1. SSRIs are relatively safe

2. The actual mechanisms of action of SSRIs are not fully understood

3. SSRIs have been prescribed so widely in the last few decades

SSRIs are extremely well studied in scientific literature. To be clear when I say well studied I mean that the corpus of literature is broad, not that the corpus is comprehensive to the point that it can be claimed a solved problem. If you would like lots of placebo blind controlled trials and a bunch of different ways of looking at the problem you will find a welcome home in SSRI's.

Note also that I'm not saying SSRI's are a great solution to every problem simply because they are well studied. They just have a lot of data points for people to use to make informed decisions. Which is always a good thing - and it's a luxury you rarely get in pharmacology.

Conversely, we've heard this sentiment from people using their first cannabis, psychedelic,

or even just their latest drink.

Sure, most or many people are probably exaggerating.

That said, I have known a lot of suicidal people, and almost arbitrarily things can make a big difference.

I have to ask do these zaps feel good, bad, do they hurt, do they tickle. I can't quite imagine what zap is supposed to mean.

Without any history of SSRI use, when I read something funny or clever, I've often experienced a weird feeling which could be described as electric, but also tickly and kind of good feeling. Mostly in my brain and upper spine.

I also get this listening to ASMR audio. Not sure if that's the same thing we're referring to though.

excitement / ASMR moment

No, absolutely not like that.

For all the doom and gloom of SSRIs, I haven't had any real side effects and they've helped a lot

For anyone reading who's unfamiliar, this is a ridiculous dose of MDMA. A normal recreational dose would be 0.1g-0.2g once every few months. (I have no idea whether this dose is safe or not, just saying it's a common one for people to take.)

A bad thing about MDMA is that you become tolerant to it very quickly, so people who do it too regularly need to take more and more over time to feel the effects. That's probably what happened to the parent comment's friend.

given how typical "street" samples test with diy kits and at mail-in labs, it's not even unreasonable to suggest that might have actually been the case.

What's normal and recreational is much less well defined.

The euphoria caused by MDMA combined with literally any other drug (MDMA is like ketchup, can be combined with anything) synergizes and can quickly escalate to rampant re-dosing that _exponentially_ increases tolerance, all while preventing the receptor to re-regulate.

The "sads" following MDMA binges are so ironically over-bearing to a point of near artificial-ness and it is nearly obviously attributable to the chemical.

MDPM/6-APB are interesting as they are euphoric and serotonic but with less manic depressive the next circadian cycle.

This gave me literal chills when I read it because this exact thing happened to me for the same reason as your acquaintance (but far, far lower doses). I was prone to getting sleep paralysis anyways, but abusing MDMA resulted in the most terrifying experience of my life two nights in a row. Your description was spot on.. I felt the covers on my bed being pulled off of me by some demonic presence the first night, and the second night the same thing happened but that time I was lifted out of my bed and slowly dragged away. Felt like I was awake and perfectly conscious the entire time and I literally frozen with fear to the point where I couldn't speak. I stayed up the entire night after that for fear of it happening again. I also got terrible brain zaps for weeks afterwards, too.

I am all for freedom of drugs and people experiencing one of the most beautiful states of mind one can achieve, but 4g MDMA over 4 days is literally in the attempted brain-damage territory.

There’s something about Sertraline (Zoloft) that seems to make it quite reliable at causing brain zaps. 3 people I’ve known who stopped Sertraline all experienced brain zaps. 1 of those people also talked about stopping Prozac (cold turkey) and Lexapro (4wk taper) and did not have the zaps, but a 4-month taper of Sertraline was not enough to avoid them.

In fact in the article they recommend switching to Prozac and then tapering that, as a way to avoid the zaps.

I believe Lexapro is a highly selective SSRI, which might explain its lack of withdrawal symptoms (and also its "does absolutely nothing" effect for some people). Prozac has a very long half-life compared to other SSRIs so it's basically got an in-built taper, and is why it's often 'cross-tapered' to when coming off another SSRI.

Still, it’s been a life changing drug for me and I haven’t really had any bad side effects while I’ve been taking it.

I've had a brainzap when I was used MDMA somewhat regularly for a short period in the 90s. It was only once, so it was more a weird "What is this? I feel... something... in my brain?" But I don't think I would want to deal with it happening spontaneously and constantly like withdrawal symptoms present. Sounds awful.

I take Effexor which is an SNRI... From what I've read, is one of the worst in terms of withdrawal (brainzaps and other side-effects). I'm really not liking the idea of me having to someday go off of it, so far for now it keeps me stable, but... if something happened where I would need to go off of it, I'm not looking forward to it.

The long half-life is also the reason it's prescribed for SSRI withdrawal symptoms.

