17 ms·

There is little research into the long-term effects of using antidepressants

201 points by DiabloD3 10y ago

pc2g4d 10y ago
I was also put on antidepressants as a teenager and am trying to get off them after well over a decade. It's a tricky task to distinguish the withdrawal effects (which can be extreme) from the difficult emotions that come with rediscovering how to face the world without the drugs. It really feels like a part of my personality was frozen in time when I went on the drugs, and that as I come off them slowly that part of me has thawed. And that can be painful, but also extremely rewarding. It forced me to acknowledge truths about myself that I resisted for many years. It forced me to be more real with people in my life. It's the realization that I was depressed for actual emotional reasons and not just because of some putative neurochemical imbalance, the idea of which in such huge numbers makes absolutely no evolutionary sense. A trait this common is not a disorder---it's a survival mechanism.
- jakebasile 10y ago
  I'm glad you are feeling better but while some people's problems do come from emotional sources, please don't act like the chemical imbalances in the brains of other people aren't a disorder. I promise you, I and others like me have tried our damndest to "feel better".
  - frgtpsswrdlame 10y ago
    Can we really distinguish those two sources? It seems to me that the chemicals and the emotions are the same thing.
    - Crespyl 10y ago
      The problem, I think, is that sometimes the chemicals come first and other times the emotions come first. Both can lead to a self-reinforcing downward spiral, but trying to fix the wrong half is likely to be ineffective.
      - frgtpsswrdlame 10y ago
        I'm out of my depth here so apologies if I'm stepping into some Very Bad Anatomy but my point is that neither one can come first because they are the same thing, that those chemicals are your emotions and vice versa.
        kolinko 10y ago
        They don't map one to one. There's a thousand variants of emotions, and just a few neurotransmitters. Also, even with all the chemistry being fine, there can be certain receptors messed up, or parts of brain not functioning properly. A story I read in "Listening to Prozac" was about a patient that for years couldn't get over his low self esteem issues. He worked through all of them, but the feeling persistent, and there were no other issues with his mood aside from that. He was finally put on antidepressants, and that issue was fixed. Unfortunately, whenever he tried to get off them, the issue - and only that issue - kept coming back. The theory is that something made that part of his brain resistant to serotonin. There are many kinds of serotonin receptors, and perhaps a genetic problem messed up one of them. Or there was an issue with serotonin not being delivered where it should've been. Or who knows what. In the end, increased serotonin levels fixed that. A blunt tool, but no other one worked. Similarly with attention deficit (which comes with anxiety and sleep issues quite often) - the original theory was that it was due to dopamine issues, because increasing dopamine levels helped most people. The current theory is that in many cases it may a whole class of issues - from a mechanical damage to prefrontal cortex to allergies, magnesium processing issues, tyrosine processing problems, or even a deficiency in nicotinic receptors (where supplementing nicotine is really a solution!) Also, in most cases it's probably more than issue at root. The problem is that it's difficult to figure it all out, and many cases medicine is simply not there yet.
        pdkl95 10y ago
        > a deficiency in nicotinic receptors (where supplementing nicotine is really a solution!) My doctor actually recommended nicotine for that exact reason. My family's history with heavy tobacco use combined (my father in particular) and my experiences with nicotine in the past were positive, so the doctor suggested trying a strong nicotine patch for a while. It worked reasonably well, and more importantly it didn't have the (many) problems the usual SNRI or NDRI. Nicotine definitely does have its own problems, but it's an interesting option that deserves more research. (We had also discussed briefly the idea of trying a very small dose of one of the acetylcholinesterase inhibitors used for Alzheimer's, but eventually decided against it, because they can be somewhat dangerous drugs.) For decades, research on the nicotinic acetylcholine receptors was limited (probably tanks to the tobacco industry). Research in this area is improving a lot, but it will take time to make up for the lost time.
  - psyc 10y ago
    This isn't like a reprimand or anything, just to point out that this problem cuts both ways. Having been entangled with the mental health system for 20 years, I say the lion's share of attention and advice, from everywhere and everybody, comes from the chemical imbalance / illness / disorder perspective. And this really, really does leave those of us who don't respond to drugs and are fundamentally unhappy with our lives very frustrated and without anywhere to turn. Yeah, therapy's a thing, but it's commonly perfunctory and treated as secondary. Treating depression like it's just one thing can harm sufferers on both "sides".
    - JamesBarney 10y ago
      A big reason drugs are preferred to therapy is that the drugs are far cheaper. 6 months of antidepressants can be like $80, 6 months of bi-weekly therapy $5,600.
      - bspn 10y ago
        My understanding is that mental health therapy should be covered by most insurance plans these days so the out-of-pocket shouldn't be that high. While it's a sample size of only one, my wife sees her therapist bi-weekly and I think the co-pay is $20 per session. A month's supply of Duloxetine (generic Cymbalta) actually costs us more per month at $45.
        nugget 10y ago
        It's incredibly difficult to find a great therapist. There is a fundamental supply and demand imbalance, and plenty of quacks on the supply side.
      - humbleMouse 10y ago
        Not to mention the potential cost of missing work to go to therapy. Some people don't have PTO or a flexible schedule and getting to therapy appointments is a real pain in the ass.
      - fivestar 10y ago
  - pharrington 10y ago
    OP is not telling you to "feel better" - he is saying he was only able to tackle his depression after taking a more holistic approach to monitoring and changing his brain operation. Emotions are, quite literally, certain chemical states in animals with nervous systems of at least a certain complexity. That's where the "chemical imbalance" mantra falls apart - at best, it adds no information, and even worse, its used to peddle drugs which are developed without coherent and predictable models of the neurology involved in the symptoms/diseases they're supposed to treat. Medical doctors get at least one objective measure of your blood pressure before prescribing blood pressure medicine. When was the least time you heard of a psychiatrist only prescribing meds after performing an MRI?
    - kolinko 10y ago
      What new information would current state fMRI give them? If I'm not mistaken, a person that is depressed due to environment will have similar fMRI as a person who has messed up biology (not just neurotransmitters btw). Also, even with acute depression, antidepressants may help to get the patient on track.
      - pharrington 10y ago
        https://www.nih.gov/news-events/nih-research-matters/brain-scan-may-predict-best-depression-treatment https://www.nih.gov/news-events/nih-research-matters/brain-s... The objective outcomes differ with different treatments even in cases of subjective success. The specific neurology (protein levels, chemical ratios, etc) should determine how exactly you intend to alter it.
    - pw 10y ago
      Psychiatrists (well, ER doctors, usually) do, in fact, perform MRI's before prescribing meds. This happened to me when I was first diagnosed with bipolar disorder, and I assumed it's not an uncommon practice. It's easy to think of psychiatry being wishy-washy when all you're considering is mild to moderate depression and the like, but it becomes much harder when you consider the entire spectrum of mental illness. Full-blown mania, psychotic depression, or untreated schizophrenia scream illness in a way that is hardly subjective.
  - zardo 10y ago
    >I promise you, I and others like me have tried our damndest to "feel better". There is a whole arm of behavioral therapy based on the idea that trying to feel better, is a major cause of people feeling bad. https://en.m.wikipedia.org/wiki/Acceptance_and_commitment_therapy https://en.m.wikipedia.org/wiki/Acceptance_and_commitment_th... Of course, it doesn't work for everyone.
  - InclinedPlane 10y ago
    I'm not quite sure how to respond to this, so I apologies in advance if it comes off wrong. I would say it's not about trying to "feel better", you can't just force yourself to not feel depressed, the brain is too complex for that. There are, however, many rigorously proven methods for tackling depression that can work in replacement of or in addition to medications. The one I think has the most merit is mindfulness based cognitive behavioral therapy. The idea is to build up a new set of habits, coping skills, and behavior patterns that let you life your life without getting sucked into depression. Depression is vastly more complex than simply "a flaw in brain chemistry", that's very reductive reasoning but it's been a relatively successful one for the psychiatrist business and pharmaceutical industry. That brain chemistry is as much a symptom as it is a cause though. And with enough work it's possible to make yourself more resilient to potentially depressing circumstances and thoughts. It's possible to train yourself to recognize and change the constantly running background narrative of negative self-talk that gets you down, the rumination, the trains of thought that seem so unavoidable, and so on. And then on top of that to build better habits, to tackle your problems, that you're in control of, and prevent them from growing out of control, to regularly exercise, etc. Of course, it can be difficult if not near impossible to do all that, or, really, anything whatsoever, if you're deeply depressed. Which is why for many people it's necessary to begin anti-depressants before starting therapy, making behavioral/cognitive changes, etc. The problem the parent poster is talking about is the tendency today to just shove people into the top of the process and call that done. It's now expected that most people who have experienced major depression should just take anti-depressants for their entire life and that's the "cure" for their problems. With only a token concern for building up the skills, habits, and coping mechanisms that people actually need. You see the same thing with a lot of other things like ADHD or anxiety, with a tendency to look for the chemical answer first and foremost and call that good enough.
- meesterdude 10y ago
  Thank you! This really hits home for me. It's exactly how i've feel but always get ridiculed for because of the sheer number of people who are prescribed it and that it works for them so I must be wrong. I don't doubt that some people really do need it, but I was not one of them (I didn't respond well to them) and I have a hard time believing so much of the population actually needs them too. But if anything, better solutions / alternatives need to be presented and made available before people are just thrown off something that has helped them handle some really tough stuff. But the problem with that is, then the drug companies wouldn't make so much money. (which, I think plays a large part of it)
  - kolinko 10y ago
    It's not just that - it's that from a perspective of a psychiatrist there is no safer drug to get someone out of a deep hole. The thing is that people should be trying to figure out what was the underlying issue and whether it's possible to fix it. Not many doctors have the motivation to do this infortunately, and many patients don't either. I've met people with adhd and daytime sleepiness, who spent years on antidepressants. The effect was that they still couldn't focus, but didn't feel depressed because of that, and didn't even know they had problem.
