It's different for everyone. I can't stress that enough. But for me, it's amazing. It's like a silver bullet. It literally makes me happy. I know people say it's artificial happiness, etc etc but it really legitimately allows me to be happy. My stress levels go way down, and my self discipline increases. It doesn't turn me to a zombie-- I was a zombie before compared to now. Always distracted and held behind by my anxiety and difficulties expressing myself.

I get why people do drugs-- they make people feel good instead of bad. But this stuff feels like a cheat code. It makes me feel good all of the time. From the perspective of a my old depressed self, feeling neurotypical like this is like being high all the time. I should also state I've only been on it about 6 months, so long term experience is to be seen.

There are also other options, if you're willing to try. Exercise of course can be a big help. Cold showers totally eliminate my depression as well. Wim Hof breathing was life changing in terms of anxiety, though I would never have in a million years thought that a breathing exercise could help me. There are some supplements, like Saffron and Kanna, out there than can help as well. I use some of these, and together they enormous difference.

Do you mind me asking what you were like before?

I’ve had generalised anxiety disorder for ~12 years and have kept it manageable using some of the techniques you’ve described (breathing and meditation being the main two) however this year has brought some challenges that has really ramped it up and is now causing major issues that I’m struggling to manage.

My doctor was happy to prescribe some for me, but I’m scared as hell about starting them. Side affects aside, getting off them sounds like it can be a nightmare.

My anxiety was “manageable” for most of my life but this year it boiled over. I would get something like panic attacks multiple times a day with a racing heart and was constantly distracted by catastrophic thinking the whole day so I knew I couldn’t manage basic life by myself anymore. I’ve been quite happy with SSRIs but I wouldn’t mind going off them once my life and the world settles down.

Basically I felt like I didn’t have the mental energy to fight with just active methods like meditation and needed some passive baseline help from medication

Getting off SSRIs varies from person to person. Typically if you're careful to slowly taper down your dose you shouldn't experience any weird side effects.

I can quit cold-turkey from a high dose without issue, but that seems to be rare.

I'm a residency trained pharmacist and someone whose life was improved immensely by antidepressants from ages 19 - 37(bupropion x 10+ years, SSRI x 2 years, SNRI x 5 years). These drugs will change your affect (your mood) but not your intellect.

I am also currently not on medication x 2 months for the first time in about 18 years, so I have seen myself both on and off meds and I have a deep mechanistic understanding of these drugs.

I promise you that no drug that you can take can make any permanent changes to *edit* to your mind (there are rare cases unrelated to SSRI where side effects like tardive dyskinesia or pulmonary fibrosis can be irreversible). The SSRI have about a 4-6 week period of onset and offset where the extra serotonin floating around starts to cause fewer serotonin receptors to be expressed and subsequently enhances your brain's sensitivity to serotonin. It is for this reason that you do not see results overnight when starting a serotonergic drug.

Stopping the drug, a similar effect is seen. I had about a week of slight discomfort related to withdrawal symptoms, then 2-3 weeks of feeling a bit slower than normal, and now I feel just fine. Throughout this whole brain remodeling process both on and off meds, I never lost a step at work, which is to say that I maintained excellent performance as a midlevel practitioner and maintained several side hustles and even started a consulting business.

My honest interpersonal advice (not medical advice) is to give meds a try man. Your life has been severely affected by your mental state, and you could potentially see significant improvement....but even if you dont, you'll stop the drug and be no worse off than when you started.

As someone generally outspoken against the class of drug, but has required it for short term due to imbalances caused by health issues: listen to this comment.

Watch yourself closely, and have your smarter and less judgey friends and family do the same, because the doctors sure as hell don't have enough time with you to do so.

But, listen to this comment.

So this is my story, I won't' claim it invalidates anyone else's experience and it will have an element of anecdotal. Everyone can have different levels of depression and there are many variables at play (current lifestyle, health etc).

I found myself in an utter mess. I constantly felt depressed or under huge stress from rampant anxiety. The best way of describing my depression is to imagine wearing a weighted jacket, just constantly pulling you down and zapping all zest from your life. Here I was, working a very well paid job, loving young family and everything going for me and I just wanted to crawl into a ball and die.

