A doctor said this and it was such a good metaphor: imagine that you have a 3000 year old machine (which no one understands anymore) with a bunch of cogs and gears, and you’re looking down at it from above. You’re trying to fix a gear that is slightly out of alignment further down in the machine, you can’t really tell which one it is but you know roughly which area, and to fix it you drop a rock into the machine and watch it fall down.
That’s what we’re doing with SSRIs. We’re dropping a rock that manipulates our serotonin, which gives a bunch of effects but not the one we’re after. The one we’re after is somewhere down the line. It’s affected by processes that are affected by the serotonin somehow. We’re not exactly sure which one it is, but we know that if we drop the rock in there it will make the gears align sooner or later.
Which is why it takes time, and why it has some odd effects on people sometimes.
edit: added a detail I missed, to make it clearer.
That’s a good metaphor! I’m not sure about the rock though, throwing a rock into a complicated machine doesn’t seem like the best idea. I’d consider replacing it with oil, where it needs to cover the gears at the top first before it can drip down.
Yes! That’s the point of the metaphor! The SSRI is the rock. We’re not exactly sure how it’s gonna land, or what it’s total effects are on the machine, but it’s the tool we have and it’s the one we’re using. I don’t remember where I heard it, but I instantly understood why I became so paranoid all those years ago when I tried antidepressants.
edit: and that doesn’t mean that a person shouldn’t try using them. They can be incredibly effective. But they are what they are. Not a quick fix, and (to most people) not a long term solution.
SSRIs are the most effective means we have in terms of medication. That doesn’t mean that they’re the solution. They’re a short term stop gap. The changing of routines and everything that goes on in appointments with psychologists is supposed to be the oil. Many times however that oil isn’t used.
Other than that we can only hope that we figure out some better tool for the job.
Some doctor told my dad a while ago that he felt like we weren’t that far off from physically poking around in a mind and hoping that we fixed it- or that we’re closer to that than understanding it.
It’s an old and second hand story. I do appreciate the idea though that we’ve found ways to disrupt the mind that can be beneficial, but that we’re not at the level of being able to do more than throw a cog in the works in a general direction.
For me it makes it easier to accept when the first - or second thing does work. We’re just trying things. It’s not like we know what is gonna unclog the works.
This is getting pretty deep into a metaphor. Sorry
but having a proper solution would make selling meds for a long time harder!
weed has many medicinal effects, and yet it’s illegal in most places
LSD has many medicinal effects, and yet it’s not even allowed to be studied in most places! There’s so many stories out there saying how psychedelics outright cured someone’s depression or anxiety, but no proper in depth studies on them.
I think it’s because nobody is really looking for a cure, well, I bet a lot of doctors want to but sadly they depend on funding & legality of their research. The only way for them to do any studies is to get money from the money men & a permission from the goverment (also ruled by the money men), and since they’re trying to look into claims like “one dose of this cheap to make drug cured me of depression!” then the best business decision is to say “fuck off”
I enjoy exploring altered states of being and the first time I tried LSD, after maybe a week or so, I discovered I was suddenly capable of saying no to people. Before that I’d sacrifice my own wellbeing just so I could help another person with something minor. During the LSD trip I remember seeing myself in my mind and the other me told me “love yourself more”.
This is one account of hundrets, if not thousands, of ones similar to mine. LSD (and psychedelics in general) most certainly has properties that can be incredibly beneficial for mental health.
Per weed it helps you chill out lol, not much to say here, it’s alcohol lite but without being physically addictive. Wonderful for anxiety, just not long term most likely.
This is all awesome but any mind altering substance really needs to be used with a therapist when we are talking about average people in a large population. I’d also argue they both have benefits but their drawbacks are just too strong.
Weed is mostly non addictive but comes with other issues and isn’t perfect. Heart issues? Family history of schizophrenia? Either of those could be really bad. Is this a good argument for legalization and harm reduction? Yes. I’m not sure about widespread psychiatric use though. Perhaps more with a therapist but that therapist would be key - similar to the shamans of indigenous cultures.
