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Some thoughts from someone who's been prescribed anti depressants in adolescence but never took them because I believed the doctor misdiagnosed: * Do these dru

by qrybam 10y ago

Some thoughts from someone who's been prescribed anti depressants in adolescence but never took them because I believed the doctor misdiagnosed: * Do these drugs genuinely help or is it just a strong placebo response? * If the anecdotal evidence increases the odds from 1 in 100 to 1 in 4, would this be considered normal in medicine? Of course the symptoms could be attributed to the wrong thing here but they sound pretty horrific. My initial reaction was that in the future we'll look back at these drugs as barbaric, similar to how we view lobotomies today. Edit: formatting

Confusion 10y ago
I take only a very small dose of paroxetine and if I don't take it for a few days, my girlfriend notices (long before withdrawal symptoms occur). Without it I'm more impatient, stubborn and less capable of self-reflection. When I take it I'm just a more pleasant person and with that my entire life becomes more pleasant, because many interactions with other people are more constructive and productive. It is my firm conviction that a lot of people would benefit from small adjustments to their brain chemistry. I'm lucky to have found something that works for me.
hiram112 10y ago
The SSRIs have always been controversial. Some studies claim they're rarely more effective than placebos, but more often than not they're effective enough with a pretty safe profile, this article not withstanding. The safe profile is one of the reasons they're probably over prescribed, along with the high profitability. Many doctors give them out like candy, even though many people probably don't suffer from the physiological ailments that the drugs target. There is little debate, though, on the statistical efficacy of the older (less profitable, off patent) tricyclics and especially MAOI class of drugs. Unfortunately, the side effects of these drugs are far more serious. Most GPs will not even prescribe them, as only psychiatrists will have experience. But for someone with lifelong treatment resistant depression, they can be a God-send. Asd as far as barbaric, realize that the most effective treatment for depression is still electric shock therapy.
- mattmanser 10y ago
  In the UK they don't give them out like candy. Are you talking about US doctors?
  - johnchristopher 10y ago
    I can confirm it's the case in France and Belgium.
threeseed 10y ago
Antidepressants in general work. However they have a range of side effects and efficacy profiles depending on the person. Then have saved far more lives they they have killed. So no I don't think we will be negatively looking back at this era.
- marincounty 10y ago
  I have taken seven different anti-depressants. I started with Prozac. I really believed they would help. All I got was side effects. "That's just antidotal evidence!" Yes--it is, but wouldn't you think, just one time, I would have gotten a bit of a Placebo Effect? I really thought every new drug would help. Their was no doubt on my mind they wouldn't work. It wasen't until years later I looked into the studies. I looked into the 62% improvement over Placebo claims. I noticed the small studies. I noticed the way they determined improvement, like determining success by slight improvement(three questions answered differently) in standard, dubious psychological tests. I came away hoping all western medicine isn't evaluated like this--a lot of drugs are studied terribly. Anyways, a Psychologist did some interesting research on the efficacy of the wonder drugs a few years ago. I have a weird feeling his conclusions were the truth. I wish they weren't. https://www.psychologytoday.com/blog/looking-in-the-cultural-mirror/201202/debunking-antidepressants https://www.psychologytoday.com/blog/looking-in-the-cultural...
- khed 10y ago
  There is no well done study I have heard of that supports your position. In general SSRIs have an effect size that is so low it is not clinically relevant. There are multiple meta analyses that demonstrate that.
pmoriarty 10y ago
People react quite differently to these mind-altering drugs -- and there are a lot of them, with different effects on different people. They "worked" for someone I know when they were in a very dark place, but the price was a permanent dulling of their emotions, even after they stopped taking them. Someone else I know underwent extreme personality changes on a different antidepressant, becoming more aggressive and basically an asshole, and I had to beg them to stop taking it. Your mileage may vary. They are very serious things.
rtpg 10y ago
