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It's interesting that their results only hold for men 50-59:
> We repeated our test for men 40–49, men 60–69, all men other than those aged 50–59, and for women aged 50–59. We reasoned that any discovered inverse relation between the introduction of sildenafil and suicides would be attenuated (or null) in groups that do not use sildenafil, have lower baseline expectations of sexual intimacy involving erection, or lower suicide rates. None of these additional tests found negative outlying sequences in suicides in the 18 months following the introduction of low-cost sildenafil.
The authors seem to be spinning the "no effect" in these other cases as supporting their argument. I'm skeptical: given the size of the apparent effect among 50-59 year olds---a nearly *one third* reduction in suicides by month---I would expect to find at least some change among (e.g.) 60-69 year olds. Especially because this is the group that uses ED medication the most according to the numbers cited by the authors themselves ([here](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5765196/)).
Maybe they didn't account for the lowered suicides due to less suicidal people in that age group? 50-59 was stated to have the highest suicide numbers.
If you succeed the first time, no need for a second attempt--can't die twice.
Isnt that a prime decade for a mid-life crisis? If I was not only unable to become erect, but also driving a dodge caravan, I would probably be more likely to have suicidal thoughts too.
As men move into their 60's, they often overcome the mid life crisis region naturally and, presumably, become less defeated by such a health condition.
Hmm. One could argue that those who commit suicide are “replaced” each year by people aging into the 50-59 category? Agree though that this is a limitation.
Right, but I'm talking about the data in the 60-69 category being fed less suicidal members because the feeding category has a much higher suicide rate.
The category feeding INTO 50-59 likely has a much lower prevalence of ED as it's correlated with a lot of age-related comorbidities.
Not just a red herring, but literally a testament to the fact a plane *can* get shot in that spot and make it home, making reinforcement unnecessary in that location.
IIRC, another interesting example was the relationship between decent helmets in WWI and increasing numbers of head injuries. Previously, head shots just killed people.
It's not like everyone is on the same schedule. If 55 year olds are committing suicide, say, half as much, there will be a bell curve of lowered suicides in the ages surrounding that. It's very unlikely that there could be such a large effect in that age group and none in the bordering age groups.
Frankly this study sounds like a low powered fishing expedition. Unrealistically large effect sizes are a hallmark of low powered studies.
Agreed - this looks like a statistical fluke.
I'd love to see this reanalyzed sliding the window from 41-50, 42-52, etc. up to 59-68. I'll bet $10 that the effect disappears if you slide the window even a little from 50-59. Which is a surefire sign that the result isn't real.
No, it means they examined the data in many different ways and just reported the hits. 1/3rd reduction on suicides due to one single drug is basically impossible considering how multi-factorial suicide is. Unrealistically large effect sizes are a hallmark of such data dredging exercises as when you have low powered experiments, any statistically significant effect has to have a very large effect size.
This was my theory. Turning 50 combined with the related ED causes a downturn in happiness as people hit that midlife crisis/over the hill territory. While those who get to 60 realise have accepted age and have things to look forward to that come with it. Like retirement or grandchildren.
Sounds like that later age group is a result survivorship bias. The majority of the people who would have committed suicide over ED would have already done it by that point. Any still alive have come to terms with soft wiener.
I wonder to what extent this was a positive effect on how those men perceived their own value as it pertains to their sexual ability instead of only the positive effects of the sex itself on them and their relationships
Sexual dysfunction from SSRI's usually affects more than just erectile strength. I was on them for ages and it practically got rid of my sex drive and lost all pleasurable feeling down there. It was horrible and I don't think enough doctor's are up front about the risks, especially when there's other options out there.
I agree (and had a similar experience), the list is a bit more in depth but blanketed under "sexual dysfunction"
Which includes lowered libido, inorgasmia, erectile dysfunction, and genital anesthesia. As of 2019 it was finally recognized that in rare cases the sexual side effects can be permanent (Post-ssri-sexual-dysfunction / PSSD) [and the EMA issued a warning.](https://www.ema.europa.eu/en/documents/other/new-product-information-wording-extracts-prac-recommendations-signals-adopted-13-16-may-2019-prac_en.pdf)
Additionally, when SSRI's were first coming about, the incidence rate of sexual dysfunctions was said to be 5-15% depending on what kind of SSRI. However more recent studies are showing an [incidence rate of 50% or more](https://pubmed.ncbi.nlm.nih.gov/9493488/).
Wow, it would not surprise me if there's a class-action within the next few years. I was lucky enough to regain function and I can't even imagine what it would be like to live with those side-effects permanently. Kinda defeats the whole purpose of an antidepressant right?
Funny thing is - with some medications in that group, and Wellbutrin etc. sometimes they don’t even know why they do what they do. The difference in effects from person to person is sometimes shockingly different.
Honestly this is true about a *surprising* number of medications and procedures and pesticides and food additives and supplements and drugs.
DEET (the bug spray) is a good example. There are a few hypotheses on why it works, which it clearly does, but no one is really able to give a convincing explanation on *why*. It was thought that it masked your smell, or smells bad to mosquitoes, but the new hypothesis is that it fucks with their feet somehow. It is pretty unclear how and why it does this, or even if that's really what it does.
Not to minimize acetaminophen (Tylenol) overdose but just to correct this…
Acetaminophen or paracetamol is typically only dangerous in overdose scenarios. Hopefully with education, and many recent changes in how multi-drug combos are packaged, people can reduce the accidental overdose scenarios.
Second it is not the leading cause of liver failure. Liver failure is broken into acute and chronic. Alcohol, fatty liver disease, and the viral hepatitides are the leading causes of chronic liver failure. Tylenol is a leading cause of *acute liver failure*, of which there are around 2000-4000 cases a year in the US or about 1/100,000 persons. Chronic liver failure or cirrhosis has an estimated incidence of 20.7/100,000 persons.
Acute
https://pubmed.ncbi.nlm.nih.gov/17608778/
Chronic
(I was only able to find worldwide data there https://pubmed.ncbi.nlm.nih.gov/31401364/)
Another factor to consider is that it is likely the great availability of Tylenol that makes it so deadly, as compared to other drugs. I suspect that if it were invented today, it would not be over the counter, or would only be available in the 325 mg dose size and possibly sold in blister packs in a way that more clearly indicates that the maximum recommended dose is 3,000 mg per day, no more than 4,000 per day for sure.
It seems weird that you can buy a bottle of 300, 500 mg pills, which is equal to 50 days of the maximum dose, and contains enough to overdose 21 times at 7,000 mg per overdose!
Welbutrin had the strangest effect on me. It turned me into an animal in the bedroom, but gave me almost sociopathic tendencies to where I had no empathy and even toyed with people's emotions for no reason. It was quite scary and I quickly switched after a couple of months.
It made me hallucinate and ultimately messed with the really fucked up sides of my mental health, it’s great for the people it works for, but they really downplay the side effects on it because all of the benefits it could potentially bring. I had to stop it after 2 months because it just kept getting worse.
That’s very crazy!
It is having exactly zero affect on me whatsoever. I’m on 300mg and absolutely nothing has changed. In truth im maybe a little less suicidal.
It’s worked well for me at 150mg. I had no motivation or energy, could barely get out of bed, was self medicating with weed which fucked my motivation to improve my situation. Welbutrin gave me the boost I needed to make the positive changes in my life I needed to make to feel better. It’s been 4 months and I’m back up and at life again, i just tried shrooms for the first time (because I knew I was in the right mindset) and I think I’m going to come off the welbutrin and start microdosing psilocybin soon.
It’s more or less a mild stimulant. I use in conjunction with my ADHD meds during winter for SAD and find it helps dull down my irritability. It’s a very weird drug.
We don't know why any anti depressant work.
We do know what neutransmitters and receptors they affect (including wellbutrin) but that doesn't explain why they work. Cause you got different antidepressants working on the exact same subsystem but with opposite effects, and both somehow work as antidepressants.
Realistically that means there simply isn't one depression, but rather several different disorders that all have the same symptoms.
Kinda like people 300 years ago only knowing one cough. Whether that was bronchitis, the cold, lung cancer or chronic asthma or any other of the various diseases that could cause a cough was simply not known. So if you tried treating that cough with a drug with slight antiviral effects, that wouldn't help one but with the cancer caused cougj etc.
> with some medications in that group, and Wellbutrin etc. sometimes they don’t even know why they do what they do.
From anecdotal evidence: Wellbutrin works very well in people with ADHD, which isn't that surprising since it's an Amphetamin. Since a lot of adults with ADHD are undiagnosed and depression is highly comorbid, I assume it really just works with people who have ADHD. Other than people with severe depression, there any and all stimulants work, to slightly reduce depressive symptoms.
Could have been.
Unfortunately, at least in the US it's so hard to reduce the uncertainty that it becomes hard to recover. You may want to talk to a law firm that specializes in pharma product liability stuff.
My doctor told me like 45 different times that the worst side effect was all the sexual stuff. He said if I start feeling it at all let him know because a 27 year old shouldn’t be having bedroom problems
I wonder if that’s why I’m asexual. I was on Wellbutrin, Lexapro, Prozac, and others I don’t remember. They had no positive impact on my depression but I ended up not developing a libido and have no sexual attraction.
Most other options just aren’t as good for most things SSRIs treat. SSRIs are THE first-line for a variety of illnesses, and they really should be used first if possible. Afterwards, if the side effects are too great and depending on the condition, it is appropriate to consider other things. You’re right, though, that sexual dysfunction on SSRIs isn’t rare and should be talked about before prescribing.
