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SSRIs - Saviors or Villains?2025-11-17
“The good physician treats the disease; the great physician treats the patient who has the disease.”
—William Osler
SSRIs (selective serotonin re-uptake inhibitors) are some of the most prescribed medications in the world, certainly in industrialized countries. They are increasingly prescribed in younger people. Is there a net benefit to society, and even a therapeutic benefit for most individuals?
What they do is keep more serotonin floating around in the brain. That leads to a reduced perception of stress, but also blunts a lot of other basic drives and desires, including sexual ones. That is a major drawback, with long-term individual and societal consequences, such as decreasing natality.
The key issues of prescribing them at an individual level are those of fit, quantity, and time.
For people with stress disorders and anxiety they may be a good fit. For others they may help indirectly at best, such as in some cases of depression due to stress and co-morbid with anxiety. And in many others they may make things worse, such as in unrecognized bipolar spectrum disorders (which are much more common than appreciated), where they lead to mixed states, activation, even manias. As a result of that, they may cause impulsive behaviors, possibly including suicides and violence.
In terms of quantity, minimal effective doses should be used, to avoid side-effects, particularly the lack of desire for normal things in life. They cannot be stopped abruptly, have to be tapered very slowly, particularly those that have a short half-life (last a short time in the body), as they lead to unpleasant and even dangerous withdrawal symptoms, such as suicidality. It is possible that some of the suicidality we see in younger people taking them, particularly adolescents, is due to them skipping doses or stopping the medication abruptly without telling others.
In terms of time, they need to be prescribed in most people for a limited duration, to help kick-start a recovery process from stress, until lifestyle changes and positive psychology practices kick in.
In my clinical and research experience over the years, and now when we test individuals at MindX Sciences, SSRIs are often not among the top matches. A lot of the so-called treatment-refractory depression cases referred to us turn out to be bipolar spectrum. Those individuals do much better when a low dose mood stabilizer that fits their blood biomarker profile is added and kept for prevention, and their SSRIs are tapered. Then they can move on with their lives, implement positive lifestyle changes (nutrition, exercise, sleep), and new mindsets.
As we are entering an era of more precise, personalized, and preventive mental health, it is likely that the overall excessive use of SSRIs will decline, and we will see societal and individual improvements as a result of that.