I can't comment on anti-depressants, but for a similar case (ADHD meds), where societies attitudes regarding meds are similar. ADHD has by far the most successful medical treatment of any mental illness. Something like 90% of cases get positive response out of medication, with 35-40% of people having all their symptoms handled. My understanding is that for treatment of clinical depression, medication helps around 75% of cases, but that most people continue to have symptoms even when under medication due to the nature of the illness. In both cases, though, treatment is understood to be a continuous process. You cannot be cured of these illnesses, you can only cope with the side effects. The treatments are like a prosthetic leg: No matter how much you use it, removing it will bring you back to square one. There's a lot of research showing the positive effects of medication (and in ADHD's case, the futility of non-medication-based treatments), but there's still a major fight for acknowledging the validity of this form of treatment. Major parts of the population do not think these illnesses are even real! But it's all pretty dangerous. We have some understanding of how brains work around these illnesses thanks to the research gone into it, but there's a lot of complex interactions going on. Not that physical medicine is much different.
- adamweld 10y ago
  >There's a lot of research showing the positive effects of medication (and in ADHD's case, the futility of non-medication-based treatments), but there's still a major fight for acknowledging the validity of this form of treatment. Is this really relevant considering the extremely rapid rise in prescription and use of ADHD medication? In my anecdotal experience with friends who take these pills, they very quickly create a reliance on the substance and have significant side effects in the long term. I honestly believe they can be quite harmful to a person's mind. Now, for ADHD there unfortunately aren't good non-medication treatments. But depression is a completely different matter - making lifestyle changes as simple as going for a hike every weekend can easily be as effective or more effective than any medication.
  - mickronome 10y ago
    They can be harmful, but diagnosed ADHD/ADD is almost guaranteed to be harmful, maybe especially in todays society. More than doubled risk of depression is only one of the risks of the above diagnoses, and while many of the risks could be said to be more of a societal issue - at least in the beginning - they tend to cause actual health problems over time. Overprescription can always be an issue for any medication, but that's not really an issue with the medication itself is it ?
csydas 10y ago
Heh, as someone who was on SSRIs for a long time at high dosages, they definitely do something, but the issue is less whether the drugs do anything and more what you do during that time. Personal experience with Sertraline - it doesn't make you happy or feel better or anything. It just numbs you, and you're really susceptible during this time. It's part of the reason why therapy is also really important in addition to the drugs to help get down to the core of what you're having issues with. The old Zoloft "sad blob" to "happy blob" commercials are a real disservice to modern anti-depressant medicine since it is a very incomplete picture. Aside from glossing over the side effects of the medication, the pills themselves don't do much except stop the feeling of absoutely horribleness for awhile. They don't make you feel better - they don't make you feel much of anything. But things at least stop seeming hopeless after awhile, and hopefully you can begin to address the underlying issues. In the case of true chemical imbalances like it's suspected I have, during this time you help find non-drug related coping mechanisms. Finding ways to help create a strong positive part of your life so the imbalances are offset and don't hit as hard. A lot of this comes just through therapy or at least a counselor while you work. My first few times on SSRIs were the result of rather serious and dangerous break downs where those around me had pretty good reason to think I was a threat to myself. But these cases were mishandled pretty heavily since the doc just wrote a prescription for Sertraline and sent me on my way. Therapy wasn't even discussed, and our insurance at the time certainly didn't cover it since it was a non-essential medical procedure. It wasn't until many years later and many changes of drugs later that I was finally in a position when I could do both therapy and have the drugs to assist that I actually made some progress -- the counselor and the psychiatrist worked in tandem; the counselor worked and would constantly try to see how I was when we lowered the dosage, the psychiatrist spent time making sure that the dosage was enough to keep me level, not pushing either way and consulting with the counselor to ensure they had a source of info that wasn't me. I hope we find something better since looking back at the SSRI period, it was not a very good time in my life and I was lucky enough to get to a situation where I could get proper mental healthcare. I can't imagine how many others were just tossed on an SSRI without the proper monitoring and assistance necessary to actually make use of the effect, or worse, who weren't watched at all as the more dangerous side effects kicked in.
- kefka 10y ago
khed 10y ago
They are almost all placebo response. The real effect is so small it's probably not useful clinically. They also cause suicidal ideation and sexual dysfunction is a large minority of patients.