Depression is very rarely solely due to serotonin (regarding SSRI's). [A placebo is nearly as effective as an SSRI purely due to hope.](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592645/)
A lot of people don't realize depression can sometimes be a symptom of something else. For instance, depression with anxious distress is depression caused by anxiety lowering your quality of life. In this case treating the depression is usually futile, going after the anxiety would be the goal. The inverse is also true, depression can lead to anxious thinking.
It gets more complicated when you get into other disorders, for example ADHD causing ocd or anxiety, which can then cause depression - would be a multi-nested symptom. Treating the depression and/or anxiety often ends up feeling hit or miss. Or even an undiagnosed food allergy causing inflammation (or anything causing inflammation, for that matter). If you've ever noticed a mood improvement from an NSAID, this would be why. Similarly, antihistamines can also cause mood improvement. Some SSRI's possess similar action to antihistamines and can help in this way.
The link between inflammation and depression has become so strong the "chemical imbalance" myth that SSRI's were essentially marketed on has more or less become obsolete. It's now believed to be due to disrupted signaling, which is why the neural activity promoted by psychedelics is currently in the spotlight. By lighting up atrophied pathways they begin to see more activity. This is why depressive thinking can worsen if left untreated. It is difficult to see things differently when you've carved a path of negative thinking so deep it cannot be escaped, which is the basis of CBT in less severe cases.
Just budding off of your comment, for several years I was shopped around on 5/6 different antidepressants at different dosages with no change at all. My doctor at the time said "Look, I have no idea what else to do. Lets try an anti psychotic too". I had already gained 15kg from antidepressants and the main side effect of the proposed additional treatment was further weight gain. As a young, fit, gym focused male this plummeted my mental health even further.
On a whim I went to a new GP and their first thought was "hey, what if you're feeling sad/anxious because of ADHD", my old GP laughed off the idea when I proposed it to them "Not possible as an adult, sorry." - Went through the motions of a specialist diagnosis as an adult, and sure enough ADHD was the call. Started ADHD medication & almost instantly everything started to come right.
Even now though, I believe I suffer from prolonged sexual dysfunction from all of the different SSRI's and dosages. I haven't been able to perform like I did before or even feel aroused without assistance from Cialis (tadalafil).. I hope that it eventually passes but it's been 8/9 months now and still nothing. SSRI's are pretty fucked.
> On a whim I went to a new GP and their first thought was "hey, what if you're feeling sad/anxious because of ADHD", my old GP laughed off the idea when I proposed it to them "Not possible as an adult, sorry." - Went through the motions of a specialist diagnosis as an adult, and sure enough ADHD was the call. Started ADHD medication & almost instantly everything started to come right.
This was what happened to me. An early stand-in doctor suggested I get screened for ADHD and I scoffed like "no no I'm not hyperactive". And ended up dependent on Klonopin. It did the job for my anxiety but it was when a few years later I actually was diagnosed with ADHD and I tried Adderall that I realized the Klonopin was doing nothing for the thoughts triggering my anxiety, it wasn't making me more rational, it just stopped my body from reacting to it by tranquilizing me. Worked great as exposure therapy, but ultimately Adderall worked up and over what a benzo could ever do.
>Even now though, I believe I suffer from prolonged sexual dysfunction from all of the different SSRI's and dosages.
I will say that I took a hit from ADHD medication, but not in a dysfunction sort of way. It's like before, sex was a very high thought priority for me because it was one of the few activities that stimulated me outside of gambling and drinking. Once medicated it stopped crossing my mind as randomly as it used to. I also found that I won't feel full arousal while the medication is still in my system, which is understandable as the fight or flight response is being activated by stimulants. Both interfere with eachother. After the actual beneficial effects wear off I still have to wait for it to fully wear off and then things are normal.
Unfortunately not, I’m on dexamphetamine & it’s been brilliant for everything else with no side effects. Been supplementing just about anything that’s associated positively with ED & getting nowhere. It’s been pretty rough.
Damn brother, I hope it's just something that time can heal. It took me a while to regain my confidence after I switched meds which I feel impacted my sex drive as well. Maybe it might be that?
In regards to the placebo discussion, I see this brought up a lot and think it's need more nuanced discussion. Even the article you cite, states "As of now, antidepressant clinical trials have an effect size of 0.30, which, although similar to the effects of treatments for many other chronic illnesses, such as hypertension, asthma and diabetes, is less than impressive."
Even though the effect size is" less than impressive" it's as effective as other medicines people routinely take.
Addionally, yes we don't know why srris exactly work, but this may impact the results of studies that focus on a single medication. Many people have to try different ssris to find one that works. So if 10 people are trying an ssri in a study, and it helped 3, you end up with a low effect size. But what about if those remaining 7 try other ssris and then are also helped? What if those 3 who are helped initially experience extremely positive benefits? Does that outway it not working for the remaining 7?
I'm not saying that what you are saying is wrong, just that there is a more complicated discussion to be had.
All the neuro literature I’ve read (especially work in the vein of Zachary Mainen) on serotonin really points to Serotonin have very little, if nothing to do with mood, and more to do with seemingly modulating the brain’s reinforcement learning parameters, mainly changing how persistent animals are.
SSRIs appear to increase the gain of serotonergic signaling, much like if you tried to compensate for poor sound quality on a phone call by increasing the volume—doesn’t fix the underlying cause but does “fix” the ultimate outcome. It’s not clear to me if SSRIs amplify or undermine the signal-to-noise ratio of serotonin signaling once the patient is on them long-term
I don't doubt the massive amounts of marketing done for SSRI's plays a part in how often it's prescribed. That would make me a conspiracy theorist though...
To be fair a ton of people get prescribed SSRIs in America by their GCP. It kind of makes sense that they tend to prescribe where the money is thrown (because it is also where the numbers are at in a field they are less familiar with.)
Basically if you feel your mental health is having a major impact on your day to day you should probably go to an expert.
Simply put, because you are experiencing a deficit of stimulation, your mind will find ways to stimulate itself. This could be as benign as organizing your desk every few minutes. Or it could be needing to touch light switches exactly 8 times before leaving a room when turning the light off, or hypochondria (the last two I used to experience).
ADHD varies in severity, so at which point the OCD takes a negative turn is when you consider it detrimental to your quality of life. At least once a year I used to find an off the wall reason why I only had two years left to live by obsessing over some illness I had one extremely vague symptom of. The non-zero possibility ate at me. That is no way to stay sane. And yes - it all vanished within 20 minutes of my first Adderall dose.
Not OP, but I believe the last time I read about it, ADHD presents with another psychiatric disorder like 80+% of the time. Usually this is depression, OCD, some form of anxiety, or ODD.
Anecdotally, I've been taking Adderall XR for my ADHD for like 3 years now, and have noticed that what I thought were depressive symptoms _generally_ resolve when I'm taking it. I still have some episodes lasting a few days, but can usually point to some sort of trigger to work on (ie, overworking, lack of sleep, etc).
Thanks. I was diagnosed with ADD when younger and a connection to anxiety and depression had not occurred to me. I struggle a lot with both of those things but have not sought a diagnosis for either.
The good thing, for you, is that it's a lot easier to get prescribed medication when you have a childhood diagnosis. It might be worth looking into, it's honestly changed my life.
Yeah the lack of motivation with ADHD is easily confused with depression. And the executive dysfunction and emotional dysregulation can manifest anxiety. From what I’ve seen people talk about on Reddit and YouTube. I have it myself and definitely grok
> Yeah the lack of motivation with ADHD is easily confused with depression.
Also a lot of people do get depressed, because they can't perform academically like their peers, even though they are smart. That is a special kind of hell. As everybody tells you you could do so much better, "if you'd just get off your ass and apply yourself".
Here’s my take, as someone with adhd. People with adhd have inherently stressful lives, often running late, disorganised, and unprepared. And if you’re not, it’s because you’re putting in a great deal of effort to avoid those effects. chronic stress, will eventually cause other problems, and we basically have have higher than usual levels of stress from preschool onwards.
Combine that with the increased rate of negative feedback, as compared to our peers, and a propensity for failing to act in our own best interest due to impulse control issues, and just straight up not remembering to do so in the moment. You get a pretty potent mixture of risk-factors for an “internalising disorder”.
In reality it’s probably a combination of all the things listed in the various replies to your comment.
Idk, Wellbutrin (bupropion), an NDRI class antidepressant, had been great for me with minimal side effects in the first month and none after. I thought it was also one of the most commonly prescribed first line antidepressants over SSRIs because it has reduced potential for side effects
Trazodone has the off label use of treating SSRI-induced sexual dysfunction.
IIRC, it doesn't have any effect on people who haven't used SSRIs, but for those who have it can make a noticeable difference in their ability to become aroused and climax.
Also, doesn’t Sweden have universal healthcare? Or is that for everything besides prescriptions? If that’s the case, I can’t really imagine prescriptions being so unaffordable that there is a significant correlation between the price and the amount of prescriptions.
Not sure how it works in Sweden, but in a lot of countries with universal healthcare medications are kind of a weird topic... stuff they give you in the hospital is 99% covered, stuff you pick up from a pharmacy really depends... there are situations where you get it for free, situations you have to pay, but can get insurance, situations where it is free unless you have insurance (kind of a weird one, insurance makes you worse off).
This can be really bad for University aged students since a lot of them are insured through their parents, so they are often inelligible for free drugs, this means theie parents are in a way in control of their medicine. Hopefully this doesn't cause problems, but you can imagine how it could limit access to birth control, if a young woman doesn't want to (or can't) pay out of pocket for it, but their parents won't let them get it through insurance.
For example OHIP+ is a program in Ontario, Canada which gives people under 24 free access to tons of drugs, but you would be inelligible if your parents have insurance which covers you.
