Live data from Hacker News

Many People Taking Antidepressants Discover They Cannot Quit

nytimes.com

141–150 of 233 posts

Re: Many People Taking Antidepressants Discover They Cannot Quit

#141
post #57

Earlier quoted context omitted.

SSRI’s are no more effective than placebo or exercise in multiple studies: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674785/#

but when you look across 522 studies with more than 100k participants, evidence of efficacy is indisputable: https://www.ncbi.nlm.nih.gov/pubmed/29477251

The Cipriani study is a nice meta-analysis: "The random-effects summary SMD for all antidepressants was 0·30" This site explains SMD: http://handbook-5-1.cochrane.org/chapter_9/9_2_3_2_the_stand.... This site shows what 0.3 looks like (actually shows 0.2 and 0.5): http://rpsychologist.com/short-r-script-to-plot-effect-sizes.... Typically, when people are summarizing this line of research saying that there is no effect, they are talking about these kinds of effect sizes which look like they round to pretty much no effect. I think using SMD for reporting by itself is unfortunate: my understanding is that the drugs have large effects for a minority of patients -- rather than that they shift everyone's emotional experience over a little bit.

Re: Many People Taking Antidepressants Discover They Cannot Quit

#142

Earlier quoted context omitted.

I take Wellbutrin and Lamictal (a mood stabilizer) every single day for PTSD and I wouldn’t really be able to function without them. I really wouldn’t call myself or the psychiatrist who prescribed them irresponsible. I’d say it’s equally irresponsible to make a blanket statement about something that does actually help people in certain circumstances. That being said, there are a number of GPs out there who prescribe…

Have you had a chance to apply for a phase 3 trial of MDMA for PTSD? Maps.org

I’ve seriously considered it. I’ve done MDMA once in my life and it was honestly the only time I’ve ever felt anything even remotely close to peace and calm inside my mind and body. It was like this miracle evening without flash backs and anxiety.

Re: Many People Taking Antidepressants Discover They Cannot Quit

#143
post #54

Earlier quoted context omitted.

There is no doubt that antidepressant therapy needs to be combined with psychotherapy, sports, meditation and just reducing the unhealthy parts of your life. The cost of taking antidepressants is really low however. Most of the time, they have almost no side effects, and are proven to help https://www.bmj.com/content/360/bmj.k847 Where I live, they are pretty cheap. I find that there is undue bias against antidepress…

How exactly is the cost really low? The study you linked doesn't scientifically prove antidepressants help. Exactly, what undue bias against antidepressants have you found?

I often see antidepressants held to more stringent standards of evidence, theoretical backing, and safety than other treatments. It's pretty common to see someone claim that the chemical imbalance theory is bunk and that antidepressants don't outperform placebo, then glowingly endorse something else with markedly less scientific support as a treatment for depressive disorders (e.g. exercise, supplements, insight-oriented psychotherapies, mindfulness meditation).

Re: Many People Taking Antidepressants Discover They Cannot Quit

#144
post #60
post #50

Earlier quoted context omitted.

Meta studies still show that antidepressants help more than the placebo https://www.bmj.com/content/360/bmj.k847

And multiple studies show them no more effective than exercise: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674785/ The bigger problem is “depression” is not reproducibly measurable, because it has no falsifiable or biomedical marker.

>> The bigger problem is “depression” is not reproducibly measurable, because it has no falsifiable or biomedical marker.

That's something I like to point out using SSRIs as an example. The claim is that they increase levels of serotonin and that the cause of the depression is reduced serotonin. The thing is, nobody actually checks your serotonin levels and says "oh that's low take this." Then there's the problem of why ones serotonin is low when it wasn't always that way. There are probably many causes of depression and quite possibly some that don't lower serotonin.

Re: Many People Taking Antidepressants Discover They Cannot Quit

#145
post #11
post #6

This shouldn't come as a surprise to anyone. Modern medicine is not in the business of curing diseases. It's all about disease and symptom management.

This is psychiatry . We don't know how to cure the underlying diseases, because we don't entirely understand them. When the field can actually cure them, like for PTSD and certain anxiety disorders, it's very happy to.

I think we're on the verge of some really big breakthroughs when it comes to understanding the brain though. The research group I work for (for only six more days.. sigh..) just released a pre-print of a paper mapping out all of the mouse brain's cell types[0][1].

> The mammalian nervous system executes complex behaviors controlled by specialised, precisely positioned and interacting cell types. Here, we used RNA sequencing of half a million single cells to create a detailed census of cell types in the mouse nervous system. We mapped cell types spatially and derived a hierarchical, data-driven taxonomy. (...) The resource presented here lays a solid foundation for understanding the molecular architecture of the mammalian nervous system, and enables genetic manipulation of specific cell types.

(you may wonder what mice have to do with human brains: on a "cellular" and "genetic" level, mice are already close enough to humans to be decent substitutes for researching quite a lot of fundamental stuff about how the brain works)

We already had an atlas of where every gene was activated in the mouse brain since 2006, but this was at the tissue level[2][3]. Only recently it has become possible to research at the cellular level which genes are activated. That has enabled the possibility of classifying cell types by gene activation. Not only that, by tracking gene activation over various stages of development, we can see how the genes interact and activate each other, and get a better insight in how the brain develops its various different cell types.

