Comment by isoprophlex

I suffer from severe crippling OCD and anxiety. Years of therapy and psychoanalysis have failed to find any cause, and, if anything, made it worse. The best explanation has been it's probably because I'm autistic, and these things tend to happen to autistics.

Luckily, sertraline was an almost instant cure.

I can come off it for periods, but it tends to reoccur after a while. So, it does mean I have to take a drug indefinitely, but is that really a problem? It turns my life into one worth living.

The reason we can't take sleeping pills daily is because they stop working in fairly short order. But if, like antidepressants (typically), they didn't lose their effectiveness over time, would there even be a problem with using sleeping pills if you had trouble sleeping?

Agree. But sometimes there is no "root cause", the brain is still a mystery. If you had been depressed even when you knew there was nothing to worry about, you would see it differently, because then you deduce that the black cloud is produced within.

Chemistry trumps psychology. Good enough chemistry enables cognitive treatments. But to fix the wrong chemistry you need chemistry.

Also they are often prescribed as a life-long solution, instead of a temporary stop-gap to get through some bad state of mind while, as you said, "tackling the root cause". At some point they will potentially stop working which requires switching meds and often the next one won't work as well, plus, leaving the user stuck with withdrawal symptoms for unspecified amount of time (potentially years) and anti-depressant pushers don't usually warn about this, or even acknowledge it when confronted with "since stopping I have symptom x, y, z".

Source: multiple friends, family and forums (while researching how to help friends & family get off of various SSRIs).

> but rather that they're abused by psychiatrists

Doctors of all countries have been under a lot of pressure by patients and health administrators to "fix the issue and quick". The last thing that your doctor wants is giving you pills so you go away, but that's what the context very strongly incentivize. You want doctors to stop abusing pills, stop asking them for immediate fix. Give them less patients, more time and more resources to deal with the health of the population. Also, prevention.

"It's like if we took sleeping pills every time we had trouble sleeping. Having said that, I just realised I have the impression that's exactly what people do in the USA?"

Not that my personal experience is actually a statistically significant sample, but I don't know anybody who takes sleeping pills. Or maybe I do, but they haven't told me. I've also never heard heavy sleeping pill use is one of the stereotypes about Americans. There are an estimated 342 million people in the United States, so impressions aren't always meaningful.

It's a symptom of the "health care" insurance industry. Many people end up paying a specialist doctor's co-pay when they see a psychiatrist. Some plans limit you to a maximum number of sessions you can have (6, in my case) per year. Talk therapy eats up sessions and co-pays like Pac-Man eats dots. One doctor expected me to come in twice a week. Americans don't get all the PTO and/or excused sick time they want to accommodate such a schedule.

Most forms of depressions have no "root cause" you can fix. Sometimes they have amplifiers or triggers, you might be able to work around, but that also demands first to reach a point where the patient is able to work on something.

> The hate on antidepressants is not because they're not effective, but rather that they're abused by psychiatrists.

I don’t know how rampant that problem actually is, but I don’t think you should discount the impact of social stigma when it comes to mental health. It is only in the past 10 to 15 years, at least in the US, that mental health has entered the public dialogue in any meaningful sense. Historically it has been a source of massive shame with people expressing embarrassment at their loved ones suffering from mental health crises. And now we have a whole generation of influencers and politicians who are trying to tell people to pour out all their medications, reject doctors wholesale, take their specific brand of colloidal silver, and be free.

I just think this is a lot more complicated than “psychiatrists abuse the diagnosis.”

> I have the impression that's exactly what people do in the USA?

It's not a great idea to make general assumptions about such a large and diverse country. Some drugs may be over prescribed, I have no idea if Ambien is one of them, but trying to fit 340 million people across 50 states into the same box isn't going to be very accurate.

> It's like if we took sleeping pills every time we had trouble sleeping. Having said that, I just realised I have the impression that's exactly what people do in the USA?

I can't speak for USA but in parts of Europe a lot of people have PTSD that prevents normal sleep, so they end up on these pills, and then they end up with PTSD and worse insomnia caused by long term use of sleep meds.

I think it's just incentives. Easier to take a pill than to deal with horrible trauma. And that probably stays true forever.

