After 10 years on them, the next 6 months were absolute hell (i legit thought at one point I might go full Joaquin Phoenix in Joker) but I made it through, no small part thanks to my wonderful amazing wife.
Rebound depression have been an issue - though in general I feel like I am much better off without the antidepressants now than with them - and I've also noticed that pulling an all nighter would actually fix the rebounds for a bit. A small dose of melatonin before bed worked wonders for me now. I sleep better and the rebounds are extremely rare.
This is especially true if you are at risk for withdrawal, they will want to prevent that.
There are many drugs a GP can prescribe that are just as dangerous or more so.
There is a reason SSRI are schedule 4 and not schedule 2 . They cannot kill you the same way [1]
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[1] While there is a lot of politics in the classification and putting weed or LSD in schedule 1 is very questionable the list is generally medically accurate.
I wouldn’t advocate you get a prescription for antipsychotics from your orthopedist, but SSRIs from a GP is probably pretty safe.
Obviously, it depends on the doctor and the symptoms. But a good GP will also refer you out to a specialist when needed. That’s a big part of their job: assessing when to call in a specialist.
I can't even believe I'm having to defend this position in front of this crowd, but now many GP's dismissed the symptoms of women's post-partum depression before it become a topic of mainstream discussion on television talk shows? Doctors are not perfect and are not free from various biases, and having had experience with your particular condition is invaluable to you.
Weird example given you're arguing against GPs prescribing antidepressants because patients may lie.
And I'd like to see someone lying to get SSRIs out of all the possible choices.
You're arguing like something as at stake for you or you have bone to pick, I'm saying very generic anodyne things, i'm arguing for sober reasonableness.
More broadly, in rural settings specialists are often impractical to access. So, the best possible standard of care is effectively off the table.
> I'm saying very generic anodyne things, i'm arguing for sober reasonableness
You're saying vague things that are roughly as controversial as "water is wet" when read literally, but are out of place and tone-deaf in the context of above discussion.
Just be honest: tell your GP that your previous provider quit/retired/changed insurance. Bring your prior RX bottles or paperwork. Let them know you have an appointment with your new provider on X date and ask them to cover you until then.
I've done this when changing insurance (twice) and when moving states (New provider had a waitlist. First time she wrote one month then when I reported the waitlist situation she ended up covering it for 3-4 months).
My parents live on a fairly highly populated island, and the only doctor decided to leave. No new one is allowed to move in to serve the population until the government gets around to setting that up. It will probably be a year or more of thousands of elderly people having no medical care at all.
I explained on the phone that in the US, this demand and lack of supply would quickly sort itself out by someone moving in and setting up. Being a certified MD in the state is all they'd need. This was mind-blowing to my socialized-medicine parents.
After that was when I ended up cold turkey because I lost my doctor and psychiatrists during a big move and couldn't get a refill at any clinic in the new town.
It ended up working out, but it took about a year of absolute torture and probably about another year of just "weirdness". But these days I'm "normal" and off the drugs and never been happier.
I can't prove it, but even dumb teenage me felt instinctively that extreme sleep deprivation was likely to take a long and possibly permanent toll. I don't think anything that extreme can really be practiced in moderation, because it's more like taking heroin than eating too many cakes, etc., i.e., it's not a 'granular' indulgence.
I would hesitate to call this a hot take on my part, since I am guessing that in that period of my life, I probably stayed up for two days on several hundred occasions, if not more.
For anyone else suffering from severe depression, this is an easy answer, maybe; but there are better easy answers than this. Cannabis (I am not a partaker since I was an student) would be better than this.
Really, do anything but this. It's not 'free'; nothing that works is free.
I hate being dependent on a doc. Try to reduce this horrible risk by going up and down on dose to get a little stock pile to feel a bit safer.
But changes little I guess
Going cold turkey was absolute hell, but it worked out well for me because of my excellent support system.
Would not recommend at all for anyone else though, absolutely not: tapering with a doctor is 100% the best course of action.
The real reason SSRIs are so popular is that they work (not always, but often to some extent) and for depression it's much cheaper to make a pill than book a therapists time
They're a preferred treatment because they're usually effective and they're far safer than other medication classes for depression.