- rm_-rf_slash 10y ago
  I had a similar experience after ending my 15 years on Concerta/Ritalin. I was so used to feeling "always on," that it warped my worldview. That, to me, was more disconcerting than having to reevaluate my understanding of myself. I can identify with my medicated self, because I am always in some sort of flux and I accept that ambiguity. I cannot relate to my medicated worldview; I am out of Plato's Cave.
- kolinko 10y ago
  Remember that this is just your experience - just like some people have messed up insulin, some others have serotonin. It's just that in this case we distinguish genetic issues from environmental.
- mjevans 10y ago
  My own personal opinion is that modern society is more crazy than most patients. This is likely the root cause of over-prescribing drugs. Yes people are in need of changes in their life to feel better, but the solution should be for society to suck less, not some pill to mask the symptoms in individuals.
  - derefr 10y ago
    Note that anti-depressants—at least in the case of episodic depression—are supposed to be used as a crutch, not as a "management therapy." You prescribe anti-depressants to someone who can't get out of bed to see a therapist, so that they will then get out of bed to see a therapist, where the therapist can then get them over their depression. Anti-depressants are not supposed to be used "mask pain" any more than crutches are supposed to be used to "mask pain" in your leg. They're supposed to take the pressure off a thing that generates pain, so that you can work productively on making your life better (healing the leg) so that you don't need the crutch. Though, that being said, there's also a second, less obvious thing anti-depressants do: first-line anti-depressants specifically are hard to distinguish from placebos, but that's okay because first-line antidepressants are often prescribed by doctors who believe† that a placebo is, in fact, all a person might need in order to feel better. That's why they're given out so freely: placebos are pure benefit (no risks, possible reward) so it doesn't hurt to try them before doing literally anything else. If the person doesn't improve under first-line placebos, then the doctor will move on to figuring out what "actual" medical interventions might help. † This approach is doctrine among psychologists, but not necessarily what your average psychiatrist/therapist/prescribing GP will be thinking about. Prescribers "out in the field" are mostly following the DSM guidelines for first-line/second-line/Nth-line treatments of depression, which just say that the first-line pharmaceutical interventions are very well-tolerated and low-risk.
    - mjevans 10y ago
      I can see how you were probably trying to say that these medications are supposed to be used to empower the kind of changes you thought I was talking about. However, I'm actually talking about society in general being depressive. About it being difficult to socialize because of distance, economic/social divides (real or imagined), the time spent at work (duration and even sometimes just the conflict) or because transportion is so bad/costly. There are also those who are stuck in some rural/suburban desert of contact and opportunity. My ultimate point is that the /depression/ might actually exist for valid reasons. That in a pre-modern society this feeling could be a survival trait in driving an individual to leave a bad or over-populated area for new/different grounds. However modern society has closed off these historic reactions and has not replaced them with modern equivalents. Thus the subjects experience learned helplessness, as there isn't any way out and they thus give up on looking for or taking opportunities to have a way out. This same lack of a visible, viable, and valued escape trajectory can also explain other contexts where subjects act against the rational interests of themselves and the communities that they seek to remain part of. For example, when I was describing the above class of scenario victims of abuse from those close to them (parents/spouses/etc) come to mind.
- pc2g4d 10y ago
  Thanks to everyone for their heartfelt responses and interesting viewpoints! Some have pushed back regarding the notion of serotonin imbalance. I would point you to literature that strongly challenges the idea of straightforward neurochemical imbalance as the cause of depression. This is a good place to start: http://kellybroganmd.com/depression-serotonin/ http://kellybroganmd.com/depression-serotonin/ From that article: > "The most applicable analogy is that of the woman with social phobia who finds that drinking two cocktails eases her symptoms. One could imagine, how, in a 6 week randomized trial, this “treatment” could be found efficacious and recommended for daily use and even prevention of symptoms. How her withdrawal symptoms after 10 years of daily compliance could lead those around her to believe that she “needed” the alcohol to correct an imbalance. This analogy is all too close to the truth." I believed in the chemical imbalance theory for many years, but now I am persuaded that it's more marketing slogan than scientific reality. This is not to say that antidepressants cannot have beneficial effects. Just that it's not clear that they are correcting any naturally occurring imbalance. As far as the interesting point that emotions and neurochemical brain states may be equivalent, I grant that this may be true. I guess it was more my way of referring to two approaches to emotional problems: the first, which sees the problems originating in the brain chemistry, internalizing the dysfunction within the sufferer. The second, which sees the brain chemistry mostly as a reaction to the life and environment of the sufferer, wherein the true dysfunction lies. This points people in the direction of their relationships, the congruence of their values and choices, their life philosophy, etc. which I find a more productive pursuit.
  - hosh 10y ago
    This is exactly why I've been trying to get my step-daughter off of the meds. She is on the autism spectrum, and her previous guardian solved behavior problems by pushing more and more meds. We've weaned her off of the anti-psychotic and in the process of weaning her off of the anti-anxiety. We'll see if we can do the same for the vyvanse or adderall. I have worked with a lot of intense emotions and pain within myself. I have faced them in life and in meditative, psychedelic, and dream states. There are not a lot of darkness and intense emotions that faze me much anymore -- though it isn't as if I've become invulnerable to emotions. If anything, I've become to be more sensitive to emotions, and being OK with that vulnerability. Whatever the emotional state or the narrative, the way it dissolves generally remains the same. In all the things I have tried, the key ingredient has always been mindfulness. I have found that surfacing up deeply-buried emotions don't do much if one becomes mindless and intoxicated by those emotions. At the same time, I have also tried suppression and repression. Numbing oneself or cutting oneself off from the emotions at best, defers the emotional work you end up doing. Instead, it usually causes more damage. Mood-altering drugs can help _if_ they are taken along with therapy that necessarily includes mindfulness. The therapy helps change and shift deeply-held beliefs, and it is the mindfulness that lets one unwind the damage from root cause. The drugs in question can help if they support such a process, to be able to help face the scary things within you. If they are taken as a way to _avoid_ this kind of work, yeah, I too also hear they can freeze you at that emotional maturity level.
- CodeWriter23 10y ago
  I empathize with your struggles to be chemically independent and to dig deep to confront your truth. Any naysayers just don't and can't understand your path. Without digging to deep, I just want to express my support and a {{{{{{{giant internet hug from a stranger}}}}}}}
- Steeeve 10y ago
  > It really feels like a part of my personality was frozen in time when I went on the drugs, and that as I come off them slowly that part of me has thawed. I'm sure you are talking about antidepressants, but I wonder if the same isn't true for people who have consumed recreational drugs for extended periods. It seems natural that if you regularly alter your internal chemistry, the natural processes that would happen in an unaltered states (such as psychological maturation) would also be altered. I also wonder if there isn't a standardized therapy kind of like PT for physical injuries for bringing people back up to speed emotionally.
  - md224 10y ago
    It's also possible that antidepressants (and drugs of abuse) numb some part of your mind that's broken due to emotional trauma, and as a result you lose that part of your personality while it heals. Then, when you come off the drug, you're all better. It's like a kind of mental anesthetic. This could explain why many drug abuse problems spontaneously resolve. I'll admit this sounds kind of insane, but I'll also point out that we still really know so little about the actual workings of our own minds. Maybe we're misunderstanding the relationship between people and psychoactive drugs.
- ohstopitu 10y ago
  Just out of curiosity - what would be the adverse effects of being on anti-depressants all your life? Are there any side effects that negatively effect you if you use it in medical doses?
seibelj 10y ago
Anti-depressants literally saved my life. I tried to manage my anxiety / depression for years with diet, exercise, therapy, mindfulness, and meditation without great success. 2 weeks of lexapro was a night and day difference. Don't be afraid of medication if other options fail.
- khaannn 10y ago
  This is also my story. Tried everything and only the meds helped.
- ghk 10y ago
  Same here. Lexapro made most of my depression and anxiety go away. With that initial chemical help, I was able to double down on my exercises and good dieting. Before SSRI's, I did not have enough "drive" to exercise hard or eat well.
- otto_ortega 10y ago
  I concur. Don't be afraid of the medication, just make sure to consult a (good) qualified professional that helps you figure out the right prescription for your particular scenario, and don't fall in the overuse/abuse trap.
- tcj_phx 10y ago
  > 2 weeks of lexapro was a night and day difference. My girlfriend thought that lexapro had helped her years before she met me... She escaped from the psychiatrists who only cared about making her feel worse with their "anti-psychotics", and got her new medical providers to prescribe lexapro instead. After a week she realized that her new rapid heartbeat was certainly caused by the lexapro. She took her last benzo (class of "anxiety" drug that makes anxiety worse over time), and it was all downhill from there... SSRIs were approved on the basis of fraudulent science. The legal profession was recently able to secure a $3 million verdict against Glaxo Smith Klein - a rather successful lawyer jumped in front of a train after a few days on Paxil. Here's a writeup: https://www.madinamerica.com/2017/05/change-in-chicago-the-dolin-verdict/ https://www.madinamerica.com/2017/05/change-in-chicago-the-d...
jakebasile 10y ago
I'll tell you, with 100% conviction, that I would not be alive today without prescription antidepressants and mood stabilizers. Of course there are side effects, and it can take a while to find the right drug or combination of drugs for your particular brain chemistry. In most cases, I've considered the side effects worth the improvement to my life. Even with them, I'm still not completely "normal". These symptoms are with me for the rest of my life barring some amazing medical discovery. Mental health issues as a whole are difficult to bring up, even to a doctor. I actually worry about writing this on my real account. It's looked down on as if "you just can't handle life" so you "just feel sad". Chemotherapy is also a very unpleasant experience, but I don't think there would be much interest in an article about some imagined overprescription of chemotherapy.