> like if we took sleeping pills every time we had trouble sleeping

Yes, that's normal in the US. I have multiple family members who take Ambien (zolpidem) before bed every night.

The US is heavily over-medicated, for sure. The pharma reps are very intimate with our doctors and it expresses as one might expect. If you go to the doc with nearly any significant complaint, you will very likely come away with some drugs. But it is not all doctors; people want easy fixes that do not require any change in habits. Not an easy problem to solve, systemically.

you're not wrong that pharmaceutical crutches are overused. but as an outsider to these problems my 'ambient impression' was always one of haha antidepressants are for suckers. well, in my specific case, so what if i'm a sucker... they're super effective in fixing what appears to be a defective winter brain.

Wellbutrin can/should(?) be taken indefinitely and there's nothing wrong with that, it doesn't pose big long term health risks. As I understand it the issue is with SSRIs (they do pose health risks, obviously there's nothing wrong with taking them if it is a net positive for you).

> The hate on antidepressants is not because they're not effective,

But that’s exactly what many claim. Even this article is trying to claim that Vitamin D has 4.5X higher effect size than antidepressants (e.g. that they don’t work)

> It's like if we took sleeping pills every time we had trouble sleeping. Having said that, I just realised I have the impression that's exactly what people do in the USA?

USA is actually not the world leader in over medication in this domain, even though it’s popular and safe to hate on Americans. The rates of benzodiazepine and Z-drug prescription in some countries like France are substantially higher than the USA.

> Ideally, a professional will prescribe them as a necessary helper to becoming (more) mentally healthy whilst tackling the root cause.

I wish people would stop saying this.

Our understanding of the brain is not sufficiently sophisticated to allow us to identify the "root cause" (whatever that means) of depression in most people. Indeed we have no reason to believe that there even is a root cause to most people's depression.

If you take antidepressants, go to therapy (or meditate or exercise or whatever), then go off them and still feel good, that's great.

And if you take antidepressants indefinitely because doing so improves your life, that's also great! Your life is improved! This isn't an "abuse" of the drugs.

No psychiatrist is making you do anything. They're advising you based on their clinical judgement and experience, but ultimately it's your decision to take the pills or not. If your goal is to go on antidepressants temporarily, any decent psychiatrist will support you in that (because, again, they understand that they can't make you take the pills one day longer than you want to).

I've been on Lexapro and done evidence-based therapy for years. They both have been helpful, but if I had to pick one, I'd immediately pick Lexapro. For me it is a miracle drug. And the miracle is, I can choose how I feel.

(I also added a small dose of Buspar to help with the sexual side-effects.)

If you're on the fence about trying an antidepressant, I really encourage you to talk to a psychiatrist. If you try it and hate it, then you can stop. But a lot of people try it and love it. And I think a lot more people would be willing to try it if the notion that this is somehow "wrong" were gone.

For further reading I recommend https://lorienpsych.com/2021/06/05/depression/. I don't agree with everything Scott Alexander says, but his writing about mental health specifically has been useful to me.

I've been off and on them for years, usually my doctors seem to prefer if I'm off them and indeed treat them more as short term "stabilizers" so that my brain has a bit more space to deal with things.

This has been true across two countries (Scotland, Hong Kong) and multiple doctors, with a third country's (China) doctor suggesting I try out sleeping tablets for a few weeks - and only giving me a very limited supply of them - to try out instead.

I wonder if the "here take these" is a predominantly American phenomenon due to the weird incentives around health care costs (I'm being genuine here - maybe it's predominant in other countries too, I honestly don't know!)

It's not like sleeping pills at all actually. Sleeping pills have a huge dependence and tolerance factor. Antidepressants, generally, do not. Once you find one that works, they keep working effectively forever.

It's actually like statins. Ideally, a doctor will recommend diet changes in addition to the pills. However, relying on lifestyle interventions almost never is effective, And the more we learn about it, the more we realize that cholesterol is mostly genetic based rather than diet based anyway. So the most effective thing they can do is say "here, take these indefinitely". And thank God they do because it saves thousands of lives annually.

For many people with depression, a neurochemical imbalance is the root cause. Just like with statins, addressing it means taking some pills.