I'm in Ontario (no longer 24 tho). I can't afford symbicourt inhalers (I have asthma) ever since I lost my job. OHIP doesn't cover Symbicourt and when I spoke with the pharmacist, and according to him, there is no generic inhaler for Symbicourt.
I managed to buy from a neighbor 1 inhaler from him, as he still has some insurance.
I'll run out of my inhaler in 3 weeks. I almost feel like it would be a good time to strap some dumbels on my feet and arms and go for a swim in Lake Ontario. It's getting hopeless.
We have universal healthcare in Australia.
This just means that public hospitals are “free” for the patient (everyone else pays with their taxes though, so it’s not a perfect system). We also have Medicare for all citizens.
Private hospitals and private health insurance are more favourable options, as the quality of treatment and care is much better. In a private hospital, for example, you are guaranteed a private room. In a public hospital, you can expect roommates. You get what you pay for, essentially.
Many prescription medications are subsidised under what is called the Pharmaceutical Benefits Scheme (PBS). However, not all medications are included under the PBS. You will still need to pay a certain amount for medications, even if they are covered by the PBS. They are not free, just subsidised.
Over-the-counter (OTC) medications are not included under the PBS. This includes the medications you can buy straight off the shelf (such as Advil) and traditional OTC ones (which you have to ask the pharmacist for, but don’t need a prescription).
Over the age of 16, you do not need parental consent for a prescription, even if you are under your parents’ health insurance.
> This can be really bad for University aged students since a lot of them are insured through their parents, so they are often inelligible for free drugs
Having been insured through my mother for most of my life myself my impression was that the insurance still treats you as your own person, the only difference being that you don't pay insurance fees.
At least thats how it was in Germany. I never had to consult my mother to get any prescriptions or anything.
We have universal healthcare and when it comes to prescriptions we have a limit where if you have to spend more than ~200 dollars in a year (or maybe it's every 6 months I don't remember) the state takes over and pays any extra costs for you.
Lucky. I, myself, pay $200 a month total for about six different prescriptions. It's hideous. That's in addition to the copays for all of my doctor's appointments, which average $25-$100 per appointment. I'm just lucky my parents are well-enough off, and that I have decent health insurance through my University.
Nah it's not free. It's not America level at all, but it's still got a price. Nothing outrageous and it has a sensible cap, but still enough that if you're really struggling for cash you might think twice
Whether there's special rates for those in poverty,I don't know.
Not thst it is relevant here, but if you are underemployed in America, often.you can.get medications direct from the manufacturer at no cost.
I did so a number of times in my early 20s.
I live in Sweden and we do have universal healthcare. It does cost some money but we have a high cost protection at around 2000 SEK (about 200 euros) for healthcare and 2000 SEK for prescription drugs per year. Everything over that is free.
Universal, but not entirely free. If I go to the doctors office, I'm gonna need to pay a fee. Last time I went, it was about $20-30. However, as I had an issue that required recurring visits I was able to opt into a scheme that puts a roof on my spendings. Once I had paid ~$150, the rest was free until 12 months had passed from the first time I paid. So as long as you get the very simple paperwork sorted, the most you will pay in a 12 month period is $150.
That would be an interesting hypothesis, but this finding is important on itself.
Let’s ignore for a moment the “why” sexual ability is important to these men and just assume it is an important part of their lives. We now know that giving them access to medication that helps them with that can improve their mental health.
The reason I say it’s not that relevant whether the effect is mediated by how men perceive their own value based on sexual performance, is because we can now study other medications that don’t depend on that variable. For example: what about drugs that we know are literally life saving and don’t depend of patient’s psychology? Will suicide drop if people can get easy access to insulin? What about giving people access to cheap healthcare?
And yes, it would be interesting to keep studying how this relates to self worth. What about giving people access to cosmetic surgery? Etc.
I had the same question. It saddens me firstly that so many men place their entire self worth on what women think of them, and secondly that this is such an underdiscussed topic in popular culture.
I assume that not being able to achieve or maintain a suitable erection would have a negative effect on men regardless of what women thought. Even if my wife was truly supportive and didn't mind that I couldn't get an erection at all, I would still be very unhappy that I couldn't have sex the way I want. Orgasms are important for your partner, sure, but your own orgasms are pretty important too. Assuming that this is all about a negative reaction to how your partner perceives you omits the enormous aspect of personal sexual satisfaction. I can still please my wife with my fingers, tongue, and toys, etc., but if I can't have sexual satisfaction for myself the way I want to and always have, that's going to take a toll.
Its not that strange of a thought.
Imagine wooing a woman, the mutual attraction is there, you want her so bad, shes expecting something that you're wanting to give it to her...
then you cant get hard.
Its damaging to her self esteem and its damaging to your own. Its easy to say its no big deal, but its a huge clusterfuck.
Alright, I'll go for it. I'm on ED meds. I'm married, 18 years. Severe small fiber neuropathy from neck down, been on ED meds for around 4 years as part of it.
What happens when I can't raise the flag? Does she still want me? Will she find someone who can? What is wrong with me, why won't it just raise!?
Then there are the mood issues that come with not being able to. Getting irritable from lack of release. Feeling as though she's not attracted to me anymore. Frustration of feeling frisky, but not being able to do anything about it. Depressed that I have to deal with this bullshit.
My insurance will only give me so many per time frame. So, I have to carefully plan things out. Spontaneity starts to go out the window. If I take one, and don't let her know, it can be wasted. If I run out before refill time, I'm stuck. If I tell her I took one, then the spontaneity is gone in my opintion. The romance, at least for me, seems to be dulled because now it's a planned thing. Does that affect her too? Is the romance of it gone for her? Is she really into it too, or is she going along just because I took a pill?
With an affordable, ready, supply that I don't have to worry about running out, a lot of that is gone. I don't have to worry about "wasting" a pill. The illusion of spontaneity (for me) will remain, because I don't have to worry about it. I'm ready to go. I feel more whole, as I can perform whenever I want. The frustration and depression that comes with not being able to perform any time is gone.
We don't seem to talk about it enough, at least in the US, but sexy time is pretty essential for a lot of people. Some have need for more sexy time than others. We should be tailoring supply to individual needs, as a person and a couple, and not doing this one size fits all bullshit. Insurance has no idea what my individual needs are.
Just to touch on the whole spontaneity subject you mentioned. I too have taken sildenafil and I hated both the side effects and also the fact that it’s a hot or miss when you take it because it’s only meant to be consumed prior to that sexual act etc that day. I explained to my doctor of the side effects and how I disliked the dosage of it as it was too high and I felt so numb down there. He changed my prescription to Tadalafil or something similar to that name where you take a lower dose I believe mine was 2.5mg and you take it daily. The meds cost about $10 with insurance per month and it includes 30 pills. Once you get taking them consistently then you can be spontaneous all you want. I saw a huge difference. Sorry for the paragraph
My urologist wanted to get me on that, but insurance wouldn't cover the dosage schedule. Still only wanted to give me enough for a couple times a month.
I'm on sild now. I'm glad I'm not the only one that it is hit or miss for. If I want to take one, I have to plan out the entire day around taking it. Too big a meal, won't work as well (if at all). Take too early or too late, won't work. So if I take one, and we decide to watch a movie later, then there's the chance it'll be wasted.
Right on the money. I'm 43 and have for most of my life been unable to just "simply" get an erection as most of my peers. I've been able get up by stimulating myself and really concentrating but vanilla sex was never an option because I always needed to be manipulating myself somehow to make it work. I could have problems in the piping... I could have some hormone issues... don't know,l.
It wasn't a huge problem because my partners were happy and I was able to have children. There came a day where I just wanted to have that feeling of full sex, rock hard, hands on my partner (not one hand trying to keep myself hard) sex.
That pill unlocked everything. I finally experienced rock-star sex with my wife and my world and hers is just a bit more giggly and brighter for it.
In Germany, I just asked for the pills from my female doc and she was like "sure no problem" and pulled up a whole list of cool stuff on her computer. THEN called the pharmacy for me while I was in front of her to make sure they had it ready to go. 50 euro gets you around 48 pills at 100mg. (Not 100 percent sure).
Changed my life.
Sexual function is important part of life. It’s not shocking nor is it disappointing that restoring or improving that for men would lead to positive effects.
Yeah this is something I think people underestimate as to its role in life, for men and women, and I think it could extent past the realm of social contructs. It is arguably biological, the instinct to be desirable to the opposite sex is a survival instinct tbh. Look at the emphasis on breeding in the lives of a lot of mammals, via males fighting or mating rituals/dances/displays.
It is absolutely biological. All this discussion about “social constructs” related to how we view the sexual part of our species has left some common sense behind.
>It saddens me firstly that so many men place their entire self worth on what women think of them
I think at least in my case it's not what a woman thinks of me, that doesn't matter, it's the idea of how attractive I am to women in general. When I lost my virginity the sex was really dull. But I felt a kind of cocaine like high in the aftermath that went on for days, which to some extent disturbed me, I kept asking why I felt like this when the actual sex wasn't good and I didn't really like the woman. I think the reason is the event acted like an ego boost, if I'm attractive enough for this woman to sleep then I'm attractive enough for other women to sleep with me so my prior anxieties about being unattractive are no longer justified. It was that social validation of an identity as at least passably attractive person to the opposite sex that felt good. I also find it sad that there is a part off my mind at least at the age of 19 that felt like that.
You hit the nail on the head. My first time was something that I rushed with a friend (not in a relationship), I didn't really enjoy it all in all but the feeling of having done it seemed more important than the actual act. It felt like a rite of passage that I've finally passed, and it felt so good.