I was just on the verge of going to see a Dr to get prescribed something, but I was hesitant about this from stories of side effects. It seemed no one had a consistent experience and some had a horrible time, with a few finding them great.

I went to see a therapist which really helped me to unspool everything, as my life seemed like a blur at the end. They recommended to me a book. The book was called 'feeling good' by Dr David Burns an American psychiatrist, and it was basically a manual of using Cognitive therapy on yourself. I found it laid out in away my engineering brain could grab onto. The text is a little dated, when it comes to case studies, but everything is very applicable. The premise is that we constantly shape our emotions based on our thinking and that if you can challenge your thinking, you change the way you feel. I devoured this book and within a few weeks felts massively better. I now find that depression can start to creep back in, but I can right away use some tools to get myself right again.

Some will read this and think 'if this guy was fixed by a book, it could not have been 'real' depression'. What do you have to lose though, 1/2 weeks of trying something out and $20 on the price of the book.

Books and tapes can be insanely helpful with cognitive pattern adjustments.

So can others prodding us. We've forgotten the value of both of these.

It explains why "we" don't seek these things — and simultaneously let others take their place (ads, behavioural suggestions in media, etc).

100% positive. Even though outwardly I was a popular, social, active, easy-going kid/teen I suffered from constant anxiety and sometimes depression throughout my childhood and adolescence. (I wasn't aware of it at the time -- thought it was normal to feel that way.) I also would also often feel inexplicable dread about doing things I usually enjoyed, like music or sports. I would often make excuses to skip these things and stay home in bed... even though they were my hobbies and nobody was forcing me to do them.

Finally things came to a head around age 19-20 when I dropped out of university two years in a row due to depression/anxiety. I had no real problem with school -- but I would just get a month or so in and it would feel unbearable to even think about going to class or opening a book. And I liked school!

After the second time a doctor suggested I start on a small dose of escitalopram. Within a week I was more or less rid of the anxiety, and I think for me an overload of anxiety was what would put me into a depressive state. The biggest thing for me was gaining the ability to have some control over my thoughts. Prior to starting medication my internal monologue was basically just an uncontrollable, irrational, negative stream of consciousness. Since starting, by default I feel... "OK". Which is perfect -- they are not happy pills for me. I still feel negative emotions and I still have bad days but I am able to live my life!

I am still taking 5/10mg alternating daily 10 years later.

SSRIs feel like a forced mood lift. Like Coca Cola gives you a sugar high. It has that same artificial-chemical vibe, just inside your brain. You are aware you are less depressed, and it's not from you, that's about it. You reason and perform intellectual tasks at the same pace as before, just less ruminating and negative mood.

They also kill your sex drive and can cause some difficultly in the act of sex. This has few studies but needs more. It's unfortunately underexplored. For some people this is a feature and not a bug.

The come down from the artficial mood lift can be unpleasant, it doesn't take long to get used to, but it can be a source of moodiness if you're not aware of what the experience of coming down is like.

It won't sterilize or neuter your brain. Taking it is likely orders of magnitude better than not taking it. Not because SSRIs are a pancea, but because getting out of bed is so much better than staying inside all day and SSRIs might help.

30mg of Saffron (yes the spice) is a more pleasant mood lifter, even though it tastes quite bitter. It shares some qualities with SSRIs and other meds.

Being always-online can feed ritual and delusion just as much as it distracts you from them. The intellectual content on the internet eventually turns into theology if you go far enough with it. Prayer and faith can help see through rituals and delusions clearly.

The sex issue is disturbing. I found that the drug (now I don't even remember which one) didn't eliminate sex drive... it just made it nearly impossible to, ahem, complete the journey to satisfaction!

And given the long ramp-up/taper-down time with these things, it's not as if you can just lay off them on date night.

Yeah it would fit a little too well in a dystopian novel. I wouldn't be surprised if some of the benefit people see from SSRIs is no longer being distracted by sexual frustration, well outside of sex.

It's frankly irresponsible that the side effects are not mentioned upfront, psychiatrists and psychologists get away with too much individual judgement about what the patient should (or should not) know.