Sometimes the root problem is that your neurochemistry is FUBAR and no amount of counseling with overcome a biological cause.

Frankly, I see this as similar to telling diabetics that they should use just enough insulin to get them to learn to stop being diabetic. That’s possible for a few type 2 diabetics who could make lifestyle changes that got them back into good ranges. It’s completely useless for type 1 diabetics, or type 2 who can no longer go back.

I’m neither diabetic nor depressed. I don’t have a dog in this hunt. I’m just always astonished at “have you tried not being depressed?” Some people can “snap out of it”. Many times that number of people cannot.

> I just realised I have the impression that's exactly what people do in the USA?

How would you have formed that impression? Whatever media and culture you’re consuming, or how you are interpreting it, is leading you to incorrect conclusions. You should examine that.

We all live in a cultural bubble but any time you find yourself thinking that millions of people somewhere else do something crazy, you should probably talk to someone from there.

Sleeping meds might be prescribed at a higher rate in the US, that wouldn’t surprise me due to the specific incentives in our health care system. But that’s a far cry from your impression.

Every time I have a yearly physical, my GP will ask if I have feelings of depression.

I know this road leads to SSRIs at the very least, so I always reply in the negative.

The parent comment hints to me that this might be a mistake. I do not want to become accustomed to an antidepressant, so perhaps my course of action was correct.

I was measured low on Vitamin D, which I've hopefully corrected, and I haven't always eaten fish regularly. Perhaps I should pay more attention to that.

The truth about antidepressants is that the majority of people with depression that respond to an antidepressant would also have responded to a placebo. This doesn't mean that their depression isn't real or that antidepressants "don't work". It just means that placebo has a relatively high response rate in trials for depression. The hate is (among other points) because they are only arguably, marginally, better than placebo, and antidepressants also have real side effects (activation syndrome, increased suicidality, sexual side effects, withdrawals, etc.) over placebo.

Yeah some people pop a melatonin every night before bed

> It's like if we took sleeping pills every time we had trouble sleeping. Having said that, I just realised I have the impression that's exactly what people do in the USA?

I'm not sure if it is common but I've definitely taken my fair share of my dog's trazodone.

> but rather that they're abused by psychiatrists

Well that but also they have poorly understood long term effects even after being discontinued (in some people, not others) and they don't work for everyone. The latter is probably most of the reason they get hated on. I don't recall the source but a given antidepressant only works for something like 1/3 or less of the population. So take a person not in a great place emotionally, who is also statistically not in a great place in life overall, subject them to an insufferable bureaucratic process, give them a drug that doesn't end up working for them, add in some pretty wild side effects, sprinkle on a few long term effects that persist after they discontinue the thing that didn't work to begin with, and of course you end up with a bad reputation.

The tl;dr is that our understanding of the brain and mood disorders kind of sucks.

"Imagine if we took insulin every time our pancreas failed to properly process sugar."

> it's more of a "here, take these indefinitely"

And when you question this approach, the famous lecture comes: "but diabetes patients take insulin for life. You realize depression is a real condition and need to be treated right?"

yep and it works too.

To add to this discussion as someone who had above experience this winter, after (literally) years of mood fluctuations, fatigue and brain fog.

I have started taking SSRI after a harder-than-usual body collapse, and after no matter what I did my mood hasn't improved for a month. Regular running, meditating, writing, crafting, coding etc were my antidote to my mood swings but this time it didn't work. Started taking SSRI and continue doing all this things, and I was reborn.

My therapist said that a big chunk of why i am feeling better is also because I kept doing things that are good for me. That she sees with a lot of her patients that they think a pill will magically change the situation. It doesn't work on itself, you need to show up and do things that release serotonin in your body.

But seriously, unbelievable, years of frustration and friction in my life disappeared and I have never felt better.

> Depression is deceptively common

I didn't even know I had it, but when I was diagnosed, my psychiatrist was very concerned and made a point of encouraging me to keep in touch, making sure I worked through things and engaged with the problem. I initially thought something like "I'm fine, just a little down here and there, I wonder if this person is inventing work for themselves?"