- frgtpsswrdlame 10y ago
  >I don't think there would be much interest in an article about some imagined overprescription of chemotherapy Perhaps that's because it's possible to objectively know if someone has cancer? I'm not sure the same is true of depression. I was on an anti-depressant for about a year in college. It didn't save my life and looking back I didn't even need it.
  - jakebasile 10y ago
    There are guidelines for determining if someone has depression and/or other mental health diseases, just like any other disease. You can't take an x-ray and see depression like a tumor, but you can talk to the patient and their family to gauge and track symptoms. see: https://www.nimh.nih.gov/health/topics/depression/index.shtml https://www.nimh.nih.gov/health/topics/depression/index.shtm... http://images.pearsonclinical.com/images/assets/basc-3/basc3resources/DSM5_DiagnosticCriteria_MajorDepressiveDisorder.pdf http://images.pearsonclinical.com/images/assets/basc-3/basc3...
    - frgtpsswrdlame 10y ago
      Sure, what I'm saying is that a doctor found that I met those guidelines (apparently) and prescribed me a drug. I don't think I ever needed it, I was just struggling with a transitional period in my life. It didn't really improve my life, in fact between the reduced appetite and hampered sexual performance I'd say it definitely was a negative. After reading some research about the performance of antidepressants vs placebos and the possibility of my sexual side effects becoming permanent I decided I was out. All of which is to say, are anti-depressants over prescribed? I can say yes, if only by my one case.
nicolashahn 10y ago
I was on various medications off and on over 6 years. I needed them before that but they helped immensely once I had them. However, I've found that they're unnecessary and even detrimental long term, if you can tackle the underlying reason behind the depression (the side effects can be huge). For me, it was a lifestyle change that involved better diet and exercise (like everyone recommends), as well as associating myself with people that I enjoyed being around and who encouraged me to be better and disassociating myself from people who brought me down. The most important piece, however, was that I was able to fundamentally change my thoughts and perspective on life. Instead of telling myself "I'm a failure" I tell myself "I found one way that doesn't work." Instead of "I hate myself" it's "how can I make myself better?" Instead of "they don't actually like me" it's "I don't care, because I don't need everyone's acceptance to be content." I was able to do this mainly through reading various mindfulness books but most importantly Stoic philosophy. "A Guide to the Good Life" was fundamental. The rest came through general maturity through life experience, accepting the world the way it is and coming to terms with it, as well as using that knowledge to get what I want from it. A combination of these things, plus finally becoming financially independent and moving to a place that suits me better, has led me to believe that for me antidepressants are a temporary tool to help you learn to manage depression. There may be a chance that I need them again in the future but I feel very secure where I am now, and more confident and happy than I have ever been in my life previously. What has led me to believe that the same also holds true for most people is that I've known many other depressed and medicated people before in my life. What I find in almost all of them (who remain depressed and medicated) is that they view the medication AS the fix, instead of the tool that helps you find it. They accept that the medication will bring them enough contentment to live out the rest of their life. Because of this, they never try to change it. They're living the same life they were, except now they aren't as miserable. Maybe it was a good thing that the side effects were too much for me but I wasn't able to live that way, they forced me to find a way to improve my situation. I believe that many people just haven't been able to find the right ways to change their life to live without medication. Of course, this doesn't apply to the ones that can't fix their situation for whatever reason, but the reality is that a lot of people are being medicated, and most of them do have the power to change their lives to render medication unnecessary.
- 10y ago
baus 10y ago
They don't talk about SNRIs like venlafaxine in the article, but I can say from first had experience that the withdrawal symptoms from those are pretty extreme. This is a difficult decision, but I've decided to not take SNRIs or SSRIs to manage bipolar depression, although they are commonly prescribed because I found the side effects to out weigh the benefits
- dsnuh 10y ago
  I've been on venlafaxine 75mg (prescribed 150mg, but didn't like the increased side effects) for about a year now, I felt elevated mood a bit, but it did little to address bipolar cycling in my case. Recently I was prescribed Lamictal (lamotrigine) off label by my psychitrist as a mood stabilizer. I have just this week come up to therapeutic doses. It has been a huge change. I don't feel like I have experienced any additional side effects, and my mood is much more even. If you've never tried it, you may want to do some research online. Many bipolar patients have reported similar results.
  - _acme 10y ago
    Lamictal carries the potential for severe side effects, much more so than SSRIs/SNRIs. Lamotrigine prescribing information has a black box warning about life-threatening skin reactions, including Stevens–Johnson syndrome, DRESS syndrome and toxic epidermal necrolysis.
  - baus 10y ago
    I currently take 5mg of Abilify
wu-ikkyu 10y ago
I see a lot in here about the popular "chemical imbalance" theory, which is worth noting is more of a big pharma sales pitch at this point in time than actual objective science. Antidepressants and the Placebo Effect https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592645/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592645/ Antidepressants versus placebo in major depression: an overview https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/
- kolinko 10y ago
  You picked two articles that fit your worldview, and ignored all the critique around them. That's not objective science. Also, even the first one of the articles you quoted clearly says in the conclusion that there is an effect to antidepressants. Here is one of the articles the critique of the critique you mentioned: http://www.nytimes.com/2011/07/10/opinion/sunday/10antidepressants.html http://www.nytimes.com/2011/07/10/opinion/sunday/10antidepre...
  - wu-ikkyu 10y ago
    >fit your worldview, and ignored all the critique around them. That's not objective science. ^This is an accurate description of western psychiatry in general, ironically, because 1) psychiatry is not objective science 2) psychiatry assumes individual deviation from society's norms is the root of disorder, rather than seriously considering the disorder of society's norms at large. >In 2013, Frances said that "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests https://en.wikipedia.org/wiki/Allen_Frances https://en.wikipedia.org/wiki/Allen_Frances
    - mmjaa 10y ago
      >1) psychiatry is not objective science 2) psychiatry assumes individual deviation from society's norms is the root of disorder, rather than seriously considering the disorder of society's norms at large. I believe this is an accurate statement, and the reason for these two points being so extant is that Psychiatry is, these days, more like a state-supported official religion. Its definitely not science. If you don't think the way society wants you to think (i.e. religion), you are cast out from it: this is Psychiatrys' job.
panglott 10y ago
The medical model of mental and behavioral problems is a lot better than the moralistic model. But physical health is also a poor metaphor for mental health, and this article reveals some of the reasons why. Like the doctor comparing the antidepressant use to insulin, even if the doctor was just trying to de-stigmatize the anti-depressants. But human minds and personalities grow and change in response to the environment they're in and as part of normal aging and development.
- psyc 10y ago
  I wish the biopsychosocial model would catch on. Maybe it needs a catchier name.
  - kolinko 10y ago
    I'm building a browser game that educates people in this. There is nothing I can publish yet, but shoot me an e-mail (kolinko@gmail.com), and I'd love to discuss it in more detail. (I hope I don't break any HN rules with this comment - there is no landing page, and I don't have a public pitch I could share here yet).
Burnt_Foot 10y ago
I've been on different forms of ssri, snris since the age of seven. I'm 32 now. It's debatable my parents used medication as a way of silencing me, as I was lashing out and making suicide attempts and violent threats as a response to my father's physical and sexual abuse. Regardless, I've been on so long I don't believe I could function without them. Every time I've gone off, whether cold turkey or under a psychiatrist's supervision, I've fell into the deepest, even catatonic, depressions of my life. Even had a psychotic break which required shock treatment. I've been in therapy, ptsd groups, religiously exercised, meditation, journaling, and a whole lot more, but the medication has always been there. Both sides of my family have a history of suicide, alcoholism, depression, and other mental illnesses. I feel like an addict but also justify it, in that you wouldn't shame a diabetic for taking insulin.
pasbesoin 10y ago
Whether you view the drugs, and their long-term use, as a benefit, or not, here's how I see it. The pharmaceutical companies have these drugs approved. And they are being prescribed and used, long-term. So, what's the benefit for them in doing longitudinal studies? What's the upside, versus the potential downside of discovering negative effects? If you want longitudinal studies, you're going to have to look outside the industry. An essential reason we need to keep government research around and well-funded.
a3n 10y ago
First, everyone's depression is specifically their own. While there are groups of people who react similar to each other, that doesn't at all negate the experience of other different groups and their reactions. I take an SSRI. It's worked well for me. If the cause of my depression is a defect in the serotonin path, then I see no reason why I, with that particular problem, should wean myself off my SSRI; I don't think SSRIs repair the serotonin path, they just mitigate the defect (production or transmission). If I had a defective leg, with no hope of repair or regeneration, I wouldn't try to wean myself off my brace.
- bitexploder 10y ago
  Same with ADHD and dopamine release. It is why amphetamines are so effective at treating legitimate ADHD. Mundane chores everyone has to do go from unimaginably difficult to start to moderately rewarding with the magic of a brain releasing its pent up dopamine. It isn't even a dopamine production problem for many with ADHD, the brain just won't release it like it does for most people. You can train it to some extent, but the defect will always exist in the ADHD brain.
notadoc 10y ago
First try legitimate physical exercise, lifestyle changes, counseling.
- bitexploder 10y ago
  Not trying to give you a hard time, this is of course good advice, but please never tell that to anyone you care about in a depressive episode. Time and place. Virtually every person with depression has been given this advice a million times. If it were just that, they would have done it. It took me a long time to accept that it just isn't that simple for people with long term depression. That is a huge part of fighting it long term, but those habits are hard to gain and easy to lose, putting someone back in the hole. People with depression also just need people. Support, acknowledgement of their struggle, listening, acceptance. I have a strong inclination to help people fix things. My younger self had a hard time accepting there were things I could not fix or figure out.
