[iliketosleep]

It does seems as though SSRIs shouldn't be used as first-line therapy. They are powerful drugs that alter brain chemistry in ways that aren't properly understood. There are a number of low-hanging fruit which can be tried first, such as increased exposure to sunlight, exercise, change in diet, meditation, CBT and so on. But if all of these fail, an SSRI is definitely worth trying - they do work for some people.

[curun1r]

This is exactly my view. I see medication as the nuclear option. It's important to have it in reserve, since it can work, but you should try everything else first because of how badly the medication route can go. The "first do no harm" doctrine is violated by taking a medication-first approach.

[DanBC]

Depression is a sometimes fatal illness, and advice like this causes real harm.

[tomnipotent]

> I see medication as the nuclear option. It's important to have it in reserve, since it can work, but you should try everything else first

For many people this isn't an option - medication is required to even get them to a stable enough baseline for other treatment options to be effective.

Views like this are very unhelpful and help to perpetuate shame, which can prevent people that need help from seeking it because the treatment doesn't line up with the views, morals, and general opinions of the people around them.

[curun1r]

> Views like this are very unhelpful and help to perpetuate shame

No, my view is a hard-earned perspective that I've gained through personally having the system fail me. I lost a decade of my life to the medication-first mentality and I resent your implication that trying to help others avoid the same outcome is in any way dangerous.

I do concede that drugs work for some people, but views like yours that lead to over-medication are what is truly dangerous. What we need is well-rounded advice that allows patients to make informed decisions about their road to recovery. Medication is one possible path, but it's not the only path and it's not without it's downsides. It can ruin lives just as much as it can save lives, and people need to know that. It permanently alters brain chemistry, so it's an irrevocable choice, unlike almost all other approaches.

[tomnipotent]

> I resent your implication that trying to help others avoid the same outcome is in any way dangerous.

I resent bad medical advice offered on a public forum. An absolute position in anything is always bad advice when the facts are not known. Parents let their children down, I'm not suddenly going to eschew all parenting because of it.

> What we need is well-rounded advice that allows patients to make informed decisions about their road to recovery. Medication is one possible path, but it's not the only path and it's not without it's downsides.

I think we're actually on the same page, then. Recovery is complicated and we all need to do our best supporting everyone in whatever unique journey leads to their recovery. Medication and therapy (along with family, meditation etc.) are all critical to the process and you don't always get the choice of one without the other. I'm sorry that medication and mental health professionals let you down.

I grew up a little differently than most. Drug-dealing parents, foster care, hoarding, crime & violence, and much worse. I escaped it during the late 90s because I learned to do things other people couldn't (build websites), but I brought my trauma with me as an adult until - as the VP of a start-up that raised over $300MM - lost my shit and then disappeared for 2 years on a "spiritual journey" that included seeing over three dozen mental health professionals.

If it hadn't been for a chance recreational encounter with MDMA the day before my dad died of a sudden heart attack (which precipitated me losing my shit), I would have withdrew into drugs & alcohol instead of seeking the help I needed. I'm especially glad I didn't listen to all the people around me that offered bad advice ("you're fine, look how successful you are") because they couldn't possibly have known the extent of my problems.

[Arbitrary4657]

Sorry about your martyrdom, but you're taking an absolute position yourself right now.

[tomnipotent]

By sharing a personal story along with how medication was able to help me? My position is leaving it up to mental health professionals to recommend whether someone needs medications, and encouraging people to see multiple professionals, including second opinions, before beginning anything as serious as therapy or medication.

Maybe you'd feel more at home at reddit.

[subcosmos]

They saved my life after a decade of trying everything else.

[loceng]

Do you mind sharing what "everything else" you tried included?