After a day debating @joannamoncrieff's views on antidepressants I learned something useful. That SSRIs produce a generally altered mental state is meaningful and under appreciated by people outside psychiatry. And it's not some 'newfangled' idea - it was the original view of psych drugs and Lilly/Pfizer did a disservice to the field pushing the idea that SSRIs were a targeted correction of a specific, known pathophysiology. Moncrieff named it, formalized it, and forced the field to confront it. That’s a genuine contribution. The alcohol analogy even works, sort of. Alcohol and SSRIs are both psychoactive, just like a praying mantis and a tiger are both predators. But she became so attached to the idea and pushed it to such an extreme that she became self-discrediting and discredited a useful insight that could have benefited the general public. The claim that there's no role for chronic use of any psych drug doesn’t survive contact with the evidence and it isn't credibly debatable to anyone who's seen a psychotic schizophrenic repeatedly relapse off therapy. SSRIs are the closest case, but at best you can argue that lots of people didn't/don't understand the risks, not that they don't help anyone. Clozapine keeps people alive in a condition that is obviously biologically based on heritability, separated-twin and adoption data. The drug-centred framing could have been a real correction to the overselling of the targeted correction of a chemical-imbalance story that filtered out of psychiatry and into primary care and the general public. Instead it got pushed to an extreme that’s plainly false and the false version buried the useful insight that could have helped millions and millions.

New Study: Antidepressant use is associated with Sudden Cardiac Death (SCD) "Compared with the general population, patients treated for 1-5 years had a 41% increased risk of SCD, while those treated for six years or more had a 74% increased risk." heartrhythmjournal.com/artic…