10 ms·

I think this should be investigated.The use of anti-depressants amount to performing medical experiments on people. E.g. Let's see this anti-depressant, then ev

I think this should be investigated.The use of anti-depressants amount to performing medical experiments on people. E.g. Let's see this anti-depressant, then evaluate side-effects, if it doesn't work switch to different one or adjust the dosage. There is no scientific basis to do that. The supposed chemical inbalance is not being measured so the doctors really are giving people random drugs and those drugs are difficult to quit without medical supervision as well. When you quitting you feel so horrible you rather keep taking them. This is a huge money making racket for big pharma and make doctors look like charlatans at the same time casting doubts on medical profession. This only feeds to another camp like anti-vaxx.

dangrossman 7y ago
You're commenting on such an investigation. As for the try-and-evaluate method of matching antidepressants to patients, that is the best medicine has to offer right now. There's not a better way that they're choosing not to use, and the drugs do have measurable, significant benefits for patients once they find one or more that's effective for them. The "supposed chemical imbalance is not being measured" because that's more a figure of speech than a scientific theory, and there is no practical way to measure it and correlate it to mood imbalance, depression or other symptoms. What alternative do you propose?
- seieste 7y ago
  Until recently, few pharmaceutical companies pre-registered antidepressant trials, which allowed them to selectively publish. This means that antidepressants may be nowhere near as effective as commonly believed, and so doctors are overweighting the benefits compared to the costs of side effects. . “While only half of these trials had formally significant effectiveness, published reports almost ubiquitously claimed significant results. "Negative" trials were either left unpublished or were distorted to present "positive" results.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2412901/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2412901/ If this is true, then many people who currently take antidepressants may actually be better, not worse, without them, since at least they’d avoid the side effects. Further, the “chemical imbalance” theory that is propagated through paid advertising has no applicability to a doctor prescribing an antidepressant, since the doctor has no way of measuring and monitoring that imbalance should one exist.
  - JudgeWapner 7y ago
    > the “chemical imbalance” theory that is propagated through paid advertising I've never seen a pharmaceutical ad that used that term. The only thing I recall from the ads is them distinguishing clinical depression from feeling blue.
    - doitLP 7y ago
      It’s pervasive, especially in the early days of marketing antidepressants to the general public. Example, probably the most the most recognizable anti-depressant ad ever (at least in the US): https://m.youtube.com/watch?v=twhvtzd6gXA https://m.youtube.com/watch?v=twhvtzd6gXA @ 0:20
      - JudgeWapner 7y ago
        ok, I concede that one. They used the term "imbalance of chemicals". To be fair, though, that was a "vintage commercial" and undated. And everything else is not disputed: how to recognize the symptoms of depression. However, I don't fault Big Pharma for not figuring out how to explain the neurochemistry of SSRI's in a 30 second TV ad.
        doitLP 7y ago
        Well that’s kind of the point. The name SSRI is itself a marketing term. For every such drug, the mechanism of action is still unknown.
        JudgeWapner 7y ago
        the mechanism that many drugs use, such as nitrous oxide aren't fully known. the wikipedia page for SSRI doesn't seem to look like marketing. a drug doesn't have to be fully understood in order for it to be effective.
        hcknwscommenter 7y ago
        That's quite a statement. I mean, sure, the entirety of why selectively inhibiting serotonin reuptake might affect psychological outcomes may be a bit fuzzy at the end, but there is a pretty solid theory here isn't there? The drugs work by selectively inhibiting serotonin reuptake. This leads to more serotonin signaling. Sure it gets a little fuzzy from there to how this mechanism affects mood disorders with various competing theories, but "unknown" is quite a stretch here.
- ddorian43 7y ago
  He is completely unaware that most(all?) those drugs can be easily quit if done very slowly. He just wants a silver bullet.
  - scroblart 7y ago
    Try finding a psychiatrist willing to help you through that. Most won't (it is seen as risky and liability-generating).
    - ddorian43 7y ago
      That doesn't make any sense. So if a drug isn't providing any benefits (or too many side effects) your doc won't help you to quit it ??
      - scroblart 7y ago
        Often the doctor that a person has when they realize that they need to get off a medication is not the original doctor that prescribed the medication. And yes, most psychiatrists don't want the liability of weaning somebody off a medication. You are right, it doesn't make any sense--it certainly is not good for patients.
