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Comment by sillysaurusx | Hacker News Reader

Whatever else is true, in my personal life a dose of Prozac completely transformed me from who I was to who I am. It took months, and it was a gradual change, but pretty much everyone in my life universally noticed the difference.

Me most of all. I haven’t had intense thoughts for years, whereas they were a daily occurrence before.

I started in 2016, and can safely say I’d be a worse person without it. I only wish I’d started when I was 17, but unfortunately my mom had the brilliant idea of slipping me antidepressants while saying they were something else, which made it rather hard to trust anything to do with antidepressants. I imagine people here have different horror stories that make it hard to just try them for a few months.

There may be no clear evidence that they work, but they do something for me. What do they do, if not work? It produced a positive outcome which wasn’t placebo.

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"I imagine people here have different horror stories that make it hard to just try them for a few months."

Post SSRI sexual dysfunction. SSRIs cause decrease in sexual function for most people who take them while they're on them, but for some, it's permanent. There is no effective treatment, you are stuck sexually dysfunctional for the rest of your life.

Doctors do not warn you this is a possibility. Just bam, no warning, life ruined forever.

I take Sidenafil for this which works for me, but I guess for other people it might be less effective.

Since we’re being honest, the only effects I’ve noticed are going soft after 20 minutes or so, and more difficulty finishing. Sidenafil helps with the former. As for the latter, it isn’t every time, and I don’t mind it much, but everyone’s different.

I think it’s important to address this issue head on though. The horror stories of sexual dysfunction were one reason I put off trying antidepressants. But (a) you’ll see the effects coming on gradually, (b) it’s not permanent, and (c) for me it wasn’t nearly as intense as people made it seem.

The whole point I'm making is that it is permanent. That's the whole issue I'm talking about here. It doesn't go away. Ever.

If yours goes away when you stop taking SSRIs, then you aren't suffering PSSD (post SSRI sexual dysfunction) in the first place.

Interesting. I hadn’t heard of PSSD.

From https://annals-general-psychiatry.biomedcentral.com/articles...

> A 19-year retrospective cohort analysis was conducted using a computerized database of the largest HMO in Israel. ED was defined by phosphodiesterase-5 inhibitors prescriptions. 12,302 males aged 21–49 met the following criteria: non-smokers, no medical or psychiatric comorbidities or medications associated with ED, no alcohol or substance use.

> SAs were associated with an increased risk for ED (cOR = 3.6, p < 0.000001, 95% CI 2.8–4.8), which remained significant after adjusting for age, SES, BMI, depression and anxiety (aOR = 3.2, p < 0.000001, 95% CI 2.3–4.4). The risk for PSSD was 1 in 216 patients (0.46%) treated with SAs. The prevalence of PSSD was 4.3 per 100,000.

4.3 per 100k is lower than the US murder rate (6.8 per 100k). You’re right that it’s a consideration, but it seems pretty rare.

It's saying the overall prevalence in the population from which the study group was drawn was 4.3 per 100k. The study cohort (young men who took SAs during the study time frame) was less than 1000 people, of whom 4 exhibited PSSD. So incidence within the studied group was around 100x the general population prevalence.

Fair, thanks.

> Out of the 866 subjects of the study group, four subjects (0.46%) met full case criteria for PSSD (see Fig. 1B). These subjects were 32, 34, 37, and 42 years-old. They used antidepressants with at least a partial serotonergic mechanism (escitalopram, paroxetine, imipramine, or nortriptyline) for 4–8 months before initiating treatment for erectile dysfunction with PDE-5 inhibitors (all used tadalafil and vardenafil, but not sildenafil). They continued to have erectile dysfunction after drug discontinuation as evidenced by 3.6–14.8 months of PDE-5 inhibitor treatment at the end of the study period. The prevalence of PSSD in males of ages 21–49 years of the population of the CHS Tel-Aviv district is 4.3 per 100,000 (4 in 92,476).

4 in 866 is pretty good odds, but everyone has different risk profiles. I’ll be sure to mention it next time Prozac comes up.

But… shouldn’t we compare with depressed people who don’t take SSRIs? Could this be a side effect of depression rather than the drug?

The people in question were depressed and not on SSRIs - they had libidos.

I got to watch in real time as my libido evaporated, immediately desisted the pills and yet...

Bullshit it's that low.

I say this as someone who kept his SSRI induced asexuality to himself for 20 years; I was ashamed and humiliated.

fuck. :D

I had three months of fluoxetine, and 20 years damned near asexual. I can't say it helped with the depression - but it sure helped add another layer of shame.

