Another +1 for Sertraline. It worked wonder for me after 2 years of depression (classified as mild to severe using some clinical test).

I've been taking it for 4 months, and since my life has gotten back to normal my doctor has advised tapering off of it, starting today. We'll see how it goes.

I thought it was standard procedure to advise trying tapering off if your life got back to normal, and see how it goes (at least that's how my doctor presented it). I guess that's not a worldwide standard though.

For what we've been reading this last years, it's not like antidepressants are worthless, it's like antidepressants aren't doing what we think are doing.

The "depression is lack of serotonin" theories seem to have less and less base every day, but SSRIs don't only act on serotonin (just review their side effects).

I've done, mostly, vortioxetine and sertraline. For some of us, some SSRIs or SNRIs work. Some don't. Probably it's not because of the serotonin. They have weirdly different effects depending on the person. But there's something going on that we still don't understand. Both because we don't understand the whole mechanism of depression, nor WTF the SSRIs and SNRIs are doing in our mind and body.

At least in my humble opinion.

I completely agree. I believe we have no idea how these drugs work at the moment.

For one, serotonin receptors are _everywhere_, notably the gut, which also has a strong relationship with emotional state. And as you point out, they don't just affect serotonin. Given we have a whole bunch of drugs that attempt to be serotonin selective, but where each one affects different people in different ways, it seems likely to me that the non-serotonin effects are likely significant.

Plus, what's the reason so many of us are anxious, depressed, neurotic, autistic, ADHD, etc. without obvious cause? Why would a huge chunk of the population have a imbalance of brain chemicals?

Ultimately I suspect my GAD/OCD is probably environmental, but environmental in a way that I can't easily identify or fix. Maybe it's the unnatural desk job oriented lifestyle I have, or maybe it's plastics in my blood, processed foods, lack of religion, social media or something else. Or maybe the neurotransmitters just sometimes need a kick up the arse to get them back into proper functioning.

All I really know is sertraline helps me live a normal life, and for that I'm thankful.

> Why would a huge chunk of the population have a imbalance of brain chemicals?

That's what I think about from time to time as well. I have ADD and take meds for it. But I'm pretty sure that I only need these meds to be able to work in an open-space, corporate IT environment with dead-lines, responsibilities etc.

Without meds I get overwhelmed and panicky quickly, when taking them they turn me into kind of an office robot who's able to work without getting too stressed out or distracted by other things.

I suspect that I wouldn't need the meds if I had a different job. Which feels weird, because it sounds like I'm trying to fit into an environment, instead of being in an environment which fits me, if that makes sense. Then again, maybe everyone has to do that and it's just my biased perspective that I'm the one who's not made for it.

Which sucks, because I love IT, also as a hobby.

The easiest examples for that: Sometimes I do an IT project at home, maybe build a PC, configure a homelab, try out Stable Diffusion or edit videos from time to time. If I do these things at home I can easily sit in front of the computer for 5+ hours and loose track of time, but I don't seem to be able to be as focused for IT projects at work if I'm unmedicated. Unless they really interest me.

I believe the same thing. In fact, I believe people with ADD have a natural advantage in pre-modern settings. We are built to run long distances, outsmart prey, and forage. A distraction isn’t a distraction on that environment, it’s awareness and quickly thinking through possibilities and avenues of success.

If anything it is more of an attention surplus than an attention deficit.

This is a point that Dr. Richard Barkley, one of the major researchers in ADHD in the last few decades, has stated slightly differently. In a sort of jest, he mentions that [ADD] should be called “intention deficit disorder” as there is plenty of attention to be given to things, sufferers just lack a lot intentionality behind their actions. This ultimately manifests as an executive disfunction which prevents this slice of the population from subconsciously knowing how to prioritize or assess the importance/value/urgency of stimuli.

> I believe people with ADD have a natural advantage in pre-modern settings

Totally, yeah. I can't prove it of course, but I've noticed countless of times that I seem to be extremely more aware of my surroundings than my friends etc. I hear and see more compared to them, which has positive and negative sides.

Same here, man. It’s for the reason you described in your first paragraph. Working in a soul sucking corporate office space is so painful for certain personality types.

