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Speaking from anecdotal reports from autistic people, SSRIs generally don't seem to go over well with autistic people.

If your partner is autistic and suspects that they're ADHD as well that's not uncommon, with the estimated rates of ADHD occurring in autistic folks being at around 20-40%.

If your partner is ADHD or suspects being ADHD then PMDD is extremely common as dopamine drops due to hormone changes around menstruation.

Without writing a whole piece on something when I don't have the spoons for it, serotonin can compete in the brain with dopamine and SSRIs can reduce dopamine transmission.

If we go by a hypothesis that your partner is correct about PMDD and ADHD, what we should expect to see from an SSRI would be an aggravation of their PMDD and a deterioration of their mental health overall, all things being equal.

If your partner is looking for a better alternative in the antidepressant class, venlafaxine is likely the best bet as it is an SNRI with dopaminergic effects at higher dosages. Venlafaxine can be combined relatively safely with mirtazapine, which is unusual for antidepressants, and this may boost the effects on the PMDD symptoms or other symptoms - this combination is well known as a potent treatment for depression that is not responding well to other antidepressants.

Bupropion is the other candidate to consider as it has a desirable effect on both norepinephrine and dopamine for an ADHDer although the evidence for it treating PMDD shows that it is less effective than venlafaxine.

If we're throwing shit at the wall to see what sticks, agomelatine is an antidepressant that is unique in that it's the only one that has been shown to have a side effect profile lesser than placebo and it doesn't cause withdrawals so it's possible to stop it without tapering down. There's little to no evidence establishing it as a suitable treatment for PMDD but I figured that it was worth an honourable mention given the concerns that you have identified.

But with all this said, it takes a psychiatrist to really understand these things and it requires good knowledge of the case history of the patient to be able to determine what would really work best, and even then it's still a bit of a guessing game as neurochemistry is very complex and it's more of an art than a science to figure out what would work for any given person for reasons I won't bother going into here.

Honestly though, if your partner is an ADHDer or suspects that they have ADHD then really their best bet is stimulants because antidepressants rarely manage to treat ADHD symptoms by themselves.

I would urge caution about jumping to conclusions about psychiatric meds - the nervous system is both extremely complicated and also kind of simple in the sense that it relies on a few key things in order to achieve a lot (well, basically everything...) which means that tweaking the levels of one thing in the nervous system often has major flow-on effects for other parts of the system, like it or not. Add to that the fact that meds like antidepressants almost always have a really broad effect across the brain, not to mention across a lot of different neurotransmitters as well, and it starts getting really, really complicated.

Throw into the mix the fact that an individual might have an abnormal amount of receptors or transporters in any particular part of the brain and this may cause a "deficit", not in the neurotransmitter itself but a sort of shortfall compared to "demand", and thus treating this shortfall usually entails broad spectrum treatment which can increase the neurotransmitters elsewhere in the brain which can easily cause side effects worse than what the particular medication is treating.

It's just really, really complicated. Add into that that one person's depression might be due to low serotonin, another's might be due to low norepinephrine, another's might be due to low dopamine... or likely some combination of these and the complexity gets kinda staggering to try and wrap your head around.

If you've ever played one of those puzzle games where flicking one switch turns other ones on/off and you have to make a path or turn all of one row to a particular setting, that's what psychiatric meds are like - you often don't get a grasp of how one change affects the rest of the system and it often takes a few tries until you even understand what you're dealing with and to develop a good plan for how to proceed.

I guess I'm trying to say that antidepressants have a long list of side effects because they typically affect a lot of systems, especially in the brain, and typically a lot of different chemicals in the brain in different ways. It's easy to get spooked by this or to become very cynical about it (believe me, I understand this very well personally) but I'd try to withhold from making snap judgements.

There's hardly a medication out there that doesn't have horror stories attached to it but then again the same could easily be said for all sorts of common foods that we eat - caffeine can trigger mania in some people with bipolar, gluten can make someone so sick that they're incapacitated for days, there's a particular amino acid that can cause brain damage for people with a certain condition meaning that they have to carefully restrict their protein intake, salt could be enough to cause a particular person to have a heart attack, heck in situations of heart failure your fluid ntake is restricted...

If we went by horror stories caused by the effects of dietary intake then we would be avoiding salt, sugar, wheat, protein, dairy, water, carbohydrates, fats... it's hard to imagine a single thing that would be considered safe.

Not a doctor and not autistic, but I've been on an SSRI (Zoloft) in combination with Buspirone for about a year for anxiety although I'm currently tapering off. I have experienced irritability when coming on or tapering off of it.

