7 ms·

Not only we don’t understand the mechanism causing depression, we don’t really understand (as far as I am aware) why medications work or don’t work. I deal with

by jeklj 8y ago

Not only we don’t understand the mechanism causing depression, we don’t really understand (as far as I am aware) why medications work or don’t work. I deal with mild depression sometimes, but this scares me off of considering medication for it. I’ve encountered so many horror stories of withdrawal symptoms... you really need to be at a point of desperation to consider drugs for it, imo.

gumby 8y ago
Sadly this is true. "depression", like so many diseases, is named after its symptoms rather than etiology. So if we even have an effective drug, it will only be effective on a subset of the sufferers. Plus we understand so little macro neurochemistry we don't even understand which apparently correlated biomarkers are causal and which are consequential. The same problem exists with other neurological diseases such as Alzheimers. With depression, as it seems to affect higher function, we even have difficulty (and treatment affordances) with non-chemical stimuli. Still, it's very much worth working on -- people are suffering such serious debilitation.
- Elof 8y ago
  I’ve benefited greatly from various medications combined with non-chemical strategies. When I first considered medication I talked with my Doctor, talked with some friends that are Doctors, and did my own research and every resource came up with the same basic info, we don’t actually know that much... Add onto that finding a combination of things that ‘worked’ was a trial and error process that took over a year, all while I was dealing with my mental health issues. Sadly so many people in a similar situation don’t have the flexibility, access and/or support to go down the path that I did. Often they will opt out because of the stigma associated with having mental health issues. The fact that we know so little leaves tons of room for improvement in addressing mental health, but I worry that we have a very long road to giant leaps in addressing mental health unless we can destigmatize mental disabilities (and other neurological conditions)
finaliteration 8y ago
I think a larger problem is that it’s such a crapshoot about which treatments will work for a given individual, pharmaceutical or not. It took me about 10 therapists with varying backgrounds before I finally found one that would help. It also took me trying several different medications to find a combination that’s actually effective. It’s a lot of work and effort, and most people suffering through depression, anxiety, or another debilitating mental health disorder don’t have the energy to keep trying over and over again after failing. For me it was actually a matter of life or death and needing to keep going for my family that drove me to keep trying.
- Elof 8y ago
  I had a very similar experience to what you’re describing and most other folks I know that have ‘figured out’ a treatment share a similar experience as well (more info in a comment below).
- InGodsName 8y ago
  what worked in your case?
  - Elof 8y ago
    I have bipolar disorder and take a stimulant, a mood stabilizer, and sometimes an antidepressant. I’ve done my best to make my personal and professional work schedule comfortable, do mindful breathing exercises, take almost all my meeting outside and walking, and try to exercize 3 times a week. It’s a lot to manage while having a family but it’s very worth it IMO
  - finaliteration 8y ago
    I suffer from PTSD due to childhood trauma which is ultimately the cause of my anxiety, depression, mood swings, etc,. Right now I’m seeing a therapist who specializes in trauma and going through EMDR (eye movement desensitization and reprocessing) treatment. I’ve also taken Wellbutrin (anti-depressant) and Lamictal (mood stabilizer) for the last 18 months or so. I also just have to constantly keep busy. I fill my time with work and activities with my family. I rarely take downtime because if I do the dread and flashbacks rear their ugly heads.
ultimape 8y ago
My first experience with an antidepressant left me feeling quite ill. Ironically, its one of the ones that gets prescribed often because it has little side-effects. Turned out that this wasn't true, and I was one of the small percentage who experienced Discontinuation Syndrome (https://www.karger.com/Article/FullText/370338 https://www.karger.com/Article/FullText/370338). Having such a bad reaction to it lead me down a wild goose chase toward finding out the way my body processes serotonin ala a gene test, helped me figure out what was causing the depression to begin with. Another reply here talks about how it seems to be a crapshoot for finding effective drugs and a lot of trial and error. I think that there may be promise in doing drug targeting genetic tests and possibly microbiome sampling as a way to help people avoid the run-around. In my case, knowing this ahead of time would have helped me avoid a lot of suffering and 3 years of obsessively searching for answers.
- atomical 8y ago
  Genetic tests seem pointless. It's cheaper and faster to take the drug and find out if one is a responder.
  - aaavl2821 8y ago
    I think what s/he's referring to are tests for mutations in certain liver enzymes that are known to interfere with a drugs function. These are cheap and quick tests (these aren't sequencing based tests) and quite good at predicting non-responders On the other hand it can take 4-6 weeks to see if someone responds to a drug, and the drug can cause adverse events in addition to not treating the disease So in this case it is cheaper, faster and safer to take the test before prescribing
  - volkl48 8y ago
    The side effects of many of the medications can be quite harsh and severely affect your mental state when they don't agree with you. The most obvious example of such would be the significant number of people who experience suicidal ideation or commit it/make attempts as a result of going on certain medications. But at the less extreme end, you're likely looking at least a month or two, more likely 3 or 4 for each medication attempt. That's going on, taking it for long enough to have an effect, going back off, repeat. With how severe the side effects can be for many, that's enough time to lose a job, fail out of college, etc. And you're asking them to potentially spend years in that cycle to maybe fine something that works.
astazangasta 8y ago
Most medications DON'T work for most people. For example here[1] is a meta-analysis from 2004 of the top 6 antidepressants which finds that 80% of the effect is achieved by placebo, and the remaining effect is statistically, but not clinically, significant (that is, the effect size is tiny). Here[2] is another follow-up that shows that there may be effects only in the most severely-depressed patients. In addition the theoretical foundation of many drugs is lacking - the seratonin theory underlying SSRIs, for example, is now widely rejected (although SSRIs continue to be prescribed for some reason probably relating to drug company profits). Given the well-known addictive nature of most anti-depressants, I have always advised my friends to steer away from them, or wean themselves off, and favor talking therapies instead. Everyone else should do the same. [1] https://www.researchgate.net/publication/228550299_The_Emperor's_New_Drugs_An_Analysis_of_Antidepressant_Medication_Data_Submitted_to_the_US_Food_and_Drug_Administration https://www.researchgate.net/publication/228550299_The_Emper... [2] https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0050045 https://journals.plos.org/plosmedicine/article?id=10.1371/jo...
- DanBC 8y ago
  Do you know you're listing a paper widely described as one of the most controversial psychology papers? Here's a response, using the same data, but getting different results: https://annals-general-psychiatry.biomedcentral.com/articles/10.1186/1744-859X-12-26 https://annals-general-psychiatry.biomedcentral.com/articles... > The results reported here conclude the debate on the efficacy of antidepressants and suggest that antidepressants are clearly superior to placebo. They also suggest that baseline severity cannot be utilized to dictate whether the treatment should include medication or not. Suggestions like this, proposed by guidelines or institutions (e.g. the NICE), should be considered mistaken.
  - astazangasta 8y ago
    I'd expect any paper that shits on an entire field and especially on a massively profitable industry to be controversial. Here is Kirsch's reply to Fountolakis's paper, by the way: https://academic.oup.com/ijnp/article/15/8/1193/659638 https://academic.oup.com/ijnp/article/15/8/1193/659638
InGodsName 8y ago
Did you try Withania, i wonder why it's never prescribed bu anyone: https://examine.com/supplements/ashwagandha/ https://examine.com/supplements/ashwagandha/
perseusmandate 8y ago
Having gone off antidepressants cold turkey 4+ times withdrawal stuff is wildly overblown, which is corroborated by almost all the literature It probably has more to do with a relapse back into depressive symptoms than anything in most cases