For me at least, I’ve always thought it would be cool to be a delivery driver or someone who’s out and about everyday moving around… but I stuck with IT because it makes astronomically more money.

So sitting at a desk all day will require me be medicated because my baseline preference is to be up and moving, working with my hands, talking to people, etc.

I think a lot of people with ADHD that’s severe enough to require medication are just people who don’t do work that truly fits their personality.

Which if we’re being honest, sitting at a desk all day is not natural. I never needed Adderall when I was working in a warehouse in college, or when I was a city guide that was supposed to walk around downtown and greet people.

tl;dr Unnatural lifestyles require unnatural supplements.

As your sibling post pointed out I think our adhd was a benefit in preindustrial times, or at least in preagricultural times.

And a desk job with a fun coding project to do (fun coding usually doesn't pay as well) was fine for years. Hyperfocus was nothing but upside except for having to do taxes or do he occasional tedious task.

But when you get too good at your domain, and you have 10 unrelated coding projects, even if they are all fun, adhd is no longer your friend. #include wife and kids and doctors appointments and birthday parties and ... Adderall helps now. I need to turn off my hyper adaptation quite often now.

By will alone I set my mind in motion, but I need amphetamines to slow it. It is like we were born as mentat and instead need drugs for everything except that.

Hear, hear. There's a lot of us in this same boat. These asocial, sedentary IT jobs + hectic lifestyles are out of sync with our biology and psychology.

I didn't know it at the time, but I was in the same situation for years. I started doing blue collar work at mine sites and oil/gas pads. For me, it's a good fit. And the people are real.

>Why would a huge chunk of the population have a imbalance of brain chemicals?

Because they are all members of a society whose food production is controlled by 2 or 3 mega-corporations, who also, incidentally, have an interest in selling pharmaceutical products to make people feel better about their lives ..

That's quite a huge accusation, do you have any evidence to back that up at all?

Cause if I understand the implication correctly, you're basically saying that the 2-3 megacorps who control food production (which is already far from true, IMO) are literally poisoning people to cause them to need antidepressants.

Are pharmaceuticals food?

https://www.theguardian.com/environment/ng-interactive/2021/...

Americans eat the most hyper-processed food on the planet. They're also over-prescribed with anti-depressant pharmaceuticals. Causation/Correlation? You decide: move outside the scope of Bayer's and Monsanto's reach, and see for yourself how less depressed you feel on a daily basis after a few months of real food ..

Final word: Nestlé.

Is there anywhere outside their reach that doesn't involve giving up all the other benefits of the industrial revolution? I'm not a Luddite, I like labor saving devices andblife saving procedures, and even some medicines.

You assume a lot of competence on the part of these large actors to collude and conspire at the macro level.

Let’s assume, for sake of argument, the conclusion of your assertion is true in that we are being poisoned and offered medication to mitigate the effects of said poison. This is more likely the effects of independent actors acting upon their respective self-interests.

Food companies try to drive costs down to sell cheaper products at the same price, which may end up having poor health consequences by virtue of untested substances having mass exposure. Pharmaceutical companies respond to market forces by developing drugs they can get funding for, which usually ends up being ailments that a lot of people have. There are way more efficient ways for them to team up and make money, this is just a side-effect of large institutions acting in self-interest.

> what‘s the reason so many of use are anxious, depressed, neurotic, autistic, ADHD, etc. without obvious cause?

Because modernity hasn’t been an unmitigated success. In the pursuit of abundance, we’ve made all sorts of trade offs that we are now realizing have had unintended consequences to mental and physical health. Every leap forward has felt like progress but has underlying negatives. The world has trade offs!

The move from agrarian to industry to service/knowledge based economies, as an example, has produced countless benefits, but as another commenter mentioned: sitting at a desk certainly isn’t as healthy as moving in the fields. Being in big urban environments to facilitate the new economy has produced amazing culture and a more inclusive community, but at the cost of tight-knit lifelong social networks, noise and air pollution, crime, etc.

I’m not saying yesteryear was better - I’m pointing out the trade offs that were made and how we are now recognizing some of the costs. Perhaps the pendulum needs to swing back to some degree to ease these costs if we as a society aren’t happy with the price paid. There is a return policy!