  - zamalek 10y ago
    It's also dangerous advice. Seek professional attention first.
- omginternets 10y ago
  You're definitely not wrong, but the issue is that these are very difficult things to do in the midst of a depressive episode.
lawnchair_larry 10y ago
I wonder why people care whether or not somebody else really needs them. For arguments sake, let's say they don't. Suppose they can just man up and learn to deal with their first world problems. What do you lose by them taking something to make that easier? Do you normally fix all of your other problems in the most difficult way? We all seek ways to get an edge, if not against others, then at least to reclaim some of our own time and well-being. From their perspective, there are 3 kinds of people. There's the positive, motivated guy who can't wait to get out of bed and go make his mark on the world. Then, there is the similar character who has to take SSRIs or whatever to keep that going. Then there is the lethargic person who has to fight every day to pretend to give a shit, can't keep relationships together, doesn't get promotions, and doesn't feel motivated to learn new skills or hobbies. The last person doesn't really have the option of being person #1, but they may have a choice between being #2 or #3. Since all three of them end up in the ground after a few more decades anyway, why does it matter to others how they get there? Maybe the last 10 years or so of their life will cause them complications due to longterm use. It's hard to view that as a bad trade for folks who were miserable and/or suicidal for the first 50.
- omginternets 10y ago
  >What do you lose by them taking something to make that easier? Going with your argument, one stands to lose on at least two fronts: 1. severe side-effects 2. potential long-term harm stemming from chronic use (as per the present article) >Do you normally fix all of your other problems in the most difficult way? This is disingenuous. The argument is that fixing depression sans medication is a better (= safer, more effective) way. Granted, this argument is far from being obviously correct. Things also get murkier when we admit that there are various forms of depression, but that's not the point. The point is rather that you're arguing against a straw-man.
  - lawnchair_larry 10y ago
    Neither 1 nor 2 answer the question. Why do you care if they do it? You suffer no side effects or long term harm.
Gfdfgjjmbvcd 10y ago
This hits home as my wife was admitted to a psychiatric ward today, again, for major depression. I am lost, with a business to run, a full time job in addition, two daughters, and struggles with minor depression and anxiety myself. She is on two antidepressants, Vyvanse (amphetamines), Provigil, and then takes trazadone to sleep. Her Dr will first increase one, then after that fails will add another or switch her. She's treated like a human Guinea pig. No one has thought to question whether the medications contribute. No one has looked at the problem holistically. Her diet is absolute shit, she doesn't exercise, she really doesn't take care of herself at all. And the medical professionals all tell her it's not her. She has a disease, she has a chemical imbalance, it is completely out of her control. Long story short, I see both sides. There most certainly IS personal responsibility. Even more damaging though is the state of psychiatric and mental health. It's learned, and reinforced, helplessness.
- asymmetric 10y ago
  I don't have much to add, other than I feel for you. I hope things get better for you, and for your loved ones.
- aedron 10y ago
  Man, that sounds rough. Puts some other problems into perspective. I feel for you and hope you guys pull through. I say this as someone who has been through worse stuff in my life than most people.
- BasDirks 10y ago
  Take care.
- fivestar 10y ago
  So you don't think your lifestyle as listed above has anything to do with your anxiety and mental health issues?
askvictor 10y ago
There are plenty of anecdotes here, which are fine for those wanting to share their story (I've been on two types of antidepressants myself). However, the point of this article is that there is insufficient long-term data. Anecdotes do not a longitudinal study make. And one of the major problems with depression is that it's subjective. Antidepressants have major onset side-effects, that take around a month to stabilise. So, you're feeling pretty crappy, but take the pills in the belief they'll make you better, and you have some strategies to deal with the nausea and other side-effects. In that onset month, you're probably feeling even crappier than before. But then your body/mind adjusts, the onset side-effects go away, and you feel better. So you report that you feel better after one month. Which skews the data pretty badly, as it's hard to be objective about how good/bad you're feeling at the best of times, let alone when you're in a slump and/or feeling nauseous from the drugs. For all of those people who say that antidepressants saved or improved their lives (or the life of a loved one), spare a thought for those where antidepressants led a decrease in quality of life, or worse.
jdavis703 10y ago
I wonder how much of Sarah's issues were a "nocebo" response, thinking that withdrawal would be bad. If so it might help if doctors and pharmacies provided a "guided reduction" (e.g. you get 19mg one week, 18mg the next etc). People might feel better just thinking that an "expert" has designed this program.
- askvictor 10y ago
  I don't know about Seroxat, but I've experienced undeniable symptoms withdrawing from antidepressants: "brain zaps" that I had no idea about until I started experiencing them, then found other people who had written of experiencing them as well. Additionally to those, I had a weird whooshing sound that I would hear whenever I moved my eyes to the top left. Took me a while to figure out the pattern/trigger (seemed random at first, and I thought I had something stuck in my ear). Actually kind of fascinating, if scary. That was on top of the nausea etc. And this was a 'guided' withdrawl (under medical direction). I don't discount that there might be a placebo/nocebo response in the side-effects (both onset and withdrawl) as well (as with any medication)
deleted 10y ago
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dabber 10y ago
And of course the first ad in the article is for an antidepressant. Drop the ad script in and forget it they said... Targeted ads they said...
peteretep 10y ago
This is a terrible article. It leads with a random three paragraph anecdote about coming off an SSRI. This is a pretty well-known and well-documented phenomenon, and contributes nothing to a discussion of their safety. And then: > But many experts believe these drugs > do more good than harm Followed by a quote of someone saying the opposite, and nothing more to back that statement up at all. > Many SSRI users report blunted emotions That's kind of the point > “They should be called anti-sex drugs > rather than antidepressant drugs,” says > Jon Jureidini, a *child* psychiatrist Seriously? They're quoting a paediatric psychiatrist on the effects on libido of anti-depressants. Just a thought: if you're a child psychiatrist and your patients are having lots of sex, there may be other issues affecting their mental health. The article gets no less sloppy. Clickbait is clickbait even when wrapped up to look vaguely scientific.
liragg 10y ago
I was diagnosed of Parkinson disease 2 years ago at age 63. Symptoms were tremor in right leg, loss of handwriting ability, and soft voice. I also have difficulty rising from a seated position and have balance issues. I started out taking only Azilect, then Mirapex, and last 2 month Sinemet. Several months ago I started falling frequently, hence the reason for Sinemet.My first son was in search of permanent cure because he spent a lot of money on my medication,so he check online and saw good testimonies about Parkinson disease cured with the help of herbal medicine purchased from perfecthealthherbalmedicinehome,so we decided to give it a try,we contacted perfecthealth through email perfecthealthherbalmedicine gmail com and purchased the herbal medicine for Parkinson disease,we received the herbal medicine at our door step after two days of purchase ,the shipping was so fast.i used the herbal medicine for a month and 2 weeks,all my symptoms disappears,and my doctor confirmed am Parkinson disease free now ,i promised to tell the whole world about perfecthealthherbalmedicinehome.please contact perfecthealth to get your own cure , website :www perfecthealthherbal weebly com.
liragg 10y ago
LIRA MURPHY I was diagnosed of Parkinson disease 2 years ago at age 63. Symptoms were tremor in right leg, loss of handwriting ability, and soft voice. I also have difficulty rising from a seated position and have balance issues. I started out taking only Azilect, then Mirapex, and last 2 month Sinemet. Several months ago I started falling frequently, hence the reason for Sinemet.My first son was in search of permanent cure because he spent a lot of money on my medication,so he check online and saw good testimonies about Parkinson disease cured with the help of herbal medicine purchased from perfecthealthherbalmedicinehome,so we decided to give it a try,we contacted perfecthealth through email perfecthealthherbalmedicine @ gmail .com and purchased the herbal medicine for Parkinson disease,we received the herbal medicine at our door step after two days of purchase ,the shipping was so fast.i used the herbal medicine for a month and 2 weeks,all my symptoms disappears,and my doctor confirmed am Parkinson disease free now ,i promised to tell the whole world about perfecthealthherbalmedicinehome.please contact perfecthealth to get your own cure , website :www perfecthealthherbal . weebly com.
thanatropism 10y ago
Ok, I can't resist this. First, chunk of the reason why SSRIs and to a lesser extent benzodiazepines are (perhaps) overprescribed is that they are safe, at least in the short term. In the bad old times antidepressants were dangerous, let alone antipsychotics and such. There's some interesting literature pointing to lithium as the Stephen-Curry-mit-Keith-Jarrett standard for long-term management of treatment-resistent depression, but man, taking lithium sucks. If all I had was the garden variety blues I would sure opt for the Zitalocipraoamezaxx they advertise on TV. Second, I think people are over-eager to blame pharma and not the doctors. These are tools, people, and power tools at that. Yes, some research released by pharma is biased in that they do not release the unfavorable studies, but there are plenty of blogs out there poring over the technicalia, as well as sharing experiences in real patient care. Maybe some of these things are overprescribed to the gen pop but they're still useful to us. Third, isn't funny that we're expected to be open-minded about recreational drugs and puritannical about pharmaceuticals? Effectively in many parts of the world now you can legally buy weed but cannot get Klonopin when needed unless you work through the system somehow. This should go without saying, but fourth: the goal of psychiatric treatment is never to make you happy or realignm your chakras. A pdoc doesn't ask "are you happy, are you sad", he asks "are you functional?" Meaning first: am I able to work? (This is the first thing -- it's not good for someone mentally ill to be homeless). Next: am I able to maintain and grow my personal relationships? Is my sex life ok? Am I overall satisfied with my quality of life and my ability to take and handle new challenges? If I can't get an erection (meds sometimes impact that), that's something he can try and help. If I'm questioning the usefulness of being a knowledge worker in a society pumped by a bubble of BS? That's on me. Your goals as a human being are still up to you.

