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Tapering of SSRI treatment to mitigate withdrawal symptoms (thelancet.com)
67 points by bookofjoe 13 days ago | hide | past | web | favorite | 99 comments

I discovered this when coming off Citalopram. The waking nausea and discomfort were unpleasant, but the worst part was undoubtedly the lucid, extraordinarily intense and violent nightmares that would begin the moment I fell asleep and continue, for hours at a time, for the entirety of my sleep.

After trying to quit cold turkey a couple of times, I researched about tapering strategies online, bought some pill cutters and started a very gradual dose reduction. So long as I only halved the dose every 2-3 days, I was fine. But I had to go down to a minuscule fragment of a pill before I could quit completely. Until that point, missing one of the reduced doses would still induce withdrawal symptoms just as intense as the full one had.

It's really interesting to hear someone else say this. I too have suffered occasionally from intense, violent nightmares. They don't necessarily continue all night, but the imagery is extremely disturbing, like a Hellraiser movie. I also took SSRIs like Paxil and Celexa in my early to mid twenties.

Recently, I've also begun experimenting with microdosing. I know almost nothing about the science of psychedelics but I've heard that they mimic the chemical structure of serotonin. I've also had a couple of intense nightmares recently. I wonder if there's somehow a connection between the effect of serotonin or things like it and the tendency to experience intense imagery in dreams.

Perhaps it's not exactly the quality (negative or positive) of the content but the intensity that is magnified. I think I could just as well say that I've had a number of intensely positive dreams while taking these substances but I can't speak objectively about it.

I've experienced similar, although I ended up switching from citalopram to fluoxetine. I've woken up crying, punching the shit out of the pillow next to me (luckily sleep alone), screaming... the dreams are visceral. How many times I've woken up and felt the sheets because my entire body had the sensation of taking a huge piss in a dream, that intense feeling of relief.

Never got withdrawal symptoms from the first round some time ago, unless you call a second bout a withdrawal. Sleeping at night has become a bit of an adventure.

Serotonergic signalling is a really important regulator of sleep architecture, and this is why psychiatrists are increasingly prescribing trazadone as a sleeping aid. It was previously used as an antidepressant, but lower doses and it is a remarkably effective sleeping pill. 5-htp has similar effects, and this is why its sold as a sleep-aid supplement.

In my experience, all of these drugs can bring on intense very visually pleasant trippy dreams, with the occasional intense violent nightmare. Aside from the mood and sleep architecture effects, I wish I knew more about the neuroscience separating the positive from negative experiences.

Yeah, I take GABA before sleep to induce intense dreams. It works all the time for me.

I mean, I'm no scientist but dreams seem to serve a purpose on some level and it doesn't surprise me that after all of that time locked down behind a medication your dream state might have something to communicate to you.

Weird, I get the vivid dreams while on Citalopram, not after missing a dose.

My dose is only 10mg though (used to be 20mg).

Night terrors are no joke. I had to taper off Effexor by 1/2 mg a day to avoid them.

I was on sertraline for almost 15 years. It took multiple tries to get off. I finally slowly tapered off. The worst withdraw symptom was the zaps for me.

I wish I had never started to begin with. I feel like a part of me is gone now. It is hard to describe.

I was on Paxil for almost ten years. God, the zaps, the nausea, and the memory loss when coming off of it!

I just read a book the other day that I’ve had for awhile but hadn’t read—or so I thought. While reading it, some of it seemed familiar but I just assumed I had started it but never finished. I went to post it to my Goodreads account only to find it already there complete with a review that I had written. I have no memory of writing that review, much less of ever actually finishing the book.

I realized I had read it towards the end of my time on my medication.

That’s a prosaic example compared to the conversations my wife and I have where she’ll mention something funny or endearing about our children who were toddlers at the time but I simply can’t remember them.

If you’re thinking about using SSRI’s for anxiety I encourage you to find a therapist who has an evidence-based practice like ACT.

I was on Effexor for about three years. Once or twice during that time I forgot to take it and got a sample of a dreadful sensation that was unlike anything I had ever experienced. This caused me to look up and read about withdrawal problems people had reported. I was taking three of them a day and I began tapering by taking two-1/2 a day for a couple of weeks and then moving to two a day for two weeks and so on. Over the course of about three months I weaned myself off without once having any sort of withdrawal effect that I could recognize. I was happy to be free.

