I would like to know how SSRI medications work exactly and how safe they are? I have heard that they mess up your brain’s metabolism and sometimes cause suicidal thoughts. If SSRI’s are dangerous what would you guys recommend as an alternative?
a) No one knows. Well, that’s an oversimplification…the biochem and pharma people have a pretty solid idea of how SSRI pharmaceuticals slow down the systemic reuptake of serotonin, not a huge black-box mystery going on there; but in terms of how they work w/regards to the mental-emotional ailments for which they are prescribed, it’s still very much fuzzy focus because those ailments themselves are not well-understood. As you probably know, the mainstream modern psychiatric approach is to assume that the symptoms we know and describe as “depression” (and a double-handful of other psych dx for which SSRI’s are now prescribed) are symptoms of specific physiological problems of the neurological or neurochemical systems of the body. But not only do they not know with great precision which ones and exactly how they manifest as “depression” (and/or etc), it isn’t even compellingly clear that they’re right to begin with. In other words, whatever neuro or neurochem conditions that may exist and correlate with “depression” (et al) may be symptoms themselves.
b) As they cease to be brand-new shiny heroic wonderdrugs, as data comes in over time, it does appear that SSRI’s are as imbued with problems, even if not quite as many as the worst of the psychiatric drugs of previous eras. Yes, they can cause “paradoxical” problems such as suicidal ideation (which in turn can cause actual suicide of course); and yes, the pharmaceutical companies were caught red-handed manipulating research data to hide the extent to which these drugs aren’t as safe as they wanted us to believe.
c) Nothing in life is without tradeoffs and risks. On the one hand, SSRI’s may not be for you. Not every negative emotional condition, no matter how chronic or unpleasant or debilitating, is necessarily a “disease” — there is plenty of anecdotal evidence that life-circumstances can cause the very manifestations that will result in a psychiatric diagnosis and an SSRI prescription if you go to the shrinks about them, but disappear over time if those life-circumstances can be altered. So if you can get up off the floor and examine life and cope and make changes despite the depression, I’d say try that first.
On the other hand, the very nature of depression is that it makes it difficult-to-impossible to do anything of the sort. So in the spirit of “whatever gets you through”, an SSRI med may prove useful to you.
I would call it a crutch. A crutch is not a bad thing: ask anyone who has twisted the fuck out of their ankle or broken their foot! But a crutch is only for some people a permanent device; for others it is a thing you use while you heal, and then put aside.
FWIW, one explanation for the “antidepressants cause people to commit suicide” phenomenon that I’ve heard basically goes like this:
- The depressed people had suicidal thoughts/wanted to commit suicide before taking medication.
- However, their depression was such that they barely had the desire/energy to get out of bed, much less commit suicide.
- The antidepressants perked them up enough that they now had the energy to actually commit suicide, and so some of them did.
And this is why many medical experts recommend counseling in addition to medication.
Anybody that takes them needs to be watched for any negative thought processes for weeks after starting or changing doses. The people that commit suicide are not being observed properly at that stage. Every different drug or reformulation will react different for someone. I think in the case of this type of drug, that substituting a generic or a company reformulation without notification should be a criminal act under law. I have seen people that use this type of drug, that don’t get how seriously you screw up the workings of these drugs, by drinking a beer. They then swing into unstable personalities for days, if they don’t do anything else.
In dealing with Sydenhams Chorea as an adult, you are stuck with a small group of drugs to help control symptoms. One of the drugs in the class you asked about made me want to pound the crap out of anyone in site and I loathed you. I skipped a day, and the hate went away. I took the medicine the next day to feel exactly the same way. The medicines went on my list of alergic medicines for the doctors. Another drug in the same class was not a problem although it didn’t help either. People should be closely observed as the medicine build up to an effective dose in the body. It normaly takes one month to get to the correct steady level and only after a couple months can it be said to fail and a new drug tried. You’ll have to what for the other drug to clear up to a month before they start the new one. All this is being done with only couple doctor visits while being implimented. There is no close observation over the first month which is a serious problem with these drugs being subscribed as the patent will not likely notice or help themselves, when their mind functions change. Imagine this being given to a unstable person in the first place, and their reaction is to go a bit farther in the wrong direction.It can add that little extra push, when the brain functions change, even without a severe reaction like mine above.
In a study conducted in the UK, SSRI’s performed less effectively than other antidepressant drugs:
The problem is that other antidepressants, namely tricyclics and MAOIs, are highly toxic in overdose. Giving this to the most depressed people, often with suicidal ideations, less optimal. Luckily SSRIs are some of the safest drugs in overdose out there. Certainly it is far easier to get into trouble with Tylenol or aspirin than with Prozac.
SSRIs are the first-line drugs for several psychiatric conditions, including depression, anxiety and panic disorders. They are second line for a few others. While the well-publicized problems and drug company manglings of the situation certainly should be considered, these are among the most prescribed drugs out there. I’m not saying they are perfect, nor am I saying they should be used without monitoring. But they are lifesavers for many. They have well-known side effects (sexual side effects especially anorgasmia, anticholinergic properties, sedation, apathy, etc.) and limitations (long time to get an effect, different drugs in the same class have different effects on different people), they have pretty good dosing regimens, etc.
I wouldn’t worry about their toxicity or efficacy when taking these drugs, especially when comparing what a huge impact a major depressive episode can take on your life. Just be careful, like with any new med.
We’re probably skirting dangerously close to giving medical advice here, so I’ll start and end with two disclaimers, and probably stick one in the middle: only a medical professional is qualified to give you advice - and when it comes to SSRI’s {or any psychiatric drug}, make sure it’s a good medical professional.
Harmonious Discord’s last sentence deserves a bolding: unfortunately, one of the major drawbacks of SSRI’s is that unlike say analgesics, they do affect different people differently, and some of these effects can profoundly and negatively affect a patient’s mental state, albeit temporarily {paradoxical reactions, which exacerbate rather than ameliorate the condition}. It’s unfortunately impossible to predict exactly what the effect will be on each particular user until the drug has been tried.
Disclaimer: the following is intended as personal anecdote for illustration only, and should in no way be construed as medical advice - hence no mention of the particular drugs.
I had to experiment with three or four different SSRI’s in order to treat my depression and anxiety disorder, and some of them had very unpleasant reactions - one would alleviate the depression but cause mood swings and violent bouts of anger, another would exarcerbate the depression and trigger suicidal thoughts, another would simply send me to sleep.
Fortunately, I have a very good doctor and psychiatrist, and tried each drug in turn under very close supervision, with instructions that any aberrant feelings, however unpleasant, were a temporary side effect of the drug: it was a very uncomfortable few months, as it can take several weeks for the full effect of the SSRI to manifest itself, so the process of trial-and-error can be very drawn out.
Fortunately we found the right drug with a minimum of side effects, but it is not a process that I would recommend to anyone without very good medical help and a full explanation of the possible side-effects and steps that can be taken to alleviate those. See a doctor. Ask lots of questions.