Inner Compass Initiative

🧵 In case you missed it: Finally, researchers are calling for more work on the sexual effects of antidepressants after the drugs are stopped. Published earlier this year, a review of trials comparing SSRIs with placebo found that roughly one in three people on an SSRI had orgasm problems, compared with about one in ten on placebo. That finding matters because orgasm problems have never been part of the formal criteria used to diagnose depression. Reduced interest in sex can sit inside the broader sense of loss of interest or pleasure, but loss of or difficulty reaching orgasm itself has never been listed as a diagnostic feature. Overall questionnaire scores often failed to pick up the difference that showed up when orgasm and satisfaction were examined on their own. A single total number, or a general question about sex, can therefore leave the specific problem unrecorded — both in trials and in ordinary care. Most of the trials ran only about eight weeks. The authors note that longer follow-up is still needed, including on what happens after the drugs are stopped. 1/3

More people than ever are looking beyond the existing mental health industry. And that means, for our next conference, you’ll find new faces, new thinking, and new ways of working that don’t start and end inside the usual clinical frames. One of those new faces is Sam Fuesy — here’s a little more about her and what you can look forward to from her talk. You can join her January 26–28, 2027 in Boston — link below to get your tickets now.

Are you supporting a loved one who’s tapering psychiatric drugs and moving on from the mental health industry? If so, our live session tomorrow (November 4) with Yael Abramson is just for you. It’s part of our new Family Support and Learning Community in our mutual aid platform, Inner Compass Exchange. As a young adult, Yael went through five episodes of psychosis and 15 years of suicidal ideation, with repeated hospitalizations. She faced severe trauma and loss and, like so many, was told she would need psychiatric drugs for the rest of her life. Instead, she found her own way off them and, through a different understanding of these experiences, to a place of peace of mind and freedom. Now, as a mentor, she is passing on all she’s learned so you can walk alongside your loved one with clearer understanding and steadier support. You can join the session via the link in below.

As our founder, @LauraDelano, often says, there is an information crisis around psychiatric drugs. Too many people lack the full information they need to make meaningful choices about starting, continuing, or stopping them. There’s another gap, too: the knowledge and experience of people who have been through the psychiatric system are routinely left out of the conversation. With Laura’s appointment as senior policy adviser at the U.S. Department of Health and Human Services, we hope to see real change: safer prescribing and deprescribing, and meaningful informed choice for everyone, whether or not they want to come off psychiatric drugs. ICI remains independent and nonpartisan. The people we serve come from all walks of life, across political, cultural, and personal backgrounds. Access to comprehensive, unbiased information matters to all of us. Read the article via the link in comments (free subscription required).

Families need support, too. Our new Family Support and Learning Community on Exchange brings together people supporting a loved one through psychiatric drug tapering and withdrawal. We meet on live video calls every other week to ask questions, share experiences, and learn from one another. A private discussion space keeps those conversations going between calls. Together, we’ll explore what it means to support someone through distress beyond a medicalized understanding of what they’re going through. Membership also includes full access to our step-by-step Taper Companion Guide and an archive of Exchange livestream recordings. We’d love to have you join us. Details via the link below.

“The control I wanted over my depression was not in stifling it to a point of nonexistence but an acceptance that it would need tending to, as long as I live.” New for Inner Compass Insight by Chandler Shea Wilson: growing up with unspoken emotional struggles, the routines and relationships that shaped how she learned to carry them, and what it means to accept that those struggles can exist alongside a life you still want to live. See link below to read the new Substack.

Ever tried to stop an antidepressant such as an SSRI or SNRI (or other psychiatric drug) and found reductions harder as you approach zero? For example, you’re tapering Effexor and found little difference when you reduced it from 225mg to 150mg. But later, you tried to drop from 75mg to 37.5mg and felt worse (and in different ways) than before you started the Effexor? You’re not imagining it. Brain imaging studies show that the effect of these drugs on the brain is not linear — it’s hyperbolic. At higher doses, much of the drug’s effect is already in place, so a larger reduction may change relatively little. But much smaller doses have a substantial effect, which means even modest cuts can have a dramatically larger impact on the brain as you get closer to zero. That’s where hyperbolic tapering can help reduce the risk of withdrawal: as your overall dose gets progressively smaller, the amount you cut each time gets progressively smaller as well. Our founder Laura Delano (@LauraDelano) touches on this in her recent conversation with Blake Mycoskie (@BlakeMycoskie) on No Magic Pill. See link below to watch the full episode.

ICYMI: Heartbreak. Grief. Loneliness. Homesickness. Shame. Exhaustion. First love gone wrong. The particular despair that follows betrayal. The long stretch of not knowing who you are yet. None of these are simple and none of them are binary. The existing mental health industry still reduces them to cold, clinical terms — depression, anxiety, a disorder, an episode — as if the right label could stand in for the life underneath it. That is the problem Dilvin Yasa touches on in Marie Claire Australia: lean far enough into blanket labels and you stop getting to know yourself as a person. Psychiatrist Suzanne Garfinkle-Crowell, quoted in the same piece, puts the translation work back where it belongs. If someone says they “have depression,” they may be saying they are sad, lonely, in despair. What words or phrases would more accurately name the difficulties that first led you to a psychiatric diagnosis? You can read the article via the link below.

ICYMI: For years, people tapering psychiatric drugs have described a “windows and waves” pattern of withdrawal: a crash after a dose cut, then a stretch of settling if the dose is held. Clinicians have often interpreted that crash as the original condition returning, but a new study followed people through a six-month antidepressant taper and found exactly the same wave pattern. Led by Michael Hengartner (@HengartnerMP) with Mark Horowitz (@markhoro), the research found people tapering reported their mood dropped after each reduction, then eased when the dose stayed put—even at very low doses. Notably, the mood changes were aligned with physical complaints. Once those physical complaints were taken into account, the rise in depression scores was no longer significant. That will not surprise you if you have lived it, but the research is still worth reading. You can find coverage of it including a link to the original paper via the link below.