I’m sorry for that feeling. Is it possible it is not the Sertraline but just you are not the same person you were 15 years ago. I know I’m not.

How long ago did you finalize your tapering and stop altogether?

It has been about two years now.

I know someone who was on diazepam for only a year and he says that it took him longer than a year from the point of final dose to start feeling himself again. I know diazepam is not the same class of drugs, but hopefully the same is true for you - the longer you go from the final dose the more yourself you feel.

Well for one, you’re not supposed to take benzodiazepines longer than a few weeks. Benzo withdrawal can be life-threatening if you’re accustomed to a high enough dose.

Strangely, I've gone cold turkey off of SSRI's and with the exception of Paxil, have never experienced the Brain Zaps or extreme withdrawal symptoms others report. I wonder why it would vary?

Also, sample size=1, CBD oil for me appears to have many of the anti-anxiety affects that the other SSRI's have provided me, with much less side affects. Although, the dosing is all over the map and varies from manufacturer, so that's a challenge. But it does seem to provide me some relief. I just hope I’m not doing long term damage..

I took myself off my SSRI's about a decade ago, and I experienced the brain/hands/feet zaps, but none of the other symptoms. I'd been on the medication for about 4 years at that time.

I guess genetics are at play. For example, I have a genetic mutation that means I metabolise tricyclics much faster (and tricyclics block the reabsorption of serotonin and norepinephrine, much like SNRIs). Rate of metabolism would affect peak plasma concentrations and half life.

It's quite possible that similar mutations exist that affect SSRI metabolism.

I believe the reason for the variation in discontinuation symptoms between different SSRIs is that half-life of Paxil (paroxetine) is shorter (24h) than that of some of the other drugs in the group such as Prozac (fluoxetine) (2-4 days, and a metabolite is 1-2 weeks.

Dose dependent maybe? Length of time on the antidepressant?

What dose for cbd? Does it get expensive?

It is expensive. Usually 45-60 dollars for a months supply.

I’ve used the American Shaman water soluble full-spectrum and Medterra isolate CBD oil. Both were effective for me with a slight preference towards the Medterra isolate.

It’s about the most “normal” feeling I’ve ever had. Definitely by far the most effective treatment I’ve had for anxiety, and that’s including the SSRI’s. Probably beats Lexapro because of the near non-existent side effects for me. But again, sample size 1.

The /r/cbd group is a good starting place.

CBD isolate by itself can be a lot cheaper. The cheapest I've found is online from Fully Activated, around $20/g. You should be able to mix your own tinctures with liquid coconut oil, and optionally sunflower lecithin.

Try an SNRI. They have more of the "zap" effects when DC'd.

This is my experience too. I think some of this also comes with movement tracking. More of a dopamine/neuropinephrine signaling axis.

Patients have been saying this for literally decades. I remember blogs written by people who learned to do this themselves without any support from their medical professionals, networking and sharing info with each other on the best way to do it, in the early fucking naughties.

Also, it took decades for studies to be done on minimally effective doses for SSRIs leading to uncounted (and unlitigated) cases of people suffering and dying needlessly.

I hope people here are aware of the sheer number and scale of issues in this industry, from bribing prescribers to false advertisement and covering up of studies, with vast wings of the companies dedicated to 'PR' "managing" these issues.

The explanations I've heard from medical professionals of "why" these drugs work are comically full of holes. They don't really know what's happening with them, and this institutional arrogance, and the 'incidental' buckets of money, are why it's taken 5 decades for this basic, basic, basic fucking research to begin to come out.

The currently best-accepted theories to why antidepressants work involve slow but measurable changes in grey matter densities in key parts of the brain. We haven't had this kind of high-resolution MRI technology for very long.

A, that doesn't actually explain :how they work:.

And B, that hasn't stopped these guys from coming out with ridiculous stories as to how they work, speaking them with the utmost confidence, which is what I took issue with there specifically.

Someone I love had to stop an SSRI and I helped her hack her capsules. I bought empty capsules online and we counted out the beads to allow her to taper mg by mg. Basically this but about 10 years ago: https://www.newscientist.com/article/2140106-people-are-hack...

I am excited for the day when we can fully understand just how the gut-brain connection actually works and where depression/anxiety come from. Giving people real genuine long-term relief over the course of their life.