Sex hormones and stimulus need to make it to the brain to orgasm "right".

Receptor inhibitors will obviously inhibit receptors from receiving more than only "depression or anxiety related" signals.

Do the studies, but...seems like an easy win.

I have no experience with SSRIs.

I had a severe depression between 2007-2011. I used N-acetylcysteine and I benefitted a lot from it.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3044191/

Also consider a ketogenic diet. Currently I'm experimenting with it. So far I like it. Prepare for some extreme insomnia in the beginning. This should be getting better after a week. Should not be a problem in your case as you are already spending 22 hours in bed a day.

https://www.psychologytoday.com/us/blog/evolutionary-psychia...

https://www.psychologytoday.com/us/blog/advancing-psychiatry...

I got on 10 mg escitalopram (Lexapro) in 2014 for social anxiety disorder, generalized anxiety disorder, and depression. I just tapered off these last few months.

Pros:

* Legitimate reductions to anxiety - no longer crippling most of the time.

* Made it harder to fall into depressive episodes. So, it did its job, I guess.

* Did not make me a blunted zombie or sterilize my brain.

Cons:

* Increased sleepiness: unable to wake up at "normal" hours without significant effort, frequent urge to take naps during the day. I slept a lot over the past 8 years, more than I would have liked to. My sleep schedule normalized as soon as I quit.

* Extremely hard to quit, even with a taper. You have to take it really, really, really slow. I developed severe appetite loss and nausea as a withdrawal symptom and ended up losing 13-14 lbs and became underweight. I've only just now got it under control.

If you don't mind me asking, why did you decide to discontinue use? Do you feel like you're done needing it? Are you checking back in with your "natural" self to compare against the past 8 years? I assume the effects of the drug don't last after discontinuing use so your anxieties will theoretically return?

I was tired (literally) of the side effects, and I simply felt that I didn't need it anymore. I'm a different person than I was when I started, and I know how to manage my anxiety and depression a lot better now.

> I assume the effects of the drug don't last after discontinuing use so your anxieties will theoretically return?

Yeah, in theory, my anxiety could get much worse sometime in the next few months. I've dealt with that before when I discontinued a different SSRI. If it happens though, I'll be much more prepared this time.

Nothing.

I was put on them pretty young, along with a few other things. I don't remember much different in my day to day. I don't get why I was diagnosed with depression at the time, as I was an angry and ambitious kid, not a depressed one. It wouldn't be until years later I felt anything resembling depression and it certainly was much different than what I felt in my pre teen/teen years.

They did screw me out of some oppurtunities later on, which sucked at the time I guess, but it worked out well in the end.

Funny, I didn't learn about he nasty side effects till I was off them for years, And I would certainly prefer something else nowadays.

Let's imagine that for any desired outcome you can empirically derive a function of the form:

success ~= ability * effort * environment

Let's take your effective intelligence as your measure of success.

Then your ability is your innate capacity for intellectual activity, your effort is how you apply yourself in situations that require intellect, and your environment is everything else about your life, including your capacity for motivating yourself.

Taking properly prescribed psychiatric medicine will dramatically change the environment in which you are applying your intelligence.

If your environment is otherwise driving your effective intelligence down to zero, is there really a risk?

Had anxiety and depression from anxiety. Got lexapro and didn’t like how it felt. Switched to welbutrin, and it worked great to get off the couch and made anxiety about being late or not doing things way less. Still like an XL in winter months. Benzos felt like a magic bullet for anxiety, a little too good, you can see why they are addictive. But you sound like a good candidate for some short term temazepam or something. Anyway, after all this, saw a naturopath. Gave the rundown of everything, all my symptoms, why I tried, what those things helped or didn’t help with in a massive 3 hour interview. Ran a battery of blood and urine tests for a baseline. I was near the bottom but within the “acceptable range” of the bell curve. But then I remembered that are statistics are lies, bell curves say nothing about the individual, my naturopath agreed and got a tiny dose 25 microgram of levothyroxine and that was it, that was my life changing drug. Low thyroid is so often misdiagnosed in younger people. Sometimes a TSH or T3 level in the acceptable range does not mean it’s enough for you. The thyroid regulates all other hormone systems including the anxiety hormones and the confidence hormones such as testosterone. If I were you I’d get some short term benzos to give you the courage to see a naturopath and then inquire about your thyroid. It’s super common for your thyroid to be fucked up, and many environmental and genetic factors can affect it. There’s even autoimmune things. If you have allergies and the like, it’s almost certain your body will eventually try to eat it’s own thyroid. Seriously, check it out.

