3 ms·

> It's not right to call it withdrawal. These drugs are not addictive like benzos or alcohol are. What does “not addictive” matter? Clearly, SSRIs are somethin

> It's not right to call it withdrawal. These drugs are not addictive like benzos or alcohol are. What does “not addictive” matter? Clearly, SSRIs are something that induce a dependency, because the withdrawal symptoms are horrific. A drug doesn't need to give you a high to create a dependency problem. > If any symptom reappears it's just that the mental disease most usually changed form after so long time. How do you know that? This is a problem with some other kinds of psychiatric medications too (certain antipsychotics for example), the reckless assumption that anything that happens after cessation of the drug was just an underlying symptom that the drug had suppressed. That could be the case, but you mustn't just take it for granted. I think most worrying is the cases where a drug has only a placebo effect until the point of withdrawal. If your underlying bias is towards assuming the drug is effective, then the disaster following withdrawal might make you think the drug was holding it back this whole time. But in fact, the drug may have caused the entire harm.

tsoukase 1mo ago
The guideline "The benefit must outweigh the harm" is more relevant for aD drugs than anything else in medicine. The problem is that it's difficult to estimate the risk for such relatively rare but debilitating side effect. When I prescribe an aD, there is a wide margin of expected benefit taking into consideration a dozen of long term risks, among which, I admit, PSSD is of less worry. Others more important are cardiovascular, metabolic (permanent weight gain), cognitive (dementia), even social (disruption of relationships).
1718627440 1mo ago
>that induce a dependency, because the withdrawal symptoms are horrific Isn't that the definition of addictive?
- TazeTSchnitzel 1mo ago
  The person I'm replying to doesn't seem to think so. I'm imagining this concept of addiction requires some level of craving, which I don't believe you get with SSRIs.
  - hirvi74 1mo ago
    Addictions require harm in one or more areas of your life, and the compulsive use or inability to stop despite the harm(s). I imagine many diabetics crave insulin when they cease its usage.
- hirvi74 1mo ago
  My understanding is that addictions have to have an element of psychosocial or physiological harm. Particularly compulsive usage and the inability to despite the harms is when something becomes an addiction. Quitting coffee might give someone headaches, bit more tiredness, difficulty concentrating, etc.. But that is just the body trying to achieve homeostasis. Many diabetics would have horrible withdrawal effects from ceasing their insulin usage -- a substance they cannot live without. They take it everyday and their life depends on it. But many live perfectly normal, functional lives. They do not break into cars to steal radios to pawn off for more insulin. However, jeopardizing your family’s future by taking out a second mortgage on your home just so you can keep gambling -- while you’re already drowning in debt -- and telling yourself, "If my wife finds out, she’ll divorce me and take the kids. But this is the time I win big. This time will be different." That, right there, might be the purest form of addiction there is. All without any physical dependence at all. Gambling addiction also has the highest suicide rate amongst all addictions.

tsoukase 1mo ago

The guideline "The benefit must outweigh the harm" is more relevant for aD drugs than anything else in medicine. The problem is that it's difficult to estimate the risk for such relatively rare but debilitating side effect. When I prescribe an aD, there is a wide margin of expected benefit taking into consideration a dozen of long term risks, among which, I admit, PSSD is of less worry. Others more important are cardiovascular, metabolic (permanent weight gain), cognitive (dementia), even social (disruption of relationships).

1718627440 1mo ago

>that induce a dependency, because the withdrawal symptoms are horrific Isn't that the definition of addictive?

TazeTSchnitzel 1mo ago
The person I'm replying to doesn't seem to think so. I'm imagining this concept of addiction requires some level of craving, which I don't believe you get with SSRIs.
- hirvi74 1mo ago
  Addictions require harm in one or more areas of your life, and the compulsive use or inability to stop despite the harm(s). I imagine many diabetics crave insulin when they cease its usage.
hirvi74 1mo ago
My understanding is that addictions have to have an element of psychosocial or physiological harm. Particularly compulsive usage and the inability to despite the harms is when something becomes an addiction. Quitting coffee might give someone headaches, bit more tiredness, difficulty concentrating, etc.. But that is just the body trying to achieve homeostasis. Many diabetics would have horrible withdrawal effects from ceasing their insulin usage -- a substance they cannot live without. They take it everyday and their life depends on it. But many live perfectly normal, functional lives. They do not break into cars to steal radios to pawn off for more insulin. However, jeopardizing your family’s future by taking out a second mortgage on your home just so you can keep gambling -- while you’re already drowning in debt -- and telling yourself, "If my wife finds out, she’ll divorce me and take the kids. But this is the time I win big. This time will be different." That, right there, might be the purest form of addiction there is. All without any physical dependence at all. Gambling addiction also has the highest suicide rate amongst all addictions.