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A Third of Antidepressants Are Prescribed for Something Else
- ogdoad 9y agotl;dr being happy solves a lot of problems
- tumba 9y agoThat’s a bit reductive. For example, many anti-depressants affect serotonin reputake, which is now known to be integral to gut function. Further, often these off-label uses are at doses far below the levels required for anti-depressant effects. A more accurate TL;DR might be something like: allowing off-label prescription is a two-edged sword. One the one hand, it has enabled innovation and the discovery of clinically effective treatments. On the other hand, the benefits are unevenly distributed because few doctors know about them, we know less about the side effects, and knowledge about effectiveness versus placebo is limited. I would comment that many off-label treatments using anti-depressants do have significant double-blind studies behind them.
- dang 9y agoPlease don't post shallow dismissals to this site. We're trying for something better here. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newswelcome.html https://news.ycombinator.com/newswelcome.html
- ogdoad 9y agoWasn't a dismissal, rather a comment, and technical language aside it stands as true: being happy "solves" problems collaterally, by rendering us oblivious to them.
- dang 9y agoIf you don't want your comments to be read as standard internet snarkytropes, you'll need to distinguish what you mean more clearly. In this case, the trivialization of an entire article to an idiotic tautalogy kind of signals that. On HN, if you have a substantive point to make, make it thoughtfully; if you don't, please don't comment until you do.
- DanBC 9y agoAntidepressants don't make people happy, they stop people being depressed.
- asdjasldkjkljd 9y agoThough I'm sure the guy with IBD would be pretty depressed if they couldn't help him medicate it, so how off-label is it really.
- deleted 9y ago[deleted]
- cthalupa 9y agoI recently started suffering from chronic headaches that usually start in the morning when I wake up, and come and go throughout the day. After getting an MRI and ruling out a brain tumor, we've been trying a variety of medications to take care of it. The most successful so far is an anti-depressant. Duloxetine. SNRI. I do have some of the side effects - my libido is markedly decreased, but it was fairly high to begin with, so I'm probably at about low-average now. I can still get in the mood on demand, and still want to initiate several times a week, so I'm more than happy to make the trade off to not have a basically constant headache 80% of my waking hours. Off label prescription is a pretty common thing. Personally, I'm glad for it.
- paul 9y agoThis may interest you: https://techcrunch.com/2017/10/08/curing-the-incurable/ https://techcrunch.com/2017/10/08/curing-the-incurable/
- deleted 9y ago[deleted]
- cthalupa 9y agoThankfully, mine are more of a mild annoyance than cripplingly painful. I'll check out Curable though, thank you!
- napsterbr 9y agoWhen I started taking duloxetine, I've experienced most or all of the side effects in the first ~4 weeks. After that they all went away. A friend of mine also had the same experience. This is a small data point but who knows, not sure how recently you started taking the meds but there is a chance all the side effects will vanish :)
- cthalupa 9y agoGlad to hear they went away! The side effects are pretty mild, though if I miss a dose the headache I get after is usually amplified.
- xkcd-sucks 9y agoYeah, this is a consequence of the fact that "antidepressant" is a marketing word, not a physically descriptive word.
- saas_co_de 9y agoYes, drugs have all kinds of secondary effects, and some may be useful for many things. (aspirin being the most notorious) Once you test something out on enough people it becomes much easier to find these patterns of secondary effects. It is actually kind of unfortunate that because of the stigma associated with mental illness some patients will refuse to take anti-depressants when prescribed for other conditions where they could be helpful.
- phkahler 9y agoCrohn's can also be improved with Glycine according to someone I know who started taking it for other reasons. A bit of googling then showed there may well be a connection, so the result made some sense. YMMV of course.
- mikestew 9y agoI figured it was going to be something like Wellbutrin to quit smoking which, while off-label, kinda makes sense. But IBD? Can’t say I saw that coming. Because I’m not all that interested in the topic I just skimmed, but I gather it is not well understood why such wildly off-label use works? (And “no, go read the article” is acceptable. :-) )
- astura 9y agoUm... Smoking cessation is not an off-label use of bupropion (Wellbutrin), it's an FDA approved use and it's very openly marketed as such. As far as the reason it seems to work, that was given as: >Studies on mice had shown that instead of blocking the action of inflammatory proteins, bupropion appeared to lower the production of those proteins in the first place. Bupropion also FDA approved for weight loss when mixed with the opioid antagonist naltrexone (brand-name Contrave). No use "make sense" more or less than any other use use, it's a substance that has lots of effects on the body.
