different provider or trying something else, but in reality their provider would be misleading them. Some patients would even die as a result of taking a particular placebo and depending on it—either because of side effects or due to the lack of effectiveness—when they tragically would have been better off trying a different approach or medication. How could a patient possibly give informed consent in such a scenario, for one thing? How could they meaningfully compare treatment options and make their own informed choices when the advice they receive includes lies?
Alas, some providers believe in placebo effects so much more strongly than their patients’ right to autonomy that when faced with complaints of side effects, they will just lie more and more to their patients in hopes that the side effects will go away, but that’s really just more gaslighting to people who are already in difficult situations.
I ask as a nonexpert because this is a view I've read a few times from people I trust more than most, and I know two people who suffered from severe depression who credited SSRIs for getting them through.
[1] https://pubmed.ncbi.nlm.nih.gov/20051569/
What does seem clear to me is that the whole cost-benefit considerations change in favor of anti-depressants when the depression is severe. I wouldn't say anti-depressants should be first-line treatments for ordinary depression, but for severe depression, I think they are a very reasonable first-line option.
Sure, they still might not help, but the costs / harms don't seem so bad compared to the potential costs / harms of leaving the severe major depression untreated, and the other options look all pretty terrible here too.
And overall I’m very glad I took it! It got me through a rough patch, and seems (in combination with therapy, and some life changes) to have rewired me a little. Symptoms I had for a decade prior have not returned. And I’m not sure I could have made those life changes without it.
Sadly my arachnophobia came back though. Oh well.
I mentioned it though as one of the most stark changes I noticed after getting on an SSRI was pretty much immediately losing my fear of spiders. It was the first sign I had that showed it was doing something.
I used to literally, on occasion, launch my phone across the room if I was scrolling and came across a spider (sometimes drenching myself with coffee or whatever in the process!) and then one day, shortly after getting on it, I stumbled across some awful tarantula video or something and I just stared at it like “huh, why am I not freaking out”.
To the extent that we can measure depression, SSRIs have been widely proven in gold standard phase III clinical trials to help with the treatment of major depression. What exactly is supposed to be lacking in the supported evidence?
The reality of the actual trial data was very different - with catastrophic results for many.
Also, see the debate around discussing traumatic events in therapy immediately versus waiting a year.
Throwing people in the deep end doesn't always result in a swimmer :)
YMMV of course.
I tried to describe it to my doctor and he seemed like he never heard of it before and sort of look at me like I was crazy, or at least that is what I sensed. But I ended up researching online and found it was a thing that happens.
They were absolutely wrong as I have serious withdrawal reactions to Citalopram. It took me a month of micro-dosing down to safely get off a drug I was on for 15 yrs. And even then I was having constant brain & body zaps, that feel like short circuiting, for a full month after I dosed down to nothing. 6 mos later & I still can't sleep more than 6 hrs.
How did I know this was going to happen? Going cold turkey when my script ran out. I even told my psych about it numerous times but they just brushed it off.
I've had them every time I've started or stopped a *pine antidepressant.
Like, something rolls off the counter and my natural reaction would catch it.
Instead, my hand doesn't move, and a brain zap.
Physically painful.
I am glad your experience was tolerable but it’s a whole arc and everyone’s tolerance + circumstances are unique which makes it all the more challenging (even for doctors).
This isn’t a one size fits all area of medicine.
Worth noting as well that I had no expectation of any changes to my arachnophobia going in. It didn't even cross my mind.
I have been on over-max-dose venlafaxine for nearly a year now. I think it has been an enormous improvement in my life on nearly every axis, but if I miss a dose by even a few hours I get zaps, confusion, and dizziness. What happens to me now if I become unable to access my meds for more than a couple of days really keeps me up some nights.
At least that would give you more room to miss by a few hours a dose and not going haywire into withdrawal. Especially when anxiety is already a problem and withdrawal symptoms kicks back the anxiety stronger...
Hope you find something that suits you!
If I were to take your approach, and make generalized statements based on my own experiences, I would say many if not most actually do experience significant withdrawal symptoms for an extended period of time.
You need to take into account: dosage, age, health, life circumstances, and I would think even more before you can suggest even the slightest correlation or "average" experience.
I get what you're saying and I'm very glad it was easier for you than others, clearly. I think though, it's dangerous to others to make claims based on one person's experience.
Coming off of them wasn't too bad though. I got the brain zaps, but those were easy to cope with.
More than anything the whole experience was a waste of money, and what finally fixed my problems was retirement and a greater attention to my health.
Mirtazapene (ATeCA) is the only one that could manage my depression. Unfortunately, it leads to severe weight gain that my health plan's formulary refuses to cover GLP-1 for because obesity is considered "a choice". It's the only one where the depression mostly goes away and the side-effects aren't life-threatening/-debilitating for me. If I forget a single dose at night or anytime I go to sleep without taking it first, I end up with almost exactly the feeling of an alcohol hangover. It's also a pretty powerful antihistamine. I also usually can't get to sleep if I don't take it. :/
Vortioxetine gave me horrific myoclonus and vestibular symptoms.
Atomoxetine is mostly for ADHD and gave me tachycardia, profuse sweating, uncomfortable nervousness, and anxiety. It didn't do shit for my ADHD or depression.
YMMV.