Mental illness is not a byproduct of modern society, its study and treatment is. Why is the rate of mental illness going up? It's because the stigma over mental healthcare is dropping rapidly and more people are getting formally diagnosed. That's like saying schizophrenia didn't exist in antiquity, people were just attacked by actual demons and everyone else was "normal".

>Mental illness is not a byproduct of modern society, ...

I didn't state that it is solely caused by modern society.

> Why is the rate of mental illness going up? It's because the stigma over mental healthcare is dropping rapidly and more people are getting formally diagnosed.

Source? Or is this just a theory like mine?

"Mental illness is not a byproduct of modern society, its study and treatment is. "

If you have data on the incidence of depression in hunter gatherer societies we can compare to modern societies feel free to share it.

"Why is the rate of mental illness going up? It's because the stigma over mental healthcare is dropping rapidly and more people are getting formally diagnosed."

So in your mind the functioning of a society has no impact on the rate of mental health problems?

Exactly this and I have suspected for years now there is a huge gut connection. I am not saying it is the only cause (or even the sole cause) but I do believe for a lot of people it is exacerbating the issue significantly. The gut also has tons of opioid receptors and there are some scholars who now consider the spinal cord to be a serious part of the brain - and the spinal cord directly branches out in very large nerves all over the gut.

I personally notice a large positive change in my mental health when my gut is functioning properly and I am eating the right fermented foods. I do not take SSRI's and have not been diagnosed with major depression. I also find it hard to believe that it is a coincidence that as a species we have been eating and making fermented food for so long and so suddenly discontinued its use in a widespread way and are now seeing increases in many types of disease. Although lack of exercise may very well also be a huge contributing factor.

Very well said. We live in strange, unnatural times and there should be no guilt or shame in finding a way that helps you to get through it.

Depression, OCD, GAD, ADHD and most other neurological issues stem from complex feedback loops and deficiency in neurotransmitter systems.

They're labels applied to symptoms, not causes.

Like any complex system with feedback loops, sometimes intervention in the loop causes it to rebalance.

Sometimes the loop break is an intervention in serotonin, sometimes dopamine, sometimes GABA.

There is never a silver bullet. But there are bullets that make life manageable enough to break cyclic issues.

> The "depression is lack of serotonin" theories seem to have less and less base every day

But that is not true.

The problem with statement "depression is lack of serotonin" is the same as with "being overweight is due to eating too much". It is factually true, seems like an easy solution and yet is mired with lots of problems.

The problem with medication is that it treats the symptom (lack of serotonin) rather than the underlying problem (how did we get there in the first place?) Kinda like telling somebody to loose weight by restricting their diet before first understanding what caused them to gain fat in the first place. Is your diet composed of garbage? Why is it, is it because you can only cook garbage? Is it because you can't cook and only buy garbage? Is it because you sit whole day and don't exercise? Is it because you are getting depressed and make it up with food?

The treatment should address the causes of the problem and not just the symptom.

This sort of echos my criticism to the way pharmaceuticals are developed, tested, and regulated. They all treat symptoms and not fix problems. Modern medicine has really advanced in treating acute issues (broken bone, laceration, benign pain) but is shit with chronic issues because it’s focused on symptoms. We prescribe statins the moment someone’s cholesterol goes too high, but did we ever stop to figure out why it is so? Maybe it’s because this person’s favorite breakfast is a bacon-maple donut which they habitually consume 5 days per week. What we are really saying is that it’s okay to eat that cholesterol-raising food, just take this to make that number lower.

We’ve optimized our efforts on treating symptoms and not causes. Drugs that survive regulatory scrutiny and are profitable tend to be those that treat symptoms of chronic illnesses. If you can prove that someone’s LDL goes down and they will buy it for the rest of their life, that’s a drug that will survive. They don’t have a miracle cure for this because they are withholding anything, there is just no incentive to research it and if there was, there is no good way to prove that drug X will cure non-visible condition Y without good, measurable data.

I think part of the reason is that there is lots of money in treating acute symptoms with medication while there isn't much in having serious talks with patients to try to debug their lifestyle problems that might be causing their health problems and then educate them on what and why they should be doing it.

I also think people naturally tend towards easy and fast solutions even if those solutions are known not to work. This self imposed blissful ignorance is what causes people to keep buying weight loss supplements or go on diets even though both are known not to work while we know that for 99% of people there is a simple solution -- reduce stress, learn to like to eat healthy and exercise daily.

