SSRIs and the RPE

 

By Crispin Sartwell

 

Recent studies suggest that the anti-depressant medications known as selective serotonin re-uptake inhibitors (SSRIs) may drive you to suicide, even as they improve your mood. This apparently paradoxical result should lead to a deep re-thinking of medical science as we know it.

My own research suggests that the pro-suicide effect of SSRIs is not a matter of brain chemistry or serotonin levels. It's just that when they tell you that you need anti-depressants, they're telling you you're depressed, which is extremely depressing.

Depression is bad enough, but depression about the fact that you are depressed is an infinite downward spiral into hell. The more depressed you are, the more depressed you get. And the more depressed you get, the more depressed you are. Once you enter this process, there is nowhere to go but down, down, into the maw of death itself: the ultimate treatment facility.

Before you know it, you find yourself biting the Cobain stick.

Now on the other hand, many doctors seem to believe one problem is that SSRIs are being overprescribed. So let's say your depression is misdiagnosed. When the whole thing starts out you're a happy-go-lucky sap.

Then the fact that they think you need anti-depressants is enough to start you on the same downward spiral. You start asking yourself: if I'm so depressed, why do I feel so happy all the time? Pretty soon your trust of your own senses is entirely compromised and you become radically incapable of self-reflection. Your very selfhood itself is shattered like a cheap mirror.

In short, misdiagnoses of depression have probably dropped millions of happy-go-lucky suckers into an agony of existential despair and obsessive self-loathing.

Before you know it, you're swallowing that Marilyn cocktail.

But should you survive this far, the situation becomes far worse, because the doctor indicates that ≠ whether you are suffering or not ≠ you'll feel better when you take your meds. But because you are on anti-depressants (see above) you are bummed out to an extent that matches or exceeds the relief offered by the medication itself (and I am not denying that anti-depressants are dramatically effective).

So the doctor increases your dosage or drops in another med, which has precisely the same double-edged effect. You return to the doctor, and you catch just that hint of an expression that you know means: Dude. If the anti-depressants don't work, there's really no hope. You feel that you've been condemned to a lifetime of despair, even if all the time you're perfectly happy.

Before you know it, you're doing that Virginia Woolf doggy paddle.

A placebo is a completely ineffective dose of an inert substance, which sometimes has a positive effect. The anti-depressant/suicide connection is an illustration of the "reverse placebo effect" (RPE), in which what are actually effective medications have no actual effects, or actually have negative effects.

Though this conclusion is only provisional and awaits future study, it may be that all medications are subject to a reverse-placebo effect: for example the fact that you need massive doses of opioids only convinces you that you must be in severe pain. Then the more effective a medicine becomes, the worse its results.

It's enough to make you bake that Sylvia Plath casserole.