        ddorian43 7y ago
        Then you change doctors until you find someone that will listen to you.
        scroblart 7y ago
        Right. I'm saying that is easier said than done.
        orhmeh09 7y ago
        Do you not get in trouble these days for that; as in, could it not look like you’re “doctor shopping”?
- kitchenkarma 7y ago
  I had severe depression and I was a victim of such experiments. I lost two years of my life to these drugs and failed suicide two times at the end. What helped me get out of this mess was CBT therapy to change the way I think about things and how to deal with emotions, how to defuse going into the loops of sadness. I didn't need any drugs but doctors insisted it will make me feel better. Yes, I was feeling better initially - actually sometimes I could feel the effects to similar to those of cannabis. But after few months I was getting hallucinations, weird thoughts and sudden urges to kill myself. The doctors response was to change the dose or try different one. I think this should be illegal.
  - jeremyjh 7y ago
    The reason doctors do this is because it does work for many patients. Once you find the right medication the results can be life changing. I went through nearly all the SSRIs before landing on the right tricyclic. CBT works for many people too, but not everyone.
    - Amezarak 7y ago
      How do you know your depression didn’t simply run its course and resolve on its own? That’s the problem with all this experimentation.
      - jeremyjh 7y ago
        Well it didn't run its course for 12 years so that seems unlikely. I'm not sure how we'd gain knowledge without experimentation.
    - kitchenkarma 7y ago
      While at the same time doctors say they won't prescribe cannabis for pain, because (they say) there is no evidence it works, when literally a patient says he or she gets their life back, they have no problem dispensing anti-depressants like candies. I just don't buy this reasoning. This profession is corrupt to the core. My very good friend couple of months ago went to her GP because of bullying at work and she came back with a script for Citalopram. I managed to persuade her to not take it and found her a therapist instead. She is happy now and has a new job. I have a feeling that I saved her life.
- sametmax 7y ago
  For the last 40 years, people talked about psilocybin, weight lifting, lsd, fasting, meditation, wim hof and many other things that affect people's happiness. We had 4 decades for doctors to get interested in them, study them, and make protocols for them for the public. Only now are we, timidly, talking about them. It was considered hippie stuff at best, cult/lunatic ideas at worst. But turning an entire nation into drug addict is apparently fine.
  - scroblart 7y ago
    Yeah. This very apparent imbalance creates a lot of distrust for the pharma industry (as well as for medical providers).
  - polyfractal 7y ago
    Frankly, a lot of this is the patient's fault too. The vast majority of people _do not_ want to change their lifestyle. They don't want to quit smoking, drinking, eating fried food and leading a sedentary life. They don't want to lose weight or start cardio, go hiking/biking/swimming/walking, limit their caloric intake or eat more vegetables and fiber. What they want is the doctor to provide a pill to fix whatever the immediate issue is, so they can get back to their life. When providers push back on this and try to suggest lifestyle changes, many patients get _angry_. Like, yelling, shouting, complaining to administrators that the provider isn't "listening to them" or "not taking their problems seriously". People want to be fixed, not fix themselves. There's plenty of blame to go around, but a healthy share falls on patients themselves. Source: SO is a medical provider. My faith in humanity falls daily and I can't believe the crap providers have to put up with. It's like a service job dealing with irritated people all day long, except these people read a blurb on WebMD and think they are an expert.
    - sametmax 7y ago
      > The vast majority of people _do not_ want to change their lifestyle. Yes, but it's also very hard to do. I took me 30 years to actually have a nervous and hormonal system that was not fucked up. Before that, I tried for decades to restrain myself and exercise, and it was just not sustainable. I had to read so much, go through so many experiments, meet and talk to so many people to find all the stuff I needed to actually fix myself. And the work is far from over, I have yet a lot to do. I was kind of expecting medical professionals to pick up on what I needed, and actually helped me on the way. 2 did a little, out of probably 30. And I met them only because my close ones were atypical, and know original people. Our health culture is failing big time here.
dillonmckay 7y ago
Yes, it is akin to randomly trying Game Genie codes.
spinach 7y ago
In a way, all drug usage is like performing experiments on people - some of them work better on certain people than others and some of them give terrible side-effects to some and not others. This isn't just true for anti-depressants. I'd rather have the option of anti-depressants than nothing at all. They help a lot of people to live their life normally. It's true that it's hard coming off some of them, but it's worth it I think - a couple years of improvement in mental health vs a crappy week coming off it.