by qrybam 10y ago

Confusion 10y ago

I take only a very small dose of paroxetine and if I don't take it for a few days, my girlfriend notices (long before withdrawal symptoms occur). Without it I'm more impatient, stubborn and less capable of self-reflection. When I take it I'm just a more pleasant person and with that my entire life becomes more pleasant, because many interactions with other people are more constructive and productive. It is my firm conviction that a lot of people would benefit from small adjustments to their brain chemistry. I'm lucky to have found something that works for me.

hiram112 10y ago

The SSRIs have always been controversial. Some studies claim they're rarely more effective than placebos, but more often than not they're effective enough with a pretty safe profile, this article not withstanding. The safe profile is one of the reasons they're probably over prescribed, along with the high profitability. Many doctors give them out like candy, even though many people probably don't suffer from the physiological ailments that the drugs target. There is little debate, though, on the statistical efficacy of the older (less profitable, off patent) tricyclics and especially MAOI class of drugs. Unfortunately, the side effects of these drugs are far more serious. Most GPs will not even prescribe them, as only psychiatrists will have experience. But for someone with lifelong treatment resistant depression, they can be a God-send. Asd as far as barbaric, realize that the most effective treatment for depression is still electric shock therapy.

mattmanser 10y ago
In the UK they don't give them out like candy. Are you talking about US doctors?
- johnchristopher 10y ago
  I can confirm it's the case in France and Belgium.

threeseed 10y ago

Antidepressants in general work. However they have a range of side effects and efficacy profiles depending on the person. Then have saved far more lives they they have killed. So no I don't think we will be negatively looking back at this era.

marincounty 10y ago
I have taken seven different anti-depressants. I started with Prozac. I really believed they would help. All I got was side effects. "That's just antidotal evidence!" Yes--it is, but wouldn't you think, just one time, I would have gotten a bit of a Placebo Effect? I really thought every new drug would help. Their was no doubt on my mind they wouldn't work. It wasen't until years later I looked into the studies. I looked into the 62% improvement over Placebo claims. I noticed the small studies. I noticed the way they determined improvement, like determining success by slight improvement(three questions answered differently) in standard, dubious psychological tests. I came away hoping all western medicine isn't evaluated like this--a lot of drugs are studied terribly. Anyways, a Psychologist did some interesting research on the efficacy of the wonder drugs a few years ago. I have a weird feeling his conclusions were the truth. I wish they weren't. https://www.psychologytoday.com/blog/looking-in-the-cultural-mirror/201202/debunking-antidepressants https://www.psychologytoday.com/blog/looking-in-the-cultural...
khed 10y ago
There is no well done study I have heard of that supports your position. In general SSRIs have an effect size that is so low it is not clinically relevant. There are multiple meta analyses that demonstrate that.

pmoriarty 10y ago

People react quite differently to these mind-altering drugs -- and there are a lot of them, with different effects on different people. They "worked" for someone I know when they were in a very dark place, but the price was a permanent dulling of their emotions, even after they stopped taking them. Someone else I know underwent extreme personality changes on a different antidepressant, becoming more aggressive and basically an asshole, and I had to beg them to stop taking it. Your mileage may vary. They are very serious things.

