7 ms·

SSRIs need to be obsolesced already. Screw the sexual dysfunction, how about increaased risk of suicidal ideation? How about them taking two entire weeks to wor

SSRIs need to be obsolesced already. Screw the sexual dysfunction, how about increaased risk of suicidal ideation? How about them taking two entire weeks to work? 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.

Perenti 5y ago
SNRIs have resolved my suicidal ideation. I credit Effexor with saving my life. The increased risk of suicidal ideation in young anxiety patients is probably offset by the reduction in self-harm amongst the major depression people.
pyronik19 5y ago
SSRIs took me from being unable to function and leave my home due to social anxiety to knocking out the bulk of my symptoms and having a solid 15 years of being socially and professional productive. I'd prefer we keep them.
- romwell 5y ago
  I've had a very positive experience with SSRIs as well (Sertraline).
- ironmagma 5y ago
  There are probably a number of other drugs that could have done that, though.
  - R0b0t1 5y ago
    Heroin, interestingly enough. IIRC they screened pain medicine recipients for depressive symptoms and in this way determined opiates relieve major depression more efficaciously than SSRIs.
    - jamal-kumar 5y ago
      consider quitting while you're ahead.
    - ironmagma 5y ago
      Yes, and a close relative (oxycodone) is something I’ve had experience with and can confirm it’s quite good at curing the depression. The problem is the permanent brain damage and/or death it will cause when taken long-term. Link < https://www.drugabuse.gov/publications/research-reports/heroin/what-are-long-term-effects-heroin-use https://www.drugabuse.gov/publications/research-reports/hero...>
      - R0b0t1 5y ago
        I don't see opiates as a tenable longterm solution but I mentioned heroin because it's only long term side effect as far as I know is constipation, which can be managed. Same with morphine. My point in bringing this up is why accept SSRIs if they have more side effects and are less efficacious than heroin?
        ironmagma 5y ago
        Heroin is highly addictive and has a high risk of overdose. There are alternatives to SSRIs, such as SNRIs and tricyclics.
        R0b0t1 5y ago
        Both irrelevant with medical supervision. SSRIs are highly addictive too; many people never stop taking them.
diskzero 5y ago
I am in the US and I have never heard of the treatments you mentioned. I guess this is your point! This makes me very sad. I am glad a SSRI worked for me, but I know that a percentage of people will also be at great risk for self-harm.
ironmagma 5y ago
Not to mention the sometimes lifelong brain zaps which are truly disturbing and make trying to go to sleep a terrifying experience.
- bruce343434 5y ago
  > lifelong brain zaps Could you expand on this? Is this the "exploding head syndrome" where you have an incredibly "loud" hallucinatory experience just as you fall asleep?
  - ironmagma 5y ago
    I am not a doctor and do not know the difference between brain zaps and EHS (or whether there is one), but this article[1] summarizes it well. For me, it is a loud sound but sort of within the head, accompanied by the sensation you get when you receive an electrical shock, which of course startles you awake. This unfortunately occurs just at the boundary between consciousness and sleep, which after it happens a few times in a row can put you off the idea of even trying to sleep. Occasionally I did awaken thinking there had been a literal explosion in the building. I haven't taken SSRIs for 3 years and still get them, albeit less than when I was weaning off of them. [1] https://www.medicalnewstoday.com/articles/brain-zaps#how-they-feel https://www.medicalnewstoday.com/articles/brain-zaps#how-the...
bduerst 5y ago
MAOIs have potentially serious dietary interactions and side effects. They can cause serotonin sickness just by taking it with OTC tryptophan supplements. 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.
- jamal-kumar 5y ago
  This is actually the biggest thing keeping this line of treatment from being the preference, but when it comes to reversible vs irreversible MAOIs the dietary interactions are actually not a concern![1] It was actually my first comment when I was told about this, but as it turns out you're more looking at potential drug interactions with the reversible MAOIs. The dietary interactions definitely stand with the irreversible MAOIs in the first generation antidepressants, which I think are generally reserved these days for really serious depression cases that don't respond to other treatment, or parkinsons like symptoms, or people going on jungle treks to drink shaman brews. I think the benefit of treatment kicking in immediately is really key as well, 2 weeks is a long time to wait for a drug to work when you're potentially on the brink of suicide. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1188542/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1188542/
anon-guy 5y ago
http://www.nature.com/npp/journal/v20/n3/pdf/1395258a.pdf http://www.nature.com/npp/journal/v20/n3/pdf/1395258a.pdf 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.
- jamal-kumar 5y ago
  I'm pro-boner

