"Handed Out Like Candy"

Why I'm not super jazzed about "That Big SSRI Study," even though it's really good news.

Salutations, I’m Skye. I’m a psychotherapist and I write about therapy, therapy culture (yes, they’re different things), neurodiversity, trauma, creativity, addiction, psychology, meaning and relating.

This post is a reflection on

Freddie deBoer

’s “Nobody Wants to Hear Good News About Psychiatric Medicine.”

Lance Reis/Unsplash

So. Happy news about the happy pills! As it turns out, a formidably huge study published in JAMA Psychiatry has found SSRI withdrawal to be less common and less severe than psychiatry has generally assumed up until this point.¹

Let’s get the obvious essentials (which shouldn’t need to be explicitly stated) out of the way first:

1. This piece of information is unequivocally really good news. “There is Less Risk and Human Misery Happening Than We Thought” is a cracker of a headline. I am glad to hear about it, in much the same way that I would be happy to read that cancer rates are declining or that amarillo hops is actually good for my liver. Cheers.

2. I don’t have a dog in the anti-psychiatry race. I’m interested in what makes peoples’ lives better — more meaningful, purposeful, and joyful — regardless of ideology. I’m intrigued by the anti-psychiatry discourse because it reflects something about the tension between treating the malaise of an individual psyche vs offering maximally effective interventions across populations. I’ve seen SSRIs do both wondrous things and truly terrible things in my line of work, and if medication “solved” mental health tomorrow I’d be overjoyed (despite the required career pivot).

Now. Substack titan Freddie DeBoer has called out both the mainstream media and the anti-psychiatry movement for not giving this study the publicity and positivity it deserves.

Let me be clear: I think he’s got a damn good point.

I like to think of myself as reasonably well informed, and if you suspect I’m overrating myself here I also get my commitment to “ongoing learning” audited by the psych board every couple of years (imagine getting a visit from the IRS, but with less charisma and humour).

I should not be learning about something this important in my kitchen on Substack fucking Notes while balancing a cheese bagel on one knee.

At the same time, while this study is (1) unequivocally really good news and (2) criminally underreported on a level that’s suggestive of negligence and/or conspiracy, I will plead guilty to FDB’s accusation that I am not as jazzed as I perhaps ought to be about the wider implications of this finding. Again and again, I come back to what I see as the key tension in the antipsychiatry debate: individual cases make for poor mass assumptions at a population level AND YET even the best research-backed conclusions can produce very poor outcomes in a complex individual.

Essentially, I’m concerned about what this research — an overall positive — will probably be used to agitate for in public health given existing trends.

For what it’s worth, I hope I’m merely wrong and paranoid.

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“But Skye, isn’t this exactly the kind of research that should theoretically lead to more effective treatment outcomes?”

Absolutely internal Socrates, thanks for pointing that out. My concern is that while I’m not in agreement with the anti-medication crowd, I suspect the movement has mushroomed out of the decaying health system’s tendency towards the short-term and cheap-and-dirty. SSRIs are easy and affordable. But they’re not a cure-all. The medical system is already very quick to answer psychological distress — hell, even ordinary unhappiness — with pharmacological solutions. This occurs despite strong evidence-backing for the combination of psychotherapeutic treatment and/or behavioural therapies alongside appropriate medication.

Sometimes, SSRIs are all that’s needed for a person with clinical depression — an internal chemistry adjustment.

Sometimes, they’re are the only thing that gets someone functioning well enough to even begin to engage in therapeutic work. Believe me, I understand this intimately. I’ve seen it up close enough times, and that kind of unwellness makes Hell look like a tropical timeshare.

And sometimes, taking SSRIs is the psychological equivalent of taking the batteries out of a screaming smoke alarm when the house is on fire.

Despite what you’d believe watching the clinical lovefest that is TherapyTok, holistic mental health treatment usually isn’t an option unless you are rich, lucky, or both. Most people in therapy are usually people who can afford to pay for it themselves. Funding for integrative mental health approaches continues to dry up in favour of pharmacology. Therapeutic communities and grassroots clinics are closing all over the world. Transformative places. Places that worked, but cost.

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I have clients who would not be alive without SSRIs. I have also talked to people who had a harder time titrating down from antidepressants than they did detoxing from methamphetamine. I am very grateful to know that my future clients, if they need SSRIs, are less likely to experience the latter than I might have feared.

I also tend to think very few people who really need antidepressants are dissuaded by withdrawal fears, because situations where they are clinically indicated tend to involve life-or-death levels of suffering. All bets are off in severe Major Depressive Disorder, when you’re essentially dying. Better alive and having to go through withdrawal one day, than dead and beyond the reach of anything or anyone forever. Better alive and overweight, or alive and sweaty, or alive and dead below the waist than dead dead.

But it’s been my experience that SSRIs are often handed out as a “can’t hurt, why not give it a whirl” option, without serious consideration for potential issues down the line which are still possible. I’ve read enough doctor’s notes and sat in on enough public mental health meetings in the past decade to know this is real. Hell, I had SSRIs pushed at me following the suicide of a family member despite no significant score on the PHQ-9, and this experience basically encapsulates the main reason I was having a bastard of a time. Not being treated like a person, when you feel like you’ve fallen through the cracks of the world into something seemingly nobody else even cares to try and understand, tends to produce its own pathology.

Just take a pill and fuck off, would you?

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Do I want the brain chemical drugs to work, and not make people suffer? Yes, in much the same way as I want children to not get terminal leukaemia or the oceans to not boil.

But I also want people to at least have the option of accessing mental healthcare that’s expansive, dignified, evidence-backed and respectful of the fact that what works on average may not work for a given individual. Pills change brain chemistry, but so does psychotherapy. Hell, plenty of things do, as much as I will be the first person to roll my eyes at the “have you tried going outside for a walk” brigade. Antipsychiatry taken to extremes is dangerous. Suicidal people don’t need celery juice or naked ayahuasca ceremonies or crystals or whatever. They often need more than “just being listened to.” But being listened to does change brain chemistry.

Brain chemistry is experiences. Brain chemistry is feelings. Brain chemistry is thoughts. Brain chemistry is relationships. Brain chemistry is self-concept. Brain chemistry is how we think about thinking. Brain chemistry is how we think about feeling. Brain chemistry is what happens to us. Brain chemistry is how we make meaning from what happens to us.

So, yes.

I see good news about SSRIs and rejoice. I see good news about SSRIs and despair. Because I can see what remains of our willingness to treat people like complex, suffering beings who may need more comprehensive treatment, more attentive support and — God forbid, more care than a prescription — bleeding away just that little but quicker.

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Writing for a Cause

All subscription funds raised by Painting with Lightning go towards funding independent research in psychotherapeutic treatment development. My areas of experience and interest include suicide bereavement, sexual trauma, ADHD, addiction, and the use of AI in psychotherapy.

If you would like a paid subscription but can’t afford one, please email me at skyesclera@gmail.com and I’ll grant you access.

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This post was written and edited without the use of AI.

1. I’m putting this in a footnote, because I’m not able to trek all the way up the coast to get campus access to the full research paper just yet. But based on the abstract and overview: the study appears to measure discontinuation symptoms at one-week post final dose, and compare this against people still taking SSRIs. This indicates possible exclusion of test subjects who found withdrawal bad enough to tap out and go back to taking their medication. If that’s the case, the conclusions drawn are also lot less significant than claimed. Happy to be wrong.