Sorry, what does this have to do with the study? Obviously reuptake inhibitors save many lives and you're acting like they're all unusable. As a doctor, isn't this irresponsible?
He says that a) yes there are many receptors which will be triggered by the same drug at the same time, so it can have a variety of effects, b) it's possibly not worth it to take it as a preventive measure. That doesn't mean he says it shouldn't be taken to cure or at least manage debilitating disorders like depression. Cost vs benefit.
The discussion of costs/risks of treatments is usually what's missing in the casual conversations about drugs. Ketamine or psylocybin are probably the best examples in the tech community, yes they can sometimes cure a depression, or at least suppress it for a while, but they can also cause psychosis (and other non-psychiatric symptoms), so they are used only after safer options fail.
Although I'm not sure I get the concern here, sepsis is very life threatening, so paying SNRI-level risk for prevention doesn't seem like an outright bad idea. Unless the idea would be for random people to start using this drug just in case they get stabbed and go septic - then I would say this is not a good idea. But I don't think this is what the paper describes.
That wasn't my takeaway at all. As someone who's been on the receiving end of various SSRIs for big chunks of my adult life their analogy seems pretty on-brand compared to the experience of taking SSRIs. They fuck with so many things that aren't the problem at hand it beggars belief. Anyway, if anything my takeaway was confirmation of my suspicion that SSRIs are the polar opposite of targeted therapeutics.
Usually they fuck with something like extra sweating or a little trouble sleeping. Severe side effects are very rare, they are widely used because they are so well tolerated. My own anecdote is: most elderly people should be on Cymbalta because they live in so much pain. I've been offered Prozac for chronic pain, I bet it would help them too. Boomers suffer needlessly. Get them on Prozac, please.
The point is that SSRIs (and reuptake inhibitors in general) are extremely crude. It's like using a dull rock instead of a scalpel, or full body radiation to remove a mole on your hand. They have a lot of secondary and tertiary effects we don't understand, nor do we truly understand the primary mechanism.
We don't know exactly what these drugs do to the body, how they do it, or what the consequences really are.
They have good outcomes for a small section of the population and that's about all we know.
One could argue that over-prescription of such a poorly understood class of drug is far more harmful.
