The hate on antidepressants is not because they're not effective, but rather that they're abused by psychiatrists. Ideally, a professional will prescribe them as a necessary helper to becoming (more) mentally healthy whilst tackling the root cause. Most of the time however, it's more of a "here, take these indefinitely".

It's like if we took sleeping pills every time we had trouble sleeping. Having said that, I just realised I have the impression that's exactly what people do in the USA?

> I won the SSRI lottery I guess,

From reading internet comments you’d think so, but your experience is more typical than anything.

Depression is deceptively common. As a consequence, SSRI use over a lifetime is also more common than most would assume. Any drug will come with negative side effects for some portion of its users. Multiply that by the high number of people who have ever taken an SSRI and it starts to become obvious why there are so many Internet anecdotes about SSRIs not working.

Meanwhile, most people who take SSRIs successfully aren’t going around and advertising the fact that they’re on psychiatric medications. There is less stigma now than there was in the past, but it’s still not something most people like to broadcast to the world. For patients on long term SSRIs in stable states, the SSRI is just a routine thing they take in the background and don’t really think about. There’s no reason for it to come up in conversation.

Hi, author of the blog post here! Thank you for sharing your experience with antidepressants, I'm really glad it worked for you & made your life better.

I did mention the following at the end of the "antidepressants" section, but reading your comment convinced me to move it further up. The intro now reads:

> The "standardised effect size" of antidepressants on depression, vs placebo, is around 0.4. (On average; some people respond much better or much worse.)

Also, I wasn't expecting my article to do well on Hacker News; thank you everyone for the comments & critiques! I'll edit the blog post as I go along, to refine it in response to your comments.

“God, I see what you’re doing for others, and I want that for me.”

I had a very similar experience, except it killed my libido, so I chose to endure the suffering of Winter rather than live with emotional numbness.

Still, I strongly recommend it for people flirting with the abyss. It was life-changing for me while I was raising an autistic 2yo during the pandemic.

I had disk issues in my lumbar spine that caused nearly unbearable pain and terrible quality of life. Tried everything: PT, OTC painkillers, epidurals, massage, nothing worked. Was prescribed pragabalin and duloxotine. Duloxotine is an SNRI that also treats nerve pain. That combination helped some but I was sleeping 11+ hours per day and generally felt like my head was in a complete fog, was pretty much useless with work. I had been trying to avoid surgery but finally had 2 procedures in 2024 that helped immensely. Weaning off those 2 drugs was no fun: sweating constantly, anxious, headaches for about 2 weeks. Extremely happy I went the surgery route and stopped those meds. I can't imagine living day to day feeling like that.

It takes a 10 min talk with a doctor to get antidepressants around here. Perhaps a test which looks like multiple choice score of symptoms with some weights.

I had an old gf receive two different drugs each with terrible side effects. To me it looked as poison.

I decided that I would rather hurt myself myself than fuck with my brain chemistry this way.

During the dark northern Winters I lack vitamin D (your doctor can measure this using a blood test). The symptoms are some physical issues and probably something that can be described as light depression which goes away if I remember to take the vitamins.

We are all different. Some people might need anti-depressants. I just need some vitamins.

SSRIs saved my life. No exaggeration. They might be overprescribed, only effective is some individuals, and they certainly have their share of side effects, but they're still the gold standard treatment for clinical depression and anxiety.

If a drug has an 1% chance of 100% effect, it will look pretty weak in those studies.

IMO it's pretty clear that depression is a symptom of many independent issues, so it's really lame that we don't have a more accurate way of diagnosing it.

Similar story here but for ADHD and Atomoxetine.

I finally went and got diagnosed at age 46 for what had been an childhood-onset issue in retrospect. All the signs were there: inability to start work until enough challenge or novelty or a state of crisis had come about, etc. When I spoke to friends about considering treatment, they said they thought of me as a hyperfocus kind of person. But they didn't see how many support systems I had put in place to function normally, how I saw others around me just doing things while I had to work myself up to start and then keep checking and double-checking for the silly inattentive mistakes I knew from experience I would keep making.

I've had a meditation practice for a long time and it has helped with anxiety but it hasn't really helped with getting started on tasks, especially those perceived as boring. I even had to psych myself up to sit down and start meditating, even though I knew I would enjoy it.

I didn't know until a year or two ago that non-stimulant medication existed to treat ADHD. I always thought it was only Adderall and the like, and I couldn't risk anything that would ramp my anxiety up, or take additional treatment for the anxiety with SSRIs because I have severe hemophilia and any additional risk of bleeding from SSRIs was an untenable proposition.