by jeklj 8y ago

gumby 8y ago

Sadly this is true. "depression", like so many diseases, is named after its symptoms rather than etiology. So if we even have an effective drug, it will only be effective on a subset of the sufferers. Plus we understand so little macro neurochemistry we don't even understand which apparently correlated biomarkers are causal and which are consequential. The same problem exists with other neurological diseases such as Alzheimers. With depression, as it seems to affect higher function, we even have difficulty (and treatment affordances) with non-chemical stimuli. Still, it's very much worth working on -- people are suffering such serious debilitation.

Elof 8y ago
I’ve benefited greatly from various medications combined with non-chemical strategies. When I first considered medication I talked with my Doctor, talked with some friends that are Doctors, and did my own research and every resource came up with the same basic info, we don’t actually know that much... Add onto that finding a combination of things that ‘worked’ was a trial and error process that took over a year, all while I was dealing with my mental health issues. Sadly so many people in a similar situation don’t have the flexibility, access and/or support to go down the path that I did. Often they will opt out because of the stigma associated with having mental health issues. The fact that we know so little leaves tons of room for improvement in addressing mental health, but I worry that we have a very long road to giant leaps in addressing mental health unless we can destigmatize mental disabilities (and other neurological conditions)

finaliteration 8y ago

I think a larger problem is that it’s such a crapshoot about which treatments will work for a given individual, pharmaceutical or not. It took me about 10 therapists with varying backgrounds before I finally found one that would help. It also took me trying several different medications to find a combination that’s actually effective. It’s a lot of work and effort, and most people suffering through depression, anxiety, or another debilitating mental health disorder don’t have the energy to keep trying over and over again after failing. For me it was actually a matter of life or death and needing to keep going for my family that drove me to keep trying.