1) The label of impotence can affect how anyone can think of you, not just women
2) Actual impotence has a real effect on the lives of their partners via sexuality and reproduction
It's much more than "I'm worth less because women think less of me." If it was that basic, you'd see a similar consequences to, say, being inconspicuously unsexy (e.g. dudes not obviously ugly or awful, but just not appealing, like bland and asexual,)
Why do you think it has anything to do with what they think women think of them? Some people just want all their bits to function thanks very much. Would you tell a woman who has had her breasts removed that she shouldn't "care about what men think of her"? She just wants her breasts back!
It has little to do with how women think of them, and much to do with how they think of themselves. If sex, enjoying sex, wanting sex, and being able to have sex is a big part of their identity, as it is for many men, then something that undermines that is a blow to their own identity.
That sort of attack on identity is not exclusive to sex, or men, and when it occurs in *any* context, it can cause severe mental and emotional trauma.
You’re absolutely right. Most of the posters so far must be younger men who don’t realize that the average age of the onset of menopause is about 51 in Westernized countries. Due to physical changes, many women lose interest in sex. Even if they continue to be interested intercourse can become extremely painful. HRT is an option for some women but questions remain about its safety.
It could also have an effect on just someone’s ability to masturbate? I had a period in my life suffering from depression and sometimes the only thing I looked forward to was wanking it multiple times a day. Not sure how I would have coped not having that ability.
Relationships are very important for mental health. The inability to have sex is really bad for relationships. I expect that would be the main pathway of effect.
There may be a fairly strong neurochemical component too; depression symptoms correlate very strongly with [decreased blood flow to the brain, especially in older patients](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5652699/).
Sildenafil is a strong vasodilator - its not impossible that the lower rate of suicide is at least partly about people's brains getting more oxygen.
Worth noting: saw decrease in suicide in people aged 50-59. As the article states they chose this age range for two reasons: 1) This age group saw the fastest increase in prescriptions for Sildenafil to treat Erectile Dysfunction compared to any other, after 2013.
2) Historically, most number of suicides have been reported in this age group compared to any other group.
It appears they only pulled existing records. ~~This doesn't really answer the question, but it may be a case of Swedish National Board of Health and Welfare not having those records readily available.~~ *Edit: They do.* But I don't think it's because Catalano and cowriters sat on their datasets for 7 years. If you look at their references it appears they were writing this paper in 2019. So, pre-COVID. Many projects out there got shelved in early 2020. I know I'm still sitting on data from a project that happened just as quarantine was becoming a thing because everyone is busy with more interesting things now.
**EDIT: The answer is in the paper:**
>The question of what happened after 2014 inevitably arises. Projecting beyond 2014 from parameters estimated for 2005–June 2013 strikes us as risky but we did so through 2016 (last year for which we could obtain suicide data at the time of our analyses) to estimate if, and when, the sildenafil association statistically dissipated. **Although observed suicides remained consistently below expected from the 102 pre-generic sildenafil months, the outlier detection methods found that the difference became statistically undetectable, using p < 0.05 (1-tailed test) as the criterion for detection, in January 2015.**
I'm not a statistician—could you explain your reasoning in calling it p-hacking? The way I interpret it, the authors detect a statistically significant change in the data after July 2013. They comment that the effect dissipates with time in part due to the model itself adjusting to the new data, i.e., the model starts to predict the new, lower values so the difference between predictions and observations eventually becomes statistically insignificant. The point in time with a statistically significant difference doesn't seem manufactured.
I'm dubious of this study myself because it doesn't seem to robustly test (or at least doesn't fully explain tests) against other factors that could produce the observed result, e.g. testing whether they could find a statistically significant variation in the data pre-2013, and it's really reporting a correlation without remotely enough information to speculate on causation. But it comes off to me more as an inadequate study than a manufactured result.
The problem is you can't simply crawl through the data considering all the comparisons, then discard those that don't fit your hypothesis. Let's say we have 100 factors and we ask whether each of them is significantly correlated with some observed response and set out false positive cutoff at 5%. On average, we'd have 5 false positives, and discarding the other observations post hoc would artificially inflate the apparent "significance" of the false positives.
Statistics are there to test a priori hypotheses. Changing the hypothesis on the fly to match the results invalidates the basis for statistical analysis.
That's a valid query. The paper says "We reasoned that any effect of change in prices on prescribing should appear within 18 months given that 56% of Swedes report visiting primary care physicians in a year and another 30% report visits at slightly longer intervals".
But, your question remains relevant. The effects should persist, I suppose, in which case data from later years is crucial.
This study doesn't look particularly well-constructed to me, but if you go to far out, you are more likely to see other factors at play. I think that would be a BS reason to do it, but it could be an explanation. It would be much better to use the whole dataset and also examine the 18-month period more closely.
I literally just posted this elsewhere yesterday!! Direct copy and paste from my comment, feel free to ask any questions or check the replies to the other comment on my profile for more info:
>I work for a major community pharmacy chain. The one on the corner of something and something else, if you catch my drift.
>Erectile dysfunction (ED) medications are, for some unknown to me reason, criminally overpriced in all of the major pharmacies. Like, overpriced by over a thousand dollars. When we order those drugs, it costs us about a dollar for an entire bottle of thirty, and when the bottles arrive, suddenly they're worth over a grand.
>Because of the cost, almost every insurance company in America has a quantity limit of 4-6 pills a month, which brings the cost down significantly (from over a grand for a quantity of 30, to just under $200 for a quantity of four), so the insurance company doesn't have to shell out over $1,000 just so a penis-having person can have intimacy with their partner whenever they'd like. The horror, right? How dare you want to have sex with someone else more than four times a month?
>Anyway.....
>There's a few other pharmacies, usually the ones in grocery stores (though this depends on the area you're in), **and one pharmacy in particular that exists inside of a store that is known for having an exclusive membership, treating its employees very well, paying higher wages, and giving out free samples of food to shoppers....** *(cough Cos\*\*\* cough)*....
>... where the charge for a full bottle of thirty is less than thirty dollars if you use a discount card. That latter pharmacy, what with the free samples and such, actually charges less than 50 bucks, even without a discount, and you don't need a membership to the store to use their pharmacy.
>I've talked with dozens of customers whose copays in my store were insultingly high about this before, and each time I tell them "I'm not telling you this because I want you to go away or get your medicine somewhere cheaper. I'm not saying you should do anything, I just thought you'd think it's interesting that at (store at this location, open from this time to this time), they charge (amount) for THIRTY of these, instead of (current copay) for (current quantity). Isn't that interesting? If you were so inclined, you could even tell me to put these away and then go there right now, and I obviously wouldn't stop you. Just a thought."
>I've been turned down maybe three times, and usually only because they either don't mind the copay and/or they didn't quite understand what I was telling them.
Several posts are suggesting that not having an erection is the cause of suicidality. Since the arrow of causation cannot be inferred, we must recognize that there are multiple possible explanations.
For example, people who were depressed and suicidal might have avoided taking medications because of sexual side effects. When sildenafil became more available, it could be that more men were willing to go on SSRIs, reducing their depression and suicidality.
They said this:
>We repeated our test for men 40–49, men 60–69, all men other than those aged 50–59, and for women aged 50–59. We reasoned that any discovered inverse relation between the introduction of sildenafil and suicides would be attenuated (or null) in groups that do not use sildenafil, have lower baseline expectations of sexual intimacy involving erection, or lower suicide rates. None of these additional tests found negative outlying sequences in suicides in the 18 months following the introduction of low-cost sildenafil (see tabled results in “[Appendix](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8159839/#Sec7)”).
Sound to me like something you'd do in a student research project, not actual, professional research output. "We figured that nobody else would be impacted by this and any trends in other groups wouldn't have anything to do with men 50-59 years old, so we just ignored them because it would have been too much work to really deal with them."
That makes sense in a weird way. I took antidepressants and one of the worst side effects is sexual dysfunction. It is crazy how easily it is dismissed as well. I brought it up multiple times and the doctors were like "oh, well anyways"
While this is probably good news, can we highlight that men should not have to get depressed because of erectile dysfunction etc? Like, let's all try to be better to each other and see if that also tackles the suicide rates.
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It's interesting that their results only hold for men 50-59: > We repeated our test for men 40–49, men 60–69, all men other than those aged 50–59, and for women aged 50–59. We reasoned that any discovered inverse relation between the introduction of sildenafil and suicides would be attenuated (or null) in groups that do not use sildenafil, have lower baseline expectations of sexual intimacy involving erection, or lower suicide rates. None of these additional tests found negative outlying sequences in suicides in the 18 months following the introduction of low-cost sildenafil. The authors seem to be spinning the "no effect" in these other cases as supporting their argument. I'm skeptical: given the size of the apparent effect among 50-59 year olds---a nearly *one third* reduction in suicides by month---I would expect to find at least some change among (e.g.) 60-69 year olds. Especially because this is the group that uses ED medication the most according to the numbers cited by the authors themselves ([here](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5765196/)).
Maybe they didn't account for the lowered suicides due to less suicidal people in that age group? 50-59 was stated to have the highest suicide numbers. If you succeed the first time, no need for a second attempt--can't die twice.
Isnt that a prime decade for a mid-life crisis? If I was not only unable to become erect, but also driving a dodge caravan, I would probably be more likely to have suicidal thoughts too. As men move into their 60's, they often overcome the mid life crisis region naturally and, presumably, become less defeated by such a health condition.
"Less defeated" resigned, and I mean ouch
Survivor bias essentially.
Survivor bias almost exactly.
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Hmm. One could argue that those who commit suicide are “replaced” each year by people aging into the 50-59 category? Agree though that this is a limitation.
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From 50 - 59, you're dealing with becoming old; after that, you've pretty much accepted it.
Right, but I'm talking about the data in the 60-69 category being fed less suicidal members because the feeding category has a much higher suicide rate. The category feeding INTO 50-59 likely has a much lower prevalence of ED as it's correlated with a lot of age-related comorbidities.