- dangrossman 7y ago
  I agree with your overall message, but it's much more than a crappy week to come off of some commonly prescribed antidepressants. It takes months to taper off some of them safely.
jeremyjh 7y ago
> Let's see this anti-depressant, then evaluate side-effects, if it doesn't work switch to different one or adjust the dosage. Please tell us about the alternative treatment regimen you recommend, with references to the peer-reviewed, published literature supporting its efficacy.
im3w1l 7y ago
> The supposed chemical inbalance is not being measured I like the idea of measuring. How would we do it though?
- mcguire 7y ago
  I'm assuming it would involve a blender.
CrowFly 7y ago
Anti-depressants work well for me. They solve a lot of problems for a lot of people.
skybrian 7y ago
You say "performing medical experiments" like it's a bad thing or there was some alternative, but life is usually lived based on empirical trial-and-error. This is still true after seeing the results of well-done scientific experiments. They can tell you the average effect and how much it varies, but not the effect on you personally.
javadocmd 7y ago
Forgive me for being blunt, but that's just how modern medicine works. No one has the Star Trek tricorder that can scan your body, read your genome, and detect a quantum fluctuation in your synaptic waveform matriculation to calculate how many CCs to put in the hypospray. We really only have one amazing piece of technology at our disposal: statistics. At the absolute best (and I'm not saying it's always the best...), what comes out of a pharmaceutical development pipeline is a drug that works for some people some of the time. Sure, sometimes you get broad categories to try to narrow down effectiveness, but at the individual level there is ultimately no choice but to try a drug and see if it works. And this is especially true in psych drugs, in no small part because there are so many unanswered questions about how our mind works. And that sucks. I get it. It must be so frustrating to deal with a revolving door of new regimens and new side effects, all while yearning for relief from the underlying ailment. Not to mention navigating our nightmarish medical bureaucracy. But please understand that doctors, generally, are just doing their best to help given the tools they have. If you don't currently have that kind of trust and partnership with your doctor, I hope you are able to find one with which you can. I wish you the best, and hope that this perspective will make your frustrations somewhat easier to bear.
- hedvig 7y ago
  Oh all of a sudden we should just accept some pathetically weak argument of "we just don't know". Billions at stake here and yes we can and will severely penalize anyone on the side of nonscience and profiteering where humans are harmed. We can do better. Sorry if it means consequences for certain people.
  - javadocmd 7y ago
    How can we do better?
  - PhasmaFelis 7y ago
    > Oh all of a sudden we should just accept some pathetically weak argument of "we just don't know". But we don't know, despite enormous and ongoing effort. Hopefully we'll understand eventually, but right now we don't. I'm sorry if that fact is upsetting, but you can't will knowledge into existence.
internet_user 7y ago
A. There is no such thing as "chemical imbalance". B. Medicine is as much of an art as it is science (if not more of an art). C. Only some anti-depressants are the way you describe. The most promising anti-depressant, I.V. ketamine - acts rapidly, breaks through the most resistant depression is gone from your bloodstream within minutes/hours after infusion and there are zero withdrawal effects.
- stronglikedan 7y ago
  > There is no such thing as "chemical imbalance". Why do many, many doctors say there is? It seems they, of all people, should know what they are talking about.
  - scotty79 7y ago
    Not really. Doctors are trained to recognise symptoms and match the therapy to the symptoms. They of course know mechanism of some (well understood) afflictions. But many are not that well understood and yet therapies for them exist that help some patients with those symptoms. Then when asked about the causes or the mechanism doctors just act like all humans do. They repeat rumours they heard.
  - tomhoward 7y ago
    I suspect pharma companies and doctors have settled on the term "chemical imbalance" so they have something to tell patients that is simple enough to understand but medical-sounding enough to accept. Also, general physicians have to be across such a vast range of ailments and treatment options, they don't have much ability to deeply understand the issues themselves. I'm not one for any great conspiracy behind this. For my own reasons I've researched the topic deeply, and I agree that the term "chemical imbalance" is fairly shaky, but I can accept a fairly innocent explanation for why it's come to be.
- jaredklewis 7y ago