After sitting on the idea for some time and just hoping that I could fix it with more meditation, I finally decided to see a psychiatrist. The doctor suggested Atomoxetine, but said it doesn't work for most people and even then takes 3-4 weeks to take full effect. I started on the absurdly low dose of 10mg/day for the first month to be sure it wouldn't cause additional bleeds. By day 3 I could see a huge improvement in my working memory and ability to perform tasks. It gave me insomnia for a bit but I would wake up at 3 AM, sit down happily to work and write the best code I've written in years. I could not believe the difference it made. There were quite a few side effects initially but I was willing to put up with them because of how smoothly my brain was functioning. I became a nicer person to deal with. I felt this sense of possibility and freedom that I haven't felt since my 20s. My only regret is not having done this sooner.

So yeah, please don't avoid medication based on internet reading.

As someone who tried citalopram escitalopram and sertraline, along with venlaflaxine and fluvoximine, I would suggest doing a pharmacological test for psychiatric medications.

I am an intermediate metabolized for the first three and the ones I was on most long. It did not suit me and made my orgasms go from ‘wtf’ to ‘that’s it?’ And they are still not normal 2 years after discontinuation.

I am still depressed and anxious to the point of serious consideration of these medicines to save myself, but you can save yourself the experimentation by doing a simple test and avoiding those medicines.

Anxiety depression panic attacks are something I wish more people studied along with sexual health.

Same for me with buproprion. Night and day difference. Made me wonder how different my life would be if I had been diagnosed appropriately when I was a kid.

Same for me with Adderall.

I do wonder if being highly functional and feeling capable is normal though, like as a species it seems almost dysfunctional to happily plow through 8 hour workdays and bills and appointments and all the little bureaucracies we have to navigate. Sometimes a little voice screams "Run to the woods!" when I sit down and look at a long todo list for the day, but with Adderall I can generate some semblance of enjoyment from ticking off the boxes.

Granted our world is what it is, and we are mostly helpless to enact large changes. Finding some kind of peace with reality is probably better than bashing your head against why you don't fit into it well.

I had severe SAD to the point of having a mental break where I told my wife I was flying that very day to Miami to get away from the cold. I didn’t end up flying to Miami, which is likely why I’m still married…

So I ended up spending $300 on LED bulbs, both corn bulbs and 200W equivalent, bought some 7-Way splitters for my ceiling fan so it’s holding 28 light bulbs (people have joked I have a “biblically accurate ceiling fan” because it’s so bizarre looking, like a weird glowing biblical angel), and get about 10,000 lux in my home office now. As a bonus, I don’t have to run a space heater in my home office (since I only need it in winter, I’d have been using that electricity anyway via a space heater). Solved the issue completely for me.

The things that keep me away from SSRIs are the potential for addiction and not being able to take psychedelics.

I had a friend on SSRIs not tell us they were on them when they hit a DMT vape pen at a party years ago and they got serotonin syndrome. Had I known I would have warned them not to.

Tangent… but for sweaty feet, try a ski boot dryer!

You can get them for $50… they dry out my shoes which makes them last a lot longer before they get so smelly I have to throw them away. Plus, who doesn’t like warm shoes in the morning?

That, and there are some creams called Sweat Block or whatever you can rub on your feet which reduce sweating. Those work as well.

Same story here, but different drugs. Every year Nov to Mar means no lapses whatsoever in diet, exercise, sleep, supplements, clutter, lighting otherwise the SAD will seep in and erode me. I tried udosing ADHD meds this year and suddenly subsistence is easy and I have gas left in the tank for worthwhile things.

I feel like I speedrun Maslow's hierarchy of needs.

No anhedonia so far this year and my creative output is at all-time high. Hope that helps someone get over their own biases about prescriptions.

> Cold showers, ... no alcohol, strict sleeping rituals.

I feel like doing those three things would make me feel like reheated cat shit, regardless of the weather outside.

Bessel van der Kolk also mentions in his excellent book "The Body keeps the Score" that the effect of antidepressants is correlated with the source of the depression. If the depression is a comorbidity from early childhood trauma then antidepressants are limited due to trauma-related reshaping of how the brain is organized. Cases like yours or those that a related to traumatic experiences as an adult are more the result of a shallow neurochemical imbalance which antidepressants are able to impact beneficially.

I’m glad to hear that. Another frame is that your depression turned out to be “math hard” rather than bodybuilding hard [0]. Your disciplined, methodical approaches were steady applications of effort, whereas what you actually needed was easy to implement but hard to envision.

[0] https://www.alexcrompton.com/blog/2017/05/26/hard-is-not-def...

Similar story for me, but with Bupropion (Wellbutrin). None of the SSRIs/SNRIs worked for me, spent years trying different medications, Wellburtin was finally the one that worked, and oh man what a difference.

I still think you should have tried eating a banana first.

They've been losing ground to placebo in more recent research.

