“Unfortunately, the dismissal of PSSD from other psychiatrists left Awais writing a follow-up, Can We Please Stop Bullshitting Patients With Post-SSRI Sexual Dysfunction?”
I think there’s a difference between bullshitting and wondering if a a group of individuals with an unrelentingly negative view of the profession writ large and an obvious tendency to externalize any and all difficulties to the putative malfeasance of its practitioners should have the last word. SSRIs have been around since the late 80s and yet there’s an epidemic of PSSD 25 years later? Every single reference on UpToDate was written after 2018.
I don't think this it is self justifying to say that there has to be some middle ground between total skepticism and outright acceptance of every patient claim.
Yes I think you're right that there has to be a middle ground, after all the nocebo effect is real and not all bad things will be related to the medication.
However, I worry that not taking side-effects seriously enough can drive patients towards these anti-medication campaign groups!
Thank you Thomas for the article. I’m reading it because it’s an important issue, not because I’m from “the other side”, whoever they are. I’m just a person.
P.s I don’t have an unrelentingly negative view of the profession, I just wish that there was less “us and them”. People want psychiatric care to be a place of help, not just a place of confinement. If acute care was a more creative and engaging experience, then more people would stay on their meds and not hate the profession forever more. Pps. I’m listening and reading this blog because it’s interesting to me, and I want more engagement between the so called “sides”
SSRIs and especially SNRIs have other side effects that are intermingled with their intended effects and therefore inherently more difficult to discuss, yet I still feel betrayed by my psychiatrist for not having brought up any of with this me before prescribing me Effexor, for me the worst medication I have ever taken. Emotional numbing (the functional driver of its Antidepressive effects) and an general increase in drive and energy (what the N in SNRI is for) have driven me into an obsession to watch videos of people dying, which I brought up with my psychiatrist only to be told that reflecting on my own mortality is a normal way of healing.
I'm not qualified to judge whether this doctor might have been incompetent period, but I can say that this type of treatment assessment is deeply unserious. We have informally enforced rulesets of how doctors should handle the prescription of meds with highly problematic cost-benefit structures - everyone who ever needed a benzo-script has heard the spiel a hundred times. I have my gripes with this, I think we should discriminate more strongly between benzos (sure, keep the Xanax on lockdown, but be reasonable about Valium and Klonopin) rather than fight against a class of medications in general. But more than that, the way we discuss benzodiazepine prescriptions should be derived from a framwork that assists doctors with how to discuss any medication. Patients should have to hear the long talk about K-pins, but they should have to hear it about Effexor too.
And yes, discontinuing 300 mg Effexor was much harder for me than it was to discontinue 0.5 mg Klonopin, but only one of them was officially called a "withdrawal". Not the choice I would have made.
The problem with many (not all) psychiatrists is that they are high achievers because they haven’t had any cataclysmic effects on their brains that have prevented them from achieving their goals. So many just can’t relate to their own patients. They think that these people just aren’t trying hard enough at life and can’t grasp the simplest of explanations. Their work is so all consuming that they never get the opportunity to look at the wider context, or to see their recovered patients as intelligent people. I’m glad you persevered and got your side effects taken seriously eventually.
I like this blog. I was only annoyed with SM, whoever they are. I want to make anti psychiatry a thing of the past, but the idea that Awais Aftab is some kind of eccentric exotic because he speaks to people outside the field is (if you’ll excuse the bad taste pun) madness to me. Thank you for airing this issue, Thomas
Absolutely not. I just made a post about people like you who gaslight. The difference is the vast majority of the population wasn’t on SSRIs in the 80s, 90s, or even early 2000s. It became a much bigger phenomenon in the recent decade and became overly prescribed (especially amongst youth whose hormones are still developing). There are many cases where patients have literally gone completely numb. From my own experience it has been the same. However I have dedicated my entire herbal studies over the past 3 years to healing myself and understanding how to heal others. Stop gaslighting people. We need open conversations about the effects of these medications and their potential side effects. I am not saying we shouldn’t have them available, but it should be LAST resort medication.
“purely subjective phenomenon”? “patients who refuse to take responsibility for their own difficulties?” If you have this much contempt for people with mental illness you are probably doing more harm than good in your own profession. Thanks to clinicians with attitudes like yours, I have avoided the medical profession for years to my own detriment, because I decided to take responsibility for my own difficulties with psychosis.
I’m sorry I came off that way. With all due respect, I don’t think you can judge my attitudes and clinical practice from a comment. I take care of people with psychosis everyday, take informed consent very seriously, and will work with patients to reduce medication if they feel that is the best step for them. Im sorry for your bad experiences which are unfortunately all too common.