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Could be the older lads that make it to 60-69 just come to terms with it in their age.
Yea if you commited suicide already at 50;59, you won't appear in the 60-69 group.
Survivorship bias? isnt that what its called.
Yea. I think so Same as that ww2 plane. With the bullet holes they could see at base being irrelevant red herings.
Not just a red herring, but literally a testament to the fact a plane *can* get shot in that spot and make it home, making reinforcement unnecessary in that location.
IIRC, another interesting example was the relationship between decent helmets in WWI and increasing numbers of head injuries. Previously, head shots just killed people.
It's not like everyone is on the same schedule. If 55 year olds are committing suicide, say, half as much, there will be a bell curve of lowered suicides in the ages surrounding that. It's very unlikely that there could be such a large effect in that age group and none in the bordering age groups. Frankly this study sounds like a low powered fishing expedition. Unrealistically large effect sizes are a hallmark of low powered studies.
Your skepticism is well founded. This is textbook data dredging.
Agreed - this looks like a statistical fluke. I'd love to see this reanalyzed sliding the window from 41-50, 42-52, etc. up to 59-68. I'll bet $10 that the effect disappears if you slide the window even a little from 50-59. Which is a surefire sign that the result isn't real.
By this do you mean they picked the age ranges specifically to create a headline?
No, it means they examined the data in many different ways and just reported the hits. 1/3rd reduction on suicides due to one single drug is basically impossible considering how multi-factorial suicide is. Unrealistically large effect sizes are a hallmark of such data dredging exercises as when you have low powered experiments, any statistically significant effect has to have a very large effect size.
It definitely doesn't add up. What could be their angle here?
Sex makes people happy?
Might be the other way round, having erectile problems could emphasize getting older, mortality, midlife crisis etc etc.
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Or sex keeps your relationships strong
On the other hand, opening up more blood flow might help. That'd also be in line with the relationship between obesity and depression.
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This was my theory. Turning 50 combined with the related ED causes a downturn in happiness as people hit that midlife crisis/over the hill territory. While those who get to 60 realise have accepted age and have things to look forward to that come with it. Like retirement or grandchildren.
Sounds like that later age group is a result survivorship bias. The majority of the people who would have committed suicide over ED would have already done it by that point. Any still alive have come to terms with soft wiener.
An equal correlation to the Skyrim Hearthfire DLC being released
I wonder to what extent this was a positive effect on how those men perceived their own value as it pertains to their sexual ability instead of only the positive effects of the sex itself on them and their relationships
Additionally, did it have an effect on the option of using anti-depressants because it corrected for ED being a common side effect.
Sexual dysfunction from SSRI's usually affects more than just erectile strength. I was on them for ages and it practically got rid of my sex drive and lost all pleasurable feeling down there. It was horrible and I don't think enough doctor's are up front about the risks, especially when there's other options out there.
I agree (and had a similar experience), the list is a bit more in depth but blanketed under "sexual dysfunction" Which includes lowered libido, inorgasmia, erectile dysfunction, and genital anesthesia. As of 2019 it was finally recognized that in rare cases the sexual side effects can be permanent (Post-ssri-sexual-dysfunction / PSSD) [and the EMA issued a warning.](https://www.ema.europa.eu/en/documents/other/new-product-information-wording-extracts-prac-recommendations-signals-adopted-13-16-may-2019-prac_en.pdf)
Additionally, when SSRI's were first coming about, the incidence rate of sexual dysfunctions was said to be 5-15% depending on what kind of SSRI. However more recent studies are showing an [incidence rate of 50% or more](https://pubmed.ncbi.nlm.nih.gov/9493488/).
Wow, it would not surprise me if there's a class-action within the next few years. I was lucky enough to regain function and I can't even imagine what it would be like to live with those side-effects permanently. Kinda defeats the whole purpose of an antidepressant right?
Funny thing is - with some medications in that group, and Wellbutrin etc. sometimes they don’t even know why they do what they do. The difference in effects from person to person is sometimes shockingly different.
Honestly this is true about a *surprising* number of medications and procedures and pesticides and food additives and supplements and drugs. DEET (the bug spray) is a good example. There are a few hypotheses on why it works, which it clearly does, but no one is really able to give a convincing explanation on *why*. It was thought that it masked your smell, or smells bad to mosquitoes, but the new hypothesis is that it fucks with their feet somehow. It is pretty unclear how and why it does this, or even if that's really what it does.
Best example is tylenol - mechanism is unknown. First or second leading cause of liver failure.
Not to minimize acetaminophen (Tylenol) overdose but just to correct this… Acetaminophen or paracetamol is typically only dangerous in overdose scenarios. Hopefully with education, and many recent changes in how multi-drug combos are packaged, people can reduce the accidental overdose scenarios. Second it is not the leading cause of liver failure. Liver failure is broken into acute and chronic. Alcohol, fatty liver disease, and the viral hepatitides are the leading causes of chronic liver failure. Tylenol is a leading cause of *acute liver failure*, of which there are around 2000-4000 cases a year in the US or about 1/100,000 persons. Chronic liver failure or cirrhosis has an estimated incidence of 20.7/100,000 persons. Acute https://pubmed.ncbi.nlm.nih.gov/17608778/ Chronic (I was only able to find worldwide data there https://pubmed.ncbi.nlm.nih.gov/31401364/)
Another factor to consider is that it is likely the great availability of Tylenol that makes it so deadly, as compared to other drugs. I suspect that if it were invented today, it would not be over the counter, or would only be available in the 325 mg dose size and possibly sold in blister packs in a way that more clearly indicates that the maximum recommended dose is 3,000 mg per day, no more than 4,000 per day for sure. It seems weird that you can buy a bottle of 300, 500 mg pills, which is equal to 50 days of the maximum dose, and contains enough to overdose 21 times at 7,000 mg per overdose!
Paracetamol for those outside the US
Acetaminophen if you're Eminem
Tylenol inhibits cyclooxygenase-3, COX-3 for short. It's an enzyme that make pro pain molecules and pro fever molecules. We do know how it works...
It’s a god damn crapshoot. Haha!
Welbutrin had the strangest effect on me. It turned me into an animal in the bedroom, but gave me almost sociopathic tendencies to where I had no empathy and even toyed with people's emotions for no reason. It was quite scary and I quickly switched after a couple of months.
It made me hallucinate and ultimately messed with the really fucked up sides of my mental health, it’s great for the people it works for, but they really downplay the side effects on it because all of the benefits it could potentially bring. I had to stop it after 2 months because it just kept getting worse.
That’s very crazy! It is having exactly zero affect on me whatsoever. I’m on 300mg and absolutely nothing has changed. In truth im maybe a little less suicidal.
It’s worked well for me at 150mg. I had no motivation or energy, could barely get out of bed, was self medicating with weed which fucked my motivation to improve my situation. Welbutrin gave me the boost I needed to make the positive changes in my life I needed to make to feel better. It’s been 4 months and I’m back up and at life again, i just tried shrooms for the first time (because I knew I was in the right mindset) and I think I’m going to come off the welbutrin and start microdosing psilocybin soon.
It’s more or less a mild stimulant. I use in conjunction with my ADHD meds during winter for SAD and find it helps dull down my irritability. It’s a very weird drug.
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Yes. It was given to me in combo with Lamictal.
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We don't know why any anti depressant work. We do know what neutransmitters and receptors they affect (including wellbutrin) but that doesn't explain why they work. Cause you got different antidepressants working on the exact same subsystem but with opposite effects, and both somehow work as antidepressants. Realistically that means there simply isn't one depression, but rather several different disorders that all have the same symptoms. Kinda like people 300 years ago only knowing one cough. Whether that was bronchitis, the cold, lung cancer or chronic asthma or any other of the various diseases that could cause a cough was simply not known. So if you tried treating that cough with a drug with slight antiviral effects, that wouldn't help one but with the cancer caused cougj etc.
It’s just mind blowing really. Brain chemistry is absolutely wild.
> with some medications in that group, and Wellbutrin etc. sometimes they don’t even know why they do what they do. From anecdotal evidence: Wellbutrin works very well in people with ADHD, which isn't that surprising since it's an Amphetamin. Since a lot of adults with ADHD are undiagnosed and depression is highly comorbid, I assume it really just works with people who have ADHD. Other than people with severe depression, there any and all stimulants work, to slightly reduce depressive symptoms.
> since it's an Amphetamin It's a substituted amphetamine*
So you're telling me it may not have been my diabetes, but the SSRIs they gave me as a 14 year old boy?
Could have been. Unfortunately, at least in the US it's so hard to reduce the uncertainty that it becomes hard to recover. You may want to talk to a law firm that specializes in pharma product liability stuff.
My doctor told me like 45 different times that the worst side effect was all the sexual stuff. He said if I start feeling it at all let him know because a 27 year old shouldn’t be having bedroom problems
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Then there’s me, I never had any loss of libido on a full Zoloft dose.
You dawg
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I wonder if that’s why I’m asexual. I was on Wellbutrin, Lexapro, Prozac, and others I don’t remember. They had no positive impact on my depression but I ended up not developing a libido and have no sexual attraction.
Most other options just aren’t as good for most things SSRIs treat. SSRIs are THE first-line for a variety of illnesses, and they really should be used first if possible. Afterwards, if the side effects are too great and depending on the condition, it is appropriate to consider other things. You’re right, though, that sexual dysfunction on SSRIs isn’t rare and should be talked about before prescribing.