> What we are really saying is that it’s okay to eat that cholesterol-raising food, just take this to make that number lower.

Realistically this is what most people want. I spent years watching people choose to go on medications rather than make simple lifestyle choices. Habits are powerful.

It’s not possible to treat the cause when a patient wants the easiest solution. So yea, we have a bunch of medication‘s that treat symptoms. Causes are sometimes impossible to know, the body is complex enough that we don’t even understand how some medications work at all.

+1 for sertraline.

One caveat is that you should ideally use them to get out of a funk and then discontinue if possible.

At all times get a psych you who trust.

On the flipside, just because you had a glowing review of the experience doesn't mean that those considering a lifetime addiction to these drugs should just drive straight towards the cliff.

Much care must be taken with ones mental health - especially important is to take responsibility for it, yourself. Projecting onto others, or assuming ones experience is going to be equivalent to those you 'admire or respect', is a terrible way to get into this deep, dark hole.

Addiction to antidepressants is real. Taking a pill means not taking responsibility, for too many people.

Be careful what you pimp.

> Be careful what you pimp

These aren't drugs you can just ask for (in the UK) at least and the parent wasn't "pimping". Undermining someone's account of their positive experience using therapeutic drugs because of your own bias shows an astounding lack of compassion..

Getting help, help that often involves therapeutic drugs to bootstrap other life changes _is_ taking responsibility.

Your comment neatly sums up the toxic attitude of "I don't understand it so it must be bad".

Put your ego aside and listen to people living with seriously debilitating neurological issues that you fortunately do not.

Breaking cycles or bootstrapping changes for those too overwhelmed with depression or anxiety to make lige changes are the ideal uses for the drugs. And then you are supposed to get weaned off them until the next spiral, and then ise rhem to shorten that one too. But in the US plenty of doctors seem to treat simply asking for these drugs as the requisite symptoms for diagnosis. Andany people I care about were diagnosed with chronic depression or anxiety as early teens when all sorts of things are happening. Decades later they still take them and who can say now if they ever needed them, but they certainly do now. It is the normal state for their brains and any attempt to wean would require those complex feedback loops to rebalance.

Continuous use isn't always bad either, but im the US we don't always try other options first, and if the mess work they almost never encourage you to stop, because if you hurt yourself that is a liability for them, but if you are a robot with no strong feelings about anything that eats cake, watches circuses and goes to work, then at least that is something.

Too many people take these drugs just so that they don't have to take responsibility for their own lives.

And that is the cause of a lot of ruin around the world - not just in the US.

On the contrary - there is now much evidence these drugs do not work as effectively as the glowing reviews state. There is also much evidence that they are being over-prescribed, for profit.

So it is just as toxic to say "these drugs are awesome and you should try them in spite of all of this talk about them being ineffective, addictive, and being sold for massive profit" in that context.

Your comment is execrable.

So is the conclusion that these drugs are worth the side effects, expense, and significant addiction - just because someone on the Internet had a good time on them.

These drugs do not give you a "good" time, they can at best give you a more normal one.

"normal" or "good", either way you become a "culturally acceptable" drug addict who must purchase a prescription for a drug made specifically for the purpose of creating a market of addicts.

Well yeah it's "culturally acceptable" because of they low abuse potential, which is to say there are real actual differences that go into making it culturally acceptable. No one is crushing up their SSRIs and snorting them and going in to sex work to pay for the habit the same way heroin users do, because, well it's not a drug addiction as recognized by the psychiatric industry.

>psychiatric industry

The same people reaping massive profits are telling you whether or not you should think of these drugs as 'normal' or not.

Nothing is normal about a lifetime addiction - whether the high you get is a party high, or a "I am feeling normal, where normal has been defined for me by a high priest who actually happens to also be my pimp" ..

My life-long addiction to food and water and oxygen would like to disagree.

So in order to support your facetious argument all you've done is declare that all pharmaceuticals are the equivalent to nourishment.

"Pharmaceuticals == Food, doubleplusgood, wrongthink rectified!"

Just like a junkie would.

I see we're onto name calling. I'm tapping out, thanks.

