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Most people on antidepressants don’t need them

economist.com

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Re: Most people on antidepressants don’t need them

#121

Post by welshwelsh »

cameronh90 wrote: post #21

Statements like this need to be worded very carefully. In many people's minds, saying something like "most people don't need antidepressants" quickly becomes "antidepressants are useless". Many people who may benefit from them get scared away. Speaking as someone who has been on/off antidepressants for GAD+OCD for the better part of a decade, I've had countless people tell me that antidepressants are useless and just…

>But for me, they are life changing

This is not something you can claim. How could you possibly know that the SSRI is responsible for your recovery?

I'm not going to say that antidepressants are useless, but it is important to understand how placebo works. The key point is that placebo works and it is impossible for an individual to distinguish between a placebo and a life changing drug.

In antidepressant studies, SSRIs often outperform placebo to a degree. However, the placebo group has an excellent recovery rate! That means there are people who are clinically depressed, suicidal etc. who are then given a sugar pill as part of a study and make a full recovery.

>You often need to try 2 or 3 different SSRIs

That makes it even murkier. SSRIs take a long time to work, and if you try several of them that's going to take months to years. There's a high probability that in that time, you might naturally recover. You have the combined benefit of placebo and waiting in addition to the effects of the SSRI. You tried 2 SSRIs that didn't work. What makes you so confident that it was the third?

Again, I'm not saying SSRIs are useless. But it's important that we rely on controlled studies to make these determinations. Personal experience and anecdotes are beyond worthless; for example they are the reason why homeopathy is a $20 billion dollar industry even though it is actually provably useless.

Re: Most people on antidepressants don’t need them

#122

Post by samtho »

aa-jv wrote: post #86
cameronh90 wrote: post #45

Earlier quoted context omitted.

I completely agree. I believe we have no idea how these drugs work at the moment. For one, serotonin receptors are _everywhere_, notably the gut, which also has a strong relationship with emotional state. And as you point out, they don't just affect serotonin. Given we have a whole bunch of drugs that attempt to be serotonin selective, but where each one affects different people in different ways, it seems likely to…

>Why would a huge chunk of the population have a imbalance of brain chemicals? Because they are all members of a society whose food production is controlled by 2 or 3 mega-corporations, who also, incidentally, have an interest in selling pharmaceutical products to make people feel better about their lives ..

You assume a lot of competence on the part of these large actors to collude and conspire at the macro level.

Let’s assume, for sake of argument, the conclusion of your assertion is true in that we are being poisoned and offered medication to mitigate the effects of said poison. This is more likely the effects of independent actors acting upon their respective self-interests.

Food companies try to drive costs down to sell cheaper products at the same price, which may end up having poor health consequences by virtue of untested substances having mass exposure. Pharmaceutical companies respond to market forces by developing drugs they can get funding for, which usually ends up being ailments that a lot of people have. There are way more efficient ways for them to team up and make money, this is just a side-effect of large institutions acting in self-interest.

Re: Most people on antidepressants don’t need them

#123

Post by 4ggr0 »

elemos wrote: post #90
4ggr0 wrote: post #59

Earlier quoted context omitted.

> Why would a huge chunk of the population have a imbalance of brain chemicals? That's what I think about from time to time as well. I have ADD and take meds for it. But I'm pretty sure that I only need these meds to be able to work in an open-space, corporate IT environment with dead-lines, responsibilities etc. Without meds I get overwhelmed and panicky quickly, when taking them they turn me into kind of an office…

I believe the same thing. In fact, I believe people with ADD have a natural advantage in pre-modern settings. We are built to run long distances, outsmart prey, and forage. A distraction isn’t a distraction on that environment, it’s awareness and quickly thinking through possibilities and avenues of success.

> I believe people with ADD have a natural advantage in pre-modern settings

Totally, yeah. I can't prove it of course, but I've noticed countless of times that I seem to be extremely more aware of my surroundings than my friends etc. I hear and see more compared to them, which has positive and negative sides.

Re: Most people on antidepressants don’t need them

#124

Post by samtho »

twawaaay wrote: post #79
tecleandor wrote: post #33

Earlier quoted context omitted.

For what we've been reading this last years, it's not like antidepressants are worthless, it's like antidepressants aren't doing what we think are doing. The "depression is lack of serotonin" theories seem to have less and less base every day, but SSRIs don't only act on serotonin (just review their side effects). I've done, mostly, vortioxetine and sertraline. For some of us, some SSRIs or SNRIs work. Some don't. Pr…

> The "depression is lack of serotonin" theories seem to have less and less base every day But that is not true. The problem with statement "depression is lack of serotonin" is the same as with "being overweight is due to eating too much". It is factually true, seems like an easy solution and yet is mired with lots of problems. The problem with medication is that it treats the symptom (lack of serotonin) rather than…

This sort of echos my criticism to the way pharmaceuticals are developed, tested, and regulated. They all treat symptoms and not fix problems. Modern medicine has really advanced in treating acute issues (broken bone, laceration, benign pain) but is shit with chronic issues because it’s focused on symptoms. We prescribe statins the moment someone’s cholesterol goes too high, but did we ever stop to figure out why it is so? Maybe it’s because this person’s favorite breakfast is a bacon-maple donut which they habitually consume 5 days per week. What we are really saying is that it’s okay to eat that cholesterol-raising food, just take this to make that number lower.

