3 ms·

One of the biggest surprises to me when I was taking advanced psychopathology courses was how little certainty there was around antidepressants and much of the

by kjrose 6y ago

One of the biggest surprises to me when I was taking advanced psychopathology courses was how little certainty there was around antidepressants and much of the drugs used to treat psychological disorders. For some people they work absolutely amazingly. For others it can actually have precisely the opposite intended effect. And for some it can have literally no effect. I had a long discussion with a psychiatrist about this and they more or less acknowledged that it really isn't a science and is more of an art. You try this SSRI or that SSDI with a low dosage and see what happens. Then you Amp it up gently. If it works great. If it doesn't, then you dial it back and try something else. Slowly working to drugs with more and more adverse side effects until something works. They have an idea of why it works but they don't really know precisely for every person.

lumost 6y ago
There is a profound negative consequence to this that long-term patient outcomes aren't very good with pharmaceutical interventions. In a different set of conditions I recall that Cognitive Behavioral Therapy has equivalent outcomes to medical intervention for ADHD at the 5 year mark, and afterwards wins as resistance to the medication is built. I wouldn't be surprised if similar outcomes are observed for depression. This is particularly problematic when it comes to medicating children/teenagers who are much earlier in how their brains adapt to stimulus.
- kjrose 6y ago
  Oh absolutely. Medication should be a last option or an emergency option for most cases.
- pseudalopex 6y ago
  Combining therapy and medication is more effective than either alone. For ADHD and depression. And "CBT has not been found to be particularly beneficial for children with ADHD."[1] [1] https://focus.psychiatryonline.org/doi/full/10.1176/appi.focus.10.3.334 https://focus.psychiatryonline.org/doi/full/10.1176/appi.foc...

by kjrose 6y ago

lumost 6y ago

There is a profound negative consequence to this that long-term patient outcomes aren't very good with pharmaceutical interventions. In a different set of conditions I recall that Cognitive Behavioral Therapy has equivalent outcomes to medical intervention for ADHD at the 5 year mark, and afterwards wins as resistance to the medication is built. I wouldn't be surprised if similar outcomes are observed for depression. This is particularly problematic when it comes to medicating children/teenagers who are much earlier in how their brains adapt to stimulus.

kjrose 6y ago
Oh absolutely. Medication should be a last option or an emergency option for most cases.
pseudalopex 6y ago
Combining therapy and medication is more effective than either alone. For ADHD and depression. And "CBT has not been found to be particularly beneficial for children with ADHD."[1] [1] https://focus.psychiatryonline.org/doi/full/10.1176/appi.focus.10.3.334 https://focus.psychiatryonline.org/doi/full/10.1176/appi.foc...