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> Drugs for depression may not make enough money these days since there is insufficient evidence that they really do much. Ignoring the fact that I'd like to s

> Drugs for depression may not make enough money these days since there is insufficient evidence that they really do much. Ignoring the fact that I'd like to see your evidence for the latter claim, there certainly hasn't been a drop in prescriptions of antidepressants or a lack of new patented (and popular) ones.

philovivero 9y ago
This blog post seems pretty well-cited: http://slatestarcodex.com/2017/06/05/is-pharma-research-worse-than-chance/ http://slatestarcodex.com/2017/06/05/is-pharma-research-wors... Note for the uninitiated: I'm being sarcastically understated here. The author in question is an authority in drugs for depression and writes extremely lengthy and well-cited essays. He's also a very engaging author.
- johncolanduoni 9y ago
  I've read his blog for a number of years. He is saying new drugs haven't improved much on those available at the beginning of the 21st century. Scott is not very pessimistic at all about SSRIs being useful. Here's an essay from him (that is much longer and better cited) debunking the "antidepressants are basically placebo" narrative: http://slatestarcodex.com/2014/07/07/ssris-much-more-than-you-wanted-to-know/ http://slatestarcodex.com/2014/07/07/ssris-much-more-than-yo... And another where he explicitly recommends SSRIs: http://slatestarcodex.com/2014/06/16/things-that-sometimes-help-if-youre-depressed/ http://slatestarcodex.com/2014/06/16/things-that-sometimes-h... I was really shocked that you posted something from his blog, but I guess if you've already decided the answer you can find evidence anywhere you look.
FullMtlAlcoholc 9y ago
Here is a decent summation of the effecticeness of anti-depressants as modalities for different conditions: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3398684/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3398684/ My .02c: Modern anti-depressants are less effective than the MAOi's they replaced and haven't advanced much in the last 50 years. It's not surprising since our knowledge of the brain's function and structure (at the cellular level and below) is roughly where our understanding of genetics was in the 1950's (note, it wont take 60+ years to catch up). The Human Connectome(mapping of the 100 trillion connections our neurons make) and Obama's BRAIN initiative (taking ultra detailed scans of super thin slices of the brain) as well as a mature brain informatics field will push knowledge quantum leaps forward. Lets hope scientists have learned their lesson from rhe genome and don't label parts of the brain they dont understand as junk neurons or simply take a reductionist approach. The brain is fractal... we have more or. less the same neurons as a fly. Using these same parts and simple instructions, when you scale a brain, you get us. When you Garry Kasparov was defeated by Deep Blue who tried to control them by saying you were defeated by quantity not quality period he retorted with enough quantity comes quality
- johncolanduoni 9y ago
  You're right, MAOIs and tricyclics are usually more effective than any of the newer classes. They also have drastically worse side effects, especially when you look at discontinuation rates. We're talking about the difference between making eating cheese extremely dangerous and possibly fatal (some MAOIs) and sexual dysfunction (most SSRIs). That also wasn't what they said: the claim was that antidepressants weren't really effective, not that they haven't really gotten better in the 21st century.
  - FullMtlAlcoholc 9y ago
    > You're right, MAOIs and tricyclics are usually more effective than any of the newer classes. They also have drastically worse side effects, especially when you look at discontinuation rates. We're talking about the difference between making eating cheese extremely dangerous and possibly fatal (some MAOIs) and sexual dysfunction (most SSRIs). You're looking at the older class of MAOIs. Although it is probably a bit overhyped, Selegelline has all the advantages of MAOIs with hardly any of the dietary restrictions. Only those who subsisted on a diet of aged, stinky cheese like Roquefort or otherwise consumed excessive amounts of Tyramine are at risk. You still have to be careful not to take certain medicines, mostly those containing pseudoephedrine. As selegiline is also used as a treatment for parkinson's, it has shown to be neuroprotective, and enhances/induces the differentiation of neural stem cells into neurons (neurogenesis) and is used off label as a nootropic. (Disclaimer: I was taking this prescription until I no longer needed it and saw tremendous results) Modern anti-depressants certainly are more effective than a placebo and have saved many lives. However, I think that a significant % of people would also receive the same or greater results from exercise or mindful meditation. I don't have any numbers in front of me, but anti-depressants are over-prescribed to people who are not clinically depressed but who aren't as happy as they feel they should be. As we glean more results from the various public/private brain research partnerships our undeerstanding should lead to more effective modalities of treatment. How long it takes to get through clinical trials.
  - jdietrich 9y ago
    SSRIs are a much better choice for doctors, but they're not necessarily a better choice for patients. For a doctor, it's a no-brainer to sacrifice a bit of efficacy to avoid the rare catastrophic risks of TCAs or MAOIs. For a patient, the choice may be more nuanced. The side effects of SSRIs aren't particularly dangerous, but they're often very unpleasant.