- mikestew 9y agoUm... Smoking cessation is not an off-label use of bupropion (Wellbutrin) It was twenty some years ago when I took it. I obviously haven’t kept up with the latest, but a quick search says FDA approval came shortly after it was prescribed to me. Mea culpa. And thanks for the answer.
- aristus 9y agoThis is not in the least remarkable. The article does not mention it, but several maoi inhibitor drugs are effective for common varieties of epilepsy and have been used for decades.
- roma1n 9y agoYup, most drugs used in psychiatry also have indications for neurologic conditions.
- djsumdog 9y agoI'm actually more surprised to see original content on digg .. and to see digg for that matter, than the actual content of the article.
- jkuria 9y agoSame here. Surprised that Digg still exists! Remember the Digg vs. Reddit Wars of 2006?
- boomboomsubban 9y ago"This article was first published by Wellcome on Mosaic and is republished here under a Creative Commons license"
- ekianjo 9y agoThats because antidepressant is just one of the many activities of such class of drugs. Its like saying that Viagra is a pulmonary hypertension drug, prescribed for something else. Indications are not binary things.
- ianai 9y agoNot to mention chronic conditions can easily depress someone.
- hacknat 9y agoNot to mention mood disorders are still not well understood. Anxiety and Depression actually manifest different symptoms in other cultures.
- glastra 9y agoAs true as that might be, I strongly believe depression as a disease/condition should only be diagnosed (and thus treated) if there is no real cause for the symptoms. Being sad and unable to leave the bed because (your dog died | you are morbidly obese | you are going to die in 3 months) doesn't qualify as depression.
- Broken_Hippo 9y agoActually, just because there is a reason for you to be depressed doesn't mean that you don't have depression. Depression can cause abnormal responses to life's events. Not to mention the fact that a life event - death of a loved one, death of yourself, or a bad situation - can cause an episode of clinical depression. The basics with mental health is that it needs to be abnormal and/or cause problems doing basic life stuff. So back to your example: Not leaving the bed because your dog died can be a red flag of depression. Or cause it in a few people (death of significant other, parent, or child is probably more likely to cause it though). This is especially true the longer the person has the symptom - none of us would blame a person for taking a couple days off, but you should be able to function at work a few days later. It doesn't matter if obesity is the cause of the depression if the state of mind keeps them from doing self-care. And I don't know why it would be bad to let some terminally sick person to take happy drugs. It seriously doens't matter at this point because they will probably be dead. Might as well enjoy what you can of the rest. This is probably a bad example all around and likely hard to diagnose properly.
- code4tee 9y agoSome anti-smoking drugs are actually just antidepressants sold under a different brand name. It’s literally exactly the same drug with a different name stamped on the pills, but it’s easier to get people to take the drug if they think it’s a “pill to help you quit smoking” and not an “anti depressant”
- jackhack 9y agoanti-anxiety meds, to be precise. reducing anxiety reduces the drive to smoke. it was discovered ass a side-effect during clinical trials, that many subjects spontaneously quit smoking.
- fatbird 9y agoIn my experience, they were quite upfront about the fact that it was an anti-depressant that had the effect of aiding quitting smoking, because it fairly obviously dealt with the predictable effects of trying to quit smoking: anxiety, depression, irritability. You're making it sound like a stealth SSRI channel, and it's not.
- yeukhon 9y agoI am not sure if all physicans have adequate training on psychoatic drugs, but giving SSRI to a patient with both bipolar and personality disorder can have very negative effects. So if a non-psychiatrist prescribing antidepressant to someone without adequate psychatric evaluation (and evaluation can be off too), you can end up making the patient ill. So if I were given SSRI to quit smoking, my mental health may get even more worse. Disclaimer: have bipolar and personality disorder.
- fatbird 9y agoI understand. I also understand that even with a psychiatrist prescribing it appropriately, with full evaluation and diagnosis for depression, a particular SSRI can make the patient worse, not better. I've had friends spend years working through various prescriptions (and combinations) to find what worked, and it often included some hellish periods when they felt far worse until they hit on the right drug(s).
- Nomentatus 9y agoTricyclics in general are very powerful antihistamines (this may be the real reason they work, for some in fact.) Ginger is also a very powerful antihistamine - comparable to drugs - with fewer side effects, however.
- skimaskninja87 9y agoMy mother had a stroke and was prescribed Clonazepam for her nerves and anxiety from the after effects.