We’ve optimized our efforts on treating symptoms and not causes. Drugs that survive regulatory scrutiny and are profitable tend to be those that treat symptoms of chronic illnesses. If you can prove that someone’s LDL goes down and they will buy it for the rest of their life, that’s a drug that will survive. They don’t have a miracle cure for this because they are withholding anything, there is just no incentive to research it and if there was, there is no good way to prove that drug X will cure non-visible condition Y without good, measurable data.

Re: Most people on antidepressants don’t need them

#125

Post by samtho »

welshwelsh wrote: post #121
cameronh90 wrote: post #21

Statements like this need to be worded very carefully. In many people's minds, saying something like "most people don't need antidepressants" quickly becomes "antidepressants are useless". Many people who may benefit from them get scared away. Speaking as someone who has been on/off antidepressants for GAD+OCD for the better part of a decade, I've had countless people tell me that antidepressants are useless and just…

>But for me, they are life changing This is not something you can claim. How could you possibly know that the SSRI is responsible for your recovery? I'm not going to say that antidepressants are useless, but it is important to understand how placebo works. The key point is that placebo works and it is impossible for an individual to distinguish between a placebo and a life changing drug. In antidepressant studies, SS…

> This is not something you can claim. How could you possibly know that the SSRI is responsible for your recovery?

This is the kind of trash thinking that makes it hard to get potentially life-changing medication. I take a heavily controlled substance for a sleep disorder and ADHD and our laws surrounding it’s distribution and refill are unconscionable. My life falls apart when there is lapse in medication and nobody takes it seriously. I cannot stay awake, focus, or function after about day 5 without it. It’s appalling that peoples’ well being is in danger every month because someone decided that it might be abused and restricting legal distribution is the solution for this.

First, you do not and cannot know what this person has been through or know what their baseline is. Second, if someone’s life is improved when taking a medication, what does it matter to you that they take it? I’m not going argue the efficacy of the family of SSRIs, but we need to let patients make their own decisions and assessments of what works for their situation.

Re: Most people on antidepressants don’t need them

#126

Post by twawaaay »

samtho wrote: post #124
twawaaay wrote: post #79

Earlier quoted context omitted.

> The "depression is lack of serotonin" theories seem to have less and less base every day But that is not true. The problem with statement "depression is lack of serotonin" is the same as with "being overweight is due to eating too much". It is factually true, seems like an easy solution and yet is mired with lots of problems. The problem with medication is that it treats the symptom (lack of serotonin) rather than…

This sort of echos my criticism to the way pharmaceuticals are developed, tested, and regulated. They all treat symptoms and not fix problems. Modern medicine has really advanced in treating acute issues (broken bone, laceration, benign pain) but is shit with chronic issues because it’s focused on symptoms. We prescribe statins the moment someone’s cholesterol goes too high, but did we ever stop to figure out why it…

I think part of the reason is that there is lots of money in treating acute symptoms with medication while there isn't much in having serious talks with patients to try to debug their lifestyle problems that might be causing their health problems and then educate them on what and why they should be doing it.

I also think people naturally tend towards easy and fast solutions even if those solutions are known not to work. This self imposed blissful ignorance is what causes people to keep buying weight loss supplements or go on diets even though both are known not to work while we know that for 99% of people there is a simple solution -- reduce stress, learn to like to eat healthy and exercise daily.

Re: Most people on antidepressants don’t need them

#127

Post by alphabettsy »

samtho wrote: post #124
twawaaay wrote: post #79

Earlier quoted context omitted.

> The "depression is lack of serotonin" theories seem to have less and less base every day But that is not true. The problem with statement "depression is lack of serotonin" is the same as with "being overweight is due to eating too much". It is factually true, seems like an easy solution and yet is mired with lots of problems. The problem with medication is that it treats the symptom (lack of serotonin) rather than…

This sort of echos my criticism to the way pharmaceuticals are developed, tested, and regulated. They all treat symptoms and not fix problems. Modern medicine has really advanced in treating acute issues (broken bone, laceration, benign pain) but is shit with chronic issues because it’s focused on symptoms. We prescribe statins the moment someone’s cholesterol goes too high, but did we ever stop to figure out why it…

> What we are really saying is that it’s okay to eat that cholesterol-raising food, just take this to make that number lower.

Realistically this is what most people want. I spent years watching people choose to go on medications rather than make simple lifestyle choices. Habits are powerful.

It’s not possible to treat the cause when a patient wants the easiest solution. So yea, we have a bunch of medication‘s that treat symptoms. Causes are sometimes impossible to know, the body is complex enough that we don’t even understand how some medications work at all.

Re: Most people on antidepressants don’t need them

#128

Post by jokoon »

cameronh90 wrote: post #21

Statements like this need to be worded very carefully. In many people's minds, saying something like "most people don't need antidepressants" quickly becomes "antidepressants are useless". Many people who may benefit from them get scared away. Speaking as someone who has been on/off antidepressants for GAD+OCD for the better part of a decade, I've had countless people tell me that antidepressants are useless and just…

I'm quite a difficult skeptic, and I have to admit it's difficult to make a difference between melancholy and mild depression, especially after all those years spent being mildly depressed.

Even if I hate the bootstrap argument, it still has an effect on me, despite my skepticism.

In the end, depression alters my perception of what is really good for my mental health. It's very common that patients are difficult to treat, not only because they might disagree with the diagnostic, but because they can't really understand or perceive their emotions and subtle state of mind. Depression is a bit like obesity, you go back to the cause without caring for the consequences.

I become a bit confused when my psychiatrist lets me choose if I want to keep taking those meds, instead of clearly telling me i should take them. But in my experience, those meds are good for me, even if they're not perfect.

Maybe I will stop then one day, and see what happens, but it might hurt more than I think it will.

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