4 ms·

IMO key quote the study you referenced: > In conclusion, the anti-anxiety properties of SSRIs appear to be largely dependent on expectancy effects on dopamine

IMO key quote the study you referenced: > In conclusion, the anti-anxiety properties of SSRIs appear to be largely dependent on expectancy effects on dopamine signaling while SERT blockade is not sufficient for symptom remission. Drug works, if you believe it does :)

fragcula 4y ago
It's a shame that the imagining is so expensive, because I'd love to see a true control arm with placebos and follow up scans. i.e. if you are on a placebo and are told you will get better how many do?
- daniel_iversen 4y ago
  Don’t they do truckloads of tests and comparisons on anti depression medicine all the time including blind trials etc?
  - fragcula 4y ago
    The interesting bits, for me, are the imaging scans which are expensive and slow and you need more than one for comparison per subject. Secondly the 'covert treatment' aspect, and as far as I know only Hjorth et al. do in any reasonable numbers is the giving someone the treatment and usual and tell them it's a placebo and they "shouldn't expect to get better". It's ethically tricky to do that with an anxiety disorder but I imagine a doctor telling someone with depression that will be painfully close to "you're not getting better", "we're not going to help you" and other quite rejecting disheartening ideas. But plain placebo controlled SSRI trials I think show about a 0.2 absolute benefit in SSRIs in depression. i.e. if you compare SSRI with placebo you need to treat 5 people with SSRI to see one more person respond. If you compare SSRI with no treatment, you only need to treat 3 people with depression, to have 1 more respond. Those 3 and 5 are called the 'number needed to treat' and can be compared to the 'number needed to harm'.
kokey 4y ago
I wouldn't be surprised about this when it comes to panic disorder. Just knowing you have some emergency fast acting anti anxiety medication nearby, just in case you need it, can reduce the number of panic attacks. There's probably all kinds of psychological feedback loops when people have anxiety about anxiety and then it escalates because they're anxious about it escalating. I am guessing that medication can help mitigate some components of that feedback loop for some people.
- guggalugalug 4y ago
  See also, David Foster Wallace's character David Cusk in 'The Pale King'. A wonderful portrayal of how attending to ANTs (Automatic Negative Thoughts) catalyzes this feedback loop.
davidy123 4y ago
The drug does something. It at least creates a distraction. That distraction can create a helpful feedback loop. After all, depressive/anxious/etc thoughts are generally arbitrary (though relentness), out of the all the thoughts one could have. So a chemical causing an effect, or just the process of trying an intervention can be useful. Distraction is incredibly important in therapy, it is after all ultimately how we all deal with the fact our lives have an end.

fragcula 4y ago

It's a shame that the imagining is so expensive, because I'd love to see a true control arm with placebos and follow up scans. i.e. if you are on a placebo and are told you will get better how many do?

daniel_iversen 4y ago
Don’t they do truckloads of tests and comparisons on anti depression medicine all the time including blind trials etc?
- fragcula 4y ago
  The interesting bits, for me, are the imaging scans which are expensive and slow and you need more than one for comparison per subject. Secondly the 'covert treatment' aspect, and as far as I know only Hjorth et al. do in any reasonable numbers is the giving someone the treatment and usual and tell them it's a placebo and they "shouldn't expect to get better". It's ethically tricky to do that with an anxiety disorder but I imagine a doctor telling someone with depression that will be painfully close to "you're not getting better", "we're not going to help you" and other quite rejecting disheartening ideas. But plain placebo controlled SSRI trials I think show about a 0.2 absolute benefit in SSRIs in depression. i.e. if you compare SSRI with placebo you need to treat 5 people with SSRI to see one more person respond. If you compare SSRI with no treatment, you only need to treat 3 people with depression, to have 1 more respond. Those 3 and 5 are called the 'number needed to treat' and can be compared to the 'number needed to harm'.

kokey 4y ago

I wouldn't be surprised about this when it comes to panic disorder. Just knowing you have some emergency fast acting anti anxiety medication nearby, just in case you need it, can reduce the number of panic attacks. There's probably all kinds of psychological feedback loops when people have anxiety about anxiety and then it escalates because they're anxious about it escalating. I am guessing that medication can help mitigate some components of that feedback loop for some people.

guggalugalug 4y ago
See also, David Foster Wallace's character David Cusk in 'The Pale King'. A wonderful portrayal of how attending to ANTs (Automatic Negative Thoughts) catalyzes this feedback loop.

davidy123 4y ago

The drug does something. It at least creates a distraction. That distraction can create a helpful feedback loop. After all, depressive/anxious/etc thoughts are generally arbitrary (though relentness), out of the all the thoughts one could have. So a chemical causing an effect, or just the process of trying an intervention can be useful. Distraction is incredibly important in therapy, it is after all ultimately how we all deal with the fact our lives have an end.