  > B. Medicine is as much of an art as it is science (if not more of an art). This seems like a rather novel point of view. I can’t speak to whether this view is common among medical practitioners, but as a patient I can say I dislike it. I would like that treatment options be selected and evaluated on the basis of empirical evidence. What does it even mean that medicine is an art?
djakjxnanjak 7y ago
My antidepressant is a generic, so drug companies are making hardly anything off me. That narrative doesn’t seem to fit.
- kitchenkarma 7y ago
  No license to pay, huge volume plus overcharging the national healthcare provider?
elliekelly 7y ago
For years I was told I was depressed and, as you described, “tried” one antidepressant after another. None of them helped with my symptoms (an otherwise healthy 20-something couldn’t get out of bed, sleeping constantly). It turned out I had lupus. I often wonder how many people who are being treated for depression have another illness entirely. I think a lot of times it’s just the best diagnosis currently available to many doctors. The drugs used to treat autoimmune diseases are “tested” by patients much the same way as antidepressants. Though there’s at least some bloodwork to guide the way. I’m optimistic technology and our rapidly growing understanding of gut bacteria will greatly improve the current trial and error approach.
cjohansson 7y ago
I agree. Don’t forget about the negative environmental effects of the drugs as well. Fish become sterile i.e.[1] [1] https://www.sciencealert.com/antidepressant-chemicals-are-changing-the-brains-of-great-lakes-fish https://www.sciencealert.com/antidepressant-chemicals-are-ch...
lkrubner 7y ago
About this: “There is no scientific basis to do that.” That’s a political statement. You are trying to disqualify clinical experience and an empirical approach, despite both being part of the Western scientific method for several centuries. Your view is popular and is gaining momentum everyday. Your view suggests that only double blind studies and statistical analysis amounts to “real science”. Your view has powerful factions in business that are supportive. Your view is going to do tremendous damage. Your view is ahistorical. I can only hope that you will reevaluate your view, and realize how much richer and broader the Western scientific tradition is.
- pessimizer 7y ago
  > You are trying to disqualify clinical experience and an empirical approach, despite both being part of the Western scientific method for several centuries. Being treated by any doctor (other than a surgeon when on the verge of death) has only over the past century become something that was likely to extend your life rather than shorten it. This is a result of double-blind studies and statistical analysis.
  - lkrubner 7y ago
    About this: "This is a result of double-blind studies and statistical analysis." First of all, if you want to shrink all of medical research to seeing a doctor, do you have any evidence that your statement is true? Second of all, most of the big breakthroughs in life extension were thanks to medical research that was neither double blind nor statistical, including: 1.) In the late 1700s, Edward Jennings invents the vaccine for smallpox. 2.) John Snow's theory of cholera in London 1854 3.) In the late 1800s Louis Pasteur and Joseph Lister develop the Germ Theory Of Illness, including such practical ideas as: 3.a) Louis Pasteur invents pasteurization. 3.b) Lister uses antiseptics to sterilize surgical instruments and clean wounds 4.) Alexander Fleming invents penicillin
markroseman 7y ago
Wow, where to start... 1. The whole 'chemical imbalance' thing is a gross over-simplification that might help as an introductory mental model but breaks down quickly. 2. The right thing to be measuring is symptoms, not the mythical chemical imbalance. Studies do measure changes in symptoms, typically using various rating scales, e.g. HAM-D. Measuring this way has its issues and challenges, but is being done. 3. Yes, there is an element of experimentation to find the right medication, which is hardly unique to psychiatric medications. 4. Yes, some medications are hard to quit without doing so slowly. Too many doctors don't help their patients with this. 5. Antidepressants are surprisingly effective, at least compared with many other medications. A good metric for effectiveness is the "number needed to treat" (NNT). It basically means how many people do you have to give a treatment to before you get a positive response that you otherwise wouldn't. With antidepressants, it's generally low single digits, for many around 4. Only helping 1 in 4 doesn't sound great. But check out theNNT.com for some comparisons. Aspirin to prevent heart attacks (NNT of 50-200 for people with previous heart disease, NNT 2000+ for those without previous heart disease). Antihypertensives (NNT ~100). See what's considered successful in other areas of medicine...
- khuey 7y ago
  Antidepressants are indeed effective, but those NNT numbers are based on outcomes (i.e. depression scores) that are more subjective and far more modest than the outcomes used to calculate NNT for things like aspirin or antihypertensives (cardiovascular events and/or death). I don't think they should be compared directly compared in that manner. The NNT for antihypertensives to lower blood pressure is essentially 1, after all.

