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There is a real lack of transparency in communicating some of the long term impacts of SSRIs to new patients. When I was prescribed sertraline not one doctor me
by bb123 19d ago
There is a real lack of transparency in communicating some of the long term impacts of SSRIs to new patients. When I was prescribed sertraline not one doctor mentioned the massive (and sometimes permanent!!) sexual side effects, the likelihood of weight gain or how brutal it would be to taper off.
Also, I ended up ignoring my doctor's (way too aggressive) tapering schedule and managing my own down-dosing with a pill crusher and a milligram scale. I went about 5x slower than the standard advice and avoided all of the worst side effects.
I don't think it would have changed my decision to start taking it but I would rather have known about all this up front so I could make a more informed choice.
- asa123 19d agosomewhat off topic but i’ve thought about tapering like this, but i’ve got wondered where can one get a calibrated milligram scale? or perhaps it doesn’t matter too much.
- jychang 19d agoAWS Gemini-20 below $100 Or a precision one for $$$ All the other sub-$100 ones are mostly junk, with a few decent ones. But just get the Gemini-20
- mapt 19d agoLike buying a five gallon boiling flask, one assumes this will get one put on a list in the US.
- deleted 19d ago[deleted]
- IncreasePosts 19d agoYou can just tell anyone who comes asking that you will not be harassed in your private domicile.
- bb123 19d agoMine was a $30 gold scale from Amazon. Probably not accurate but provably consistent which is what I needed. I'd compare each dose and used a calibration weight to verify.
- lazycatjumping 19d agoRelative precision is enough if you just want to get rid of pills
- mpetrovich 19d agoYou can also taper off by reducing dosage one day of the week at a time. Thats how I tapered off a 10mg Escitalopram prescription: every 4 weeks, I added another day of the week where I reduced my dosage by 5mg. Took about a year to fully taper off and had to pause for a month here and there to stabilize, but it was worth it. However, it was equally important that I had a support structure & tools to replace what the SSRI was doing. For me that was mindfulness and therapy.
- almog 19d agoMaybe another option is to dilute it with water so that you can use regular kitchen scales.
- someothherguyy 19d agoif the substance has good water solubility, you can do this by dilution, measuring volume, without a scale. sertraline for instance: https://pubchem.ncbi.nlm.nih.gov/compound/68617#section=Solubility&fullscreen=true https://pubchem.ncbi.nlm.nih.gov/compound/68617#section=Solu... don't do this with medications with special coatings or other methods for controlling release (SR/XR/etc).
- cactacea 19d agoUsing distilled water would be a good idea as well.
- IAmGraydon 19d agoYou can also do a volumetric taper if you don’t have an accurate milligram scale (and none of the ones on Amazon are accurate). Dissolve a larger, known amount of medicine in a known amount of water or propylene glycol, depending upon solubility of the medicine. Then dose the liquid by volume. For example, 1 gram of medicine in 1 liter of water = 1 mg per ml. You can easily dose even microgram amounts this way.
- wodenokoto 19d agoyou get a pill cutter. I was recommended to get one to ease in
- gwbas1c 19d agoAmazon: https://www.amazon.com/s?k=calibrated+milligram+scale https://www.amazon.com/s?k=calibrated+milligram+scale --- They're common, cheap, and plenty of (recreational) drug dealers use them.
- ebiester 19d agoThey're also fantastic for small measures for baking and cooking when it matters.
- gwbas1c 19d agoCurious: What do you make where you need such accurate measurements? I just eyeball everything when I cook. (For other things that I'm passionate about I'm much more careful.)
- roryirvine 19d agoBaking often rewards precision. I'm also an eyeballer. I'm a decent cook but a truly lousy baker.
- morsch 18d agoI sometimes wish my scale was precise to below 1g when measuring yeast for long-rising (bread) dough. A recipe may ask for 1g, and adding 2g will make a huge difference.
- kevinmchugh 18d agoThere's a few modernist cooking tricks that require small amounts - tenths of a gram - for big impacts. Sodium citrate can make any cheese melt beautifully into a smooth sauce, using something like 1% of the weight of the cheese. Any juice can take the roll of lime or lemon (in cocktails or baking) by adding a bit of citric or malic acid. Orange juice is 1% citric acid, so add 3g citric and 2g malic per 100g juice and now you can make an orange daiquiri or "key" orange pie. Emulsifiers get goopy if you use a lot, but can make a smooth syrup in small amounts. You can make a nice syrup from any nut milk with a small amount of xanthan and gum arabic. There's a wide array of ingredients including xanthan and gum arabic used in tiny amounts in gluten free baking
- dirkc 19d agoWould you be able to taper by stretching out dosages, take a pill every 25 hours instead of 24?
- _the_inflator 19d agoYou are absolutely right. In fact with the hit on men’s sexual ability sometimes or often times you could consider this a hit hot (very sinister framing) on the practical side, having in the best case no anxiety and being able to meet people and how are you supposed to date? Blue solution? Men’s inability to perform is causing a huge hit on their psyche. So in any case consider wisely, I heard many accounts of very disappointed men. It may help women, but that’s a different thing. For men - only in rare cases to be considered if ever.
