5 ms·

When I was diagnosed with depression - amongst other things - my doctor prescribed SSRIs with a caveat that they might or might not work. After a few weeks I w

When I was diagnosed with depression - amongst other things - my doctor prescribed SSRIs with a caveat that they might or might not work. After a few weeks I was tapered off them. I felt no different before, during or after them. What helped was 3 daily walks around the park, around 9km per day after each meal. Anecdotal but it is what it is. Right now I have bigger problems than just depression.

garciasn 2mo ago
Lexapro, noted in the article, was literally life changing for me. I felt better within 3d and I notice severe issues if I miss ~3d of doses in a row, even though the half-life should support ~7d without according to my physician. That said, yes; walking is the best medicine for me.
- zdragnar 2mo ago
  I start getting effects the same day if I miss my morning dose, but like you, it was life changing (in a good way) for me. I've got two friends who didn't benefit from it, so it isn't a miracle cure for everyone, sadly.
121789 2mo ago
I think exercise, sunlight, good sleep and diet, and good social relationships are all more effective than SSRIs. But anyone who's had bad depression knows how hard those things are to maintain if you're depressed. SSRIs make some portion of people functional enough where they can at least build a healthy life. But definitely not everyone, and they are definitely not "the cure"
deleted 2mo ago
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Aurornis 2mo ago
> After a few weeks I was tapered off them. > I felt no different before, during or after them. SSRI onset is slow, which is one of the common problems with treatment. In studies where they survey both the patient and their family members, the family members actually start noticing improvements before the patient. Onset is slow and it takes a long time for patients to realize the positive effects. Ideally they’re prescribed along with other lifestyle changes like your walks. It doesn’t have to be an either-or. A lot of patients get offended when doctors suggest things like walking because they think it indicates the doctor is telling them to “just walk it off” which doesn’t go well. It’s not surprising you didn’t feel anything noticeable after a few weeks. It’s also unfortunate, but not too surprising, that your doctor wasn’t informed enough to communicate these things. Some doctors are great about setting expectations and following up. Others write a prescription and send patients off to fill it without the necessary context.
- jaggederest 2mo ago
  The other problem with SSRI treatment is that individually they are only barely better than placebo. They're among the worst classes of drugs as far as NNT, effect size or remission rate (individually! STAR-D treatment algorithm works for the vast majority of people) Especially in acute cases, I think they should be replaced or augmented by something stylistically in the direction of esketamine. 6-8 weeks per medication trial is an absolute eternity, especially since some minority of major depressive episodes resolve spontaneously after a few months to a year.
  - MrDrMcCoy 2mo ago
    +1 on therapeutic ketamine. Got me out of a bad spot, and felt better long after it was over. You can get it by mail in the US from Mindbloom, who offered excellent care despite being remote in my case.
  - Aurornis 2mo ago
    > The other problem with SSRI treatment is that individually they are only barely better than placebo. They're among the worst classes of drugs as far as NNT, These numbers are really misunderstood when taken out of context. SSRIs have an NNT around 7, depending on the study you look at (random Google result https://pubmed.ncbi.nlm.nih.gov/19588448/ https://pubmed.ncbi.nlm.nih.gov/19588448/ as an example ) Which sounds terrible if you know nothing about NNT. But when you learn that Tylenol has an NNT of almost 5 and even a powerful drug like Xanax has an NNT of 4, you realize that NNT is a difficult measure of drug efficacy. > Especially in acute cases, I think they should be replaced or augmented by something stylistically in the direction of esketamine. 6-8 weeks per medication trial is an absolute eternity Ketamine and esketamine are used a lot to begin therapy. They’re not good long-term options though, so they’re best used to start treatment as a bridge to SSRI efficacy.
    - jaggederest 2mo ago
      Okay, so we set aside NNT, even though their NNH is also quite low, and that's highly relevant, what about effect size and remission rate? This feels a bit like cherrypicking. And you'll note I said "augmented", as well, if somebody is going through the treatment algorithm with SSRIs, by all means, that's the bridge to stability for somebody on a longer term course. But many people don't need anything more than acute treatment, so what about them?
clsec 2mo ago
>>Right now I have bigger problems than just depression. Just depression?! You might want to grab a little empathy before writing off something that has been a major problem in a large chunk of the populations lives. In fact, "just depression" has caused me to try to take my life multiple times. I can hardly see a "bigger problem" out there..
- john_strinlai 2mo ago
  reading some of the parents other comments, i dont think they were trying to downplay depression in general, and i dont think they meant any offense. they were, perhaps, slightly careless in their choice of words. that's all.
- Mezzie 2mo ago
  There are absolutely people with bigger problems than depression. For example, I have MS, and my mental health is absolutely one of my less concerning problems. There are so many options for mental health + the treatments are much easier to access than a lot of my symptom management meds + DMT. People undergoing chemo. People with ALS. People with bipolar (who can't take a lot of first line depression treatments) or other more complex mental health issues like schizophrenia. None of this is to downplay depression, but there are absolutely people for whom 'just depression' would be accurate. Migraines suck, but someone with cluster headaches might call them 'just migraines' and they wouldn't be wrong.
  - clsec 2mo ago
    You didn't word it like that though. And I'd argue that for people with MDD, and without those comorbidities you listed, depression is a huge problem.
    - Mezzie 2mo ago
      I'm not the GP; I'm a separate person who was providing potential context. Something can be a huge problem and still be small potatoes to people having catastrophic problems, and often those of us in very, very dire circumstances are tone policed to within an inch of our lives and have to constantly consider normal people above ourselves (and make no mistake, people with MDD are closer to normal than somebody with ALS or severe cancer). We're never allowed to express anger, never allowed to talk about having it harder, have to stop and attend to the feelings of others while ours are ignored, etc. Also, no offense, but depression can end up making people very self-centered. It's your illness that makes you think that what you're going through is more important and worse than what anyone else is going through, and it's not. (And it's not for me either: there are definitely people who have it worse than me and could say they wish their problem was 'just' MS. I just wouldn't get offended by that.)
deleted 2mo ago
[deleted]