Elof 8y ago
I had a very similar experience to what you’re describing and most other folks I know that have ‘figured out’ a treatment share a similar experience as well (more info in a comment below).
InGodsName 8y ago
what worked in your case?
- Elof 8y ago
  I have bipolar disorder and take a stimulant, a mood stabilizer, and sometimes an antidepressant. I’ve done my best to make my personal and professional work schedule comfortable, do mindful breathing exercises, take almost all my meeting outside and walking, and try to exercize 3 times a week. It’s a lot to manage while having a family but it’s very worth it IMO
- finaliteration 8y ago
  I suffer from PTSD due to childhood trauma which is ultimately the cause of my anxiety, depression, mood swings, etc,. Right now I’m seeing a therapist who specializes in trauma and going through EMDR (eye movement desensitization and reprocessing) treatment. I’ve also taken Wellbutrin (anti-depressant) and Lamictal (mood stabilizer) for the last 18 months or so. I also just have to constantly keep busy. I fill my time with work and activities with my family. I rarely take downtime because if I do the dread and flashbacks rear their ugly heads.

ultimape 8y ago

My first experience with an antidepressant left me feeling quite ill. Ironically, its one of the ones that gets prescribed often because it has little side-effects. Turned out that this wasn't true, and I was one of the small percentage who experienced Discontinuation Syndrome (https://www.karger.com/Article/FullText/370338 https://www.karger.com/Article/FullText/370338). Having such a bad reaction to it lead me down a wild goose chase toward finding out the way my body processes serotonin ala a gene test, helped me figure out what was causing the depression to begin with. Another reply here talks about how it seems to be a crapshoot for finding effective drugs and a lot of trial and error. I think that there may be promise in doing drug targeting genetic tests and possibly microbiome sampling as a way to help people avoid the run-around. In my case, knowing this ahead of time would have helped me avoid a lot of suffering and 3 years of obsessively searching for answers.

atomical 8y ago
Genetic tests seem pointless. It's cheaper and faster to take the drug and find out if one is a responder.
- aaavl2821 8y ago
  I think what s/he's referring to are tests for mutations in certain liver enzymes that are known to interfere with a drugs function. These are cheap and quick tests (these aren't sequencing based tests) and quite good at predicting non-responders On the other hand it can take 4-6 weeks to see if someone responds to a drug, and the drug can cause adverse events in addition to not treating the disease So in this case it is cheaper, faster and safer to take the test before prescribing
- volkl48 8y ago
  The side effects of many of the medications can be quite harsh and severely affect your mental state when they don't agree with you. The most obvious example of such would be the significant number of people who experience suicidal ideation or commit it/make attempts as a result of going on certain medications. But at the less extreme end, you're likely looking at least a month or two, more likely 3 or 4 for each medication attempt. That's going on, taking it for long enough to have an effect, going back off, repeat. With how severe the side effects can be for many, that's enough time to lose a job, fail out of college, etc. And you're asking them to potentially spend years in that cycle to maybe fine something that works.

astazangasta 8y ago

Most medications DON'T work for most people. For example here[1] is a meta-analysis from 2004 of the top 6 antidepressants which finds that 80% of the effect is achieved by placebo, and the remaining effect is statistically, but not clinically, significant (that is, the effect size is tiny). Here[2] is another follow-up that shows that there may be effects only in the most severely-depressed patients. In addition the theoretical foundation of many drugs is lacking - the seratonin theory underlying SSRIs, for example, is now widely rejected (although SSRIs continue to be prescribed for some reason probably relating to drug company profits). Given the well-known addictive nature of most anti-depressants, I have always advised my friends to steer away from them, or wean themselves off, and favor talking therapies instead. Everyone else should do the same. [1] https://www.researchgate.net/publication/228550299_The_Emperor's_New_Drugs_An_Analysis_of_Antidepressant_Medication_Data_Submitted_to_the_US_Food_and_Drug_Administration https://www.researchgate.net/publication/228550299_The_Emper... [2] https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0050045 https://journals.plos.org/plosmedicine/article?id=10.1371/jo...

DanBC 8y ago
Do you know you're listing a paper widely described as one of the most controversial psychology papers? Here's a response, using the same data, but getting different results: https://annals-general-psychiatry.biomedcentral.com/articles/10.1186/1744-859X-12-26 https://annals-general-psychiatry.biomedcentral.com/articles... > The results reported here conclude the debate on the efficacy of antidepressants and suggest that antidepressants are clearly superior to placebo. They also suggest that baseline severity cannot be utilized to dictate whether the treatment should include medication or not. Suggestions like this, proposed by guidelines or institutions (e.g. the NICE), should be considered mistaken.
- astazangasta 8y ago
  I'd expect any paper that shits on an entire field and especially on a massively profitable industry to be controversial. Here is Kirsch's reply to Fountolakis's paper, by the way: https://academic.oup.com/ijnp/article/15/8/1193/659638 https://academic.oup.com/ijnp/article/15/8/1193/659638

InGodsName 8y ago

Did you try Withania, i wonder why it's never prescribed bu anyone: https://examine.com/supplements/ashwagandha/ https://examine.com/supplements/ashwagandha/

perseusmandate 8y ago

Having gone off antidepressants cold turkey 4+ times withdrawal stuff is wildly overblown, which is corroborated by almost all the literature It probably has more to do with a relapse back into depressive symptoms than anything in most cases