So quick disclaimer, both my wife and I are on the Autism spectrum, we both figured this out far too late in our 20s and have been working to re-frame our mindsets about it to understand ourselves better.
Recently, she reached out to a Psychiatrist for adhd and PMDD symptoms and was immediately clocked as ASD and prescribed zoloft to help long term with PMDD syndromes.
The first night was absolute hell of mood swings and discomfort so I was looking more into SSRIs, previously all I knew is you cant just stop taking them and they make certain people’s dicks stop working.
Strolling into the zoloft subreddit is an absolutely crazy experience, half the posters are like “i’m going insane is this normal?” and they receive responses like “yeah just wait 12 weeks of these symptoms and maybe you’ll be cool”. The other half of the posts are people post 12 weeks being like “this shit cool”, but there’s a weird confirmation bias where the people who got off of it are not lurking in the zoloft subreddit. Every once and a while you’ll see someone necro-bump a year old post about someone giving it time and they’ll be like “oh yeah sorry for the late reply, the drug was incredibly bad for me and I had to get off of it”.
My wife was experiencing this out-of-character rage at certain things, but also felt a weird control over said rage and began looking into posts about that and apparently its common? Weird rage too, like being frustrated with fellow ASD people. I started connecting the dots and thinking about people in my life who were on these and holy shit, they’re absolute seething assholes to us, is this why? What is this drug???
And this doesn’t even touch getting off the drug, apparently the withdrawal is absolutely demonic for many many days. Then you have serotonin syndrome, the endless list of side effects that you have no idea if you’ll experience or not because doctors don’t give a shit and blood panels for drug reactions are too expensive to bother with.
All this stuff basically points to “neurodivergent people are being tortured with the promise of a semblance of normalcy in order to cope with our capitalist world, and all the “normalcy” is, is the ability to control your emotions externally despite them being wildly out of control internally”.
Rip me apart for this all you want but i’m leaning towards crank status being anti-anti-depressants. All this to say I’m prescribed stimulants and i’m grateful I can just take days off or just not take them when I’m happy to be my autistic-adhd self.(I know not all people can do this with ADHD, my heart goes out to them, but it’s more an issue with existing at baseline rather than going off wrecking havoc)
psyilocibin therapy needs to become more widespread because SSRIs are far more terrifying than seeing god and your subconscious.
ok, i’m on the sertraline (zoloft is the brand name) so i can at least give some info and my takes on efficacy. we can start with the basic medical information about it. the most important thing is to take it consistently, and not just dosage too quickly. dosage is typically changed in 25 mg increments for sertraline, with a typical dose of ~100 mg, a minimal starting dose of 25 mg, and a maximum dose around 200 mg possible. different dosages perform differently for different people. getting on or off, it’s best to stabilize for at least a week or two at each increment of 25 mg to avoid the worst side effects / risk of serotonin syndrome. i had some side effects getting on it, but it’s sort of a non-issue for me. i don’t think it’s helping my autistic self all that much, but it did help me stabilize my mood when i was falling off the proverbial cliff, so i’ll give it that. my best advice is that your mileage may vary and that an ssri is not for everyone. i haven’t tried hallucinogens as an alternative so i can’t speak to that.
interesting anecdote: the approval of drugs by the FDA requires that at least 2 double-blind studies of the drug indicate statistically significant benefit over a placebo. it doesn’t matter how many times the drug fails wrt approval, they just need 2 that pass. the thing with ssri’s though is all those side effects. so the approval studies were double-blinds, but with inert placebos, so both doctors and patients would generally know who had the drug and who got sugar pills. when you do double-blind studies with active placebos that mimic the side effects but not the pharmacology of ssri’s, you find that placebos are just as effective as the drug. which isn’t to say that the drug became less effective in that study; the placebo became effective by being indistinguishable from the real thing outside of the actual serotonin reuptake inhibition function.
All the stuff about the blind studies and placebos not showing a difference really makes me feel like I’m going insane, like that should really be looked at a little more closely.
i think it calls into question whether the serotonin reuptake mechanism itself is directly responsible for the improvement in depressive symptoms, but not whether it does. i heard about this a solid five years before starting ssri’s and i think they’ve still done something for me. it’s just that medicine related to the actual neurological mechanics is basically unknown. the psychology professor that told me about this also had the opinion that our understanding of the biomechanics of the mind were on the level of people in the 1800’s classifying rotoviruses and stomach cancer as “illness of the stomach” i.e. we have no fucking clue how mental illness works at a fundamental level.