rtpg 10y ago

I can't comment on anti-depressants, but for a similar case (ADHD meds), where societies attitudes regarding meds are similar. ADHD has by far the most successful medical treatment of any mental illness. Something like 90% of cases get positive response out of medication, with 35-40% of people having all their symptoms handled. My understanding is that for treatment of clinical depression, medication helps around 75% of cases, but that most people continue to have symptoms even when under medication due to the nature of the illness. In both cases, though, treatment is understood to be a continuous process. You cannot be cured of these illnesses, you can only cope with the side effects. The treatments are like a prosthetic leg: No matter how much you use it, removing it will bring you back to square one. There's a lot of research showing the positive effects of medication (and in ADHD's case, the futility of non-medication-based treatments), but there's still a major fight for acknowledging the validity of this form of treatment. Major parts of the population do not think these illnesses are even real! But it's all pretty dangerous. We have some understanding of how brains work around these illnesses thanks to the research gone into it, but there's a lot of complex interactions going on. Not that physical medicine is much different.

adamweld 10y ago
>There's a lot of research showing the positive effects of medication (and in ADHD's case, the futility of non-medication-based treatments), but there's still a major fight for acknowledging the validity of this form of treatment. Is this really relevant considering the extremely rapid rise in prescription and use of ADHD medication? In my anecdotal experience with friends who take these pills, they very quickly create a reliance on the substance and have significant side effects in the long term. I honestly believe they can be quite harmful to a person's mind. Now, for ADHD there unfortunately aren't good non-medication treatments. But depression is a completely different matter - making lifestyle changes as simple as going for a hike every weekend can easily be as effective or more effective than any medication.
- mickronome 10y ago
  They can be harmful, but diagnosed ADHD/ADD is almost guaranteed to be harmful, maybe especially in todays society. More than doubled risk of depression is only one of the risks of the above diagnoses, and while many of the risks could be said to be more of a societal issue - at least in the beginning - they tend to cause actual health problems over time. Overprescription can always be an issue for any medication, but that's not really an issue with the medication itself is it ?

csydas 10y ago

Heh, as someone who was on SSRIs for a long time at high dosages, they definitely do something, but the issue is less whether the drugs do anything and more what you do during that time. Personal experience with Sertraline - it doesn't make you happy or feel better or anything. It just numbs you, and you're really susceptible during this time. It's part of the reason why therapy is also really important in addition to the drugs to help get down to the core of what you're having issues with. The old Zoloft "sad blob" to "happy blob" commercials are a real disservice to modern anti-depressant medicine since it is a very incomplete picture. Aside from glossing over the side effects of the medication, the pills themselves don't do much except stop the feeling of absoutely horribleness for awhile. They don't make you feel better - they don't make you feel much of anything. But things at least stop seeming hopeless after awhile, and hopefully you can begin to address the underlying issues. In the case of true chemical imbalances like it's suspected I have, during this time you help find non-drug related coping mechanisms. Finding ways to help create a strong positive part of your life so the imbalances are offset and don't hit as hard. A lot of this comes just through therapy or at least a counselor while you work. My first few times on SSRIs were the result of rather serious and dangerous break downs where those around me had pretty good reason to think I was a threat to myself. But these cases were mishandled pretty heavily since the doc just wrote a prescription for Sertraline and sent me on my way. Therapy wasn't even discussed, and our insurance at the time certainly didn't cover it since it was a non-essential medical procedure. It wasn't until many years later and many changes of drugs later that I was finally in a position when I could do both therapy and have the drugs to assist that I actually made some progress -- the counselor and the psychiatrist worked in tandem; the counselor worked and would constantly try to see how I was when we lowered the dosage, the psychiatrist spent time making sure that the dosage was enough to keep me level, not pushing either way and consulting with the counselor to ensure they had a source of info that wasn't me. I hope we find something better since looking back at the SSRI period, it was not a very good time in my life and I was lucky enough to get to a situation where I could get proper mental healthcare. I can't imagine how many others were just tossed on an SSRI without the proper monitoring and assistance necessary to actually make use of the effect, or worse, who weren't watched at all as the more dangerous side effects kicked in.

kefka 10y ago

khed 10y ago

They are almost all placebo response. The real effect is so small it's probably not useful clinically. They also cause suicidal ideation and sexual dysfunction is a large minority of patients.