garciasn 2mo ago

Lexapro, noted in the article, was literally life changing for me. I felt better within 3d and I notice severe issues if I miss ~3d of doses in a row, even though the half-life should support ~7d without according to my physician. That said, yes; walking is the best medicine for me.

zdragnar 2mo ago
I start getting effects the same day if I miss my morning dose, but like you, it was life changing (in a good way) for me. I've got two friends who didn't benefit from it, so it isn't a miracle cure for everyone, sadly.

121789 2mo ago

I think exercise, sunlight, good sleep and diet, and good social relationships are all more effective than SSRIs. But anyone who's had bad depression knows how hard those things are to maintain if you're depressed. SSRIs make some portion of people functional enough where they can at least build a healthy life. But definitely not everyone, and they are definitely not "the cure"

deleted 2mo ago

[deleted]

Aurornis 2mo ago

> After a few weeks I was tapered off them. > I felt no different before, during or after them. SSRI onset is slow, which is one of the common problems with treatment. In studies where they survey both the patient and their family members, the family members actually start noticing improvements before the patient. Onset is slow and it takes a long time for patients to realize the positive effects. Ideally they’re prescribed along with other lifestyle changes like your walks. It doesn’t have to be an either-or. A lot of patients get offended when doctors suggest things like walking because they think it indicates the doctor is telling them to “just walk it off” which doesn’t go well. It’s not surprising you didn’t feel anything noticeable after a few weeks. It’s also unfortunate, but not too surprising, that your doctor wasn’t informed enough to communicate these things. Some doctors are great about setting expectations and following up. Others write a prescription and send patients off to fill it without the necessary context.

