do you feel like SSRIs are mostly pseudoscience? I'm not sure if I should be open to trying them or avoid them at all costs since I'm not sure if they even work or if they will mess me up permanently
a preliminary note that i don’t find the category ‘pseudoscience’ to be useful & would classify SSRI research more as 'methodologically shoddy science’ or 'ideologically slanted’ or 'part of a centuries-long effort on the part of psychiatrists to secure themselves professional prestige by claiming neurobiological etiologies where none are shown to exist’ &c &c. imo the notion of 'pseudoscience’ is itself pretty positivistic, ahistorical, and ideologically noxious (particularly apparent in any analysis of epistemological imperialism).
that aside: you raise two major issues with SSRIs, namely whether they work and whether they will cause you harm.
efficacy of SSRIs is contested. a 2010 meta-analysis found that in patients with mild or moderate depressive symptoms, the efficacy of SSRIs “may be minimal or nonexistent”, whilst “for patients with very severe depression, the benefit of medications over placebo is substantial”. a 2008 meta-analysis found a similar distinction between mildly vs severely depressed patients, but noted that even in the latter population, drug–placebo differences were “relatively small” and argued that the differences between drug and placebo in severely depressed patients “seems to result from a poorer response to placebo amongst more depressed patients” rather than from a greater efficacy of SSRIs. a 2012 meta-analysis found some SSRIs consistently effective over placebo treatments, but several authors disclosed major relationships with pharmaceutical companies. a 2017 meta-analysis concluded that “SSRIs might have statistically significant effects on depressive symptoms, but all trials were at high risk of bias and the clinical significance seems questionable” (emphasis added) and that “potential small beneficial effects seem to be outweighed by harmful effects”.
A total of 37 studies viewed by the FDA as having positive results were published; 1 study viewed as positive was not published. Studies viewed by the FDA as having negative or questionable results were, with 3 exceptions, either not published (22 studies) or published in a way that, in our opinion, conveyed a positive outcome (11 studies). According to the published literature, it appeared that 94% of the trials conducted were positive. By contrast, the FDA analysis showed that 51% were positive.
meta-analyses are not immune to this issue, either. in addition to the problem that a meta-analysis of a bunch of bad studies cannot magically 'cancel out’ the effects of poor study design, the authors of meta-analyses can and do also have financial interests and ties to pharmaceutical companies, and this affects their results just as it does the results of the studies they are studying. according to a 2016 analysis of antidepressant meta-analyses,
Fifty-four meta-analyses (29%) had authors who were employees of the assessed drug manufacturer, and 147 (79%) had some industry link (sponsorship or authors who were industry employees and/or had conflicts of interest). Only 58 meta-analyses (31%) had negative statements in the concluding statement of the abstract. Meta-analyses including an author who were employees of the manufacturer of the assessed drug were 22-fold less likely to have negative statements about the drug than other meta-analyses [1/54 (2%) vs. 57/131 (44%); P < 0.001]. […] There is a massive production of meta-analyses of antidepressants for depression authored by or linked to the industry, and they almost never report any caveats about antidepressants in their abstracts. Our findings add a note of caution for meta-analyses with ties to the manufacturers of the assessed products.
so, do SSRIs work? they are certainly psychoactive substances, which is to say, they do something. whether that something reduces depressive symptoms is simply not known at this point, though it is always worth keeping in mind that the 'chemical imbalance’ narrative of SSRIs (the idea that they work by 'curing’ a 'serotonin deficiency’ in the brain) has always been a profitable myth. look, any medical treatment throughout history has been vouched for by SOME patients who report that it helped them—no matter how wacky it sounds or how little evidence there was to support it. this can be for a lot of reasons: placebo effect, the remedy accidentally treating a different problem than it was intended for, the symptoms coincidentally resolving on their own. sometimes the human body is just weird and unpredictable. sometimes remedies work. i’m sorry i can’t give you a more definitive answer about whether SSRIs would help you.
i don’t mean to sound alarmist; all drugs have side effects, some of the ones above occur rarely, and you may very well decide the risk is acceptable to you to take on. i would, though, always encourage you to do thorough research into potential side effects before starting any drug, including an SSRI. more on SSRI side effects in david healy’s books 'pharmageddon’, 'let them eat prozac’, 'the antidepressant era’, and 'the creation of psychopharmacology’; 'pillaged’ by ronald w maris; and 'the myth of the chemical cure’ by joanna moncrieff.