- orangedog 19d agoYou're going to hear about it when it happens because it really bothers people when it happens but you aren't going to hear how often it statistically happens. I notice reduced desire but I'm depressed, too, it's hard to disentangle the effects, there is a ton of fud.
- pas 19d agofor anyone who's curious about the sexual side-effects, this subreddit has stories from the unlucky few https://reddit.com/r/PSSD/top/ https://reddit.com/r/PSSD/top/
- mrguyorama 19d agoThe only medication for Premature Ejaculation that exists currently is a megadose of a special SSRI which has a short half life. If you are a man, SSRIs are very likely to make you last longer in bed, and that is often a very bad thing. If you are a woman, whatever the SSRI is treating may leave you better off than before, if you found the depression or anxiety to be an obstacle to your satisfaction. Many people however don't have an effect that makes a meaningful difference. That subreddit is awful though. It's full of the same energy as health woo communities. >It's tragic that this time we won't be able to enjoy GTA 6, after we were able to enjoy Gta 5. Damn everyone who invented these destructive drugs. Like, come on man.
- swat535 19d agoAre you referring to dapoxetine ? It's not approved in US and it's not really a "megadose” of a regular SSRI since it's a different molecule. Also, this is not only medication for PE.. there are many other options like fluoxetine, citalopram, PDE5s, etc .
- sparklingmango 19d agoCould you share the specific mg/week taper you did for Sertraline?
- bb123 19d agoI did 10% relative reduction in my dose per 2 weeks, until I got down to ~2-3mg and then went cold turkey from there. Very very conservative. The 10% relative part is important - if you dropped by a constant, say 5mg, proportionally you'd be doing bigger drops each time which is where people get into trouble, especially at low doses.
- sparklingmango 7d agoOh good call. Thank you!
- YinglingHeavy 19d agoYou start with Marcus Aurelius and work your way up to Nietzsche.
- fny 19d agoThe problem is that psychiatry is an absolute zoo. Ive heard that if you go to 10 doctors you'll get 10 different opinions based on the docs personal experience. Even if there are trials for these medications, the field is not quantitative in practice. "Standard of care" is a myth.
- trentnix 19d agoThe one thing they will all agree on is that you need pills of one sort or another.
- stronglikedan 19d agoOf course, because prescribing pills is the sole job of a psychiatrist. Go to a phycologist or therapist of you want to try to talk it out. If talking doesn't work, they'll send you to a psychiatrist for medication.
- krupan 19d agoDefinitely prefer psychologists and therapists over psychiatrists, but don't discount how much something like an SSRI can help
- hirvi74 19d agoBut how does one know? According to some studies, spontaneous remission happens in about half the cases of depression in a given year. It's happened to me plenty of times. That's why I refuse to medications. All I have to do is just wait it out. I am not claiming no one gets any benefits, rather how can one be certain the benefits are actually not from something else? If the goal is to improve, then I suppose it does not truly matter. But I just like to understand things when I can.
- com2kid 19d agoPart of diagnostic criteria is how long something lasts. If you have a really good week you aren't going to get diagnosed with mania. If you have a really good month where you quit your job, move to Italy, and try to start a new job carving marble statues (and you've never carved stone in your life), well those will all be factors in any diagnoses given. On the other hand, if you feel sad because your dog died, no one should be writing you a script for anything. But if your dog died and you can't even function enough to go to work for a month, yeah it is probably temporary, but maybe some help is warranted, be that therapy or meds.
- movespebp 19d ago[dead]
- krupan 19d agoWere you experiencing side effects that made you want to get off? For the vast majority of people there really are none.
- erkt 19d agoYou think the vast majority of people do not experience side effects from anti-depressants? Wild.
- orangedog 19d agoWhat's wild about that? What does the science say? I've tried a variety and I can't say whether I've experienced side effects. That's just an anecdote but that's the thing with this discussion, that's all you will get. If people don't suffer side effects, they're not likley to get on HN and post about them, etc. The bigger issue is the person dealing with these issues is taking them because they are not well-off. If you deal with reduced desire, for example, is that a side effect of the medication or is that a side effect of being depressed. I think your "wild" is a little flippant or telling because it just points back to anecdotes.
- hirako2000 19d agoThey don't post on HN but a cousin post references an entire subreddit dedicated to it. They are also anecdotal, hundreds, thousands of people suffering side effects. Given dozen of millions people in the U.S alone are prescribed those things daily, that a drop in the ocean. But not everyone post on Reddit either
- orangedog 19d agoYes but again this is the exact example of anecdotes. Those not suffering aren't going to seek out subreddits to post about their non-problems. You can find a subreddit about everything, whether that's representative of anything or not.
- 18d ago
- j45 19d agoIt's harrowing to discover how much of the healthcare system can act like the nervous system does not exist, and the tools available to them are the only tools available, whether it's a prescription, or a focused therapy. The inability to make an informed choice when not knowing the options up front other than the recommendation is truly one of the worst parts of all of this kind of stuff. Medication can be a reasonable reality many times, but increasingly in hindsight it seems like there can be other things to check first, physiologically, etc. The number of things that are prescribed through guessing at groupings of symptoms vs just testing or imaging where it's applicable is something I truly can never unsee once I learned about it. Semi related, did you ever come across saffron in your journey and what did/didn't stand out to you about it?