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Prozac 'no better than placebo' for treating children with depression, experts
- shswkna 1y agoFrom the article: > They can also increase suicidal ideation. A very close family member committed suicide, after Prozac dosage adjustments made his brain chemistry go haywire. This happened 30 years ago, and it has been known to us that Prozac can cause this, since then. The Guardians headline is way, way understating the real situation here.
- carsoon 1y agoThe problem with suicidal depression is that if someone has created the thought pattern that death is best, then removing the symptoms of depression (lethargy, lack of energy, no willpower) now gives the person the ability to actually follow through with the act. Medications almost always target symptoms and never address root causes.
- shswkna 1y agoYes, this is what happens.
- kittensmittens5 1y agoNo it's not.
- kittensmittens5 1y ago[flagged]
- kayodelycaon 1y agoYup. Depression medication can significantly help the emotional symptoms, but that takes longer to be effective. I’m bipolar and a lot of the medication I take does not become fully effective for months. For me, my medication slowly became more effective over years as my brain no longer had to compensate for hardware problems.
- fragrom 1y agoThis is what my psychiatrist more or less warned me about when I went on medication; that a lot of people who are suicidal lack the energy and ability to plan their suicide, and medications can sometimes undo those particular symptoms and people manage to end themselves. I'm not sure what kinds of studies have been done about it, but I've had a few therapists same similar ideas. If it's not a studied phenomenon, then it has folks that believe it exists.
- doubled112 1y agoSometimes willpower improves before mood.
- autumnstwilight 1y agoI'd like to make the point that even if this does occur, it doesn't mean, "therefore this medication shouldn't be used/is worse than doing nothing," just that awareness and caution is needed. I went through a frankly terrible few months on my current meds because they removed the emotional numbness before removing the bad feelings. However, once that was over they effectively gave me my life back after 10+ years of continual exhaustion and brain fog.
- deleted 1y ago[deleted]
- DANmode 1y ago[flagged]
- DANmode 1y agoThis gets even more interesting when you realize many SSRIs are antibacterials.
- JumpCrisscross 11mo agoIt gets less interesting when one notices that social animals are much more prone to depression. Inflammation and depression are linked. Infection causes inflammation. It doesn’t follow that depression is caused by infection.
- pixelready 1y agoFinding everyone’s cow is expensive and time consuming: https://antidepressantcow.org/2020/02/the-story-of-the-antidepressant-cow https://antidepressantcow.org/2020/02/the-story-of-the-antid... But is the only true cure to the suffering. We’d have to undergo a massive reorganization of society (and upset a few hefty profit margins) to prioritize that, so we settle for the messy symptom management we have.
- deleted 1y ago[deleted]
- cornstalks 1y agoThat story doesn’t work for people with depression who otherwise have very good lives. I grew up in a stable household with a loving family and both parents present and supportive. I’ve never had financial hardship, either as a kid depending on my parents to provide or as an adult providing for myself and family. I did very well in school, had plenty of friends, never had enemies, never got bullied or even talked bad about in social circles (so far as I know…). I have no traumatic memories. I could go on and on, but despite having a virtually perfect life on paper, I have always struggled with depression and suicidal ideation. It wasn’t until my wife sat down and forced me to talk to a psychiatrist and start medication that those problems actually largely went away. In other words, I don’t think there’s a metaphorical “cow” that could have helped me. It’s annoying we don’t understand what causes depression or how antidepressants help, and their side effects suck. But for some of us, it’s literally life saving in a way nothing else has ever been.
- hirvi74 1y agoFirst of all, I want to write that I am glad you found something that worked so that you are able to remain here with us. Though, I am curious about the, "otherwise have very good lives" part. Whose definition are you using? It seems the criteria you laid out fits a "very good life" in a sociological sense -- very important, sure. You could very well have the same definition, and perhaps that is what I am trying to ask. Would you say you were satisfied in life? Despite having a good upbringing, were you (prior to medication) content or happy? I am by no means trying to change your opinion nor invalidate your experiences. I just struggle to understand how that can be true. As someone that has suffered with deep depressive bouts many times over, I just cannot subscribe to the idea that depression is inherently some sort of disorder of the brain. In fact, I am in the midst of another bout now. One that's lasted about 3 or so years. To me, I have always considered emotions/states like depression and anxiety to be signals. A warning that something in one's current environment is wrong -- even if consciously not known or difficult to observe. And if anyone is curious, I have analyzed this for myself, and I believe the etiology of my issues are directly linked to my circumstances/environment. > I don’t think there’s a metaphorical “cow” that could have helped me. The smart-ass in me can't help but suggest that maybe medication was your cow?
- squishington 1y agoMy understanding is that the optimal scenario is taking an SSRI in combination with therapy. The SSRI adds flexibility for the brain to respond to therapy and envisage new possibilities. If you don't include therapy, you've just established a new baseline to habituate to.
- tsimionescu 11mo agoThis is true overall, but it only works for a limited set of patients. It's pretty likely that what we're calling depression is a different set of diseases that manifest with common symptoms, and SSRIs + therapy work wonders for some variants, but not others. In fact, we actually do know this to be the case already: bipolar disorder also manifests with the same symptoms as depression for some time, and SSRIs + therapy are definitely not enough to treat bipolar disorder. Most likely there are other similar diseases that present with depressive symptoms that we have yet to identify distinctly and don't know how to treat effectively.
