Please don't take any advice from anyone on HN, including me. This community often attracts armchair anecdoctors. Go and speak to a doctor.

Good luck.

This has been like 15 years ago. The more I learn, the more it seems I was the textbook case doctors never expect to meet. People are not generally aware that dysphoric mania is a thing. A good diagnosis can change your life.

Everyone in my family has some sort of anxiety issue. Citalopram (with the help of therapy and lifestyle changes) helped me overcome severe anxiety, helped my brother stop throwing up whenever he got in a too-high-pressure situation, and gave my sister the willpower to move out of my parents' house and get a job.

They're good drugs with frustrating downsides. That's life. I'd still recommend them.

But please consider alternatives as CBD or a healthier routine.

So my choices are, come off the pills, and emotionally go down a dark well I may not come out of, or keep taking the pills and live with sexual dysfunction. So not a choice at all really.

Thankfully I have an understanding partner, who has seen me at my emotional worst and has no desire for that to happen again, so we work around the issues and find new ways to enjoy each other. I think it also helps that I'm staring down the barrel of my 50th birthday, so it's not like I'm a youngster who would have uncontrollable desires anyway ;)

As you probably worked out, I'm fairly open about this, and will tell anyone who asks, as I believe it's an important issue that people should be aware of.

They don’t actually solve the problem long term, you can’t really come off them ever (I know a lot of people who have tried; only one who succeeded and they were on an exceedingly low dose to begin with - it took six months before the frightening neurological symptoms subsided), and they permanently damage ability to have human connection (I don’t understand how that doesn’t worsen depression and anxiety long term).

I get that I’m the asshole for suggesting that people take a second look at the side effect profile and consider whether these might be overprescribed. I get that they do make life better overall for some people. I’ve also seen my friends become psychotic and ruin their lives when they try to get off them (because the sexual side effects and weight gain were unbearable). So IDK, it feels urgent enough to raise as a concern. Especially when so many people are taking them.

I see a lot of people given SSRIs for anxiety that could probably be better treated by e.g. not smoking so much weed. It is hard to manage the underlying factors that drive people to alcohol and drug use, but I think probably easier than being rendered impotent by SSRIs.

I get that seemingly everyone is depressed these days, but I really question giving SSRIs, which have poor efficacy and devastating side effects, before demanding lifestyle change. Walking 10k steps and CBT are useful interventions that can be easily monitored by physicians with modern technology.

I guess good for half the 20-something cohort for not being able to orgasm really ever, but it’s not great for building the physical aspect of human connection, which I maintain is important. IDK what society looks like when half the prime age population isn’t able to have a fulfilling or enjoyable sex life.

It's literally like flipping a switch. One day, the plumbing works. The next day, it doesn't. Many times I'd just give up, out of boredom.

The side-effects are clearly stated but to use myself as an example, I vastly underestimated just how strong they would be.

That said, if you're dealing with the big black dog as it were, don't use it as a reason to avoid anti-depressants if you really need them. Keep your doctor up to date about the side-effects so they can adjust your prescription. And don't be shy just because you're talking about your private parts.

And make sure you have a therapist too.

Logically I knew that my mom wouldn't die if I didn't stop my room fan at its maximum rotation or if I didn't make the sign of the cross 2^n times. But mental illness is illogical. What "good coping skills" would fix that?

Psych put me on Prozac, which numbed every feeling but panic, which it didn't touch. I got relief from a bad trip on 2C-E, in which I had such a severe panic attack that it permanently destroyed that identity and left me with depersonalization. The old me was dead, so over the following months I built a new one. OCD apparently got erased with the rest of me. I successfully went off Prozac by quitting it cold turkey and stayed off SSRIs for a decade.

I guess the takeaway is: serious mental illness exists, platitudes about life wouldn't help, SSRIs didn't help either but didn't make me dependent, and psychedelics are a crapshoot.

The thing is the rest of the world doesn't seem to feel the burning desire to get as many people on them as possible and even have alternatives which aren't as limited. Reversible MAOI drugs like moclobemide have been around since the 90s and while they have a higher interaction profile (Can't mix it with anything serotonergic basically, so no amphetamines or cocaine or other antidepressants, which is fine), the reduced side effect profile is considered a bonus and the biggest reason for lack of adoption of this along with other treatments (It's astonishing how long we have known about the ketamine thing without using it) happens to just come down to marketing and doctors scared off by the early MAOIs where you need to strongly consider diet. The new stuff even reportedly improves sexual function. And you can't get it in the USA.

