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> the reason why many people mistakenly believe that SSRIs are effective for moderate and severe depression (as opposed to not effective for any type of depress

by zzzeek 14y ago

> the reason why many people mistakenly believe that SSRIs are effective for moderate and severe depression (as opposed to not effective for any type of depression) I'm taking an SSRI now, after about ten years off, and have taken them on and off for more than two decades, and they most definitely have a dramatic effect on anxiety and depression - the effects and general mechanism are pretty obvious. Basically, emotional reactivity is reduced as well as the tendency to ruminate. For me, this effect is clear as day, as are why it causes the side effects that it does which is why I typically don't stay on them for very long. While they don't work for everyone, SSRIs have been enormously popular for at least two decades. So I gather that you believe the entirety of SSRI's popularity, as well as all the good/bad physiological effects many of us taking them find so apparent, are strictly placebo effect?

Alex3917 14y ago
"So I gather that you believe the entirety of SSRI's popularity, as well as all the good/bad physiological effects many of us taking them find so apparent, are strictly placebo effect?" When you say "I gather that you believe" you seem to be implying that it's an opinion question. But for what it's worth, that's not how it works exactly. Again read The Emperors New Drugs for a good explanation. The book Anatomy of an Epidemic also has some good info in the relevant chapter.
- zzzeek 14y ago
  Going on your statement, "not effective for any type of depression", you're saying that the SSRI I'm taking has no effect whatsoever, and that nobody else has any benefits from SSRIs. The good effects we all report are imagined. I'd just like you to directly confirm that's what you're saying. It's a little rude to state that I'm completely misguided in my healthcare choices, then to wave it off as "just go read this book" when i question that.
  - rlucas 14y ago
    It's incorrect to say that grandparent's quote "not effective" is the same as your phrase "no effect whatsoever." The suggestion, following Irving Kirsch's book, that the SSRIs are broadly "not effective," is a statement about the distribution of outcomes over a population. (It also takes into account the fact that even placebos cause changes in outcomes, and that we consider a drug not to be "effective" if its outcomes do not differ meaningfully from those attributable to placebos.) This is maybe better stated as "not efficacious" because we're talking about efficacy, vs. placebo, in a population. This is entirely different from the parent's (counterfactual) statement "the SSRI I'm taking has no effect whatsoever," which is an assertion about having any effect (not a relative effect vs. placebo) in a single individual (not a population). "Not effective"[as a vector operation and vs. a baseline established by placebo] != "has no effect whatsoever"[as a scalar operation and vs. a baseline of no intervention] Grandparent has most definitely not said that your perception of SSRI effects are "imagined," nor that you are "misguided." But you are arguing against a straw man until you at least acknowledge the distinctions here (which, it must be said, are pretty well explained in the book in question ;)
    - zzzeek 14y ago
      Thanks for the language litigation, I'm now aware of the many subtle inaccuracies in my language, despite my skepticism that my real question was really so occluded. So here it is again: Is it your opinion that the popularity of SSRIs is misguided, and that their use would be better off discouraged, since they have been shown to be no more "effective" than placebo? That the vast majority of (or all?) patients who report "success" with SSRIs are simply experiencing an effect that could just as easily be delivered via sugar pill? Wikipedia's paragraph on this here (http://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor#Depression http://en.wikipedia.org/wiki/Selective_serotonin_reuptake_in...) has a decent summary of the current status. SSRIs have been shown, by two meta-analyses, to have a "clinically significant" effect for very severe depression, and a "statistically significant" effect for moderate depression, which is considered below the threshold of usefulness. The original poster's words were, "not effective for any type of depression". So will you correct this statement as well?
      - 14y ago
dlitz 14y ago
To paraphrase: "I'm taking SSRIs right now, and they work for me." That's the medical equivalent of saying, "it works on my machine." That doesn't mean it works for everyone. It doesn't mean that it works for most people, or that there isn't a significant risk of harm to many people. Hell, your perception that it works for you doesn't even mean that it actually works for you (there could be confounding factors for all we know), and it certainly doesn't mean that it's likely to work better than the next-best alternative. Think about it: If somebody says SSRIs are incorrectly believed to be effective due to publication bias, that pretty much presupposes that there's at least one study that showed that they work. That means that somebody, somewhere had a similar experience as you've had. That doesn't make your experience a sufficient basis for prescribing these drugs on a routine basis. Clinical trials are like beta tests. The drug might work for some people (or some people might feel that it works), but that's not the only thing worth considering before you ship it to large numbers of people who need treatment.
- zzzeek 14y ago
  I'm well aware of the "they work for me, therefore they work" fallacy. I also never said they work for everyone or even most people. The fact is there's both positive and negative studies of SSRIs, the debate over their effectiveness remains ongoing, and at the moment these medications are widely accepted and used. Real world experience of these medications among a huge number of practitioners and patients is still ahead of this debate, in my opinion.

