# Are SSRI antidepressants worthless in the long term? **URL:** \ **Category:** Great Debates\ **Created:** [November 30, 2015, 7:36pm UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052 "2015-11-30T19:36:25Z")\ **Posts on this page:** 20\ **Page:** 3
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [December 2, 2015, 3:00pm UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/41 "2015-12-02T15:00:05Z")
It’s not really a GQ, since the “value” of SSRIs is essentially a value judgment. ---
**Author:** ![Francis\_Vaughan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/francis_vaughan/32/3093_2.png) [@Francis\_Vaughan](https://boards.straightdope.com/u/Francis_Vaughan)\ **Post date:** [December 2, 2015, 3:22pm UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/42 "2015-12-02T15:22:54Z")
> [@Really\_Not\_All\_That\_Bright](#): > > It’s not really a GQ, since the “value” of SSRIs is essentially a value judgment. Hard one that. As much as any medical therapy is a value judgement. If you want the FDA to certify your drug you had better be able to produce some serious backup, with numbers, to indicate that it has a useful therapeutic effect. Where it becomes harder are questions like diminishing effect. Maybe to the point where the “value” is no longer clear. Even with mental health problems effort is made to measure and report in a quantifiable manner. OTOH, the metrics can often seem arbitrary or heavy handed. And there is a whole science in just trying to work out metrics. There are a host of depression indexes and scores. The difficulty is in marrying broad brush scores, scores that can be as trivialising as a single number, with the wide gamut of depressive illness. Across the population there are clear ways of measuring “value” with such scores. With any individual, it isn’t so clear. That is where experience and sympathy from a practitioner matter. But even then, they will bring their own prejudices and biases. Long term, the only way we learn is to continue to treat people as best we can now. Medicine is a very long term controlled experiment. Every patient can be (and IMHO has a moral obligation to be) part of this experiment. Being part of the experiment is simply that you let your medical history become part of the corpus of knowledge. ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [December 2, 2015, 3:52pm UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/43 "2015-12-02T15:52:16Z")
> [@drad\_dog](#): > > You cannnot equate a Medical Dr prescribing drugs to Psych Drs prescribing drugs. There are a lot of differences. As Not Really All That Bright points out, a Psychiatrist is an MD with some additional training. > [@drad\_dog](#): > > The medical drugs are for things that are scientifically tested for. The testing for SSRIs was consistent with the testing for any other drug > [@drad\_dog](#): > > Mental illness is a whole different world. It is the wild west out there. They are finding new uses for drugs and advertising them at you. This is not analogous to insulin, for instance. not insulin, but have you watched daytime TV lately? LOTS of drugs are advertised, often inappropriately. > [@drad\_dog](#): > > If you are an unhappy emoji they can make you into a smily one. That is not science. sometimes. > [@drad\_dog](#): > > I’m only saying that depression is relative. If you end up trying to get off benzos, or possibly remeron, or Gabapentin or some other drug, you may recalibrate what it is to be down and out. I am sorry for your experience. I know many people, including me and most of my family, who have had much better results fro treating depression. > [@drad\_dog](#): > > And you may be offered one of these drugs when you only intended to be on another, but it went badly. It is always wise to research a new-to-you drug before taking it. > [@drad\_dog](#): > > I used the word psychopath as an analogy. that is rude at best > [@drad\_dog](#): > > If you haven’t had any problems with them then that’s great but the problem with psychiatry is not located within me…Talk to people in the world. Do some research into Drug companies contacts with Drs and how the business gets done. This is true for all drugs, especially the expensive ones that are still patented. Prozac is off-patent, as are many of the commonly prescribed SSRIs. > [@drad\_dog](#): > > Many times for them to be perfectly honest about a drug would be devastating in terms of liability and their career, and their whole profession actually. So it can’t be done, no matter how good the intentions of the Dr. This is false, and is a nasty thing to say. > [@drad\_dog](#): > > God wiling you won’t present a problem for them in your treatment. You’ll find out very quickly where you stand, and where their priorities are if that happens. They are guessing at what to do next all the time, and giving out drugs. (They are 20 minute appts, basically