I sent a number of articles like this one (and several of the medical publications it cites) to my psychiatrist. To her credit, she read them, and her response was that she agreed this kind of permanent change is possible, but it is extremely unlikely. (Anecdotally, she told me, she's treated thousands of people with SSRIs and had never had a report of something like this; she hadn't heard of it happening until I showed her case studies.)

I don't think that means my doctor is ignorant - I think that means permanent damage is indeed likely very uncommon.

Here is a write up from Lorien Psych (the day job of Scott Alexander at Slate Star Codex) that I think is evenhanded: https://lorienpsych.com/2020/10/25/ssris/

Alexander has his issues, but this is an area where he's actually an expert and his approach to the topic helped me a lot.

As for me, the benefits of a relatively low dose of an SSRI have really outweighed the risks so far.

The only thing, fleeting as it may be, that I find worthy of doing in life is sex, and these ed side effects have kept me from exploring the potential for a world in which I don't to cease to exist or murder in the sake of nihilism.

I'd rather destroy the lives of those around me or others' randomly than live without sex. It's just a function of my utility curve.

Unfortunately and as counter intuitive as it may seem, I'm very cautious of skin to skin diseases such as hsv and hpv, which has kept me from hiring prostitutes, even though the only thing in life I want is exactly that.

I could not find anything substantial on this specific avenue in a brief literature search, but the mechanism is there, and anecdotally people have reported success.

We need to de-schedule these drugs. At the absolute minimum, we need to get rid of the vile Schd 1 "no medical uses" to allow their research to be more politically/financially palatable.

Some manufacturers and healthcare organisations are being to label this as a potential side effect. You can find a one line warning on NHS website now.

People take the drug are usually desperate and at their most vulnerable periods in life. It’s very risky to make life-changing decisions, more so without complete knowledge.

Doctors usually won’t even listen to cases of PSSD by simply attributing the SD as remission of depression. But there’re some recent studies on how SSRI could change neutral receptors in a non-reversible way, which could be the potential mechanism.

Antidepressants are an awfully tough thing to get right. Whenever my friends talk to me about them I recommend therapy and all the other things before starting ssris or the other families of brain drugs.

For the curious, Wellbrutin is the medication we added. It helps me with depression, ADHD, sexual issues, and some anxiety.

But honestly sex is mostly in the brain and not finishing every time is only a drag if you think that it is. Personally I find it liberating, sex becomes a fun intimate pass time without an end goal. And certainly the benefits to my depression and anxiety out weigh the negatives for me.

What about modern society drives the need for such widespread use of antidepressants? Is that something we should be willing to give up? It hasn’t always been this way, has it?

YMMV! A lot!

As I get older I feel healthier when I move, touch people, give love and get love.

In the US, we _do not prioritize health_, physical nor mental. We're surrounded by shit food. We're "insured" basic baseline function, and improvement often has to come out of our own time, energy, and money. If you're in a relaxed white collar environment, its easy to duck out for an hour of therapy. If you're on the clock, it's almost impossible. This is the bigger issue.

Again, some ppl DO need SSRIs or they will harm themselves or others. But always pair with some form of talk therapy and get some daily exercise.

That being said, I wish we understood these drugs better, because I know the side effects and efficacy vary in the extreme. I know for some people it's like trying to put out a fire with gasoline.

Continued anecdata: when I forget to get my refill, the withdrawal is terrible. Dizziness, malaise, and "brain zaps". One of these days I'm going to have to wean off of it carefully before I try psychedelics.

We definitely have users that have experienced PSSD and have found our app helpful, and the underlying therapy techniques are proven.

[1] https://www.blueheart.io

More reading: https://en.wikipedia.org/wiki/Anti-psychiatry https://www.goodreads.com/book/show/6943460-the-emperor-s-ne...

Not a doctor, by the way.

