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Comment by acchow | Hacker News Reader

> SSRIs, are pretty terrible

They're terrible for some people, but they work well for others. I don't think they should automatically be disregarded.

> In the worst case, they cause suicidal ideation

Is this actually true? My understanding is that people in severe depression can have suicidal ideation but not actually be able to put in the effort/energy needed to go through with it. SSRIs initially give you a little more boost in energy before the mood-lifting effects kick in. During that middle phase, we observer higher suicide rates because you've now enabled them to have effort to follow through with their suicidal ideas.

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> Is this actually true?

GlaxoSmithKline paid the Department of Justice $3 billion for covering up evidence of this while promoting their SSRI to under-18s. They paid the fine in 2012, 11 years ago. The medical trial was done in 1994-1998.

In 2003, the (UK medicines regulator) MHRA obtained full clinical data from Glaxo, and based on that data forming robust evidence of significant increase in suicidality, both the MHRA and the FDA immediately said that paroxetine couldn't be prescribed to under-18s.

The UK govt rules on how to report medical trials were changed in relation to what happened with the publication of the Glaxo Paxil trials.

GSK paid around $1 billion in the 2000-2010s to settle several hundred lawsuits, including many many suicides and several family annihilations.

The main investigative news TV show in the UK, Panorama, reported on this in 4 shows between 2002 and 2007.

The Boston Globe did significant investigative work on this around 2005, including a book published by their reporter.

In view of that, your question comes across as at best, uninformed and naive.

Here’s a link with more info on this from the Justice Department: https://www.justice.gov/opa/pr/glaxosmithkline-plead-guilty-...

Sometimes I feel foolish for being skeptical about safety claims for food additives/cosmetics/pharmaceuticals/etc, then other times it feels completely rational.

I took Sertraline (one kind of SSRI) to treat anxiety, never had depression. No panic attacks anymore, sexual drive was still good, after 3 months I felt superhuman and like my life changed, 3 months after that the suicidal ideation started. I thought it was something I could power through, so I gave it another three months before it became unbearable, and I couldn't book an appointment with my treating doctor for another two months so I quit cold turkey. The withdrawals were so terrible, I was basically a zombie for two weeks. Took me a few months until I felt like myself again.

I no longer experience anxiety to the same degree I did back then, no use of other SSRIs or any other drugs.

This isn't meant to scare people into not trying SSRIs, just sharing my experience. I think had I been more informed of the potential risks and changed my attitude of toughing it out, it could've probably been more beneficial.

I found that dosage of Sertraline made a notable difference for me. Too high a dose would get me in a hypomanic state. That may be where you were at when feeling superhuman. But mania can't last forever and is inevitably followed by a low.

Stopping cold turkey was bad news for me, too. I got the "zaps" any time I turned my head. So, I decided to taper down, which worked fine.

I had exactly the same side effect when turning my head, and 150 mg would also make me agitated. Also, my vision worsened a bit. But without sertraline, depression wouldn't have gone away, so the drawbacks were worth it.

> Is this actually true? My understanding is that people in severe depression can have suicidal ideation but not actually be able to put in the effort/energy needed to go through with it.

It seems like you forgot the word "ideation" is in the original claim you're disputing, based on your description. Yes it is true that SSRIs can cause suicidal _ideation_. And the first step to suicide is suicidal ideation.

I have noticed ssri withdrawal causes suicidal ideation but not enough to go through with it. It's like it causes the thoughts but not the action from thoughts.

That’s excellent to hear that for you personally, the ideation did not become reality. However, suicide starts with ideation, so any suicidal ideation must be taken as a potential precursor to suicidal, even if in the end it might not actually progress.

You can only know how bad it was in retrospect.

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