only good for prescribing, right?) They won’t be admitting to any mistakes in this lifetime. And they will always treat any new problem with a new drug. If the drug itself is the problem then it is a perfect negative feedback loop, and you will be the loser. I usually see my GP for an hour, at my annual exam. Followups are often shorter, sometimes by phone or email. My GP recommended a psychologist, who books 1 hour appointments. YMMV. fwiw, I am no longer taking Prozac nor seeing the psychologist, but both were quite helpful. > [@drad\_dog](#): > > I’m not going to be saying there are no good psychs. But they regularly lie, and misrepresent effects and difficulties, and can be deathly bored with their job seeing patients for 20 minutes a shot, and this can affect your or your loved ones life tremendously. And they do it for systemic and business reasons, not necessarily reasons of their personal psychopathology. Again, I am sorry you had such a bad experience with the medical system. ---
**Author:** ![engineer\_comp\_geek](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/engineer_comp_geek/32/504_2.png) [@engineer\_comp\_geek](https://boards.straightdope.com/u/engineer_comp_geek)\ **Post date:** [December 2, 2015, 4:51pm UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/44 "2015-12-02T16:51:35Z")
**Moderator Action** This thread has veered quite a bit away from a factual topic, which isn’t all that surprising given its subject. At this point I don’t think we can steer it back into GQ territory, so let’s move it to GD instead. Hopefully the OP got enough of a factual discussion to satisfy their query, and maybe some of the more debatable aspects of the topic were useful to the OP as well. Moving thread from General Questions to Great Debates. > [@coremelt](#): > > Drad Dog, those posts are not relevant to this discussion. If you want to start a thread on corruption in the pharmacological industry do that in Great Debates forum. Leave the moderating to us, please. We don’t need any jr. mod help. Report the post next time. ---
**Author:** ![pool](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/pool/32/4152_2.png) [@pool](https://boards.straightdope.com/u/pool)\ **Post date:** [December 2, 2015, 5:18pm UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/45 "2015-12-02T17:18:51Z")
Dang I really wanted this to stay in GQ, but I don’t want to start another thread about it. ---
**Author:** ![drad\_dog](https://avatars.discourse-cdn.com/v4/letter/d/aeb1de/32.png) [@drad\_dog](https://boards.straightdope.com/u/drad_dog)\ **Post date:** [December 2, 2015, 5:22pm UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/46 "2015-12-02T17:22:46Z")
> [@Really\_Not\_All\_That\_Bright](#): > > A psychiatrist _is_ a medical doctor. I’m reporting your posts, since none of them are factual or cited. RNATB: Are you saying that psychiatry is not distinguishable from physical medicine in terms of care, medication, and prognosis? Anyone out there: This is a “reportable offense”? [http://www.salon.com/2015/10/25/how\_big\_pharma\_influences\_fda\_trials\_to\_push\_its\_own\_antidepressants\_partner/](http://www.salon.com/2015/10/25/how_big_pharma_influences_fda_trials_to_push_its_own_antidepressants_partner/) ---
**Author:** ![coremelt](https://avatars.discourse-cdn.com/v4/letter/c/4491bb/32.png) [@coremelt](https://boards.straightdope.com/u/coremelt)\ **Post date:** [December 2, 2015, 5:36pm UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/47 "2015-12-02T17:36:13Z")
> [@drad\_dog](#): > > RNATB: Are you saying that psychiatry is not distinguishable from physical medicine in terms of care, medication, and prognosis? All medicine is susceptible to research manipulation by vested interests, but nevertheless we end up with drugs that that genuinely help people. Medicine is not perfect but we muddle through and are doing a better job than we were 200 years ago. The fact that you use to focus on psychiatry in particular makes me suspect that possibly you are a Scientologist and if so then you should disclose that. ---
**Author:** ![drad\_dog](https://avatars.discourse-cdn.com/v4/letter/d/aeb1de/32.png) [@drad\_dog](https://boards.straightdope.com/u/drad_dog)\ **Post date:** [December 2, 2015, 5:51pm UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/48 "2015-12-02T17:51:34Z")
> [@Francis\_Vaughan](#): > > Hard one that. As much as any medical therapy is a value judgement. If you want the FDA to certify your drug you had better be able to produce some serious backup, with numbers, to indicate that it has a useful therapeutic effect. > > Where it becomes harder are questions like diminishing effect. Maybe to the point where the “value” is no longer clear. > > Even with mental health problems effort is made to measure and report in a quantifiable manner. OTOH, the metrics can often seem arbitrary or heavy handed. And there is a whole