dangrossman 7y ago

You're commenting on such an investigation. As for the try-and-evaluate method of matching antidepressants to patients, that is the best medicine has to offer right now. There's not a better way that they're choosing not to use, and the drugs do have measurable, significant benefits for patients once they find one or more that's effective for them. The "supposed chemical imbalance is not being measured" because that's more a figure of speech than a scientific theory, and there is no practical way to measure it and correlate it to mood imbalance, depression or other symptoms. What alternative do you propose?

seieste 7y ago
Until recently, few pharmaceutical companies pre-registered antidepressant trials, which allowed them to selectively publish. This means that antidepressants may be nowhere near as effective as commonly believed, and so doctors are overweighting the benefits compared to the costs of side effects. . “While only half of these trials had formally significant effectiveness, published reports almost ubiquitously claimed significant results. "Negative" trials were either left unpublished or were distorted to present "positive" results.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2412901/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2412901/ If this is true, then many people who currently take antidepressants may actually be better, not worse, without them, since at least they’d avoid the side effects. Further, the “chemical imbalance” theory that is propagated through paid advertising has no applicability to a doctor prescribing an antidepressant, since the doctor has no way of measuring and monitoring that imbalance should one exist.
- JudgeWapner 7y ago
  > the “chemical imbalance” theory that is propagated through paid advertising I've never seen a pharmaceutical ad that used that term. The only thing I recall from the ads is them distinguishing clinical depression from feeling blue.
  - doitLP 7y ago
    It’s pervasive, especially in the early days of marketing antidepressants to the general public. Example, probably the most the most recognizable anti-depressant ad ever (at least in the US): https://m.youtube.com/watch?v=twhvtzd6gXA https://m.youtube.com/watch?v=twhvtzd6gXA @ 0:20
    - JudgeWapner 7y ago
      ok, I concede that one. They used the term "imbalance of chemicals". To be fair, though, that was a "vintage commercial" and undated. And everything else is not disputed: how to recognize the symptoms of depression. However, I don't fault Big Pharma for not figuring out how to explain the neurochemistry of SSRI's in a 30 second TV ad.
      - doitLP 7y ago
        Well that’s kind of the point. The name SSRI is itself a marketing term. For every such drug, the mechanism of action is still unknown.
        JudgeWapner 7y ago
        the mechanism that many drugs use, such as nitrous oxide aren't fully known. the wikipedia page for SSRI doesn't seem to look like marketing. a drug doesn't have to be fully understood in order for it to be effective.
        hcknwscommenter 7y ago
        That's quite a statement. I mean, sure, the entirety of why selectively inhibiting serotonin reuptake might affect psychological outcomes may be a bit fuzzy at the end, but there is a pretty solid theory here isn't there? The drugs work by selectively inhibiting serotonin reuptake. This leads to more serotonin signaling. Sure it gets a little fuzzy from there to how this mechanism affects mood disorders with various competing theories, but "unknown" is quite a stretch here.
ddorian43 7y ago
He is completely unaware that most(all?) those drugs can be easily quit if done very slowly. He just wants a silver bullet.
- scroblart 7y ago
  Try finding a psychiatrist willing to help you through that. Most won't (it is seen as risky and liability-generating).
  - ddorian43 7y ago
    That doesn't make any sense. So if a drug isn't providing any benefits (or too many side effects) your doc won't help you to quit it ??
    - scroblart 7y ago
      Often the doctor that a person has when they realize that they need to get off a medication is not the original doctor that prescribed the medication. And yes, most psychiatrists don't want the liability of weaning somebody off a medication. You are right, it doesn't make any sense--it certainly is not good for patients.
      - ddorian43 7y ago
        Then you change doctors until you find someone that will listen to you.
        scroblart 7y ago
        Right. I'm saying that is easier said than done.
        orhmeh09 7y ago
        Do you not get in trouble these days for that; as in, could it not look like you’re “doctor shopping”?
kitchenkarma 7y ago
I had severe depression and I was a victim of such experiments. I lost two years of my life to these drugs and failed suicide two times at the end. What helped me get out of this mess was CBT therapy to change the way I think about things and how to deal with emotions, how to defuse going into the loops of sadness. I didn't need any drugs but doctors insisted it will make me feel better. Yes, I was feeling better initially - actually sometimes I could feel the effects to similar to those of cannabis. But after few months I was getting hallucinations, weird thoughts and sudden urges to kill myself. The doctors response was to change the dose or try different one. I think this should be illegal.
