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Can someone explain what the 'proper' treatment plan is supposed to be for SSRI? Doctors mostly advertise it as a tool to help get a leg up in overcoming depre

Can someone explain what the 'proper' treatment plan is supposed to be for SSRI? Doctors mostly advertise it as a tool to help get a leg up in overcoming depression with the idea being that it helps you get your shit together and somehow become not depressed. But when you actually get diagnosed, they just prescribe an SSRI and move on. If you ask what you're meant to do, they'll recommend therapy if you're lucky. And then we come to posts like this and comments like here, about people who have become dependent on SSRI just to have the same quality of life as they did before ever touching it. But now they have to go through hell to get off it. What's the idea here..? Is there an actual success path for SSRI? What percentage of patients lands on that success path?

vilifiedtwin 8y ago
> they just prescribe an SSRI and move on Not really. You would probably be visiting every now and then about side effects and probably being switched to different SSRI. This can go on for years and bring no benefits to patient. Now patient is focused on getting his/hers health back instead of just depression. Only winner here is big pharma. Good customer = dependent customer with myriad of side effects seeking for even more pills. I am writing this from my own experience.
krageon 8y ago
As I was given to understand it, the first line should be CBT or something similar (ie a therapy that doesn't involve drugs that will help you live your life). On top of this, unless you get referred directly to a psychiatrist (for example because you have made a suicide attempt) you get referred to a psychologist that will try a bunch of different "soft" approaches that will help you deal with your problems. The medication comes during this process, if it is indicated. Even if you do get medication first, the path that I expect is that you get "soft" treatment as well. The medication is supposed to get you through the really rough seas that you might succumb to otherwise, with other therapy helping you in the long term. If you go to a doctor and they just give you medication and send you on your way, you need to get a second opinion.
- Broken_Hippo 8y ago
  I'd like to add that it depends on the person. There is no freaking way I'm going to talk to a therapist, for example. Not without medication. A therapist is someone that I don't trust, and yes, I'd be honest about it. I might walk away from all treatment if I had to talk to someone regularly first. More broadly, though, it depends on what is going on with the person. There are medications that have depression or anxiety as side effects and some folks are simply going through tough situations that they cannot change. My mother took a drug for years because lowering her stress levels helped with migraines (for my mother, a tension headache triggered a migraine. Same with sinuses).
- JamesBarney 8y ago
  There's no reason medication requires therapy. Therapy has its benefits(like a great side effect profile), but it's good to remember that therapy has a lot of drawbacks too. It expensive(SSRI $3/month vs therapist $500/month), it requires a flexible schedule, and the evidence of effectiveness isn't quite as clear as medication.
  - jacobush 8y ago
    Both cognitive therapy and classic "shrink" therapy is on some level, you just talking about shit going on in your life. At the very least, if you are at the end of your rope with no (constructive) talking to be found amongst your peers in life, I am dead certain talking to a therapist is a good thing to try.
JamesBarney 8y ago
> Doctors mostly advertise it as a tool to help get a leg up in overcoming depression with the idea being that it helps you get your shit together and somehow become not depressed. But when you actually get diagnosed, they just prescribe an SSRI and move on. If you ask what you're meant to do, they'll recommend therapy if you're lucky. SSRI's are completely unrelated to getting your shit together except for the fact they make you less depressed which makes it easier to get your shit together. Doctor's talk about it the way you mentioned to feed into American moralization about drugs. But truth of it is we don't really know how they work(we have a couple of tenuous guesses), we just know they reduce depression and relapse risk. >And then we come to posts like this and comments like here, about people who have become dependent on SSRI just to have the same quality of life as they did before ever touching it. But now they have to go through hell to get off it. We don't necessarily know what their life would be like if they hadn't taken the SSRI's. Judging from the studies they'd be marginally less happy, have a greater risk of relapsing, and an increased sex drive.

vilifiedtwin 8y ago

> they just prescribe an SSRI and move on Not really. You would probably be visiting every now and then about side effects and probably being switched to different SSRI. This can go on for years and bring no benefits to patient. Now patient is focused on getting his/hers health back instead of just depression. Only winner here is big pharma. Good customer = dependent customer with myriad of side effects seeking for even more pills. I am writing this from my own experience.

krageon 8y ago

As I was given to understand it, the first line should be CBT or something similar (ie a therapy that doesn't involve drugs that will help you live your life). On top of this, unless you get referred directly to a psychiatrist (for example because you have made a suicide attempt) you get referred to a psychologist that will try a bunch of different "soft" approaches that will help you deal with your problems. The medication comes during this process, if it is indicated. Even if you do get medication first, the path that I expect is that you get "soft" treatment as well. The medication is supposed to get you through the really rough seas that you might succumb to otherwise, with other therapy helping you in the long term. If you go to a doctor and they just give you medication and send you on your way, you need to get a second opinion.

Broken_Hippo 8y ago
I'd like to add that it depends on the person. There is no freaking way I'm going to talk to a therapist, for example. Not without medication. A therapist is someone that I don't trust, and yes, I'd be honest about it. I might walk away from all treatment if I had to talk to someone regularly first. More broadly, though, it depends on what is going on with the person. There are medications that have depression or anxiety as side effects and some folks are simply going through tough situations that they cannot change. My mother took a drug for years because lowering her stress levels helped with migraines (for my mother, a tension headache triggered a migraine. Same with sinuses).
JamesBarney 8y ago
There's no reason medication requires therapy. Therapy has its benefits(like a great side effect profile), but it's good to remember that therapy has a lot of drawbacks too. It expensive(SSRI $3/month vs therapist $500/month), it requires a flexible schedule, and the evidence of effectiveness isn't quite as clear as medication.
- jacobush 8y ago
  Both cognitive therapy and classic "shrink" therapy is on some level, you just talking about shit going on in your life. At the very least, if you are at the end of your rope with no (constructive) talking to be found amongst your peers in life, I am dead certain talking to a therapist is a good thing to try.

JamesBarney 8y ago

> Doctors mostly advertise it as a tool to help get a leg up in overcoming depression with the idea being that it helps you get your shit together and somehow become not depressed. But when you actually get diagnosed, they just prescribe an SSRI and move on. If you ask what you're meant to do, they'll recommend therapy if you're lucky. SSRI's are completely unrelated to getting your shit together except for the fact they make you less depressed which makes it easier to get your shit together. Doctor's talk about it the way you mentioned to feed into American moralization about drugs. But truth of it is we don't really know how they work(we have a couple of tenuous guesses), we just know they reduce depression and relapse risk. >And then we come to posts like this and comments like here, about people who have become dependent on SSRI just to have the same quality of life as they did before ever touching it. But now they have to go through hell to get off it. We don't necessarily know what their life would be like if they hadn't taken the SSRI's. Judging from the studies they'd be marginally less happy, have a greater risk of relapsing, and an increased sex drive.