A Psychoanalytic Hypothesis Concerning the Therapeutic Action of SSRI Medications

Psychoanalysis yet to fulfill the promise that its theory and unique form of listening would contribute to our understanding of some effects of psychotropic medications. Analysts are said to listen to their patients as do no other students of mind/brain, yet we have offered no interpretation of the therapeutic benefits of highly effective SSRI (selective serotonin reuptake inhibitor) medications.

One confounding factor has been that the SSRIs challenge traditional diagnostic schemes. They bring about improvement in disorders that were not previously thought to be related to each other, such as depression, obsessive-compulsive disorder, and social anxiety. The successes of medications across diagnostic categories suggest unrecognized commonalities among them. Taken together with certain readily observed clinical phenomena (see below), these facts suggest that the essential benefits of these medications derive from their capacity to modify aggression.

Few clinicians can have failed to note the repeated reports of successfully medicated depressives to the effect that “I am no longer angry in the way I used to be.” The details vary, but these reports are consistent around the theme of the patient's being less inclined toward rages, less irritable. Events that in the past might have provoked fury are now merely irritating: “They roll off me.” Some people do not spontaneously volunteer these reports, but they will speak of the change if asked. From others one might only hear, “My friends say I'm easier to get along with.” And most evident of all is a less hurtful attitude toward the self.