4 ms·

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

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.

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.