18 ms·

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 r

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 "Negative" trials were either left unpublished or were distorted to present "positive" results.”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.
- wayoutthere 7y ago
  It’s become increasingly clear that genetics play a huge role in which psychiatric drugs are effective and which ones are not. Genetic testing for psych med effectiveness should become standard practice given how in some people, SSRIs (often the first line of defense in psych meds) can cause extended periods of psychosis. Funny thing about psychosis — when you’re psychotic, your erratic and extreme behavior doesn’t feel abnormal. You don’t feel like anything has changed. This happened to me on Prozac — the most commonly prescribed antidepressant — and it took me 3 years to put my life back together after all the damage I did to my personal relationships during that period. The anxiety I was dealing with was crippling, but it didn’t dismantle my life the way the side effects of that drug did. The treatment was absolutely worse than the disease. If they had done a genetic test first, they would have seen a red flag and avoided SSRIs all together. This testing exists today, but it’s only used in patients who show strong resistance to pharmacological intervention. It should be standard.
  - SmokeGS 7y ago
    I feel like we are so close to wirelessly monitoring all brain waves (next 50 years) we will probably be able to, in real time, recognize and diagnose abnormal brain patterns. I think it would be promising if we get this sensor tech up and then perhaps deploy nanotech to interfere with maladaptive brain patterns. The ethics of such a device is considerably sticky. TED talk by Jack Gallant https://www.youtube.com/watch?v=Ecvv-EvOj8M https://www.youtube.com/watch?v=Ecvv-EvOj8M recreating vision: https://www.youtube.com/watch?v=nsjDnYxJ0bo https://www.youtube.com/watch?v=nsjDnYxJ0bo another ted talk by John-Dylan Haynes https://www.youtube.com/watch?v=mMDuakmEEV4 https://www.youtube.com/watch?v=mMDuakmEEV4 paraphrased: "wireless non-contact mind reading tech may be cheap and mass producible within the next 50 years." the only rate limiting step with his method of decoding thoughts is that it takes time under a high energy device to pair associations in the brain. Think of how much screen time we currently use. If we could pair a wireless 'headset' like headphones while looking at pictures on a screen it would be possible to build a brain bank of children->tenenagers. Currently we just need a lot of processing power and reserved bandwidth on the internet to do some cool stuff.
    - 7y ago
- hcknwscommenter 7y ago
  That is a very odd way of looking at the issue. The scientific literature certainly has a bias in favor of publishing positive results rather than failures. However, the scientific literature in no way affects FDA/regulatory approval. Drug/treatment candidates that fail regulatory approval are not on the market. As far as negative results being "distorted" to present "positive results" is concerned, yes it is quite common to take a patient population that overall fails to show statistically significant benefit and see if there is a subset that does in fact show a statistically significant benefit. One could call that p-hunting, but as long as it is followed up and confirmed, it doesn't seem like a nefarious thing to do.
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.

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.
wayoutthere 7y ago
It’s become increasingly clear that genetics play a huge role in which psychiatric drugs are effective and which ones are not. Genetic testing for psych med effectiveness should become standard practice given how in some people, SSRIs (often the first line of defense in psych meds) can cause extended periods of psychosis. Funny thing about psychosis — when you’re psychotic, your erratic and extreme behavior doesn’t feel abnormal. You don’t feel like anything has changed. This happened to me on Prozac — the most commonly prescribed antidepressant — and it took me 3 years to put my life back together after all the damage I did to my personal relationships during that period. The anxiety I was dealing with was crippling, but it didn’t dismantle my life the way the side effects of that drug did. The treatment was absolutely worse than the disease. If they had done a genetic test first, they would have seen a red flag and avoided SSRIs all together. This testing exists today, but it’s only used in patients who show strong resistance to pharmacological intervention. It should be standard.
- SmokeGS 7y ago
  I feel like we are so close to wirelessly monitoring all brain waves (next 50 years) we will probably be able to, in real time, recognize and diagnose abnormal brain patterns. I think it would be promising if we get this sensor tech up and then perhaps deploy nanotech to interfere with maladaptive brain patterns. The ethics of such a device is considerably sticky. TED talk by Jack Gallant https://www.youtube.com/watch?v=Ecvv-EvOj8M https://www.youtube.com/watch?v=Ecvv-EvOj8M recreating vision: https://www.youtube.com/watch?v=nsjDnYxJ0bo https://www.youtube.com/watch?v=nsjDnYxJ0bo another ted talk by John-Dylan Haynes https://www.youtube.com/watch?v=mMDuakmEEV4 https://www.youtube.com/watch?v=mMDuakmEEV4 paraphrased: "wireless non-contact mind reading tech may be cheap and mass producible within the next 50 years." the only rate limiting step with his method of decoding thoughts is that it takes time under a high energy device to pair associations in the brain. Think of how much screen time we currently use. If we could pair a wireless 'headset' like headphones while looking at pictures on a screen it would be possible to build a brain bank of children->tenenagers. Currently we just need a lot of processing power and reserved bandwidth on the internet to do some cool stuff.
  - 7y ago
hcknwscommenter 7y ago
That is a very odd way of looking at the issue. The scientific literature certainly has a bias in favor of publishing positive results rather than failures. However, the scientific literature in no way affects FDA/regulatory approval. Drug/treatment candidates that fail regulatory approval are not on the market. As far as negative results being "distorted" to present "positive results" is concerned, yes it is quite common to take a patient population that overall fails to show statistically significant benefit and see if there is a subset that does in fact show a statistically significant benefit. One could call that p-hunting, but as long as it is followed up and confirmed, it doesn't seem like a nefarious thing to do.

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.