- Modified3019 11mo agoThis is a good thing to know, but should also be noted that the same thing can happen with simply naturally recovering from a depressive episode. The phenomenon should not be considered a reason to not medicate (which I don’t think you are implying, but some may take that as the conclusion). Instead it’s definitely something important to explicitly make people aware of. Depression or the feeling so much mental agony that the idea of escaping with death becomes comforting, is a signal that something is wrong. Realizing this has been important with weathering my own occasional dealings with severe[0]depression, once I realize “something is wrong”, I can start the annoyingly slow process of trial and error making changes to correct things. This turns depression from “how reality is” into “this is just feedback on my body’s state”. It turns things getting worse into either a “this is either a transient state or the wrong solution”. [0] Which I define as the point where any passive ideation (fantasies of dying) starts to enter the gradient of becoming involuntary. As opposed to regular negative thoughts which can (and should) be brushed away as easily as a fly landing on me. Curiously, once I noticed it also affected my ability to experience color. While I could technically see colors, it was like have a mental partial greyscale filter because there was no beauty in it, color was just a meaningless detail.
- jdietrich 11mo agoA sudden improvement in mood is one of the key warning signs for suicide. Often it's genuinely just a sudden improvement, but sometimes it is a byproduct of the relief people experience when they commit to ending their life. If you know someone who is severely depressed, you should watch them very carefully if they suddenly seem carefree. >once I noticed it also affected my ability to experience color A small amount of evidence does support the notion that depressed people literally see the world as being less vibrant. https://pubmed.ncbi.nlm.nih.gov/34689697/ https://pubmed.ncbi.nlm.nih.gov/34689697/ https://cdnsciencepub.com/doi/10.1503/jpn.200091 https://cdnsciencepub.com/doi/10.1503/jpn.200091
- ekianjo 1y agoSuicidal ideation is a risk for many CNS drugs, and not unique to Prozac as far as I know. But yes this is a major risk factor that needs to be taken in account before such kind of treatments.
- EasyMark 1y agoIsn't that a possibility with a lot of drugs though? I think it depends on the rate and not a "does or does not" type of questions. Now if the drug doesn't help more than a placebo that's clearly a huge negative, but if it has a high rate of success vs placebo then they will make adjustments and watch out for the side-effect (of course) letting patients know it's a possibility and to report if it starts happening.
- salemh 11mo agoThe efficacy of anti-depressants has been consistently over-inflated, so generations were poisoned with side-effects: suicidal ideation, homicidal tendencies, etc. https://pubmed.ncbi.nlm.nih.gov/20616621/ https://pubmed.ncbi.nlm.nih.gov/20616621/ Results: Meta-analyses of FDA trials suggest that antidepressants are only marginally efficacious compared to placebos and document profound publication bias that inflates their apparent efficacy. These meta-analyses also document a second form of bias in which researchers fail to report the negative results for the pre-specified primary outcome measure submitted to the FDA, while highlighting in published studies positive results from a secondary or even a new measure as though it was their primary measure of interest. The STARD analysis found that the effectiveness of antidepressant therapies was probably even lower than the modest one reported by the study authors with an apparent progressively increasing dropout rate across each study phase.*
- EB66 11mo agoI also had a close family member who committed suicide shortly after going on Prozac -- this also happened nearly 30 years ago. His young son later went on Prozac himself (several months after his fathers suicide) and immediately started demonstrating bizarre disinhibited anti-social behavior (e.g., damaging property, stealing from friends, etc). He was immediately yanked off Prozac when he started articulating his own thoughts of suicide. The bizarre anti-social behavior improved after discontinuing Prozac. For some people, Prozac is a very dangerous drug. It is fully deserving of its FDA black label warning (which it didn't have 30 years ago).
- slaymaker1907 11mo agoThat sounds like mania which is even more likely considering that early depression is often actually bipolar.
- deleted 11mo ago[deleted]
- marcus_holmes 1y ago> "But a new review of trial data by academics in Austria and the UK concluded that..." > "Mark Horowitz, an associate professor of psychiatry at Adelaide University and a co-author of the study," Austria - cold, has mountains, but not Adelaide University Australia - hot, has kangaroos, and Adelaide University Is the Grauniad returning to form?
- aaronbrethorst 1y agoNature is healing. https://en.wikipedia.org/wiki/The_Guardian#References_in_popular_culture https://en.wikipedia.org/wiki/The_Guardian#References_in_pop...
- djohnston 1y ago[flagged]
- forgetfreeman 1y agoIt's even more fascinating when you have first hand experience with how much unmitigated guesswork goes into selecting psychiatric meds and their dosage.
- Aeglaecia 1y agoit's somehow even more fascinating when you talk to dozens of people who were medicated as kids and get an idea of the real implications
- forgetfreeman 11mo ago...or literally watched friends get over-medicated into committing suicide.
- mberning 1y agoI used to share your opinion, and in a way I still do, but after having 3 children and seeing how horrible some of these behaviors and habits can get, I completely understand why people cave in to get some relief. The stress of dealing with severe behavioral issues day after day can easily destroy a marriage and family.
- monero-xmr 1y agoSSRIs literally saved my life, no question about it. Night and day difference, from daily panic attacks destroying my life, happiness, and career, to being almost completely better in 2 weeks after starting. I tried exercise and diet and meditation and you name it, for years!, before I gave medication a go. Do not care what the science says. It 100% worked for me. Please get help if you need it, tens of millions of people use this medicine successfully Articles like this are part of the narrative that SSRIs in general are no better than placebo. Absolutely not true for me!
- funkychicken 1y agoHopefully people don’t see articles like this (for depression) and think the results are the same for anxiety disorders.
- IAmBroom 11mo agoTHIS! SSRIs have been proven to be very effective against anxiety disorders, which in many ways mimic depression, but have different pathologies and causes. Also, they saved me.
- fgonzag 1y agoSame here, after struggling for 39 years, glp-1 + SSRI + ADHD meds have made me a normal productive human, and 2 years ago I had pretty much given up on the possibility. Having a child forced me to fix my life, and I'm incredibly happy because of it.
- lemming 1y agoOur 11 year old daughter was seriously depressed recently. N=1, but fluoxetine was life changing (and potentially life saving) for her, at least.
- thebigspacefuck 1y agoPlacebo can be life changing
- biff1 1y agoNocebo can too. Apropos the featured article, I wonder if we should worry about that when we report in the popular media that antidepressants trigger suicides.