201 points by DiabloD3 10y ago

I was also put on antidepressants as a teenager and am trying to get off them after well over a decade. It's a tricky task to distinguish the withdrawal effects (which can be extreme) from the difficult emotions that come with rediscovering how to face the world without the drugs. It really feels like a part of my personality was frozen in time when I went on the drugs, and that as I come off them slowly that part of me has thawed. And that can be painful, but also extremely rewarding. It forced me to acknowledge truths about myself that I resisted for many years. It forced me to be more real with people in my life. It's the realization that I was depressed for actual emotional reasons and not just because of some putative neurochemical imbalance, the idea of which in such huge numbers makes absolutely no evolutionary sense. A trait this common is not a disorder---it's a survival mechanism.

jakebasile 10y ago
I'm glad you are feeling better but while some people's problems do come from emotional sources, please don't act like the chemical imbalances in the brains of other people aren't a disorder. I promise you, I and others like me have tried our damndest to "feel better".
- frgtpsswrdlame 10y ago
  Can we really distinguish those two sources? It seems to me that the chemicals and the emotions are the same thing.
  - Crespyl 10y ago
    The problem, I think, is that sometimes the chemicals come first and other times the emotions come first. Both can lead to a self-reinforcing downward spiral, but trying to fix the wrong half is likely to be ineffective.
    - frgtpsswrdlame 10y ago
      I'm out of my depth here so apologies if I'm stepping into some Very Bad Anatomy but my point is that neither one can come first because they are the same thing, that those chemicals are your emotions and vice versa.
      - kolinko 10y ago
        They don't map one to one. There's a thousand variants of emotions, and just a few neurotransmitters. Also, even with all the chemistry being fine, there can be certain receptors messed up, or parts of brain not functioning properly. A story I read in "Listening to Prozac" was about a patient that for years couldn't get over his low self esteem issues. He worked through all of them, but the feeling persistent, and there were no other issues with his mood aside from that. He was finally put on antidepressants, and that issue was fixed. Unfortunately, whenever he tried to get off them, the issue - and only that issue - kept coming back. The theory is that something made that part of his brain resistant to serotonin. There are many kinds of serotonin receptors, and perhaps a genetic problem messed up one of them. Or there was an issue with serotonin not being delivered where it should've been. Or who knows what. In the end, increased serotonin levels fixed that. A blunt tool, but no other one worked. Similarly with attention deficit (which comes with anxiety and sleep issues quite often) - the original theory was that it was due to dopamine issues, because increasing dopamine levels helped most people. The current theory is that in many cases it may a whole class of issues - from a mechanical damage to prefrontal cortex to allergies, magnesium processing issues, tyrosine processing problems, or even a deficiency in nicotinic receptors (where supplementing nicotine is really a solution!) Also, in most cases it's probably more than issue at root. The problem is that it's difficult to figure it all out, and many cases medicine is simply not there yet.
        pdkl95 10y ago
        > a deficiency in nicotinic receptors (where supplementing nicotine is really a solution!) My doctor actually recommended nicotine for that exact reason. My family's history with heavy tobacco use combined (my father in particular) and my experiences with nicotine in the past were positive, so the doctor suggested trying a strong nicotine patch for a while. It worked reasonably well, and more importantly it didn't have the (many) problems the usual SNRI or NDRI. Nicotine definitely does have its own problems, but it's an interesting option that deserves more research. (We had also discussed briefly the idea of trying a very small dose of one of the acetylcholinesterase inhibitors used for Alzheimer's, but eventually decided against it, because they can be somewhat dangerous drugs.) For decades, research on the nicotinic acetylcholine receptors was limited (probably tanks to the tobacco industry). Research in this area is improving a lot, but it will take time to make up for the lost time.
- psyc 10y ago
  This isn't like a reprimand or anything, just to point out that this problem cuts both ways. Having been entangled with the mental health system for 20 years, I say the lion's share of attention and advice, from everywhere and everybody, comes from the chemical imbalance / illness / disorder perspective. And this really, really does leave those of us who don't respond to drugs and are fundamentally unhappy with our lives very frustrated and without anywhere to turn. Yeah, therapy's a thing, but it's commonly perfunctory and treated as secondary. Treating depression like it's just one thing can harm sufferers on both "sides".
  - JamesBarney 10y ago
    A big reason drugs are preferred to therapy is that the drugs are far cheaper. 6 months of antidepressants can be like $80, 6 months of bi-weekly therapy $5,600.
    - bspn 10y ago
      My understanding is that mental health therapy should be covered by most insurance plans these days so the out-of-pocket shouldn't be that high. While it's a sample size of only one, my wife sees her therapist bi-weekly and I think the co-pay is $20 per session. A month's supply of Duloxetine (generic Cymbalta) actually costs us more per month at $45.
      - nugget 10y ago
        It's incredibly difficult to find a great therapist. There is a fundamental supply and demand imbalance, and plenty of quacks on the supply side.
    - humbleMouse 10y ago
      Not to mention the potential cost of missing work to go to therapy. Some people don't have PTO or a flexible schedule and getting to therapy appointments is a real pain in the ass.
    - fivestar 10y ago
- pharrington 10y ago
  OP is not telling you to "feel better" - he is saying he was only able to tackle his depression after taking a more holistic approach to monitoring and changing his brain operation. Emotions are, quite literally, certain chemical states in animals with nervous systems of at least a certain complexity. That's where the "chemical imbalance" mantra falls apart - at best, it adds no information, and even worse, its used to peddle drugs which are developed without coherent and predictable models of the neurology involved in the symptoms/diseases they're supposed to treat. Medical doctors get at least one objective measure of your blood pressure before prescribing blood pressure medicine. When was the least time you heard of a psychiatrist only prescribing meds after performing an MRI?
  - kolinko 10y ago
    What new information would current state fMRI give them? If I'm not mistaken, a person that is depressed due to environment will have similar fMRI as a person who has messed up biology (not just neurotransmitters btw). Also, even with acute depression, antidepressants may help to get the patient on track.
    - pharrington 10y ago
      https://www.nih.gov/news-events/nih-research-matters/brain-scan-may-predict-best-depression-treatment https://www.nih.gov/news-events/nih-research-matters/brain-s... The objective outcomes differ with different treatments even in cases of subjective success. The specific neurology (protein levels, chemical ratios, etc) should determine how exactly you intend to alter it.
  - pw 10y ago
    Psychiatrists (well, ER doctors, usually) do, in fact, perform MRI's before prescribing meds. This happened to me when I was first diagnosed with bipolar disorder, and I assumed it's not an uncommon practice. It's easy to think of psychiatry being wishy-washy when all you're considering is mild to moderate depression and the like, but it becomes much harder when you consider the entire spectrum of mental illness. Full-blown mania, psychotic depression, or untreated schizophrenia scream illness in a way that is hardly subjective.
- zardo 10y ago
  >I promise you, I and others like me have tried our damndest to "feel better". There is a whole arm of behavioral therapy based on the idea that trying to feel better, is a major cause of people feeling bad. https://en.m.wikipedia.org/wiki/Acceptance_and_commitment_therapy https://en.m.wikipedia.org/wiki/Acceptance_and_commitment_th... Of course, it doesn't work for everyone.
- InclinedPlane 10y ago
  I'm not quite sure how to respond to this, so I apologies in advance if it comes off wrong. I would say it's not about trying to "feel better", you can't just force yourself to not feel depressed, the brain is too complex for that. There are, however, many rigorously proven methods for tackling depression that can work in replacement of or in addition to medications. The one I think has the most merit is mindfulness based cognitive behavioral therapy. The idea is to build up a new set of habits, coping skills, and behavior patterns that let you life your life without getting sucked into depression. Depression is vastly more complex than simply "a flaw in brain chemistry", that's very reductive reasoning but it's been a relatively successful one for the psychiatrist business and pharmaceutical industry. That brain chemistry is as much a symptom as it is a cause though. And with enough work it's possible to make yourself more resilient to potentially depressing circumstances and thoughts. It's possible to train yourself to recognize and change the constantly running background narrative of negative self-talk that gets you down, the rumination, the trains of thought that seem so unavoidable, and so on. And then on top of that to build better habits, to tackle your problems, that you're in control of, and prevent them from growing out of control, to regularly exercise, etc. Of course, it can be difficult if not near impossible to do all that, or, really, anything whatsoever, if you're deeply depressed. Which is why for many people it's necessary to begin anti-depressants before starting therapy, making behavioral/cognitive changes, etc. The problem the parent poster is talking about is the tendency today to just shove people into the top of the process and call that done. It's now expected that most people who have experienced major depression should just take anti-depressants for their entire life and that's the "cure" for their problems. With only a token concern for building up the skills, habits, and coping mechanisms that people actually need. You see the same thing with a lot of other things like ADHD or anxiety, with a tendency to look for the chemical answer first and foremost and call that good enough.
meesterdude 10y ago
