So quick disclaimer, both my wife and I are on the Autism spectrum, we both figured this out far too late in our 20s and have been working to re-frame our mindsets about it to understand ourselves better.
Recently, she reached out to a Psychiatrist for adhd and PMDD symptoms and was immediately clocked as ASD and prescribed zoloft to help long term with PMDD syndromes.
The first night was absolute hell of mood swings and discomfort so I was looking more into SSRIs, previously all I knew is you cant just stop taking them and they make certain people’s dicks stop working.
Strolling into the zoloft subreddit is an absolutely crazy experience, half the posters are like “i’m going insane is this normal?” and they receive responses like “yeah just wait 12 weeks of these symptoms and maybe you’ll be cool”. The other half of the posts are people post 12 weeks being like “this shit cool”, but there’s a weird confirmation bias where the people who got off of it are not lurking in the zoloft subreddit. Every once and a while you’ll see someone necro-bump a year old post about someone giving it time and they’ll be like “oh yeah sorry for the late reply, the drug was incredibly bad for me and I had to get off of it”.
My wife was experiencing this out-of-character rage at certain things, but also felt a weird control over said rage and began looking into posts about that and apparently its common? Weird rage too, like being frustrated with fellow ASD people. I started connecting the dots and thinking about people in my life who were on these and holy shit, they’re absolute seething assholes to us, is this why? What is this drug???
And this doesn’t even touch getting off the drug, apparently the withdrawal is absolutely demonic for many many days. Then you have serotonin syndrome, the endless list of side effects that you have no idea if you’ll experience or not because doctors don’t give a shit and blood panels for drug reactions are too expensive to bother with.
All this stuff basically points to “neurodivergent people are being tortured with the promise of a semblance of normalcy in order to cope with our capitalist world, and all the “normalcy” is, is the ability to control your emotions externally despite them being wildly out of control internally”.
Rip me apart for this all you want but i’m leaning towards crank status being anti-anti-depressants. All this to say I’m prescribed stimulants and i’m grateful I can just take days off or just not take them when I’m happy to be my autistic-adhd self.(I know not all people can do this with ADHD, my heart goes out to them, but it’s more an issue with existing at baseline rather than going off wrecking havoc)
psyilocibin therapy needs to become more widespread because SSRIs are far more terrifying than seeing god and your subconscious.
Speaking from anecdotal reports from autistic people, SSRIs generally don’t seem to go over well with autistic people.
If your partner is autistic and suspects that they’re ADHD as well that’s not uncommon, with the estimated rates of ADHD occurring in autistic folks being at around 20-40%.
If your partner is ADHD or suspects being ADHD then PMDD is extremely common as dopamine drops due to hormone changes around menstruation.
Without writing a whole piece on something when I don’t have the spoons for it, serotonin can compete in the brain with dopamine and SSRIs can reduce dopamine transmission.
If we go by a hypothesis that your partner is correct about PMDD and ADHD, what we should expect to see from an SSRI would be an aggravation of their PMDD and a deterioration of their mental health overall, all things being equal.
If your partner is looking for a better alternative in the antidepressant class, venlafaxine is likely the best bet as it is an SNRI with dopaminergic effects at higher dosages. Venlafaxine can be combined relatively safely with mirtazapine, which is unusual for antidepressants, and this may boost the effects on the PMDD symptoms or other symptoms - this combination is well known as a potent treatment for depression that is not responding well to other antidepressants.
Bupropion is the other candidate to consider as it has a desirable effect on both norepinephrine and dopamine for an ADHDer although the evidence for it treating PMDD shows that it is less effective than venlafaxine.
If we’re throwing shit at the wall to see what sticks, agomelatine is an antidepressant that is unique in that it’s the only one that has been shown to have a side effect profile lesser than placebo and it doesn’t cause withdrawals so it’s possible to stop it without tapering down. There’s little to no evidence establishing it as a suitable treatment for PMDD but I figured that it was worth an honourable mention given the concerns that you have identified.
But with all this said, it takes a psychiatrist to really understand these things and it requires good knowledge of the case history of the patient to be able to determine what would really work best, and even then it’s still a bit of a guessing game as neurochemistry is very complex and it’s more of an art than a science to figure out what would work for any given person for reasons I won’t bother going into here.
Honestly though, if your partner is an ADHDer or suspects that they have ADHD then really their best bet is stimulants because antidepressants rarely manage to treat ADHD symptoms by themselves.
I would urge caution about jumping to conclusions about psychiatric meds - the nervous system is both extremely complicated and also kind of simple in the sense that it relies on a few key things in order to achieve a lot (well, basically everything…) which means that tweaking the levels of one thing in the nervous system often has major flow-on effects for other parts of the system, like it or not. Add to that the fact that meds like antidepressants almost always have a really broad effect across the brain, not to mention across a lot of different neurotransmitters as well, and it starts getting really, really complicated.