- abraxas 11mo agoAbsolutely. These random namedrops of drugs are irritating. People respond to different psychiatric medications in wilddly different ways. And actually, the majority do not respond at all. Throwing a random name of some random medication helps absolutely nobody. It will just make some desperate people seek "this one drug" that they heard about on the internet.
- muhis 11mo agoThat was an anecdote about the medication in question, not a random namedrop. Prozac is fluoxetine.
- tcj_phx 1y ago[flagged]
- EasyMark 1y agoPuberty in general can be rough. I (a dude) had all kinds of bad thoughts and moods going through puberty and then one year it was just gone, grades improved dramatically, started making friends again, etc
- cc-d 1y ago[flagged]
- forgetfreeman 1y agoUse more words.
- khannn 1y ago[flagged]
- AnimalMuppet 1y agoUm, that's fewer words.
- deleted 11mo ago[deleted]
- khannn 11mo agoFDA = Joke
- Forgeties79 1y agoThis reads to me like over-prescription rather than lack of efficacy but I’m also not a doctor and won’t presume my kneejerk reaction is accurate. We saw a similar whiplash with Ritalin after over-prescribing in the 90’s/2000’s. ADHD medication absolutely works, but for a lot of people it didn’t for this reason.
- hirvi74 1y agoEven for people with legit ADHD, like myself, medication isn't always a home run. I think something like 10%-20% of people do not respond well to any medications. I personally am only a 'partial responder' in that I only really get an improvement in focus/concentration -- not really anything else. But hell, that is still better than life without medication.
- Forgeties79 11mo agoDefinitely didn’t mean to imply it’s a home run. I’m just saying it clearly and legitimately helps a ton of people. My point is if you include more and more people who don’t need it because of over-prescription it’s going to appear as lower overall efficacy while still helping a lot of people in the pool. Making up numbers: If only 20 out of 100 people actually have ADHD then out the gate you’ve ruled out helping 80% of the people. So if 15 of the remaining 20 see improvement in their daily lives that means 75% suddenly looks like 15%. Diagnosing and treatment is never that clean, there will always be some people who don’t necessarily need a certain medication yet get it prescribed (or don’t when they need it! Especially women with ADHD) because doctors are fallible like anybody else, systemic issues, etc. But with a commonly prescribed medication like Adderall the problem is definitely more pronounced. Anyway I’m curious enough to look more closely at the study, this is a very interesting topic. If Xanax is really not helping people that’s pretty serious.
- jdietrich 11mo agoEffect size is strongly affected by severity - people who aren't very ill just don't have as much to gain compared to people who are gravely ill. Widening diagnostic criteria and more liberal prescribing will inevitably lead to a reduction in the observed effect size. Antidepressants were bona-fide miracle drugs when we first started using them on desperately ill inpatients who experienced every moment as exquisite torture. We saw the most miserable lives completely transformed in a matter of weeks. They have become merely "sorta-kinda useful sometimes" now that we're mainly prescribing them to broadly functional people who are feeling a bit sub-par. SSRIs are a pretty poor fit for the latter cohort, because SSRIs cause significant emotional blunting in the majority of patients, to the extent that some people hypothesise that emotional blunting is the fundamental beneficial effect. Feeling quite numb is an incredible improvement if you are constantly unbearably miserable. If you have a more normal range of emotional experience than relentless misery, it is likely a sideways move at best; if your core complaint is that you feel numb and apathetic, they're probably actively harmful. SSRIs are very widely used because of their extraordinary safety, but they're often thoughtlessly prescribed by overworked primary care doctors. There are a wide range of antidepressants (and drugs that have antidepressant effects despite not being marketed as such) that are likely a better option for a large proportion of patients.
- hirvi74 1y agoI can't bring myself to try an SSRI. I just cannot do it. I've got a prescription for an NDRI on my desk, and I still won't take it. I am not anti-psychiatry either. I take psychiatric medication for a different condition already. But something about anti-depressants just doesn't sit well with me. As crazy as it may sound, I think a lot of my depression stems from living a life that is not true to myself and due to countless failed attempts to be someone I cannot never be. As far as I am concerned, depression is just a symptom of my situation and not some true disorder. For the sake of analogy, I would say it's like food poisoning. Yes, the GI issues are awful, but the body is responding appropriately.
- burnt-resistor 1y agoOne needs to not work and be able to remain at home for about a week or so to see if the side-effects are manageable. One shouldn't simply continue on with operating machinery or working a job while titrating up a new psychiatric medication. Honestly, employers should offer medical time off for this.
- sundarurfriend 1y ago> I've got a prescription for an NDRI on my desk, and I still won't take it. ... something about anti-depressants just doesn't sit well with me. At first it sounded like your antipathy was with SSRIs specifically (which I largely share), but it seems like it's anti-depressants in general. FWIW, I used to think similar to you, and roughly agree with the gist of your second paragraph, but I've come to think of antidepressants as useful in a specific way: people say "it's a crutch" as a negative thing (about a lot of things including antidepressants), but a crutch was very useful to me when recovering from a fracture, and helped me enormously with my progress; similarly, even if "depression is just a symptom of my situation", it can and does often lead to a cycle where the depression itself feeds into the situation and in turn sustains itself. An antidepressant that works for you is a good way to be able to see things more clearly, feel the motivation and insight that depression clouds out, and thus be able to break out of the cycle. It doesn't have to be a "cure" that counters a disorder, it can be a tool that you use for its purpose and then throw away (and it does sound like you're well-motivated to do that).
- 11mo ago
- burnt-resistor 1y agoMaybe SSRIs work for some, but Paxil gave me serotonin syndrome and Prozac made my mom psychotically homicidal. I've tried every SSRI titrating on and off (except Paxil), but they all caused deal-breaking side-effects.
- rrrrrrrrrrrryan 1y agoHomicidal?