[edit] Doctors note that the difference between antidepressants and placebo isn't clinically significant. They do something, but not much which is why the revival and breakthrough drug designation of psychedelics in the treatment of - especially major - depression is so exciting.
You can find articles and reviews that play games with statistics, cherry pick studies, and use various thresholds for effect size to try to downplay it, but they do work for a lot of people.
> While early trials showed a big difference between antidepressants and placebos, more recent studies have significantly narrowed that gap.
The part you're leaving out is that the placebo effect is quite strong in studies for depression and even pain. It's misleading to say "barely better than placebo" without explaining that placebo works quite well in those studies.
Placebo effect is also getting stronger over time: https://bigthink.com/health/placebo-effect-worse/
I don't think they're contrarians and cynics although some undoubtedly are. They seem to be study authors. The fact is treatments, even broadly used ones, aren't always super effective. Sometimes they're just the only ones we have, and we as humans have a bias towards action being over inaction in medical care.
I may be contrarian and cynical in a lot of things, but modern medicine isn't one of them. I just like to be data driven.
> ... but they do work for a lot of people.
They work for most of those people just about as well as a sugar pill would, yes. Slighly better. There's a real mismatch in terms of public perception of how much better they actually work.
> Contrarians and cynics have been trying the "barely better than placebo" angle for decades, but antidepressants are indeed superior to placebo.
The study that I linked showing the 30%-40% numbers are from FDA data. There's no games played, the study authors got the FDA data by FIOA.
The fact that placebo effect is strong doesn't really mean much other than depression is something that you can treat through things like therapy, which the data shows is exactly as effective as antidepressants. A psychosomatic angle, even if that's not the right word. The desire to heal is sufficient to change the way you think about your situation, and that exists no matter what you're taking.
If taking your conclusion to an extreme, the placebo effect was exactly as strong as an antidepressant - or stronger - why wouldn't we just prescribe sugar pills instead? In fact since the delta between SSRIs and sugar pills is clinically insignificant - while SSRIs have tons of side-effects - why wouldn't we just prescribe sugar pills now? Does that mean sugar pills are effective against depression, or are SSRIs treating depression largely through placebo?
Putting it another way, the placebo effect doesn't treat punch biopsy wounds. [1]
Most people who take SSRIs and swear by them have had to try multiple of them to find one that works (usually very well) for them. A study that only looks at one drug will have a much lower rate of success than a study that looked at SSRIs as an entire class of medicine.
We know from the data that SSRIs work about as well as psychotherapy. We also know that SSRIs and psychotherapy work considerably better than either treatment alone. SSRIs don't work nearly as well as we'd like, they can cause significant side-effects, but they do deliver very important benefits for many patients and they're an important tool in the psychiatric arsenal with no adequate substitute yet. We need more and better treatment options, but we shouldn't unfairly denigrate the treatment options we have right now.
I don't mean to diminish anyone's lived experience, but I've always been slightly sceptical of claims about withdrawal effects of antidepressants. I suffer from TRD and have withdrawn cold turkey from maximum doses of several antidepressants with no ill-effects, but I didn't get any significant benefits when I was taking those drugs. If you stop taking a drug that was effectively reducing your depressive symptoms and you feel terrible, there's a fairly obvious explanation.
> but I've always been slightly sceptical of claims about withdrawal effects of antidepressants.
Even the manufacturers warn against discontinuation effects. See the "If you stop taking venlafaxine" paragraph here: https://www.medicines.org.uk/emc/product/764/pil#gref
The UK NICE has advice about stopping antidepressant meds: https://www.nice.org.uk/guidance/ng215 and the UK BNF will mention withdrawal for some meds: https://bnf.nice.org.uk/drugs/venlafaxine/#treatment-cessati...
The Royal College of Psychiatrists has advice about stopping anti-depressants: https://www.rcpsych.ac.uk/mental-health/treatments-and-wellb...
Clearly, it's not a problem that affects everybody, and it's more common with some meds than others, but that doesn't mean these effects are not real.
I think it's obviously true that someone might feel anywhere from "a bit weird" to "really quite unwell" for a couple of weeks after discontinuing an antidepressant. I don't know how effective GPs are in communicating that, but you're right that it's there in the patient information leaflet.