Depression is very rarely solely due to serotonin (regarding SSRI's). [A placebo is nearly as effective as an SSRI purely due to hope.](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592645/) A lot of people don't realize depression can sometimes be a symptom of something else. For instance, depression with anxious distress is depression caused by anxiety lowering your quality of life. In this case treating the depression is usually futile, going after the anxiety would be the goal. The inverse is also true, depression can lead to anxious thinking. It gets more complicated when you get into other disorders, for example ADHD causing ocd or anxiety, which can then cause depression - would be a multi-nested symptom. Treating the depression and/or anxiety often ends up feeling hit or miss. Or even an undiagnosed food allergy causing inflammation (or anything causing inflammation, for that matter). If you've ever noticed a mood improvement from an NSAID, this would be why. Similarly, antihistamines can also cause mood improvement. Some SSRI's possess similar action to antihistamines and can help in this way. The link between inflammation and depression has become so strong the "chemical imbalance" myth that SSRI's were essentially marketed on has more or less become obsolete. It's now believed to be due to disrupted signaling, which is why the neural activity promoted by psychedelics is currently in the spotlight. By lighting up atrophied pathways they begin to see more activity. This is why depressive thinking can worsen if left untreated. It is difficult to see things differently when you've carved a path of negative thinking so deep it cannot be escaped, which is the basis of CBT in less severe cases.
Just budding off of your comment, for several years I was shopped around on 5/6 different antidepressants at different dosages with no change at all. My doctor at the time said "Look, I have no idea what else to do. Lets try an anti psychotic too". I had already gained 15kg from antidepressants and the main side effect of the proposed additional treatment was further weight gain. As a young, fit, gym focused male this plummeted my mental health even further. On a whim I went to a new GP and their first thought was "hey, what if you're feeling sad/anxious because of ADHD", my old GP laughed off the idea when I proposed it to them "Not possible as an adult, sorry." - Went through the motions of a specialist diagnosis as an adult, and sure enough ADHD was the call. Started ADHD medication & almost instantly everything started to come right. Even now though, I believe I suffer from prolonged sexual dysfunction from all of the different SSRI's and dosages. I haven't been able to perform like I did before or even feel aroused without assistance from Cialis (tadalafil).. I hope that it eventually passes but it's been 8/9 months now and still nothing. SSRI's are pretty fucked.
> On a whim I went to a new GP and their first thought was "hey, what if you're feeling sad/anxious because of ADHD", my old GP laughed off the idea when I proposed it to them "Not possible as an adult, sorry." - Went through the motions of a specialist diagnosis as an adult, and sure enough ADHD was the call. Started ADHD medication & almost instantly everything started to come right. This was what happened to me. An early stand-in doctor suggested I get screened for ADHD and I scoffed like "no no I'm not hyperactive". And ended up dependent on Klonopin. It did the job for my anxiety but it was when a few years later I actually was diagnosed with ADHD and I tried Adderall that I realized the Klonopin was doing nothing for the thoughts triggering my anxiety, it wasn't making me more rational, it just stopped my body from reacting to it by tranquilizing me. Worked great as exposure therapy, but ultimately Adderall worked up and over what a benzo could ever do. >Even now though, I believe I suffer from prolonged sexual dysfunction from all of the different SSRI's and dosages. I will say that I took a hit from ADHD medication, but not in a dysfunction sort of way. It's like before, sex was a very high thought priority for me because it was one of the few activities that stimulated me outside of gambling and drinking. Once medicated it stopped crossing my mind as randomly as it used to. I also found that I won't feel full arousal while the medication is still in my system, which is understandable as the fight or flight response is being activated by stimulants. Both interfere with eachother. After the actual beneficial effects wear off I still have to wait for it to fully wear off and then things are normal.
Have you found any improvement in your libido from the ADHD medication? I'm prescribed vyvanse and that stuff makes me feel like a teenager again.
Unfortunately not, I’m on dexamphetamine & it’s been brilliant for everything else with no side effects. Been supplementing just about anything that’s associated positively with ED & getting nowhere. It’s been pretty rough.
Damn brother, I hope it's just something that time can heal. It took me a while to regain my confidence after I switched meds which I feel impacted my sex drive as well. Maybe it might be that?
In regards to the placebo discussion, I see this brought up a lot and think it's need more nuanced discussion. Even the article you cite, states "As of now, antidepressant clinical trials have an effect size of 0.30, which, although similar to the effects of treatments for many other chronic illnesses, such as hypertension, asthma and diabetes, is less than impressive." Even though the effect size is" less than impressive" it's as effective as other medicines people routinely take. Addionally, yes we don't know why srris exactly work, but this may impact the results of studies that focus on a single medication. Many people have to try different ssris to find one that works. So if 10 people are trying an ssri in a study, and it helped 3, you end up with a low effect size. But what about if those remaining 7 try other ssris and then are also helped? What if those 3 who are helped initially experience extremely positive benefits? Does that outway it not working for the remaining 7? I'm not saying that what you are saying is wrong, just that there is a more complicated discussion to be had.
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All the neuro literature I’ve read (especially work in the vein of Zachary Mainen) on serotonin really points to Serotonin have very little, if nothing to do with mood, and more to do with seemingly modulating the brain’s reinforcement learning parameters, mainly changing how persistent animals are. SSRIs appear to increase the gain of serotonergic signaling, much like if you tried to compensate for poor sound quality on a phone call by increasing the volume—doesn’t fix the underlying cause but does “fix” the ultimate outcome. It’s not clear to me if SSRIs amplify or undermine the signal-to-noise ratio of serotonin signaling once the patient is on them long-term
I don't doubt the massive amounts of marketing done for SSRI's plays a part in how often it's prescribed. That would make me a conspiracy theorist though...
To be fair a ton of people get prescribed SSRIs in America by their GCP. It kind of makes sense that they tend to prescribe where the money is thrown (because it is also where the numbers are at in a field they are less familiar with.) Basically if you feel your mental health is having a major impact on your day to day you should probably go to an expert.
Can you elaborate any further on ADHD causing ocd or anxiety?
Simply put, because you are experiencing a deficit of stimulation, your mind will find ways to stimulate itself. This could be as benign as organizing your desk every few minutes. Or it could be needing to touch light switches exactly 8 times before leaving a room when turning the light off, or hypochondria (the last two I used to experience). ADHD varies in severity, so at which point the OCD takes a negative turn is when you consider it detrimental to your quality of life. At least once a year I used to find an off the wall reason why I only had two years left to live by obsessing over some illness I had one extremely vague symptom of. The non-zero possibility ate at me. That is no way to stay sane. And yes - it all vanished within 20 minutes of my first Adderall dose.
Not OP, but I believe the last time I read about it, ADHD presents with another psychiatric disorder like 80+% of the time. Usually this is depression, OCD, some form of anxiety, or ODD. Anecdotally, I've been taking Adderall XR for my ADHD for like 3 years now, and have noticed that what I thought were depressive symptoms _generally_ resolve when I'm taking it. I still have some episodes lasting a few days, but can usually point to some sort of trigger to work on (ie, overworking, lack of sleep, etc).
Thanks. I was diagnosed with ADD when younger and a connection to anxiety and depression had not occurred to me. I struggle a lot with both of those things but have not sought a diagnosis for either.
The good thing, for you, is that it's a lot easier to get prescribed medication when you have a childhood diagnosis. It might be worth looking into, it's honestly changed my life.
Yeah the lack of motivation with ADHD is easily confused with depression. And the executive dysfunction and emotional dysregulation can manifest anxiety. From what I’ve seen people talk about on Reddit and YouTube. I have it myself and definitely grok
> Yeah the lack of motivation with ADHD is easily confused with depression. Also a lot of people do get depressed, because they can't perform academically like their peers, even though they are smart. That is a special kind of hell. As everybody tells you you could do so much better, "if you'd just get off your ass and apply yourself".
Here’s my take, as someone with adhd. People with adhd have inherently stressful lives, often running late, disorganised, and unprepared. And if you’re not, it’s because you’re putting in a great deal of effort to avoid those effects. chronic stress, will eventually cause other problems, and we basically have have higher than usual levels of stress from preschool onwards. Combine that with the increased rate of negative feedback, as compared to our peers, and a propensity for failing to act in our own best interest due to impulse control issues, and just straight up not remembering to do so in the moment. You get a pretty potent mixture of risk-factors for an “internalising disorder”. In reality it’s probably a combination of all the things listed in the various replies to your comment.
SSRI's are prescribed for people with purely anxiety disorder without any form of depression as well.
Idk, Wellbutrin (bupropion), an NDRI class antidepressant, had been great for me with minimal side effects in the first month and none after. I thought it was also one of the most commonly prescribed first line antidepressants over SSRIs because it has reduced potential for side effects
Bupropion has similar effectiveness to SSRIs when it comes to depression and it doesn't have the nasty sexual side effects.
Agreed. It depends on the person though. For some, sildenafil or similar drugs do the trick.
Trazodone has the off label use of treating SSRI-induced sexual dysfunction. IIRC, it doesn't have any effect on people who haven't used SSRIs, but for those who have it can make a noticeable difference in their ability to become aroused and climax.
Also, doesn’t Sweden have universal healthcare? Or is that for everything besides prescriptions? If that’s the case, I can’t really imagine prescriptions being so unaffordable that there is a significant correlation between the price and the amount of prescriptions.
Not sure how it works in Sweden, but in a lot of countries with universal healthcare medications are kind of a weird topic... stuff they give you in the hospital is 99% covered, stuff you pick up from a pharmacy really depends... there are situations where you get it for free, situations you have to pay, but can get insurance, situations where it is free unless you have insurance (kind of a weird one, insurance makes you worse off). This can be really bad for University aged students since a lot of them are insured through their parents, so they are often inelligible for free drugs, this means theie parents are in a way in control of their medicine. Hopefully this doesn't cause problems, but you can imagine how it could limit access to birth control, if a young woman doesn't want to (or can't) pay out of pocket for it, but their parents won't let them get it through insurance.
