Are SSRI antidepressants worthless in the long term?

I don’t have a dog in this fight one way or the other I’m just curious. Your body in my understanding produces new neurotransmitters at fairly regular intervals, and taking SSRI’s and other reputake inhibitors prevents reabsorption but the body responds by producing less serotonin as your body adapts to the drug. So in the long term treatment of depression are SSRI’s and drugs that function in a similar manner essentially worthless, do they even have a place in treatment of long term depression.

Here is an article on the topic:

https://www.psychologytoday.com/blog/mad-in-america/201106/now-antidepressant-induced-chronic-depression-has-name-tardive-dysphoria

This article is about SSRI’s I haven’t really read enough about other types of antidepressants to wager a guess about their long term efficacy, I would think the brain would always have some clever trick to bring it’s levels of various neurotransmitters to the level it likes, in spite of alternative mechanisms of action.

By that logic, the pancreas of a diabetic should always produce enough insulin to keep blood sugar in balance and a patient with chronic pain should always produce enough endorphins to keep pain in balance.

The reason for taking an SSRI in the first place is because the brain doesn’t have a “clever trick” to keep things at an optimal level.

Having been on fluoxetine (Prozac) for years (although not for depression) I am starting to be concerned by stories like this. I believe the drug has helped me a lot, but I wouldn’t want to suffer any kind of long-term harm.

He didn’t say “optimal”, he said the level that brain likes, which in the case of the depressed, is frequently too low. Some brains seek depression.

That being said, anti-depressants in general have a dismal efficacy rate, somewhere around that of a placebo, so it is hard to tell if it is not working because the body has adapted to it, or if it is because it never worked in the first place, and the placebo effect is wearing off.

Not really kunilou if anything the Pancreas example supports what I’m saying Glucagon raises blood glucose and insulin lowers it, but there are limits to how much insulin beta cells can release, so of course it can’t produce it ad infinitum and you get insulin resistance. Maybe the brain can’t completely compensate for the medication, maybe it can I really have no clue.

At least from what I read neurotransmitters cannot be reliably measured directly or indirectly. So your only theorizing the depression is from low levels of say serotonin in reality they may be normal. I’ve read men naturally have higher rates of serotonin than women, and are less likely to suffer or seek treatment for it. I’m not sure how they know they have more unless it’s from brain structure itself, or some kind of post mortem thing???

SSRI guy here since they first came out.

Still alive, so there’s that. Sure hope you’re wrong. :slight_smile:

Development and discovery of SSRI Drugs

I think the number of other things that materially affect your long-term health that have not been verified not to do so–is so great that, on the whole, I rest easy at least about SSRI’s.

The simple answer is going to be along the lines of “it depends”. All very much IMHO here.

The manner is which simple things like gross concentrations of neurotransmitters affect complicated things like depression is only understood at the most basic levels. SSRIs come in for a lot of criticism from the fringes, and also within parts of the psychology community. There does tend to be an element whereby these criticisms come from those who find use of SSRIs in competition with their own methods or ideas. So:

Practitioners (psychologists who cannot legally prescribe SSRIs) emphasise counselling or cognitive therapies.
A very vocal group emphasise exercise
Another very vocal group (often who have had no success with SSRIs) seems to want to cast them as the work of the devil.
New agers, who want to push crystal therapies, meditation, homoeopathic remedies and the like, and who regard drugs as anathema to what they believe in.

All of these people tend to have some point of view that include something worth listening to. (Even the new agers - meditation is useful.) But depression (and its sibling anxiety) are complicated. Your depression is probably not my depression. What works for one person may simply bounce off the depression of another. (The “it worked for me, so it must work for you” attitude is common.) A combination of therapies may be the best answer. Some depressive illnesses are refractory to a whole mess of therapies, and this gives the drug therapies a bad name. You will hear stories like “no better than a placebo” yet you will hear a lot of stories from people that have been clearly helped. Where medical practice is poor is in follow-up. A great many GPs just dole out prescriptions for SSRIs and do little more to manage things. It should be no surprise that many people become disillusioned with the therapy.

The problem with arguments about regulation of neurotransmitter levels is that the transmitters are being sluiced out of the brain continuously. The argument that the brain will compensate by reducing production assumes that the brain can make enough in the first place. Again, this comes down the causes. If the levels are too low, does this mean the set point for the feedback is too low? Does it mean that the production is already flat out and can’t make enough no matter what the feedback loop says?

