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You can use medications in a temporary way to boot-strap. The difficult thing about depression is that you don't/can't do anything that would help your depressi

by lmkg 15y ago

You can use medications in a temporary way to boot-strap. The difficult thing about depression is that you don't/can't do anything that would help your depression. Medications are an unideal, but quick & easy, way to tamp your depression down to levels where its realistic to do other things that help, like therapy or lifestyle changes. Once you've made progress with those other methods, you can start weaning off of the medications. Basically, you use them to break the vicious cycle and start a virtuous one, and once the virtuous cycle is self-sustaining you don't need them anymore.

MaxGabriel 15y ago
Whitaker doesn't do as extensive an analysis of antidepressants as he does neuroleptics, but this is fairly similar to a program he supports in Finland that uses neuroleptics in very limited doses for the worst cases of schizophrenia, but their focus is shifting patients into a supportive environment with therapy.
steve-howard 15y ago
Medication is absolutely not quick&easy. It takes 4-6 weeks to take effect, and 80% of its effect is ascribed to the placebo effect. Incidentally, the only time an antidepressant had any effect on my mood (I've been on 6) is when it launched me into a manic episode. The withdrawal from some of them is also excruciating.
- mthoms 15y ago
  >80% of its effect is ascribed to the placebo effect. Citation? Thanks.
  - steve-howard 15y ago
    http://psychcentral.com/news/2008/02/26/antidepressant-data-showed-not-as-effective-as-thought/1963.html http://psychcentral.com/news/2008/02/26/antidepressant-data-... “The response to placebo in these trials was exceptionally large, duplicating more than 80% of the improvement observed in the drug groups. In contrast, the effect of placebo on pain is estimated to be about 50% of the response to pain medication.”
    - brianleb 15y ago
      I have an awful lot to say about this comment, but I'll leave it at this: The cited study included six drugs. There are currently more than 20 available on the US market. One of these 6 is no longer used (nefazodone - see the black box warning if you're curious). The study only looked at serotonin modulation. We have drugs that don't even affect serotonin now, and ones that do it much better than the old ones. [Venlafaxine is an SNRI but at low doses acts as an SSRI. To get the NE effects, one must go to the upper dosage range. Most patients can't do this because of intolerable GI discomfort. Since you're obviously negative on the subject, I'll mention that the GI upset is caused by nonspecific serotonin activity at 5HT3 and 5HT4, if I remember my receptors correctly]. The study, published in 2008, only looked at 1987-1999. Very strange. Recency is in fact important with drug trial data. PLOS Medicine is not exactly a respected medical journal... if you want good data, try Lancet, BMJ, NEJM, AJP, etc. Just because it got published definitely doesn't mean it's reliable. Very few people are actually trained to properly evaluate medical literature.
      - steve-howard 15y ago