I'm not a 100% sure I'd still be alive right now if I hadn't had the drugs to turn down the volume on my anxiety enough to get therapy and learn coping strategies. I've done psychedelics plenty and while they have therapeutic potential (and are very fun) they're not a cure all either. Frankly if you're thinking like mushrooms are good natural brain medicine versus the evil artificial brain medicine, you're way off track. They can fuck your shit up just as badly as prescribed medication and we'd see a lot more of that if they weren't illegal

All this is to say, I'm not dismissing your experience with your wife or anyone else who has a bad experience with SSRI's, but I would advise against taking a blanket stance against them.

It is not great for my sex drive, though, this is true. But then neither is crippling anxiety

ok, i'm on the sertraline (zoloft is the brand name) so i can at least give some info and my takes on efficacy. we can start with the basic medical information about it. the most important thing is to take it consistently, and not just dosage too quickly. dosage is typically changed in 25 mg increments for sertraline, with a typical dose of ~100 mg, a minimal starting dose of 25 mg, and a maximum dose around 200 mg possible. different dosages perform differently for different people. getting on or off, it's best to stabilize for at least a week or two at each increment of 25 mg to avoid the worst side effects / risk of serotonin syndrome. i had some side effects getting on it, but it's sort of a non-issue for me. i don't think it's helping my autistic self all that much, but it did help me stabilize my mood when i was falling off the proverbial cliff, so i'll give it that. my best advice is that your mileage may vary and that an ssri is not for everyone. i haven't tried hallucinogens as an alternative so i can't speak to that.

interesting anecdote: the approval of drugs by the FDA requires that at least 2 double-blind studies of the drug indicate statistically significant benefit over a placebo. it doesn't matter how many times the drug fails wrt approval, they just need 2 that pass. the thing with ssri's though is all those side effects. so the approval studies were double-blinds, but with inert placebos, so both doctors and patients would generally know who had the drug and who got sugar pills. when you do double-blind studies with active placebos that mimic the side effects but not the pharmacology of ssri's, you find that placebos are just as effective as the drug. which isn't to say that the drug became less effective in that study; the placebo became effective by being indistinguishable from the real thing outside of the actual serotonin reuptake inhibition function.

My wife uses SSRIs to help manage her mood and - after the initial onboarding period (which isn't particularly pleasant) - she's a genuinely happier and chiller person. The big problem she has is with the drug interacting with excessive alcohol. So when she cuts loose, there's this huge fall off and we routinely have some sort of hyper-dramatic situation that involves me staying up till 4am to help her come down. But the solution to this has been non-alcoholic beer.

That said, she's on Lexapro not Zoloft, so... Idk. There's half a dozen different kinds of SSRI with a variety of symptoms and side-effects.

All this stuff basically points to "neurodivergent people are being tortured with the promise of a semblance of normalcy in order to cope with our capitalist world, and all the "normalcy" is, is the ability to control your emotions externally despite them being wildly out of control internally".

I'd have to get her on here to confirm, but from the conversations we've had it isn't just kettling your emotions with an inebriated facade. Its more like tuning down the accelerator, so you don't go 0-60 faster than your brain can process the flood of emotions. It doesn't mean she never gets angry or never cries or never bursts into a snorting-giggle at a clever joke or funny video. Its very much an internal, rather than external, inhibitor which effectively lets her decide whether she's going to ride her feelings or tamp them down.

Rip me apart for this all you want but i'm leaning towards crank status being anti-anti-depressants.

I mean, its your decision in the end. I'd just advise against seeing other people on SSRIs as these inebriated zombies. And yes, there's definitely some degree of selection bias on anonymous public forums. FFS, I wouldn't be surprised if some number of accounts are entirely fictional for marketing or agitprop purposes.

That is why you hash these questions out with a doctor, with a support group of similarly situated people, and with your loved ones who get to deal with you in the good times and bad.

From my personal experience, this stuff only gets harder to manage as you get older. And I've watched more than one relationship implode because one or both partners decided medication wasn't for them... which then spiraled into manic episodes and violent confrontations that strike me as far worse than any side effect.

But hell, if psyilocibin therapy gets the job done, more power to you. The goal is to achieve some sense of stability in your life and however you come by that is a valid solution.

Just for anyone lurking this thread with anxiety/depression, I went on escitalopram, and I am so glad I did and will always sing it's praises. Not that it will work for everyone, some people will have adverse reactions as people are saying here. But for me it's made a dramatic improvement in my quality of life. If you are already at your lowest low, it's worth at least talking to a doctor.