Thank you! This really hits home for me. It's exactly how i've feel but always get ridiculed for because of the sheer number of people who are prescribed it and that it works for them so I must be wrong. I don't doubt that some people really do need it, but I was not one of them (I didn't respond well to them) and I have a hard time believing so much of the population actually needs them too. But if anything, better solutions / alternatives need to be presented and made available before people are just thrown off something that has helped them handle some really tough stuff. But the problem with that is, then the drug companies wouldn't make so much money. (which, I think plays a large part of it)
- kolinko 10y ago
  It's not just that - it's that from a perspective of a psychiatrist there is no safer drug to get someone out of a deep hole. The thing is that people should be trying to figure out what was the underlying issue and whether it's possible to fix it. Not many doctors have the motivation to do this infortunately, and many patients don't either. I've met people with adhd and daytime sleepiness, who spent years on antidepressants. The effect was that they still couldn't focus, but didn't feel depressed because of that, and didn't even know they had problem.
rm_-rf_slash 10y ago
I had a similar experience after ending my 15 years on Concerta/Ritalin. I was so used to feeling "always on," that it warped my worldview. That, to me, was more disconcerting than having to reevaluate my understanding of myself. I can identify with my medicated self, because I am always in some sort of flux and I accept that ambiguity. I cannot relate to my medicated worldview; I am out of Plato's Cave.
kolinko 10y ago
Remember that this is just your experience - just like some people have messed up insulin, some others have serotonin. It's just that in this case we distinguish genetic issues from environmental.
mjevans 10y ago
My own personal opinion is that modern society is more crazy than most patients. This is likely the root cause of over-prescribing drugs. Yes people are in need of changes in their life to feel better, but the solution should be for society to suck less, not some pill to mask the symptoms in individuals.
- derefr 10y ago
  Note that anti-depressants—at least in the case of episodic depression—are supposed to be used as a crutch, not as a "management therapy." You prescribe anti-depressants to someone who can't get out of bed to see a therapist, so that they will then get out of bed to see a therapist, where the therapist can then get them over their depression. Anti-depressants are not supposed to be used "mask pain" any more than crutches are supposed to be used to "mask pain" in your leg. They're supposed to take the pressure off a thing that generates pain, so that you can work productively on making your life better (healing the leg) so that you don't need the crutch. Though, that being said, there's also a second, less obvious thing anti-depressants do: first-line anti-depressants specifically are hard to distinguish from placebos, but that's okay because first-line antidepressants are often prescribed by doctors who believe† that a placebo is, in fact, all a person might need in order to feel better. That's why they're given out so freely: placebos are pure benefit (no risks, possible reward) so it doesn't hurt to try them before doing literally anything else. If the person doesn't improve under first-line placebos, then the doctor will move on to figuring out what "actual" medical interventions might help. † This approach is doctrine among psychologists, but not necessarily what your average psychiatrist/therapist/prescribing GP will be thinking about. Prescribers "out in the field" are mostly following the DSM guidelines for first-line/second-line/Nth-line treatments of depression, which just say that the first-line pharmaceutical interventions are very well-tolerated and low-risk.
  - mjevans 10y ago
    I can see how you were probably trying to say that these medications are supposed to be used to empower the kind of changes you thought I was talking about. However, I'm actually talking about society in general being depressive. About it being difficult to socialize because of distance, economic/social divides (real or imagined), the time spent at work (duration and even sometimes just the conflict) or because transportion is so bad/costly. There are also those who are stuck in some rural/suburban desert of contact and opportunity. My ultimate point is that the /depression/ might actually exist for valid reasons. That in a pre-modern society this feeling could be a survival trait in driving an individual to leave a bad or over-populated area for new/different grounds. However modern society has closed off these historic reactions and has not replaced them with modern equivalents. Thus the subjects experience learned helplessness, as there isn't any way out and they thus give up on looking for or taking opportunities to have a way out. This same lack of a visible, viable, and valued escape trajectory can also explain other contexts where subjects act against the rational interests of themselves and the communities that they seek to remain part of. For example, when I was describing the above class of scenario victims of abuse from those close to them (parents/spouses/etc) come to mind.
pc2g4d 10y ago
Thanks to everyone for their heartfelt responses and interesting viewpoints! Some have pushed back regarding the notion of serotonin imbalance. I would point you to literature that strongly challenges the idea of straightforward neurochemical imbalance as the cause of depression. This is a good place to start: http://kellybroganmd.com/depression-serotonin/ http://kellybroganmd.com/depression-serotonin/ From that article: > "The most applicable analogy is that of the woman with social phobia who finds that drinking two cocktails eases her symptoms. One could imagine, how, in a 6 week randomized trial, this “treatment” could be found efficacious and recommended for daily use and even prevention of symptoms. How her withdrawal symptoms after 10 years of daily compliance could lead those around her to believe that she “needed” the alcohol to correct an imbalance. This analogy is all too close to the truth." I believed in the chemical imbalance theory for many years, but now I am persuaded that it's more marketing slogan than scientific reality. This is not to say that antidepressants cannot have beneficial effects. Just that it's not clear that they are correcting any naturally occurring imbalance. As far as the interesting point that emotions and neurochemical brain states may be equivalent, I grant that this may be true. I guess it was more my way of referring to two approaches to emotional problems: the first, which sees the problems originating in the brain chemistry, internalizing the dysfunction within the sufferer. The second, which sees the brain chemistry mostly as a reaction to the life and environment of the sufferer, wherein the true dysfunction lies. This points people in the direction of their relationships, the congruence of their values and choices, their life philosophy, etc. which I find a more productive pursuit.
- hosh 10y ago
  This is exactly why I've been trying to get my step-daughter off of the meds. She is on the autism spectrum, and her previous guardian solved behavior problems by pushing more and more meds. We've weaned her off of the anti-psychotic and in the process of weaning her off of the anti-anxiety. We'll see if we can do the same for the vyvanse or adderall. I have worked with a lot of intense emotions and pain within myself. I have faced them in life and in meditative, psychedelic, and dream states. There are not a lot of darkness and intense emotions that faze me much anymore -- though it isn't as if I've become invulnerable to emotions. If anything, I've become to be more sensitive to emotions, and being OK with that vulnerability. Whatever the emotional state or the narrative, the way it dissolves generally remains the same. In all the things I have tried, the key ingredient has always been mindfulness. I have found that surfacing up deeply-buried emotions don't do much if one becomes mindless and intoxicated by those emotions. At the same time, I have also tried suppression and repression. Numbing oneself or cutting oneself off from the emotions at best, defers the emotional work you end up doing. Instead, it usually causes more damage. Mood-altering drugs can help _if_ they are taken along with therapy that necessarily includes mindfulness. The therapy helps change and shift deeply-held beliefs, and it is the mindfulness that lets one unwind the damage from root cause. The drugs in question can help if they support such a process, to be able to help face the scary things within you. If they are taken as a way to _avoid_ this kind of work, yeah, I too also hear they can freeze you at that emotional maturity level.
CodeWriter23 10y ago
I empathize with your struggles to be chemically independent and to dig deep to confront your truth. Any naysayers just don't and can't understand your path. Without digging to deep, I just want to express my support and a {{{{{{{giant internet hug from a stranger}}}}}}}
Steeeve 10y ago
> It really feels like a part of my personality was frozen in time when I went on the drugs, and that as I come off them slowly that part of me has thawed. I'm sure you are talking about antidepressants, but I wonder if the same isn't true for people who have consumed recreational drugs for extended periods. It seems natural that if you regularly alter your internal chemistry, the natural processes that would happen in an unaltered states (such as psychological maturation) would also be altered. I also wonder if there isn't a standardized therapy kind of like PT for physical injuries for bringing people back up to speed emotionally.
- md224 10y ago
  It's also possible that antidepressants (and drugs of abuse) numb some part of your mind that's broken due to emotional trauma, and as a result you lose that part of your personality while it heals. Then, when you come off the drug, you're all better. It's like a kind of mental anesthetic. This could explain why many drug abuse problems spontaneously resolve. I'll admit this sounds kind of insane, but I'll also point out that we still really know so little about the actual workings of our own minds. Maybe we're misunderstanding the relationship between people and psychoactive drugs.
ohstopitu 10y ago
Just out of curiosity - what would be the adverse effects of being on anti-depressants all your life? Are there any side effects that negatively effect you if you use it in medical doses?

seibelj 10y ago

Anti-depressants literally saved my life. I tried to manage my anxiety / depression for years with diet, exercise, therapy, mindfulness, and meditation without great success. 2 weeks of lexapro was a night and day difference. Don't be afraid of medication if other options fail.