Some of the comments on here are scary. I've been using Sertraline on and off for 13 years and have never suffered any ill effects other than minor nausea and tiredness. This is, according to the vast body of research done, the majority of people's experiences. Most importantly, I feel better when I take it. If you're thinking of taking SSRIs, please don't let the comments here scare you. They can have a massively positive effect.

Exactly. I never understood why is there such a witch hunt against SSRIs and not only on HN. I have a strong suspicion alternative-medicine folks are just pushing it.

There may be, but on this forum I just see people sharing shit that happened to them. It's a self selected group. If you see a headline and some bad stuff has happened to you, it's only natural that you may want to tell about it.

True. Well this is me diluting it. SSRIs saved my life.

like any "internet review", the outliers are going to dominate the conversation. the drugs either saved the person's life or they had terrible side effects (or both).

that said, a concerning issue with antidepressants is that doctors don't really understand how or why they work. the condition they treat, depression, is also not very well understood and does not seem to have a single root cause. out of twenty or so major drugs, a doctor has very little ability to predict which one will work for a particular patient. when you put all these factors together, being prescribed drugs for depression feels a lot more like "pulling random levers until something works" than most other forms of medical treatment.

I don't share your suspicion that most of this is alternative-medicine shilling. enough of my close friends have experienced the same positive and negative effects described here that I will take most accounts as genuine.

> If you're thinking of taking SSRIs, please don't let the comments here scare you.

Is this what you actually think, or just what the drug is telling you to think though? I would much rather just be depressed than chemically castrate my brain.

SSRIs don't "tell" you to think anything. Your comment is ignorant about a complex subject.

If you'd "rather be depressed" then you've never suffered from depression.

SSRI discontinuation is really horrible and most doctors don't tell you up front the hell that it is. To me, its a sin up there with not telling opioid patients what that'll be like to stop.

I've been with two partners that stopped SSRI's after a long time. The brain zaps lasted for months, and the memory, mood issues, and sex drive changes were also severe. Both times it left an irreparable change to our relationship.

For the majority of people, this isn't the case. The body of evidence backs this up. I'm sorry you and your partners had a bad experience, but comparing it to opioid withdrawal is an unfair comparison and could discourage people from getting help who need it.

I'm willing to concede to evidence, but it wasnt just those two stories. I must know a lot of bad luck people.

The people I know who took drugs like that I would prefer to have killed themselves honestly.

Many folks are on these drugs not because of depression or anxiety.

I got put on SSRIs because it was the only thing that helped my IBS after getting some kind of GI infection while traveling in Europe.

I had an anxiety related diagnosis and have been on Citalopram and Methylphenidate. I quit with both after a while due to lack of effect.

Recently I got an autism diagnosis and got Fluoxetine prescribed.

Getting on it was a living hell. I was extremely tired, could barely walk the stairs, my body was in pain, I could not drink coffee anymore, just to mention some effects.

I endured, and I am much less edgy, more social, less depressed, and less anxious

The only remaining side effect is that alcohol effect is nearly 2x as strong as it used to be. And it already was strong for me. So one glass is the max for me... tho I had a similar effect from Citalopram.

My point being, for me Prozac works with making my autism's effects less severe allowing me to function better in our NT society. According to my psychiatrist (specialised in autism) I was not the first whom she described [Edit: prescribed] that ie. I wasn't an isolated case.

IBS (at least some types) are very likely closely related to anxiety disorders (but with a visceral motor component). Low FODMAP has been shown to help, though it’s not clear that it is treating the psychomotor cause , but one of the best interventions is increase in physical activity... similar to GAD.

I want to nip this falsehood in the butt as I am studying this for my PhD.

IBS has many causes one main of is people having an autoimmune disease due to the bodily production of anti-vinculin from molecular mimicry of the toxin causing food poisoning anti-cdtb.

The remaining causes are related to MAST cell destabilization, SIBO, etc. Anxiety is thought to play a role in symptom management in the same way having being anxious about a broken foot will make you foot hurt more.

I have IBS because of severe social anxiety, but I don't have any anxiety because of IBS.