- jeremyjh 7y ago
  The reason doctors do this is because it does work for many patients. Once you find the right medication the results can be life changing. I went through nearly all the SSRIs before landing on the right tricyclic. CBT works for many people too, but not everyone.
  - Amezarak 7y ago
    How do you know your depression didn’t simply run its course and resolve on its own? That’s the problem with all this experimentation.
    - jeremyjh 7y ago
      Well it didn't run its course for 12 years so that seems unlikely. I'm not sure how we'd gain knowledge without experimentation.
  - kitchenkarma 7y ago
    While at the same time doctors say they won't prescribe cannabis for pain, because (they say) there is no evidence it works, when literally a patient says he or she gets their life back, they have no problem dispensing anti-depressants like candies. I just don't buy this reasoning. This profession is corrupt to the core. My very good friend couple of months ago went to her GP because of bullying at work and she came back with a script for Citalopram. I managed to persuade her to not take it and found her a therapist instead. She is happy now and has a new job. I have a feeling that I saved her life.
sametmax 7y ago
For the last 40 years, people talked about psilocybin, weight lifting, lsd, fasting, meditation, wim hof and many other things that affect people's happiness. We had 4 decades for doctors to get interested in them, study them, and make protocols for them for the public. Only now are we, timidly, talking about them. It was considered hippie stuff at best, cult/lunatic ideas at worst. But turning an entire nation into drug addict is apparently fine.
- scroblart 7y ago
  Yeah. This very apparent imbalance creates a lot of distrust for the pharma industry (as well as for medical providers).
- polyfractal 7y ago
  Frankly, a lot of this is the patient's fault too. The vast majority of people _do not_ want to change their lifestyle. They don't want to quit smoking, drinking, eating fried food and leading a sedentary life. They don't want to lose weight or start cardio, go hiking/biking/swimming/walking, limit their caloric intake or eat more vegetables and fiber. What they want is the doctor to provide a pill to fix whatever the immediate issue is, so they can get back to their life. When providers push back on this and try to suggest lifestyle changes, many patients get _angry_. Like, yelling, shouting, complaining to administrators that the provider isn't "listening to them" or "not taking their problems seriously". People want to be fixed, not fix themselves. There's plenty of blame to go around, but a healthy share falls on patients themselves. Source: SO is a medical provider. My faith in humanity falls daily and I can't believe the crap providers have to put up with. It's like a service job dealing with irritated people all day long, except these people read a blurb on WebMD and think they are an expert.
  - sametmax 7y ago
    > The vast majority of people _do not_ want to change their lifestyle. Yes, but it's also very hard to do. I took me 30 years to actually have a nervous and hormonal system that was not fucked up. Before that, I tried for decades to restrain myself and exercise, and it was just not sustainable. I had to read so much, go through so many experiments, meet and talk to so many people to find all the stuff I needed to actually fix myself. And the work is far from over, I have yet a lot to do. I was kind of expecting medical professionals to pick up on what I needed, and actually helped me on the way. 2 did a little, out of probably 30. And I met them only because my close ones were atypical, and know original people. Our health culture is failing big time here.

dillonmckay 7y ago

Yes, it is akin to randomly trying Game Genie codes.

spinach 7y ago

In a way, all drug usage is like performing experiments on people - some of them work better on certain people than others and some of them give terrible side-effects to some and not others. This isn't just true for anti-depressants. I'd rather have the option of anti-depressants than nothing at all. They help a lot of people to live their life normally. It's true that it's hard coming off some of them, but it's worth it I think - a couple years of improvement in mental health vs a crappy week coming off it.

dangrossman 7y ago
I agree with your overall message, but it's much more than a crappy week to come off of some commonly prescribed antidepressants. It takes months to taper off some of them safely.

jeremyjh 7y ago

> Let's see this anti-depressant, then evaluate side-effects, if it doesn't work switch to different one or adjust the dosage. Please tell us about the alternative treatment regimen you recommend, with references to the peer-reviewed, published literature supporting its efficacy.

im3w1l 7y ago

> The supposed chemical inbalance is not being measured I like the idea of measuring. How would we do it though?

mcguire 7y ago
I'm assuming it would involve a blender.