khaannn 10y ago
This is also my story. Tried everything and only the meds helped.
ghk 10y ago
Same here. Lexapro made most of my depression and anxiety go away. With that initial chemical help, I was able to double down on my exercises and good dieting. Before SSRI's, I did not have enough "drive" to exercise hard or eat well.
otto_ortega 10y ago
I concur. Don't be afraid of the medication, just make sure to consult a (good) qualified professional that helps you figure out the right prescription for your particular scenario, and don't fall in the overuse/abuse trap.
tcj_phx 10y ago
> 2 weeks of lexapro was a night and day difference. My girlfriend thought that lexapro had helped her years before she met me... She escaped from the psychiatrists who only cared about making her feel worse with their "anti-psychotics", and got her new medical providers to prescribe lexapro instead. After a week she realized that her new rapid heartbeat was certainly caused by the lexapro. She took her last benzo (class of "anxiety" drug that makes anxiety worse over time), and it was all downhill from there... SSRIs were approved on the basis of fraudulent science. The legal profession was recently able to secure a $3 million verdict against Glaxo Smith Klein - a rather successful lawyer jumped in front of a train after a few days on Paxil. Here's a writeup: https://www.madinamerica.com/2017/05/change-in-chicago-the-dolin-verdict/ https://www.madinamerica.com/2017/05/change-in-chicago-the-d...

jakebasile 10y ago

I'll tell you, with 100% conviction, that I would not be alive today without prescription antidepressants and mood stabilizers. Of course there are side effects, and it can take a while to find the right drug or combination of drugs for your particular brain chemistry. In most cases, I've considered the side effects worth the improvement to my life. Even with them, I'm still not completely "normal". These symptoms are with me for the rest of my life barring some amazing medical discovery. Mental health issues as a whole are difficult to bring up, even to a doctor. I actually worry about writing this on my real account. It's looked down on as if "you just can't handle life" so you "just feel sad". Chemotherapy is also a very unpleasant experience, but I don't think there would be much interest in an article about some imagined overprescription of chemotherapy.

frgtpsswrdlame 10y ago
>I don't think there would be much interest in an article about some imagined overprescription of chemotherapy Perhaps that's because it's possible to objectively know if someone has cancer? I'm not sure the same is true of depression. I was on an anti-depressant for about a year in college. It didn't save my life and looking back I didn't even need it.
- jakebasile 10y ago
  There are guidelines for determining if someone has depression and/or other mental health diseases, just like any other disease. You can't take an x-ray and see depression like a tumor, but you can talk to the patient and their family to gauge and track symptoms. see: https://www.nimh.nih.gov/health/topics/depression/index.shtml https://www.nimh.nih.gov/health/topics/depression/index.shtm... http://images.pearsonclinical.com/images/assets/basc-3/basc3resources/DSM5_DiagnosticCriteria_MajorDepressiveDisorder.pdf http://images.pearsonclinical.com/images/assets/basc-3/basc3...
  - frgtpsswrdlame 10y ago
    Sure, what I'm saying is that a doctor found that I met those guidelines (apparently) and prescribed me a drug. I don't think I ever needed it, I was just struggling with a transitional period in my life. It didn't really improve my life, in fact between the reduced appetite and hampered sexual performance I'd say it definitely was a negative. After reading some research about the performance of antidepressants vs placebos and the possibility of my sexual side effects becoming permanent I decided I was out. All of which is to say, are anti-depressants over prescribed? I can say yes, if only by my one case.

nicolashahn 10y ago

I was on various medications off and on over 6 years. I needed them before that but they helped immensely once I had them. However, I've found that they're unnecessary and even detrimental long term, if you can tackle the underlying reason behind the depression (the side effects can be huge). For me, it was a lifestyle change that involved better diet and exercise (like everyone recommends), as well as associating myself with people that I enjoyed being around and who encouraged me to be better and disassociating myself from people who brought me down. The most important piece, however, was that I was able to fundamentally change my thoughts and perspective on life. Instead of telling myself "I'm a failure" I tell myself "I found one way that doesn't work." Instead of "I hate myself" it's "how can I make myself better?" Instead of "they don't actually like me" it's "I don't care, because I don't need everyone's acceptance to be content." I was able to do this mainly through reading various mindfulness books but most importantly Stoic philosophy. "A Guide to the Good Life" was fundamental. The rest came through general maturity through life experience, accepting the world the way it is and coming to terms with it, as well as using that knowledge to get what I want from it. A combination of these things, plus finally becoming financially independent and moving to a place that suits me better, has led me to believe that for me antidepressants are a temporary tool to help you learn to manage depression. There may be a chance that I need them again in the future but I feel very secure where I am now, and more confident and happy than I have ever been in my life previously. What has led me to believe that the same also holds true for most people is that I've known many other depressed and medicated people before in my life. What I find in almost all of them (who remain depressed and medicated) is that they view the medication AS the fix, instead of the tool that helps you find it. They accept that the medication will bring them enough contentment to live out the rest of their life. Because of this, they never try to change it. They're living the same life they were, except now they aren't as miserable. Maybe it was a good thing that the side effects were too much for me but I wasn't able to live that way, they forced me to find a way to improve my situation. I believe that many people just haven't been able to find the right ways to change their life to live without medication. Of course, this doesn't apply to the ones that can't fix their situation for whatever reason, but the reality is that a lot of people are being medicated, and most of them do have the power to change their lives to render medication unnecessary.

10y ago

baus 10y ago

They don't talk about SNRIs like venlafaxine in the article, but I can say from first had experience that the withdrawal symptoms from those are pretty extreme. This is a difficult decision, but I've decided to not take SNRIs or SSRIs to manage bipolar depression, although they are commonly prescribed because I found the side effects to out weigh the benefits

dsnuh 10y ago
I've been on venlafaxine 75mg (prescribed 150mg, but didn't like the increased side effects) for about a year now, I felt elevated mood a bit, but it did little to address bipolar cycling in my case. Recently I was prescribed Lamictal (lamotrigine) off label by my psychitrist as a mood stabilizer. I have just this week come up to therapeutic doses. It has been a huge change. I don't feel like I have experienced any additional side effects, and my mood is much more even. If you've never tried it, you may want to do some research online. Many bipolar patients have reported similar results.
- _acme 10y ago
  Lamictal carries the potential for severe side effects, much more so than SSRIs/SNRIs. Lamotrigine prescribing information has a black box warning about life-threatening skin reactions, including Stevens–Johnson syndrome, DRESS syndrome and toxic epidermal necrolysis.
- baus 10y ago
  I currently take 5mg of Abilify

wu-ikkyu 10y ago

I see a lot in here about the popular "chemical imbalance" theory, which is worth noting is more of a big pharma sales pitch at this point in time than actual objective science. Antidepressants and the Placebo Effect https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592645/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592645/ Antidepressants versus placebo in major depression: an overview https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/

kolinko 10y ago
You picked two articles that fit your worldview, and ignored all the critique around them. That's not objective science. Also, even the first one of the articles you quoted clearly says in the conclusion that there is an effect to antidepressants. Here is one of the articles the critique of the critique you mentioned: http://www.nytimes.com/2011/07/10/opinion/sunday/10antidepressants.html http://www.nytimes.com/2011/07/10/opinion/sunday/10antidepre...
- wu-ikkyu 10y ago
  >fit your worldview, and ignored all the critique around them. That's not objective science. ^This is an accurate description of western psychiatry in general, ironically, because 1) psychiatry is not objective science 2) psychiatry assumes individual deviation from society's norms is the root of disorder, rather than seriously considering the disorder of society's norms at large. >In 2013, Frances said that "psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests https://en.wikipedia.org/wiki/Allen_Frances https://en.wikipedia.org/wiki/Allen_Frances
  - mmjaa 10y ago
    >1) psychiatry is not objective science 2) psychiatry assumes individual deviation from society's norms is the root of disorder, rather than seriously considering the disorder of society's norms at large. I believe this is an accurate statement, and the reason for these two points being so extant is that Psychiatry is, these days, more like a state-supported official religion. Its definitely not science. If you don't think the way society wants you to think (i.e. religion), you are cast out from it: this is Psychiatrys' job.

panglott 10y ago

The medical model of mental and behavioral problems is a lot better than the moralistic model. But physical health is also a poor metaphor for mental health, and this article reveals some of the reasons why. Like the doctor comparing the antidepressant use to insulin, even if the doctor was just trying to de-stigmatize the anti-depressants. But human minds and personalities grow and change in response to the environment they're in and as part of normal aging and development.

psyc 10y ago
I wish the biopsychosocial model would catch on. Maybe it needs a catchier name.
- kolinko 10y ago
  I'm building a browser game that educates people in this. There is nothing I can publish yet, but shoot me an e-mail (kolinko@gmail.com), and I'd love to discuss it in more detail. (I hope I don't break any HN rules with this comment - there is no landing page, and I don't have a public pitch I could share here yet).