philovivero 9y ago

This blog post seems pretty well-cited: http://slatestarcodex.com/2017/06/05/is-pharma-research-worse-than-chance/ http://slatestarcodex.com/2017/06/05/is-pharma-research-wors... Note for the uninitiated: I'm being sarcastically understated here. The author in question is an authority in drugs for depression and writes extremely lengthy and well-cited essays. He's also a very engaging author.

johncolanduoni 9y ago
I've read his blog for a number of years. He is saying new drugs haven't improved much on those available at the beginning of the 21st century. Scott is not very pessimistic at all about SSRIs being useful. Here's an essay from him (that is much longer and better cited) debunking the "antidepressants are basically placebo" narrative: http://slatestarcodex.com/2014/07/07/ssris-much-more-than-you-wanted-to-know/ http://slatestarcodex.com/2014/07/07/ssris-much-more-than-yo... And another where he explicitly recommends SSRIs: http://slatestarcodex.com/2014/06/16/things-that-sometimes-help-if-youre-depressed/ http://slatestarcodex.com/2014/06/16/things-that-sometimes-h... I was really shocked that you posted something from his blog, but I guess if you've already decided the answer you can find evidence anywhere you look.

FullMtlAlcoholc 9y ago

Here is a decent summation of the effecticeness of anti-depressants as modalities for different conditions: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3398684/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3398684/ My .02c: Modern anti-depressants are less effective than the MAOi's they replaced and haven't advanced much in the last 50 years. It's not surprising since our knowledge of the brain's function and structure (at the cellular level and below) is roughly where our understanding of genetics was in the 1950's (note, it wont take 60+ years to catch up). The Human Connectome(mapping of the 100 trillion connections our neurons make) and Obama's BRAIN initiative (taking ultra detailed scans of super thin slices of the brain) as well as a mature brain informatics field will push knowledge quantum leaps forward. Lets hope scientists have learned their lesson from rhe genome and don't label parts of the brain they dont understand as junk neurons or simply take a reductionist approach. The brain is fractal... we have more or. less the same neurons as a fly. Using these same parts and simple instructions, when you scale a brain, you get us. When you Garry Kasparov was defeated by Deep Blue who tried to control them by saying you were defeated by quantity not quality period he retorted with enough quantity comes quality

johncolanduoni 9y ago
You're right, MAOIs and tricyclics are usually more effective than any of the newer classes. They also have drastically worse side effects, especially when you look at discontinuation rates. We're talking about the difference between making eating cheese extremely dangerous and possibly fatal (some MAOIs) and sexual dysfunction (most SSRIs). That also wasn't what they said: the claim was that antidepressants weren't really effective, not that they haven't really gotten better in the 21st century.
- FullMtlAlcoholc 9y ago
  > You're right, MAOIs and tricyclics are usually more effective than any of the newer classes. They also have drastically worse side effects, especially when you look at discontinuation rates. We're talking about the difference between making eating cheese extremely dangerous and possibly fatal (some MAOIs) and sexual dysfunction (most SSRIs). You're looking at the older class of MAOIs. Although it is probably a bit overhyped, Selegelline has all the advantages of MAOIs with hardly any of the dietary restrictions. Only those who subsisted on a diet of aged, stinky cheese like Roquefort or otherwise consumed excessive amounts of Tyramine are at risk. You still have to be careful not to take certain medicines, mostly those containing pseudoephedrine. As selegiline is also used as a treatment for parkinson's, it has shown to be neuroprotective, and enhances/induces the differentiation of neural stem cells into neurons (neurogenesis) and is used off label as a nootropic. (Disclaimer: I was taking this prescription until I no longer needed it and saw tremendous results) Modern anti-depressants certainly are more effective than a placebo and have saved many lives. However, I think that a significant % of people would also receive the same or greater results from exercise or mindful meditation. I don't have any numbers in front of me, but anti-depressants are over-prescribed to people who are not clinically depressed but who aren't as happy as they feel they should be. As we glean more results from the various public/private brain research partnerships our undeerstanding should lead to more effective modalities of treatment. How long it takes to get through clinical trials.
- jdietrich 9y ago
  SSRIs are a much better choice for doctors, but they're not necessarily a better choice for patients. For a doctor, it's a no-brainer to sacrifice a bit of efficacy to avoid the rare catastrophic risks of TCAs or MAOIs. For a patient, the choice may be more nuanced. The side effects of SSRIs aren't particularly dangerous, but they're often very unpleasant.