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Without antidepressants I'd be fully housebound from agoraphobia. They work. Not perfect. And tolerance at different dosages build over time. But it's not a pl

Without antidepressants I'd be fully housebound from agoraphobia. They work. Not perfect. And tolerance at different dosages build over time. But it's not a placebo effect.

dimal 2y ago
Correction: they work _for you_. This may sound pedantic but I see this blanket assertion all the time from people who take psych meds and have them work for them. There is a very large group of people for whom they do not work, and others in which they cause serious harm. I’m glad they work for you, but please don’t assume that they work for everyone. They don’t.
- burnished 2y ago
  Thats clear from context, not every personal account needs the PSA, especially since your access is mediated by layers of professionals.
  - dimal 2y ago
    I disagree. It’s not clear from the context. People often generalize their experiences to think they apply to everyone. With psych meds, this is very common. I don’t expect a PSA, just a recognition that “they work” cannot be stated as an absolute. I don’t know what you mean by access being mediated by layers of professionals.
    - burnished 2y ago
      You have to first see a doctor who will prescribe the medication followed by a pharmacist. I don't see a claim by OP that their experience generalizes absolutely. I'm also having a hard time seriously believing you don't think people are aware that folk can have varied reactions, people become aware of allergies as a concept usually well before psychiatric medication. Just to be clear - I don't mind you adding in that additional context/reminder, I think additional perspective like that is frequently helpful, but I do resent you demanding others add it in your stead like they've missed an obligation or made a mistake.
  - esperent 2y ago
    > mediated by layers of professionals. In the developed world, yes. In much of the world (perhaps even most of the world) you can simply walk into a small local pharmacy and buy pretty much anything. Antidepressants, valium, antibiotics, whatever. Only uppers tend to have stricter controls, but I've heard you could find them with a bit of legwork.
- hnpolicestate 2y ago
  "There is a very large group of people for whom they do not work" - many people are unwilling to wait the proper amount of time "4-6 weeks" for efficacy to manifest *especially* when for the first 2-3 weeks you many times feel much worse than baseline. First month on Effexor made me feel miserable. More anxious but much, much more irritable and depressed. Then one day a month in I'm sitting at my desk and I suddenly feel high as a kite lol. Melting bliss. That feeling too fades and then you just feel better than baseline until you build tolerance to current dose. Raise, rinse and repeat. Better than having to be near an exit whenever inside a structure!
  - heavyset_go 2y ago
    Doctors I've talked to have said it's 4 to 6 weeks to reach a baseline, where the medication reaches a steady level in the blood and receptor changes in the brain reach a new equilibrium, but even up to 2+ months for the real effect to kick in. Those 4-6 weeks are when your brain is adapting to an ever increasing serum level of antidepressants, and it takes about ~2 weeks for serotonin receptors to downregulate in response. That time can be very uncomfortable, specifically because SSRIs indirectly activate 5HT2C, leading to dysphoria, anxiety, etc, before the receptor is sufficiently downregulated. tl;dr: it can take longer than 4-6 weeks for efficacy to manifest
    - mylastattempt 2y ago
      This is what I've heard from those I know that take anti depressants - the time that is suggested before you would be able to look back and say: "I'm doing much better than four weeks ago", is a bit daunting. First and foremost because you take them at a point in your life where you're, well, depressed (used as a blanket term here). So patiently waiting for the effect to manifest is a burden in itself, in addition to hoping it works and not being sure if you're experiencing a placebo or actual effect. But what scares me more, personally, is that it takes such a long time to get on and ween off. It seems to fundamentally change something in the human body or brain. As opposed to e.g. amphetamines, and benzos, which may have long lasting effects from prolonged use, but otherwise appear to be pretty straight forward. Having never needed antidepressants, I'm curious if others who have taken them, worried about this before or afterwards?
- olyjohn 2y ago
  This is the same for every drug. None of them work the same for everybody all the time. Like they say everybody is different.
beaglesss 2y ago
I am curious how they link to suicide and homicide. Antidepressants seem to be most dangerous when they make people just motivated enough to execute maladaptive ideas but not functional enough to become happy productive people. This is obviously a corner case that doesn't apply to the vast majority of people on antidepressants but it brings up some worthwhile discussions.
- more_corn 2y ago
  If you stop taking your SSRI suddenly, your depression is even worse than when you started. This is why doctors strongly urge patients to ween instead of dropping off suddenly. That effect (massive increase in symptoms in cases where patients stop medication suddenly) probably contributes to a significant portion of the risk.
  - hollerith 2y ago
    Depression makes it hard to get things done. I heard that the SSRI can eliminate that symptom before it eliminates the desire to die, and that is where a lot of the risk of suicide comes from -- which of course is during the first weeks or months after starting the SSRI.
    - hirvi74 2y ago
      I've also heard that some people with unipolar depression might actually be misdiagnosed and have a form of bipolar disorder. SSRIs can potentially invoke manic/mixed states in some individuals with bipolar disorder, which might also account for some of the increased risk in suicide from SSRIs.
    - rincebrain 2y ago
      More or less. Your actual perceived "mood" is generally the "last" thing to change with basically all flavors of traditional antidepressant, since it's more or less your calibration of how much life sucks over time, and it takes a while of noticing it sucks less to recalibrate. So every doctor I've ever had has given me a very similar lecture about being very cautious, because depression is more or less characterized as having reduced or no ability to actually drive yourself to do things, and then you feel like shit as that keeps happening and your frame of mind goes sour. But conversely, if the antidepressant affects the "underlying" problem, your inability to turn thought into deed, it will take time (and possibly therapy) for you to recalibrate again, and then you have a window of "I want to die, nothing will ever improve", coupled with a newfound ability to successfully turn thought into deed. It's one reason things like ketamine and psilocybin are seen as wild - when they work, both generally improve at once, so you avoid that problem.
more_corn 2y ago
Exactly. We know that they DO work, but we don’t know how. Not a doctor and this is not brain health advice, but SSRIs take several weeks to start working. If they work because “more serotonin in the brain treatments depression” they should start working instantly. The two week lag indicates that they work based on a secondary effect caused by long term elevation of serotonin. And it’s maddening that we don’t seem to know what that effect is.
- deleted 2y ago
  [deleted]
- marssaxman 2y ago
  Sometimes an SSRI does start working instantly. That was my experience the first time I took Zoloft; I remember leaving work early that afternoon for a walk in the park, marveling at the way all the colors in the world had become more vivid. When I tried Zoloft again years later, during another bout of depression, I felt nothing: not right away, not for weeks after, no change at all. I suspect that there is not really any such ailment as depression, any more than there is any such disease as fever; that is, the pattern of symptoms we see represents a reaction to some underlying problem, and many different kinds of problems may cause similar symptoms, while requiring different solutions.
  - StefanBatory 2y ago
    For me sertaline was way more gradual. And it was never that I suddenly felt right - it's just that after few weeks I noticed my floor on feeling very down for up a bit. (I got prescribed it for anxiety)