Burnt_Foot 10y ago

I've been on different forms of ssri, snris since the age of seven. I'm 32 now. It's debatable my parents used medication as a way of silencing me, as I was lashing out and making suicide attempts and violent threats as a response to my father's physical and sexual abuse. Regardless, I've been on so long I don't believe I could function without them. Every time I've gone off, whether cold turkey or under a psychiatrist's supervision, I've fell into the deepest, even catatonic, depressions of my life. Even had a psychotic break which required shock treatment. I've been in therapy, ptsd groups, religiously exercised, meditation, journaling, and a whole lot more, but the medication has always been there. Both sides of my family have a history of suicide, alcoholism, depression, and other mental illnesses. I feel like an addict but also justify it, in that you wouldn't shame a diabetic for taking insulin.

pasbesoin 10y ago

Whether you view the drugs, and their long-term use, as a benefit, or not, here's how I see it. The pharmaceutical companies have these drugs approved. And they are being prescribed and used, long-term. So, what's the benefit for them in doing longitudinal studies? What's the upside, versus the potential downside of discovering negative effects? If you want longitudinal studies, you're going to have to look outside the industry. An essential reason we need to keep government research around and well-funded.

a3n 10y ago

First, everyone's depression is specifically their own. While there are groups of people who react similar to each other, that doesn't at all negate the experience of other different groups and their reactions. I take an SSRI. It's worked well for me. If the cause of my depression is a defect in the serotonin path, then I see no reason why I, with that particular problem, should wean myself off my SSRI; I don't think SSRIs repair the serotonin path, they just mitigate the defect (production or transmission). If I had a defective leg, with no hope of repair or regeneration, I wouldn't try to wean myself off my brace.

bitexploder 10y ago
Same with ADHD and dopamine release. It is why amphetamines are so effective at treating legitimate ADHD. Mundane chores everyone has to do go from unimaginably difficult to start to moderately rewarding with the magic of a brain releasing its pent up dopamine. It isn't even a dopamine production problem for many with ADHD, the brain just won't release it like it does for most people. You can train it to some extent, but the defect will always exist in the ADHD brain.

notadoc 10y ago

First try legitimate physical exercise, lifestyle changes, counseling.

bitexploder 10y ago
Not trying to give you a hard time, this is of course good advice, but please never tell that to anyone you care about in a depressive episode. Time and place. Virtually every person with depression has been given this advice a million times. If it were just that, they would have done it. It took me a long time to accept that it just isn't that simple for people with long term depression. That is a huge part of fighting it long term, but those habits are hard to gain and easy to lose, putting someone back in the hole. People with depression also just need people. Support, acknowledgement of their struggle, listening, acceptance. I have a strong inclination to help people fix things. My younger self had a hard time accepting there were things I could not fix or figure out.
- zamalek 10y ago
  It's also dangerous advice. Seek professional attention first.
omginternets 10y ago
You're definitely not wrong, but the issue is that these are very difficult things to do in the midst of a depressive episode.

lawnchair_larry 10y ago

I wonder why people care whether or not somebody else really needs them. For arguments sake, let's say they don't. Suppose they can just man up and learn to deal with their first world problems. What do you lose by them taking something to make that easier? Do you normally fix all of your other problems in the most difficult way? We all seek ways to get an edge, if not against others, then at least to reclaim some of our own time and well-being. From their perspective, there are 3 kinds of people. There's the positive, motivated guy who can't wait to get out of bed and go make his mark on the world. Then, there is the similar character who has to take SSRIs or whatever to keep that going. Then there is the lethargic person who has to fight every day to pretend to give a shit, can't keep relationships together, doesn't get promotions, and doesn't feel motivated to learn new skills or hobbies. The last person doesn't really have the option of being person #1, but they may have a choice between being #2 or #3. Since all three of them end up in the ground after a few more decades anyway, why does it matter to others how they get there? Maybe the last 10 years or so of their life will cause them complications due to longterm use. It's hard to view that as a bad trade for folks who were miserable and/or suicidal for the first 50.

omginternets 10y ago
>What do you lose by them taking something to make that easier? Going with your argument, one stands to lose on at least two fronts: 1. severe side-effects 2. potential long-term harm stemming from chronic use (as per the present article) >Do you normally fix all of your other problems in the most difficult way? This is disingenuous. The argument is that fixing depression sans medication is a better (= safer, more effective) way. Granted, this argument is far from being obviously correct. Things also get murkier when we admit that there are various forms of depression, but that's not the point. The point is rather that you're arguing against a straw-man.
- lawnchair_larry 10y ago
  Neither 1 nor 2 answer the question. Why do you care if they do it? You suffer no side effects or long term harm.

Gfdfgjjmbvcd 10y ago

This hits home as my wife was admitted to a psychiatric ward today, again, for major depression. I am lost, with a business to run, a full time job in addition, two daughters, and struggles with minor depression and anxiety myself. She is on two antidepressants, Vyvanse (amphetamines), Provigil, and then takes trazadone to sleep. Her Dr will first increase one, then after that fails will add another or switch her. She's treated like a human Guinea pig. No one has thought to question whether the medications contribute. No one has looked at the problem holistically. Her diet is absolute shit, she doesn't exercise, she really doesn't take care of herself at all. And the medical professionals all tell her it's not her. She has a disease, she has a chemical imbalance, it is completely out of her control. Long story short, I see both sides. There most certainly IS personal responsibility. Even more damaging though is the state of psychiatric and mental health. It's learned, and reinforced, helplessness.

asymmetric 10y ago
I don't have much to add, other than I feel for you. I hope things get better for you, and for your loved ones.
aedron 10y ago
Man, that sounds rough. Puts some other problems into perspective. I feel for you and hope you guys pull through. I say this as someone who has been through worse stuff in my life than most people.
BasDirks 10y ago
Take care.
fivestar 10y ago
So you don't think your lifestyle as listed above has anything to do with your anxiety and mental health issues?

askvictor 10y ago

There are plenty of anecdotes here, which are fine for those wanting to share their story (I've been on two types of antidepressants myself). However, the point of this article is that there is insufficient long-term data. Anecdotes do not a longitudinal study make. And one of the major problems with depression is that it's subjective. Antidepressants have major onset side-effects, that take around a month to stabilise. So, you're feeling pretty crappy, but take the pills in the belief they'll make you better, and you have some strategies to deal with the nausea and other side-effects. In that onset month, you're probably feeling even crappier than before. But then your body/mind adjusts, the onset side-effects go away, and you feel better. So you report that you feel better after one month. Which skews the data pretty badly, as it's hard to be objective about how good/bad you're feeling at the best of times, let alone when you're in a slump and/or feeling nauseous from the drugs. For all of those people who say that antidepressants saved or improved their lives (or the life of a loved one), spare a thought for those where antidepressants led a decrease in quality of life, or worse.

jdavis703 10y ago

I wonder how much of Sarah's issues were a "nocebo" response, thinking that withdrawal would be bad. If so it might help if doctors and pharmacies provided a "guided reduction" (e.g. you get 19mg one week, 18mg the next etc). People might feel better just thinking that an "expert" has designed this program.

askvictor 10y ago
I don't know about Seroxat, but I've experienced undeniable symptoms withdrawing from antidepressants: "brain zaps" that I had no idea about until I started experiencing them, then found other people who had written of experiencing them as well. Additionally to those, I had a weird whooshing sound that I would hear whenever I moved my eyes to the top left. Took me a while to figure out the pattern/trigger (seemed random at first, and I thought I had something stuck in my ear). Actually kind of fascinating, if scary. That was on top of the nausea etc. And this was a 'guided' withdrawl (under medical direction). I don't discount that there might be a placebo/nocebo response in the side-effects (both onset and withdrawl) as well (as with any medication)

deleted 10y ago

[deleted]

dabber 10y ago

And of course the first ad in the article is for an antidepressant. Drop the ad script in and forget it they said... Targeted ads they said...

peteretep 10y ago

This is a terrible article. It leads with a random three paragraph anecdote about coming off an SSRI. This is a pretty well-known and well-documented phenomenon, and contributes nothing to a discussion of their safety. And then: > But many experts believe these drugs > do more good than harm Followed by a quote of someone saying the opposite, and nothing more to back that statement up at all. > Many SSRI users report blunted emotions That's kind of the point > “They should be called anti-sex drugs > rather than antidepressant drugs,” says > Jon Jureidini, a *child* psychiatrist Seriously? They're quoting a paediatric psychiatrist on the effects on libido of anti-depressants. Just a thought: if you're a child psychiatrist and your patients are having lots of sex, there may be other issues affecting their mental health. The article gets no less sloppy. Clickbait is clickbait even when wrapped up to look vaguely scientific.

liragg 10y ago

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liragg 10y ago

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thanatropism 10y ago

Ok, I can't resist this. First, chunk of the reason why SSRIs and to a lesser extent benzodiazepines are (perhaps) overprescribed is that they are safe, at least in the short term. In the bad old times antidepressants were dangerous, let alone antipsychotics and such. There's some interesting literature pointing to lithium as the Stephen-Curry-mit-Keith-Jarrett standard for long-term management of treatment-resistent depression, but man, taking lithium sucks. If all I had was the garden variety blues I would sure opt for the Zitalocipraoamezaxx they advertise on TV. Second, I think people are over-eager to blame pharma and not the doctors. These are tools, people, and power tools at that. Yes, some research released by pharma is biased in that they do not release the unfavorable studies, but there are plenty of blogs out there poring over the technicalia, as well as sharing experiences in real patient care. Maybe some of these things are overprescribed to the gen pop but they're still useful to us. Third, isn't funny that we're expected to be open-minded about recreational drugs and puritannical about pharmaceuticals? Effectively in many parts of the world now you can legally buy weed but cannot get Klonopin when needed unless you work through the system somehow. This should go without saying, but fourth: the goal of psychiatric treatment is never to make you happy or realignm your chakras. A pdoc doesn't ask "are you happy, are you sad", he asks "are you functional?" Meaning first: am I able to work? (This is the first thing -- it's not good for someone mentally ill to be homeless). Next: am I able to maintain and grow my personal relationships? Is my sex life ok? Am I overall satisfied with my quality of life and my ability to take and handle new challenges? If I can't get an erection (meds sometimes impact that), that's something he can try and help. If I'm questioning the usefulness of being a knowledge worker in a society pumped by a bubble of BS? That's on me. Your goals as a human being are still up to you.