What’s the Harm in Taking an Antidepressant?


We know that all drugs have side effects. That’s just part of the deal right? But is it really possible that an antidepressant can cause a sane person to act like a cold-blooded criminal?

I imagined my audience would be wondering as much as I arrived to an unseasonably chilly day at King’s College in London. I was there to share what I have learned about the medications that I so dutifully and faithfully prescribed during the early part of my career, and also about the deep potential for healing depression in simple, safe ways, according to the latest science.

The day before my flight, I had received an email from a man who I would choose to invite on stage with me that day. His name is David Carmichael and he wrote:

“I took the life of my 11-year-old son Ian on July 31, 2004 in a Paxil-induced state of psychosis and was charged with first degree murder. I was judged to be “not criminally responsible on account of a mental disorder” in September 2005 and received an absolute discharge from the forensic psychiatric system (in Ontario, Canada) in December 2009. I’ve been off all prescription drugs since September 2010. Prior to our family tragedy, I was a physical active sports consultant with no history of violence or mental illness.”

He told an audience of clinicians and patients, that day, about how it is that a normal citizen, prescribed a seemingly safe medication for work-related stress, goes on to commit a heinous act of violence against his beloved child. This academic classroom was heaving with grief when he finished his description of events.

This must be rare, right? Totally anomalous?


It has become my contention that the Russian Roulette that is played with each new prescription of psychotropic medication violates the physician’s most primal tenet – first do no harm – and does so in the absence of anything approximating informed consent.

Violence as a Side Effect?

Thankfully, we are often given multiple chances to wake up to a greater truth. It’s becoming easier than ever. With grassroots platforms like madinamerica.com, the information is out there, when you are ready to look beyond main stream media to what the real victims are claiming.

The truth about antidepressants and violence is also in the most recently published literature, including a critical review, hot off the press, by Carvalho et al where the authors dive into the research on the supposed safety of SSRIs and SNRIs. In this document, they present an evidence-based horror menagerie of ways in which a simple antidepressant can derail your life if it doesn’t take it. Leaving patients with new medical diagnoses, antidepressants prescribed often for difficult transitions in life like divorces and deaths, carry documented risks that your doctor cannot possibly tell you about because if they knew of them, they would put down their prescription pad immediately.

Let’s take a tour. Neatly summarized here, the adverse effects of antidepressants can sound like that droning voice in TV ads that we are inured to because we have been told these “side effects are rare, and outweighed by the benefits.”

But the benefits are shockingly limited so, let’s take a closer look at those side effects…

The Risks That Made Me Quit Prescribing

Having always represented antidepressants as safe and effective to my patients, I put down my prescription pad after learning 3 facts about psychiatric medications:

  • They result in worse long-term outcomes [1]
  • They are debilitatingly habit forming [2] [3] [4]
  • They cause unpredictable violence [5] [6]

These insights were apparently just the tip of the iceberg. Several years into the horror stories of patient experiences and new relationships with grassroots activists, I am left wondering. What on earth are these meds? How could biochemistry have ever manifested molecules capable of derailing, distorting, and suppressing the human experience to this extent?

With more unknowns than knowns at this point, the signal of harm is growing and patient alignment with this model of care, diminishing.

I pulled some choice phrases from the paper for your further enlightenment below but suffice it to say that many of these side effects are major gamechanging problems if not life-ending tragedies that render the placebo-level performance of these medications totally unacceptable.

Gut disturbance:

“Some of the most frequently reported side effects associated with the use of SSRIs and serotonin noradrenaline reuptake inhibitors (SNRIs) include nausea, diarrhea, dyspepsia, GI bleeding and abdominal pain.”

Liver toxicity:

“Two main mechanisms may be involved in antidepressant- induced liver toxicity, namely a metabolic component and/or an immuno-allergic pathway. A hypersensitivity syndrome with fever and rash as clinical manifestations, as well as with autoantibodies and eosinophilia, and a short latency period (1–6 weeks) point to a predominantly immunoallergic pathophysiological mechanism, whereas a lack of hypersensitivity syndrome and a longer latency period (i.e. 1 month to 1 year) points to an idiosyncratic metabolic mechanism.”

Weight gain:

“Notwithstanding the complexity of the clinical scenario, compelling evidence indicates that the use of most antidepressants may increase weight in a significant proportion of patients.”