If you can't see how frothy-mouthed proselytising of life-long addiction to mind-altering drugs makes you a junkie or a pimp then yes, you should tap out of this discussion.

Not that I have anything against junkies, they just shouldn't be giving other people mental health advice.

I believe I was quite careful in what I said rather than pimping antidepressants.

Each time I start a course of antidepressants, I am genuinely worried what the outcome will be. Messing with your brain chemistry isn't something to do lightly. But equally, for many people, possibly including myself, it quite literally saves their life.

However, I must take umbrage at your characterisation of how considering a course of these drugs is akin to taking on a lifetime addiction.

They do cause withdrawal/discontinuation effects if you stop suddenly, and often tapering isn't particularly pleasant either. This is something that users of these drugs have known for a long time, likely since they first hit the market, but it took a surprisingly long time for the medical industry to accept this and list it on patient information leaflets.

I also certainly accept that many doctors are quite terrible at discussing potential side effects and discontinuation syndrome with patients. This doesn't just concern antidepressants or even heavily marketed drugs. Common, generic, 50+ year old antibiotics can have really horrific side effects that aren't often mentioned by your doctor. This is a serious informed consent issue that needs addressing more widely within the medical field.

However, these drugs are not heroin. They are, for most people, relatively easy (albeit sometimes unpleasant) to taper. They don't cause the same kind of pleasure/punishment cycle that makes substances like cocaine or heroin so hard to quit. You don't become a fiend when you miss a dose, you just feel shitty and get some brain zaps. Nobody's holding up gas stations to get some dollars to pay for their Prozac. If you do discontinue antidepressants, your life is typically better for having taken them compared to when you started, and for the most part, you can take these drugs for your entire life without significant adverse consequences.

These drugs ruin lives just as efficiently as they 'improve' them.

Be very, very careful if you are going to advise people that they should overlook the evidence of this fact, "because they're great for me so you should try them too!".

Yes, you are pimping these drugs in so doing.

It's very rare that these drugs ruin someone's life. For the most part, if they don't work for you, you just stop taking them and try something else instead without any long term side consequences.

There is the very well known risk of suicide in adolescents in particular, which is printed in a black box warning on all of these drugs. This potential side effect usually very early on in the treatment, and usually occurs in people who already had suicidal tendencies. Discontinuing the drug immediately typically resolves this. Responsible doctors will weigh up this risk and ensure that everything is done to make this less likely.

Other things are like sexual side effects can persist for some time after discontinuation, but nearly always resolve eventually. Serotonin syndrome is another risk but the chance of that is fairly low unless you take other serotonin-affecting drugs.

Should these risks be weighed up when considering treatment? Absolutely. Does that make the drugs harmful overall? Absolutely not. Look at some of the people who've experienced permanent nerve damage as a result of quinolone antibiotics - yet they are still on the market because sometimes there is no alternative besides death.

>It's very rare that these drugs ruin someone's life.

I don't agree, I think its just under-reported/under-studied, because it clearly won't make anyone any money to do so ..

For-profit mental health should be illegal, or at least treated the same as religion - do it if you want, but don't force your ideologies on others who don't agree with you ..

Are diabetics "addicted" to insulin?

> Taking a pill means not taking responsibility

I think this nonsense deserves some psychoanalysis of itself, as well as acknowledging that brain chemistry does matter for various sorts of mental illness.

Insulin is not the same as prozac, yo.

One is designed to get you high so you can deal with your life in a "socially acceptable manner" - the other one helps blood sugar enter the body's cells so it can be used for energy. One is a social crutch - the other, vital medicine.

> One is designed to get you high

This is wrong. I'll flag this thread for removal.

Its not wrong, it is factually correct. Mind-altering substances get you high... these pharmaceuticals are merely socially-acceptable high-producing mind-altering substances where - guess what - the science is not final on what they are doing to human beings.

That's right, you are among the 0-15% SSRI's help. For the rest 85-100% of people they help as much as a sugar pill.

> Statements like this need to be worded very carefully. In many people's minds, saying something like "most people don't need antidepressants" quickly becomes "antidepressants are useless".

The statement is factually true and worded correctly.

But that's not enough. You have to give at least a little consideration to how your audience will interpret your words.