Same with anxiety. I would have told you something like "I'm not an anxious person at all. I don't even know what that's like, though I can sympathize with people who suffer with it". As it turned out, I was suffering pretty severe anxiety. In retrospect it's as clear as day, but at the time it was just... The way life was.

The thing is, all of my assessments remarked that I demonstrated relatively high self awareness and openness. My experience being diagnosed with ADHD and depression made me seriously concerned for people who 1) can't afford this process and support, and 2) will just continue to grind like I was, living half-dead without knowing it can be any other way.

I suspect there are a ton of these people—I think I notice them quite often—and I was arguably accidentally pulled from that stupor and would likely still be there, unaware, if it weren't for a chance encounter that caused me to think slightly differently about the possibility of having ADHD.

> I had a very similar experience, except it killed my libido

Did you, as well as the other people seconding this, have any libido left in the first place? I got on Sertraline because I was depressed, and it actually brought my libido back, by virtue of just bringing me back to a better emotional baseline.

All to say, if it had affected my libido, it'd have been a NOOP anyway in my case.

I have switched to lamotrigin, it helps to balance mood as I had bad mood in months with less sunshine. Lamotrigin is not an antidepressant, previously it was used for epilepsy stabilisation but now it is prescribed for mood swings. (This is not a medical advice.)

Speaking from personal experience, people react to different SSRIs differently. I took a popular one that had significant side effects without a whole lot of benefit, and so I stopped it and didn't try anything else for 10 years. Then I spoke to a psychiatric nurse practitioner who suggested trying several others until we found something that worked for me. I had (incorrectly) assumed that if you had e.g. sexual side effects from one SSRI, that you'd have them for all. That is not the case.

I have no experience about antidepressants myself so please excuse my stupid question.

When I hear people say "it killed my libido" I always think about the fact that hyper-sexuality can be a trauma response, and if your body is healing the hyper-sexuality is most likely also reduced.

It's like when you have a disease and then read the side effects of a medication and notice that a lot of the side effects are basically also something that can happen when your overall condition is improving but still some people report them as adverse effects and then these are added as side effects to the package label.

For example you take antibiotics but bacteria can have toxins in their body, and when the bacteria disintegrate you get more sick from the released toxins. It's called the Herxheimer effect: https://en.wikipedia.org/wiki/Jarisch%E2%80%93Herxheimer_rea...

When I started methyl-B12 supplementation I also had inflammation in sinuses for weeks but it was just from my immune system starting up again and being able to attack long-standing inflammation. Someone else would've put "fever", "headache" and "stuffed nose" onto the side effects medication label of methyl-B12.

Villazodone was created partly to address that. Once I switched to that, I had no libido-related issues again.

I spent $300 on high lumen output light bulbs. 28 200W equivalent LED bulbs and 2 LED corn bulbs. Just a TON of light. Depending on severity either run it all day (late January and February tend to be the worst months), but even 10 minutes in the morning helps substantially. Just a lot of light. You can get hung up on high CRI and full spectrum but just do it badly first, then if it works worry about perfecting the setup. I just kept buying more bulbs and as I bought, I felt better and better.

Edit: this was the blog that gave me the idea, it comes up on hacker news a lot. https://www.benkuhn.net/lux/

Libido can be supplemented with Wellbutrin. Works great, even better than before.

> except it killed my libido

Similar experience. Apparently pretty much ubiquitous with SSRIs

My personerino let me be ridiculous and fawn a bit, and tell you that you're one of my internet heroes.

Don't take it as criticism, more of a personal take on figuring out what antidepressants do for me. Furthermore, since posting that parent comment I've converted my vit. D dose to IUs and I realised i'm only taking 800 IUs daily. So a thank you for clueing me in on that, and who knows what happens if I up that. Maybe you were right all along and all i DID need was a heroic dose of vitamin D. (... thats what she said)

Thank you for the blog post! I live in New England and always had the winter blues, always just assumed it was because of the weather but never acted on it.

About a week ago, there was a reddit post claiming it's actually geographically impossible for anyone where I live to produce enough Vitamin D naturally from the sun alone, due to the shorter days and lower angles throughout the day. I had no idea.