CrowFly 7y ago

Anti-depressants work well for me. They solve a lot of problems for a lot of people.

skybrian 7y ago

You say "performing medical experiments" like it's a bad thing or there was some alternative, but life is usually lived based on empirical trial-and-error. This is still true after seeing the results of well-done scientific experiments. They can tell you the average effect and how much it varies, but not the effect on you personally.

javadocmd 7y ago

Forgive me for being blunt, but that's just how modern medicine works. No one has the Star Trek tricorder that can scan your body, read your genome, and detect a quantum fluctuation in your synaptic waveform matriculation to calculate how many CCs to put in the hypospray. We really only have one amazing piece of technology at our disposal: statistics. At the absolute best (and I'm not saying it's always the best...), what comes out of a pharmaceutical development pipeline is a drug that works for some people some of the time. Sure, sometimes you get broad categories to try to narrow down effectiveness, but at the individual level there is ultimately no choice but to try a drug and see if it works. And this is especially true in psych drugs, in no small part because there are so many unanswered questions about how our mind works. And that sucks. I get it. It must be so frustrating to deal with a revolving door of new regimens and new side effects, all while yearning for relief from the underlying ailment. Not to mention navigating our nightmarish medical bureaucracy. But please understand that doctors, generally, are just doing their best to help given the tools they have. If you don't currently have that kind of trust and partnership with your doctor, I hope you are able to find one with which you can. I wish you the best, and hope that this perspective will make your frustrations somewhat easier to bear.

hedvig 7y ago
Oh all of a sudden we should just accept some pathetically weak argument of "we just don't know". Billions at stake here and yes we can and will severely penalize anyone on the side of nonscience and profiteering where humans are harmed. We can do better. Sorry if it means consequences for certain people.
- javadocmd 7y ago
  How can we do better?
- PhasmaFelis 7y ago
  > Oh all of a sudden we should just accept some pathetically weak argument of "we just don't know". But we don't know, despite enormous and ongoing effort. Hopefully we'll understand eventually, but right now we don't. I'm sorry if that fact is upsetting, but you can't will knowledge into existence.

internet_user 7y ago

A. There is no such thing as "chemical imbalance". B. Medicine is as much of an art as it is science (if not more of an art). C. Only some anti-depressants are the way you describe. The most promising anti-depressant, I.V. ketamine - acts rapidly, breaks through the most resistant depression is gone from your bloodstream within minutes/hours after infusion and there are zero withdrawal effects.

stronglikedan 7y ago
> There is no such thing as "chemical imbalance". Why do many, many doctors say there is? It seems they, of all people, should know what they are talking about.
- scotty79 7y ago
  Not really. Doctors are trained to recognise symptoms and match the therapy to the symptoms. They of course know mechanism of some (well understood) afflictions. But many are not that well understood and yet therapies for them exist that help some patients with those symptoms. Then when asked about the causes or the mechanism doctors just act like all humans do. They repeat rumours they heard.
- tomhoward 7y ago
  I suspect pharma companies and doctors have settled on the term "chemical imbalance" so they have something to tell patients that is simple enough to understand but medical-sounding enough to accept. Also, general physicians have to be across such a vast range of ailments and treatment options, they don't have much ability to deeply understand the issues themselves. I'm not one for any great conspiracy behind this. For my own reasons I've researched the topic deeply, and I agree that the term "chemical imbalance" is fairly shaky, but I can accept a fairly innocent explanation for why it's come to be.
jaredklewis 7y ago
> B. Medicine is as much of an art as it is science (if not more of an art). This seems like a rather novel point of view. I can’t speak to whether this view is common among medical practitioners, but as a patient I can say I dislike it. I would like that treatment options be selected and evaluated on the basis of empirical evidence. What does it even mean that medicine is an art?