I also totally agree with these not being long term. I love weed but the “420 smoke every dayyyyyyy” culture also ignores the need to work on yourself and do the work with a clear head. I think that internal (ideally drug free and sober) work gets you to the point of not only benefitting from these drugs but avoiding their abuse.
Oil doesn’t fix alignment of gears. Ideally, you need to precisely go in and realign the exact gear. But we don’t have that power. So we’re throwing rocks.
Friendly reminder that sexual side effects of SSRIs are incredibly common, some medications effect more than one in four, but it is something that’s typically wildly underreported unless the practitioner brings it up, specifically, first. Not just “any side effects”.
There are multiple treatment options for people who encounter those side effects. They can range from poor libido/drive, to inability to obtain an erection or adequate vaginal moisture, to delayed or absent orgasm. All are common and all are frustrating. All can occur alone or with one or more partners.
If it’s impacting treatment or quality of life or your ability to stay compliant with meds, it’s absolutely worth discussing with your provider. There are other medications or alternative schedules to taking SSRIs. There are other meds that can be prescribed alongside SSRIs to accommodate for the side effects.
There’s other antidepressants that don’t do that. Mirtazapine for instance helps sleep, and has no real impact on sex. It’ll make you hungry, though. Buproprion will mess with your sleep but not sex, but you’ll have no appetite. They all have their own unique collection of side effects, well worth looking into other options if SSRI’s aren’t well tolerated
I totally understand that this is a necessary process for anti depressants but damn it sounds scary as fuck. “Eat these brain chemicals and come back and see us in a couple weeks”
“How does it work?”
“Fuck if I know it’s kind of like throwing a rock at an old machine. Just make sure you let me know if you experience any of the long extensive list of potential side effects!”
Like damn im for sure not a doctor but that sounds like russian roulette with brain pellets to me. If Ecstasy (which was invented by a pharmacutical company to be medication) can permanantly fuck up your brain I would bet money that these pills certainly do the same. I bite my tongue anytime someone mentions they are considering it or talking to a doctor about it, their choice. But man it scares the fuck out of me. Ill just continue to sleep all the time and stay angry lol
SSRIs definitely work for some people. It’s just that everyone’s brain chemistry is extremely different and complex. Doesn’t make it less scientific. Making the best guess is math and science.
I would say it even works for many people. We’re aware of the fact that it works, and we’re aware of the fact that it effects serotonin. We also know that serotonin isn’t what does the work. There’s something down the line that is affected by the processes of the body that just happens to react in the chain from the serotonin manipulation.
But all the other things that are affected in that chain can also do weird stuff to you if you’re unlucky. That’s why it’s important to have good communication with your physician during the process.
This is one thing where so many people I talk to got unlucky. For me, SSRIs were super lucky in that they helped alleviate depression caused by my anxiety which then helped me find other roots of the anxiety. Turns out undiagnosed ADHD is terrible for your anxiety - got diagnosed though!
Side effects for me have included stomach issues and weight not coming off even as my physical condition improves as I’ve started running again. I’ll take it for now until I start weaning off in the future. I wouldn’t say they were a lifesaver but they helped immensely.
I always recommend trying it if the doctor recommends it (and if you want it) even though I was unlucky and turned paranoid three pills in. I stopped taking them and it was over in a couple of days. So many people get helped by them and never say a word. People you and I wouldn’t ever assume were on them.
SSRIs were super lucky in that they helped alleviate depression caused by my anxiety which then helped me find other roots of the anxiety
You hit the nail on the head.
SSRIs are terrific at clearing some of the noise and making you more receptive to other therapy (namely talk therapy) and striking at the root of what’s causing the issue. I wouldn’t have even thought about talking to a therapist a year ago and it’s been revolutionary understanding my behaviors (especially those that I learned in childhood) and how I’m inadvertently passing them down to my kids.
Consequentially I’ve also been more aware of my wife’s behaviors and how she’s passing them down to the kids and she’s not quite as receptive to the criticism as I’ve been.
