Reply To: Video: Psychiatrist Claims SSRIs Reduce Empathy, Sensitivity, & Passion in Women

  • Gary Goldberg

    January 3, 2023 at 4:49 pm

    It is important to put this video into an appropriate neuropsychopharmacological context with respect to the operation of the very important, massive, and complex serotonin system of the brain which includes multiple subsystems based on a variety of different serotonin receptor subtypes. One important hypothesis relates to a division of serotonin action into two major subsystems based on 5HT1A and 5HT2A serotonin receptors and is developed in this paper by cognitive neuroscientists, Robin Carhart-Harris and David Nutt…

    …which associates the 5HT1A system with passive adaptation to stress, mostly through the generation and experience of anxiety and discomfort, and 5HT2A system with active adaptation to stress, which involves a more radical approach to the underlying problem, in terms of a fundamental shift in ‘priors.’ Consistent Carhart-Harris and Friston in their REBUS hypothesis ( RElaxed Beliefs Under pSychedelics; See: )

    The SSRI agents are active in BLOCKING the 5HT1A system by blocking these receptors, while the psychedelic agents such as LSD and psilocybin are active in FACILITATING the 5HT2A system by activating these serotoninergic receptors.

    So, this all makes a good deal of sense if we recognize that the blocking of the anxiety and discomfort associated with passive adaptation to stress by the SSRIs is to basically boost the ‘I don’t give a f*ck’ euphoric attitude through anxiolysis, which is consistent with a general ‘toning down’ of the emotional responses of passive adaptation to stress, both their important beneficial and unhelpful aspects. Which can be helpful up to a point, but which clearly has a huge down side, which relates to a general blunting of emotional response and a diminishment of a stimulus to creative thought as well as the capacity for enjoyment that depends on affective activation (like, for example, achieving an orgasm, or generating a piece of art). Leonard Cohen has a great little poem called ‘Grateful’ in the book ‘The Flame’ which is a very nice description of the superficial pleasantness of the experience of being on an SSRI and not experiencing the anxiety and emotional activation that would otherwise be appropriate.

    The problem with SSRIs in blunting anxiety is when the anxiety is an appropriate indicator of significant maladaptation to one’s circumstances. So while one may be anxious and spiraling down for an appropriate reason, the SSRI blocks that signal. In which case what one needs to do is to move toward an ‘active approach’ to adaptation, which involves a fundamental change in one’s ‘priors’ or basic beliefs about how things operate. Which is the process that is facilitated through the appropriate and carefully managed therapeutic use of psychedelic agents.