I hope someone can help me. I was slowly tapered off Effexor (started at 225mg and then slowly to 125, 75, 25). I was overcome by an existential dread that colored every living moment. I landed up in the hospital - only to resume. Has anyone had experiences like this to share? I want to get rid of this medication again this year but am afraid to start. I am well-balanced and happy at work and life atm.

Sorry to hear that. I've been on that rollercoaster, but by the sound of it not nearly that bad. On one hand, if you're happy now, why try to get off them? On the other hand, if you're determined to stop for whatever reason, talk to a psychiatrist or medical professional you trust, and discuss a plan to deal with than if it comes up again. Is it in any way similar to what caused you to start taking the meds in the first place? Has the root cause of that been addressed? Have you tried CBT, or any other therapy? Stoicism (which CBT is based on)? There might be done short term remedies to help through the withdrawl if it's just a short term thing - best to discuss these with a professional, but I've heard that sleep deprivation (skip one night of sleep; lessens depression for a week or so) is one possibility. If you can try to approach the problem with an external, interested perspective it might help; I was quite amazed at what my brain and body were doing in withdrawl despite feeling quite miserable - aside from the brain zaps, I had a funny effect on Effexor where if I looked up and to the left, I would hear a sound like two darts flying past my left ear. Hope it works out for you.

Thank you for the response. Yes - I have more tools in my mental arsenal now (meditation, stoicism). The problem is: when the dosage was lowered, it was not clear whether I was seeing a relapse or it was withdrawal. I am amazed by the sleep deprival note you mentioned (something I was not aware of at all) - thank you for that. Why stop? Because of sexual side effects (I don't want my partner to suffer my lack of drive) and weight gain. I am glad I am happy and stable now - the question is: is this my drug or am I recovered?

I'm not sure if this is helpful, but I was on 75 mg of venlafaxine (effexor) for several months to a year. Then my insurance ran out. I thought I had an additional month worth of doses, but it turned out that I only had a few doses left. I basically ended up going almost cold-turkey. I basically spent an entire week either sleeping or reading fiction in bed. The brain zaps and nausea felt terrible. I think I am lucky that I can sink that much into fiction and I won't notice the passage of time. After about a week I had to attend an event and during it I felt fine.

I have to say though that venlafaxine didn't really do anything positive for me, nor did the previous SSRIs. I still got the side-effects and withdrawal symptoms when I missed a dose though. I assume they don't work for me because that wasn't my problem in the first place. My own guess is that my issues are from ADHD, but I've only intermittently had insurance since then so I haven't been able to find out.

My experience wasn't like yours, but the withdrawal was terrible. I've read about it online and it seems that many other people seem to have found withdrawal from venlafaxine to be really bad.

Thank you for relating your experience.

My effexor comedown was rather severe, and also resulted in shivering episodes and an overnight ER visit. This was years ago.

I blame the doctor, who switched me immediately to Lexapro with zero tapering on either side. Effexor is something that really should be tapered very slowly.

If its making life awesome though, why get off of it? The stuff gave me lots of confidence and was the only thing that ever regulated my weight and energy levels.

Unfortunately people react differently. You might have better luck tapering over an even longer period.

I've been on Venlafaxine (the generic name for Effexor) and went from I believe 300 mg to 200, 100, 75 - I was able to drop the dosage once a week, but that's my experience. It could take you longer, or you might need to work with your doctor to switch to another medication that you may have better results tapering off on.

And if you're not really ready to get off of it, don't rush it. Better to deal with the side effects of being on it rather than being hospitalized or worse.

At what dose did you start feeling that way? Or was it when you stopped completely after 25mg?

The side effects were creeping in slowly - till they became too much to bear. Its like a slow invasion.

I think the key may be to very, very slowly wean yourself off. You might have to get pretty radical, like 1mg reduction per week. (That's ~2 year taper - obviously an excessive example but these drugs are weird.)

Just curious - you do you - but if you are well-balanced and happy on the meds why do you want to taper off?

I am not a pharmacist but I can think of a few reasons:

- Cost: drugs are not free, neither are doctors, though with proper health care, it is rarely an issue.

- Time: these are prescription drugs, and you may need regular visits to a doctor

- Convenience: not having to carry meds with you is one less thing to think about

- Unavailability: you may find yourself without access to your meds at the very worst time (ex: stuck in a foreign country). You definitely don't want to experience withdrawal in an already stressful situation.