jaggederest 2mo ago
The other problem with SSRI treatment is that individually they are only barely better than placebo. They're among the worst classes of drugs as far as NNT, effect size or remission rate (individually! STAR-D treatment algorithm works for the vast majority of people) Especially in acute cases, I think they should be replaced or augmented by something stylistically in the direction of esketamine. 6-8 weeks per medication trial is an absolute eternity, especially since some minority of major depressive episodes resolve spontaneously after a few months to a year.
- MrDrMcCoy 2mo ago
  +1 on therapeutic ketamine. Got me out of a bad spot, and felt better long after it was over. You can get it by mail in the US from Mindbloom, who offered excellent care despite being remote in my case.
- Aurornis 2mo ago
  > The other problem with SSRI treatment is that individually they are only barely better than placebo. They're among the worst classes of drugs as far as NNT, These numbers are really misunderstood when taken out of context. SSRIs have an NNT around 7, depending on the study you look at (random Google result https://pubmed.ncbi.nlm.nih.gov/19588448/ https://pubmed.ncbi.nlm.nih.gov/19588448/ as an example ) Which sounds terrible if you know nothing about NNT. But when you learn that Tylenol has an NNT of almost 5 and even a powerful drug like Xanax has an NNT of 4, you realize that NNT is a difficult measure of drug efficacy. > Especially in acute cases, I think they should be replaced or augmented by something stylistically in the direction of esketamine. 6-8 weeks per medication trial is an absolute eternity Ketamine and esketamine are used a lot to begin therapy. They’re not good long-term options though, so they’re best used to start treatment as a bridge to SSRI efficacy.
  - jaggederest 2mo ago
    Okay, so we set aside NNT, even though their NNH is also quite low, and that's highly relevant, what about effect size and remission rate? This feels a bit like cherrypicking. And you'll note I said "augmented", as well, if somebody is going through the treatment algorithm with SSRIs, by all means, that's the bridge to stability for somebody on a longer term course. But many people don't need anything more than acute treatment, so what about them?

clsec 2mo ago

>>Right now I have bigger problems than just depression. Just depression?! You might want to grab a little empathy before writing off something that has been a major problem in a large chunk of the populations lives. In fact, "just depression" has caused me to try to take my life multiple times. I can hardly see a "bigger problem" out there..

john_strinlai 2mo ago
reading some of the parents other comments, i dont think they were trying to downplay depression in general, and i dont think they meant any offense. they were, perhaps, slightly careless in their choice of words. that's all.
Mezzie 2mo ago
There are absolutely people with bigger problems than depression. For example, I have MS, and my mental health is absolutely one of my less concerning problems. There are so many options for mental health + the treatments are much easier to access than a lot of my symptom management meds + DMT. People undergoing chemo. People with ALS. People with bipolar (who can't take a lot of first line depression treatments) or other more complex mental health issues like schizophrenia. None of this is to downplay depression, but there are absolutely people for whom 'just depression' would be accurate. Migraines suck, but someone with cluster headaches might call them 'just migraines' and they wouldn't be wrong.
- clsec 2mo ago
  You didn't word it like that though. And I'd argue that for people with MDD, and without those comorbidities you listed, depression is a huge problem.
  - Mezzie 2mo ago
    I'm not the GP; I'm a separate person who was providing potential context. Something can be a huge problem and still be small potatoes to people having catastrophic problems, and often those of us in very, very dire circumstances are tone policed to within an inch of our lives and have to constantly consider normal people above ourselves (and make no mistake, people with MDD are closer to normal than somebody with ALS or severe cancer). We're never allowed to express anger, never allowed to talk about having it harder, have to stop and attend to the feelings of others while ours are ignored, etc. Also, no offense, but depression can end up making people very self-centered. It's your illness that makes you think that what you're going through is more important and worse than what anyone else is going through, and it's not. (And it's not for me either: there are definitely people who have it worse than me and could say they wish their problem was 'just' MS. I just wouldn't get offended by that.)

deleted 2mo ago

[deleted]