I have experience with SSRIs, and then going through other methods (which take much, much longer and more work).

SSRIs are basically a shortcut to a good mood, and no, they won't make you "dumber", but the personal reason I got off them is basically the lingering thought of getting used to them and for some reason being in a situation where I couldn't get medication, and being absolutely fucked mentally (reading up on people with benzo withdrawal didn't help).

The other methods, which involved a big shroom trip and all the shit I had to do afterward to basically essentially become a new person are much harder to execute. For example, even for the shroom trip, you need a VERY good trip sitter that is a good, qualified therapist that can lead you on a journey of introspection but also understand how shrooms work through personal experience - I was lucky to have this type of person with me during my trip.

Id say try SSRIs, but plan the taper on (and taper off if you decide to stop) periods so that you don't have anything going on. If anything, you can use the period while you are on them to essentially progress in life (get a job, then save money as much as you can), then if you decide to taper off, you have some safety net funds to live off of where you can explore other methods.

I have been taking 10mg Lexapro for the past 4ish years for OCD. Has been working great with minimal side effects. I don't know if I'm less smart, but I don't care if I am, I'm able to enjoy life more.

I was very scared to start the medicine, and I wish I would have started sooner in my life. I was scared enough that when I finally dove in, I would cut the 5mg pills in half so that I would ramp up from 2.5mg.

You should lay outside in direct sunlight few days a week, run/lift weights, go on walks in nature.

Physical exertion, vitamin D and testosterone from sunlight and exerting your breathing and cardiovascular system from running will in aggregate improve your mood and energy levels orders of magnitude better than they are now likely better than drugs will do as well without negative side effects, especially cognitive.

Start with walks and sunlight...

Give this a read about serotonin [1] very interesting point of view describing excess serotonin as an energy and metabolic inhibitor, depression inducing, harm-avoidance, hibernation chemical. SSRIs seem like a bad idea in this context. Whereas dopamine as the action chemical. Reduced light is associated with elevated serotonin and depression. You need to get out in sunlight daily off possible.

http://raypeat.com/articles/articles/serotonin-disease-aging...

To set the stage.. except the bathing and teeth thing, I'm you, just 10 years older. I didn't want the medicine. I did therapy, worked out, ran a bunch, I look like I go to the gym, I don't smoke or drink, all of the typical stuff you read as alternatives. I have 2 kids, solid marriage, CEO of a company, loving parents, no issues outside of my own head.

But my life has been out of control for years.

I started 20mg escitalopram three months ago and it changed my life. I'm no longer scared of leaving my house. I'm more focused and get tasks done quickly. A lot of my lockup moments in business and life was over analyzing everything endlessly which I was told a OCD based anxiety. Now making decisions is a quick process. My kids don't have to worry that I'm not joining them in fun on the weekends. I'm not chronically tired. I don't feel grey, or zombie, or anything else you may have read. I feel me again.

Try it. Take it for 60 days and see. You can always get off of it.

How did you find the first month? I’m terrified of starting as I’ve read that the side effects can render you unable to do anything for weeks.

If you're going to go off of them, do it right by tapering. Do not do like I did with sertraline and just go cold turkey. The payment for that was 5+ years of "brain zaps" or hypnagogic hallucinations, the sensation of an explosion or electrocution occurring at the exact moment I am about to enter sleep.

I still occasionally get them. Do not recommend.

My experience is actually rather good after 10 years. The 2 years I stopped it (fluoxetine) meant symptoms returned and quality of life declined hard.

It takes the edge away (no significant happiness/motivational boost for me). My intellect definitely has been damaged but it's impossible for me to ascribe it to any one factor.

That said without it the anxiety/panic would return and I don't know if I could take that anymore.