Duloxetine was indeed a beast to get off of. It got so bad that I would open the capsules and count the number of beads to taper as slowly as possible. It was hell

The goal is to tackle it in every way. The medicines are supposed to be supportive and not the solution. More often than not people treat it as a solution.

Thats why they are eventually tapered and discontinued once you are able to be on your own.

Similar. I was on stimulants as a kid and hated them as they did nothing but make me feel high then taper off leaving me exhausted. Nevermind the total loss of appetite. Later on as an adult I obtained adderall from a friend and experimented with it and it seemingly worked for a few days but it never stopped the intrusive thoughts or help with the anxiety. In fact all I did was chase a high with cup after cup of coffee when coming down. That put me off to meds for a long time.

More recently I was on a vacation where I took mushrooms and had a nice trip. Two days later at work I felt very relaxed driving in and sat at my desk BUT something was wrong, my head was dead quiet (the GP explained this exactly like I would.) So quiet that for a second I had a bit of panic as I thought something was wrong. Then something wonderful happened: I realized I was able to just do my work. There was no stress, no worry, no nothing. Just a calm quiet confidence to get the job done. Best day of my life.

After that I called a mental health center and connected with an ADHD specialist who has been working with me. I am also on Atomoxetine myself and while it has not brought me back to that zen head space it brings me close enough. My only gripe is at a higher dose it gives me sensations in my head. However, I learned that eating a proper breakfast helps a lot as I was taking it on a near empty stomach. Overall my life has been slowly improving and I feel more confident at work.

> So yeah, please don't avoid medication based on internet reading.

This - 100%

look my other comment for niacin

Also try wearing merino wool socks. It seems counterintuitive to put wool on your sweaty feet, but they're quite comfortable and they help you avoid that "clammy feet" feeling when you are sweating in cotton socks. They also don't develop odor the way that cotton does.

You can also 3D print them: https://www.printables.com/model/194340-60mm-radial-fan-boot...

It's more "dependency" than "addiction". No one's waking up jones-ing for another hit of their SSRI. Dependency works well because some people are dependent on it like I am dependent on glasses/contacts.

>> "The Body Keeps The Score"

Such a great book. Highly recommended.

They do for me too. Alcohol gives me a huge downer the next day but the party itself is amazing so I just waste the day after with a pillow over my head.

And I hate strict rules and rituals, I love chaos. So that also gets me down. I often stay up till 6am (the parties I mentioned above only start at midnight)

So yah it might make some people better but for me the times I break it are the ones that are exceptionally good.

10 mg a day, down from 20 but that made me feel wired, like I ate a bunch of 9V batteries for breakfast. Big pupils, trouble sleeping, manic thoughts, the works.

I'm a small, generally sensitive guy so ymmv...

Yeah, I have an extremely bright lamp designed to tread SAD that I sit, or well used to sit, in front of every morning. Daylight responsive led strip in my home office. And a pair of glasses with blue LEDs for on the go. It did... 10%? of what citalopram eventually did for me.

As a counterpoint, I experienced such severe negative symptoms after taking SSRIs that I had to be hospitalized for months. Medical treatment is not without its risks. I would always advise trying NPIs before drugs.

There are indeed some form of serious depression that are non-responsive to psychotherapy alone. Those are however not the norm. Dr. David D Burns, practising psychiatrist and author of the book Feeling Good: The New Mood Therapy has written a whole chapter in it on the appropriate use case and effectiveness of anti-depressants today. (If you are considering using anti-depressants, I urge everyone to get the latest revision of his book and read that chapter). He believes anti-depressant has its use during treatment but also shares studies that suggest modern psychotherapy, like Cognitive Therapy which he advocates, has now begun to surpass the effectiveness of anti-depressants in "curing" depression in the long-term.

A particular point he makes about depression in it is insightful: Although depression is conventionally viewed as a medical illness, research studies indicate that genetic influences appear to account for only about 16% of depression. For many individuals, life influences appear to be the most important causes.

I was incapable of the compassion you're talking about until I had a bad shroom trip and felt some horrible, hard-to-describe anxiety the next morning. It was some of the worst hours of my life until my serotonin system rebalanced itself.