Heart problems:

“SSRIs and SNRIs may promote a decrement in heart rate variability (HRV). Although the impact of the effects of antidepressants on HRV remains to be established, data indicate that a lower HRV is a significant predictor of incident cardiovascular events.”

Urinary problems:

“SSRIs can cause urinary retention by acting on central micturition pathways. Serotonin may increase the central sympathetic outflow leading to urinary storage, and at the same time inhibits parasympathetic flow, which affects voiding.”

Sexual dysfunction:

“…a significant body of data shows that antidepressants may differentially affect sexual function in multiple aspects, leading to reductions in libido, arousal dysfunction (erection in males and vaginal lubrication in females) and orgasmic dysfunctions.”

Salt imbalance:

“The mechanisms of SSRI-induced hyponatremia remain incompletely elucidated, but these agents can act by either increasing the release of antidiuretic hormone (ADH) or increasing the sensitivity to ADH resulting in a clinical picture similar to the syndrome of inappropriate secretion of ADH.”

Osteoporosis/Bone weakening:

“The use of SSRIs has been associated with a reduction in bone mineral density (BMD) and a consistent higher risk of fractures.”


“All serotonergic antidepressants have been associated with an increased risk of bleeding. The most likely mechanism responsible for these adverse reactions is a reduction of serotonin reuptake by platelets, although other mechanisms have also been implicated.”

Nervous system dysfunction:

“All kinds of EPS [extrapyramidal symptoms] are seen in patients taking antidepressants, but akathisia appears to be the most common presentation followed by dystonic reactions, parkinsonian movements and tardive dyskinesia…Headache was one of the most common side effects associated with the use of antidepressants in a large retrospective cohort of adolescents and adults.”


“Most studies indicate that approximately 10% of patients on SSRIs may develop excessive sweating, although the incidence may be higher for paroxetine.”

Sleep disturbances:

“The SSRIs and venlafaxine are associated with increased REM sleep latency and a reduction in the overall time spent in the REM phase while sleeping.”

Mood changes:

“Many patients taking SSRIs have reported experiencing emotional blunting. They often describe their emotions as being ‘damped down’ or ‘toned down’, while some patients refer to a feeling of being in ‘limbo’ and just ‘not caring’ about issues that were significant to them before…Furthermore, an activation syndrome in which patients taking antidepressants may experience anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness and impulsivity in the first 3 months of treatment may ensue.”


“The incidence of suicide and attempted suicide has been a frequently underreported adverse outcome across antidepressant RCTs.”

Overdose toxicity:

“Patients with MDD are at increased risk of suicide and overdosing of prescribed medications is a common method used to attempted suicide.”

Withdrawal Syndrome:

“These symptoms include flu-like symptoms, tremors, tachycardia, shock-like sensations, paresthesia, myalgia, tinnitus, neuralgia, ataxia, vertigo, sexual dysfunction, sleep disturbances, vivid dreams, nausea vomiting, diarrhea, worsening anxiety and mood Instability.”

Eye disease:

“A subset of patients taking SSRIs reports nonspecific visual disturbances…SSRIs may increase intraocular pressure and lead to the emergence of angle-closure glaucoma…A nested case-control study found a higher likelihood of cataracts after exposure to newer generation antidepressants.”

Hormonal imbalance:

“Long-standing increases in peripheral prolactin levels are occasionally observed in patients using ADs, including SSRIs [208] ; hyperprolactinemia may have deleterious health consequences (e.g. a decrease in BMD [bone mineral density] and hypogonadism).”

Pregnancy/Breastfeeding risk:

“Most of the data describing the presence of birth defects associated with SSRI use have been based on observational studies and drug registries. Therefore, the clinical significance of these data is questionable.”

Cancer risk:

“Preclinical studies have found that antidepressants can increase the growth of fibrosarcomas and melanomas, and may also promote mammary carcinogenesis.”

Whew! Now that’s depressing. And why don’t you know about these? Because your doctor doesn’t. I recently learned of a patient who was prescribed an antidepressant simultaneous to an antibiotic “just in case the antibiotic caused depression or mood changes”. We are trained to treat these medications as a “why not” application of pharmacology, and the truth is that, as the authors state:

the history of toxicology reminds us vividly of the lag that often occurs between the first approval of a drug for use in humans and the recognition of certain adverse events from that drug.”