BTW for a time I also tried some of the harder stuff like high dose fluoxetine plus aripiprazole+biperiden (for the extrapyramidal side effects) and that does mess you up.

Also, cannabis gave me a good boost for a bit over a year (under fluoxetine). Almost normal productivity, but with a whiff of artificiality. Not a long term solution for me though. Guess it'll stay this intermediate way for now (and ever?).

It can cause permanent orgasm dysfunction and might also cause "compulsive" behaviors like pacing (SSRIs affect the extrapyramidal system). Repeat: these side effects may continue forever, even after you get off the medications. Same deal with SNRIs. Also most psychiatric drugs increase the risk of suicide.

Psychiatrists like downplaying these side effects, so if you ask one about them, you'll leave with a feeling that it's "no big deal." This feeling is artificially induced and is the result of emotional manipulation.

You might be suffering from bottled up emotional trauma. Find a good therapist. But whatever you do, demand that the therapist not use cognitive behavioral therapy. CBT is how people with narcissistic personality disorder think.

> CBT is how people with narcissistic personality disorder think.

Can you elaborate more on this, or do you have any sources to support this claim? I have no read/heard this before, and I would like to learn more about it before coming to a conclusion about CBT.

I'm glad you're seeking help! Taking medication of almost any kind is a scary proposition nowadays.

I have taken many different SSRIs and SNRIs since when Prozac was released in the US. I'm not going to say they are without side effects, but I can honestly say they haven't affected my brain, with the exception of helping me feel like getting up in the morning and being productive.

I wish you the best and hope that all goes well. You might also want to consider cognitive behavioral therapy if it's available where you are. I found that really helpful, especially when it comes to my predilection for "catastrophizing". And it could help you decrease your escitalopram dose.

I'm not a doctor, and neither are 99.9% of people on HN, so I'm not going to give you advice on SSRIs.

However, I was (...am) depressed, and I have ADHD. I have been medicated for the latter since I was in middle school. I prefer to work through the former myself.

While I've gone places and I've done cool things, part of me feels like it's the meds, not me. I struggle with that every day. I can do basic things off my meds. But my job? Hell no.

I say this for two reasons. First: meds aren't going to flip a switch and make you happy and perfect. Second: the worst thing I deal with on a daily basis is impostor syndrome. Given my family history, that's pretty damn good.

You owe it to yourself to try helping yourself. You deserve it.

You do have other options such as therapy. I would recommend going that route if you can. If you can't, or that doesn't work, medication can be a good way to dig you out of this situation.

It sounds like your situation is bad enough to warrant some risks.

I did see a counselor for about 6 months, and I was kicked out in June, as they believed I required a higher level of care, such as an intensive outpatient program and/or an SSRI.

I've attempted to read books on OCD. I've attempted Exposure-Response Prevention on my own with limited success. I reach a wall. I don't want to experience the seemingly endless stress that I'd endure from the most significant exposures and I shutdown.

Keep trying things. You can beat this and find out the solution that works for you.

Stay away from them, sent me off the rails, got me into trouble, made me even more vulnerable to exploitative people as if we dont have enough of that in our lives anyway from authority figures, family & friends, ruined my life.

Its bad enough the internet is being used as one big phishing device, but what else would you expect from various Govt's with the collusion of big businesses and various employees! These people are blinded by their righteousness, just like religions who invented the ultimate psychological warfare program called GOD, thousands of years ago.

I would say before resorting to exogenous chemicals, try working out. Weightlifting changed my life. Maybe it will help you, maybe not, but there seems to be a habit to treat symptoms rather than address underlying causes.

If the poster can't get out of bed to take a shower, they are unlikely to be able to work out... they may need some medication before they have the energy to do something like that. Not that it's a bad idea.

I don't have anything negative to say about escitalopram at all (it helps me, no drawbacks for me) but I do want to point out that 20mg is not the recommended starting dose.

My insurance potentially would not cover 10mg, so I'd split the 20mg tablets to 10mg per day for the first week, I suppose.

SSRIs don't seem to treat OCD at low doses, so they want me to take 20mg from the beginning.

If someone is very nervous about the Rx, they can be started at 5 mg to minimize potential side effects.