- Tolerance (if applicable): You may need to up the dose regularly in order to have an effect, until you can't go further.

Why? Because of side effects. The sexual side effects are terrible. I am sure it has contributed to my weight gain. I am not sure there are studies on what happens after decades on this drug.

Flip that around: Why would you want to be continually reliant on a designer drug for the rest of your life just to feel normal?

To me, that defines a dystopian nightmare. I'd sooner go without than be shackled to the pharmaceutical industry.

Whether or not you want to be, maybe you are. And if it helps you function better, why is that bad?

I’m continually reliant on prosthetics for the rest of my life just to see normally. Other people are forever reliant on wheelchairs or pacemakers or medication that stops their immune system from tearing up their organs. And that’s ok!

^ This guy gets it

After having spent a few years studying the neurology of aging, and having my life saved by SSRIs at age 33, I've concluded that SSRIs are very much in the same category as eyeglasses, especially since 1/6 of the population takes them.

The human brain is the most complex thing in the universe. Its not perfect. We can make it better, stronger!

Because then you're not human, you're a chemical zombie.

Do you say that about people taking daily heart medication, or people with cochlear implants?

Comments like this are horribly counter-productive to people struggling with mental illness.

Imagine saying to a diabetic, "Why would you want to be continually reliant on a designer drug for the rest of your life just to feel normal?" Or closer to target, to an anorexic/body image patient, "Just eat!"

For some people it truly is life or death with anti-depressants. Some people are in shitty situations with dysfunctional brains that are actively working against their best interests. Is it really that bad that literally taking a pill solves some people's issues. Perhaps anti-depressants are over-prescribed, but damn, a pill that aligns your brain to be able to rationally handle day to day issues seems pretty neat!

If you're successfully treated by a generic anti-depressant, please ignore the hyperbole of the above commenter. If you feel you no longer need the support of your medications, work with your psychiatrist to safely wean off them. There is no impending dystopian nightmare nor is there any shame is taking anything daily to manage your mental health.

For those people, these drugs are fantastic! I should have conditioned my comment to exclude those people.

EDIT: I should add, if I got diabetes and had to take insulin, I would be pissed to the point that I'd make it my sole goal in life to find a way to live without having to take insulin.

To me, it is absolutely infuriating that I can be required to take a drug just to live. I fully understand this stuff works great for people - by all means use them! For me? I'd rather get sick and fail than live with it forever.

(Yes, I'm irrational, excessively autistically stubborn, and all the other negative things you're thinking about me. :)

I was like that. Managed to get off of antidepressants for probably 6 or 8 years, and thought that I had an introspective enough personality that I could be aware of, and condition myself to, not have a recurrence which required going back on them.

It came on so slowly that I didn't really notice, and most people around me who you would imagine should have noticed also did not. I finally hit a breaking point, and started therapy and medicine again. It has completely changed my life around, and possibly saved it.

Would I like to live without it? Well, I would like to not need it, but if it is a given that I do, then I most certainly will continue using it. I've experienced the alternative, and there is nothing preferable about it.

> I should add, if I got diabetes and had to take insulin, I would be pissed to the point that I'd make it my sole goal in life to find a way to live without having to take insulin.

I feel like you're ascribing it to some sort of moral failing then that someone would turn to medication for help. These things aren't always under people's control.

> I'd rather get sick and fail than live with it forever.

In the case of type 1 diabetes that could literally mean death. These hypotheticals are very easy to lay out, but much, much harder to live with.

> it is absolutely infuriating that I can be required to take a drug just to live

It _is_.

> I'd rather get sick and fail than live with it forever.

It's easy to say that now. When you've not slept for three days, and that happens so often it's become routine, or you've not used the phone in _months_ due to the anxiety it causes, it's not so easy.

Agreed. There's the great saying that says that healthy people have many dreams, but a sick person only one.

Venlafaxine (Effexor) costs 20c a dose for generic versions. Inthe US, where drugs are expensive. Under 10c (euro cents) here. I doubt the industry is TOO excited about ‘shackling’ people to it.

I get the cost/corporate thing. But I take a view that I am 100% ok with any substance any one person wants to take and believe that it's ok (and possible to be normal) with continued dependent use (especially if it has benefit, like living a happier or more productive live). And in fact with harder drugs it seems to me a lot of the problems would be solved if we give 100% reliable access with no impurities.