Plus, most of the more serious side effects take a lot more time to manifest than the typical length any given patient remained in the older clinical trials that secured FDA approval and grounded the official manufacturer literature.

I am glad we have these tools, but I suspect they are vastly overused, and patients not well informed.

Same I am in outstanding physical health and my diet / exercise is excellent. Taking Lexipro has made a massive improvement on my emotional bandwidth. I take vitamin D / fish oil and bits of other supplements. At least for me no question this medication even at a 10mg dose has made a major positive impact.

Thank you for saying this, I wholeheartedly agree. Antidepressants have an excessively bad reputation.

I'm sure they have their problems too on occasion, but for me the decision to start taking Escitalopram was one of the best things I've ever done.

The side effects were totally negligible compared to the benefits.

I've stopped taking it a year ago or so and... it's basically cured me.

I'm not saying antidepressant are a literal pharmaceutical cure for depression, but in my case it simply put me in a position mentally to change habits and patterns of thinking in a sustainable way.

My only regret is not doing this 10 years earlier; the poor reputation contributed to that.

I had a similar experience except instead of antidepressants it was when i started taking Adderall as an adult. A sense of peace and serenity in my mind that I had never felt before, it was almost overwhelming.

I had pretty much the same reaction after two days of taking it.

Took a while longer to get the dose right so that my anxiety also mostly disappeared, but the difference in quality of life it made for me is hard to put into words.

What dosage of Citalopram? 40 mg/day?

(Roughly equivalent to Lexapro 15mg/day; Saffron 30 mg/day if Crocin+Safranal properly standardized)

> This just goes to show that for me, they're extremely effective.

I am not so convinced. Perhaps your case was simpler, but people can feel chronic depression. They may take some drugs to modify that, but what if the external factors won't change? You can see this issue for some people who have a disease that only gets progressively worse. I think we can not unify all this as "dislike on antidepressants" as a one-size-fits-all formula.

and then the effects wear of. You just feel "normal" or the same as before. I used to take ssri meds too. It was nice in the beginning. Stopping was a nightmare, I needed to taper down foe like half a year..

Imaging the number of people that this comment could inspire to get on SSRIs lol

I'm not saying it's a bad.

But I'm also saying there are no magic pills...!

Thank you for your comment. I think that can help many people.

How do you know it was the SSRI?

To cherry-pick a quote from a review of SSRI studies:

>the magnitude of symptom reduction was about 40% with antidepressants and about 30% with placebo.

That tells me that antidepressants have some effectiveness, but placebos work shockingly well. You can give someone a sugar pill with no medical properties whatsoever, and a good portion of people will recover, likely crediting the pill for their recovery.

Do you take the citalopram year round, then?

As someone that falls on the side of “depression is real and antidepressants can help” it is very clear that there are people in this thread that need to hold their tongues because they know not of what they speak. (Not you OP)

There are some forms of depression that you cannot think or act your way out of. If you haven’t experienced that, I promise that you do not understand what it is like. You cannot really understand unless you have experienced it. Your opinion on it is irrelevant, and frequently offensive.

The same is true for people that say that antidepressants are mostly placebo. They are not. When people say that antidepressants saved their life, they aren’t joking or exaggerating in the least.

Yes, I understand that other therapies are also effective, and that some people are non-responsive to some drugs.

Keep your pet theories to yourself if you are not a subject matter expert or someone who has experienced it first hand.

Edit: I understand that the placebo effect is still an effect. My point is that there are a lot of people being incredibly dismissive of real lived experiences and outcomes on a VERY serious issue.

If it is SAD have you tried bright daylight balanced lighting?

Re "citalopram" and "SSRI lottery I guess"...in fact, citalopram is not a true SSRI and in fact no SSRI is only an SSRI as they also on, at increasing doses, many other neurotransmitters like norepinephprine and Muscarinic acetylcholine receptors.

However, citalopram specifically has a big effect on the histaminegma the sigma-1 receptor. I will focus on the sigma-1 receptor:

https://www.sciencedirect.com/science/article/pii/S134786131...

Never heard of it? Yeah, don't be ashamed, it is the biggest secret in depression. In fact they are finding that many "SSRIs" are sigma-1 agonists, even prozac.

https://www.frontiersin.org/files/Articles/1691987/fnins-19-...

It tunrs out that Sigma receptors modulate glutamatergic dysfunction in depression, and glutamate, being excitatory, well, you can. make your assumptions from there.

https://www.frontiersin.org/journals/neuroscience/articles/1...

It seems the main function of the Sigma-1 receptor is Calcium release. And calcium ion channels are one of the most studies ion channels in mood disorders. By increasing calcium release you increase neuronal activity, hence, the uplifted mood.