Zyban though, somehow that made girls pretty again.

And mushrooms dragged me back from a long bout of suicidality with a single dose.

> It produced a positive outcome which wasn’t placebo.

I just want to point out for understanding, that placebo effects are real effects; and even more surprisingly, they can work even if you know you are taking a placebo. It's completely legitimate to consider placebo effects part of the efficacy of a medication.

My understanding (I used to say the same thing) is that this is now understood to be false, and that placebos don’t affect objective indicators, only self reported perception, and that perception reverts to the mean over time with the placebo.

many medical complaints have no objective measure, like "how much" pain or "enough sleep". And if a sleep aid or painkiller has a reliable immediate palliative effect, in addition to its longer term effect, that's part of "the cure".

Per the article:

> For some commentators, the recent downfall of the chemical imbalance theory has cast doubt on the use of existing antidepressant drugs, which were meant to restore the lost serotonin. Yet the data certainly suggests that they work better than placebos – and the authors of these two new books can explain why. For Nord, it is because antidepressant drugs help to correct the fundamental biases in someone’s perceptions of the world. This change occurs incredibly quickly. People with depression are more likely to see anger, and less likely to see happiness, in neutral facial expressions – but in many patients, this tendency begins to disappear after they have taken just one antidepressant pill. Gold, meanwhile, points to studies showing that our current antidepressant pills encourage the birth of new brain cells and neural connections, which would help people to break free of the hyperactive stress response.

Damn. I've tried about 5 anti-depression meds + threapy so far and I still want to leap off a skyscraper... luckily(?) there's none in my area

Keep trying. I don’t want to give you false hope, but it’s entirely possible that you’ve just gotten unlucky for a variety of reasons.

It’s worth keeping in mind that long ago I was prescribed Prozac but didn’t take it consistently, so I didn’t notice any effect. It wasn’t until I did it every day for 60 days that I noticed changes. It’s like https://youtu.be/D8BZPAeCGEc?si=xjYSD9t5DprFfMRm but easier, since you just need to take a pill every day.

So keep consistent, and keep your head up. I believe in you.

thank you :)

some days are better than others I guess... lot of not so fun ones. that particular day was just a minefield I guess

I have something new to try though. So I guess it's something.

Try ketamine. It's been shown to work well for people for whom other things haven't worked (and for others).

Easily available online (at the moment) through telemedicine from places like this one https://www.joyous.team/ (no affiliation) that charges $129/mo.

My psych was against it, saying he's tried it with a couple of patients but 'the effects/benefits just go away'. Sadly I live in Canada so it looks like that one's out :(

It does sound interesting though.. maybe I should poke him a bit more about it.. thanks :)

Really sorry to hear this. I know it’s frustrating (I really do) but keep trying.

Over the course of 25 years I tried 42 different anti-depressants (practically all of them across all classes), atypicals, mood stabilizers, off-label Parkinson’s drugs, off-label anti-seizure drugs, benzodiazepines, you name it. Often multiple times (because time, age, etc) in incredible varieties of combinations, dosages, etc, etc.

The 43rd changed my life.

It’s rough, frustrating, and long but you need to keep trying keys until one (or more) fits the lock. Whether that’s these kinds of medications, ketamine, mushrooms, therapy, selling your worldly possessions and becoming a monk, whatever.

It doesn’t really matter how you do it - it’s life or death.

Oh wow! I'm glad you found something that worked :)

Yeah, off-label is something I hear a lot... and indeed it's super super frustrating

and thanks.. :)

Have you tried the prescription thyroid hormone supplement liothyronine (T3)? There’s some good evidence that it boosts the effects of antidepressants and may have antidepressant properties on its own.

interesting! I have had my thyroid tested and it's within range so nothing was offered, but I should ask my psych about it, thanks :)

> I haven’t had intense thoughts for years

Intense in both directions or only intensely negative?

Intensely negative. For what it’s worth, my scientific success came after I began Prozac, so it didn’t seem to affect creativity or chasing the highs of a breakthrough. If anything, it was easier to focus.

But again, everyone is different, and you should monitor your own condition along with your doctor and adjust dosage accordingly.

Will you have to take them for life?

Maybe, but I won’t mind. Everyone’s different and experiences different side effects, but for me personally the side effects were much more preferable to the way things were.

I know I can look it up but what are the side effects?

Some honest commentary is over at https://news.ycombinator.com/item?id=37490719

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