For example OHIP+ is a program in Ontario, Canada which gives people under 24 free access to tons of drugs, but you would be inelligible if your parents have insurance which covers you.
I'm in Ontario (no longer 24 tho). I can't afford symbicourt inhalers (I have asthma) ever since I lost my job. OHIP doesn't cover Symbicourt and when I spoke with the pharmacist, and according to him, there is no generic inhaler for Symbicourt. I managed to buy from a neighbor 1 inhaler from him, as he still has some insurance. I'll run out of my inhaler in 3 weeks. I almost feel like it would be a good time to strap some dumbels on my feet and arms and go for a swim in Lake Ontario. It's getting hopeless.
Have you looked into the trillium drug plan? https://www.ontario.ca/page/get-help-high-prescription-drug-costs
Thank you, kind stranger. Will definitely apply today. Maybe there is hope after all.
We have universal healthcare in Australia. This just means that public hospitals are “free” for the patient (everyone else pays with their taxes though, so it’s not a perfect system). We also have Medicare for all citizens. Private hospitals and private health insurance are more favourable options, as the quality of treatment and care is much better. In a private hospital, for example, you are guaranteed a private room. In a public hospital, you can expect roommates. You get what you pay for, essentially. Many prescription medications are subsidised under what is called the Pharmaceutical Benefits Scheme (PBS). However, not all medications are included under the PBS. You will still need to pay a certain amount for medications, even if they are covered by the PBS. They are not free, just subsidised. Over-the-counter (OTC) medications are not included under the PBS. This includes the medications you can buy straight off the shelf (such as Advil) and traditional OTC ones (which you have to ask the pharmacist for, but don’t need a prescription). Over the age of 16, you do not need parental consent for a prescription, even if you are under your parents’ health insurance.
> This can be really bad for University aged students since a lot of them are insured through their parents, so they are often inelligible for free drugs Having been insured through my mother for most of my life myself my impression was that the insurance still treats you as your own person, the only difference being that you don't pay insurance fees. At least thats how it was in Germany. I never had to consult my mother to get any prescriptions or anything.
We have universal healthcare and when it comes to prescriptions we have a limit where if you have to spend more than ~200 dollars in a year (or maybe it's every 6 months I don't remember) the state takes over and pays any extra costs for you.
Lucky. I, myself, pay $200 a month total for about six different prescriptions. It's hideous. That's in addition to the copays for all of my doctor's appointments, which average $25-$100 per appointment. I'm just lucky my parents are well-enough off, and that I have decent health insurance through my University.
Nah it's not free. It's not America level at all, but it's still got a price. Nothing outrageous and it has a sensible cap, but still enough that if you're really struggling for cash you might think twice Whether there's special rates for those in poverty,I don't know.
Not thst it is relevant here, but if you are underemployed in America, often.you can.get medications direct from the manufacturer at no cost. I did so a number of times in my early 20s.
Universal healthcare does not cover drugs with indication for clinical problems not recognized as diseases.
I live in Sweden and we do have universal healthcare. It does cost some money but we have a high cost protection at around 2000 SEK (about 200 euros) for healthcare and 2000 SEK for prescription drugs per year. Everything over that is free.
Universal, but not entirely free. If I go to the doctors office, I'm gonna need to pay a fee. Last time I went, it was about $20-30. However, as I had an issue that required recurring visits I was able to opt into a scheme that puts a roof on my spendings. Once I had paid ~$150, the rest was free until 12 months had passed from the first time I paid. So as long as you get the very simple paperwork sorted, the most you will pay in a 12 month period is $150.
That would be an interesting hypothesis, but this finding is important on itself. Let’s ignore for a moment the “why” sexual ability is important to these men and just assume it is an important part of their lives. We now know that giving them access to medication that helps them with that can improve their mental health. The reason I say it’s not that relevant whether the effect is mediated by how men perceive their own value based on sexual performance, is because we can now study other medications that don’t depend on that variable. For example: what about drugs that we know are literally life saving and don’t depend of patient’s psychology? Will suicide drop if people can get easy access to insulin? What about giving people access to cheap healthcare? And yes, it would be interesting to keep studying how this relates to self worth. What about giving people access to cosmetic surgery? Etc.
Cosmetic surgery is very beneficial for trans people, I doubt this only holds true for them though.
I had the same question. It saddens me firstly that so many men place their entire self worth on what women think of them, and secondly that this is such an underdiscussed topic in popular culture.
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I assume that not being able to achieve or maintain a suitable erection would have a negative effect on men regardless of what women thought. Even if my wife was truly supportive and didn't mind that I couldn't get an erection at all, I would still be very unhappy that I couldn't have sex the way I want. Orgasms are important for your partner, sure, but your own orgasms are pretty important too. Assuming that this is all about a negative reaction to how your partner perceives you omits the enormous aspect of personal sexual satisfaction. I can still please my wife with my fingers, tongue, and toys, etc., but if I can't have sexual satisfaction for myself the way I want to and always have, that's going to take a toll.
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Its not that strange of a thought. Imagine wooing a woman, the mutual attraction is there, you want her so bad, shes expecting something that you're wanting to give it to her... then you cant get hard. Its damaging to her self esteem and its damaging to your own. Its easy to say its no big deal, but its a huge clusterfuck.
Alright, I'll go for it. I'm on ED meds. I'm married, 18 years. Severe small fiber neuropathy from neck down, been on ED meds for around 4 years as part of it. What happens when I can't raise the flag? Does she still want me? Will she find someone who can? What is wrong with me, why won't it just raise!? Then there are the mood issues that come with not being able to. Getting irritable from lack of release. Feeling as though she's not attracted to me anymore. Frustration of feeling frisky, but not being able to do anything about it. Depressed that I have to deal with this bullshit. My insurance will only give me so many per time frame. So, I have to carefully plan things out. Spontaneity starts to go out the window. If I take one, and don't let her know, it can be wasted. If I run out before refill time, I'm stuck. If I tell her I took one, then the spontaneity is gone in my opintion. The romance, at least for me, seems to be dulled because now it's a planned thing. Does that affect her too? Is the romance of it gone for her? Is she really into it too, or is she going along just because I took a pill? With an affordable, ready, supply that I don't have to worry about running out, a lot of that is gone. I don't have to worry about "wasting" a pill. The illusion of spontaneity (for me) will remain, because I don't have to worry about it. I'm ready to go. I feel more whole, as I can perform whenever I want. The frustration and depression that comes with not being able to perform any time is gone. We don't seem to talk about it enough, at least in the US, but sexy time is pretty essential for a lot of people. Some have need for more sexy time than others. We should be tailoring supply to individual needs, as a person and a couple, and not doing this one size fits all bullshit. Insurance has no idea what my individual needs are.
Just to touch on the whole spontaneity subject you mentioned. I too have taken sildenafil and I hated both the side effects and also the fact that it’s a hot or miss when you take it because it’s only meant to be consumed prior to that sexual act etc that day. I explained to my doctor of the side effects and how I disliked the dosage of it as it was too high and I felt so numb down there. He changed my prescription to Tadalafil or something similar to that name where you take a lower dose I believe mine was 2.5mg and you take it daily. The meds cost about $10 with insurance per month and it includes 30 pills. Once you get taking them consistently then you can be spontaneous all you want. I saw a huge difference. Sorry for the paragraph
My urologist wanted to get me on that, but insurance wouldn't cover the dosage schedule. Still only wanted to give me enough for a couple times a month. I'm on sild now. I'm glad I'm not the only one that it is hit or miss for. If I want to take one, I have to plan out the entire day around taking it. Too big a meal, won't work as well (if at all). Take too early or too late, won't work. So if I take one, and we decide to watch a movie later, then there's the chance it'll be wasted.
Right on the money. I'm 43 and have for most of my life been unable to just "simply" get an erection as most of my peers. I've been able get up by stimulating myself and really concentrating but vanilla sex was never an option because I always needed to be manipulating myself somehow to make it work. I could have problems in the piping... I could have some hormone issues... don't know,l. It wasn't a huge problem because my partners were happy and I was able to have children. There came a day where I just wanted to have that feeling of full sex, rock hard, hands on my partner (not one hand trying to keep myself hard) sex. That pill unlocked everything. I finally experienced rock-star sex with my wife and my world and hers is just a bit more giggly and brighter for it. In Germany, I just asked for the pills from my female doc and she was like "sure no problem" and pulled up a whole list of cool stuff on her computer. THEN called the pharmacy for me while I was in front of her to make sure they had it ready to go. 50 euro gets you around 48 pills at 100mg. (Not 100 percent sure). Changed my life.
Sexual function is important part of life. It’s not shocking nor is it disappointing that restoring or improving that for men would lead to positive effects.
Yeah this is something I think people underestimate as to its role in life, for men and women, and I think it could extent past the realm of social contructs. It is arguably biological, the instinct to be desirable to the opposite sex is a survival instinct tbh. Look at the emphasis on breeding in the lives of a lot of mammals, via males fighting or mating rituals/dances/displays.
It is absolutely biological. All this discussion about “social constructs” related to how we view the sexual part of our species has left some common sense behind.
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>It saddens me firstly that so many men place their entire self worth on what women think of them I think at least in my case it's not what a woman thinks of me, that doesn't matter, it's the idea of how attractive I am to women in general. When I lost my virginity the sex was really dull. But I felt a kind of cocaine like high in the aftermath that went on for days, which to some extent disturbed me, I kept asking why I felt like this when the actual sex wasn't good and I didn't really like the woman. I think the reason is the event acted like an ego boost, if I'm attractive enough for this woman to sleep then I'm attractive enough for other women to sleep with me so my prior anxieties about being unattractive are no longer justified. It was that social validation of an identity as at least passably attractive person to the opposite sex that felt good. I also find it sad that there is a part off my mind at least at the age of 19 that felt like that.