I think one such meme is around agency, with the underlying meme being that humans have no control over their circumstances or mental state. They have anxiety or they have depression. It's part of their identity, and these seem to be thought of as immutable diseases.

And it's a social faux pas to suggest to someone with anxiety (particularly someone you are not super close with) that if they altered their behavior and consciously tried to work on their thought patterns, that they could get better. In our culture now, that gets translated as 'blaming the victim', because with a victim mindset, such a suggestion implies that it's the fault of the person.

It's an unfortunate state of affairs. It feels like we are increasingly leaning into concepts such as an 'external locus of control' and 'learned helplessness' as a society. I don't know how we can push back on these ideas at scale, but if we don't, it's hard not seeing mental health issues and the externalities of the easy pharmacological solutions expand.

Sort of. As I understand it, SSRIs have poor efficacy for mild depression, but have better efficacy against severe depression.

> CBT are useful interventions that can be easily monitored by physicians with modern technology.

The 'difficulty' with CBT, or indeed any other therapy, is it's expensive. And our health care system (at least in the UK) is quite underfunded.

This problem isn’t just related to mental disorders. I think you are also undermining how difficult changing human behavior is, especially in relation to mental disorders and addictions. Ideally, SSRI’s are used to make behavioral changes easier.

You really don’t have a clue why people reach for these drugs.

> Recently met an older (early 30s guy) and it was seriously cool having a sexual experience that didn’t end with “don’t bother I’m just not going to finish no matter how long we go.”

Reading that was like reading that your worst nightmare is actually true. nervous laugh

As a guy in their 30s, on multiple occasions I've comforted myself with "self, it doesn't matter to them if we finish, they're probably so appreciative that we're more focused on them than ourselves. you're doing great, self." And your comment is just NOPE and slashes my self esteem to shreds!

And this too!: > by e.g. not smoking so much weed...

CUTS DOWN MY MENTAL SUPPORT FRAMEWORK LIKE A SCYTHE. :) <3

I needed that solid slap across the face, I was in danger of becoming too comfortable with my sexuality, now I have the ammo to fuel my insecurity and shame, and push it back down where it belongs. A million thanks.

Self medicated this past weekend and had some major breakthroughs with my long time depression/suicidal intrusive thoughts. Nice thing is you don’t have to stay on it unlike other antidepressants—I would never do a medication that you have to constantly take.

I cut out salt and caffeine, increased potassium and exercised every day. I went back in two months and my blood pressure was 120/80. She took it four times because she didn't believe it. I think the primary thing was the caffeine - it just gives me a temporary but strong spike in blood pressure.

Years later, a doctor prescribed me Lexapro. I actually picked up the prescription. But I never took it. I started exercising every day, started mindful meditation, removed sugar from my diet, read the book Learned Optimism and did the CBT-like work in there. Ended up never taking the SSRI but haven't had anxiety in 7 years. (btw Learned Optimism was recommended to me on HN).

Some people definitely need medication - I worked with a guy in his early 20s that had cholesterol of 400+. I saw him eat oatmeal every day for breakfast and lunch and then saw his cholesterol go up to 420. I'm sure there are people that need SSRIs. But it does seem like doctors at least prescribed it to me when I didn't need it.

Knowing that one person in one thousand saw some issue is very different from 20% of people. Especially as almost every medication I've ever seen advertised has a list two pages long of possible side effects.

How is a person supposed to make an informed judgment?

SSRIs are not perfect but have a safer track record of being a first-attack against depression and anxiety, before having to resort to bigger guns like MAOIs.

You have to take pills more often (3x a day vs 1 a day) and only one potential benefit over SSRI which is less likelihood of sexual dysfunction.

They would have discontinued the medication, terminated the doctor patient realationship, then waited for things to "go back to normal" when they were off the drug but found it never did.

In fact they may have voiced concerns to her and she may have said "it will go back to normal if you discontinue the drug". But they never went off the drugs until they fired her as their doctor, so she would never know about the subsequent problems.

He has a major conflict on this topic in particular though.

Livejournal-era Scott (squid314) expressed eugenicist views on the mentally ill (paying schizophrenics to get sterilized): https://www.twitter.com/ArsonAtDennys/status/136101934712109...

So I would not trust his claimed views whatsoever on the libido effects of other psychiatric medication and would look for other sources.