science in just trying to work out metrics. There are a host of depression indexes and scores. The difficulty is in marrying broad brush scores, scores that can be as trivialising as a single number, with the wide gamut of depressive illness. Across the population there are clear ways of measuring “value” with such scores. With any individual, it isn’t so clear. That is where experience and sympathy from a practitioner matter. But even then, they will bring their own prejudices and biases. > > Long term, the only way we learn is to continue to treat people as best we can now. Medicine is a very long term controlled experiment. Every patient can be (and IMHO has a moral obligation to be) part of this experiment. Being part of the experiment is simply that you let your medical history become part of the corpus of knowledge. “If you want the FDA to certify your drug you had better be able to produce some serious backup, with numbers, to indicate that it has a useful therapeutic effect.” I’m not sure what you’re basing that opinion on. I am not trying to be rude if you are a Dr. I believe that the system of clinical trials has been corrupted industry-wide. There is nothing to gain from hiding from that. [http://www.sott.net/article/268191-Corruption-of-science-Results-from-many-large-clinical-trials-are-never-published](http://www.sott.net/article/268191-Corruption-of-science-Results-from-many-large-clinical-trials-are-never-published) It would be just a palliative to reduce this to small arguments about your and my Dr or your any my experience of your or my drug. This kind of creeping corruption affects everyone. Psychiatry is more vulnerable. Therefore there are problems in every part of the chain. From invention, to purposing the drug, to studying it, to the leverage on Drs. and institutions, to ADVERTISING, to liability concerns, to the drugs affects, and finally to discontinuation, which might be the biggest problem of all, for many of these drugs. ---
**Author:** ![coremelt](https://avatars.discourse-cdn.com/v4/letter/c/4491bb/32.png) [@coremelt](https://boards.straightdope.com/u/coremelt)\ **Post date:** [December 2, 2015, 5:54pm UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/49 "2015-12-02T17:54:00Z")
drad dog, are you a Scientologist? Please answer the question? ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [December 2, 2015, 6:42pm UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/50 "2015-12-02T18:42:39Z")
> [@drad\_dog](#): > > RNATB: Are you saying that psychiatry is not distinguishable from physical medicine in terms of care, medication, and prognosis? “Physical medicine” is a [specific specialty](https://en.wikipedia.org/wiki/Physical_medicine_and_rehabilitation). Assuming you mean branches that treat the body, sure. But then many areas of medicine are distinguishable. ---
**Author:** ![storyteller0910](https://avatars.discourse-cdn.com/v4/letter/s/ecae2f/32.png) [@storyteller0910](https://boards.straightdope.com/u/storyteller0910)\ **Post date:** [December 2, 2015, 8:42pm UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/51 "2015-12-02T20:42:33Z")
> [@drad\_dog](#): > > “If you want the FDA to certify your drug you had better be able to produce some serious backup, with numbers, to indicate that it has a useful therapeutic effect.” > > I’m not sure what you’re basing that opinion on. I am not trying to be rude if you are a Dr. I work in the industry, and I am quite certain that quote is accurate. I am basing that opinion on more than a decade working to get drugs certified, and extensive knowledge of and experience with the process by which that happens. > [@](#): > > I believe that the system of clinical trials has been corrupted industry-wide. I’m not sure what you’re basing that opinion on. I am not trying to be rude if you’re actually a Dr. ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [December 3, 2015, 1:47am UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/52 "2015-12-03T01:47:58Z")
> [@drad\_dog](#): > > RNATB: Are you saying that psychiatry is not distinguishable from physical medicine in terms of care, medication, and prognosis? > > Anyone out there: This is a “reportable offense”? > > [http://www.salon.com/2015/10/25/how\_big\_pharma\_influences\_fda\_trials\_to\_push\_its\_own\_antidepressants\_partner/](http://www.salon.com/2015/10/25/how_big_pharma_influences_fda_trials_to_push_its_own_antidepressants_partner/) Psychiatry is a specialty, like anesthesiology, ophthalmology, gastroenterology, or being a plastic surgeon. To be a psychiatrist you need to first graduate medical school, and get all the training other MDs get. There are other credentials that people who tag mental health disorders have, but those don’t let you prescribe drugs. I don’t know what is “reportable”, but you have been extremely rude to doctors in general and psychiatrists in particular. And your rude statements have included several items that aren’t true. Again, I am sorry you had such a bad experience with Psychiatry, but I do not believe your experience is the norm. ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [December 3, 2015, 4:50am UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/53 "2015-12-03T04:50:17Z")