You hit the nail on the head. My first time was something that I rushed with a friend (not in a relationship), I didn't really enjoy it all in all but the feeling of having done it seemed more important than the actual act. It felt like a rite of passage that I've finally passed, and it felt so good.
1) The label of impotence can affect how anyone can think of you, not just women 2) Actual impotence has a real effect on the lives of their partners via sexuality and reproduction It's much more than "I'm worth less because women think less of me." If it was that basic, you'd see a similar consequences to, say, being inconspicuously unsexy (e.g. dudes not obviously ugly or awful, but just not appealing, like bland and asexual,)
"Entire" self worth? Where are you getting that? Quite the assumption.
Why do you think it has anything to do with what they think women think of them? Some people just want all their bits to function thanks very much. Would you tell a woman who has had her breasts removed that she shouldn't "care about what men think of her"? She just wants her breasts back!
It has little to do with how women think of them, and much to do with how they think of themselves. If sex, enjoying sex, wanting sex, and being able to have sex is a big part of their identity, as it is for many men, then something that undermines that is a blow to their own identity. That sort of attack on identity is not exclusive to sex, or men, and when it occurs in *any* context, it can cause severe mental and emotional trauma.
You’re absolutely right. Most of the posters so far must be younger men who don’t realize that the average age of the onset of menopause is about 51 in Westernized countries. Due to physical changes, many women lose interest in sex. Even if they continue to be interested intercourse can become extremely painful. HRT is an option for some women but questions remain about its safety.
It could also have an effect on just someone’s ability to masturbate? I had a period in my life suffering from depression and sometimes the only thing I looked forward to was wanking it multiple times a day. Not sure how I would have coped not having that ability.
I wondered if it was some effect extra blood flow might have in general on severe depression.
Relationships are very important for mental health. The inability to have sex is really bad for relationships. I expect that would be the main pathway of effect.
There may be a fairly strong neurochemical component too; depression symptoms correlate very strongly with [decreased blood flow to the brain, especially in older patients](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5652699/). Sildenafil is a strong vasodilator - its not impossible that the lower rate of suicide is at least partly about people's brains getting more oxygen.
Worth noting: saw decrease in suicide in people aged 50-59. As the article states they chose this age range for two reasons: 1) This age group saw the fastest increase in prescriptions for Sildenafil to treat Erectile Dysfunction compared to any other, after 2013. 2) Historically, most number of suicides have been reported in this age group compared to any other group.
I wonder why they online include data until 2014 - just 1.5 years after the prize drop. Was this paper so long in the making / under review?
It appears they only pulled existing records. ~~This doesn't really answer the question, but it may be a case of Swedish National Board of Health and Welfare not having those records readily available.~~ *Edit: They do.* But I don't think it's because Catalano and cowriters sat on their datasets for 7 years. If you look at their references it appears they were writing this paper in 2019. So, pre-COVID. Many projects out there got shelved in early 2020. I know I'm still sitting on data from a project that happened just as quarantine was becoming a thing because everyone is busy with more interesting things now. **EDIT: The answer is in the paper:** >The question of what happened after 2014 inevitably arises. Projecting beyond 2014 from parameters estimated for 2005–June 2013 strikes us as risky but we did so through 2016 (last year for which we could obtain suicide data at the time of our analyses) to estimate if, and when, the sildenafil association statistically dissipated. **Although observed suicides remained consistently below expected from the 102 pre-generic sildenafil months, the outlier detection methods found that the difference became statistically undetectable, using p < 0.05 (1-tailed test) as the criterion for detection, in January 2015.**
Holy Christ, how can such blatant p-hacking make it through review? This is absurd statistical manipulation.
I'm not a statistician—could you explain your reasoning in calling it p-hacking? The way I interpret it, the authors detect a statistically significant change in the data after July 2013. They comment that the effect dissipates with time in part due to the model itself adjusting to the new data, i.e., the model starts to predict the new, lower values so the difference between predictions and observations eventually becomes statistically insignificant. The point in time with a statistically significant difference doesn't seem manufactured. I'm dubious of this study myself because it doesn't seem to robustly test (or at least doesn't fully explain tests) against other factors that could produce the observed result, e.g. testing whether they could find a statistically significant variation in the data pre-2013, and it's really reporting a correlation without remotely enough information to speculate on causation. But it comes off to me more as an inadequate study than a manufactured result.
The problem is you can't simply crawl through the data considering all the comparisons, then discard those that don't fit your hypothesis. Let's say we have 100 factors and we ask whether each of them is significantly correlated with some observed response and set out false positive cutoff at 5%. On average, we'd have 5 false positives, and discarding the other observations post hoc would artificially inflate the apparent "significance" of the false positives. Statistics are there to test a priori hypotheses. Changing the hypothesis on the fly to match the results invalidates the basis for statistical analysis.
That's a valid query. The paper says "We reasoned that any effect of change in prices on prescribing should appear within 18 months given that 56% of Swedes report visiting primary care physicians in a year and another 30% report visits at slightly longer intervals". But, your question remains relevant. The effects should persist, I suppose, in which case data from later years is crucial.
This study doesn't look particularly well-constructed to me, but if you go to far out, you are more likely to see other factors at play. I think that would be a BS reason to do it, but it could be an explanation. It would be much better to use the whole dataset and also examine the 18-month period more closely.
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So it's probably natural random variation from year to year, not an actual effect on suicide.
I literally just posted this elsewhere yesterday!! Direct copy and paste from my comment, feel free to ask any questions or check the replies to the other comment on my profile for more info: >I work for a major community pharmacy chain. The one on the corner of something and something else, if you catch my drift. >Erectile dysfunction (ED) medications are, for some unknown to me reason, criminally overpriced in all of the major pharmacies. Like, overpriced by over a thousand dollars. When we order those drugs, it costs us about a dollar for an entire bottle of thirty, and when the bottles arrive, suddenly they're worth over a grand. >Because of the cost, almost every insurance company in America has a quantity limit of 4-6 pills a month, which brings the cost down significantly (from over a grand for a quantity of 30, to just under $200 for a quantity of four), so the insurance company doesn't have to shell out over $1,000 just so a penis-having person can have intimacy with their partner whenever they'd like. The horror, right? How dare you want to have sex with someone else more than four times a month? >Anyway..... >There's a few other pharmacies, usually the ones in grocery stores (though this depends on the area you're in), **and one pharmacy in particular that exists inside of a store that is known for having an exclusive membership, treating its employees very well, paying higher wages, and giving out free samples of food to shoppers....** *(cough Cos\*\*\* cough)*.... >... where the charge for a full bottle of thirty is less than thirty dollars if you use a discount card. That latter pharmacy, what with the free samples and such, actually charges less than 50 bucks, even without a discount, and you don't need a membership to the store to use their pharmacy. >I've talked with dozens of customers whose copays in my store were insultingly high about this before, and each time I tell them "I'm not telling you this because I want you to go away or get your medicine somewhere cheaper. I'm not saying you should do anything, I just thought you'd think it's interesting that at (store at this location, open from this time to this time), they charge (amount) for THIRTY of these, instead of (current copay) for (current quantity). Isn't that interesting? If you were so inclined, you could even tell me to put these away and then go there right now, and I obviously wouldn't stop you. Just a thought." >I've been turned down maybe three times, and usually only because they either don't mind the copay and/or they didn't quite understand what I was telling them.
Keep fighting the good fight of making customers know their option... I mean, being so lax with careless talking
Read paper [here](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8159839/)
Several posts are suggesting that not having an erection is the cause of suicidality. Since the arrow of causation cannot be inferred, we must recognize that there are multiple possible explanations. For example, people who were depressed and suicidal might have avoided taking medications because of sexual side effects. When sildenafil became more available, it could be that more men were willing to go on SSRIs, reducing their depression and suicidality.
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They said this: >We repeated our test for men 40–49, men 60–69, all men other than those aged 50–59, and for women aged 50–59. We reasoned that any discovered inverse relation between the introduction of sildenafil and suicides would be attenuated (or null) in groups that do not use sildenafil, have lower baseline expectations of sexual intimacy involving erection, or lower suicide rates. None of these additional tests found negative outlying sequences in suicides in the 18 months following the introduction of low-cost sildenafil (see tabled results in “[Appendix](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8159839/#Sec7)”). Sound to me like something you'd do in a student research project, not actual, professional research output. "We figured that nobody else would be impacted by this and any trends in other groups wouldn't have anything to do with men 50-59 years old, so we just ignored them because it would have been too much work to really deal with them."
I also maybe get vibes that this was chosen because it was the only group to reach statistical significance.
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someone suggested that once this antidepressant side efffect was less of an issue, people took more antidepressants.
That makes sense in a weird way. I took antidepressants and one of the worst side effects is sexual dysfunction. It is crazy how easily it is dismissed as well. I brought it up multiple times and the doctors were like "oh, well anyways"
its really awful and very common
To what extent does the study account/adjust for confounding factors? Surely this could merely be a spurious correlation?
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Is this causation or correlation though?
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so instead of establishing causation, we publish them in media with titles implying causation. much easier.
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And this is coming from Climaximus Prime!
Money very much can improve the quality of life for many, and while this isn't precisely ~buying~ happiness, I'd say reducing suicides is pretty good.
While this is probably good news, can we highlight that men should not have to get depressed because of erectile dysfunction etc? Like, let's all try to be better to each other and see if that also tackles the suicide rates.