- burnt-resistor 1y agoYep. My dad recounted that in 1989, he had to restrain her because she (then age 40) had a psychotic episode described as a "murderous impulse" just after starting a brand new "wonder pill", Prozac. This was quite uncharacteristic for a tiny, docile woman who is often described as "sweet" and "nice" who never had any psychiatric symptoms before or since except a couple of brief times of situational depression. There's a lot of FUD and social ills washing in mass media rather than less biased peer-reviewed research that blames individuals, conflates preexisting conditions with medication side-effects, and clouds the issue of whether SSRIs increase suicide and/or violent psychosis or not. Check out one of the modern black box warnings of fluoxetine (Prozac) that only addresses a subset of side-effects, suicide in children and young adults: https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=4b8fcce1-abfc-4631-9975-9d66e178dab6 https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?set... Somehow, I doubt there is much motivation to look for economically inconvenient and unnerving side-effects in some demographics, especially if they're adults who can easily be blamed entirely for all of their own actions because it's "definitely not" due to a (formerly) profitable pill or a pseudoscientific profession that doesn't exactly know how the medications it prescribes work, who would benefit from or be harmed by them, or have any ability to measure the organ or system they're supposed treating.
- tcj_phx 11mo agoThanks for sharing your mom's experience with big pharma's then-new wonder-drug. > Somehow, I doubt there is much motivation to look for economically inconvenient and unnerving side-effects in some demographics, Robert Whitaker examined the pharmaceutical industry's ideological capture of conventional psychiatry in his third book, Psychiatry Under the Influence. https://robertwhitakerbooks.com/psychiatry-under-the-influence/ https://robertwhitakerbooks.com/psychiatry-under-the-influen... I've written for the Mad in America Foundation's webzine. My latest piece was titled Theodoric of Arizona: State-Sanctioned Pharma-Based Pseudo-Doctor: https://www.madinamerica.com/2024/07/theodoric-arizona/ https://www.madinamerica.com/2024/07/theodoric-arizona/ This was inspired by the old SNL skit, Theodoric of York, Medieval Barber. The article is structured around my proposal of a Theodoric’s Principle of Medical Advancement, to explain why medical progress is so glacial.
- mhuffman 1y agoThey must have been pretty damn confident of the results to give depressed children a placebo.
- deleted 1y ago[deleted]
- comex 1y agoI think this is the paper in question? https://osf.io/preprints/psyarxiv/wk4et_v3 https://osf.io/preprints/psyarxiv/wk4et_v3 Clinical trials of antidepressants are weird because they're usually short-term (6-12 weeks), whereas practical use of antidepressants usually lasts years. I personally suspect that short-term trials show an exaggerated placebo effect, because the novelty doesn't have time to wear off.
- tsoukase 1y agoAntidepressants benefit specific populations, those that have a predominant "internal" stress/depression and not due to a profound external trauma. They will not help a child that is continuously bullied, but one that has inherited a depressive trend. This holds for children and adults, barring some differences due to age maturity. Saying "no difference from placebo" for a treatment that is used by hundreds of millions is poor science, if not misinformation and malice.
- RickJWagner 11mo agoFortunately, there are well documented lifestyle adaptions that can sharply reduce depression. Religion is a good example. https://pmc.ncbi.nlm.nih.gov/articles/PMC3426191/ https://pmc.ncbi.nlm.nih.gov/articles/PMC3426191/
- deleted 11mo ago[deleted]
- bossyTeacher 11mo agoSwapping one problem for another. Religion sounds like the worst place for someone who is mentally vulnerable. It's like pulling out your credit card in a shopping mall full of salesmen who are under tremendous pressure to make big sales asap
- RickJWagner 11mo agoI have seen no studies that suggest such a thing. Hoards of studies suggest religion is good for mental health. I can be persuaded, though. Can you show research?
- bossyTeacher 11mo agoFor whose mental health? My point is that religion brings its own shared of issues. And by religion here I mean organised religion. Religions that don't involve rituals or gatherings with other people in hierarchical settings are different (but I assume most people are after rituals and gatherings with other people in well defined settings imo rather than the actual metaphysical beliefs). - If you look at highly religious areas like the bible belt, they are often linked to worse mental health outcomes for those who don't the religious worldview such as queer people https://www.thetrevorproject.org/research-briefs/lgbtq-youth-in-the-south-dec-2021 https://www.thetrevorproject.org/research-briefs/lgbtq-youth... https://pmc.ncbi.nlm.nih.gov/articles/PMC8724198 https://pmc.ncbi.nlm.nih.gov/articles/PMC8724198 https://pmc.ncbi.nlm.nih.gov/articles/PMC10752621 https://pmc.ncbi.nlm.nih.gov/articles/PMC10752621 - That wave of christianism, ironically called christian science, was the cause of mental distress and deaths of tons of children due to the parents religious views. Religious based neglect is a common form of religious based abuse too. https://childrenshealthcare.org/victims https://childrenshealthcare.org/victims https://pmc.ncbi.nlm.nih.gov/articles/PMC7545013 https://pmc.ncbi.nlm.nih.gov/articles/PMC7545013 https://pubmed.ncbi.nlm.nih.gov/9521945/ https://pubmed.ncbi.nlm.nih.gov/9521945/ - Having religious parents is often associated with conditions like anxiety or depression https://pmc.ncbi.nlm.nih.gov/articles/PMC10719686 https://pmc.ncbi.nlm.nih.gov/articles/PMC10719686 - Struggles of a religious nature causing mental health issues all the way up to suicidal ideation https://www.sciencedirect.com/science/article/pii/S2666915323001786 https://www.sciencedirect.com/science/article/pii/S266691532... https://pmc.ncbi.nlm.nih.gov/articles/PMC4776639 https://pmc.ncbi.nlm.nih.gov/articles/PMC4776639 https://www.researchgate.net/publication/371293385_SUICIDE_ATTEMPT_SPIRITUAL_STRUGGLES_AND_MENTAL_HEALTH_A_CASE_STUDY_OF_AN_EVANGELICAL_PASTOR https://www.researchgate.net/publication/371293385_SUICIDE_A...