djakjxnanjak 7y ago

My antidepressant is a generic, so drug companies are making hardly anything off me. That narrative doesn’t seem to fit.

kitchenkarma 7y ago
No license to pay, huge volume plus overcharging the national healthcare provider?

elliekelly 7y ago

For years I was told I was depressed and, as you described, “tried” one antidepressant after another. None of them helped with my symptoms (an otherwise healthy 20-something couldn’t get out of bed, sleeping constantly). It turned out I had lupus. I often wonder how many people who are being treated for depression have another illness entirely. I think a lot of times it’s just the best diagnosis currently available to many doctors. The drugs used to treat autoimmune diseases are “tested” by patients much the same way as antidepressants. Though there’s at least some bloodwork to guide the way. I’m optimistic technology and our rapidly growing understanding of gut bacteria will greatly improve the current trial and error approach.

cjohansson 7y ago

I agree. Don’t forget about the negative environmental effects of the drugs as well. Fish become sterile i.e.[1] [1] https://www.sciencealert.com/antidepressant-chemicals-are-changing-the-brains-of-great-lakes-fish https://www.sciencealert.com/antidepressant-chemicals-are-ch...

lkrubner 7y ago

About this: “There is no scientific basis to do that.” That’s a political statement. You are trying to disqualify clinical experience and an empirical approach, despite both being part of the Western scientific method for several centuries. Your view is popular and is gaining momentum everyday. Your view suggests that only double blind studies and statistical analysis amounts to “real science”. Your view has powerful factions in business that are supportive. Your view is going to do tremendous damage. Your view is ahistorical. I can only hope that you will reevaluate your view, and realize how much richer and broader the Western scientific tradition is.

pessimizer 7y ago
> You are trying to disqualify clinical experience and an empirical approach, despite both being part of the Western scientific method for several centuries. Being treated by any doctor (other than a surgeon when on the verge of death) has only over the past century become something that was likely to extend your life rather than shorten it. This is a result of double-blind studies and statistical analysis.
- lkrubner 7y ago
  About this: "This is a result of double-blind studies and statistical analysis." First of all, if you want to shrink all of medical research to seeing a doctor, do you have any evidence that your statement is true? Second of all, most of the big breakthroughs in life extension were thanks to medical research that was neither double blind nor statistical, including: 1.) In the late 1700s, Edward Jennings invents the vaccine for smallpox. 2.) John Snow's theory of cholera in London 1854 3.) In the late 1800s Louis Pasteur and Joseph Lister develop the Germ Theory Of Illness, including such practical ideas as: 3.a) Louis Pasteur invents pasteurization. 3.b) Lister uses antiseptics to sterilize surgical instruments and clean wounds 4.) Alexander Fleming invents penicillin

markroseman 7y ago

Wow, where to start... 1. The whole 'chemical imbalance' thing is a gross over-simplification that might help as an introductory mental model but breaks down quickly. 2. The right thing to be measuring is symptoms, not the mythical chemical imbalance. Studies do measure changes in symptoms, typically using various rating scales, e.g. HAM-D. Measuring this way has its issues and challenges, but is being done. 3. Yes, there is an element of experimentation to find the right medication, which is hardly unique to psychiatric medications. 4. Yes, some medications are hard to quit without doing so slowly. Too many doctors don't help their patients with this. 5. Antidepressants are surprisingly effective, at least compared with many other medications. A good metric for effectiveness is the "number needed to treat" (NNT). It basically means how many people do you have to give a treatment to before you get a positive response that you otherwise wouldn't. With antidepressants, it's generally low single digits, for many around 4. Only helping 1 in 4 doesn't sound great. But check out theNNT.com for some comparisons. Aspirin to prevent heart attacks (NNT of 50-200 for people with previous heart disease, NNT 2000+ for those without previous heart disease). Antihypertensives (NNT ~100). See what's considered successful in other areas of medicine...

khuey 7y ago
Antidepressants are indeed effective, but those NNT numbers are based on outcomes (i.e. depression scores) that are more subjective and far more modest than the outcomes used to calculate NNT for things like aspirin or antihypertensives (cardiovascular events and/or death). I don't think they should be compared directly compared in that manner. The NNT for antihypertensives to lower blood pressure is essentially 1, after all.