Does it mean that this brain intrinsically just needs more than some other brains? Are there a complicated set of issues that are helped by increasing levels of serotonin?

“SSRI poop out” is a real issue, google that term (It’s SFW) to get lots of forum discussions. When that occurs then PDocs’s can change to prescribing an SNRI instead. So far SNRIs seem much less likely to lose their effectiveness over time.

There’s also Tricyclics and SARIs, what works on one person well doesn’t work on others, theres lots of trial and error and this can take a long term because you usually need to stay on an anti-depressant for 3 months to give it a real chance to work.

Explanation of SSRI vs SNRI vs Tricyclics vs SARIs

They currently seem to be causing problems for me–things that can’t be explained as simple anxiety or depression. (Depression, for one thing, is long term, and doesn’t make you dizzy.)

But I think it may have to do with how fucked up my brain got from benzos–I’ve been more senstive to even the slightest change in my medicine ever since. It’s why I’m, unfortunately, too scared to try and fix the issue.

I took Celexa for about ten years. I believe it gradually became less effective, because my symptoms progressively returned. I switched to a Zoloft / Wellbutrin combo and my symptoms went back into remission.

My two cents. As always, anecdote does not equal data.

My advice is to stay away. They are not the worst. But Drs and Drug Companies are going to sell you down the tubes and ruin your life if you let them. They have no idea what the long term on any of these is and: They will always err on the side of saying the drug is benign until proven otherwise, and then they may not even at that point. Then you’re on your own. It is a completely amoral profession. Think about it. They are not going to lose their licence or career over some patient.

Imagine taking a drug you didn’t really have to take, but it was an attempt to “improve.” your life.

You gradually stop taking it over 3 weeks on Drs rec. You have a discontinuation syndrome, panic attacks, TMJ and you’re out of work for a few weeks. The Dr. is going to give you a benzo as needed probably.

Maybe you’re in a hostile situation at work, and you have to take the benzos every day, and are hooked. If the benzos stop working, and they will, the Dr will up the dose and give you seroquel, risperdal or something else to try on you in addition to the benzos. They don’t like when you are in their office and sick and can never associate it with the medicines they give you or the discontinuation syndromes that may be associated. (Every body’s different) so all they know how to do is give you another drug. Yes you are a nail, and guess what they are holding? You are putting your life in someone elses hands with these meds.

If you ever have to taper off a drug over a 2 year period, (Can you even imagine that?) be disabled, lose your job, etc. do you think you will want to trust a Dr about this stuff again? It happens every day. Go over to benzo buddies and read. I’ll see you there.

This is a case where an intelligent answer requires at least a cursory understanding of what’s going on in the actual brain.

To simplify a couple textbooks on neuroscience schools made me read, it comes down to the brain carefully regulates the receptors and neurotransmitter release at each synapse. If someone stuck a drug in that made a neurotransmitter more or less common, this means that the synapses using this neurotransmitter will start firing more than they should or less than they should, depending on whether the drug raises or lowers levels and whether the neurotransmitter is inhibitory or causes excitation.

Either way, in principle, feedback should eventually make any psychiatric drug do nothing at all. This clearly isn’t true - there’s a limit to this regulatory mechanism, just like you can only turn the knob on your stereo up or down so high.

But, the high points are this
a. As far as the brain is concerned, any drug that tampers with neurotransmitters increases the rate of neural errors
b. Any drug that tampers with neurotransmitters, the brain is going to try to adapt in a way that resists the change

TLDR : Psychiatric drugs aren’t for everybody, and it’s going to do more harm than good to pop a few pills if your symptoms are mild. In most cases the drugs will not make you more intelligent overall, they can’t, as you are disrupting a self-tuning system. The current setup is that psychiatrists believe these drugs are so amazing that they will write a script based on the flimsiest, briefest exam and a weak complaint.

This is poor decision making. But hey, at least it’s not benzos…

I have several close friends that have had good results from SSRI / SNRI and turned their lives around after long periods of depression and suicidal ideation. And also SSRI / SNRI are NOT benzos, completely different things.

Yes they can be abused or over-prescribed, but they really do work for many people.

Could they stop their SSRIs tomorrow if they needed to? Then they are, in some small way, prisoners.