Taking these risks seems all the more unecessary with the robust outcomes of lifestyle medicine – multimodal, multi-tier interventions that are low cost, immediately available, and side effect free. As the authors conclude:

The findings of this review suggest that long-term treatment with new generation ADs should be avoided if alternative treatments are available.”

I would have to agree and affirm that these “alternative” treatments are indeed available. These treatments offer not only resolution of symptoms and elimination/avoidance of meds, but an entirely new experience of self. This is not about getting “back to normal,” it’s about integration, evolution, and vitality. I’ve been working for several years to make self-healing toolkits available to everyone considering an antidepressant or looking to come off of one for less than the price of one doctor visit. Check it out!

* * * * *

[1] http://www.power2u.org/downloads/AnatomyofanEpidemic-SummaryofFindings-Whitaker.pdf
[2] https://www.karger.com/Article/FullText/371865
[3] http://www.madinamerica.com/psychiatric-drug-withdrawal/#/home/
[4] http://kellybroganmd.com/stop-madness-coming-psych-meds/
[5] http://kellybroganmd.com/homicide-and-the-ssri-alibi/


Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


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  1. Always glad to see Kelly Brogan’s posts on MIA. MIA needs to attract more Integrative/Functional practitioners. There’s undoubtedly a lot that Integrative/Functional medicine can do to help with child and adults issues (‘mental’, behavioural).

    But people will only stop swallowing the pills, and stuffing their children with them, when they can stop believing in magical solutions. Beyond psychiatry’s lies and omissions (and beyond where drugs are forced), people themselves need to stop believing that pills of all sorts magically solve problems (NONE do).

    Liz Sydney

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    • The pill is the physical representation of hope. Consuming hope. I hope for a better future.
      People make money on exploiting that hope.

      Is the cure worse than the disease? is the question everyone must ask.

      The solution coming from the bottom to the top (“people themselves need to stop believing”), or the top to the bottom?

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  2. The benefits must be weighed with the costs. I first took an SSRI for multiple reasons, including the fact that I had an auto-immune condition, and stress would cause me to flare. The SSRI really helped reduce my stress, anxiety, and depression. However, it also gave me side effects, predominately brain fog, no interest in sex, ringing in the ears, loss of sensitivity to the feelings of others (I didn’t understand why people got so bothered by things), and sleep disturbances. Eventually, the medication wasn’t doing anything for my stress, anxiety, or depression, and the brain fog was getting really bad (even though my doctor told me that SSRI’s don’t give brain fog). I wanted to get off the SSRI. So I went to see my doctor to figure out how I should taper off the medication. Since my anxiety and depression levels were back to being high, my doctor’s recommendation was to double my dosage. That’s when I realized I would have to get off the SSRI on my own. It was very difficult. I tapered very slowly. I started getting panic attacks all the time. My auto-immune disease came back. I temporarily went back on the SSRI, thinking it would resolve the flareup from my auto-immune disease. It didn’t. I ended up being sick for one year, bedridden for 5 1/2 months, and hospitalized 3 times. Once I was in remission, I tapered off the SSRI. This time it was easier to taper off it having tapered off it the first time. I still have anxiety and depression issues, but they aren’t as bad as when I was on the SSRI and getting all those negative side effects. Plus, the side effects have been lessening over time. I don’t regret taking an SSRI. I regret taking it for too long. Yet, I was on a low dosage. Imagine if I had been on a larger dose.

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  3. I think there are times when drugs for depression might be helpful. I think too many people are given drugs when non-drug approaches to their problems…maybe no “professional” intervention, at all…might be the better course of action.

    I regret entering Mental Health, Inc. Long story…I think I was going to end up in “the system” for at least a while, because of a lot of comined factors. My intro drug was an SSRI, and it was off to the races from there (common story, I see now).

    These “antidepressants” are serious drugs. Until I miraculously recovered from what was done to me, Mental Health, Inc. had annihilated me, at a young age…and Paxil was the first step on the road to Hell.

