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I am curious how they link to suicide and homicide. Antidepressants seem to be most dangerous when they make people just motivated enough to execute maladaptiv

I am curious how they link to suicide and homicide. Antidepressants seem to be most dangerous when they make people just motivated enough to execute maladaptive ideas but not functional enough to become happy productive people. This is obviously a corner case that doesn't apply to the vast majority of people on antidepressants but it brings up some worthwhile discussions.

more_corn 2y ago
If you stop taking your SSRI suddenly, your depression is even worse than when you started. This is why doctors strongly urge patients to ween instead of dropping off suddenly. That effect (massive increase in symptoms in cases where patients stop medication suddenly) probably contributes to a significant portion of the risk.
- hollerith 2y ago
  Depression makes it hard to get things done. I heard that the SSRI can eliminate that symptom before it eliminates the desire to die, and that is where a lot of the risk of suicide comes from -- which of course is during the first weeks or months after starting the SSRI.
  - hirvi74 2y ago
    I've also heard that some people with unipolar depression might actually be misdiagnosed and have a form of bipolar disorder. SSRIs can potentially invoke manic/mixed states in some individuals with bipolar disorder, which might also account for some of the increased risk in suicide from SSRIs.
  - rincebrain 2y ago
    More or less. Your actual perceived "mood" is generally the "last" thing to change with basically all flavors of traditional antidepressant, since it's more or less your calibration of how much life sucks over time, and it takes a while of noticing it sucks less to recalibrate. So every doctor I've ever had has given me a very similar lecture about being very cautious, because depression is more or less characterized as having reduced or no ability to actually drive yourself to do things, and then you feel like shit as that keeps happening and your frame of mind goes sour. But conversely, if the antidepressant affects the "underlying" problem, your inability to turn thought into deed, it will take time (and possibly therapy) for you to recalibrate again, and then you have a window of "I want to die, nothing will ever improve", coupled with a newfound ability to successfully turn thought into deed. It's one reason things like ketamine and psilocybin are seen as wild - when they work, both generally improve at once, so you avoid that problem.
    - hollerith 2y ago
      I like your explanation better than my explanation.
      - rincebrain 2y ago
        Thank you; for all its long-windedness, I've had to explain things about this a lot of times to people who have no frame of reference, similar to having to explain to people who have never experienced a disconnect between intent to do something and doing it that no, it's not simply a matter of actually not wanting to do it, it's that I sit here frustrated, having decided I will do this, and still not doing it, for no evident reason. Since that's completely outside their experience, they often conclude you're lying, not "people work differently".
  - johnisgood 2y ago
    One of the reasons for why they are commonly prescribed with benzodiazepines, at least in the first couple of weeks.
- magicpin 2y ago
  Does the average GP know the proper protocol for weening off an SSRI? Or does someone need to go to a specialist for that?
  - superb_dev 2y ago
    In my experience, you wanna talk to a psychiatrist or in general some who specializes in prescribing drugs for mental health. Your GP just isn't gonna be familiar with all of the ins and outs
  - johnisgood 2y ago
    Most GPs I have talked to know next to nothing about psychiatric medications. The incompetence runs deep, not limited to psychiatric medications. Just for an example: they know absolutely nothing about seizures caused by withdrawal symptoms of benzodiazpines. In fact, I had a psychiatrist who I had an appointment to after one month, and he knew I was on 2 x 2 mg of alprazolam, well, imagine what would have happened if I could not have gotten my hands on benzodiazpines: seizures. I had them before. No one really cared, my psychiatrist didn't, my GP didn't.
- hirvi74 2y ago
  I mean, isn't that true of plenty of substances? What goes up must come down, to use such analogy. Take a look at many psychoactive substances. Sudden cessation after prolong usage typically presents as symptoms that are the opposite of whatever the substance provided.
  - burnished 2y ago
    No, its pretty unusual for a substance to cause noteworthy harm after sudden cessation. This is distinct from developing a tolerance, which as you note is pretty normal for humans.
    - hirvi74 2y ago
      What is defined as noteworthy harm? Are we talking about noteworthy short-term effects or as far on the spectrum as death? I can think of quite a few substance which result in harm with sudden cessation after prolonged usage -- Alcohol, benzodiazapines, antihypertensives, etc.. Perhaps medications like: antipsychotics, anticonvulsants, immunosupressants, etc. as well? Obviously individual reactions vary and nothing is a guarantee in medicine, but I believe many substances can cause noteworthy issues with sudden cessation that are greater than just the reemergence of the underlying condition being treated. However I am probably more wrong than right on most topics, so (anyone) feel free to correct me if I am mistaken.
- thoughtpalette 2y ago
  Also "brain zaps". Highly recommend listening to your physician with a proper roll off period instead of cold turkey. Also be wary of taking certain recreational drugs (Molly, X) due to seretonin syndrome.
yareally 2y ago
It may sound odd, but suicides can happen when the medication is actually working. It gives the patient just enough motivation to finally do what they were unable to do because they were so paralyzed by anxiety and depression. It's really sad.