It really is eye opening to have a good long conversation about what’s troubling you with someone who understands the intricacies of how the mind works and how it pieces things together.
For classical antidepressants
Chemicals tend to function pretty fast but the effect is designed to be subtle because you need to live a normal life, capable of dealing with and feeling both ups and downs. not be perpetually smiling or brain dead.
After some time “a few weeks” of taking a daily dose your body and mind adjust to the subtle changes causing a stable therapeutic effect. At least thats what I understand is the idea.
But lately there is also sm of a psychedelic renaissance of medicine and they work entirely different where a single dose within a therapeutic setting creates a longer lasting feeling of increased well being.
Nasal Ketamine seems to receive allot of attention, near instantly improving the condition. They tend to need 1 dose every 5 weeks so its less addictive then classic medicine. But i do admit it instant improvement for treatment resistant medications is a bold claim and still subject of more research.
The side effects can last for weeks. It’s like a really shitty onboarding process. For some, the side effects are not bad. Personally I can say that the first 2 to 4 weeks are usually filled with nausea, extreme fatigue and exhaustion.
The way that these sorts of meds have been described to me is that “they give you a leg up”, meaning it gives you just enough of a “boost” that you might actually follow through on therapy and the strategies it offers.
It has been years now, and still no luck. I’d love to live a normal life, whatever the fuck that means lol
It depends on what you mean by “start working.” The first time I took a sertraline, I felt absolutely baked, but I feel like it took weeks for the desirable effects to take hold.
Then again, my doctor also told me that something like 60% of the effects are a placebo.
Regardless, yes, he would give me like a month of these individal samples at a time. I’m not sure how he swung that. It was like 2003 or 2004.
Don’t antidepressants take weeks to start working?
A doctor said this and it was such a good metaphor: imagine that you have a 3000 year old machine (which no one understands anymore) with a bunch of cogs and gears, and you’re looking down at it from above. You’re trying to fix a gear that is slightly out of alignment further down in the machine, you can’t really tell which one it is but you know roughly which area, and to fix it you drop a rock into the machine and watch it fall down.
That’s what we’re doing with SSRIs. We’re dropping a rock that manipulates our serotonin, which gives a bunch of effects but not the one we’re after. The one we’re after is somewhere down the line. It’s affected by processes that are affected by the serotonin somehow. We’re not exactly sure which one it is, but we know that if we drop the rock in there it will make the gears align sooner or later.
Which is why it takes time, and why it has some odd effects on people sometimes.
edit: added a detail I missed, to make it clearer.
That’s a good metaphor! I’m not sure about the rock though, throwing a rock into a complicated machine doesn’t seem like the best idea. I’d consider replacing it with oil, where it needs to cover the gears at the top first before it can drip down.
Yes! That’s the point of the metaphor! The SSRI is the rock. We’re not exactly sure how it’s gonna land, or what it’s total effects are on the machine, but it’s the tool we have and it’s the one we’re using. I don’t remember where I heard it, but I instantly understood why I became so paranoid all those years ago when I tried antidepressants.
edit: and that doesn’t mean that a person shouldn’t try using them. They can be incredibly effective. But they are what they are. Not a quick fix, and (to most people) not a long term solution.
deleted by creator
SSRIs are the most effective means we have in terms of medication. That doesn’t mean that they’re the solution. They’re a short term stop gap. The changing of routines and everything that goes on in appointments with psychologists is supposed to be the oil. Many times however that oil isn’t used.
Other than that we can only hope that we figure out some better tool for the job.
it’s the best thing we’ve got. and honestly, it ain’t that bad
personally the first week it fucked me up but after that, life changing effects. truly life changing.
Some doctor told my dad a while ago that he felt like we weren’t that far off from physically poking around in a mind and hoping that we fixed it- or that we’re closer to that than understanding it.
It’s an old and second hand story. I do appreciate the idea though that we’ve found ways to disrupt the mind that can be beneficial, but that we’re not at the level of being able to do more than throw a cog in the works in a general direction.
