I don't think Scott Alexander's page is a 'relatively objective resource'. He is, as you point out, a 'psychiatrist who regularly prescribes them' and also used to take them. It is full of special pleading where he relitigates extremely high quality meta-analyses to overlay his own opinion:
> That is, there are a bunch of tests that ask you a bunch of questions about your feelings and symptoms, and you can add them up and call that a “depression score”, and if you do that, antidepressants have an effect size of 0.3. Or you can ask patients “how depressed do you feel on a scale of 1-10”, and if you do that, antidepressants have an effect size of 0.5. I think the latter is better, because it’s what we actually care about (how patients are doing), and the tests are kind of dumb and ask about a lot of symptoms most people realistically aren’t experiencing.
(In other words, if you ask a patient with depression how they are feeling, and they say 'great', and then you ask them questions like "are you managing to shower every day", or "did you think about suicide a lot this week" and they give the same answers as a depressed person, they are cured!)
Does weird napkin math which clearly can't be justified:
> For those people, they will have a large real effect size of 1.0, plus a large placebo effect size of 0.9, for a very large total effect size of 1.9.
(How do you get to add the placebo effect back on to the postulated 'large real effect size'??)
Says that extremely common side effects are 'very unusual':
> It can be any or all of decreased libido, difficulty orgasming, difficulty getting an erection, difficulty enjoying sex, or decreased sensation in the genitals. These usually go away a few weeks to months after stopping the medication, but in rare cases they might linger for months or years, and there are a few people who say their sexual side effects never went away. These cases are very unusual and still not well understood.
(Note that in the same article he points out that, in general, the medication only improves mood or anxiety while you keep taking it, when you stop taking it you still have the depression or other conditions. So the fact that sexual disfunction usually gets resolved after stopping taking the medication isn't much relief. For most people SSRIs will never lead to a steady state where you are stable with regards to your mental health issue and also are able to enjoy sex.)
Makes armchair psych connection between well-studied things which are not the same:
> When everything goes right, SSRIs blunt negative but not positive emotions. But many people even at reasonable doses will notice that their most extreme positive emotions become a little less extreme (this may be part of the problem with sex).
(Difficulty getting aroused or orgasming or feeling in the mood for sex is not the same as "most extreme positive emotions becoming a little less extreme")