Hacker News Reader

Comment by BjoernKW | Hacker News Reader

[flagged]

Fluoxetine is one of two medicines listed in WHO Model List of Essential Medicines for the treatment of depression since 2007 (use of other SSRIs are also allowed)[1]. The listing means it has proven to be safe and effective enough that WHO believes it should be readily available in every healthcare system. You will need much more than a Wikipedia article listing side effects for the entire drug class, without incidence rate, to convince people these drugs aren't what they seem.

Also relevant to this article, WHO since 2023 does not recommend Fluoxetine (or any antidepressants) for children younger than 12 years[2].

[1]: https://iris.who.int/server/api/core/bitstreams/17642505-ecd...

[2]: https://list.essentialmeds.org/recommendations/313

The WHO hardly is a reliable, neutral source. It's a political organization that's subject to all sorts of outside influences.

During my first manic episode I was handed sertraline. This pushed the mania full send and I lost a lot of time that I can't account for, things I did I can't remember but friends have recalled. Climbing the house to get in through the upstairs window whilst having the house key on me. Locking myself in my room for a week or two convinced I was the real world John Connor and Arnie was looking for me. Blowing all my savings on cocaine for me and anybody in my vicinity in a month. Going through a gram of mdma more than once in a night. Feeling like I was on a therapeutic dose of MDMA for a few months and thinking this was what SSRIs were meant to feel like. The list goes on.

I will admit I was semi cognizant of the distorted thinking/reality so played it down when talking to the psychiatrist I was urgently (+2 months into it) referred to for early psychosis intervention. I was eventually handed a dozen valium (which the doctor was incredibly hesitant to prescribe, for good reasons) which let me sleep and the mania lifted.

I'm terrified of SSRIs now. I have been diagnosed bipolar for a few years now (went private because in the UK unless you're a danger you're ignored). This week was the first session with a clinical psychologist in a bipolar group. Unsurprisingly almost everyone had a similar experience with SSRIs.

I'm speculating here but I'm pretty sure if you did an MRI on my brain you'd see lesions from the mixing of mdma and sertraline (I get myoclonic jerks to this day).

> I'm terrified of SSRIs now.

Surely the massive amounts of cocaine and MDMA bear some responsibility.

SSRIs are definitely not commonly recommended or normally used for treating bipolar disorder - especially not for people who are showing signs of a manic episode.

Unfortunately, this is one of the major limitations of our diagnosing abilities with mental illness: when someone presents with severe depressive symptoms and no other known history of mental illness, we have no real way of telling whether it should be classed as Major Depression, or whether it may be Bipolar disorder.

So, sadly, yours is a common story where people with bipolar disorder that initially manifests with a depressive episode get treated with SSRIs that then push them into their first manic episode. I've had a good friend go through something very similar (though, thankfully, less severe in terms of intensity of the manic episode).

If you were given SSRIs to handle the start of your manic episode, that to me seems like a gross mistake by your physician.

ssris are known to unmask or precipitate manic episodes in people with family history of bipolar or schizophrenia.

> I'm speculating here but I'm pretty sure if you did an MRI on my brain you'd see lesions from the mixing of mdma and sertraline

ssris actually block the serotonergic effects of mdma and similar.

> I'm speculating here but I'm pretty sure if you did an MRI on my brain you'd see lesions from the mixing of mdma and sertraline (I get myoclonic jerks to this day).

Could you speak more to this? A family member was recently diagnosed with myoclonic jerks without a clear root cause, so treatment has been hit or miss so far. I’m trying to learn what I can to help inform them.

Every medication can have severe and permanent side effects, the question is how often that occurs for a particular drug, and how that stacks up against the quality-of-life improvement from taking that drug.

And whether patients are properly informed of the risks (I was not)

> Every medication can have severe and permanent side effects

SSRIs are by an order of a magnitude worse than any other common medication in that respect.

Moreover, like I said there's little evidence these drugs actually achieve any quality-of-life improvement beyond a placebo effect.

SSRIs are very bad, but antipsychotics are worse. There are many other reasons, but a demonstrative one is that there is a cumulative annual risk as high as 7% of developing a permanent movement disorder when on them.

TD is no joke!

It was really hard for my ex to have to choose between anti-psychs and the potential side effects, or exceedingly strong paranoia with incredibly lucid hallucinations - I did not envy her position

I think the reality is likely more nuanced than 'all good' or 'all bad.' While the side effects you linked are real risks that should be taken seriously, claiming these drugs are 'by no means safe,' cause 'mostly permanent' damage, or lack evidence is a pretty extreme generalization that doesn't align with the experience of millions of patients.

Speaking for myself, I took sertraline for years and it did wonders for my mental health. It didn't ruin my life or numb me, it gave me the ability to regulate my emotions when I previously struggled immensely with anger and crippling anxiety.

It’s possible for these drugs to be handed out too easily in some contexts and simultaneously be life-saving, effective treatments for those who genuinely need them. Suggesting they violate 'do no harm' ignores the massive harm caused by leaving severe mental health struggles untreated.

Reply on news.ycombinator.com