- dboreham 11mo agoChemicals like this imho act like "global variables" for the neural network. Perhaps a bit like temperature in an LLM. They have an effect, but the effect is sort of holographic -- there's no way to predict/compute exactly what the effect will be, because it's a function of parameters that include all the training data, specifics of neuron function that depend on DNA and other environmental factors and so on. The effect might be beneficial, by some definition of beneficial, but it might not. Even a simple chemical like ethanol has a wide variety of effects on different people.
- sharts 11mo agoI thought this was already known? I can’t recall exactly but there was some research pointing to SSRIs in general as not being particularly effective at all. They were just hyped a lot and became mainstream.
- area51org 11mo agoI wouldn't go that far, but there was a now-famous study (Princeton?) that showed that doing aerobic exercise for maybe 30 mins every day, about five days per week, was equally effective at alleviating depression symptoms.
- jdietrich 11mo agoThere's one big problem with that - getting seriously depressed people to do 30 minutes of exercise (or anything else) five days a week. "Get more exercise" is excellent advice for someone who feels a bit down, but it's absolutely useless for someone who can barely summon up the strength to eat or brush their teeth.
- jasonfarnon 11mo agoIt gets even harder if you offer them the alternative of just taking a pill. For widespread health policy, we should want the proportion of depressives who will never learn to manage it themselves because a pill is offered to be smaller than the proportion for whom the pill is effective. I had always assumed these pills were effective enough but studies like these make me wonder.
- jdietrich 11mo agoThey are by no means mutually exclusive. If you want depressed people to get more exercise, then a really useful starting point is to give them a pill that could rapidly increase their energy and motivation. The idea that people will be stuck on those pills forever is just lazy psychiatry; ongoing maintenance treatment is often the best option for patients with a history of severe depression and a high risk of relapse, but antidepressants are equally useful as a stepping-stone towards self-management. Bluntly, if someone is capable of actually starting and sticking with an exercise routine, then they aren't very depressed and should not be offered medication as a first-line treatment. Antidepressants are markedly less effective in patients with milder illnesses, so psychotherapy and lifestyle interventions are a far better initial treatment option. It's only when these treatments fail - or when engaging with them is severely impaired by the severity of the illness - that medication becomes the favoured option.
- robertakarobin 11mo agoI was very young when my mom started Prozac but do remember how angry and sad she was before compared to after. Years later there was a time when me and my sister noticed our mom was acting a bit strange -- more snappish and irritable than usual, and she even started dressing differently. Then at dinner she announced proudly that she had been off Prozac for a month. My sister and I looked at each other and at the same time went, "Ohhhh!" Mom was shocked that we'd noticed such a difference in her behavior and started taking the medication again. I've been on the exact same dose as her for 15 years, and my 7-year-old son just started half that dose. If I have a good day it's impossible to day whether that's due to Prozac. But since starting Prozac I have been much more likely to have good days than bad. So, since Prozac is cheap and I don't seem to suffer any side effects, I plan to keep taking it in perpetuity. What I tell my kids is that getting depressed, feeling sad, feeling hopeless -- those are all normal feelings that everyone has from time to time. Pills can't or shouldn't keep you from feeling depressed if you have something to be depressed about. Pills are for people who feel depressed but don't have something to be depressed about -- they have food, shelter, friends, opportunities to contribute and be productive, nothing traumatic has happened, but they feel hopeless anyway -- and that's called Depression, which is different from "being depressed."
- jacobgkau 11mo agoYour anecdote has nothing to do with whether it's better than a placebo or not.
- Razengan 11mo ago> treating depression Most of the "treatment" is apparently just telling people to stop feeling sad [0], or giving them drugs [0] https://old.reddit.com/r/thanksimcured https://old.reddit.com/r/thanksimcured but no one bothers to take the time out to sit down and figure out WHY they feel sad and FIX THAT FOR THEM. That takes too much work. Sometimes depression is this vague feeling that this world is just wrong. That Damocles' sword of mortality. The nagging sense of ultimate pointlessness. You can't really "fix" that. But having stuff to ignore it helps, like video games :')
- area51org 11mo agoDepression isn't just feeling sad. It's not necessarily caused by anything external. You cannot necessarily just "figure out why" you feel bad; that's really not how it usually works.
- NoMoreNicksLeft 11mo ago>It's not necessarily caused by anything external. Y Then how could a drug fix it? We're positing that there is not only a mechanism causing it, but that this mechanism can be manipulated external to their own self/agency/whatever. I think that it is at least as absurd to posit that you can come up with one chemical substance or another that will alleviate their depression when you dismiss the idea of coming up with a sequence of words spoken to them that might alleviate their depression. It's the conceit that we have a better idea of how their brains work chemically than we do of how their brains work cognitively.
- integralid 11mo ago>Then how could a drug fix it? Many things that are not necessarily caused by anything external can be fixed by drugs. I don't understand your point. If the problem is brain not working correctly (because some organ is not doing it's job properly) then no sequence of words will make the brain physically fix itself, just like no sequence of words will cure a heart attack. Of course it depends, and many people just need a correct therapy. I'm not dismissing talking and figuring out the root cause.
- Zak 11mo agoA post on HN a couple years ago discussed research showing antidepressants only work for about 15% of patients: https://news.ycombinator.com/item?id=37671529 https://news.ycombinator.com/item?id=37671529 The thing is, they work very well for that 15%. I suspect the eventual conclusion will be that depression is a syndrome with multiple causes rather than a single condition, and SSRIs treat one of the causes. Edit: Mark Horowitz is one of the authors of both studies.