Throw into the mix the fact that an individual might have an abnormal amount of receptors or transporters in any particular part of the brain and this may cause a “deficit”, not in the neurotransmitter itself but a sort of shortfall compared to “demand”, and thus treating this shortfall usually entails broad spectrum treatment which can increase the neurotransmitters elsewhere in the brain which can easily cause side effects worse than what the particular medication is treating.
It’s just really, really complicated. Add into that that one person’s depression might be due to low serotonin, another’s might be due to low norepinephrine, another’s might be due to low dopamine… or likely some combination of these and the complexity gets kinda staggering to try and wrap your head around.
If you’ve ever played one of those puzzle games where flicking one switch turns other ones on/off and you have to make a path or turn all of one row to a particular setting, that’s what psychiatric meds are like - you often don’t get a grasp of how one change affects the rest of the system and it often takes a few tries until you even understand what you’re dealing with and to develop a good plan for how to proceed.
I guess I’m trying to say that antidepressants have a long list of side effects because they typically affect a lot of systems, especially in the brain, and typically a lot of different chemicals in the brain in different ways. It’s easy to get spooked by this or to become very cynical about it (believe me, I understand this very well personally) but I’d try to withhold from making snap judgements.
There’s hardly a medication out there that doesn’t have horror stories attached to it but then again the same could easily be said for all sorts of common foods that we eat - caffeine can trigger mania in some people with bipolar, gluten can make someone so sick that they’re incapacitated for days, there’s a particular amino acid that can cause brain damage for people with a certain condition meaning that they have to carefully restrict their protein intake, salt could be enough to cause a particular person to have a heart attack, heck in situations of heart failure your fluid ntake is restricted…
If we went by horror stories caused by the effects of dietary intake then we would be avoiding salt, sugar, wheat, protein, dairy, water, carbohydrates, fats… it’s hard to imagine a single thing that would be considered safe.
I told my wife that I was going to “post a rant on the bear site so the true materialists come out of the wood work to explain things to me” and this is basically what I was anticipating. Thank you for being a valuable member of this community.
The doc was actually a NP and wanted to see if the zoloft would help the PMDD but doubted she had ADHD, just that she was on the ASD spectrum. The NP was extremely sweet and understanding about the ASD apparently, I really hope she knows what she’s doing with this stuff, the thing about SSRIs with autistic people you mentioned is concerning.
Thanks, that’s a big compliment.
I think the general awareness of ADHD is abysmally low and, not to shit on any particular doctor (let alone a specialist 😬) but if I encounter someone who is AFAB and late-diagnosed/undiagnosed autistic then that’s gonna raise a hell of a lot of flags for needing to investigate before you’d be able to either rule an ADHD diagnosis in or out.
Women are much more likely to go undiagnosed for ADHD. Whether it’s due to socialisation or it’s a distinct behavioural difference or something in between, ADHD women tend to fly under the radar.
Adult ADHDers, especially the undiagnosed and late-diagnosed, also fly under the radar because they are much less likely to exhibit the hyperactivity and the outward signs of impulsivity that are easy to catch for the purposes of diagnosis, not to mention that they tend to have developed all sorts of coping strategies to conceal and compensate for ADHD throughout their lives.
ADHD in autism was, until recently, not even “permitted” to be diagnosed formally and there’s a desperate need for better research and education amongst healthcare providers on this. The combination of autism and ADHD is, imo, unlike either autism or ADHD by itself and when co-occuring it’s not nearly as simple as just the combination of the two.
But the combination of all three of these factors together in one person?
Yeah, I’m not sure even the foremost experts in ADHD would be able to identify ADHD in a case like that on the first session…
Idk. I’m not a doctor and I’m not an expert or anything like that but I would encourage your wife to do a screening test outside of the NP’s direction or to get her to come up with a list of symptoms that she’s identified that seem to map onto ADHD to take to the NP so she can make a case for herself. Otherwise it might require seeing a different doc because, unfortunately, some of them are just a bit outdated or they have preconceptions about these things.
Anyway, I hope my input has been helpful and hit me up anytime if you ever need my input in future. Good luck with it!
A book came out recently, Empire of Normality. I’ve only read one chapter so far, one from the middle of the book about anti-psychiatry.
CW: state of mental healthcare
It talks about the twentieth-century critics and their effects. Basically some Marxists came to similar conclusions as the libertarians (who accepted e.g. Hayek’s political economy and went on to influence the neoliberals). The Marxists were against the conditions of asylums while the libertarians just didn’t want to pay for them. A consensus led to their closure and a move to community care. Unfortunately, being implemented under neoliberalism, this meant reducing the funding and basically denying help to loads of people who needed it.
