Ask HN: What is your experience with SSRIs?

Let's imagine that for any desired outcome you can empirically derive a function of the form:

success ~= ability * effort * environment

Let's take your effective intelligence as your measure of success.

Then your ability is your innate capacity for intellectual activity, your effort is how you apply yourself in situations that require intellect, and your environment is everything else about your life, including your capacity for motivating yourself.

Taking properly prescribed psychiatric medicine will dramatically change the environment in which you are applying your intelligence.

If your environment is otherwise driving your effective intelligence down to zero, is there really a risk?

I have no experience with SSRIs.

I had a severe depression between 2007-2011. I used N-acetylcysteine and I benefitted a lot from it.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3044191/

Also consider a ketogenic diet. Currently I'm experimenting with it. So far I like it. Prepare for some extreme insomnia in the beginning. This should be getting better after a week. Should not be a problem in your case as you are already spending 22 hours in bed a day.

https://www.psychologytoday.com/us/blog/evolutionary-psychia...

https://www.psychologytoday.com/us/blog/advancing-psychiatry...

You do have other options such as therapy. I would recommend going that route if you can. If you can't, or that doesn't work, medication can be a good way to dig you out of this situation.

It sounds like your situation is bad enough to warrant some risks.

Gave me the runs something fierce. Turns out I didn't need drugs, just an occasional lay.

Changed my life. Therapy helps but it doesn’t help with the physical anxiety symptoms like muscle tensions, stomach issues, etc. Therapy is good for CBT but ONLY after you find the therapist you jive with. If you don’t connect with your therapist then everything is much less effective.

SSRIs feel like a forced mood lift. Like Coca Cola gives you a sugar high. It has that same artificial-chemical vibe, just inside your brain. You are aware you are less depressed, and it's not from you, that's about it. You reason and perform intellectual tasks at the same pace as before, just less ruminating and negative mood.

They also kill your sex drive and can cause some difficultly in the act of sex. This has few studies but needs more. It's unfortunately underexplored. For some people this is a feature and not a bug.

The come down from the artficial mood lift can be unpleasant, it doesn't take long to get used to, but it can be a source of moodiness if you're not aware of what the experience of coming down is like.

It won't sterilize or neuter your brain. Taking it is likely orders of magnitude better than not taking it. Not because SSRIs are a pancea, but because getting out of bed is so much better than staying inside all day and SSRIs might help.

30mg of Saffron (yes the spice) is a more pleasant mood lifter, even though it tastes quite bitter. It shares some qualities with SSRIs and other meds.

Being always-online can feed ritual and delusion just as much as it distracts you from them. The intellectual content on the internet eventually turns into theology if you go far enough with it. Prayer and faith can help see through rituals and delusions clearly.

I would warn you against taking the responses that you read on here (including this one) as an objective sample -- HN is not representative of the broader world, and (just like with product reviews) your sample may be biased towards people who either LOVE them or HATE them (and are thus motivated to comment).

However, I can tell you some references that helped me become much less stressed about SSRIs and their friends, and indeed if they were indicated by a doctor I would now take them much more readily.

Scott Alexander (pen name) is a psychiatrist (MD) and all-around smart due who writes extensively about the medical system, medicine for mental health, and the challenges these systems create. He has an excellent series of blog posts which review the data :

https://slatestarcodex.com/2014/07/07/ssris-much-more-than-y...

https://slatestarcodex.com/2018/11/07/ssris-an-update/

It's scary to take drugs which alter your mental state. I don't drink and have never done any sort of recreational drug for this reason. But Scott helped convince me that both it was both possible that SSRIs would help me and unlikely that they would cause long-term damage.

I'm a residency trained pharmacist and someone whose life was improved immensely by antidepressants from ages 19 - 37(bupropion x 10+ years, SSRI x 2 years, SNRI x 5 years). These drugs will change your affect (your mood) but not your intellect.

I am also currently not on medication x 2 months for the first time in about 18 years, so I have seen myself both on and off meds and I have a deep mechanistic understanding of these drugs.

