What this Medicine is and What it is Used For

Biomedical Construction of SSRIs

Western medical science understands SSRIs through a neurochemical lens, framing them as precise correctives for serotonin dysregulation. The dominant narrative positions these drugs as inhibitors of serotonin reuptake, a mechanism believed to amplify neurotransmitter activity in synaptic clefts, thereby alleviating symptoms of depression and anxiety. This perspective emerged from mid-20th century monoamine theories, which linked depression to deficits in serotonin and norepinephrine, a hypothesis reinforced by post-mortem studies showing altered serotonin metabolites in depressed individuals.

The clinical application of SSRIs extends beyond depression to include anxiety disorders, PTSD, and OCD, reflecting an expanding diagnostic terrain where serotonin dysregulation is implicated. Meta-analyses of randomized controlled trials assert their efficacy, citing statistically significant improvements on standardized scales like the Hamilton Depression Rating Scale. Yet these claims are tempered by modest effect sizes and high discontinuation rates, with half of users abandoning treatment within six months due to intolerable side effects or perceived ineffectiveness.

Clinical trials, side effects, psychopathology scales, efficacy and implementations rates constitute the core understanding of what SSRI antidepressants are and how they are understood and “listened to” by western medical sciences. However, the low adherence rates and controversies surrounding the strong role of SSRIs in the mental health clinic points at complex realities beyond biomedical understanding. The serotonin hypothesis, once a cornerstone of psychopharmacology, now faces scrutiny for its lack of direct evidence correlating serotonin levels with mood disorders. Alternative frameworks, such as neuroplasticity or the gut-brain axis, challenge the view of depression as a chemical imbalance, proposing instead that SSRIs may work through broader systemic changes, like promoting neural growth or altering gut microbiota.

The Erasure of Lived Experience

At 17, in 2012, it never occurred to me that I had a role in describing my experiences in the leaflet, or if anyone even reads these leaflets beyond those feeling adventurous. The leaflet felt distant and scientific, filled with numbers and technical terms. My lived experiences were far from the statistical descriptions and recommendations in the leaflet. The quantified experiences from clinical trials, coupled with medical staff reports of patient side effects, were translated from distant sources in faraway lands into a single leaflet. The leaflet presented a universal subject of SSRI antidepressants as prescribed by pharmaceutical companies. The problem arose when I couldn't recognize myself in that description.”

Autoethnographic Diary, 19 May 2025

The realities described by pharmaceutical leaflets, universal, statistical, scientific, are often disconnected from the experiences unfolding at “the level of flesh and bone.” The pharmaceutical leaflet, intended as a universal guide to the SSRIs user, felt far different to the realities I was experiencing in my own. For me, changes in sleep, appetite, emotion, sexuality, productivity, and sense of self, amongst others, redefined how I conceived antidepressants. Pharmaceuticals are not simply inert objects awaiting clinical deployment; rather, their effects and meanings are produced through a choreography of bodies, infrastructures, institutions, and narratives (Hardon & Sanabria, 2017; Sismondo & Greene, 2015).

Biomedical discourse often sidelines the messy realities of SSRI use. Clinical trials, designed to isolate drug effects from confounding variables, strip away the social and embodied contexts of medication, the "ecologies" surrounding the consumption of the SSRI antidepressants.

What gets lost are the paradoxical changes reported by users: the sharpening of focus alongside emotional detachment, the relief from suicidal thoughts paired with a dulled capacity for joy. These contradictions resist the tidy binaries of "effective" or "ineffective" proposed by the historical process of quantification of mental health.

Digital Ethnographies and Autoethnography: Methodology

Following how Western medical sciences “listen” and understand (prominently through measurements, scales, databases…) what SSRI antidepressants are, I propose following people with lived experience in SSRI antidepressants to further understand how they “listen” and understand this medication. The participants become their own ethnographers and fellow colleagues in this process where we aim to exchange ideas on what SSRI antidepressants are for us.

The research employed digital ethnography to document SSRI use as a lived, relational practice. Over twelve months, interactions in Discord mental health communities revealed how users navigate medication in everyday life. These spaces, moderated by peers rather than clinicians, allowed for uncensored discussions of tapering strategies, self-experimentation with doses, and the stigma of "needing pills." Unlike clinical trials, which isolate drug effects, this approach captured the entanglement of SSRIs with work, relationships, and self-perception. My methodology constitutes a process of inquire on SSRI antidepressants ontologies for those people experiencing these drugs themselves, including how they reached those understandings.

Semi-structured interviews deepened these insights, inviting participants to narrate their medication journeys beyond symptom checklists. Questions like, "How did your sense of self change?" elicited stories of trade-offs. These narratives contradicted the linear progress plots of RCTs, instead depicting health as a contested, evolving negotiation.

Autoethnographic reflections further contextualized the picture. The researcher’s own experience with fluoxetine, providing my own intimate understanding through first person experiences and detailed descriptions bridged the analytic and the personal. This duality mirrored participants’ insights and allowed for detailed everyday embodied reflections.

Ethical Considerations in Digital Fieldwork

Digital ethnography in mental health, conducted exclusively in online spaces, involves particularly profound ethical stakes. The consumption of antidepressants constitutes highly sensitive information, situating my participant-ethnographers within recognized vulnerable populations.

My ethical approach adhered to the Association of Internet Researchers (AoIR) guidelines for internet research ethics, which provide nuanced frameworks for respecting participant autonomy and contextual sensitivities (Markham & Buchanan, 2012).

Ethical approval was granted by the University of Warwick Humanities and Social Sciences Research Ethics Committee (HSSREC 51/23-24). Stringent ethical protocols were implemented: all interviewees received detailed information sheets and provided explicit written consent, with the option to withdraw at any time without repercussions.

My status as a researcher focusing on antidepressant experiences was communicated transparently across Discord profiles, introductory posts, and direct communications with server administrators and participants. In passive observation of publicly accessible channels, no identifiable data, verbatim quotes, or usernames were collected; only anonymized thematic and contextual notes were recorded to minimize disruption and uphold privacy.

Amid rising “researcher fatigue” among online communities, I grounded every engagement in respect, patience, and abstention from intrusive practices. Some servers explicitly prohibited research participation citing past negative experiences, a boundary that was respected without contest. This ethical stance reflects the imperative of fostering trust and minimizing potential harm while conducting research within digitally mediated, vulnerable populations (Markham & Buchanan, 2012; Thompson et al., 2021).