Without antidepressants I'd be fully housebound from agoraphobia. They work. Not perfect. And tolerance at different dosages build over time. But it's not a placebo effect.

dimal 2y ago

Correction: they work _for you_. This may sound pedantic but I see this blanket assertion all the time from people who take psych meds and have them work for them. There is a very large group of people for whom they do not work, and others in which they cause serious harm. I’m glad they work for you, but please don’t assume that they work for everyone. They don’t.

burnished 2y ago
Thats clear from context, not every personal account needs the PSA, especially since your access is mediated by layers of professionals.
- dimal 2y ago
  I disagree. It’s not clear from the context. People often generalize their experiences to think they apply to everyone. With psych meds, this is very common. I don’t expect a PSA, just a recognition that “they work” cannot be stated as an absolute. I don’t know what you mean by access being mediated by layers of professionals.
  - burnished 2y ago
    You have to first see a doctor who will prescribe the medication followed by a pharmacist. I don't see a claim by OP that their experience generalizes absolutely. I'm also having a hard time seriously believing you don't think people are aware that folk can have varied reactions, people become aware of allergies as a concept usually well before psychiatric medication. Just to be clear - I don't mind you adding in that additional context/reminder, I think additional perspective like that is frequently helpful, but I do resent you demanding others add it in your stead like they've missed an obligation or made a mistake.
- esperent 2y ago
  > mediated by layers of professionals. In the developed world, yes. In much of the world (perhaps even most of the world) you can simply walk into a small local pharmacy and buy pretty much anything. Antidepressants, valium, antibiotics, whatever. Only uppers tend to have stricter controls, but I've heard you could find them with a bit of legwork.
hnpolicestate 2y ago
"There is a very large group of people for whom they do not work" - many people are unwilling to wait the proper amount of time "4-6 weeks" for efficacy to manifest *especially* when for the first 2-3 weeks you many times feel much worse than baseline. First month on Effexor made me feel miserable. More anxious but much, much more irritable and depressed. Then one day a month in I'm sitting at my desk and I suddenly feel high as a kite lol. Melting bliss. That feeling too fades and then you just feel better than baseline until you build tolerance to current dose. Raise, rinse and repeat. Better than having to be near an exit whenever inside a structure!
- heavyset_go 2y ago
  Doctors I've talked to have said it's 4 to 6 weeks to reach a baseline, where the medication reaches a steady level in the blood and receptor changes in the brain reach a new equilibrium, but even up to 2+ months for the real effect to kick in. Those 4-6 weeks are when your brain is adapting to an ever increasing serum level of antidepressants, and it takes about ~2 weeks for serotonin receptors to downregulate in response. That time can be very uncomfortable, specifically because SSRIs indirectly activate 5HT2C, leading to dysphoria, anxiety, etc, before the receptor is sufficiently downregulated. tl;dr: it can take longer than 4-6 weeks for efficacy to manifest
  - mylastattempt 2y ago
    This is what I've heard from those I know that take anti depressants - the time that is suggested before you would be able to look back and say: "I'm doing much better than four weeks ago", is a bit daunting. First and foremost because you take them at a point in your life where you're, well, depressed (used as a blanket term here). So patiently waiting for the effect to manifest is a burden in itself, in addition to hoping it works and not being sure if you're experiencing a placebo or actual effect. But what scares me more, personally, is that it takes such a long time to get on and ween off. It seems to fundamentally change something in the human body or brain. As opposed to e.g. amphetamines, and benzos, which may have long lasting effects from prolonged use, but otherwise appear to be pretty straight forward. Having never needed antidepressants, I'm curious if others who have taken them, worried about this before or afterwards?
olyjohn 2y ago
This is the same for every drug. None of them work the same for everybody all the time. Like they say everybody is different.