- rootw0rm 9y agoI can't take an article about drugs seriously if it's written by someone who takes antidepressants for depression/anxiety.
- Lerc 9y agoHere's an interesting counterpoint to the anecdote at the start of the story. I have chronic treatment resistant depression. Gone through many different treatments. The thing that works best for me is a treatment I receive for something else. A THF-alpha inhibitor (in my case Etanercept), so I'm in practically the opposite position to the guy in the article. I suspect there's a link in some form of branch of depression that comes with the autoimmune grab bag of fun.
- jokoon 9y agoIt's because antidepressant are a miracle drug. Sedentary work weeks and normative society will always drain your energy and kill your soul. I have the opinion that most people should use antidepressants.
- jdietrich 9y agoDrug companies have aggressively and unlawfully marketed off-label use for decades, with the most egregious examples being psychiatric drugs. Pfizer were fined $2.3bn for off-label promotion of Bextra, Geodon, Zyvox and Lyrica. Eli Lilly were fined $1.4bn for off-label promotion of Zyprexa. GSK were fined $3bn for a slew of misconduct, including off-label promotion of a dozen drugs. AstraZeneca were fined $520m for off-label promotion of Seroquel. Abbott were fined $800m for off-label promotion of Depakote. Novartis were fined $422m for off-label promotion of Trileptal. Despite these huge fines, the unlawful marketing continues. I don't think we're taking the issue nearly seriously enough. For years, drug companies have been telling (and even bribing) doctors to prescribe drugs with serious side-effects to vulnerable patients based on no real evidence. There's a deep malaise at the heart of the pharmaceuticals industry. Marketing has become the core function of many drug companies. Blatantly fraudulent marketing is endemic. Drug companies are chalking up billion dollar fines as a cost of doing business. I urge you to read the GSK settlement agreement. They admitted to promoting the prescription of Paxil to children, while having no evidence of efficacy and hiding evidence that it increased the risk of suicide. They admitted to hiding evidence that Avandia increased the risk of congestive heart failure and myocardial infarction. They admitted to bribing doctors to prescribe half a dozen drugs for off-label use. This level of corruption would be outrageous in the developing world, let alone the richest country on earth. https://www.justice.gov/opa/pr/glaxosmithkline-plead-guilty-and-pay-3-billion-resolve-fraud-allegations-and-failure-report https://www.justice.gov/opa/pr/glaxosmithkline-plead-guilty-...
- harimau777 9y agoJust asked a retired pharmacist and clinical social worker (two family members) about this. They said that there were numerous things that anti-depressants are prescribed for (smoking cessation, OCD, anxiety, etc.) which are NOT off-label uses.
- mhalle 9y agoTwo other interesting examples: Trazadone is one of the most commonly prescribed insomnia medications. It isn't FDA approved for that. It is a decade's old generic antidepressant. The sleep dose is much less than the regulated theraputic dose. Through mechanisms not fully understood, people with liver disease often experience intense skin itching. Standard dermatology approaches have essentially no effect. SSRIs are one well tolerated treatment. In neither case is their obvious profit motive or overselling by drug companies.
- frgtpsswrdlame 9y agoSure but shouldn't those drugs undergo FDA approval for those uses? You make it sound as if they're very effective without many side effects so (as far as FDA approvals go) it shouldn't be too hard.
- mhalle 9y agoNo, I was just noting two other examples.
- DougWebb 9y agoMy ex-wife had intense skin itching. We didn't realize that her transplanted liver had started failing. A neighbor happened to notice her scratching, and happened to know about the liver disease connection, and happened to mention it. After some tests to confirm her liver was failing her meds were adjusted to slow the process down. It failed several years later anyway (she survived a second liver transplant) but without proper treatment it would've failed much sooner. I always say to be wary of treating symptoms instead of underlying causes. Taking an antidepressant to soothe intense skin itching can kill you, if that's all you're doing for it. Your dermatologist may not know any better, or may not care.
- evanbishop 9y agoI am glad that Briggs could heal his ulcerative colitis with an unorthodox treatment. "On occasions when she stopped taking bupropion, the blood and abdominal pain returned until she started taking the drug again." Yet I guess I am unimpressed when I hear that symptoms diminish with use of a drug like bupropion. Eventually when the patient gets tired of the side effects they will get off the medication. This will leave them with the return of the illness they used the drug to treat in addition to the damage it caused in other parts of the body. Masking symptoms is sort of psychiatry's gambit so I guess this is nothing new.