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PaperclipPerfector  6d ago (text post)   19050 thread views

Culture War Roundup for the week of August 31, 2026

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I think there are a lot of problems in the field. Over diagnosis of disorders and over medication are perennial concerns in psychiatry and psychology. Psychology, upon which psychiatry is based has a replication problem meaning that most results are never subjected to scrutiny. Given these problems, I don’t think it reasonable to simply nod along to what psychiatry says without bothering to do something as crazy as read the evidence.

I have no objection to people attempting to evaluate for themselves the persuasiveness of the arguments, the research, the literature, and so on. It is very common here and elsewhere for people to just go "no fuck you they must be woke and im mad about covid" which is the exact level of analysis exhibited by the "he did it cause he's a gemini" people.

Psychiatry is fundamental a medical field which means that inter rater reliability, effect size, and so on are baked in and seriously researched. They do have some problems but most of that is structural (ex: SSRIs clearly work, why does the literature not show that to some extent?...well medical research is hard).

While medical research has all kinds of problems the stance here is comically overblown.

For instance most of the over-dx problems make sense in context (for instance giving people labels so they can get insurance coverage for therapy, scummy patients/doctors in the ADHD market, and so on).

SSRIs do not clearly work. That is, it is far from clear the benefit outweighs the harms. There has been little studies on long term SSRI usage despite SSRIs being highly addictive (ie trials were measured in terms of weeks; not years).

SSRIs are one of the most commonly used medication types in the world, to my knowledge there is no reliable evidence of long term harms beyond the known side effects. The side effect profile is one of the best in psychiatric medicine, in fact we do use them despite the fact that they have less clinical effect because the harms are so low. Research on effect size does not generate enthusiasm but anyone who has actually prescribed knows they work just not for all patients. They are also not highly addictive. Some can generate a mostly mild withdrawal syndrome but some don't. Something that is highly addictive is Heroin. Heroin and Zoloft are not in the same category.

Addictive is the wrong word—they are very challenging to come off (especially if used for some time) and can create significant withdrawal issues.

And the side effects are quite bad

The majority of patients have no symptoms of discontinuation, and for those that do a simple taper is more than sufficient. Prozac self-tapers. Paxil is an exception but doesn't have any modern use cases. A different class of medication (SNRIs) cause "brain zaps" and are legitimately hard to get off of.

Side effects for the vast majority of patients consist of mild transient symptoms on initiation AND the more problematic side effect which is sexual side effects. This is relatively easy to treat if it's endorsed, or addressed by switching to another medication.

Very few patients have side effects while on steady use other than the sexual side effects.

Significant issues with SSRIs do occur with certain subtypes of patients, usually those are patients who have another type of issue (ex: Bipolar, Borderline) and don't need that kind of medication, or have predominately anxious phenotypes for which medication is significantly less reliable choice and are better treated with therapy.

They do have the black box warning for SI but I don't think any PCP or Psychiatrist I've ever talked to has observed it, it's probably not real and got stuck because of cautious regulators.

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