in addition to the above, SSRIs are known to come with a risk of 'discontinuation syndrome’—that is, chemical withdrawal when stopping the drug. this, too, is often downplayed by physicians; many still deny that it can even happen. some patients don’t experience it at all, though i can tell you purely anecdotally that SSRI withdrawal was so miserable for me i simply gave up on quitting for over a year, despite the fact that at that point i was already thoroughly experienced with chemical withdrawals from other, 'harder’ drugs. again, i am not telling you not to go on SSRIs if you decide these risks are worth it to you! i simply think this is a decision that should always be made with full knowledge (indeed, this is a core, though routinely violated, principle of medical 'informed consent’).
ultimately this is not a decision anyone should make for you; it’s your body and mind that are at stake here. as always i think that anyone considering any kind of medical treatment should have full knowledge about it and should be making all decisions freely and autonomously. i am genuinely not pushing any agenda 'for’ or 'against’ SSRIs, only against prescription of them that is done carelessly, coercively, or without fully informing patients of what risks they’re taking on and what benefits they can hope to see.
Too many people are forgetting these things too quickly:
-SESTA/FOSTA passed. Despite the many, many warnings of sex workers.
-A bunch of apps started their censorship policies because Apple directly threatened their revenue if they didn’t promise to cut down on the amount of porn on their sites
-MasterCard and VISA tried to outright stop processing OnlyFans work SPECIFICALLY because of the association with sex work, and no other feasible financial reason.
There is not a sudden regressive movement among individual people. Free The Nipple didn’t fade into obscurity because people didn’t care. It was stopped. By policies. By laws. By arrests. By censorship. These things have been purposefully put in place by companies and politicians. They saw the work we were trying to do wrt bodily autonomy, sexual liberation, and sexual freedom, and they forcibly put a stop to it.
You keep making jokes like “teehee as a family abolitionist I just want children to die in the woods” but like… that actually is what happened to kids before the invention of the family. There actually is no alternative
this is the funniest ask ive ever gotten in my life
casveman in 40,000 BC after letting the fifth baby crawl off into the woods alone: hmm . maybe we should come up with another way to do this i dont think the first four are coming back
the idea of a prehistoric society with a 100% unconditional infant mortality rate is making me lose it
caveman sitting up late every night in his workshop trying to find a way to stop children from being eaten alive by wolves before inventing “The Milf”
do you all remember in the early 2010s where people were talking about freeing the nipple and that mixed-gender sports should become a thing and the removal of period tax and all of that and then some people realised that would mean trans people too ans they instantly decided to revert to bioessentialism 101 and now i have to see grating sentences like Well maybe jeopardy should be gender-segregated because males have a biological advantage in pressing a button
all goofing aside I genuinely don’t understand the urge to reimagine Taylor Allison Swift as a secretly queer icon when the pop music scene™ is like. literally overflowing with women who actually like women. Gaga and Kesha and Miley and Halsey are right there. Rina Sawayama and Hayley Kiyoko and Rebecca Black and Kehlani and Victoria Monét and Miya Folick if you’re willing to get slightly less top 100. Janelle and Demi for them nonbinary takes on liking girls. like what are we doing here. like I’m not even saying you can’t enjoy Taylor but why would you hang all your little gay hopes on her.
Isn’t Lady Gaga bisexual?
yes that is indeed why she’s on the list of famous women who like women
why have multiple people reblogged this with some horse-assed “um actually most of these people are bi or pan” did I fucking stutter I said they like girls. what is your point. I’m going to kill you.
I have always been wary of the psychiatric industry, but its only very recently that i started to read anti-psychiatric works. Your blog is the first time i saw that the "chemical imbalances causing mental illness" is a myth, and honestly its something im having a hard time wrapping my head around.
