I have been on various SSRIs in the past 15 years for anxiety and depression (Prozac, Wellbutrin, Zoloft, Celexa). FYI: I am noticing Celexa is the winner. I have seen in media and criminal defenses that they may cause suicide, further depression, and psychotic episodes. I understand how basic SSRIs work on the brain so how does this happen? What causes the contraindication when these are a drug that should bring mental benefits?
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They can cause suicide risk because people who are being lifted out of severe depression by SSRIs are more likely to attempt suicide because they are still severely depressed but finally have the motivation to give it a shot.
It can get worse because sometimes drugs have the opposite of the intended reaction. This is pretty rare.
I haven’t heard of SSRIs causing psychotic episodes. But I guess it would be possible if it pushed someone into a manic episode which can cause psychosis. Depression can cause it as well but it’s pretty rare.
Absolutely Gabapentin. I’ve seen too many horror stories from that one. Whenever GP is mentioned usually someone shrieks and I heard a new horror story.
In short form: We don’t really know.
The leading theory in the case of further depression and the risk of suicide is that SSRIs, in some, only partially influence depression. This may be due to low dosage, or just differences in how individuals’ brains work, but this can lead to some symptoms being suppressed while others come to the forefront, as well as recovery just *enough* to gain energy back but not lose suicidality.
Another case is simply that in particular people, serotonin (the second S in SSRI) isn’t the problem chemical. SSRIs work by preventing the brain from getting rid of free-floating serotonin, which if you have a deficit, is very useful, but can be unwanted if you don’t. Our brain chemistry and how it affects us is a very careful balance, and an excess of serotonin doesn’t equate entirely with euphoria. (It’s also dangerous, but that’s mostly in the case of overdose and drug mixing.)
As for psychosis, see above about the careful balance. Almost all psychiatric medications have a risk of psychosis because of it. Edit: Also, if SSRIs are prescribed to someone bipolar who was misdiagnosed, mania can cause psychosis as well, and SSRIs can exacerbate bipolar symptoms.
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