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Comment by BjoernKW | Hacker News Reader

With SSRIs you have a one in three chance for any number of the following side effects; many of them permanent, even after discontinuing medication (if you actually manage to do so, since SSRI come with severe withdrawal symptoms):

- sexual dysfunction

- loss of emotion and creativity

- drowsiness

- insomnia (including real fun stuff like night terrors)

- fatigue

- nausea

- tremors

I'd hardly call that safe or manageable.

With even the most potent psychedelics such as LSD, on the other hand, there's merely a one in thousand chance for severe side effects.

I'd go as far as prohibiting the prescription of SSRIs for all but the most severe cases (such as a severe depression where the patient is actually suicidal). For everything else these drugs are commonly used for, e.g., mild depression, OCD, or IBS, there are other - in many cases better - options with far less devastating (if any) adverse effects.

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> many of them permanent

Almost none of these would be permanent, and you certainly don't have a 1 in 3 chance of them being permanent. Where did you get that number?

> With even the most potent psychedelics such as LSD, on the other hand, there's merely a one in thousand chance for severe side effects.

This is fucking nuts. We're in a thread about how taking too much can clearly cause weeks of psychosis, and how easy it is to do that. There's nothing wrong with warning about the risks of SSRIs, but to claim you have a 1 in 3 chance of having permanent nausea while, in the same breath, claiming psychedelics are 100x safer, is beyond irresponsible.

> Almost none of these would be permanent

Sexual dysfunction caused by SSRIs in many cases persists for the rest of the patient's life.

> and you certainly don't have a 1 in 3 chance of them being permanent. Where did you get that number?

Those are actual numbers from scientific studies: https://pmc.ncbi.nlm.nih.gov/articles/PMC2719451/

> in the same breath, claiming psychedelics are 100x safer, is beyond irresponsible.

Stating mere facts isn't irresponsible and those are the facts:

When taking SSRIs you have a one in three chance to permanently and severely change your life for the worse.

When taking LSD you have a 1 in 1,000 chance of suffering a psychotic break.

What's irresponsible - and unethical - is twisting and misrepresenting these facts - to the extent of outright lying about the purported innocuousness of SSRI, as is wont in the psychiatric community.

> Sexual dysfunction caused by SSRIs in many cases persists for the rest of the patient's life

You said most symptoms were permanent, don't back down now. Sexual Dysfunction is a pretty broad term, how would you even link it to being affected by an SSRI?

> Those are actual numbers from scientific studies: https://pmc.ncbi.nlm.nih.gov/articles/PMC2719451/

Literally says NOTHING about being permanent, this is about symptoms experienced while on SSRIs. Did you read your own source?

> When taking LSD you have a 1 in 1,000 chance of suffering a psychotic break

Where are you getting this number? It lacks so much context. What dosage gives you a 1/1000 chances of a psychotic break? Are you aware people are just taking whatever amount of Ketamine they feel like?

You seem to be arguing that Ketamine is somehow 300+ times safer than SSRIs as if you can compare the two 1:1. That is now how medication works.

> You said most symptoms were permanent, don't back down now. Sexual Dysfunction is a pretty broad term, how would you even link it to being affected by an SSRI?

There you go: https://www.tga.gov.au/news/safety-updates/updated-warnings-...

https://annals-general-psychiatry.biomedcentral.com/articles...

https://pmc.ncbi.nlm.nih.gov/articles/PMC8061302/

https://rxisk.org/post-ssri-sexual-dysfunction-pssd/

> Where are you getting this number?

There you go (for instance): "Cohen suggests a low rate of prolonged psychotic reactions in LSD users (1.8 per 1000) [19]"

https://www.nature.com/articles/s41380-024-02800-5#Sec35

> Are you aware people are just taking whatever amount of Ketamine they feel like?

Ketamine is a totally different type of drug. Deriving anything about psychedelics from the amount of Ketamine people take is entirely nonsensical.

Buddy, you're doing something called Source Bombing. I've read through 3 of these links and they directly contradict what you argued. I'm not going to waste my free time reading through the rest if you aren't going to bother reading at least one of them yourself.

With regards to Ketamine.

> There you go (for instance): "Cohen suggests a low rate of prolonged psychotic reactions in LSD users (1.8 per 1000) [19]"

That is a description of one of the many studies included in this meta-analysis. This is from the same article.

> Taken together, the effective risk of psychedelic-induced psychosis or worsening of pre-existing psychotic symptoms in schizophrenia -as well as in the early stages of the psychosis spectrum- remains incompletely understood

Also

> Overall quality of studies was low and only few studies (n = 9) could be included in the meta-analysis, hence the presented findings should be interpreted with caution.

> Buddy, you're doing something called Source Bombing.

You're doing something called "Moving the goalposts" by first asking for sources and then complaining because those sources don't support the very narrow construal you seem to be applying to my argument.

Those sources are scientific studies, which by the very nature of the scientific processes of course are open-ended.

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