I promise you that no drug that you can take can make any permanent changes to *edit* to your mind (there are rare cases unrelated to SSRI where side effects like tardive dyskinesia or pulmonary fibrosis can be irreversible). The SSRI have about a 4-6 week period of onset and offset where the extra serotonin floating around starts to cause fewer serotonin receptors to be expressed and subsequently enhances your brain's sensitivity to serotonin. It is for this reason that you do not see results overnight when starting a serotonergic drug.

Stopping the drug, a similar effect is seen. I had about a week of slight discomfort related to withdrawal symptoms, then 2-3 weeks of feeling a bit slower than normal, and now I feel just fine. Throughout this whole brain remodeling process both on and off meds, I never lost a step at work, which is to say that I maintained excellent performance as a midlevel practitioner and maintained several side hustles and even started a consulting business.

My honest interpersonal advice (not medical advice) is to give meds a try man. Your life has been severely affected by your mental state, and you could potentially see significant improvement....but even if you dont, you'll stop the drug and be no worse off than when you started.

To set the stage.. except the bathing and teeth thing, I'm you, just 10 years older. I didn't want the medicine. I did therapy, worked out, ran a bunch, I look like I go to the gym, I don't smoke or drink, all of the typical stuff you read as alternatives. I have 2 kids, solid marriage, CEO of a company, loving parents, no issues outside of my own head.

But my life has been out of control for years.

I started 20mg escitalopram three months ago and it changed my life. I'm no longer scared of leaving my house. I'm more focused and get tasks done quickly. A lot of my lockup moments in business and life was over analyzing everything endlessly which I was told a OCD based anxiety. Now making decisions is a quick process. My kids don't have to worry that I'm not joining them in fun on the weekends. I'm not chronically tired. I don't feel grey, or zombie, or anything else you may have read. I feel me again.

Try it. Take it for 60 days and see. You can always get off of it.

It's different for everyone. I can't stress that enough. But for me, it's amazing. It's like a silver bullet. It literally makes me happy. I know people say it's artificial happiness, etc etc but it really legitimately allows me to be happy. My stress levels go way down, and my self discipline increases. It doesn't turn me to a zombie-- I was a zombie before compared to now. Always distracted and held behind by my anxiety and difficulties expressing myself.

I get why people do drugs-- they make people feel good instead of bad. But this stuff feels like a cheat code. It makes me feel good all of the time. From the perspective of a my old depressed self, feeling neurotypical like this is like being high all the time. I should also state I've only been on it about 6 months, so long term experience is to be seen.

There are also other options, if you're willing to try. Exercise of course can be a big help. Cold showers totally eliminate my depression as well. Wim Hof breathing was life changing in terms of anxiety, though I would never have in a million years thought that a breathing exercise could help me. There are some supplements, like Saffron and Kanna, out there than can help as well. I use some of these, and together they enormous difference.

I don't have anything negative to say about escitalopram at all (it helps me, no drawbacks for me) but I do want to point out that 20mg is not the recommended starting dose.

20mg is a high starting dose. I’m on 10mg for anxiety (and maybe depression) and it has worked very well. The first few weeks were fairly physically bad but since then I have noticed minimal side effects. It sounds like you are a “zombie” right now. I haven’t noticed any mental decline and my motivation is much better since Im not stuck in anxiety loops. I’ve gone back to the gym, use less recreational drugs and get more done (important as a dad) since going on them.

Nothing.

I was put on them pretty young, along with a few other things. I don't remember much different in my day to day. I don't get why I was diagnosed with depression at the time, as I was an angry and ambitious kid, not a depressed one. It wouldn't be until years later I felt anything resembling depression and it certainly was much different than what I felt in my pre teen/teen years.

They did screw me out of some oppurtunities later on, which sucked at the time I guess, but it worked out well in the end.

Funny, I didn't learn about he nasty side effects till I was off them for years, And I would certainly prefer something else nowadays.

I would say before resorting to exogenous chemicals, try working out. Weightlifting changed my life. Maybe it will help you, maybe not, but there seems to be a habit to treat symptoms rather than address underlying causes.