Just as a counterpoint, I'm autistic and have been on fluoxetine (Prozac) for decades now. It was prescribed when I was only diagnosed with depression, but looking back, the main effect has been to somewhat buffer me against meltdowns. I'll still melt down once in a while from sensory or emotional stress, but it used to happen a lot more. I haven't had any problems with side effects; getting off of it to try a different medication has involved a two week taper.

https://www.counterpunch.org/2024/01/17/scientific-misconduct-and-fraud-the-final-nail-in-psychiatrys-antidepressant-coffin/

I got prescribed sertraline and pressured into it. Absolute worst time of my life, a week later I was tearing my face off in the fetal position in a bean field. Absolutely 1000% awful, put me off ever trying an antidepressant ever again in my life, I would honestly sooner die. Maybe it's better if you go three months with it but even a single day of that experience wouldn't be worth it.

Glad that they seem to work for some people. I would never recommend denying them to people if they help, but alternative non-drug treatments need to be much more accessible.

My wife is on sertraline, and I am absolutely 100% sure it saved her life. She's been depressed and on-and-off suicidal for her whole life. After a pretty dramatic escalation in her symptoms about 18 months ago, I finally got her to give medication a try. It turns out that she is one of the very lucky (and very small) minority of people who respond extremely well and extremely quickly. Within a month her depression had almost totally abated for the first time since she was 10 years old (she's about 40), and she's been stable ever since. She was worried that it would blunt her feelings or make her experience "artificial happiness," but it so far has not; she says it just makes her stop blowing everything out of proportion, and lets her get perspective on how bad something really is. The phrase "life-changing" sometimes gets overused, I think, but this truly was. The only real downside has been the drug interaction stuff, since she's always been a recreational substance enjoyer. She has to be a lot more careful with some drugs (MDMA in particular), and others don't work as well as they used to (LSD in particular). Other than that, she couldn't be happier with the decision, and has told me multiple times how much she wishes she would have tried this decades sooner. Her life is just so much better now.

I should reiterate, however, that she is definitely in the lucky minority. The very first thing she tried not only worked, but worked quickly, well, and without major side effect. Most people are not that fortunate, and I've absolutely heard some horror stories. I think a lot of doctors aren't nearly as careful as they should be with these drugs, and we don't appreciate enough how powerful and nervous-system-overhauling they are.

Yeah damn. This is why I never wanted to be on anti depressants even though I've had suicidal thoughts since puberty. My ex got on zoloft and wanted me to, to check before transitioning if I was just transitioning because I was depressed. Your post is making me happy that I resisted.

Side note on the mushroom therapy - I've been doing once a week .5-.7g little mushroom hangout and it's been really nice tbh. I know it's not microdosing but it's also not a journey or anything. Ihope I'm not damaging my brain or mind though, my understanding is that psilocybin is quite safe

psyilocibin therapy needs to become more widespread because SSRIs are far more terrifying than seeing god and your subconscious.

I was just about to say. If you haven't already tried it, microdosing 0.1-0.2g has more or less the same effect of an SSRI but you can actually feel it and there aren't crazy side effects. At that dose there are no hallucinations or internal journey. It just turns that day into a warm summer morning where everything is better/easier/more engaging.

Like all drugs, everything affects everyone differently, but one dose of sertraline (Zoloft) gave me auditory hallucinations, suicidal thoughts, and a month of severe sexual dysfunction, so yeah, I'm on board the fuck-that-shit train

I’ve been on an SSRI once after things spiraled out of control leading to the worst hospital experience of my life that made me super anxious about seeking healthcare ever since. When I was on it, all it did was numb my emotions and give me sexual dysfunction which actually took away something that I used to cope thus making things worse in the long run.

I sure on the side of less drugs to maintain a socially acceptable mood but understand that there are uses and needs that they do help with, I just think we could solve more of these issues by making the world better to exist in. I’ve also seen people talk about how some drugs just in a sense overwrite parts of you to be more socially acceptable when we could make these changes to be more accommodating. Lots of psych meds can have gnarly side effects and the fewer to live comfortably the better.