For me it makes it easier to accept when the first - or second thing does work. We’re just trying things. It’s not like we know what is gonna unclog the works.
This is getting pretty deep into a metaphor. Sorry
puts conspiracy hat on
but having a proper solution would make selling meds for a long time harder!
weed has many medicinal effects, and yet it’s illegal in most places
LSD has many medicinal effects, and yet it’s not even allowed to be studied in most places! There’s so many stories out there saying how psychedelics outright cured someone’s depression or anxiety, but no proper in depth studies on them.
I think it’s because nobody is really looking for a cure, well, I bet a lot of doctors want to but sadly they depend on funding & legality of their research. The only way for them to do any studies is to get money from the money men & a permission from the goverment (also ruled by the money men), and since they’re trying to look into claims like “one dose of this cheap to make drug cured me of depression!” then the best business decision is to say “fuck off”
while what you say totally stands in capitalism, lsd and weed are probably quite bad ideas.
i think.
I enjoy exploring altered states of being and the first time I tried LSD, after maybe a week or so, I discovered I was suddenly capable of saying no to people. Before that I’d sacrifice my own wellbeing just so I could help another person with something minor. During the LSD trip I remember seeing myself in my mind and the other me told me “love yourself more”.
This is one account of hundrets, if not thousands, of ones similar to mine. LSD (and psychedelics in general) most certainly has properties that can be incredibly beneficial for mental health.
Per weed it helps you chill out lol, not much to say here, it’s alcohol lite but without being physically addictive. Wonderful for anxiety, just not long term most likely.
This is all awesome but any mind altering substance really needs to be used with a therapist when we are talking about average people in a large population. I’d also argue they both have benefits but their drawbacks are just too strong.
Weed is mostly non addictive but comes with other issues and isn’t perfect. Heart issues? Family history of schizophrenia? Either of those could be really bad. Is this a good argument for legalization and harm reduction? Yes. I’m not sure about widespread psychiatric use though. Perhaps more with a therapist but that therapist would be key - similar to the shamans of indigenous cultures.
I also totally agree with these not being long term. I love weed but the “420 smoke every dayyyyyyy” culture also ignores the need to work on yourself and do the work with a clear head. I think that internal (ideally drug free and sober) work gets you to the point of not only benefitting from these drugs but avoiding their abuse.
Oil doesn’t fix alignment of gears. Ideally, you need to precisely go in and realign the exact gear. But we don’t have that power. So we’re throwing rocks.
“the rock may or may not cause the inability to cum and sleep”
Friendly reminder that sexual side effects of SSRIs are incredibly common, some medications effect more than one in four, but it is something that’s typically wildly underreported unless the practitioner brings it up, specifically, first. Not just “any side effects”.
There are multiple treatment options for people who encounter those side effects. They can range from poor libido/drive, to inability to obtain an erection or adequate vaginal moisture, to delayed or absent orgasm. All are common and all are frustrating. All can occur alone or with one or more partners.
If it’s impacting treatment or quality of life or your ability to stay compliant with meds, it’s absolutely worth discussing with your provider. There are other medications or alternative schedules to taking SSRIs. There are other meds that can be prescribed alongside SSRIs to accommodate for the side effects.
Relevant article from Journal of Clinical Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6832699/
There’s other antidepressants that don’t do that. Mirtazapine for instance helps sleep, and has no real impact on sex. It’ll make you hungry, though. Buproprion will mess with your sleep but not sex, but you’ll have no appetite. They all have their own unique collection of side effects, well worth looking into other options if SSRI’s aren’t well tolerated
Thanks. I’m just making jokes. Fortunately most of my side effects went away, although I still have wild dreams.
I totally understand that this is a necessary process for anti depressants but damn it sounds scary as fuck. “Eat these brain chemicals and come back and see us in a couple weeks”
“How does it work?”