I am "merely" a programmer/interaction designer building tools for easier data exploration, and can't pretend to understand the fine details, but that sounds like it is Kind Of A Big Deal for anyone researching brains.

For example: until now, we could only see which genes are correlated with higher chances of a certain mental illness (by looking at the genetic makeup of people with and without these illnesses). But that is not the same as knowing what those genes do. Furthermore, many of mental illnesses are partially nature, partially nurture: you have to be unlucky enough to have a mix of genes that makes it possible or more likely to manifest an illness, but for the disease to truly manifest itself you also requires an environmental trigger.

When we can follow individual cell development at the genetic expression level, we can start to figure out what changes when certain genes and/or certain stimuli are present or absent.

There is an equivalent science project underway to map out all the cell types in the human body, not just the brain[4]. On top of that, the techniques that let scientists analyse the RNA expression in individual cells are getting cheaper and faster all the time[5]. My guess is that major breakthroughs in understanding how the body works, including the brain, will start coming in very quickly.

(and I'm not even talking about the implications for machine learning)

[0] https://twitter.com/slinnarsson/status/981919808726892545

[1] https://www.biorxiv.org/content/biorxiv/early/2018/04/05/294...

[2] http://mouse.brain-map.org/

[3] https://en.wikipedia.org/wiki/Allen_Brain_Atlas#Mouse_Brain

[4] https://www.humancellatlas.org/

[5] http://www.alleninstitute.org/what-we-do/brain-science/news-...

Re: Many People Taking Antidepressants Discover They Cannot Quit

#146
I tried exactly 14 different antidepressants, at different dosages in the last 10 years. None of them got any positive effect and I could stop without feeling anything different too, except, on some cases, very mild "brain zaps". I do not know why not any of this drugs had any (positive) effect (only some common collateral effects in some cases) but I wonder if there is a correlation between the drug doing it's work and being hard to quit...

Re: Many People Taking Antidepressants Discover They Cannot Quit

#147
post #47

Earlier quoted context omitted.

Same thing happened to me going off of Lexapro. I called it "the zaps".

That's exactly how I felt getting off of Effexor. I stopped taking them completely one day and after trying to push past the zaps for two weeks I got back on them. I had to get of them gradually by splitting the pills open and splitting up the little balls instead.

Okay, this is way too much information, but I googled furiously to try to discover what awful parasite had laid its eggs in my intestinal track when I started noticing those tiny white balls in the toilet.

Re: Many People Taking Antidepressants Discover They Cannot Quit

#148

Earlier quoted context omitted.

Have you had a chance to apply for a phase 3 trial of MDMA for PTSD? Maps.org

I’ve seriously considered it. I’ve done MDMA once in my life and it was honestly the only time I’ve ever felt anything even remotely close to peace and calm inside my mind and body. It was like this miracle evening without flash backs and anxiety.

You may be able to get into a trial. In a therapeutic setting, folks are often able to release the underlying trauma and move beyond it. A great book about this is Trust, Surrender, Receive by Anne Other (AnneOther.com).

Re: Many People Taking Antidepressants Discover They Cannot Quit

#149

Earlier quoted context omitted.

1) So do placibos 2) They're common while tapering too. 3) Agreed 4) Possibly true. What's unpolite about mentioning this? 5) Wrong analogy; depression only increases would be analogous to increased cholesterol. What are statin drug side effects when quitting, from the drug. 6) The mechanism of action isn't even fully understand. You're absolutely wrong to claim "we would have seen them (long-term side effects)". Isn…

well said... in order, then... 1. Read the reference before responding; the study looked (in part) at antidepressant-placebo differences. Also - I can't prescribe placebo. 2. Got anything to back that up? 3. OK 4. Because it implies that some of the 'withdrawal' symptoms are actually recurrent depressive/anxious symptoms (which can include somatic symptoms). Which is different than arguing that all of these symptoms…

>> Lived experience is critically important, but it does not trump data.

I would argue that for an individual, lived experience trumps all data - for them. Data is an aggregate of individual experiences. A single persons experience is a data point, not an anecdote.

Re: Many People Taking Antidepressants Discover They Cannot Quit

#150
post #89
post #65

Earlier quoted context omitted.

> Also, I lost interest in sex, and it took forever to reach orgasm. This is a common side effect of SSRIs. I have the same, but I very much enjoy that side effect. Saves time, and already got a child anyway. I still love pleasuring my significant other just as much as before, btw. People who have bi-polar usually get mood stabilisers such as lithium prescribed. Perhaps anti-psychotics? SSRIs are known to be problema…

Lithium sucks, or so I've heard. Modafinil (antinarcoleptic, originally) plus lamotrigine (anticonvulsant, originally) works well for me. It's easy to tweak the ratio as circumstances warrant. Edit: About sex. My wife at the time did like that I took longer to reach orgasm. However, after we separated, I discovered that wearing a condom made orgasm unreachable. And that did become a problem. Albeit an amusing one, in…

Don’t discount lithium, it may turn out better than modafinil for you.
Post reply on HN