Sertraline is a potent SSRI in terms of inhibiting the serotonin transporter protein itself. It also has a relatively short half-life. Makes sense that cessation would induce withdrawal symptoms.

It's the same principle behind prescribing Suboxone for opioid withdrawal. The drug has a ridiculously long half-life, so it has the potential to smooth out what would otherwise be acute withdrawal.

For those curious about what a brain zap is, it's like you're going about your normal business, then you feel a jolt like you're surprised, but only in your head. Then it's difficult to remember what you were thinking about prior to the zap. When it happened to me last, I stopped walking and couldn't resume my inner monologue/ train of thought. I just started walking and let another one conjure itself up.

It's been decades since I've had one, Wellbutrin is much better.

Idk how a doctor can just dismiss it. Ofc there is a variety in “brightness” out there but being that thick is something else.

Seems like another example of: "Deadly Psychiatry and Organised Denial" https://www.deadlymedicines.dk/deadly-psychiatry-and-organis... "Deadly Psychiatry and Organised Denial explains in evidence-based detail why the way we currently use psychiatric drugs does far more harm than good. Professor, Doctor of Medical Science, Peter C. Gøtzsche documents that psychiatric drugs kill more than half a million people every year among those aged 65 and above in the United States and Europe. This makes psychiatric drugs the third leading cause of death, after heart disease and cancer. Gøtzsche explains that we could reduce our current usage of psychotropic drugs by 98% and at the same time improve patients’ mental and physical health and survival. It can be difficult, however, to come off the drugs, as many people become dependent on them. As the withdrawal symptoms can be severe, long-lasting and even dangerous, slow tapering is usually necessary. In his book, Gøtzsche debunks the many myths that leading psychiatrists – very often on drug industry payroll – have created and nurtured over decades in order to conceal the fact that biological psychiatry has generally been a failure. Biological psychiatry sees drugs as the “solution” for virtually all problems, in marked contrast to the patients’ views. Most patients don’t respond to the drugs they receive but, unfortunately, the psychiatrists’ frustrations over the lack of progress often lead to more diagnoses, more drugs and higher doses, harming the patients further."

Other alternatives for health and wellness I have collected: https://github.com/pdfernhout/High-Performance-Organizations...

One example from there: "The Depression Cure: The 6-Step Program to Beat Depression without Drugs" by Stephen S. Ilardi

From the Amazon book blurb: "In the past decade, depression rates have skyrocketed, and one in four Americans suffer from major depression at some point in their lives. Where have we gone wrong? Dr. Stephen Ilardi sheds light on our current predicament and reminds us that our bodies were never designed for the sleep-deprived, poorly nourished, frenzied pace of twenty-first century life. Inspired by the extraordinary resilience of aboriginal groups like the Kaluli of Papua New Guinea, Dr. Ilardi prescribes an easy-to-follow, clinically proven program that harks back to what our bodies were originally made for and what they continue to need with these six components:

  * Brain Food [supplement with Omega 3s; remember your brain is mostly fat]
  * Don't Think, Do [avoid excessive rumination by doing things]
  * Antidepressant Exercise [aerobic exercise is medicine]
  * Let There Be Light [get natural sunlight and supplement as needed with vitamin D3]
  * Get Connected [engage in face-to-face social activities regularly]
  * Habits of Healthy Sleep [get enough sleep by following basic guidelines]

TL;DR as Ilardi says: "We were never designed for the sedentary, indoor, sleep-deprived, socially-isolated, fast-food-laden, frenetic pace of modern life. (Stephen Ilardi, PhD)"

That said, if you are on prescription psychotropic meds already, do not stop taking them or change doses without some medically-approved plan for getting off them. Peter Gøtzsche wrote an entire book about that: "Mental Health Survival Kit and Withdrawal from Psychiatric Drugs: A User's Guide" https://www.amazon.com/Mental-Health-Survival-Withdrawal-Psy... "This book can help people with mental health issues to survive and return to a normal life. Citizens believe, and the science shows, that medications for depression and psychosis and admission to a psychiatric ward are more often harmful than beneficial. Yet most patients take psychiatric drugs for years. Doctors have made hundreds of millions of patients dependent on psychiatric drugs without knowing how to help them taper off the drugs safely, which can be very difficult. The book explains in detail how harmful psychiatric drugs are and gives detailed advice about how to come off them. You will learn: ... that psychiatric drugs should never be stopped abruptly because withdrawal reactions can be dangerous..."

There is probably some true to this advice, but the issue is not that it's some hidden secret, it's that fact that is basically infeasible for a majority of people.