by zzzeek 14y ago

Alex3917 14y ago

"So I gather that you believe the entirety of SSRI's popularity, as well as all the good/bad physiological effects many of us taking them find so apparent, are strictly placebo effect?" When you say "I gather that you believe" you seem to be implying that it's an opinion question. But for what it's worth, that's not how it works exactly. Again read The Emperors New Drugs for a good explanation. The book Anatomy of an Epidemic also has some good info in the relevant chapter.

zzzeek 14y ago
Going on your statement, "not effective for any type of depression", you're saying that the SSRI I'm taking has no effect whatsoever, and that nobody else has any benefits from SSRIs. The good effects we all report are imagined. I'd just like you to directly confirm that's what you're saying. It's a little rude to state that I'm completely misguided in my healthcare choices, then to wave it off as "just go read this book" when i question that.
- rlucas 14y ago
  It's incorrect to say that grandparent's quote "not effective" is the same as your phrase "no effect whatsoever." The suggestion, following Irving Kirsch's book, that the SSRIs are broadly "not effective," is a statement about the distribution of outcomes over a population. (It also takes into account the fact that even placebos cause changes in outcomes, and that we consider a drug not to be "effective" if its outcomes do not differ meaningfully from those attributable to placebos.) This is maybe better stated as "not efficacious" because we're talking about efficacy, vs. placebo, in a population. This is entirely different from the parent's (counterfactual) statement "the SSRI I'm taking has no effect whatsoever," which is an assertion about having any effect (not a relative effect vs. placebo) in a single individual (not a population). "Not effective"[as a vector operation and vs. a baseline established by placebo] != "has no effect whatsoever"[as a scalar operation and vs. a baseline of no intervention] Grandparent has most definitely not said that your perception of SSRI effects are "imagined," nor that you are "misguided." But you are arguing against a straw man until you at least acknowledge the distinctions here (which, it must be said, are pretty well explained in the book in question ;)
  - zzzeek 14y ago
    Thanks for the language litigation, I'm now aware of the many subtle inaccuracies in my language, despite my skepticism that my real question was really so occluded. So here it is again: Is it your opinion that the popularity of SSRIs is misguided, and that their use would be better off discouraged, since they have been shown to be no more "effective" than placebo? That the vast majority of (or all?) patients who report "success" with SSRIs are simply experiencing an effect that could just as easily be delivered via sugar pill? Wikipedia's paragraph on this here (http://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor#Depression http://en.wikipedia.org/wiki/Selective_serotonin_reuptake_in...) has a decent summary of the current status. SSRIs have been shown, by two meta-analyses, to have a "clinically significant" effect for very severe depression, and a "statistically significant" effect for moderate depression, which is considered below the threshold of usefulness. The original poster's words were, "not effective for any type of depression". So will you correct this statement as well?
    - 14y ago

dlitz 14y ago

To paraphrase: "I'm taking SSRIs right now, and they work for me." That's the medical equivalent of saying, "it works on my machine." That doesn't mean it works for everyone. It doesn't mean that it works for most people, or that there isn't a significant risk of harm to many people. Hell, your perception that it works for you doesn't even mean that it actually works for you (there could be confounding factors for all we know), and it certainly doesn't mean that it's likely to work better than the next-best alternative. Think about it: If somebody says SSRIs are incorrectly believed to be effective due to publication bias, that pretty much presupposes that there's at least one study that showed that they work. That means that somebody, somewhere had a similar experience as you've had. That doesn't make your experience a sufficient basis for prescribing these drugs on a routine basis. Clinical trials are like beta tests. The drug might work for some people (or some people might feel that it works), but that's not the only thing worth considering before you ship it to large numbers of people who need treatment.

zzzeek 14y ago
I'm well aware of the "they work for me, therefore they work" fallacy. I also never said they work for everyone or even most people. The fact is there's both positive and negative studies of SSRIs, the debate over their effectiveness remains ongoing, and at the moment these medications are widely accepted and used. Real world experience of these medications among a huge number of practitioners and patients is still ahead of this debate, in my opinion.