- CGMthrowaway 11mo agoThe NNT[1] of Prozac, and SSRIs in general, has been previously estimated around 6. Meaning that treatment is more helpful than a sugar pill in only 1 out of 6 cases (a dirty secret). Meanwhile the NNH[2] is as low as 21, that is 1 in 21 cases will stop due to negative side effects. Source: https://www.aafp.org/pubs/afp/issues/2008/0315/p785.html https://www.aafp.org/pubs/afp/issues/2008/0315/p785.html [1]Number Need to Treat, that is, number of patients you need to treat to prevent one additional bad outcome [2]Number Needed to Harm, that is, number of patients you need to treat to generate side effects so bad that someone halts treatment
- H8crilA 11mo agoI suspect the biggest, but not the only, problem with these supposedly weak SSRI/SNRI numbers we routinely see in clinical trials has to do with the definition of depression, with the diagnosis itself. For example it has some of the worst inter-rater reliability across the entire DSM (meaning that two doctors are least likely to both reach the same diagnosis in the same patient independently). So if you start from a poorly defined set, which likely encompasses some genuine affective disorders, people going through difficult times, undiagnosed personality disorders, dysthymic ADHDers, burned out ASDs, and God knows who else - yeah, you'll get poor performance data. Every psychiatrist knows intuitively that SSRIs/SNRIs do work, even if you have to trial a few. Also, without arguing about the number, that 15% is not exactly the same 15% for each drug. Also, since we're here: the secret knowledge about depression (and affective disorders in general) is that it is an episodic illness, where episodes are measured in weeks or in months. Most people experience just one episode which will end whether or not any medical intervention is undertaken, although the intervention can greatly shorten the course and avoid a potential suicide. But some will not stop at one episode, and can go on to have multiple episodes, perhaps develop melancholic features or even suffer from a lifelong recurrence. It is in the latter groups where medication is the most effective.
- atbpaca 11mo agoHere the context is prozac FOR CHILDREN, not in general. Yet some people make a point in commenting that SSRIs are ineffective in general because they believe in some big pharma conspiracy. This is spreading misinformation. The truth is that SSRIs are modestly more effective than a placebo for approximately >> one third of the individuals << who try them. In other words, SSRIs are effective for more than 60-66% of adults. Moreover, there are a few different types of SSRIs. It takes time to find the one that fits you.
- mkehrt 11mo agoI'd really be curious about distribution of the result they see. The folklore is definitely that that there's vary high variance in how people respond to SSRIs, and not recommending them because the average value is low is pretty irresponsible.
- slantedview 11mo agoMy understanding with SSRIs and other depression meds is that they are hit and miss for anyone. I have a family member who, as a teen, suffered from severe depression and didn't want to live. Therapy wasn't able to help - it was actually the therapist who recommended more drastic measures such as medication. And so they tried Prozac and that worked. Having seen the reversal myself, it's hard to understand how this is placebo.
- thisislife2 11mo agoThe placebo effect ( https://www.health.harvard.edu/newsletter_article/the-power-of-the-placebo-effect https://www.health.harvard.edu/newsletter_article/the-power-... )? (In the context we are discussing it, Prozac could be considered as an active placebo - https://en.wikipedia.org/wiki/Active_placebo https://en.wikipedia.org/wiki/Active_placebo ).
- undeveloper 11mo agoIt is extremely hit and miss. My understanding is that for those with "shit life syndrome", prozac is generally ineffective, but for those with genetic predispositions it can be extremely helpful. the catch is that the two are not exclusive, and those with genetic predispositions to depression may never have it, and people with bad life circumstances may feel more stable mentally with prozac and better equipped to tackle life's challenges.
- bgnn 11mo agoMy own experience with SSRIs was very unpleasant. Sure, it worked to reduce my anxiety problems while I was on them for years. The first year I was off of them was the worst though. I didn't have that bad anxiety ever, as in constant panic and feeking of impeding doom. This made me realize that they aren't really an option of me. So began my long therapy journey. After 7 years of weekly therapy, a healthy work-life balance, and regular exercise I'm just feeling better than ever. So, I'd buy that they don't fix your brain. They definitely reduced anxiety for me and I can see the value for stabilizing people so they can do the heaking work in therapy.
- hintklb 11mo agoMy experience as well. SSRI and other similar drugs for anxiety remove a strong signal to your brain and bring other issues or signal. But the issue is that nobody wants to really look at the cause. We are all trying to treat the symptoms with those quick-fix pills. The cause is deep in our society. We are too stressed, lost touch with each others, work on meaningless jobs (or downright negative jobs for society.. if you work at Meta or TikTok, yes your job is in fact a negative for society). I have also been on a journey for the last 5 years on working on myself and bringing those things back in my life and I have been feeling better than ever: - A lot of outdoor time and exercise. - Take the time to build a community of friends that genuinely care for each other - Work on some projects that you feel help humanity and each other (or volunteer). - Build things you are proud of. Build a legacy All of those removed almost all anxiety and depression. It is not an easy journey but I'm shocked how few people even consider making those changes
- nkmnz 11mo agoI hear this story over and over again and it makes me sad. Medication for depression, anxiety, or adhd should be used to enable the work with a therapist, not to make life bearable without working on the underlying problems. Been there, done that. Wasted a couple of otherwise good years on not doing the work.
- gnarlouse 11mo agoRFK Jr dancing
- phkahler 11mo agoI thought Prozac was for anxiety.
- ksenzee 11mo agoFluoxetine has received FDA approval to treat major depressive disorder (8 and older), obsessive-compulsive disorder (7 and older), panic disorder (with or without agoraphobia), [and] bulimia nervosa... https://www.ncbi.nlm.nih.gov/books/NBK459223/ https://www.ncbi.nlm.nih.gov/books/NBK459223/
- paul7986 11mo agoNone of those drugs helped me personally in the 90s (Prozac, Zoloft, etc). What helped me personally was talking about my problems with other humans only to the learn we all are "crazy,(aka totally normal)" and the majority all deal with something similar. Anxiety, OCD, insecurity .. all are parts of the human condition we all deal with throughout our lives.