It is quite probable they experience positive outcomes. But if you read it again the example I gave didn’t start out with benzos. You just have no idea what may happen in the future and the Drs will not be there for you if it falls apart.

Example: I have been told by a Dr (At the best hosp in the US for this) that Gabapentin has no withdrawal syndrome and can be stopped. He promised me. A kid in the group I attended the next week said Gaba was the worst withdrawal he ever had. (And that his drug of choice was Gaba and weed) No matter how much research you do you wont find a consensus on this. It’s new and the Drs don’t care if you get hung on it.

If you ever had to take 2 years to get off a prescribed drug you wouldn’t want to be on one again. You probably wouldn’t see your depression in the same way. You’d be happy to get away with your life. Making drugs and creating the markets for them is out of control, and I wouldn’t be so sure it’s only benzos you have to worry about.

So a diabetic that needs insulin to survive is a prisoner? Some people do well off SSRI/SNRI’s and some don’t . You don’t want want to use them thats fine but you should respect other peoples choices and at least acknowledge that they help some people.

And yes from my friends experiences Doctors were there when they fell apart, it was the Doctors that helped him get his life back together again.

Changing from one SSRI, or one cocktail of antidepressants, over time is as far as I know par for the course.

Over the course of 30 years I have been on quite a few.

Also, the “diabetics take insulin every day and that’s just the way it is” realization with any medicine for mental health is often quite a difficult one. Quite difficult, but quite true. And then you forget why you take them every day, thank God, and just take them like a morning vitamin.

And occasionally realize that.

Jesus, deja vu. Those are the exact words my doctor used in 1986 when he prescribed Xanax to me. He seriously thought I should take it the rest of my life. Of course, I became hopelessly addicted, and by the end I was taking it every three hours, up to 7mg per day. I have never been the same.

Depression runs in my family. Just based on my family’s anecdotal data, I’d say they are life-savers for some and ineffective for others.

they were prisoners of depression before they started taking any drugs. Seriously, depression can be a big deal.

Several family members have stopped taking SSRIs, either because they didn’t work or because their life had improved in other ways and they were able to maintain a healthy mental state without drugs. I don’t know the details of how they tapered off, but it didn’t include getting hooked on benzos. I don’t think it included taking benzodiazepines at all. Two family members (who have been treated for depression and anxiety) tried valium once, for different reasons, and both felt so good that it terrified them and they stopped right away.

I am sorry for your predicament.

Again:
Benzos are not antidepressants. Benzos are well known to be difficult to discontinue after even relatively short lengths of time taking them regularly.

I’ve had arguments with people who use the word “addicted” to continued therapy with antidepressants (and, in my case, mood stabilizers). There are similarities in practice, which is helpful almost always to muck up the issue.

Discontinue needed treatment with one set of drugs, you “decompensate,” as the term of art has it–a strange word, but perfectly correct to understand the chicken-and-egg relationship that is touched upthread. You may return to/get depressed, the pathology.

Discontinue incessant alcohol/heroin/benzos, you may return to whatever mental state you were in (“had,” in the case of the disease of depression) and also turn to a new pathology, which is not taking alcohol/heroin/benzos.

I don’t know where the “disrespect” came in. I’m not against whatever works. I have experience with all of these. But you have to realize what you are into. Yes you are a prisoner when you need to take insulin. Who said you were not?

I think you are being very naive when you trust psychopharm Drs. It’s like going into a room with a psychopath and getting life advice. I am sure that there will be other drugs just as harmful as benzos that will be made and Drs will give them out, until someone makes trouble for them about it. IOW “Not a benzo” is not a comforting idea to me anymore. Heroin was supposed to be the “answer” to the Morphine problem.

Here is one of my friends experience: This is a Dr who is a teacher at one of the nations top medical schools, and who has had Op eds in the New York Times about “Patient Etiquette”: Said Ativan was easy to get off of. Would get mad when he was paged, for good reason or not; Said Remeron was easy to get off of; Didn’t ever acknowledge or was not aware of Remeron discontinuation syndrome, or benzo intradose withdrawal pain (Denied it); Was falling asleep during 20 minute appts; Basically through incompetence or design forced the person to get another Dr to get off the benzos, because he actually knew how hard it would be and didn’t want to help. At every step his only response to a problem was to prescribe another drug.