What I don't see as particularly plausible are the extremely long withdrawal syndromes reportedly lasting many months or years, or the extremely prolonged tapering regimes that involve tiny fractional doses. I cannot conceive of any plausible biological mechanism for these symptoms, or a plausible mechanism by which a tiny fraction of a clinically relevant dose might alleviate them. Prolonged post-withdrawal effects are reasonably common with GABAergic drugs, but the mechanism and mode of action of these drugs is radically different.
If someone has been taking 20mg of escitalopram, it's perfectly sensible to step down to 10mg and perhaps 5mg over a few weeks to allow their serotonin system to upregulate without too much drama. If they're a year down the line, they're taking 0.2mg and they feel suicidal if they miss a dose, I don't think there's a biochemical explanation for their symptoms.
That is indeed very cynical! However, it's not correct. SSRIs are actually much easier to quit than our previous generation antidepressants. The first "S" in SSRI stands for "Selective", meaning they more or less selectively work on the serotonin transporter. Older medications were less selective and worked on a lot of different systems, which often meant withdrawal was even more difficult as multiple different systems were in rebound all at once.
The older medications can be more effective for resistant cases, but due to the higher side effect profile and more difficult withdrawal they are second line treatment.
> They say "It can take up to a month for it to work" is just a way to make sure dependency is strong enough by that point to make withdrawal unbearable.
Quite the conspiracy theory.
But again, it's unfounded. SSRIs are known to take up to a month to work because the antidepressant effect is the result of a sequence of changes that happens over time. The brain has to arrive at a new equilibrium with medication, and the various systems and feedback loops don't immediately recalibrate.
The biggest flaw in the theory that “they” prescribe SSRIs to get people addicted is that most SSRIs are cheap. $4/month at Walmart cheap, or $10 every 3 months. The common ones are long off patent.
I hope nobody takes the parent comment too seriously. If you're suffering from major depression, don't let HN conspiracy theory comments scare you away from trying treatments that work well for many people (though not everyone, but you don't know if you don't try)
You need to right plan and support, but it’s worth it in my opinion.
Have you tried any trauma work or Transpersonal work?
It really isn’t sustainable…as I lost a really good job over it. Now I’m sticking to a schedule with 8 hours of sleep but I don’t ever get that “feel good” kick. Just perpetually drained and unmotivated.
Getting 4-6 hours of sleep generally won't do it. You really have to upset the whole system to trigger the effect.
Which is also why it's completely unsustainable. More of a novelty and research topic, not an actual treatment.
Sleep deprivation can be legitimately useful in crisis situations. Before the discovery of ketamine as a rapid-acting antidepressant, sleep deprivation was one of the only effective treatment options for an acutely suicidal patient. It doesn't solve anything long-term, but it can at least give the patient a bit of respite from their distress and perhaps engender a little hope.
Edit: I regret pulling focus off parent comment and OP, but also deeply appreciate everyone’s comments.
i.e. amongst non-psychoactive hemp flower there are relaxing indicas for insomnia, functional hybrids for chronic pain, sativas for a pick-me-up, etc.
I saw your other comment and am intrigued. What do you use to extract with? Ethanol? Glycerine? Link to the tek?
As to your other comment about pharma -- I'm a believer in the right tool for the job. "Natural" is always preferred but sometimes the lads in the lab can deliver results too.
I start by grinding the flower to small pieces, or use shake which is significantly less expensive and of similar quality, and matters less if your not gonna smoke it.
Next I take 3-3.5 ounces and cook it in the oven. I've tried a few different things. Mason jar or a Pyrex pan. I've done some smaller batches in the past, but now I do 4 ounces at once, a normal size mason jar doesn't usually fit everything. Ive used pickle jars and jalapeno jars which are larger and can fit everything. I heat the oven to 245, and put it in there for an hour, rotating and shaking it every 15 to 20 minutes. Don't cover the jar too tight, as it can explode from pressure. If you use a mason jar, you can use foil with the lid instead of the normal metal cap. I also use a temperature gun on my oven to check on it, many ovens will not be accurate.