- blastersyndrome 11mo agoWhen I was a teen I was put on Prozac because I threatened to commit suicide. The drug absolutely destroyed me. Within a few days of taking it, I was in a bizarre state of delirium where I would sleep something like 18 hours a day. When I wasn't asleep I would gnash my teeth at my parents. At school I would lash out at my classmates and randomly punch the walls of my classroom. I was taken off the drug after about five days but I didn't fully recover. To this day, my emotions are severely blunted. I still have complete anhedonia and avolition. I can go on a roller coaster and feel not a shred of an adrenaline rush. Nothing. I struggle maintaining relationships with people because I have no innate "desire" to do so. The drug is absolutely evil and should never be given to minors.
- ryeights 11mo agoI don’t want to discount your experience, but attributing a lifetime of symptoms to 5 doses of SSRIs (when you were already exhibiting an unstable mental state) seems extreme.
- staticman2 11mo agoI've seen a post like this before on reddit. We know SSRI's really do cause permanent sexual dysfunctional in a small minority of people, small enough that this side effect doesn't come up in traditional FDA tests. If a side effect is extremely rare it would be impossible or at least impractical to prove in a population. Grandparent could be right or wrong about how the drug affected them, maybe their brain suffered from other issues and the timing of the medications was purelycoincidental, but if they are correct, your dismissive response is exactly what we'd expect given when they are saying sounds unusual/ improbable.
- ryeights 11mo ago> If a side effect is extremely rare it would be impossible or at least impractical to prove in a population. This is also true for a non-existent side effect. I’m not trying to tell GP he is wrong, just that from a reader’s perspective, extraordinary claims require extraordinary evidence.
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- BjoernKW 11mo ago[flagged]
- konmok 11mo agoEvery medication can have severe and permanent side effects, the question is how often that occurs for a particular drug, and how that stacks up against the quality-of-life improvement from taking that drug.
- piperswe 11mo agoAnd whether patients are properly informed of the risks (I was not)
- BjoernKW 11mo ago> Every medication can have severe and permanent side effects SSRIs are by an order of a magnitude worse than any other common medication in that respect. Moreover, like I said there's little evidence these drugs actually achieve any quality-of-life improvement beyond a placebo effect.
- ckw 11mo agoSSRIs are very bad, but antipsychotics are worse. There are many other reasons, but a demonstrative one is that there is a cumulative annual risk as high as 7% of developing a permanent movement disorder when on them.
- phatskat 11mo agoTD is no joke! It was really hard for my ex to have to choose between anti-psychs and the potential side effects, or exceedingly strong paranoia with incredibly lucid hallucinations - I did not envy her position
- litigator 11mo agoDuring my first manic episode I was handed sertraline. This pushed the mania full send and I lost a lot of time that I can't account for, things I did I can't remember but friends have recalled. Climbing the house to get in through the upstairs window whilst having the house key on me. Locking myself in my room for a week or two convinced I was the real world John Connor and Arnie was looking for me. Blowing all my savings on cocaine for me and anybody in my vicinity in a month. Going through a gram of mdma more than once in a night. Feeling like I was on a therapeutic dose of MDMA for a few months and thinking this was what SSRIs were meant to feel like. The list goes on. I will admit I was semi cognizant of the distorted thinking/reality so played it down when talking to the psychiatrist I was urgently (+2 months into it) referred to for early psychosis intervention. I was eventually handed a dozen valium (which the doctor was incredibly hesitant to prescribe, for good reasons) which let me sleep and the mania lifted. I'm terrified of SSRIs now. I have been diagnosed bipolar for a few years now (went private because in the UK unless you're a danger you're ignored). This week was the first session with a clinical psychologist in a bipolar group. Unsurprisingly almost everyone had a similar experience with SSRIs. I'm speculating here but I'm pretty sure if you did an MRI on my brain you'd see lesions from the mixing of mdma and sertraline (I get myoclonic jerks to this day).
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- burner420042 11mo agoNot to get into the historic details but growing up there was lot of tension in my parent's house. When you're a kid you feel these things and are aware of the issues that cause them, but you haven't yet learned how to talk about them or the right words to describe the truth of them. Instead you internalize them. The lack of learning constructive perspectives and ways for discussing emotions while young, may very much be a source of depression, the same way people say "he can't help it, he has ADHD". I was about 16 and the doctor recommended this new SSRI called ... I think it was Paxil, The side effects, especially if you missed a dose are hard to describe. If you missed a dose you couldn't function at school, and everyone thought you were really stoned. Also, you could look at a pretty girl and just nothing. A 16 year old boy doesn't know why THAT's happening, neither does the girl, and it just makes things worse. Try having that conversation with your Dad, while doped out on the drugs he told you to take. Imagine the anxiety. It's really depressing. Better to be alone, and safe in one's bedroom and on the Internet... ( and that was 20 years ago ). Around the same time there was Ritalin and maybe a few others came out. The issues kids are facing, the feelings they are then given pills to erase are still there, even when numbed to them. The answer lies somewhere in familial stability and relearning respect?, and how to constructively frame life's difficulties and teach that to our kids. I would never give my kids anything that altered their brain chemistry. Even as adults, the only way is through.
- tondara 11mo agoAs an adult, Prozac for me has been life changing and for the better. After suffering from anxiety and depression since childhood I have been able to get a new lease on life in my 40s. It is a drug that needs to be respected though, start on the lowest dose and give it months to settle. Find a doctor you trust and that will take time to discuss your situation. I feel that often this class of drugs is often prescribed without careful consideration and people are ramped up to higher dosages faster than they should be by doctors who are rushing to see the next patient.