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  4. I took Paxil for 60 days and it quit working in the 90s after being on Zoloft for 90 days and it quit working. I’m on 5 meds now because without them I’m suicidal and homicidal. I don’t have a choice. I don’t have a luxury like normal people of a choice. It’s easy for these holistic people to tout choices when they don’t have to live in my head. I’ve been in the mental health system since 1993. I’ve been having nightmares since age 3, on no meds because I was abused. So the sleep disturbances are going to be there either way as far as that goes. If I could afford it I would get TMS, but I can’t. It’s my only option at this point to get better.

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    • wordtrix

      Have you ever thought about doing some trauma work. It’s not easy work and it’s not that easy to find a good therapist who can do real trauma work, but I have the feeling that you might find some relief if you tried. Yoga often helps people, as well as acupuncture. If you can resolve some of the trauma issues you just might be able to resolve the nightmares and the suicidal/homicidal feelings. It might be worth a try.

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  5. I helped to put a man into our state prison, for sexually molesting his daughters. A huge part of his defense, and really the guy’s whole life, revolved around this idea that he suffered from a ~~Brain Chemical Imbalance~~ and had this disorder called ~~Bipolar~~.

    And yes, the man was a bit strange to talk to. Most of all he said stupid things, irresponsible things, and he held to some very conservative and non-sensical views, which were typical of those in his church.

    But the most intense thing about him was that he was absolutely terrified of feeling his feelings, instead he believed in denial and motivationalism. This was typical of those in his church. He had gotten kicked out of a more moderate church. And he believed that to avoid feeling his feelings he had to have those drugs.

    But I have also known others who have been convinced by the White Coats that they also suffer from ~~ Bipolar II ~~. And so they also are terrified of feeling their feelings. And they believe that they have to have those drugs. They live in total fear.

    So what I wrote to the DA is that learning to live in one’s own skin is the work of a lifetime. But that guy and his church were committed to the exact opposite.

    So of course when people think that way, and when they accept chemical mood alterants, prescription or street, they are going to have no center, no ability to absorb and adapt as new stresses arise. And so it is not at all surprising that some of them sometimes will do extreme and destructive things.

    Psychotherapy, Psychiatric Drugs, Motivationalism, Evangelical Christianity, street drugs and alcohol are all sold on the same lie, “You can live a good life without having to go thru the Hero’s Journey, without having to stand up for your self and vanquish foes. You best strategy is denial and Live and Let Live.” And so when you listen to this, you are getting your teeth kicked in each and everyday. The work place is bad, but at least in the work place there are some norms that you have to respect people. The very worst is the arena of intimate relationships because that is a true jungle with no rules. If you don’t fit with other people’s denial systems, but instead threaten them, they will chew you up and spit you out.

    And none of this will ever change until you forcefully reject Live and Let Live and Psychotherapy and chemical mood alterants, and instead go through that Hero’s Journey and fight and obtain justice.

    I helped put a Pentecostal Daughter Molester into prison. The opportunity was handed to me, and so I knew I must take it. I consider him to be my first scalp. So I am always bragging about my role in it. But I also know that that alone does not do it. It was just a first test.

    Those of us who have survived the middle-class family, something which only exists because it is allowed to exploit and abuse children, must organize, stop taking chemicals and stop talking to any kind of therapists, and instead we must start winning some tangible victories. I am talking about lawsuits, criminal cases, and getting some laws changed.

    Psychotherapy, Psych Meds, and Street Drugs all depend on the same very dangerous lie.

    “It’s such a hero’s journey to hold accountable the people who harmed you …”




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    • I don’t know. When I first took the SSRI, it really helped me. I had spent my life taking very tiny baby steps. The steps were too small to get anywhere. The SSRI helped me get over that. I was taking giant steps when I was first on the SSRI. It was just that the SSRI stopped working, and the side effects kept getting worse. It was also extremely difficult to get off the SSRI. The medical community will say that the SSRI is out of the system after a short time. However, the damage it has done lasts a long time. I was at my worst eight months after getting off the SSRI. And no, things like cognitive behavior therapy aren’t enough.

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      • CBT is vastly overrated. But it is the one of the few, if not the only, kind of psychotherapy that most psychiatrists have ever heard of – anything else they consider useless w**king. This may be because they tend to be fairly `straight up and down’ people and CBT has nice ordered things like pages to be filled out, and standardised protocols. Most don’t know how to use it properly and/or when to abandon or alter it to fit the person they’re actually talking to. They aren’t interested in the messy, `people are all different’ approach found in some other methods – like Schema and Formulation. Also, since the major factor is the relationship between the person and the therapist, it’s not easy to establish this in 10 minute bites.

