4 ms·

Hmm but Prozac was never that great anyway. There is very little evidence that depression is caused by chemical imbalance in the brain, it's something that big

Hmm but Prozac was never that great anyway. There is very little evidence that depression is caused by chemical imbalance in the brain, it's something that big pharma have sold you so they can sell their drugs. Great book on the topic, check out lost connections.

stordoff 8y ago
There is however evidence that they work: https://www.nhs.uk/news/medication/big-new-study-confirms-antidepressants-work-better-placebo/ https://www.nhs.uk/news/medication/big-new-study-confirms-an...
- Alex3917 8y ago
  IIRC there have only been two studies on antidepressants that have gone on longer than 2 years and have been properly placebo controlled (active placebo, no washout group), so if a metastudy claims to include 21 studies then that's pretty good evidence that the metastudy is flawed.
  - SketchySeaBeast 8y ago
    As depression has an average course of 4 months I wonder what effects we should expect to see after years.
    - DuskStar 8y ago
      What's the average course of antidepressants, though? I know in my case it's been quite a lot longer than 4 months...
  - stordoff 8y ago
    This is noted in the limitations : > The results are reported after 8 weeks of treatment, so we don't know if they apply to long-term use of antidepressants. I'm not sure why you would discount an improvement in symptoms over 8 weeks though. Many major depressive episodes will be resolved in that time ("The median duration of MDE was 3.0 months; 50% of participants recovered within 3 months"[1]), so even if they are not suitable, or less effective, for long term care, that can still be a improvement in quality of life. [1] https://www.ncbi.nlm.nih.gov/pubmed/12204924 https://www.ncbi.nlm.nih.gov/pubmed/12204924 (FWIW, it was 21 antidepressants, not 21 studies: "The researchers found 522 studies covering 116,477 patients in total. This included 101 previously unpublished studies.")
    - Alex3917 8y ago
      > I'm not sure why you would discount an improvement in symptoms over 8 weeks though. I'm not, but I don't think anyone is arguing that SSRIs can't be effective for some people with severe depression when used in the short term. The issue is that that only represents a small percentage of patients.
kl4m 8y ago
The best thing about publishing books is they don't need that pesky peer review!
darpa_escapee 8y ago
Yes, while the "moar serotonin = moar happy" explanation of why antidepressants work is oversimplified and wrong in many cases, there is empirical evidence that some antidepressants are effective at treating the symptoms of depression and other illnesses.
- shadowbannedtoo 8y ago
  I'm to depressed to look it up again, but there was a Psychologist Dr. Irving Kirsh whom used the Freedom of Information Act to study All the studies on antidepressants. He found they didn't work better than Placebo. I looked up the first thing I found on Google. https://www.psychologytoday.com/us/blog/psych-unseen/201802/do-antidepressants-work-yes-no-and-yes-again https://www.psychologytoday.com/us/blog/psych-unseen/201802/... This is written about Kirsh's study, and it's confusing. Kirsh interpolation of the raw data showed that antidepressants don't work, and work less so for extremely depressed patients. This doctor claims the opposite? Pesonally, I find the research on the efficacy of antidepressants very confusing. To those whom are depressed, I can offer this, it does get better with age.
pw 8y ago
You can also check out Peter Kramer's "Ordinarily Well: The Case for Antidepressants" for the exact opposite take. And "Against Depression", also by Peter Kramer, is a good take on recent findings about the biological roots of depression.
- _underfl0w_ 8y ago
  Does Mr. Kramer have anything peer-reviewed?
  - SketchySeaBeast 8y ago
    Dr. Kramer - he's a psychiatrist, who specializes in depression. I only point this out as the gentleman who wrote "Lost Connections" is a journalist, and thus holds no education to the discussion.
aaaaaaaaaaab 8y ago
There’s very little evidence for a broken leg being caused by the lack of plaster around it, yet nobody questions its efficacy...
- wu-ikkyu 8y ago
  How is that comparable? Seems like a non sequitur
  - aaaaaaaaaaab 8y ago
    The treatment of a condition need not be the “inverse” of its cause. A broken bone can be fixed by immobilizing it via a plaster cast. Did the bone break due to the lack of plaster? Eczema can be fixed by applying topical steroids. Did eczema develop due to the lack of topical steroids? Depression can be fixed by inducing changes in neurochemistry. Did depression arise due to an imbalance in neurochemistry?
  - deleted 8y ago
    [deleted]
philwelch 8y ago
I'm generally skeptical about SSRI's, but I think this goes too far into conspiracy territory. The problem with SSRI's, especially in my experience and from my understanding, is that they aim for "mildly beneficial with minimal side effects" and hit somewhere closer to, "mildly beneficial with understated side effects that many patients will be too embarrassed to report". This doesn't mean SSRI's are total junk, but it does mean that they're kind of mediocre. Ketamine is more of a high-risk high-reward drug, similar to the use of CNS stimulants to treat ADD. There's no question that amphetamines help people focus. There's also, understandably, far more concern about giving people amphetamines in the first place. Also, it's easier to convince patients to take a boring prescription drug than to sell them on, "I think the real solution to your problem is this really scary-sounding drug that people take at raves; trust me, I'm a psychiatrist."

stordoff 8y ago

There is however evidence that they work: https://www.nhs.uk/news/medication/big-new-study-confirms-antidepressants-work-better-placebo/ https://www.nhs.uk/news/medication/big-new-study-confirms-an...