I only cook 3 ounces because I keep the rest uncooked to use later. Heating the CBDa will turn it into CBD. You probably won't get everything converted, so there will be a little bit left. You'll keep some of the terpenes if you cover what your heating. Some people believe that the terpenes in cannabis, which give it flavor and taste, can be helpful. Personally, I believe that some of them may be helpful, but some of them are harmful, especially when inhaled. Helpful in the way that they could boost the effects or create strain specific effects.
Now to the uncooked 0.5-1 ounce, I keep that so I can have CBDa and a little THCa. It's commonly thought that you need to heat these acidic cannabinoids to make them useful, but this is not the case. The acidic version like CBDa and THCa have their own effects, such as a much more powerful anti inflammatory effect, stronger anxiolytic effects, and different serotonin effects. I would also like to add that normal CBD is excellent for blood pressure. If your goal is to get high, then youll probably want to turn your THCa into THC. Leaving some uncooked will also make the final product taste very strongly of the original strain, if your into that. There's another cannabinoid called CBGa, which is the precursor to CBD and THC, when the plant is growing it goes from the enzymes it produces, to CBGa, to THCa (or CBDa), the THCa will then degrade into THC, then finally into CBN. You could make your own CBN by heating THC for a long period of time. Another cool thing you could do is convert CBD into D8-THC with citric acid. I'll also note that CBG/a is supposedly good for your gut health, inflammation, and protects your brain. Ive taken higher doses of CBG, and experienced some irritability when taking it, but I can't confirm that it was from that, I'll have to experiment more in the future.
Now onto the next step.
Next I take all of the material in the jar, cooked and uncooked, and cover it with 95% food grain alcohol. I use this because it's safe to consume. I assume I can't get 100% of the solvent out later, and using isopropyl or butane would not be safe to consume. So I cover it, shake it up, and stick it in the freezer. Shaking it every so often. You could leave it in for a few hours or days, you might get a little more out. If you leave it for more than a few minutes, you'll get a lot of chlorophyll, which will make the final product very dark due to how light interacts with it. I put it in the freezer to try and reduce this a little bit, but it probably doesn't help too much, nor does it really bother me.
After letting it soak in the solvent, I take it out and strain it into a bowl using a nut milk bag, then transfer it to a beaker. Now here is where my process can definitely be improved. Currently, I put the beaker in a pot with a small amount of water, to evaporate off the alcohol. This is kind of wasteful, as you lose the alcohol after now. Instead, and in the future, I would like to set up a distillation apparatus so that I can catch all the evaporating alcohol to use again. I just haven't got the equipment yet.
Now you should let all the alcohol be removed from the solution. I keep it at about 120-150 degrees fahrenheit. When it's done, you'll have a small amount of black oil, 15 to 20 grams of pure concentrate. I assume the efficiency is about 85-90% from what we started with. But this isn't all, the oil that is now in the beaker is very thick, it's hard to get it out in its current form. So, take the amount of concentrate you have now, and subtract it from the final amount you want to have. I turn 4 ounces into a 60 ml bottle. Usually I have about 20 grams of concentrate. So Ill use 40 grams here. I have another measuring cup, I fill this with a mixture of MCT oil, grape seed oil, and sunflower lecithin. MCT oil vs grape seed oil is a choice you can make, some people's bodies don't react to MCT oil well (nausea, usually from large doses, 1+ tbsp at once, especially if you've never had it before). I use a combination of all three. The MCT may help with absorption into your body later as well as bind together in the final product better. The sunflower lecithin is an emulsifier, which will help your body absorb it when you take it. Use at least 1/3 sunflower lecithin. These 2 oils also can have positive effects on your health.
Now you take this mixture, and heat it up until it's homogeneous. Then dump that into the existing black oil concentrate while still heating it to dilute it to your desired dosage and overall amount. Carefully shake the beaker in a circlular motion to help mix it in. I estimate that with 4 ounces, you'll get about 250-350mg of cannabinoids per gram in the oil. That range depends on your starting material potency and amount.
