Do you think SSRIs are a good idea?
Do you think SSRIs are a good idea?
Mild NSFW warning: this post mentions sexual side effects of medication.
SSRIs are the most common type of antidepressant (examples are Prozac/fluoxetine, Zoloft/sertraline, Paxil/paroxetine).
If you have experience with them, do you think they're a good idea?
I came across a paper about side effects which I haven't heard discussed before. Many people know that SSRIs have sexual effects, but apparently they also affect fertility.
This paper describes SSRIs as "gonadotoxic", leading to effects like "decreased sperm concentration and motility, increased [DNA] fragmentation, and decreased reproductive organ weights".
The paper does say "this effect does seem to be reversible", so if you stop SSRIs, your sex organs should apparently go back to normal. But still, some people are on SSRIs for long periods of time, right?
I would be interested to hear others' thoughts, if you have any.
Edit: Thanks for the replies to this post, they're interesting.
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I don't have any issues with the drugs themselves. That said, there's serious consent issues around these medications, at least in the U.S.
Such as being overprescribed for conditions that they don't treat well (CPTSD and PTSD for instance), having the positive effects overstated (they're okay for mild to moderate depression, and not great for off label uses such as those just mentioned), and having the side effects downplayed (addictive is addictive, we don't need new words like discontinuation syndrome, when withdrawal communicates clearly). SSRIs aren't even the worst offenders on the market when it comes to this. SNRIs often have a very short half life, and a single missed dose can cause crippling withdrawal.
But how many of us have been prescribed these off label? With no indication of their addictive nature and potential withdrawal, not to mention sexual dysfunction? And for conditions that they don't treat well to begin with? That's not informed consent.
What does off label mean?
Conditions that are on the label are the conditions the medication is intended to treat, in this case mild to moderate depression. Off label would be using a medication for something else, like using an SSRI to treat hot flushing in menopause or antipsychotics as a sleeping aid. Technically it may work, but the studies are not there to back it, evidence is poor, so it is not shown to he effective and may have associated harm.
Thank you, I wasn’t familiar with the term.
The reason I mentioned it is because the efficacy isn't there especially with stuff like CPTSD and PTSD. So, you give a patient an antidepressant and you diagnose them with depression so the insurance will pay for it, when the underlying cause is actually childhood trauma and then they get a false hope that the depression medication is going to fix them. And they get misdiagnosed in the process.
All of this is problematic for a number of reasons. And of course if the medication doesn't work the doctor will just say well let's try a different SSRI because often we need to go through three or four of them before we find something that works.
What works best for CPTSD is trauma-informed therapy. Thankfully the medical community seems to be getting wiser. And listening to patients better, at least around here.
I would second this. My partner was on an anticonvulsant for a bipolar diagnosis. Why? Because it is used, at a lower dose, as a mood stabiliser. She had limited effect at the sstandard dosage, so the psychiatrist went up in dose to get an effect.
Ultimately she got off all of the meds and is doing better without them, but that is her and her experience, the meds may be useful for some people and not others.
For something other than depression. Like borderline personality disorder or PTSD.
Can I ask what you mean by withdrawal vs discontinuation syndrome?
If you can schedule yourself off of a medicine isn’t that different than withdrawal and addiction? Or do you have a specific use case that you’re considering addictive?
This is all very new to me
Withdrawal and discontinuation syndrome are synonyms. The later term was coined by the pharmaceutical industry in order to distance SSRIs from opioids in the minds of doctors and patients.
You can taper off of heroin and you can taper off of an SSRI but if you stop either cold turkey, you are going into withdrawal.
The common word for a substance that does this is that it is addictive. When a person says heroin is addictive they are referring to the fact that it produces physical withdrawal when you stop it.
Heroin is also habit forming, SSRIs are not habit forming as they do not create psychological reinforcement through dopamine pathways. So, they do not create a psychological addiction or habit, but they remain physically addictive and your body will still suffer from withdrawal when you quit.
When someone quits coffee we say they have caffeine withdrawals. When someone quits SSRIs we say they have discontinuation syndrome?
It's corporate marketing meant to minimize risks in the minds of doctors and patients. We already had a word for it.
Hence, there's a lot of informed consent issues with psychiatric medication in general but especially SSRIs.
Thanks again, that makes sense