Trust me, while I benefit from psychiatry, I am by no means a fan of psychiatry as a whole. However, your comment only focuses on depression. There are plenty other disorders that psychiatry deals with, like Schizophrenia, that the list of advice above would hardly make a dent in for many.

just exercise! just eat healthy! just relax! just don't ruminate! just be not depressed!

So easy when you're not depressed. Fucking impossible for a lot of people who are depressed.

Working with my GP to titrate off Sertraline (Zoloft) at the moment.

My GP, like many others, wasnt really aware of the issues with getting off the drugs!

I describe the brain zaps as like a wave of electricity.

Like a Sci-Fi pulsing wave. As if i've got some sort of giant capacitor discharging in my brain.

The sort of thing from a 50s Sci-Fi movie thats a tower of electricity, glowing and pulsing and radiating an electrical light show!

Exactly the sort of thing that might re-animate Frankenstein!

It's not painful as such, but it's debilitating and causes you to literally pause and make a sharp intake of breath.

I hate being on the bloody things. Wish I'd never started them. CBT is much more effective in the long term, for me. YMMV.

I find SSRIs kill my motivation and creativity.

I'd really suggest anyone think twice before assuming these pills, that GPs dish out like candy, are an easy and consequence free solution!

I think far more people might find that they need to taper very slowly if more people got past the first step of tapering instead of just staying on them indefinitely. Many people feel more anxious and depressed on a slightly lower dose and take that as confirmation that they were born needing it, when it might be more the case that their brain has adapted to depend on it. If they were able to reduce more slowly and comfortably this might be more obvious. That matches what I saw with the person I know who is finally doing well on low dose Prozac.

This was the case for me! It took me months to titrate down to 0 from Sertraline. Withdrawal side effects were terrible, and I’m pretty turned off to SSRIs in general now. My past doctors talked them up as “safe”, and treated the ramp down process as a tiny inconsequential mention.

I had tried to stop after stabilizing on a half dose, 1/4 dose, etc., and the side effects were too unpleasant so I had to start back up. I could only stop after I titrated down to 1/8th, every other day.

(Though in theory the contents should be homogenized, so you could dump the powder and take a proportion of it)

That’s forbidden knowledge. For some reason they tend to just write you a recipe and see ya in a year, good luck with collateral damage to your life.

SSRIs get advertised as making you indifferent to bad things, well, you become indifferent to all things. Like a vegetable. It’s an amplitude modulator, not a negative cut off. I wonder how much that correlates with “psychotypes” and general development, because it almost feels like you become an average normal person, and not in a good sense. Blind, dumbed (not dumb but unmotivated), indifferent, uninterested. Just living through a life with a sort of a brainfog. Maybe SSRIs show success in large enough groups for which this is a natural state??

Also you can’t come. Ever watched The Fist of Rage?

Oh and if you hate bloody things, you’ll hate to cancel these much more :). Brain zaps are not the worst, it feels like all your psyche gets barely hinged together for quite a while. Like a wood house with every joint shaken a little for slack.

I'd really suggest anyone think twice before assuming these pills, that GPs dish out like candy, are an easy and consequence free solution!

Full agree.

I've heard of people experiencing similar things when practicing techniques for Lucid Dreaming or Astral Projection.

Fucking sucked.

As an aside, there are several dozen drugs that street dealers sell as “MDMA” with wildly variable dose-response curves. 4 grams of MDMA sounds insane but it is absolutely feasible that a person could end up having to take that much of some other cathinone/MDxx drug for a comparable experience

MDMA depending on where you are and what you got can be quite a few things, it's why test kits are important. It's not to say that MDMA cannot cause brain zaps, but given that we know that MDMA is usually cut with a lot of filler/other drugs without the user knowing, I would acknowledge it could do it, but would always have doubt it was actually the MDMA due to the knowledge that whatever the users who experienced brain zaps took likely had many other drugs/substances in it. In the current political climate surrounding drugs, I'm not even sure how a study could effectively be done correctly.

Which is unfortunate because brain zaps really suck and withdrawal from SSRIs is pretty rough. I easily get into addictive substances, and have successfully stopped use on quite a few pretty heavy things, and they didn't come close to the withdrawals from SSRIs for me. This is personal experience of course, and likely many other factors in my life helped with my stopping some recreational drugs without hugely adverse affects, but SSRIs just nothing helped and at the time (2010-2015), I really couldn't find any reliable information online or from doctors about the brain zaps.

I'm glad to read this article because it's great to see that there is attention to this and more focus on the side effects of SSRIs. SSRIs definitely can help many people, but it is pretty intense drug and the withdrawal is nasty for quite a few people.

As for whether or not it's 'really MDMA', not everybody is popping pressed ecstasy tablets. It's trivial to send a few crushed crystals to a spectroscopy lab and I very rarely see samples cut with anything other than carbohydrates.