Perenti 5y ago

SNRIs have resolved my suicidal ideation. I credit Effexor with saving my life. The increased risk of suicidal ideation in young anxiety patients is probably offset by the reduction in self-harm amongst the major depression people.

pyronik19 5y ago

SSRIs took me from being unable to function and leave my home due to social anxiety to knocking out the bulk of my symptoms and having a solid 15 years of being socially and professional productive. I'd prefer we keep them.

romwell 5y ago
I've had a very positive experience with SSRIs as well (Sertraline).
ironmagma 5y ago
There are probably a number of other drugs that could have done that, though.
- R0b0t1 5y ago
  Heroin, interestingly enough. IIRC they screened pain medicine recipients for depressive symptoms and in this way determined opiates relieve major depression more efficaciously than SSRIs.
  - jamal-kumar 5y ago
    consider quitting while you're ahead.
  - ironmagma 5y ago
    Yes, and a close relative (oxycodone) is something I’ve had experience with and can confirm it’s quite good at curing the depression. The problem is the permanent brain damage and/or death it will cause when taken long-term. Link < https://www.drugabuse.gov/publications/research-reports/heroin/what-are-long-term-effects-heroin-use https://www.drugabuse.gov/publications/research-reports/hero...>
    - R0b0t1 5y ago
      I don't see opiates as a tenable longterm solution but I mentioned heroin because it's only long term side effect as far as I know is constipation, which can be managed. Same with morphine. My point in bringing this up is why accept SSRIs if they have more side effects and are less efficacious than heroin?
      - ironmagma 5y ago
        Heroin is highly addictive and has a high risk of overdose. There are alternatives to SSRIs, such as SNRIs and tricyclics.
        R0b0t1 5y ago
        Both irrelevant with medical supervision. SSRIs are highly addictive too; many people never stop taking them.

diskzero 5y ago

I am in the US and I have never heard of the treatments you mentioned. I guess this is your point! This makes me very sad. I am glad a SSRI worked for me, but I know that a percentage of people will also be at great risk for self-harm.

ironmagma 5y ago

Not to mention the sometimes lifelong brain zaps which are truly disturbing and make trying to go to sleep a terrifying experience.

bruce343434 5y ago
> lifelong brain zaps Could you expand on this? Is this the "exploding head syndrome" where you have an incredibly "loud" hallucinatory experience just as you fall asleep?
- ironmagma 5y ago
  I am not a doctor and do not know the difference between brain zaps and EHS (or whether there is one), but this article[1] summarizes it well. For me, it is a loud sound but sort of within the head, accompanied by the sensation you get when you receive an electrical shock, which of course startles you awake. This unfortunately occurs just at the boundary between consciousness and sleep, which after it happens a few times in a row can put you off the idea of even trying to sleep. Occasionally I did awaken thinking there had been a literal explosion in the building. I haven't taken SSRIs for 3 years and still get them, albeit less than when I was weaning off of them. [1] https://www.medicalnewstoday.com/articles/brain-zaps#how-they-feel https://www.medicalnewstoday.com/articles/brain-zaps#how-the...

bduerst 5y ago

MAOIs have potentially serious dietary interactions and side effects. They can cause serotonin sickness just by taking it with OTC tryptophan supplements. 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.

jamal-kumar 5y ago
This is actually the biggest thing keeping this line of treatment from being the preference, but when it comes to reversible vs irreversible MAOIs the dietary interactions are actually not a concern![1] It was actually my first comment when I was told about this, but as it turns out you're more looking at potential drug interactions with the reversible MAOIs. The dietary interactions definitely stand with the irreversible MAOIs in the first generation antidepressants, which I think are generally reserved these days for really serious depression cases that don't respond to other treatment, or parkinsons like symptoms, or people going on jungle treks to drink shaman brews. I think the benefit of treatment kicking in immediately is really key as well, 2 weeks is a long time to wait for a drug to work when you're potentially on the brink of suicide. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1188542/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1188542/

anon-guy 5y ago

http://www.nature.com/npp/journal/v20/n3/pdf/1395258a.pdf http://www.nature.com/npp/journal/v20/n3/pdf/1395258a.pdf 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.

jamal-kumar 5y ago
I'm pro-boner