Something else to mention is that eating cannabinoids provides a different effect than smoking them. Your body digests and metabolizes them differently. When it comes to THC, which there will be a small but notable amount of, especially if you have no tolerance, your body will turn it into 11-hydroxy-THC. Depending on your genetics and how well you absorb it (some people can't absorb edibles at all), it will be about 5x stronger than the same amount smoked, while lasting longer. If you don't want any THC, make sure what your getting has none or very little in it. Personally, I don't like taking pure THC strains anymore, but the tiny bit that does occur in CBD dominant hemp, does boost the overall effects in good way unless I take too much.
To respond to a few other things you said. Inhaling can have a different head space effect, yes. With that said, eating it does produce a more powerful, sometimes more sedative effect, more psychedelic. The first time I made THC edibles and took them, it felt like the first time I smoked, everything was hilarious and I talked a lot. I also stopped smoking due to my lungs, unfortunately from covid, but I've found now that taking oil is a lot easier to do consistently (primarily CBD), and is much less addictive than smoking (because the act of smoking itself can be addictive), so it feels like less of a "drug".
My other comment about pharma may have come off a little harsh. I do believe there is good, but also bad. Some doctors are more empathetic and understanding, while others are there for their job, don't research outside what they already know, and push what they are told to. To be the best, you must have a genuine interest and desire to know more, maybe even an obsession, with whatever it is. Pharmaceuticals certainly have their place, as not everything can be solved with nature. Though I also believe many drugs produced by pharma are designed to be sold and make money, not to cure and help people, which is a conflict of interest.
I learned years ago that any chemical that helps you sleep ensures that you can't sleep without it. I've used everything from thc to Benadryl to lavender and everything in between.
It all had the same effects: slowly degrading effectiveness and sleeplessness without it.
Pro-tip: find the source of your insomnia. Is it chemical or is it electrical or is it just habit? Doing a real sleep test and working with doctors was life changing. Mine was habit and anxiety. Meditation and therapy have helped.
Anecdotal, I know. But what happens when the thc runs out? You crash. That's what I did.
I’ve managed with 5mg THC pills for years. Never had to increase the dosage. I’ve never ever slept well. But back before kids it was easier to just sleep in if I had to.
As best as I can tell, the cause is my adhd or related. My brain will simply. Not. Stop. Racing.
That was a life-changer for me.
Needless to say I went from awful sleep to going to bed as the sun went down (in summer), and not waking up until sunrise, all in the matter of days.
Thinking back on it, I really should get back into that.
It’s basically bedtime “stories” that are more like improvised narrative mazes that are just interesting enough to keep your interest (and exhaust your brain) but not interesting or meaningful enough to keep you awake.
I went from laying awake for hours and hours as a general nightly routine to falling asleep reliably in 10-20 minutes. I didn’t even know it was possible to fall asleep that fast.
As a tip: There’s nothing to “get” about the podcast. It’s just a treadmill for the overactive parts of your brain.
Exactly. Back when I read more, I would have books to stimulate (daytime/commute reading) and 'bedtime books', which had to be interesting enough to read, but also effortful and ultimately tiring enough to promote sleep.
Now I do the same with TV shows in Plex, late at night. Unusually, it's the documentaries that stop me sleeping, and the classic US TV shows (that I like) that help me drift away.
One trick I found myself is to visualise things in the noise from your closed eyes. Try to interpret something you can vaguely see, and then try to visualise it. This imposes a kind of clear image for a short duration for me, from which I try to see and visualise something else in there and so on, kind of like a visual association chain. That really gets me sleepy after a couple of minutes!
Ooh, the visualization whirlwind. This is the first time I’ve ever hear anyone talk about it or had to give it a name. At least for me it’s just tons of images flashing before my eyes, rapidly changing, only tenuously guided by my mind.
Imposing the images works for me similarly to when you "can't unsee" something. Like when you start seeing something specific in a generic shape or pattern, like with clouds. I tell myself that I see something, which makes me actually visualise it.
In the end I went to the GP for anxiety and came out with a depression diagnosis and a bottle of Lexapro. Lucky for me I didn't get the crazy side effects and in combination with melatonin at least getting to sleep is no longer a problem.
In the past I've also found that deliberately clearing my thoughts is a way to slip from 'day mode' to those dozy random thoughts, but its often hard to remember in the moment and doesn't always work.
i also eat well, and make sure to not have blue light exposure for the last hour of my day.