I have sex on a regular basis, and it's not nearly as bad as these side effects make it sound. It's different, sure, but you can definitely have enjoyable sex.

You need to take antidepressants every single day for at least 30 days before you'll notice any effect whatsoever. Every day, without fail. If you haven't tried that yet, I urge you to; it was nothing short of miraculous, and there was no reason for me to live so many years in misery.

That why it is at the same level as breathing, eating and shitting in:

- https://en.wikipedia.org/wiki/Maslow%27s_hierarchy_of_needs

ps. Having sex in rubber with prostitute is safer in terms of HPV/HSF infection then with average female in UK without any protection (especially with Y gen) :) So I would not worry about it THAT much.

Honestly, the "about" is that we've developed medicines that aren't nearly as horrible as the medicines of yesteryear. Prozac wasn't marketed until the 80's, and a lot of other things have been marketed since then. Marketing is key too - it is really hard to take this stuff if you don't know something is available. And misery has been with us for quite some time.

Is that something we should be willing to give up? Well, no. Giving up antidepressants means that people suffer more. We could work on reducing the general population's suffering and anxiety. We aren't 100% sure on how to do this, it seems, but we know things like easily affordable health care and a safety net helps out lots.

It hasn’t always been this way, has it? Actually, yes. And no. I'm not convinced that housewives that used to take vallium in the 70's were taking it because they were happy, for example. We didn't always think to write about this stuff - doubly so when going on about it could get you in a non-modern mental hospital. The 'no' is simply because we can do something about it now. I like to think we are more compassionate overall now, but I have no real reason to think this.

As a man in his 30s growing up I witnessed a shift in attitudes from "just man up" to "seek help", so there's that.

If anything I would suggest humanity to give up dating apps. They're essentially making people feel inadequate and pay for the dubious privilege.

It's completely possible that there's something messed up in modern society that causes depression, or in medicine that diagnoses depression and/or prescribes antidepressants, but the null hypothesis would be that before modern times, people were... just depressed. And then more recently that they'd try treating it with cocaine/meth/etc. Or that they'd fail to treat it, and some percentage of those people would commit suicide, and the remainder would never admit that there was anything wrong, both of which mean the outcome you observe wouldn't happen.

Again, this isn't to say there isn't a more interesting answer, just that you have to at least consider the possibility that it's not something about modern society.

GPs have very limited amounts of time for individual patients. Therapists, counsellors and psychiatrists are expensive and have mixed results, and require a significant time investment from the patient and the professional. It may be a long time before any kind of talk therapy has results. For many people who go into a doctor's office complaining of depression symptoms, it will go away within a reasonable timeframe. In many countries, there are waiting lists for any kind of further treatment.

The whole situation adds up to handing out SSRIs as a first line treatment when anyone comes to a GP reporting depressive symptoms; it's cheap, it buys time, it gives the patient a feeling that they're doing something to work on their issue, and gives them time to sign up for further support and get through their waiting list. As far as the GP knows, in most cases, side effects are rare. For many people coming in with mild depressive symptoms, there is some temporary life factor that will go away within the first course of treatment, and with it the symptoms, and that is a "success" for the SSRI stats.

Of course, anyone who's been on SSRIs of various types for any longer length of time knows that's bullshit, and they're quite serious substances with prolonged side effects and withdrawals. I really hope the situation changes.

There's little space for compassion and sociability. Most people in the West spend 8 hours a day working through an endlessly growing backlog of demands, all the while justifying each hour to clients and managers, then go home to drink and watch TV or scroll through news feeds. Our brains are not suited to constantly worrying over the demands of others while being so disengaged from social face to face contact.

I have severe anxiety and I always just accepted it. After taking 75mg/day of Effexor, I don't have that anxiety anymore and I can function like a normal human. I'm in my mid-30s and I can have sex 3-4x/day easily and it still functions like when I was 15.

I wouldn't blame it all on anti-depressants, since sexual issues for 35+ year old men are common even without them. Blaming anti-depressants is convenient though since no one wants to blame it on genetics/health.

There may also be selection effects as men in their late 30s may not have 'paired up' so to speak due to depression. But still, I'm curious if anyone has stats on how many people are on these drugs.