Is it that mood regulation struggles, labelled as a mental illnesses, has more to do with outside factors instead of the person "just being that way"? Is it therefore unlikely for someone to have struggles with mood regulation if they cant identify any external causes that would cause them to be, for example, extremely agoraphobic or to have anger management issues? Im asking this for myself mainly, cause i always had intense agoraphobia no matter how i often go outside my home (in fact it was worse when i was a teen and i was outside the house in even more back then). I cant think of any reason for me to be like this than chemical imbalances in my brain.
the specific ‘chemical imbalance’ myth i was talking about in this post is the idea that depression is caused by low serotonin, and that therefore SSRIs—serotonin re-uptake inhibitors, ie drugs that cause a higher level of serotonin in the brain—ought to cure or at least ameliorate depression. this conjecture is belied by the fact that SSRIs don’t, at a population level, reliably perform better than placebo.
although a neurobiological cause of 'mental illness’ has long been the holy grail of psychiatry, the serotonin imbalance myth is far from the only hypothesis that psychiatrists and neuroscientists have proposed. so, a critique of the serotonin myth is not synonymous with, or generalisable to, a critique of every neurobiological mechanism purported to explain psychiatric diagnoses. you may be interested to know, though, that genomics and neuroscience have not identified a biological cause of any psychiatric diagnosis (p. 851).
all human experiences are biologically instantiated, including in the brain and wider nervous system. we are embodied beings. however, it is a leap to assume that such instantiation is automatically equivalent to a causal explanation or disease etiology. in other words, to deny that psychiatric diagnoses are known to be biologically caused does not mean we deny that thoughts and thought patterns express in the physical matter of neuroanatomy. this is a major philosophical sticking point to keep in mind whenever you’re looking at something like, eg, a study that purports to show 'brain differences’ in those assigned a certain psychiatric diagnosis. another thing to consider is whether these papers are plagued with methodological issues or financial conflicts of interest.
i can’t possibly tell you why you exhibit agoraphobia. however, when i talk about social, economic, and environmental factors that may contribute to the patterns of behaviour labelled as 'mental illness’, i’m talking about much more than the individual choice to leave your house. since phobias are 'anxiety disorders’, i might start by probing into questions like: is the world you live in safe? do you perceive it as safe? do you or your community face existential threats that may confront you more obviously when you go outside? are you nervous around other people, and if so, might that be connected to fears (well-founded or not) about interpersonal violence and harm? do you think any of these anxieties may be connected to the hostility and inaccessible design of the social environment and economic conditions?
human behaviour and thought varies. some of those variations may be totally benign; others may be helpful or harmful to the person living with them. it would be weird if every single of the 8 billion people on earth experienced precisely the same amount of anxiety about any situation, no? all of this is to say: yeah, it’s entirely possible you have been, for one reason or another (genetic, neuroanatomical, social, &c) predisposed to experience high, even debilitating levels of anxiety when leaving your home. most human characteristics develop from a tangle of social, environmental, material causes—ie, from a combination of 'nature’ and 'nurture’. what doesn’t follow, though, is the claim that there is therefore a discrete, 'diseased’ element of your brain or brain functioning that can simply be cured or eliminated through psychiatric intervention.
however, it is a critical point of anti-psychiatry to challenge psychiatric and neuroscientific claims to neurobiological determinism where psychiatric diagnoses are concerned. this is for many reasons, including: a) that these claims have not been demonstrated to actually be true [see above]; b) that they rob pathologised people of agency and self-determination [see: you’re too sick to know you’re sick, and the doctor will fix you now]; c) that they are often pushed by pharmaceutical companies with financial interests, or grant-funded researchers with… financial interests; d) that they are politically seductive in various eugenic, hereditarian discourses that seek to eliminate the biologically 'unfit’ element from society.
this is implied but i just wanted to add- absolutely none of this means that emotional suffering is the fault of the individual or something unimportant. many ppl chafe against the idea that “mental illness” is not biologically caused because they think that biological causation is the only thing that could validate or legitimize their suffering. part of psych abolition is abandoning the dichotomy of “biologically ingrained inevitability VS things that are stupid + your fault”. anatomical fault/genetics/hormones/biology are not the sole reasons why things happen + sometimes things do happen that are unexplainable!
it’s okay to not know why you are agoraphobic because u don’t need to know why in order to heal or be validated in yr suffering. further, even if they did identify a specific biological mechanism mediating your agoraphobia, addressing that mechanism could not possibly address the trauma it has likely caused, the social shifts it has likely caused, the cultural context in which it occurred, the economic/lifestyle impacts, the ways in which it has shaped your life history, etc. this idea that everything happens because of the body therefore shifting the body can change everything gives almost no thought to the millions of things outside the body which shape who we are + what we feel + why we do the things we do.