My broader point is that there are several references to Marxist writers if you wanted some materialist references. I’ve not yet come across their views on medication and they might not be in there but you might find them by following the footnotes.
I have ADHD myself and a sibling on the ASD spectrum, so likely on it a bit mysel, (by what my psychiatrist has told me). I wanted to briefly add my experience to what the wonderful commenter that you replied to.
First, there are some genetic medicine blood tests that can be helpful in predicting how one will react to psychoactive drugs. My wife had such screening after bad reactions to several medications. Basically, there are known variants of the genes involved in the structures of neurons and there is a large amount of data that has been correlated to these variants in patients and/or the mechanisms through which the medicines work. With this information, drug familes can be eliminated or recommended based upon likelihood of effectiveness or adverse reaction. Being neurochemistry, however, it’s still not exact and trying different medications may still be necassary.
Now, my personal experience. I started on an SNRI last year, after hitting what turned out to be weird hormonal issues that caused me to have periodic bouts of extreme anxiety. The one that I’ve used is closely related to the one mentioned by the previous commenter, desvenlafexine. It’s an active metabolite of venlafexine, meaning that it has a more rapid onset for effectiveness as the body doesn’t need to metabolize venlafexine into its active form. I found that improved my resilience significantly with hormone-driven issues (since mostly corrected) and with the overlap in activity with ADHD meds (stims act as dopamine and norepinepherine reuptake inhibitors) there seems to be improvement in those symptoms as well. Note however, that SNRIs can also modulate how stimulants work, even caffeine. So, it’s important to be careful with those - I’ve mostly stopped having morning coffee.
caffeine can trigger mania in some people with bipolar
Where did you see this? I’ve been told this isn’t the case
Not a doctor and not autistic, but I’ve been on an SSRI (Zoloft) in combination with Buspirone for about a year for anxiety although I’m currently tapering off. I have experienced irritability when coming on or tapering off of it.
I’m not a 100% sure I’d still be alive right now if I hadn’t had the drugs to turn down the volume on my anxiety enough to get therapy and learn coping strategies. I’ve done psychedelics plenty and while they have therapeutic potential (and are very fun) they’re not a cure all either. Frankly if you’re thinking like mushrooms are good natural brain medicine versus the evil artificial brain medicine, you’re way off track. They can fuck your shit up just as badly as prescribed medication and we’d see a lot more of that if they weren’t illegal
All this is to say, I’m not dismissing your experience with your wife or anyone else who has a bad experience with SSRI’s, but I would advise against taking a blanket stance against them.
It is not great for my sex drive, though, this is true. But then neither is crippling anxiety
ok, i’m on the sertraline (zoloft is the brand name) so i can at least give some info and my takes on efficacy. we can start with the basic medical information about it. the most important thing is to take it consistently, and not just dosage too quickly. dosage is typically changed in 25 mg increments for sertraline, with a typical dose of ~100 mg, a minimal starting dose of 25 mg, and a maximum dose around 200 mg possible. different dosages perform differently for different people. getting on or off, it’s best to stabilize for at least a week or two at each increment of 25 mg to avoid the worst side effects / risk of serotonin syndrome. i had some side effects getting on it, but it’s sort of a non-issue for me. i don’t think it’s helping my autistic self all that much, but it did help me stabilize my mood when i was falling off the proverbial cliff, so i’ll give it that. my best advice is that your mileage may vary and that an ssri is not for everyone. i haven’t tried hallucinogens as an alternative so i can’t speak to that.
interesting anecdote: the approval of drugs by the FDA requires that at least 2 double-blind studies of the drug indicate statistically significant benefit over a placebo. it doesn’t matter how many times the drug fails wrt approval, they just need 2 that pass. the thing with ssri’s though is all those side effects. so the approval studies were double-blinds, but with inert placebos, so both doctors and patients would generally know who had the drug and who got sugar pills. when you do double-blind studies with active placebos that mimic the side effects but not the pharmacology of ssri’s, you find that placebos are just as effective as the drug. which isn’t to say that the drug became less effective in that study; the placebo became effective by being indistinguishable from the real thing outside of the actual serotonin reuptake inhibition function.
All the stuff about the blind studies and placebos not showing a difference really makes me feel like I’m going insane, like that should really be looked at a little more closely.
i think it calls into question whether the serotonin reuptake mechanism itself is directly responsible for the improvement in depressive symptoms, but not whether it does. i heard about this a solid five years before starting ssri’s and i think they’ve still done something for me. it’s just that medicine related to the actual neurological mechanics is basically unknown. the psychology professor that told me about this also had the opinion that our understanding of the biomechanics of the mind were on the level of people in the 1800’s classifying rotoviruses and stomach cancer as “illness of the stomach” i.e. we have no fucking clue how mental illness works at a fundamental level.