Disclaimer: I am not a neurochemist. That said, for the majority of patients, SSRI’s are probably wasteful and pointless. There is probably a quite small minority that benefit from them, but being severely depressed to begin with, they probably aren’t very profitable to sell to. So the rest of us get the goofy, “Your soul has a cold,” marketing. ---
**Author:** ![drad\_dog](https://avatars.discourse-cdn.com/v4/letter/d/aeb1de/32.png) [@drad\_dog](https://boards.straightdope.com/u/drad_dog)\ **Post date:** [December 3, 2015, 8:33am UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/54 "2015-12-03T08:33:57Z")
> [@storyteller0910](#): > > I work in the industry, and I am quite certain that quote is accurate. I am basing that opinion on more than a decade working to get drugs certified, and extensive knowledge of and experience with the process by which that happens. > > I’m not sure what you’re basing that opinion on. I am not trying to be rude if you’re actually a Dr. I posted something on this already. I’m not going to keep posting the same things. When I find others I will. You’re in the industry? What is your job? How do you see the relationship of Drs to the Drug Companies? Do you think that money doesn’t play a part? Mu understanding is that negative outcomes in trials are not reported, and that much medical literature is ghostwritten by the drug companies. This doesn’t happen? Tell us how the system protects itself from these conflicts of interest. I live in the medical capital of the country, and I have good insurance. I have had just as many or more bad Drs as good ones, and I’m not being nearly as rude as they are in their practice. I’m not lying or exaggerating. I let my Drs off the hook for whatever they do. You have no leverage with them anyway. They will simply say you are wrong if you say they are sleeping during your appt, for instance. (It’s your “issue”) Dr.s are crazy. I’m being “rude” to them here on a web forum??? Boo hoo hoo. These Drs can cause more harm to a person under the cover of law than anyone else on the planet except for POTUS using a drone maybe. You want to sanction me for libel or ban me. Come on and do it. I’ll give a deposition anytime. I’m sorry if you got a Dr in your family. You’ll be well taken care of so I’m not crying. I’m trying to see where you’re coming from. Most reasonable people know there’s problems in this system. ---
**Author:** ![truthSeeker2](https://avatars.discourse-cdn.com/v4/letter/t/7cd45c/32.png) [@truthSeeker2](https://boards.straightdope.com/u/truthSeeker2)\ **Post date:** [December 3, 2015, 11:48am UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/55 "2015-12-03T11:48:22Z")
> [@foolsguinea](#): > > Disclaimer: I am not a neurochemist. That said, for the majority of patients, SSRI’s are probably wasteful and pointless. > > There is probably a quite small minority that benefit from them, but being severely depressed to begin with, they probably aren’t very profitable to sell to. So the rest of us get the goofy, “Your soul has a cold,” marketing. I think a distinction should be made between chronic and acute. For acute depression, SSRI may be useful imo. Get relief from an SSRI in acute depression, try to develop perspective/ambition in life, having someone for support and love is crucial ofcourse and then one should be fine. Speaking from my own experience. Agree that for chronic depression, SSRIs may not be very effective. ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [December 3, 2015, 1:13pm UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/56 "2015-12-03T13:13:59Z")
I believe they are effective long-term for some people. My personal experience was acute. Maybe I should share that, but I don’t have the time now. ---
**Author:** ![Stoneburg](https://avatars.discourse-cdn.com/v4/letter/s/df705f/32.png) [@Stoneburg](https://boards.straightdope.com/u/Stoneburg)\ **Post date:** [December 3, 2015, 1:38pm UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/57 "2015-12-03T13:38:31Z")
The story about how SSRI’s was sold and marketed as a miracle drug against depression is quite gross, and points towards some systemic corruption that stems from an unhealthy relationship between the medical sector and the pharmacological industry. Professor Irving Kirsch, associate director of Placebo Studies at Harvard writes (my bolding): > [@](#): > > Antidepressants are supposed to work by fixing a chemical imbalance, specifically, a lack of serotonin in the brain. Indeed, their supposed effectiveness is the primary evidence for the chemical