more_corn 2y ago

If you stop taking your SSRI suddenly, your depression is even worse than when you started. This is why doctors strongly urge patients to ween instead of dropping off suddenly. That effect (massive increase in symptoms in cases where patients stop medication suddenly) probably contributes to a significant portion of the risk.

hollerith 2y ago
Depression makes it hard to get things done. I heard that the SSRI can eliminate that symptom before it eliminates the desire to die, and that is where a lot of the risk of suicide comes from -- which of course is during the first weeks or months after starting the SSRI.
- hirvi74 2y ago
  I've also heard that some people with unipolar depression might actually be misdiagnosed and have a form of bipolar disorder. SSRIs can potentially invoke manic/mixed states in some individuals with bipolar disorder, which might also account for some of the increased risk in suicide from SSRIs.
- rincebrain 2y ago
  More or less. Your actual perceived "mood" is generally the "last" thing to change with basically all flavors of traditional antidepressant, since it's more or less your calibration of how much life sucks over time, and it takes a while of noticing it sucks less to recalibrate. So every doctor I've ever had has given me a very similar lecture about being very cautious, because depression is more or less characterized as having reduced or no ability to actually drive yourself to do things, and then you feel like shit as that keeps happening and your frame of mind goes sour. But conversely, if the antidepressant affects the "underlying" problem, your inability to turn thought into deed, it will take time (and possibly therapy) for you to recalibrate again, and then you have a window of "I want to die, nothing will ever improve", coupled with a newfound ability to successfully turn thought into deed. It's one reason things like ketamine and psilocybin are seen as wild - when they work, both generally improve at once, so you avoid that problem.
  - hollerith 2y ago
    I like your explanation better than my explanation.
    - rincebrain 2y ago
      Thank you; for all its long-windedness, I've had to explain things about this a lot of times to people who have no frame of reference, similar to having to explain to people who have never experienced a disconnect between intent to do something and doing it that no, it's not simply a matter of actually not wanting to do it, it's that I sit here frustrated, having decided I will do this, and still not doing it, for no evident reason. Since that's completely outside their experience, they often conclude you're lying, not "people work differently".
- johnisgood 2y ago
  One of the reasons for why they are commonly prescribed with benzodiazepines, at least in the first couple of weeks.
magicpin 2y ago
Does the average GP know the proper protocol for weening off an SSRI? Or does someone need to go to a specialist for that?
- superb_dev 2y ago
  In my experience, you wanna talk to a psychiatrist or in general some who specializes in prescribing drugs for mental health. Your GP just isn't gonna be familiar with all of the ins and outs
- johnisgood 2y ago
  Most GPs I have talked to know next to nothing about psychiatric medications. The incompetence runs deep, not limited to psychiatric medications. Just for an example: they know absolutely nothing about seizures caused by withdrawal symptoms of benzodiazpines. In fact, I had a psychiatrist who I had an appointment to after one month, and he knew I was on 2 x 2 mg of alprazolam, well, imagine what would have happened if I could not have gotten my hands on benzodiazpines: seizures. I had them before. No one really cared, my psychiatrist didn't, my GP didn't.
hirvi74 2y ago
I mean, isn't that true of plenty of substances? What goes up must come down, to use such analogy. Take a look at many psychoactive substances. Sudden cessation after prolong usage typically presents as symptoms that are the opposite of whatever the substance provided.
- burnished 2y ago
  No, its pretty unusual for a substance to cause noteworthy harm after sudden cessation. This is distinct from developing a tolerance, which as you note is pretty normal for humans.
  - hirvi74 2y ago
    What is defined as noteworthy harm? Are we talking about noteworthy short-term effects or as far on the spectrum as death? I can think of quite a few substance which result in harm with sudden cessation after prolonged usage -- Alcohol, benzodiazapines, antihypertensives, etc.. Perhaps medications like: antipsychotics, anticonvulsants, immunosupressants, etc. as well? Obviously individual reactions vary and nothing is a guarantee in medicine, but I believe many substances can cause noteworthy issues with sudden cessation that are greater than just the reemergence of the underlying condition being treated. However I am probably more wrong than right on most topics, so (anyone) feel free to correct me if I am mistaken.
thoughtpalette 2y ago
Also "brain zaps". Highly recommend listening to your physician with a proper roll off period instead of cold turkey. Also be wary of taking certain recreational drugs (Molly, X) due to seretonin syndrome.

yareally 2y ago

It may sound odd, but suicides can happen when the medication is actually working. It gives the patient just enough motivation to finally do what they were unable to do because they were so paralyzed by anxiety and depression. It's really sad.