Oh yeah, I firmly believe in "your body, take what you want". Just that I want to take what I want, not what I get hooked on from pharmaceutical solutions.

I'm already taking HRT every day for the rest of my life, might as well take an SSRI to help my brain work better too.

Being a slave to my OCD vs. having some semblance of control over it is not even a question.

Can someone explain what the 'proper' treatment plan is supposed to be for SSRI?

Doctors mostly advertise it as a tool to help get a leg up in overcoming depression with the idea being that it helps you get your shit together and somehow become not depressed. But when you actually get diagnosed, they just prescribe an SSRI and move on. If you ask what you're meant to do, they'll recommend therapy if you're lucky.

And then we come to posts like this and comments like here, about people who have become dependent on SSRI just to have the same quality of life as they did before ever touching it. But now they have to go through hell to get off it.

What's the idea here..? Is there an actual success path for SSRI? What percentage of patients lands on that success path?

> Doctors mostly advertise it as a tool to help get a leg up in overcoming depression with the idea being that it helps you get your shit together and somehow become not depressed. But when you actually get diagnosed, they just prescribe an SSRI and move on. If you ask what you're meant to do, they'll recommend therapy if you're lucky.

SSRI's are completely unrelated to getting your shit together except for the fact they make you less depressed which makes it easier to get your shit together. Doctor's talk about it the way you mentioned to feed into American moralization about drugs. But truth of it is we don't really know how they work(we have a couple of tenuous guesses), we just know they reduce depression and relapse risk.

>And then we come to posts like this and comments like here, about people who have become dependent on SSRI just to have the same quality of life as they did before ever touching it. But now they have to go through hell to get off it.

We don't necessarily know what their life would be like if they hadn't taken the SSRI's. Judging from the studies they'd be marginally less happy, have a greater risk of relapsing, and an increased sex drive.

As I was given to understand it, the first line should be CBT or something similar (ie a therapy that doesn't involve drugs that will help you live your life). On top of this, unless you get referred directly to a psychiatrist (for example because you have made a suicide attempt) you get referred to a psychologist that will try a bunch of different "soft" approaches that will help you deal with your problems. The medication comes during this process, if it is indicated.

Even if you do get medication first, the path that I expect is that you get "soft" treatment as well. The medication is supposed to get you through the really rough seas that you might succumb to otherwise, with other therapy helping you in the long term. If you go to a doctor and they just give you medication and send you on your way, you need to get a second opinion.

I'd like to add that it depends on the person.

There is no freaking way I'm going to talk to a therapist, for example. Not without medication. A therapist is someone that I don't trust, and yes, I'd be honest about it. I might walk away from all treatment if I had to talk to someone regularly first.

More broadly, though, it depends on what is going on with the person. There are medications that have depression or anxiety as side effects and some folks are simply going through tough situations that they cannot change. My mother took a drug for years because lowering her stress levels helped with migraines (for my mother, a tension headache triggered a migraine. Same with sinuses).

There's no reason medication requires therapy.

Therapy has its benefits(like a great side effect profile), but it's good to remember that therapy has a lot of drawbacks too. It expensive(SSRI $3/month vs therapist $500/month), it requires a flexible schedule, and the evidence of effectiveness isn't quite as clear as medication.

Both cognitive therapy and classic "shrink" therapy is on some level, you just talking about shit going on in your life. At the very least, if you are at the end of your rope with no (constructive) talking to be found amongst your peers in life, I am dead certain talking to a therapist is a good thing to try.

Wow. I'm quite interested in how many people at HN seem to have experience with SSRIs.

I'd be interested if people drawn to tech were for whatever reason more likely to be on them - or if there is some other casual relationship that works in the opposite direction.

A quick google search told me that ~15% of American's take anti-depressants. Depression is quite common among the general populace. I think tech sector people have access to the health care they need to get the help they need.

I'm not saying you are, but to destigmatize that statistic a bit, ~60% of Americans need corrective vision of some sort, and 33% have high blood pressure. Just because someone needs help for something doesn't mean that anything is fundamentally wrong with them.

I'll add to this by saying that going on zoloft a year ago has been like the best nootropic experience of my life. In many ways, the first 6 months were like a persistent 24/7 microdose on MDMA ..... it was incredible. I also turned my life around and accomplished some of my life's most impressive work, all while not trying to kill myself anymore!

