SSRI
Article
SSRI is a recurring concept in the Astral Codex Ten archive, appearing 4 times across 4 issues between May 25, 2021 and August 13, 2024. The archive places it in contexts such as “which would technically make it an SSRI”; “a different drug, the SSRI antidepressant fluvoxamine”; “a drug that prevents serotonin reuptake (like an SSRI)“. It most often appears alongside FDA, aspirin, dopamine.
Metadata
- Category: Concepts
- Mention count: 4
- Issue count: 4
- First seen: May 25, 2021
- Last seen: August 13, 2024
Appears In
- Peer Review Request: Depression
- The FDA Has Punted Decisions About Luvox Prescription To The Deepest Recesses Of The Human Soul
- The Psychopharmacology Of The FTX Crash
- Why Does Ozempic Cure All Diseases?
Related Pages
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- FDA (3 shared issues)
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- aspirin (2 shared issues)
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- dopamine (2 shared issues)
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- imipramine (2 shared issues)
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- serotonin (2 shared issues)
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- US (2 shared issues)
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- 2002 meta-analysis by Cochrane Collaboration (1 shared issues)
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- 5-HTP (1 shared issues)
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- 5-HTP (1 shared issues)
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- @AutismCapital (1 shared issues)
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- Adderall (1 shared issues)
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- ADHD (1 shared issues)
External Links
Source Context
Recovered passages from the original issue text. When the raw archive preserved outbound links inside the source passage, they are listed directly under the quote.
Advantages of escitalopram: it’s slightly better at dealing with anxiety, rumination, and obsessive thoughts, although some studies have challenged this. Disadvantages of escitalopram: it frequently decreases sex drive/ability/performance, and occasionally causes tiredness, weight gain, or emotional flatness. Read more at my page on SSRIs.
Inline links: SSRIs
If one of these doesn’t work, try the other. If neither of them work, and you’re feeling optimistic, you might want to try a different SSRI, maybe sertraline. If that doesn’t work, move on to second-line treatments. Some of the better second-line treatments are duloxetine, mirtazapine, and amitriptyline.
Duloxetine is an SNRI, which supposedly means it might have some advantages over SSRIs, although studies are not completely clear. It might be better for patients with chronic pain, since it sometimes helps this also. I tend to avoid the other popular SNRI, venlafaxine, because it has very difficult withdrawal and no obvious advantages over duloxetine.
But a different drug, the SSRI antidepressant fluvoxamine, actually did really well! It decreased COVID hospitalizations by about 30% - not the perfect cure rate the rumors attributed to ivermectin, but a substantial decrease. Given the size and professionalism of this study, and another smaller one that also got positive results, I and many others take Luvox pretty seriously. At this point I’d give it 60-40 it works.
What are the risks? Like every medication, including Tylenol, aspirin, etc, Luvox has some common minor side effects and some rare major ones. But let’s step back a second. Fluvoxamine is a bog-standard SSRI. Its side effects are generic SSRI side effects. We give SSRIs to 30 million people a year, or about 10% of all Americans. As a psychiatrist, I’m not supposed to say flippant things like “we give SSRIs out like candy”. We do careful risk-benefit analysis and when appropriate we screen patients for various risk factors. But after we do all that stuff, we give them to 10% of Americans, compared to 12% of Americans who got candy last Halloween. So you can draw your own conclusion about how severe we think the risks are.
Inline links: 12% of Americans
For some reason the same experts who don’t mind prescribing SSRIs when people have mild depression freak out about prescribing them when they’re the only evidence-based oral medication for a deadly global pandemic. “What about SSRI withdrawal?”, they ask. After a ten day course? On 100 mg imipramine-equivalent dose? Minimal. “What about long QT syndrome?” The VA system took 35,000 high-risk older patients off of an unusually-likely-to-cause-QT-syndrome SSRI in 2011, and were unable to find any evidence that this prevented even a single case of the syndrome, let alone any negative outcome!
Inline links: even a single case of the syndrome
This is what happens with serotonin. If you take a drug that prevents serotonin breakdown (like a traditional MAOI) and a drug that prevents serotonin reuptake (like an SSRI) at the same time, you definitely die. Lots of doctors have noticed that the MAOI + stimulant situation is pretty similar and decided you shouldn’t take these at the same time either. So some people following the FTX situation have wondered whether this combo might have been very dangerous - either to Sam’s health or to his risk-management ability.
Whenever we discover a new wonder drug, scientists rush to demonstrate that all those lifestyle changes - the ones you should do anyway - actually work through the same mechanism as the wonder drug. So for example, when SSRIs were the hot new thing, psychiatrists announced that all the normal stuff that brightens your mood worked through serotonin. Sunlight? Serotonin. Exercise? Serotonin. Having a good, trauma-free childhood? Serotonin. In the cold light of day and/or SSRI patents expiring, most of these effects were later found to be fake, or at least too small to care about.
Other explanations will be more sinister. Pharma companies are always looking for more reasons to prescribe their drugs. And even unaffiliated scientists can get caught up in the excitement. Being a GLP-1 researcher now is probably a pretty great job, just like being an SSRI researcher thirty years ago. Probably some of these won’t replicate, and in a few years we’ll be left with a thinner and more believable profile of GLP-1 effects.