My wife uses SSRIs to help manage her mood and - after the initial onboarding period (which isn’t particularly pleasant) - she’s a genuinely happier and chiller person. The big problem she has is with the drug interacting with excessive alcohol. So when she cuts loose, there’s this huge fall off and we routinely have some sort of hyper-dramatic situation that involves me staying up till 4am to help her come down. But the solution to this has been non-alcoholic beer.
That said, she’s on Lexapro not Zoloft, so… Idk. There’s half a dozen different kinds of SSRI with a variety of symptoms and side-effects.
All this stuff basically points to “neurodivergent people are being tortured with the promise of a semblance of normalcy in order to cope with our capitalist world, and all the “normalcy” is, is the ability to control your emotions externally despite them being wildly out of control internally”.
I’d have to get her on here to confirm, but from the conversations we’ve had it isn’t just kettling your emotions with an inebriated facade. Its more like tuning down the accelerator, so you don’t go 0-60 faster than your brain can process the flood of emotions. It doesn’t mean she never gets angry or never cries or never bursts into a snorting-giggle at a clever joke or funny video. Its very much an internal, rather than external, inhibitor which effectively lets her decide whether she’s going to ride her feelings or tamp them down.
Rip me apart for this all you want but i’m leaning towards crank status being anti-anti-depressants.
I mean, its your decision in the end. I’d just advise against seeing other people on SSRIs as these inebriated zombies. And yes, there’s definitely some degree of selection bias on anonymous public forums. FFS, I wouldn’t be surprised if some number of accounts are entirely fictional for marketing or agitprop purposes.
That is why you hash these questions out with a doctor, with a support group of similarly situated people, and with your loved ones who get to deal with you in the good times and bad.
From my personal experience, this stuff only gets harder to manage as you get older. And I’ve watched more than one relationship implode because one or both partners decided medication wasn’t for them… which then spiraled into manic episodes and violent confrontations that strike me as far worse than any side effect.
But hell, if psyilocibin therapy gets the job done, more power to you. The goal is to achieve some sense of stability in your life and however you come by that is a valid solution.
I think something I realized with what you shared is a single drug or class of drugs is prescribed for a wide range of issues. I don’t really want to be an anti-medicine crank to be honest.
seeing other people on SSRIs as these inebriated zombies
Yeah I definitely don’t want to do that in a broad sense, more realizing people who were weirdly cruel to us also happen to be on these.
I’ve watched more than one relationship implode because one or both partners decided medication wasn’t for them… which then spiraled
Seeing this is interesting, because its getting prescribed for people who never had manic episodes like this in the first place, so like, if that’s happening the drug may make sense, but if that was never the issue, then what’s going on.
I want to triple mention i’m not against medication, but I wonder if stuff gets prescribed incorrectly at times, and how the medical field views these edge cases, especially when there’s per-concieved notions about the neurodiverse and how they’re able to get healthcare.
but if that was never the issue, then what’s going on.
I can also say from personal experience that manic episodes aren’t explicitly reserved for the neuro-divergent. Nor are they something you’re necessarily going to know about just by being friends with someone. Extreme anxiety and stress can provoke all sorts of negative and self-destructive responses.
I knew about my friends’ episodes only years after they’d broken up. I’ve had a few experiences with my wife - who has generally always been a very friendly and loving person - that I don’t exactly brag about to other people because they’re fucking miserable and traumatic and not fun to remember.
That’s totally aside from the question of medication. But I note it to say that you don’t always know what’s going on under the surface. And if somebody gets on a mood stabilizer, I would not assume your knowledge of their habits to be exclusive to their experiences. Having said that, you only need to go through the history of - say - lobotomies to know that overreaction and overmedication and extreme interventions aren’t unheard of either.
I want to triple mention i’m not against medication, but I wonder if stuff gets prescribed incorrectly at times, and how the medical field views these edge cases, especially when there’s per-concieved notions about the neurodiverse and how they’re able to get healthcare.
In a better world with a better health care system and an economy that sees physician consultations as a beneficial hygienic service rather than an annoying bit of maintenance overhead, I would like to believe we’d be having continual back-and-forths with our physicians as part of long-running and population inclusive medical science studies. And, as a consequence, we’d be regularly revisiting the impact different medical decisions are having on patients. We’d expect that we could either provide adjustments as necessary or speak with some meaningful authority when we say “This is about as good as we’re going to get it given the resources at hand” and consider ways of mitigating discomforts on the side.
But that shit cost money. So instead we’re going to give Jeff Bezos another yacht while we tell everyone else that quality services are unaffordable.
because its getting prescribed for people who never had manic episodes like this in the first place
This shouldn’t happen, SSRIs/SNRIs are not mood stabilizers and can actually trigger manic episodes in people with bipolar disorder. This is a well known effect and can help differentiate bipolar people who may seek treatment for depression first.