But what really helped me, especially since I have crazy ADHD, is exercise. I lift when I get up, and do 1-2 hours of hard HIIT in the evenings after work. My body is absolutely shot by the time I'm done so I really don't have the energy to have my brain go all over the place. This coupled with a nice cold plunge in the evenings after said workouts (and another cold shower before I sleep), and good nutrition has helped me big time.
The THC does help, especially if I do it at the right time. If I smoke in the afternoons I am absolutely destroyed by sundown. I do fear it's creating an addiction or a physical dependence, but I value my sleep considerably.
Except melatonin, because that's what your body natural produces as a signal for sleep.
do people really not know how to debate anymore? your argument would get an F at Harvard Debate Club because of the strength of your argument, not the accuracy of it.
so falling asleep with a drug is an improvement
Amazing stuff, much better than the sleeping pill prescription I had years back (Lunesta).
Or strenuous physical activity all day.
The lack of strenuous physical activity all day is a real problem with modern life. We did not evolve to be sedentary.
If it's a solid, just break it.
If you can buy a THC tincture, you can easily use dilution and volumetric dosing to titrate your doses down over time.
I am a top % light sleeper - hard to sleep, inconsistent, never could sleep outside of basically ideal conditions.
Was prescribed Tirzepatide (similar to Semaglutide) and it fixed my sleep like nothing else has - I actually feel tired at a normal hour and doze off, two thing I never really did before. At the lowest dose you won't lose weight beyond the first few months, and you can maintain weight with small effort even still. So even if you are completely healthy weight, it could be useful.
I wouldn't normally think recommending a totally unrelated drug for sleep issues would be sane, but it also happens to have a ton of other positive effects for me at least. And the safety profile seems solid, esp compared to other sleep drugs. Plus not psychoactive and actually reduces your addictive behaviors especially in terms of nicotine/THC. Certainly a lot better side effect profile than THC (imo, from research).
IMO, THC can be the lesser of two evils in comparison.
I would highly recommend getting off it asap. Maybe taper off if you can't quit right away. First nights will be tough: sleepless, cold sweats, crazy dreams, but then it should get much much better. Be well!
Tip for getting off weed - start by lowering the damn dosage. A lot of commonly used products are the equivalent of a triple shot. And folks do it daily.
YMMV. That's me after a sleepless night.
Of course the drug war was a classist and racist thing and ultimately a failure because its propaganda couldn't keep up with people's desire for cannabis and the truth on how its far less dangerous than they were told. But to win politically you need to go big, so now we've over-corrected into cannabis being entirely harmless or even being a wonderdrug and cure-all, which obviously isn't true.
I see people on reddit recommend it for any number of health issues which I think is reckless and ignorant. A lot of these people have health issues that need to be treated. Covering up these issues with cannabis isn't going to help in the long run. Worse, almost zero discussion on how cannabis can trigger lifelong schizophrenia for people who have schizophrenia in their family and have latest schizophrenia that otherwise would have remained dormant for a long time, even the rest of their lives.
It reminds me a bit of the crony capitalism that kept stevia from being used as a sweetener. Society over-corrected with that as well, and honestly it tastes kinda terrible. And like all sweetners, who knows if its healthy. I don't think the blind watchmaker was expecting sweetness with no calories the same way she didn't expect being able to artificially shoot up your dopamine and serotonin with things like cannabis.
I don't think modern people realize how unbelievably delicate our bodies and mind are and how many 'ordinary' things are reckless and risky experimentation on us. I think we're still in this 19th century mindset of "conquering nature with science," which is obviously a pretty flawed premise and poor social philosophy. I'm not sure if its even possible for a capitalist technological society to leave that mindset.
Meh, I was like that prior to using THC. I will admit that it can sometimes increase brain-fog the next day. But I'd say the pros and cons are pretty 75/25 split for me.
Same thing with CBD and its analogues.
CBN will knock me out and it isn't active at CB1 like THC is, so it doesn't get you high.
Thank me later.
To try carnivore elimination diet, you should eat nothing else than beef, salt and water for at least 30 days.