I'm not saying it's the same thing as depression or regular anxiety, but it gave me tremendous perspective on how bad these conditions can be and you just don't have the ability to "shake it off" when things are unbalanced.

Maybe that's how my wife feels when she's off the meds. Shit. Now imagine having a douchebag by your side second-guessing your pain. Never again.

> The same is true for people that say that antidepressants are mostly placebo. They are not.

In fairness, anti-depressants are a lot of drugs. The article gives a list. 23 of them seemed to be better than placebo, 19 of them were much less clear.

> When people say that antidepressants saved their life, they aren’t joking or exaggerating in the least.

Placebos can also save people's lives.

A: The same is true for people that say that antidepressants are mostly placebo. They are not.

B: When people say that antidepressants saved their life, they aren’t joking or exaggerating in the least.

Are placebos unable to save lives?

Not claiming antidepressants are or are not mostly placebo, and don't mean to minimize the pain of depression in anyway. I just don't think whether or not they saved a person's life is an indication either way. The placebo effect is real, right? As in the subject actually gets better after taking it.

> Keep your pet theories to yourself if you are not a subject matter expert or someone who has experienced it first hand.

This is the internet, friend. I wish you the best, but maybe don't put too much hope into that one. I think you'll have better luck cultivating the ability to be comfortable having your own beliefs while others have different (possibly wrong!) ones.

The placebo effect is a statistical reporting effect. Not a physical effect.

Lexapro saved my life

This is my first year, doc told me to wait until at least march, April to start talking about tapering. I have zero symptoms in summer, so I'm inclined to get off them outside the darkest months... we'll see how bad the discontinuation syndrome hits.

something's fucking my hydro balance. i've done my fair share of psychedelics, and i have to keep drinking water on shrooms too. i dont know, something highly idiomatic haha. i also sweat more in other places, but my feet are the moistest. right now i just change socks often, it's hardly a debilitating side effect...

have u ever tried niacin?

If you spend a lot of time among some folks or talk a lot to LLMs, you are guaranteed to pick up manners, manners of speech, ways of thinking, behaviors (where applicable) ...

Me and my brother just can't stop mixing English and German when we talk to each other. But we don't or barely do it when we talk to others.

When I learned about code, logic, math, I started talking and thinking in different ways and from different and towards different perspectives.

The more I read, which I haven't done in a long long while, the more massive and vast the info I pack into a few sentences becomes.

The more I draw or play the guitar or work on game mechanics and story design or dialogues, the more annoying my speech and manners become but to my environment, that also means that I become "more" social and actually somewhat likeable and bearable.

You smell like Non-evidence based arrogance. I was always surrounded by people who smelled like that. But they are good little copypasta soldiers who follow trends and mutually assure that they don't go completely off the rails. But if one does, they leave him on his real or imaginary battlefield. Nobody wants to evolve anymore. It hurts some people just a little too much, I guess. They'd rather poison others and have their code deleted before getting to live a second life. I hope I could get you on edge a little. I'm just fucking around. But you will probably think something the likes of ... "there's always some truth to it when ..."

The OP just writes well. Also an llm is unlikely to write "thru"

It does not, at all. Forming that judgment because of “Enter X” is ridiculous. I recognize my friend Claude in disguise all the time on HN and this is not one of those cases.

See, I'm all for calling out LLM spam, but because of people like you who have a terrible calibration and make false accusations against obviously human generated messages, I get all manners of people criticising me for pointing out things I know for sure are actually LLM-generated. You really think "Enter citalopram" as a singular instance you point out weights this more towards LLM-generated than "thru" and "reheated cat shit", among the entire tone of the message, weights it towards human-generated? Your heuristics are wildly miscalibrated.

Your sense of smell is not something to write home about.

Yes only I wrote it while taking a shit. Sorry man.

A kinda strained endeavor, I must say. It's not bad but the SSRI side effects make continuous hydration obviously important. A small price to pay.

How would you prove that?

I just spent $300 on LED light bulbs. Especially if you have an older house the sockets are all wired up for incandescents so you can just split the socket and run 7 bulbs per socket, I have 30 light bulbs, including two 200W corn bulbs and the rest are “100-200W equivalent”