3 ms·

I find the "medical uncertainty" part of this more interesting than the "antidepressant" part. There are a number of medical problems, side effects, interactio

I find the "medical uncertainty" part of this more interesting than the "antidepressant" part. There are a number of medical problems, side effects, interactions, etc that only a very, very small number of people experience. Doctors, rightly, seem skeptical of anecdotes that haven't been borne out in large studies - they're likely to go with the most common explanation for something and usually be right. But how do people who really are experiencing rare problems get the right care for them? Doing their own research, talking to doctor after doctor until someone believes them? Why should the medical community do research into problems that only affect a few people? Even if they do decide it's worth it, is it possible if the sample sizes are going to be small? Say I could volunteer to prove through experimentation that if you give me medication X, I get symptom Y, and when you give me a placebo, I don't get symptom Y, but no one else has ever experienced symptom Y from medication X, does anyone care? All hard questions that I wish there were answers to.

PragmaticPulp 6y ago
There's another layer to this which makes it all the more difficult: The nocebo effect. In short, the nocebo effect is like the placebo effect but for side effects. If a patient consumes a lot of articles and anecdotes about negative side effects of a certain drug, they are far more likely to experience those side effects for themself, even if they receive placebo. This is becoming a greater problem as more patients read up on side effects through the worst of the worst side effect stories shared on social media.
- flatline 6y ago
  I always thought nocebo was a belief that the medicine would have not therapeutic effect, which is then borne out in reality. But the amplified side effects dovetail with my understanding. As an anecdotal data point, I'm a redhead with a periodic liver condition and a fast metabolism, and I don't metabolize medications normally. I take an antispasmodic for pain relief in doses that leave some people catatonic and it has little to no negative effects on me, over a decade of use. I've tried low doses of muscle relaxants that leave me reeling drunk for hours. Had two awful experiences on SSRIs, I will never try those again should I ever have the need of an antidepressant. I suspect there are sub-populations of people like me who are statistical outliers.
  - wincy 6y ago
    I don’t remember what the test is, but there’s genetic tests for common medication that show how likely it is to have a weird side effect. I once had a psychotic episode after taking Wellbutrin, despite having no history of psychosis (before or since!) My daughter got a genetic screen and a baseline interaction is a 1, with 10 being way off, I suppose. My daughter got a 9 for Wellbutrin. I assume I gave her that. Something about my chemistry just doesn’t interact with that drug the way other people do.
  - teekert 6y ago
    There is this: https://www.labqualitydays.fi/en/news/pharmacogenetics-do-you-have-your-dna-passport/ https://www.labqualitydays.fi/en/news/pharmacogenetics-do-yo... just the first thing I found.
yawnxyz 6y ago
reminds me of the history of patients with alpha-gal allergies (https://en.wikipedia.org/wiki/Alpha-gal_allergy https://en.wikipedia.org/wiki/Alpha-gal_allergy) and how they were pretty much shunned / gaslit because only a few people had experienced the symptoms. Apparently the only reason the link link between tick bits and the allergy was because the researcher studying the pheomenon got bitten by a tick and developed the allergy himself. There's a great Radiolab episode on this.
rscho 6y ago
TBF, (experienced) docs usually believe their patients even when they tell weird stuff, but: 1. we tend to overlay our own interpretation over what is described. Because that's pretty much the only way if we are to hope to do something about it. 2. In cases where something really unusual (meaning, not described in the literature) happens, modern medicine is an exercise in flying blind. Our profession is completely bound by best practices guidelines. The days of individual experimentation are long gone, and no one will ever forgive you for taking the off-path if there are negative consequences in this day and age.

PragmaticPulp 6y ago

There's another layer to this which makes it all the more difficult: The nocebo effect. In short, the nocebo effect is like the placebo effect but for side effects. If a patient consumes a lot of articles and anecdotes about negative side effects of a certain drug, they are far more likely to experience those side effects for themself, even if they receive placebo. This is becoming a greater problem as more patients read up on side effects through the worst of the worst side effect stories shared on social media.

flatline 6y ago
I always thought nocebo was a belief that the medicine would have not therapeutic effect, which is then borne out in reality. But the amplified side effects dovetail with my understanding. As an anecdotal data point, I'm a redhead with a periodic liver condition and a fast metabolism, and I don't metabolize medications normally. I take an antispasmodic for pain relief in doses that leave some people catatonic and it has little to no negative effects on me, over a decade of use. I've tried low doses of muscle relaxants that leave me reeling drunk for hours. Had two awful experiences on SSRIs, I will never try those again should I ever have the need of an antidepressant. I suspect there are sub-populations of people like me who are statistical outliers.
- wincy 6y ago
  I don’t remember what the test is, but there’s genetic tests for common medication that show how likely it is to have a weird side effect. I once had a psychotic episode after taking Wellbutrin, despite having no history of psychosis (before or since!) My daughter got a genetic screen and a baseline interaction is a 1, with 10 being way off, I suppose. My daughter got a 9 for Wellbutrin. I assume I gave her that. Something about my chemistry just doesn’t interact with that drug the way other people do.
- teekert 6y ago
  There is this: https://www.labqualitydays.fi/en/news/pharmacogenetics-do-you-have-your-dna-passport/ https://www.labqualitydays.fi/en/news/pharmacogenetics-do-yo... just the first thing I found.

yawnxyz 6y ago

reminds me of the history of patients with alpha-gal allergies (https://en.wikipedia.org/wiki/Alpha-gal_allergy https://en.wikipedia.org/wiki/Alpha-gal_allergy) and how they were pretty much shunned / gaslit because only a few people had experienced the symptoms. Apparently the only reason the link link between tick bits and the allergy was because the researcher studying the pheomenon got bitten by a tick and developed the allergy himself. There's a great Radiolab episode on this.

rscho 6y ago

TBF, (experienced) docs usually believe their patients even when they tell weird stuff, but: 1. we tend to overlay our own interpretation over what is described. Because that's pretty much the only way if we are to hope to do something about it. 2. In cases where something really unusual (meaning, not described in the literature) happens, modern medicine is an exercise in flying blind. Our profession is completely bound by best practices guidelines. The days of individual experimentation are long gone, and no one will ever forgive you for taking the off-path if there are negative consequences in this day and age.