Ask HN: What is your experience with SSRIs?
I&#x27;m happy to describe my experiences with SSRIs, but to be frank, I think I need to address some of what you describe about yourself in your post first. I am not a mental health professional or a healthcare provider, but I deeply empathize with the sense you express that your brain is &quot;all you have.&quot;<p>I also want to tell you that it&#x27;s a lie. You don&#x27;t have your brain right now. A well-operating brain does not typically do the things your brain is doing. Maybe by your &quot;brain&quot; you mean your intellect and your insight into your situation, which you fortunately <i>do</i> have - but I can assure you that SSRIs are not going to diminish this, in fact, they&#x27;re likely to do the opposite.<p>I take 10mg of citalopram and 60mg of buspirone daily. Eventually, I plan to switch that up and take 20mg of citalopram, dropping the buspirone.* Like you, I was incredibly nervous about starting them. I tried duloxetine (couldn&#x27;t stomach it, literally) and bupropion (too anxiety-inducing, though it had a nice stimulating effect) before trying my current blend. Each medication brought with it fears along similar lines to yours: sexual side effects, losing my intellect, blunting my emotions, losing my sense of self&#x2F;continuity. Here&#x27;s what actually happened:<p>About a month after I started on citalopram, I encountered a situation which would commonly provoke a panic attack... and it didn&#x27;t come. I knew that I <i>should</i> feel anxious, that I had felt that way in the past in these situations, and indeed, I <i>was</i> worried - but only in a normal way, &quot;hmm, this could be a problem.&quot; Not the shaking and fast breathing and inability to think about anything else that panic attacks bring. It was a fascinating, slightly disassociative sensation, to know that by all the rules of my own brain that I was used to, I <i>ought</i> to be feeling awful, and instead I felt okay. Not happy, not unconcerned, but rational, functional, so, okay. I don&#x27;t feel artificially happy because I&#x27;m still not <i>happy</i>. I&#x27;m just able to deal with my problems.<p>This continues to be my experience. I still have panic attacks sometimes. I&#x27;m still an anxious person. But there are lots of situations now where rather than feeling intensely anxious, I now just feel a normal amount of concern. Like a normal person would. I&#x27;m still me. I&#x27;m as sharp (or dull) as ever. It&#x27;s just the panic that is missing, and I don&#x27;t feel any lesser for it.<p>I have experienced side effects: Buspirone makes me very dizzy, and hungover if I miss a dose, so I take it just before bed. Citalopram makes me more activated&#x2F;awake, so I take it in the morning. Some people feel the opposite, or nothing. I have had sexual side effects as well. They were moderately unpleasant, but they went away after a few months and now I am normal again. (I&#x27;m confident I didn&#x27;t just get used to them and mistake them for normal, because I no longer have problems I temporarily had.)<p>Getting on and tapering off these drugs is a pain in the ass. (Start slowly. Do <i>not</i> start with the full 20mg, you won&#x27;t feel good.) And it is true that there is an extremely small non-zero chance that you could be permanently altered in some way - sexual or otherwise - by trying one. But I would view that as an extraordinarily unlikely occurrence - you are almost certainly not that unlucky, because almost nobody is. I would recommend giving them a try.<p>A resource I found very helpful was Lorien Psychology&#x27;s SSRI article: <a href="https:&#x2F;&#x2F;lorienpsych.com&#x2F;2020&#x2F;10&#x2F;25&#x2F;ssris&#x2F;" rel="nofollow">https:&#x2F;&#x2F;lorienpsych.com&#x2F;2020&#x2F;10&#x2F;25&#x2F;ssris&#x2F;</a>. This is by Scott Alexander, the same person who writes Slate Star Codex, but is more recent work. There are lots of things Alexander writes and believes that I don&#x27;t agree with, but he is a licensed psychiatrist and I find his approach helpful.<p>I also want to say that I think from your description you may need more help than what any med or combination of meds can provide. You should devote the energy you have to finding a good therapist that you can trust. This is much harder than it should be and probably merits its own Ask HN&#x2F;discussion, but once you have one, you will have a much easier time making these decisions with their help. I recommend regular talk therapy, too - whether with your psychiatrist or a separate provider. SSRIs work best when they are not the only treatment you&#x27;re trying.<p>*(Note that buspirone is not an SSRI, which is why I only address it tangentially. I&#x27;m getting rid of it because its benefit is pretty marginal compared to citalopram, and I feel disproportionately bad if I miss a dose. It&#x27;s a great &quot;gateway drug&quot; to SSRIs though, if you want to try it. My side effects are unfortunate but very very rare.)