imbalance theory. But analyses of the published data and the unpublished data that were hidden by drug companies reveals that most (if not all) of the benefits are due to the placebo effect. Some antidepressants increase serotonin levels, some decrease it, and some have no effect at all on serotonin. Nevertheless, they all show the same therapeutic benefit. Even the small statistical difference between antidepressants and placebos may be an enhanced placebo effect, due to the fact that most patients and doctors in clinical trials successfully break blind. **The serotonin theory is as close as any theory in the history of science to having been proved wrong. Instead of curing depression, popular antidepressants may induce a biological vulnerability making people more likely to become depressed in the future.** [Link to the full article](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/). Conclusion: We’ve been sold a placebo who’s side effects are worse than any actual benefits, and we’ve been sold it in a way that encourages life long addiction. Ouch. ---
**Author:** ![drad\_dog](https://avatars.discourse-cdn.com/v4/letter/d/aeb1de/32.png) [@drad\_dog](https://boards.straightdope.com/u/drad_dog)\ **Post date:** [December 3, 2015, 5:16pm UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/58 "2015-12-03T17:16:56Z")
> [@puzzlegal](#): > > I believe they are effective long-term for some people. My personal experience was acute. Maybe I should share that, but I don’t have the time now. I get real passionate about my experiences. I can’t say I haven’t been helped by these either. But I really don’t know. I support you in your journey. Good luck, hang in there. ---
**Author:** ![drad\_dog](https://avatars.discourse-cdn.com/v4/letter/d/aeb1de/32.png) [@drad\_dog](https://boards.straightdope.com/u/drad_dog)\ **Post date:** [December 3, 2015, 5:32pm UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/59 "2015-12-03T17:32:56Z")
> [@Stoneburg](#): > > The story about how SSRI’s was sold and marketed as a miracle drug against depression is quite gross, and points towards some systemic corruption that stems from an unhealthy relationship between the medical sector and the pharmacological industry. > > Professor Irving Kirsch, associate director of Placebo Studies at Harvard writes (my bolding): > > [Link to the full article](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/). > Conclusion: We’ve been sold a placebo who’s side effects are worse than any actual benefits, and we’ve been sold it in a way that encourages life long addiction. Ouch. Benzos are an even more radical example. If you’ve been on them you realize that your original anxiety is long since forgotten or folded into the need for the pill. It doesn’t take much time either. The pills end up causing the thing they are sold to cure. And it is much more intense than the original feeling, because it is scientifically designed to be that way. Hooray for science. If you don’t kill yourself, it may take years of tapering, and you may never come back fully. I believe you do, but it is a matter of debate. Meanwhile Dr.s can be obtuse or in denial or disingenuous about it. ( I don’t think they will ever say) Mine didn’t want to help me get off. He let me know passively aggressively. I had to find another Dr, in another hospital, because his colleagues wouldn’t help me. (One ratted me out to him after I tried to make an appt) This Dr is a Harvard professor. He wrote an op ed for the NYT about “Patient Etiquette,” the point of which is that it was unnecessary to train med students in “Empathy” when it is more important to do the small things like wearing your ID and introducing yourself by name to the patient. He would start to doze during our 20 minute appts and I noticed him pressing his fingernail into his hand to stay alert. It’s the truth guys. Please don’t accuse me of making this up or being a scientologist. It’s public record. ---
**Author:** ![truthSeeker2](https://avatars.discourse-cdn.com/v4/letter/t/7cd45c/32.png) [@truthSeeker2](https://boards.straightdope.com/u/truthSeeker2)\ **Post date:** [December 3, 2015, 5:50pm UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/60 "2015-12-03T17:50:07Z")
> [@drad\_dog](#): > > Benzos are an even more radical example. If you’ve been on them you realize that your original anxiety is long since forgotten or folded into the need for the pill. It doesn’t take much time either. > > The pills end up causing the thing they are sold to cure. And it is much more intense than the original feeling. > : > : > . Agreed, once the effect of these pills(benzo pills) wears off, the fear/anxiety is worse than what it was before taking the pill. Its quite dangerous I would say. [Previous page](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052.md?page=2) [Next page](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052.md?page=4)