I have been taking 10mg Lexapro for the past 4ish years for OCD. Has been working great with minimal side effects. I don't know if I'm less smart, but I don't care if I am, I'm able to enjoy life more.

I was very scared to start the medicine, and I wish I would have started sooner in my life. I was scared enough that when I finally dove in, I would cut the 5mg pills in half so that I would ramp up from 2.5mg.

I got on 10 mg escitalopram (Lexapro) in 2014 for social anxiety disorder, generalized anxiety disorder, and depression. I just tapered off these last few months.

Pros:

* Legitimate reductions to anxiety - no longer crippling most of the time.

* Made it harder to fall into depressive episodes. So, it did its job, I guess.

* Did not make me a blunted zombie or sterilize my brain.

Cons:

* Increased sleepiness: unable to wake up at "normal" hours without significant effort, frequent urge to take naps during the day. I slept a lot over the past 8 years, more than I would have liked to. My sleep schedule normalized as soon as I quit.

* Extremely hard to quit, even with a taper. You have to take it really, really, really slow. I developed severe appetite loss and nausea as a withdrawal symptom and ended up losing 13-14 lbs and became underweight. I've only just now got it under control.

I had severe social phobia, generalized anxiety, and OCD growing up. After some time switching medications I started on citalopram (escitalopram is the reverse isomer and closely related) in my late teens. It changed my life massively for the better. I've dropped it from time to time, but have been on 20mg again since the pandemic.

Sexual side effects are common, and for me disappear after approximately three months. Drowsiness is also common, which is why I'm no longer on 40mg.

For all the commenters mentioning sex issues with SSRIs, ask your doctor about Vortioxetine (Brintellix).

You should lay outside in direct sunlight few days a week, run/lift weights, go on walks in nature.

Physical exertion, vitamin D and testosterone from sunlight and exerting your breathing and cardiovascular system from running will in aggregate improve your mood and energy levels orders of magnitude better than they are now likely better than drugs will do as well without negative side effects, especially cognitive.

Start with walks and sunlight...

Give this a read about serotonin [1] very interesting point of view describing excess serotonin as an energy and metabolic inhibitor, depression inducing, harm-avoidance, hibernation chemical. SSRIs seem like a bad idea in this context. Whereas dopamine as the action chemical. Reduced light is associated with elevated serotonin and depression. You need to get out in sunlight daily off possible.

http://raypeat.com/articles/articles/serotonin-disease-aging...

Have you considered psychedelics at all? Changed my life you do not need dependence on it like SSRIs.

I'm not a doctor, and neither are 99.9% of people on HN, so I'm not going to give you advice on SSRIs.

However, I was (...am) depressed, and I have ADHD. I have been medicated for the latter since I was in middle school. I prefer to work through the former myself.

While I've gone places and I've done cool things, part of me feels like it's the meds, not me. I struggle with that every day. I can do basic things off my meds. But my job? Hell no.

I say this for two reasons. First: meds aren't going to flip a switch and make you happy and perfect. Second: the worst thing I deal with on a daily basis is impostor syndrome. Given my family history, that's pretty damn good.

You owe it to yourself to try helping yourself. You deserve it.

pluses and minuses for me. Went on Sertraline (zoloft) for a couple years for anxiety issues. I had some weight gain and sexual side effects, but nothing too unmanageable. Getting on was rough for me with lots of side effects for 6-8 weeks. Once on and past side effects from external comments I seemed much less anxious. I guess I was. The anxious inner chatter was less. But, somehow, and this is ultimately why I tapered off, I was just more complacent. I let things slide which I shouldn’t have. I didn’t really see how many until I was back off. My anxious inner chatter and I are a bit better friends since the temporary banishment anyway so I don’t regret the experiment. At one point I added brupropion to try to help with some of the sexual side effects, but ended up with a tinnitus problem that took ~6 months after cessation to fully resolve. Brains are funny things. Good luck tweaking yours!

Try LSD or mushrooms. Will change your mind.

If you’re really that incapacitated (4 years in bed?), why are you afraid of what drugs might do to you? You should be doing anything possible to return to society.