Beyond solving a massive sudden depression, it was actually quite enhancing. I felt like I was in the movie limitless. Given the pathways SSRIs target in the brain, I'd say they have similar benefits to all of that SV legacy around psychedelic use....

Sadly, things normalized and the burst of awesome tapered off. Now the medication is the new normal, and skipping doses brings the depression back, just not nearly as bad as it was. Hopefully some day we will learn how to tweak it so the immensely positive experiences last forever.

These days, I no longer think of antidepressants as any kind of crutch. If anything, it is another tool in the transhumanists toolbox allowing the human body to perform better than nature has provided.

Tapering to mitigate discontinuation syndrome is standard practise in country of publication and has been for a long time, why is this news.

The suicidal ideation listed as a side-effect on packets of SSRI's is almost entirely due to people deciding to go "cold turkey".

Reading about the withdrawal symptoms I have to wonder why people arent up in arms about it as with the so called opioid crisis. Different to opiods, SSRI are meant to be taken for long periods. The SSRI withdrawal seems to just be accepted as a part of the treatment.

Having experienced antidepressant withdrawal syndrome and having lost a friend to opioid addiction. I would say that comparing the two is preposterous.

Thats comparing the effects on friends an family with the effects on the user. Which in turn, is a bit unfair. It wouldnt be much usefull to talk about people who got suicidal because of SSRI side effects either. It is a rare side effect that might happen and not something that apparently happens regularly like withdrawal.

edit: I am not looking for a moral equivalence here but didnt have another example where addiction and physical withdrawal is accepted beforehand for a treatment.

Sorry I don´t follow you.

If you take properly prescribed opioids it is unlikely you get addicted, withdrawal symptoms or die. Those are issues stemming from miss use. Personally induced or by a careless physician. The exception is in palliative care and chronic pain where it still beats the alternative.

Apparently you get SSRI withdrawal from normal prescribed use. And its not surprising if you consider how long people have to take antidepressants.

I am a bit shocked, that something as commonly prescribed as SSRI have such severe withdrawal symptoms from normal use. Of the top of my head, i dont know of many kinds of prescription drugs that cause a withdrawal once you finish your regiment.

You view of these things don't converge with my experiences at all. The flue-like 'withdrawal' from ssri's is not nice, but it is peanuts compared to drugs with a misuse potential like opioids. Opioids rewrite your brain's reward system, the withdrawals are excruciating, and your former addiction will be a part of you for the rest of your life.

As I wrote having first and second hand experience with both kinds of withdrawal I think talking the danger of opioids down while talking ssri's up is wrong and dangerous.

And I think its wrong and dangerous to lump together the side effects of opiod miss use and the side effects from proper prescribed regiments. By all means, Opiod miss use is dangerous. Nothing new here, we as humanity have known that for centuries by now. But I think its only reasonable to point out, that withdrawal being an expectable side effect of a SSRI regime is extremely scary. That there is a insane panic about even medical use of Opiods while no one blushes an eye about that kind of severe expectable side effects is worrying.

Sure they are not comparable in risk, but the hurdle for a SSRI prescription is also quite a bit lower then the one for Opiod prescription.

Opiates kill[1], and are used recreationally. Those are two big differences.

[1] SSRIs _can_, but rarely https://www.ncbi.nlm.nih.gov/pubmed/9786310

Opiates can kill if used wrong. And yes they are used recreational, the big problem occur when they are not used as prescribed.

SSRI apparently has a withdrawal problem even with proper usage

But SSRI's don't have as much of an abuse problem - there's not immediate feedback that makes you want to take more SSRI's - at best you feel "normal" and "numb in a different way" with a side order of sexual dysfunction. Nobody is going to street vendors for that.

Opiates have a withdrawal problem with proper usage (as a long term user of prescribed opiates, I am frequently warned of this).

I was super depressed until I discovered Ketamine, so I took my credit card and started getting Ketamine sessions which costs roughly 600 dollar per session.

I was shocked to see how much it benefited me for chump change sum of 600 dollars.

SSRIs never worked for me to begin with. I did many other illegal drugs like Amphetamine, Weeds, Meta amphetamine they helped but only in short term.

How long does one "ketamin session" work? Is it normal for this to be so expensive?

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