The SSRI Lexapro [0] helped my girlfriend relapse on cocaine, before i met her. Cocaine is a much stronger anti-depressant than the SSRI's due to its effects as a Mono-Amine Oxidase Inhibitor [2] (1st generation anti-depressants).
Eventually the professionals figured out she is a poor methylator, and can't convert folic acid into Folate. Folate (Vitamin B9) is important for DNA synthesis. Food companies fortify with folic acid because it's more stable than other forms of Vitamin B9, even though we now know that some people are harmed by this fortification [1]. On the whole, fortification seems to be beneficial (fewer deformed babies), but poor methylators and old people seem to have negative side effects from getting their vitamin B9 from folic acid.
She said adding the L-Methyl-Folate was like flipping a switch between "depressed" and "normal". Her involuntary medical professionals didn't say, "hey sorry we made a mistake, you're not actually broken", and continue to ignore the actual causes of her condition.
[0] https://en.wikipedia.org/wiki/Escitalopram
[1] https://now.tufts.edu/articles/folic-acid-too-much-good-thin... / https://www.futurity.org/folic-acid-too-much-of-a-good-thing...
[2] https://en.wikipedia.org/wiki/Monoamine_oxidase_inhibitor
(edit - added bit about cocaine being an MAOI)
I have a hard time keeping track of where I read what; I haven't found a source on a cursory search.
Some of the other contraindications (for the disparate group in that 1% you mentioned) are still important to mention, I think.
If you're not certain you'll always have health insurance. If you may ever want to try MDMA therapy, or just about any type of psychedelic therapy (or use them recreationally). If you're uncomfortable with being on something like this super long term and/or are concerned about withdrawal issues. If you can't stand the thought of risking becoming a happy-ish, functional zombie with no sexual interest in your partner. If you're worried the doctor won't diagnose you correctly. If you're not sure you can emotionally handle going through potentially a year or more of trial & error and having to wait months each time for results. Then think twice.
I am extremely glad for the people SSRIs have saved, especially those who wouldn't have made it otherwise. It is also incredibly clear to me that despite my continuing issues with depression, they are probably the wrong approach for me.
If I could add anything to the SSRI topic it would be that mental health treatment is incomplete without a form a therapy. If a person's treatment plan includes SSRIs, that's great, but it should always include therapy.
Which was a literal lifesaver, because the first SSRI I took gave me severe stomach pains. I spent at least 2 hours every night spitting into the dorm room sink with the lights out.
Instead of quitting, I knew to ask for a different SSRI. I also knew to switch therapists when the first one just talked at me the whole time. I then got one who listened a lot at first, then started challenging things I said after we had some trust.
And one more helpful thing J knew: medication was like a crutch. And, despite that usually being a negative metaphor, I saw it as a positive. If you break your leg, you use a crutch while it heals. Your treatment should be the crutch (meds) and therapy. The therapy works better when you can think better.
I ended up not needing my meds anymore. I still have overall flattened affect and bouts of depression, but I can deal with them. To torture the metaphor, it's like having a slight limp from the broken leg. I'll never be "back to normal" but still find life worth living.
Arguably for low to moderate depressive disorders there hasn't been conclusive evidence that psychiatric prescriptions work, however there IS conclusive evidence that for major depression the benefits are at a minimum "small" and up to "substantial" ([4],[5]).
So as soon as we discuss depression, everyone might mean something different. It's a sad state of affairs because now people think they're talking about the same things but they're really not - they just happen to have had different psychiatrists who assessed things and behaved perhaps differently, and where one might have really mostly needed therapy and the other both therapy and antidepressants, in the end everyone went home with a prescription for the fancy SSRI of the year. Psychiatrists as a whole need to reevaluate the rate of prescriptions, the tools to assess major depressive disorder, and the actual array of treatments that are available to them.
I've had wrong diagnoses. I've had appointments that my doctors missed without rescheduling even though I was there. I've had those 15-minutes-and-you're-out meetings with a psychiatrist, whose prescriptions for what conveniently is the "newest pill" were given along with free samples until one day you have to pay for something you can't afford or switch treatment and deal with weeks of uncertainty, and so on.
I have been saved from death and cycles of immense self-destruction by a healthy relationship with a knowledgeable and experienced psychiatrist willing to take me, when my legal troubles had by then reduced my options and driven me further to the edge. Some real discussions, a carefully explained switch from SSRI to RIMA, which worked. "Is that what it is to feel somewhat normal? I can't believe people feel like that most of the time!!"
It allowed me to truly know what therapy is, because there was more to the day than being unconscious or wanting to be dead or death-by-proxy. Therapy gave out some tools to live and interact in a healthy way with myself and others, and to seek more tools too.
The struggle still exists entirely and comes back in heavy waves some days. A lot more difficulties are now an inherent part of my life and rebuilding things will take time and struggles. But psychiatric treatment gave me legs I had lost for nearly all of my life, and therapy taught me to walk again, and I'm well intent on walking out of everything I fell into - regardless of how long and arduous the path is. And whenever I'm able to, to take others out of the pit too.
[0] https://en.wikipedia.org/wiki/Serotonin%E2%80%93norepinephri...
[1] https://en.wikipedia.org/wiki/Norepinephrine_reuptake_inhibi...
[2] https://en.wikipedia.org/wiki/Monoamine_oxidase_inhibitor
[3] https://en.wikipedia.org/wiki/Tricyclic_antidepressant
SSRIs are some of the most widely-used medications. Tens of millions of people in the United States alone use SSRIs regularly with good results.
No medication is perfect, obviously, and at scale we're bound to see a percentage of people have negative experiences. The problem is that when tens of millions of people have tried SSRIs, even 1% significantly negative reactions adds up to a very large number of people. If 1% of those negative reactions make a point of blasting their negative experience all over the internet, we'll see thousands of negative reports everywhere.
Combine this with the fact that few people are willing to publicly admit that SSRIs helped them, and the bias toward negative reviews online is huge.
SSRIs are a particularly difficult topic, because they have a noticeable treatment lag (can take up to 1-2 months for positive effects, with positive effects increasing up to 6 months out) and can, in some cases, temporarily worsen symptoms during the initial ramp-up period.
Even more difficult, not all SSRIs are the same. It might take 2-3 trials before someone finds the SSRI that works best for them. It might also take several dose adjustments to find the right tradeoff between efficacy and side effects. Unfortunately, many people go online and seek out horror stories before they have a chance to go through a few rounds of medication adjustments to make it work for them.
Thanks for sharing your positive success story online. SSRIs aren't for everyone, but it would be a shame for people to spend years suffering from depression when a few SSRI trials might reveal an easy improvement to their lives. Worst case, they can taper off (tapering helps avoid discontinuation effects) and move on to different treatment avenues.