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Originally Posted by Mike Irwin
Just about every drug can have side effects, including psychological side effects.
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Not directly. Not every drug directly manipulates dopamine, serotonin, or norepinephrine concentrations in the synapse.
It's well documented that SSRIs, over time, affect the post-synaptic serotonin receptor density, leading to tolerance. It's suspicious that people who have been on these drugs long-term claim to receive benefits from them long after their last dosage increase. If there are any studies showing continued efficacy after a year or two of taking this class of drug at the same dosage, saying "it just works" begs the question:
how? What mechanism of action is allowing these drugs to work if the brain has adapted to that increase in serotonin availability by decreasing serotonin receptor density?
If people were being prescribed cocaine (another neurotransmitter-related drug, although it affects more than serotonin) long-term, by the millions, and for psychological problems, would you not be the least bit skeptical, and would you not encourage them to investigate other solutions before they resort to such drastic measures?
Here's a hypothesis for why SSRIs might be psychologically harmful:
Serotonin levels vary a certain amount without medication, but apparently not much:
(that's from a journal article on circadian rhythms: unmedicated serotonin levels)
I have not found similar graphs for serotonin density in the synapse, before and after taking a SSRI, but I would expect there to be a more dramatic variation when taking a SSRI (due to the drug concentration and therefore its efficacy fluctuating over the dosage period), except in the case of continuous-release / sustained-release versions available for some SSRIs.
If there is higher variance, that must not be a major problem for most people (or else it would show up in medical trials), but who knows what effects that might have on someone who's already unstable.