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  6. Dear Wordtrix

    I can identify with your frustration. I’m a “holistic” person myself – with lived experience of Recovery.

    I attended substance abuse groups while withdrawing from prescribed drugs; and found them to be very helpful. These groups are free and confidential with very good support ( – I suffered terrible anxiety when I withdrew from my meds).

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  7. I think there could be underlying nutritional issues (in addition to emotional issues) that result in anxiety and depression. I used to think that SSRI’s were a miracle drug because they took away all my anxiety and depression. But then they stopped working, and the negative side effects were getting worse. I listened to a lot of health summits and tried many things. I found that folate (not folic acid), avoiding sugar, and avoiding wheat, rye, and barley substantially reduced my anxiety and depression. I’m not saying these things take the anxiety and depression away completely. I’m also not saying these things will work for everyone. I’m just saying there is probably a reason for the anxiety and depression, and it’s good to try to figure out what that reason is so that you can solve it. It might take many years to figure it out, and you may never figure it out. Still I think it’s worth it to look into it because even though SSRI’s may take away the anxiety and depression in the beginning, they could stop working and they could end up doing more harm than good.

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  8. One problem I have is that many of us seem to think that doctors are simply oblivious to some effects of these drugs. I do not think that is the case. I am not suggesting some massive conspiracy, but I am saying that where the rubber hits the roads, the doctors prescribing these drugs have decided that its better to medicalize problems– frustrations, the ill effects of a sick society, etc.– and “treat” these problems with potentially dangerous, often expensive, frequently ineffective “medications” than it is to deal with the problems (and people/”patients”) in a non-drug, possibly non-medical, manner. Power, prestige, profit, etc. all come into play.

    I think, on and individual basis, the popularity of these drugs shows how the elites deal with the problems of the rest of us. A doctor who drugs a lower status person is simply treating the “patient” how many upper class people treat those beneath them.

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    • I believe you make a good point here. I cannot be convinced, at this point in time, that doctors don’t know about the horrible effects of these drugs. I refuse to call them side effects since I believe that this is nothing but playing word games to not deal with the reality of what happens when you take these things. Everything and anything that the drug does, good or bad, is an effect, not a “side-effect”.

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    • You are so right! The diagnostic process itself is a means of “blaming the victim” and distancing ourselves from the “mentally ill” individual, as well as avoiding any and all responsibility for doing something about the situations that may have caused the problem. ADHD is a great example. The fact that a child can’t stand sitting through your class does NOT mean there is something wrong with the kid! Maybe your class is incredibly boring, or this kid simply hates to sit around doing nothing with his body, or the kid is super smart and figured out what you’re “teaching” about two years back, or you’re talking over the kid’s head and he has no idea what you’re talking about but is embarrassed to admit it, or the kid is distracted by the fact that his dad threatened to kill his mom last night and he’s wondering if she’ll still be alive when he gets home today… you get the drift. But with “ADHD”, no one has to ask any of those uncomfortable questions, and the teacher doesn’t have to change a thing! We simply blame the kid’s brain and put him on a drug that makes him less annoying to the teacher, despite long-term evidence that this does NOTHING to improve the kid’s overall well being down the road.

      It’s a cop out. The least powerful person in the room takes the blame, which is probably what got them to be labeled “mentally ill” in the first place!

      —- Steve

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  9. As long as people believe that psychotherapy can solve their problems, or believe that street drugs or alcohol can solve their problems, what chance is there that they will refuse prescription drugs?

    And what do you think we should do about this?

    I say:

    1. Outlaw forced treatment
    2. Outlaw giving psych meds to children
    3. Enforce mandatory reporting, any therapy on children must be reported to Child Protection.
    4. Take profit out of Medical Child Abuse ( formerly Munchausen’s By Proxy ), parents are responsible for all harms inflicted, and disinheritance of one’s child is prohibited.


