[NotPavlovsDog]

Anecdotes and auto-biographies are the easiest to write, as they require the least research and one is already so familiar with the protagonist.

It will be nice to see ketamine and psychedelics as part of a toolbox professionals can use for treatment. Many current antidepressants cause strong suicidal and homicidal urges. Look at the widely prescribed citalopram disclaimer.

Here's an anecdote: close person to me was crying from how hard they wanted to end it all, as well as delivered urinary tract problems, for life, from one month of citalopram, as per prescription dose.

Or you know, we could discuss somewhat proper research in connection to treatment for depression. The current chemical solutions have so many side-effects that there is a reason medical professionals have been proactively trying and seeking alternative treatment. Ketamine appears very promising.

[emodendroket]

I don't think "this is a possible result of this treatment, as observed one time" is an illegitimate subject of inquiry because it's not a table of statistics.

[cinntaile]

If you check possible side-effects of very common medicine you can probably find some terrifying stuff that happens to 1 out of 10 million people. If it gets reported on in the media, it would seem a lot more common than it is. To be clear I'm not saying that's the case here, I have no idea.

[emodendroket]

Sure but would that make it wrong for an essayist to write about it if it happened to them? Writing about personal experiences seems to be a substantial portion of this guy's beat.

[Mattasher]

It's also worth considering that this one person's experience may represent the reactions of many. Over two-decades ago the Chicago Reader published one of the most fascinating "drug memoirs" I've ever read, and the author also had a terrible reaction to Ketamine, albeit under very bad circumstances:

https://chicagoreader.com/news-politics/me-and-my-monkey/

[tptacek]

The relationship between SSRIs and suicidality is well established, as I understand it (but then, the relationship between the condition SSRIs treat and suicidality is even more well established).

I didn't think that was the case with homicidality, though. I went looking, and I found a lot of nutbag sources saying it was the case; that's no surprise, the claim has become a political football in the US (it's an attempted rationale for our mass shooting problem).

Are there very reputable sources to suggest that SSRIs cause homicidal ideation? It's a big claim.

(A quick note: for me, the first Google result is a BMJ journal hit --- but it appears to be a "letter to the editor" type situation, and opens "The FDA admitted in 2007 that SSRIs can cause madness at all ages and that the drugs are very dangerous; otherwise daily monitoring wouldn’t be needed".)

[mr_00ff00]

Does anyone have info on how/why anti-depressants cause suicidal and homicidal thoughts? I know when it comes to the brain, conventional logic fails, but you would think anti-depressants would stop suicidal thoughts.

I googled it and couldn’t find anything.

[to11mtm]

I'll bite.

You have to find the right one, and the right dosage. Otherwise it's like having the wrong air/fuel mix in a car. Unfortunately a lot of doctors will just throw out whatever they think works [0].

A competent MHD, in my experience:

- Will use both a patient's verbally provided information as well as lab tests (i.e. neurotransmitter levels) in deciding what to try to prescribe.

- For initial starting of medication will follow up in 30-45 days.

- Changes in medication (examples might be things like dosage change, or changing within the same class of medication, i.e. going from one SNRI to another) will usually have a 45-60 day follow up

- Continued follow-up on neurotransmitter levels, 6-12 months after initial starting of treatment, and once stable every 2 or so years.

[0] - My favorite example of this was a doctor who insisted I continue to take a medication that was causing me to be unable to drive. When I looked around the room and saw that every single calendar, pen, and notepad had the name of said medication, well that frankly ruined my opinion of MHDs for another couple of years (which made it take longer to finally find the right treatment.)

[zdragnar]

I have never had a doctor test my neurotransmitter levels, and have seen several for depression over the course of my life. For the most part, though, mine has been "mild" enough that I've been treated by general doctors and not psychiatrists (though therapy was involved for a time).

I do wish that there was a shorter check-in period. SSRIs do take 30-45 days to fully kick in, but if they are causing harm, that starts much sooner. I was on two that made me worse, one just gave me headaches for the two weeks that I took it, and the other triggered episodes of intense anger within two days.

Lexapro has been a life saver for me, though I know others for whom it didn't work. I think if I had felt my doctor was more involved than the 6 week check in, I might have felt a bit less alone during some of those times wondering if I was experiencing side effects or simply my illness.

[cjbgkagh]

Depression often has a component of being emotionally numb. The blunting of emotions can have a protective effect, reverse that and you could be in for an avalanche of emotions you haven’t felt in a long time.

[kranke155]

As far as I know our knowledge of the brain and how anti depressants work is so thin that the answer to your question is … we don’t know.

It does happen tho, I 100% had violent suicidal urges on sertraline due to a misdiagnosis. They immediately put me off it but I was terrified. It was the most sudden and extreme mood change I’ve ever experienced.

[jemmyw]

I've taken several courses of SSRIs. I think it works like this: you're depressed and you have dark thoughts but you don't really feel motivated to do ANYTHING. Then you take some pills and at first they send your mood all over the place, but those thoughts are still present and prevalent. So now you feel pretty good about the idea of killing yourself.