beaglesss 2y ago

I am curious how they link to suicide and homicide. Antidepressants seem to be most dangerous when they make people just motivated enough to execute maladaptive ideas but not functional enough to become happy productive people. This is obviously a corner case that doesn't apply to the vast majority of people on antidepressants but it brings up some worthwhile discussions.

more_corn 2y ago
If you stop taking your SSRI suddenly, your depression is even worse than when you started. This is why doctors strongly urge patients to ween instead of dropping off suddenly. That effect (massive increase in symptoms in cases where patients stop medication suddenly) probably contributes to a significant portion of the risk.
- hollerith 2y ago
  Depression makes it hard to get things done. I heard that the SSRI can eliminate that symptom before it eliminates the desire to die, and that is where a lot of the risk of suicide comes from -- which of course is during the first weeks or months after starting the SSRI.
  - hirvi74 2y ago
    I've also heard that some people with unipolar depression might actually be misdiagnosed and have a form of bipolar disorder. SSRIs can potentially invoke manic/mixed states in some individuals with bipolar disorder, which might also account for some of the increased risk in suicide from SSRIs.
  - rincebrain 2y ago
    More or less. Your actual perceived "mood" is generally the "last" thing to change with basically all flavors of traditional antidepressant, since it's more or less your calibration of how much life sucks over time, and it takes a while of noticing it sucks less to recalibrate. So every doctor I've ever had has given me a very similar lecture about being very cautious, because depression is more or less characterized as having reduced or no ability to actually drive yourself to do things, and then you feel like shit as that keeps happening and your frame of mind goes sour. But conversely, if the antidepressant affects the "underlying" problem, your inability to turn thought into deed, it will take time (and possibly therapy) for you to recalibrate again, and then you have a window of "I want to die, nothing will ever improve", coupled with a newfound ability to successfully turn thought into deed. It's one reason things like ketamine and psilocybin are seen as wild - when they work, both generally improve at once, so you avoid that problem.

more_corn 2y ago

Exactly. We know that they DO work, but we don’t know how. Not a doctor and this is not brain health advice, but SSRIs take several weeks to start working. If they work because “more serotonin in the brain treatments depression” they should start working instantly. The two week lag indicates that they work based on a secondary effect caused by long term elevation of serotonin. And it’s maddening that we don’t seem to know what that effect is.

deleted 2y ago
[deleted]
marssaxman 2y ago
Sometimes an SSRI does start working instantly. That was my experience the first time I took Zoloft; I remember leaving work early that afternoon for a walk in the park, marveling at the way all the colors in the world had become more vivid. When I tried Zoloft again years later, during another bout of depression, I felt nothing: not right away, not for weeks after, no change at all. I suspect that there is not really any such ailment as depression, any more than there is any such disease as fever; that is, the pattern of symptoms we see represents a reaction to some underlying problem, and many different kinds of problems may cause similar symptoms, while requiring different solutions.
- StefanBatory 2y ago
  For me sertaline was way more gradual. And it was never that I suddenly felt right - it's just that after few weeks I noticed my floor on feeling very down for up a bit. (I got prescribed it for anxiety)