I could be mistaken but I believe there’s research that revealed SSRIs are only about about as effective as a placebo. Anecdotally speaking, I’ve never had a good experience with SSRIs, but some people swear by them! so it probably depends on individual brain chemistry or something

idk, Paroxetine worked alright for my depression it wasn't flawless, i gained some weight and the first month did kinda suck with insomnia and feeling detached (no one noticed because im usually pretty introverted anyways).

i switched to bupropion (non-SSRI) though as i felt like it was a better anti-depressant. For me withdrawal wasn't bad, just a bit of nausea and went away after a week, i was terrified seeing experiences other people had with withdrawal but it went much smoother than i expected.

I was on citalopram/celexa for 3 months and felt no difference. they switched me to sertraline/zoloft which i've been on for 2 months and i still notice nothing - it's like i'm not even taking anything

SSRIs can work for some people. They work for me and have the right effects and don't have bad side effects. I live with Major Depressive Disorder and so when i get depressed, i don't get overwhelming depressed to the point of extreme symptoms, which was the norm for me before. I can also have control over my facial expressions, instead of looking angry or worried (or however peoole would interpret the look on my face i had no control over before) all the time.

They suck to get started on and they suck to get off of. And they don't work for everyone. I think they're worth trying depending on what you're dealing with, but not everyone reacts to them the same way.

My understanding of the science is that we know what SSRIs do to you chemically when you take them, but we do not know exactly why they help many people who deal with depression and anxienty.

I got on Venlafaxine for about 3 months and shit sucked. I was actually pretty good for the first month despite the brain zaps and lack of arousal. It kinda smoothed out all the big emotional swings into something more managable.

That was until 3 months in when I got full-blown psychosis. Suddenly I thought my doctor was trying to kill me and was replacing my pills with poison. The police were about to kick down my door. I started checking my windows every few hours to make sure no one was staring into my room.

Then about a week later after going cold-turkey I realized that I was being paranoid. Never went on any other anti-depressant after that. Psychedelics are what I started self-medicating with and I prefer them. They don't prevent the extreme negatives as much but they do make the normal stuff a lot better.

Does anybody have any take on PSSD? SSRIs have been strongly suggested but I am deathly afraid of any damage being done to my libido and sense of intimacy.

Straight up, try a different one. SSRI's are a pretty big class of drugs, each with there own chemical formulation and difference in how they work. If a psychotropic medication is giving you negative effects, then ask to be switched, simple as. Each person's individual body chemistry is going to react differently, and getting a handle on symptoms is a matter of finding the right "cocktail". Lexapro and Prozac are a couple off the top of my head that are pretty popular and are commonly known to be more "agreeable" to a broader range of people. I have ADHD and take Lexapro. My partner has ASD and didn't like Lexapro long term and switched to Prozac and it's been a game changer. Talk to the psychiatrist and tell them you want to try something else.

Tried ssris, it took the edge off a little but nothing else changed. It didn't fix my depression. (Walking around and lots of time and friends "fixed it")

Adderall definitely works for me. Just 5mg sporadically and I am more pleasant to be around, so I'm told.

Yea they're basically a coin toss and like half the double blind studies point to it being a placebo

Possibly looking into mood stabilizers and Wellbutrin as well?

I used to take Lexapro for depression but it's also prescribed for anxiety.

After the first month my suicidal and existential thoughts sort of got real numb and in the far back of my mind I stead of feeling always there and occasionally flatout smacking me in the face. That was nice.

I generally have a low libido anyway unless I'm high or drunk so there wasn't a real noticable difference there but like it didn't break my dick or anything.

The bitch part was that my insurance kept making me jump through hoops to get refills and wouldn't ever tell me what I needed to do each month and would just change shit without telling me. I ended up splitting pills several times for fear of running out and at one point tried supplementing HTP5 which caused a sever anxiety attack that ended me up in the urgent care with a steroid shot in the butt to calm me down.

Further bullshit from insurance and rationing ensued and I eventually got fired and insurance so I rationed over tine until my last refill was gone in hopes that my mind wouldn't spiral.

I'm hesitant to get back on meds now due to my experience.

But when I had a proper prescription it was alright.

I think I'd rather microdose E or shrooms at this point in my life though.

I have a panic disorder that I (somewhat) control with SNRIs, and in my experience there's this emotional blunting effect that makes regulation easier up to a certain point. However, unlike unmedicated emotional response, there isn't a slow build up that you can use to identify a coming attack. The blunting means I feel completely fine right up to the edge and then everything unravels without warning; once that threshold is passed it's like a switch is flipped.

Sertraline (Zoloft) helped my depression immensely but exacerbated my adhd symptoms

This is why I'm probably never going to bother with SSRIs, even though I have serious depression.