> Statements like this need to be worded very carefully.

I had a whole thing typed up, but deleted it, because I really only had one question: How would you word it differently?

To me it seems a carefully worded as possible, while still alerting to the fact that a class of drugs with terrible side effects are being massively overprescribed.

>But for me, they are life changing

This is not something you can claim. How could you possibly know that the SSRI is responsible for your recovery?

I'm not going to say that antidepressants are useless, but it is important to understand how placebo works. The key point is that placebo works and it is impossible for an individual to distinguish between a placebo and a life changing drug.

In antidepressant studies, SSRIs often outperform placebo to a degree. However, the placebo group has an excellent recovery rate! That means there are people who are clinically depressed, suicidal etc. who are then given a sugar pill as part of a study and make a full recovery.

>You often need to try 2 or 3 different SSRIs

That makes it even murkier. SSRIs take a long time to work, and if you try several of them that's going to take months to years. There's a high probability that in that time, you might naturally recover. You have the combined benefit of placebo and waiting in addition to the effects of the SSRI. You tried 2 SSRIs that didn't work. What makes you so confident that it was the third?

Again, I'm not saying SSRIs are useless. But it's important that we rely on controlled studies to make these determinations. Personal experience and anecdotes are beyond worthless; for example they are the reason why homeopathy is a $20 billion dollar industry even though it is actually provably useless.

> This is not something you can claim. How could you possibly know that the SSRI is responsible for your recovery?

This is the kind of trash thinking that makes it hard to get potentially life-changing medication. I take a heavily controlled substance for a sleep disorder and ADHD and our laws surrounding it’s distribution and refill are unconscionable. My life falls apart when there is lapse in medication and nobody takes it seriously. I cannot stay awake, focus, or function after about day 5 without it. It’s appalling that peoples’ well being is in danger every month because someone decided that it might be abused and restricting legal distribution is the solution for this.

First, you do not and cannot know what this person has been through or know what their baseline is. Second, if someone’s life is improved when taking a medication, what does it matter to you that they take it? I’m not going argue the efficacy of the family of SSRIs, but we need to let patients make their own decisions and assessments of what works for their situation.

Your "controlled studies", to mean anything at all, depend utterly on accurate, specific diagnosis. But for most of these conditions, the only way to get any specificity is to note which medications help. Absent any way to produce accurate, specific diagnosis, such trials are a waste of time and money.

> How could you possibly know that the SSRI is responsible for your recovery?

By noticing their effects? Seriously, what kind of condescending question is that, implying people can't tell severe differences in their own state of mind. Disregard it as "beyond worthless" anecdotes as much as you want, when this stuff works it's very clear and not some "might be placebo" kind of deal, including remarks from other people who notice the changes.

> That makes it even murkier. SSRIs take a long time to work, and if you try several of them that's going to take months to years.

Better months than the rest of my life.

Presented like a true graduate of the Facebook School of Medicine and Immunology.

I'm quite a difficult skeptic, and I have to admit it's difficult to make a difference between melancholy and mild depression, especially after all those years spent being mildly depressed.

Even if I hate the bootstrap argument, it still has an effect on me, despite my skepticism.

In the end, depression alters my perception of what is really good for my mental health. It's very common that patients are difficult to treat, not only because they might disagree with the diagnostic, but because they can't really understand or perceive their emotions and subtle state of mind. Depression is a bit like obesity, you go back to the cause without caring for the consequences.

I become a bit confused when my psychiatrist lets me choose if I want to keep taking those meds, instead of clearly telling me i should take them. But in my experience, those meds are good for me, even if they're not perfect.

Maybe I will stop then one day, and see what happens, but it might hurt more than I think it will.

Maybe if antidepressants weren't pushed so hard by big pharma, people would respect their use more.

If I may,

it's like the recent trend to call everything rape and sexual assault. At some point I have to start naturally doubting the claim on its face. That doesn't imply I think these things don't happen, just that I don't think someone making a stupid dad joke should turn into the woman shouting sexual assault and I find myself questioning all accusations as a result.

---

I have no opinions on any specific person taking antidepressants, but it's not unreasonable for people to get weary when you can't throw a stick without hitting someone who has been diagnosed with something that's being medicated with antidepressants.