Alex3917 8y ago
IIRC there have only been two studies on antidepressants that have gone on longer than 2 years and have been properly placebo controlled (active placebo, no washout group), so if a metastudy claims to include 21 studies then that's pretty good evidence that the metastudy is flawed.
- SketchySeaBeast 8y ago
  As depression has an average course of 4 months I wonder what effects we should expect to see after years.
  - DuskStar 8y ago
    What's the average course of antidepressants, though? I know in my case it's been quite a lot longer than 4 months...
- stordoff 8y ago
  This is noted in the limitations : > The results are reported after 8 weeks of treatment, so we don't know if they apply to long-term use of antidepressants. I'm not sure why you would discount an improvement in symptoms over 8 weeks though. Many major depressive episodes will be resolved in that time ("The median duration of MDE was 3.0 months; 50% of participants recovered within 3 months"[1]), so even if they are not suitable, or less effective, for long term care, that can still be a improvement in quality of life. [1] https://www.ncbi.nlm.nih.gov/pubmed/12204924 https://www.ncbi.nlm.nih.gov/pubmed/12204924 (FWIW, it was 21 antidepressants, not 21 studies: "The researchers found 522 studies covering 116,477 patients in total. This included 101 previously unpublished studies.")
  - Alex3917 8y ago
    > I'm not sure why you would discount an improvement in symptoms over 8 weeks though. I'm not, but I don't think anyone is arguing that SSRIs can't be effective for some people with severe depression when used in the short term. The issue is that that only represents a small percentage of patients.

kl4m 8y ago

The best thing about publishing books is they don't need that pesky peer review!

darpa_escapee 8y ago

Yes, while the "moar serotonin = moar happy" explanation of why antidepressants work is oversimplified and wrong in many cases, there is empirical evidence that some antidepressants are effective at treating the symptoms of depression and other illnesses.

shadowbannedtoo 8y ago
I'm to depressed to look it up again, but there was a Psychologist Dr. Irving Kirsh whom used the Freedom of Information Act to study All the studies on antidepressants. He found they didn't work better than Placebo. I looked up the first thing I found on Google. https://www.psychologytoday.com/us/blog/psych-unseen/201802/do-antidepressants-work-yes-no-and-yes-again https://www.psychologytoday.com/us/blog/psych-unseen/201802/... This is written about Kirsh's study, and it's confusing. Kirsh interpolation of the raw data showed that antidepressants don't work, and work less so for extremely depressed patients. This doctor claims the opposite? Pesonally, I find the research on the efficacy of antidepressants very confusing. To those whom are depressed, I can offer this, it does get better with age.

pw 8y ago

You can also check out Peter Kramer's "Ordinarily Well: The Case for Antidepressants" for the exact opposite take. And "Against Depression", also by Peter Kramer, is a good take on recent findings about the biological roots of depression.

_underfl0w_ 8y ago
Does Mr. Kramer have anything peer-reviewed?
- SketchySeaBeast 8y ago
  Dr. Kramer - he's a psychiatrist, who specializes in depression. I only point this out as the gentleman who wrote "Lost Connections" is a journalist, and thus holds no education to the discussion.

aaaaaaaaaaab 8y ago

There’s very little evidence for a broken leg being caused by the lack of plaster around it, yet nobody questions its efficacy...

wu-ikkyu 8y ago
How is that comparable? Seems like a non sequitur
- aaaaaaaaaaab 8y ago
  The treatment of a condition need not be the “inverse” of its cause. A broken bone can be fixed by immobilizing it via a plaster cast. Did the bone break due to the lack of plaster? Eczema can be fixed by applying topical steroids. Did eczema develop due to the lack of topical steroids? Depression can be fixed by inducing changes in neurochemistry. Did depression arise due to an imbalance in neurochemistry?
- deleted 8y ago
  [deleted]

philwelch 8y ago

I'm generally skeptical about SSRI's, but I think this goes too far into conspiracy territory. The problem with SSRI's, especially in my experience and from my understanding, is that they aim for "mildly beneficial with minimal side effects" and hit somewhere closer to, "mildly beneficial with understated side effects that many patients will be too embarrassed to report". This doesn't mean SSRI's are total junk, but it does mean that they're kind of mediocre. Ketamine is more of a high-risk high-reward drug, similar to the use of CNS stimulants to treat ADD. There's no question that amphetamines help people focus. There's also, understandably, far more concern about giving people amphetamines in the first place. Also, it's easier to convince patients to take a boring prescription drug than to sell them on, "I think the real solution to your problem is this really scary-sounding drug that people take at raves; trust me, I'm a psychiatrist."