        There's still no denying that the placebo effect plays a substantial role in the efficacy of antidepressant medications. It's part of the reason that fewer new medications are making it onto the market. Additionally, the SNRIs are marginally more effective, at best, than SSRIs in the treatment of depression. They are usually more expensive though! Fibromyalgia is a different story. I'm negative on the subject because I have been on six different antidepressants and they did nothing but cause me intense discomfort. I took desvenlafaxine at a non-noradrenergic dosage level, and it still made me insomniac, gained weight fast, triggered manic symptoms, and caused intense withdrawal symptoms. I was also on an NDRI (non-sertonergic) and a tetracyclic. I am not a doctor, but given how a doctor is responsible for putting me on a carousel of medications that screwed up my body for over six months, I don't particularly care who's considered qualified to read papers.
- SoftwareMaven 15y ago
  But just taking sugar pills won't make you feel better. Your mind has to believe in what you are taking to gain the placebo effect.
  - Alex3917 15y ago
    "But just taking sugar pills won't make you feel better. Your mind has to believe in what you are taking to gain the placebo effect." This isn't true. Again, look at the research: http://articles.latimes.com/print/2010/dec/22/health/la-he-placebo-effect-20101223 http://articles.latimes.com/print/2010/dec/22/health/la-he-p...
    - deleted 15y ago
      [deleted]
    - SoftwareMaven 15y ago
      That is really interesting. I look at that and see a strong reason to look to cheaper, non-Western medicine, which has traditionally not been able to prove why it works. I would be very interested to see a similar study for treatment of a disease that we understand better. IBS has no real treatment of cause; all treatments are palliative and all treatments effectiveness seem to be strongly correlated with the patient's mental state. Of course, even this could be hugely beneficial for a huge range of diseases like Parkinsons and the like. I think this would be phenomenal if you were able to show a similar level of improvement with something like cancer or staff infections.
      - Alex3917 15y ago
        "I think this would be phenomenal if you were able to show a similar level of improvement with something like cancer or staff infections." http://www.maps.org/videos/source3/video14.html http://www.maps.org/videos/source3/video14.html Some interesting preliminary research on using ayahuasca to cure cancer. (Which the indigenous practitioners say works because it puts the user in touch with plant spirits or whatever.)
- lmkg 15y ago
  You are absolutely correct medication is not a trivial solution to your problems. The ramp-up time is significant, and if you're unlucky you'll have to re-adjust dosages or switch medications a few times. My point was that popping a pill in the morning is easier to get yourself to do than dragging your ass across town to see a therapist, or getting out of your apartment to go running for an hour.
  - steve-howard 15y ago
    I had done both for some time. To be honest, seeing my psychiatrist made me feel like a petri dish, whereas my therapist is one of the most understanding and caring human beings I've ever met. Psychiatric medicine has terrible side effects, and popping pills has made me feel more horrible than depression at times. (especially considering they actually did nothing for me).
SoftwareMaven 15y ago
I agree with others that meds are not quick and easy. They should be considered when other efforts are failing. Each medication, as mentioned elsewhere, takes 4-6 weeks to show efficacy, and any particular medicine may not be effective, so you may spend six months finding your solution. On the other hand, if you have tried non-medicinal alternatives and you think you are getting worse (or you are already at a seriously bad state), the drugs can be life-savers. But quick, they are not.