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  10. Thanks for the blog, Kelly. Just the other day I printed out some information on the antidepressants for a friend of my mother who was recently prescribed an antidepressant, ironically, at the suggestion of her daughter to the doctor, rather than the doctor thinking she needed it. It sounded to me like the daughter might be in an antidepressant induced hypomanic state, and this is part of what was causing the frustration on the part of my mother’s friend. I’ll go ahead and print this out for her as well, so she may make a well informed decision as to whether to start the antidepressant or not. It’s a shame the majority in the medical community are so misinformed as to the adverse effects of the drugs they are prescribing in a “why not” fashion.

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  11. I’ve always refused to get on these medications, everyone of them has made me feel worse and increased my anxiety. They would always tell me that it would take time for me to get used to the effects but if I huff gasoline long enough I would get used to that to,lol.

    To me the really scary thing about these drugs is it could be one of the causes for the lack of compassion and empathy that seems to be so common these days.

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  12. Here’s a question. If the SSRI’s commonly cause suicidal thinking as a “side effect” what good are they? They’re supposed to prevent suicide.

    Every psychiatrist behind a mass shooting (most shooters are in psych treatment) is guilty of reckless disregard of human life and public safety. He is at least as morally responsible as the shooter and should be charged with manslaughter if not as an accessory to murder.

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    • I agree. It is also important to recall that these studies showing increased suicidal thinking or behavior SCREEN OUT suicidal people before starting the experiment! So the results are actually reflecting not the total number of suicidal thinkers in the group, but the total number BECOMING suicidal as a result of “treatment.” Especially when we look at the long-term outcomes being so poor, “antidepressants” are not only generally ineffective, they are overall more dangerous than they are useful.

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      • Since reducing my Effexor by nearly 70% I’m no longer suicidal. I can think more abstractly now too (my IQ has gone up noticeably.) Unfortunately I feel like I have the flu 24/7, can’t quit coughing, and have nearly scratched myself bald from the overwhelming itch that won’t go away. 🙁

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        • Just remember if these symptoms are due to reducing Effexor, then they will probably go away eventually.

          In the meantime, see your PCP.

          I’m not a health practitioner; however, I do have issues with my lymphatic system. Getting my lymphatic system cleansed and moving helped me fight off colds. It also helped reduce itchiness. If you are interested, you can find information about natural treatments for the lymphatic system online.

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  13. Before SSRIs, people drank alcohol to reduce anxiety and depression. Alcohol reduces inhibitions. People are more likely to do something they will regret under the influence of alcohol. People with violent tendencies may become more violent. But people who aren’t murders aren’t going to go kill someone just because they had something to drink. We have something called free will.

    It’s the same with SSRIs. An SSRI isn’t going to make a person who is not a murderer go out and kill someone. Therefore, a psychiatrist is not and should not be held responsible for someone else committing murder. That would be like holding a bartender responsible for any crimes committed by anyone the bartender had served. We, as individuals, are responsible for our actions. We can’t blame our actions on bartenders and psychiatrists.

    As for the side effect of committing suicide, medicines work that way. A painkiller can cause rebound headaches. An anti-inflammatory can cause greater susceptibility to inflammation. And an SSRI can increase depression.

    So what are SSRIs good for? They worked wonders for me when I first took them. I was able to stop my compulsive, negative thinking. I wasn’t so sensitive to what others said. I didn’t take things so personally. It was like getting the effects of alcohol without getting drunk. However, the SSRIs gradually stopped working. Their side effects increased. And it was extremely difficult to get off of them. I don’t regret having been on SSRIs. I regret having been on them for so long. And then there is a risk of getting extremely depressed if one decides to stop taking SSRIs. Anyone who is suicidal should not be given SSRIs.

    Many psychiatrists over-prescribe SSRIs. SSRIs are an easy and quick way to make patients feel better. The idea is for SSRIs to reduce depression/anxiety so that psychiatrists can help their patients work on their depression/anxiety. However, the reality is that once a patient has been prescribed SSRIs, any attempt to get off of the SSRIs will increase depression/anxiety. What’s worse is that if the SSRIs stop working, psychiatrists don’t respond by taking patients off of them. Instead, they want to increase the dosage or add another medication. However, this will only result in greater side effects and greater difficulty of getting off of the SSRIs. Still, it is what psychiatrists recommend.

    Based on my personal experience, it may take only several days for the SSRIs to leave the body, but the changes that have been done to the body take much longer to resolve. The depression/anxiety after getting off of SSRIs is intense and lasts a long time.

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