Nevertheless, I don’t think it’s controversial to say that patients, particularly those with personality disorders, have difficulty taking responsibility. Not even just patients, humans, myself included. The PSSD community appears to be to consist in the main of people
who view psychiatry as the devil incarnate for not informing them about a side effect that may not even be attributable to the medication and was not widely published in the first two decades of clinical practice with that class of medications. And it’s not just that community, it’s much of the affiliated groups which were, in fact, platformed by Awais before he became more savvy about the motivations of his interlocutors. This is a psychiatry blog and I’m sorry if the frustrations of practitioners working in this atmosphere occasionally surface.
Closed shops and tribalism don’t help anyone, we need to air our differences of opinion if we are to achieve better outcomes in the future. The treatments of the past gave rise to the anti psychiatry movement as well as giving some people their lives back. It’s a checkered history and more cross pollination and listening is needed on both “sides”. If you lost your job, your income, your status in society, your grip on reality, your autonomy and your own identity all in one day and all you were offered was a locked room and some pills, then you might feel a little underwhelmed with how your life is going, especially if your medic is too busy to see you for more than 10 minutes and has decided that they don’t respect you as a person. If you deal with people with psychosis every day, then I can only assume you understand just how disabling it is. I have avoided the psychiatric ward out of sheer luck, but I haven’t heard anyone else describe a positive experience in one yet, even if they agreed later that they needed to be there. I’m not an anti psychiatrist, but when autonomy loss is such a painful, degrading experience in wards today, I’m not surprised that it’s still a problem.
I do agree conversation with good faith critics and especially patients is necessary. People like Joanna Moncrief are not a good example of this.
Your point re: acute care is indisputable; unfortunately psychiatrists have basically zero to do with how terrible it is. I don’t know a psychiatrist who wouldn’t want more beds and less legal restrictions. Hospital admin, malpractice attorneys and politicians have different ideas.
I do believe that psychiatry is a vocation. I need psychiatrists to be stable, high achievers to be able to help me. That said, there is a large subset of people who have had an absence of what they need while their brains were still forming who won’t respond well if you take a “I’m the doctor, you’re the patient” approach. It infantilises them all over again and they just dissociate from what you are telling them. They have to trust you, and begin to believe what you are telling them, and that you are on their side. It really is a vocation, but it can be done. All the best with your work.
'Paracetamol' (laughs in American).
Acetaminophen? How do you even pronounce that?
“Unfortunately, the dismissal of PSSD from other psychiatrists left Awais writing a follow-up, Can We Please Stop Bullshitting Patients With Post-SSRI Sexual Dysfunction?”
I think there’s a difference between bullshitting and wondering if a a group of individuals with an unrelentingly negative view of the profession writ large and an obvious tendency to externalize any and all difficulties to the putative malfeasance of its practitioners should have the last word. SSRIs have been around since the late 80s and yet there’s an epidemic of PSSD 25 years later? Every single reference on UpToDate was written after 2018.
I don't think this it is self justifying to say that there has to be some middle ground between total skepticism and outright acceptance of every patient claim.
Yes I think you're right that there has to be a middle ground, after all the nocebo effect is real and not all bad things will be related to the medication.
However, I worry that not taking side-effects seriously enough can drive patients towards these anti-medication campaign groups!
It’s not the side effects, it’s the condescending attitude that drives people away elsewhere
Thank you Thomas for the article. I’m reading it because it’s an important issue, not because I’m from “the other side”, whoever they are. I’m just a person.
P.s I don’t have an unrelentingly negative view of the profession, I just wish that there was less “us and them”. People want psychiatric care to be a place of help, not just a place of confinement. If acute care was a more creative and engaging experience, then more people would stay on their meds and not hate the profession forever more. Pps. I’m listening and reading this blog because it’s interesting to me, and I want more engagement between the so called “sides”
SSRIs and especially SNRIs have other side effects that are intermingled with their intended effects and therefore inherently more difficult to discuss, yet I still feel betrayed by my psychiatrist for not having brought up any of with this me before prescribing me Effexor, for me the worst medication I have ever taken. Emotional numbing (the functional driver of its Antidepressive effects) and an general increase in drive and energy (what the N in SNRI is for) have driven me into an obsession to watch videos of people dying, which I brought up with my psychiatrist only to be told that reflecting on my own mortality is a normal way of healing.
I'm not qualified to judge whether this doctor might have been incompetent period, but I can say that this type of treatment assessment is deeply unserious. We have informally enforced rulesets of how doctors should handle the prescription of meds with highly problematic cost-benefit structures - everyone who ever needed a benzo-script has heard the spiel a hundred times. I have my gripes with this, I think we should discriminate more strongly between benzos (sure, keep the Xanax on lockdown, but be reasonable about Valium and Klonopin) rather than fight against a class of medications in general. But more than that, the way we discuss benzodiazepine prescriptions should be derived from a framwork that assists doctors with how to discuss any medication. Patients should have to hear the long talk about K-pins, but they should have to hear it about Effexor too.