by lmkg 15y ago

MaxGabriel 15y ago

Whitaker doesn't do as extensive an analysis of antidepressants as he does neuroleptics, but this is fairly similar to a program he supports in Finland that uses neuroleptics in very limited doses for the worst cases of schizophrenia, but their focus is shifting patients into a supportive environment with therapy.

steve-howard 15y ago

Medication is absolutely not quick&easy. It takes 4-6 weeks to take effect, and 80% of its effect is ascribed to the placebo effect. Incidentally, the only time an antidepressant had any effect on my mood (I've been on 6) is when it launched me into a manic episode. The withdrawal from some of them is also excruciating.

mthoms 15y ago
>80% of its effect is ascribed to the placebo effect. Citation? Thanks.
- steve-howard 15y ago
  http://psychcentral.com/news/2008/02/26/antidepressant-data-showed-not-as-effective-as-thought/1963.html http://psychcentral.com/news/2008/02/26/antidepressant-data-... “The response to placebo in these trials was exceptionally large, duplicating more than 80% of the improvement observed in the drug groups. In contrast, the effect of placebo on pain is estimated to be about 50% of the response to pain medication.”
  - brianleb 15y ago
    I have an awful lot to say about this comment, but I'll leave it at this: The cited study included six drugs. There are currently more than 20 available on the US market. One of these 6 is no longer used (nefazodone - see the black box warning if you're curious). The study only looked at serotonin modulation. We have drugs that don't even affect serotonin now, and ones that do it much better than the old ones. [Venlafaxine is an SNRI but at low doses acts as an SSRI. To get the NE effects, one must go to the upper dosage range. Most patients can't do this because of intolerable GI discomfort. Since you're obviously negative on the subject, I'll mention that the GI upset is caused by nonspecific serotonin activity at 5HT3 and 5HT4, if I remember my receptors correctly]. The study, published in 2008, only looked at 1987-1999. Very strange. Recency is in fact important with drug trial data. PLOS Medicine is not exactly a respected medical journal... if you want good data, try Lancet, BMJ, NEJM, AJP, etc. Just because it got published definitely doesn't mean it's reliable. Very few people are actually trained to properly evaluate medical literature.
    - steve-howard 15y ago
      There's still no denying that the placebo effect plays a substantial role in the efficacy of antidepressant medications. It's part of the reason that fewer new medications are making it onto the market. Additionally, the SNRIs are marginally more effective, at best, than SSRIs in the treatment of depression. They are usually more expensive though! Fibromyalgia is a different story. I'm negative on the subject because I have been on six different antidepressants and they did nothing but cause me intense discomfort. I took desvenlafaxine at a non-noradrenergic dosage level, and it still made me insomniac, gained weight fast, triggered manic symptoms, and caused intense withdrawal symptoms. I was also on an NDRI (non-sertonergic) and a tetracyclic. I am not a doctor, but given how a doctor is responsible for putting me on a carousel of medications that screwed up my body for over six months, I don't particularly care who's considered qualified to read papers.
SoftwareMaven 15y ago
But just taking sugar pills won't make you feel better. Your mind has to believe in what you are taking to gain the placebo effect.
- Alex3917 15y ago
  "But just taking sugar pills won't make you feel better. Your mind has to believe in what you are taking to gain the placebo effect." This isn't true. Again, look at the research: http://articles.latimes.com/print/2010/dec/22/health/la-he-placebo-effect-20101223 http://articles.latimes.com/print/2010/dec/22/health/la-he-p...
  - deleted 15y ago
    [deleted]
  - SoftwareMaven 15y ago
    That is really interesting. I look at that and see a strong reason to look to cheaper, non-Western medicine, which has traditionally not been able to prove why it works. I would be very interested to see a similar study for treatment of a disease that we understand better. IBS has no real treatment of cause; all treatments are palliative and all treatments effectiveness seem to be strongly correlated with the patient's mental state. Of course, even this could be hugely beneficial for a huge range of diseases like Parkinsons and the like. I think this would be phenomenal if you were able to show a similar level of improvement with something like cancer or staff infections.
    - Alex3917 15y ago
      "I think this would be phenomenal if you were able to show a similar level of improvement with something like cancer or staff infections." http://www.maps.org/videos/source3/video14.html http://www.maps.org/videos/source3/video14.html Some interesting preliminary research on using ayahuasca to cure cancer. (Which the indigenous practitioners say works because it puts the user in touch with plant spirits or whatever.)
lmkg 15y ago
You are absolutely correct medication is not a trivial solution to your problems. The ramp-up time is significant, and if you're unlucky you'll have to re-adjust dosages or switch medications a few times. My point was that popping a pill in the morning is easier to get yourself to do than dragging your ass across town to see a therapist, or getting out of your apartment to go running for an hour.
- steve-howard 15y ago
  I had done both for some time. To be honest, seeing my psychiatrist made me feel like a petri dish, whereas my therapist is one of the most understanding and caring human beings I've ever met. Psychiatric medicine has terrible side effects, and popping pills has made me feel more horrible than depression at times. (especially considering they actually did nothing for me).

SoftwareMaven 15y ago

I agree with others that meds are not quick and easy. They should be considered when other efforts are failing. Each medication, as mentioned elsewhere, takes 4-6 weeks to show efficacy, and any particular medicine may not be effective, so you may spend six months finding your solution. On the other hand, if you have tried non-medicinal alternatives and you think you are getting worse (or you are already at a seriously bad state), the drugs can be life-savers. But quick, they are not.