It is too bad that the sigma-1 receptor is just starting to be studied and there is limited evidence of how omega-3 and Vitamin D effect it. But I do know that Vitamin D has a huge effect on SLC6A4 (SERT).

https://www.nature.com/articles/s41598-020-79388-7

I have Schizoaffective Disorder Bipolar Type (disabled) and have been on no less than 14 types of meds. I knwo how they work better than my psychiatrists, which I why I no longer take them. I also know my genetics which gave me clues to what is happening in my body. Now I eat a mostly seafood diet and my needs for meds has mostly vanished. I am still an odd old fellow, but at least I am not ranting in the streets or trying to kill myself anymore.

Meds saved my life, but a diet high in Omega 3, D, and a bunch of other things has removed so much suffering from my life, more than any medication has.

(Also, if you want to get into the weeds of depression, you might wat to look at ATP and depression https://onlinelibrary.wiley.com/doi/full/10.1111/cns.14536)

Yah. Measuring the effects of these drugs with a single effect size number is ridiculous. They work exceptionally well for some people (myself included). It seems as well that SSRIs work much more reliably on anxiety disorders than on depression.

Getting on them can be a ball ache (or entirely painless; escitalopram was easy on and easy off, Wellbutrin was a nightmare to get on, but also easy off), but entirely worth a shot for anyone symptomatic.

> I won the SSRI lottery I guess, the side effect are sweaty feet, vivid dreams and a dry mouth. That's all.

Yes, you did. Had the same medication and got tremors and stiffness so bad I thought I had early-onset Parkinson. Could hardly unlock the door without dropping the keys five or six times. Fortunately, it ceased when I stopped the SSRI.

Have you tried SAD lamp light therapy? But not those lamps you get on amazon or other marketed SAD lamps, those are a scam. Just buy a 2 floodlights that are pretty powerful, say 100 watt each. Works like a charm. 15-30 mins a day its all it takes

I experienced this but ended up getting off of them after developing some back/hip issues but I didn’t think it was related, it wasn’t until I quit the citalopram that my shoulders were suddenly relaxed and the hip “looseness” or constant need to be adjusted back into place went away, like everything tightened back up, it is really strange, then I looked up how SSRIs can impact this and even bone healing, decided I couldn’t risk my body falling apart.

sweet feet seems so random, maybe some serotonin receptors down there? are they noticeably sweety?

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I'm guessing you can afford spending $300 on light therapy glasses.

Disclaimer: I'm not a doctor, but saw 4 seasons of dr. House. Moreover, few hours of Huberman Lab on sleep and light and most importantly, this episode of Additude Mag Podcast on curing SAD and ADHD day-rhytm shifting with light glasses: https://www.youtube.com/watch?v=fu4mLgkNc6I

What happens in the seasonal affective disorder season is the sunlight pattern diverges from 6-18 that we evolved with. Without daily reminder of getting enough sun (or sun-like) light at the 6 o'clock⁰, your body clock will drift.

It can start by feeling groggy instead of refreshed in the morning, even if you've slept enough. And can escalate into loosing the will to do anything or even live.

No wonder. You're still an animal. You need to be fed, put to bed, etc. at a specific time. If you try to make your body sleep during the day, and eat and work during what body expects to be night, you won't really sleep and won't really live/work. Enough of not really sleeping and not really living - you mess up your body, your gut biome, your hormonal balance and your brain chemistry. You kind of should get depressed when you do it.

You can steer your body clock with light. Most of us do it, by exposing ourselves to strong (strong enough it won't matter if it includes blue wavelength or not).

But you can do it consciously (and in a way good for you) by putting on light therapy glasses (I'm using Lumiere 3¹, and they are not the only ones, find your own) at 6⁰ everyday, or right after you wake up if you're trying to readjust your rhythm. Or if you have time and want to save $200, use a stationary lamp and just sit in front of it doing nothing. I don't have the time. When readjusting, small doses of melatonin (0.5mg) 1h before sleep will accelerate body clock shift.

But don't listen to me, if you have SAD, you should really listen to that ADHD experts episode.

I feel for you, struggling with that stuff for a long time. Vit D, fish oil (lot of). All lights at home set to reduce intensity after 18. Strict going to bed routine. Still sleep poorly once in a while, but can do things in winter again. Hope it will help :)

0: choose whatever suits you. With small doses of melatonin and discipline in using light glasses you can even flip day and night. Just stay consistent, good farmer always feeds his cows at the same time.

1: at the time of buying ( fall '25 ) they were cheapest and best overall in norway. Solid build, ok battery, can have them on during yoga using attached rubbers and kind of can have them over glasses. Mine are very large and have blue light filter, but I manage 20min without eyeglasses. Medical certificate. Few leds, holo strip, battery and some plastic - my inner Scrooge says it's not worth $285, but everything else was worse and more expensive.