And yes, discontinuing 300 mg Effexor was much harder for me than it was to discontinue 0.5 mg Klonopin, but only one of them was officially called a "withdrawal". Not the choice I would have made.
The problem with many (not all) psychiatrists is that they are high achievers because they haven’t had any cataclysmic effects on their brains that have prevented them from achieving their goals. So many just can’t relate to their own patients. They think that these people just aren’t trying hard enough at life and can’t grasp the simplest of explanations. Their work is so all consuming that they never get the opportunity to look at the wider context, or to see their recovered patients as intelligent people. I’m glad you persevered and got your side effects taken seriously eventually.
I like this blog. I was only annoyed with SM, whoever they are. I want to make anti psychiatry a thing of the past, but the idea that Awais Aftab is some kind of eccentric exotic because he speaks to people outside the field is (if you’ll excuse the bad taste pun) madness to me. Thank you for airing this issue, Thomas
Thanks for commenting, I can see why that comment has annoyed to be fair!
I’m quite a chilled out person in the main. I like constructive discussion best
Absolutely not. I just made a post about people like you who gaslight. The difference is the vast majority of the population wasn’t on SSRIs in the 80s, 90s, or even early 2000s. It became a much bigger phenomenon in the recent decade and became overly prescribed (especially amongst youth whose hormones are still developing). There are many cases where patients have literally gone completely numb. From my own experience it has been the same. However I have dedicated my entire herbal studies over the past 3 years to healing myself and understanding how to heal others. Stop gaslighting people. We need open conversations about the effects of these medications and their potential side effects. I am not saying we shouldn’t have them available, but it should be LAST resort medication.
“purely subjective phenomenon”? “patients who refuse to take responsibility for their own difficulties?” If you have this much contempt for people with mental illness you are probably doing more harm than good in your own profession. Thanks to clinicians with attitudes like yours, I have avoided the medical profession for years to my own detriment, because I decided to take responsibility for my own difficulties with psychosis.
I’m sorry I came off that way. With all due respect, I don’t think you can judge my attitudes and clinical practice from a comment. I take care of people with psychosis everyday, take informed consent very seriously, and will work with patients to reduce medication if they feel that is the best step for them. Im sorry for your bad experiences which are unfortunately all too common.
Nevertheless, I don’t think it’s controversial to say that patients, particularly those with personality disorders, have difficulty taking responsibility. Not even just patients, humans, myself included. The PSSD community appears to be to consist in the main of people
who view psychiatry as the devil incarnate for not informing them about a side effect that may not even be attributable to the medication and was not widely published in the first two decades of clinical practice with that class of medications. And it’s not just that community, it’s much of the affiliated groups which were, in fact, platformed by Awais before he became more savvy about the motivations of his interlocutors. This is a psychiatry blog and I’m sorry if the frustrations of practitioners working in this atmosphere occasionally surface.
Closed shops and tribalism don’t help anyone, we need to air our differences of opinion if we are to achieve better outcomes in the future. The treatments of the past gave rise to the anti psychiatry movement as well as giving some people their lives back. It’s a checkered history and more cross pollination and listening is needed on both “sides”. If you lost your job, your income, your status in society, your grip on reality, your autonomy and your own identity all in one day and all you were offered was a locked room and some pills, then you might feel a little underwhelmed with how your life is going, especially if your medic is too busy to see you for more than 10 minutes and has decided that they don’t respect you as a person. If you deal with people with psychosis every day, then I can only assume you understand just how disabling it is. I have avoided the psychiatric ward out of sheer luck, but I haven’t heard anyone else describe a positive experience in one yet, even if they agreed later that they needed to be there. I’m not an anti psychiatrist, but when autonomy loss is such a painful, degrading experience in wards today, I’m not surprised that it’s still a problem.
I do agree conversation with good faith critics and especially patients is necessary. People like Joanna Moncrief are not a good example of this.
Your point re: acute care is indisputable; unfortunately psychiatrists have basically zero to do with how terrible it is. I don’t know a psychiatrist who wouldn’t want more beds and less legal restrictions. Hospital admin, malpractice attorneys and politicians have different ideas.
I do believe that psychiatry is a vocation. I need psychiatrists to be stable, high achievers to be able to help me. That said, there is a large subset of people who have had an absence of what they need while their brains were still forming who won’t respond well if you take a “I’m the doctor, you’re the patient” approach. It infantilises them all over again and they just dissociate from what you are telling them. They have to trust you, and begin to believe what you are telling them, and that you are on their side. It really is a vocation, but it can be done. All the best with your work.
Thank you for the exchange and all the best.