“Fuck if I know it’s kind of like throwing a rock at an old machine. Just make sure you let me know if you experience any of the long extensive list of potential side effects!” Like damn im for sure not a doctor but that sounds like russian roulette with brain pellets to me. If Ecstasy (which was invented by a pharmacutical company to be medication) can permanantly fuck up your brain I would bet money that these pills certainly do the same. I bite my tongue anytime someone mentions they are considering it or talking to a doctor about it, their choice. But man it scares the fuck out of me. Ill just continue to sleep all the time and stay angry lol
Sure, but that’s a lot medicine. We know it works, just not why. We know why many things work and how, but far from all of them.
They’re really not that scary, as long as you take your prescription as instructed and have regular contact with a physician.
This is a great metaphor for why psychiatry is pseudoscience
SSRIs definitely work for some people. It’s just that everyone’s brain chemistry is extremely different and complex. Doesn’t make it less scientific. Making the best guess is math and science.
I would say it even works for many people. We’re aware of the fact that it works, and we’re aware of the fact that it effects serotonin. We also know that serotonin isn’t what does the work. There’s something down the line that is affected by the processes of the body that just happens to react in the chain from the serotonin manipulation.
But all the other things that are affected in that chain can also do weird stuff to you if you’re unlucky. That’s why it’s important to have good communication with your physician during the process.
This is one thing where so many people I talk to got unlucky. For me, SSRIs were super lucky in that they helped alleviate depression caused by my anxiety which then helped me find other roots of the anxiety. Turns out undiagnosed ADHD is terrible for your anxiety - got diagnosed though!
Side effects for me have included stomach issues and weight not coming off even as my physical condition improves as I’ve started running again. I’ll take it for now until I start weaning off in the future. I wouldn’t say they were a lifesaver but they helped immensely.
I always recommend trying it if the doctor recommends it (and if you want it) even though I was unlucky and turned paranoid three pills in. I stopped taking them and it was over in a couple of days. So many people get helped by them and never say a word. People you and I wouldn’t ever assume were on them.
You hit the nail on the head.
SSRIs are terrific at clearing some of the noise and making you more receptive to other therapy (namely talk therapy) and striking at the root of what’s causing the issue. I wouldn’t have even thought about talking to a therapist a year ago and it’s been revolutionary understanding my behaviors (especially those that I learned in childhood) and how I’m inadvertently passing them down to my kids.
Consequentially I’ve also been more aware of my wife’s behaviors and how she’s passing them down to the kids and she’s not quite as receptive to the criticism as I’ve been.
It really is eye opening to have a good long conversation about what’s troubling you with someone who understands the intricacies of how the mind works and how it pieces things together.
Yes and no, also i am not a medical professional.
For classical antidepressants Chemicals tend to function pretty fast but the effect is designed to be subtle because you need to live a normal life, capable of dealing with and feeling both ups and downs. not be perpetually smiling or brain dead.
After some time “a few weeks” of taking a daily dose your body and mind adjust to the subtle changes causing a stable therapeutic effect. At least thats what I understand is the idea.
But lately there is also sm of a psychedelic renaissance of medicine and they work entirely different where a single dose within a therapeutic setting creates a longer lasting feeling of increased well being.
Nasal Ketamine seems to receive allot of attention, near instantly improving the condition. They tend to need 1 dose every 5 weeks so its less addictive then classic medicine. But i do admit it instant improvement for treatment resistant medications is a bold claim and still subject of more research.
The side effects can last for weeks. It’s like a really shitty onboarding process. For some, the side effects are not bad. Personally I can say that the first 2 to 4 weeks are usually filled with nausea, extreme fatigue and exhaustion.
The way that these sorts of meds have been described to me is that “they give you a leg up”, meaning it gives you just enough of a “boost” that you might actually follow through on therapy and the strategies it offers.
It has been years now, and still no luck. I’d love to live a normal life, whatever the fuck that means lol
It depends on what you mean by “start working.” The first time I took a sertraline, I felt absolutely baked, but I feel like it took weeks for the desirable effects to take hold.
Then again, my doctor also told me that something like 60% of the effects are a placebo.
Regardless, yes, he would give me like a month of these individal samples at a time. I’m not sure how he swung that. It was like 2003 or 2004.