I had severe social phobia, generalized anxiety, and OCD growing up. After some time switching medications I started on citalopram (escitalopram is the reverse isomer and closely related) in my late teens. It changed my life massively for the better. I've dropped it from time to time, but have been on 20mg again since the pandemic.

Sexual side effects are common, and for me disappear after approximately three months. Drowsiness is also common, which is why I'm no longer on 40mg.

20mg is a high starting dose. I’m on 10mg for anxiety (and maybe depression) and it has worked very well. The first few weeks were fairly physically bad but since then I have noticed minimal side effects. It sounds like you are a “zombie” right now. I haven’t noticed any mental decline and my motivation is much better since Im not stuck in anxiety loops. I’ve gone back to the gym, use less recreational drugs and get more done (important as a dad) since going on them.

You may want to look into the resources available at amenclinics.com. Research and evidence-based advances in psychiatry over the years with FDA-approved SPECT and PET scans that show what is occurring in the brain or if there is evidence of TBI along with the evidence of brain-gut health connection may offer you a different perspective and treatment direction. This is a lot different than a 20 minute consult for a prescription.

If you’re really that incapacitated (4 years in bed?), why are you afraid of what drugs might do to you? You should be doing anything possible to return to society.

Escitalopram for anxiety works quite well, you should continue with it, mostly along with Therapy to create productive coping mechanisms against anxiety.

Totally depends on the person, I’ve tried literally every SSRI and they all make my condition worse, but for my girlfriend they have radically changed her life in a positive way.

What ultimately works best for me is the Keto diet. I would recommend you just try a bunch of different things with professional supervision. There is little harm in it and there is probably some modality that will help you.

pluses and minuses for me. Went on Sertraline (zoloft) for a couple years for anxiety issues. I had some weight gain and sexual side effects, but nothing too unmanageable. Getting on was rough for me with lots of side effects for 6-8 weeks. Once on and past side effects from external comments I seemed much less anxious. I guess I was. The anxious inner chatter was less. But, somehow, and this is ultimately why I tapered off, I was just more complacent. I let things slide which I shouldn’t have. I didn’t really see how many until I was back off. My anxious inner chatter and I are a bit better friends since the temporary banishment anyway so I don’t regret the experiment. At one point I added brupropion to try to help with some of the sexual side effects, but ended up with a tinnitus problem that took ~6 months after cessation to fully resolve. Brains are funny things. Good luck tweaking yours!

I would warn you against taking the responses that you read on here (including this one) as an objective sample -- HN is not representative of the broader world, and (just like with product reviews) your sample may be biased towards people who either LOVE them or HATE them (and are thus motivated to comment).

However, I can tell you some references that helped me become much less stressed about SSRIs and their friends, and indeed if they were indicated by a doctor I would now take them much more readily.

Scott Alexander (pen name) is a psychiatrist (MD) and all-around smart due who writes extensively about the medical system, medicine for mental health, and the challenges these systems create. He has an excellent series of blog posts which review the data :

https://slatestarcodex.com/2014/07/07/ssris-much-more-than-y...

https://slatestarcodex.com/2018/11/07/ssris-an-update/

It's scary to take drugs which alter your mental state. I don't drink and have never done any sort of recreational drug for this reason. But Scott helped convince me that both it was both possible that SSRIs would help me and unlikely that they would cause long-term damage.

Changed my life. Therapy helps but it doesn’t help with the physical anxiety symptoms like muscle tensions, stomach issues, etc. Therapy is good for CBT but ONLY after you find the therapist you jive with. If you don’t connect with your therapist then everything is much less effective.

No personal experience with SSRIs.

But if I were in your shoes I'd first take shrooms in the woods and if that didn't help, try one of those newfangled Ketamine therapies they've been doing as an alternative to SSRIs to treat depression.

Go brush your teeth, get a Sonicare, it's epic.

Gave me the runs something fierce. Turns out I didn't need drugs, just an occasional lay.

I took 10mg of escitalopram during 2 months for anxiety, depression and suicidal thoughts. It had no effects. I'm currently on week 3 of 50mg of sertraline. I didn't notice any change yet.

