
Ask HN: Should I Take Prozac? - WMLPDrVQowNsre
I am a mid-level software engineer, raised religious, who in the past few years has gone through the &quot;jaded atheist&quot; phase that I suspect affects many engineers - a tendency towards only believing things that can be proven using western scientific method, which religion cannot be.<p>This phase has become ultra-logical at an existential level; why are humans obsessed with living? I believe that humans create their own purpose, and I used to derive purpose from work but recently work has been going poorly. I have had bouts of depression - low motivation, low energy, feel as though there is little reason for living.<p>I saw a psychiatrist who prescribed me Prozac to help with the low energy and motivation. I have heard SSRIs are hard to come off of. I&#x27;m wondering if this is just a depressive phase and if I should try to move past it without this drug, or if this drug could kick start an improvement in motivation and feeling like there are reasons for living.<p>Has anyone taken Prozac for similar reasons, and can you share your experience with it -- positives and negatives?
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smt88
Any advice here other than "talk to multiple doctors and decide for yourself"
is bad and dangerous.

SSRIs can be life-saving, or they can ruin your life. People have different
degrees of illness and different reactions. No one can help you figure this
out except a doctor.

You can and should get multiple opinions if you don't feel confident in your
current psychiatrist's recommendation.

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DanBC
> I have heard SSRIs are hard to come off of

SSRIs can have unpleasant discontinuation effects. These don't affect
everyone, and they don't affect people in the same way. I know people on low
dose venlafaxine who struggled. I was on high dose venlafaxine for years and
stopped almost overnight with no problems. Currently we think only very small
numbers of people ahve severe serious enduring problems coming off SSRIs. It
is, of course, totally fine for you to examine the risks vs the rewards of
taking medication. Personally, and this is only my opinion, meds saved my life
and I am glad they were available to me.

You may want to look at an evidence-based talking therapy as well. Cognitive
behaviour therapy has good evidence (especially if you do it face to face, one
to one, with an experienced therapist). It's a short form therapy so the
maximum length of treatment is 21 weeks, but most people need less than that.

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PaulHoule
Prozac and its metabolites have a long half-life in the body (weeks); relative
to other SSRIs Prozac is a rough ride but the natural tapering makes
discontinuation easy. Other SSRI drugs (e.g. Sertraline, Lexapro, ...) are
also off-patent and are pretty good.

Successful treatment with antidepressants will involve waiting a week or two,
probably increasing the dose and trying other medications if the one you are
using doesn't work or has side effects.

Effexor is also available in generic and it is an SNRI that hits receptors and
overall is more effective, but it is harder to quit.

The big negative for some people is that SSRIs suppress the sexual response.
This could be anything from "My girlfriend thinks it's great because now I can
____for two hours " to "I took one tab of Lexapro and I didn't have sex, think
about sex, look at porn, anything for a week"

Some people won't care, some people will get into trouble with their partner,
some people might get along better with their partner. The effect is dose
dependent.

You are living in the 21st century and can partake of it's advances. But also
try these other things:

* exercise (if you could two hours of cardio most days that would be ideal) * psychotherapy

also things that work for some people:

* pets (raising chickens is a common southeast asian treatment for depression) * going to church (if you get something out of it and it may or may not be Christian) * volunteer activities: (Most of the Christian churches in my area run a soup kitchen; the lady who used to run it is scheduled for sentencing by a federal court because of what she did at an anti-war protest; it is a mellow scene where nobody will trouble you about religion but will recognize that "good works" can be meaningful to people) * audit use of alcohol and other drugs: many people have problems

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DanBC
Everyone needs to do exercise because it has a range of important side
effects.

The evidence for exercise as a treatment for mental ill health is not good.
It's really hard to disentangle the effect of any form of "activation" (this
doesn't have to be exercise, it could be joining a book reading club) from the
benefits gained through exercise.

We know it can be difficult for people to start and then maintain an exercise
regime, and this failure to stick to it can cause some people to feel bad
about the failure.

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scarface74
Please don't take medical advice from random people on the Internet.

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neilwilson
Avoid the drugs. They alter your brain, deadening it and stop you being as
good at your job. I'd recommend a book called Mind Over Mood.
[https://www.mindovermood.com](https://www.mindovermood.com)

I was told: When you find yourself thinking dark thoughts just stop doing it.
It's that easy to fix depression, and also that ridiculously hard. Crack it
though and you're sorted for life.

Throw away the symptomatic crutch and address the root causes. It's the
engineering way.

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PaulHoule
Most evidence is that antidepressants and other forms of therapy (particularly
CBT) go together like peanut butter and jelly.

Depressant drugs such as Xanax or Klonopin on the other hand open up ion
channels in your neurons that let the electrical charge drain out. You get
fast and often complete relief from anxiety but learning and memory is
impaired.

People who use benzodiazepines for a long time seem to grow older but not grow
up, you see them and they still have the same conversation that they had with
you ten years ago, they just don't seem to move on the way that most people
do.

That's not true about antidepressants.

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qplex
What "most evidence". Please provide something tangible instead of analogies.

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PaulHoule
See
[https://www.ncbi.nlm.nih.gov/pubmed/15507582](https://www.ncbi.nlm.nih.gov/pubmed/15507582)

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qplex
So from your linked study:

>"The remission rate for combined treatment did not differ from that for CBT
alone (P = .42) "

With the conclusion:

>Children and adolescents with OCD should begin treatment with the combination
of CBT plus a selective serotonin reuptake inhibitor or CBT alone.

Basically they didn't find any difference between patients on SSRIs and
therapy, to those doing only therapy.

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qplex
I'm not a doctor, but I really would not recommend SSRIs. At all. This is from
personal experience, but there are a lot of anecdotes and research around that
agrees.

I didn't really read this book, since this wasn't really new stuff to me, but
skimming through it seemed like a pretty good overview:

[https://www.amazon.com/Lost-Connections-Uncovering-
Depressio...](https://www.amazon.com/Lost-Connections-Uncovering-Depression-
Unexpected/dp/163286830X)