- tombert 11mo agoI don't know if I'd call it "placebo" for me; prozac gave me the worst, most horrible pit of sadness I've ever had in my entire life. I couldn't stop feeling guilty over every single bad thing I have ever done, and it completely killed my appetite and that probably didn't do great for my mood either. I was only on it for about two months until I begged my doc to get me off of it. She told me that it's one of those things that doesn't affect everyone, but since I was already taking Wellbutrin it can have negative effects. Never again. I'm taking Pristiq now and that has been considerably better.
- ecshafer 11mo agoPikachuface.jpg The mass prescribing of SSRIs is going to be seen like leaches (well worse since leaches actually do help in some cases). The rock bottom levels of replication of results in physchiatry and these SSRIs, the whole area should be treated much more like snake oil than it is.
- JadeNB 11mo agoFor some reason, the title mangler chopped off the word "say": "Prozac ‘no better than placebo’ for treating children with depression, experts say."
- erelong 11mo agoHarvard: "Exercise is an all-natural treatment to fight depression" https://www.health.harvard.edu/mind-and-mood/exercise-is-an-all-natural-treatment-to-fight-depression https://www.health.harvard.edu/mind-and-mood/exercise-is-an-... "Seasonal Affective Order, or SAD ... has been linked to vitamin D, otherwise known as the sunshine vitamin, because the skin absorbs it through exposure to sunlight." https://www.va.gov/washington-dc-health-care/stories/combating-seasonal-affective-disorder/ https://www.va.gov/washington-dc-health-care/stories/combati... "Consider adding some of these steps into your daily routine to improve your mood:" "Spend time outside to get ample vitamin D ... Eat foods rich in vitamin D (salmon, eggs, tuna, etc.) Take vitamin D supplements"
- jac241 11mo agoThe disclosure section in the cited research article may indicate a financial interest in the authors being able to say that Prozac is not effective: “ MAH and JM are co-applicants on the RELEASE and RELEASE + trials in Australia, funded by the Medical Research Future Fund (MRFF) and the National Health and Medical Research Council (NHMRC), evaluating hyperbolic tapering of antidepressants against care as usual. MAH reports being a co-founder of and consultant to Outro Health, a digital clinic which provides support for patients in the US to help stop no longer needed antidepressant treatment using gradual, hyperbolic tapering; and receives royalties for the Maudsley Deprescribing Guidelines. JM receives royalties for books about psychiatric drugs, and was a co-applicant on the REDUCE trial, funded by the National Institute of Health Research, evaluating digital support for patients stopping long-term antidepressant treatment. MP and RL have no conflicts of interest to declare.” I would caution those in this thread who have never seen or treated patients in any psychiatric clinic or hospital let alone a pediatric one to be careful assuming that they have adequate experience to make sweeping judgements on the utility of antidepressants in children.
- collingreen 11mo agoThis should get locked. People are horrible.
- drekipus 11mo agoDepression is literally a lack of meaning and beauty. This gets imposed on us by society through social norms, and increasingly not working for people But rather than fixing society, we will impose experimental drugs on kids. In some cases altering their lives irreversibily It absolutely should be discussed and openly talked about
- squigz 11mo agoMaybe because "Fixing society" (putting aside questions of what that even means...) is going to take a long, long time and a lot of effort. Which isn't to say we shouldn't continue to fix it (hint: we do!) but it doesn't mean we should just ignore other ways of helping our kids. > we will impose experimental drugs on kids What a terribly disengeuous way of putting it! "Imposing" implies there's not a choice. And all drugs are experimental in that we are constantly learning about the effects they have on us and adjusting our knowledge accordingly.
- drekipus 11mo ago> implies there's not a choice There isn't a choice if * Questing it is "morally wrong" as it's made out to be * It's the only solution.
- squigz 11mo agoNobody's saying it's "morally wrong" not to give your kids antidepressants - but nor is it morally wrong to give them to them. What tends to be "morally wrong" is when parents are like "I'm not giving my kids those pills! There's no such thing as depression! Just go play outside some more!" - in other words, dismissing your children's feelings
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- Ardren 11mo agoAs someone with MDD, reading these comments is depressing. It's full of people who don't even know what MDD is exists and that people should stop being sad. Hacker News really does attract a specific type of person...
- SubiculumCode 11mo agosmall effects in overall trial does not mean that for some individuals the effects were very large. The Heterogeneity is Real.
- hcknwscommenter 11mo agoI have overseen over 20 phase III clinical trials. Many of those clinical trials have failed to show statistical efficacy. In every single one of those trials there are patients who see dramatic and undeniable benefits. In the oncology field, we continue to treat such patients even when the statistics say, no benefit. And, sometimes those patients just stay better. My point is, when the trial shows "no better than placebo", it doesn't mean the treatment doesn't work. It might be that. But more likely it means we don't know how to define the population of folks for whom the treatment does work. Maybe it's a particular genetic background, maybe it's age, gender, serum CPR or Tau level. Maybe it's something else. This stuff is complicated and interesting. And we are still figuring it out.
- Braxton1980 11mo agoCouldn't this be explained by children being misdiagnosed as having depression? If those children just had a temporary sadness then the placebo would appear to work?
- timtim51251 11mo agoIts not just children, its adults too. Because of the FOIA we have seen the studies these drug companies made disappear and this applies to probably every single antidepressants. Keep in mind the placebo effect happens in about 30% of people which are the people that think it works and then eventually stops working.
- darthvaden 11mo agoSo people who used it till now. What are they now? Stupid
- FatherOfCurses 11mo agoFolks who are ideologically opposed to psychiatric drugs are almost as irritating as folks who are ideologically opposed to vaccines.
- hollerith 11mo agoI agree. I like the position of Dr. Josef Witt-Doerring, board-certified psychiatrist, who maintains that psych drugs are appropriate in certain circumstances. He says that if they were used only when appropriate (i.e., not as a response to an adverse life event and only after a trial of interventions like counseling, exercise, keto diet, gluten-free diet and evaluation for physiological disorders) they'd be used at about 5% of the rate that they used now.