Makes me happy but destroys my sleep. I'm currently taking Sertraline. I've tried other SSRI's but teh same thing happens. Terrible broken sleep

For all the commenters mentioning sex issues with SSRIs, ask your doctor about Vortioxetine (Brintellix).

Have you considered psychedelics at all? Changed my life you do not need dependence on it like SSRIs.

Try LSD or mushrooms. Will change your mind.

Try a Ghost Pipe tincture.

for me (depression) they had no effect at all

I'm happy to describe my experiences with SSRIs, but to be frank, I think I need to address some of what you describe about yourself in your post first. I am not a mental health professional or a healthcare provider, but I deeply empathize with the sense you express that your brain is "all you have."

I also want to tell you that it's a lie. You don't have your brain right now. A well-operating brain does not typically do the things your brain is doing. Maybe by your "brain" you mean your intellect and your insight into your situation, which you fortunately do have - but I can assure you that SSRIs are not going to diminish this, in fact, they're likely to do the opposite.

I take 10mg of citalopram and 60mg of buspirone daily. Eventually, I plan to switch that up and take 20mg of citalopram, dropping the buspirone.* Like you, I was incredibly nervous about starting them. I tried duloxetine (couldn't stomach it, literally) and bupropion (too anxiety-inducing, though it had a nice stimulating effect) before trying my current blend. Each medication brought with it fears along similar lines to yours: sexual side effects, losing my intellect, blunting my emotions, losing my sense of self/continuity. Here's what actually happened:

About a month after I started on citalopram, I encountered a situation which would commonly provoke a panic attack... and it didn't come. I knew that I should feel anxious, that I had felt that way in the past in these situations, and indeed, I was worried - but only in a normal way, "hmm, this could be a problem." Not the shaking and fast breathing and inability to think about anything else that panic attacks bring. It was a fascinating, slightly disassociative sensation, to know that by all the rules of my own brain that I was used to, I ought to be feeling awful, and instead I felt okay. Not happy, not unconcerned, but rational, functional, so, okay. I don't feel artificially happy because I'm still not happy. I'm just able to deal with my problems.

This continues to be my experience. I still have panic attacks sometimes. I'm still an anxious person. But there are lots of situations now where rather than feeling intensely anxious, I now just feel a normal amount of concern. Like a normal person would. I'm still me. I'm as sharp (or dull) as ever. It's just the panic that is missing, and I don't feel any lesser for it.

I have experienced side effects: Buspirone makes me very dizzy, and hungover if I miss a dose, so I take it just before bed. Citalopram makes me more activated/awake, so I take it in the morning. Some people feel the opposite, or nothing. I have had sexual side effects as well. They were moderately unpleasant, but they went away after a few months and now I am normal again. (I'm confident I didn't just get used to them and mistake them for normal, because I no longer have problems I temporarily had.)

Getting on and tapering off these drugs is a pain in the ass. (Start slowly. Do not start with the full 20mg, you won't feel good.) And it is true that there is an extremely small non-zero chance that you could be permanently altered in some way - sexual or otherwise - by trying one. But I would view that as an extraordinarily unlikely occurrence - you are almost certainly not that unlucky, because almost nobody is. I would recommend giving them a try.

A resource I found very helpful was Lorien Psychology's SSRI article: https://lorienpsych.com/2020/10/25/ssris/. This is by Scott Alexander, the same person who writes Slate Star Codex, but is more recent work. There are lots of things Alexander writes and believes that I don't agree with, but he is a licensed psychiatrist and I find his approach helpful.

I also want to say that I think from your description you may need more help than what any med or combination of meds can provide. You should devote the energy you have to finding a good therapist that you can trust. This is much harder than it should be and probably merits its own Ask HN/discussion, but once you have one, you will have a much easier time making these decisions with their help. I recommend regular talk therapy, too - whether with your psychiatrist or a separate provider. SSRIs work best when they are not the only treatment you're trying.

*(Note that buspirone is not an SSRI, which is why I only address it tangentially. I'm getting rid of it because its benefit is pretty marginal compared to citalopram, and I feel disproportionately bad if I miss a dose. It's a great "gateway drug" to SSRIs though, if you want to try it. My side effects are unfortunate but very very rare.)