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Prozac 'no better than placebo' for treating children with depression, experts

theguardian.com

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Re: Prozac 'no better than placebo' for treating children with depression, experts

#411

Post by conartist6 »

conartist6 wrote: post #404
robertakarobin wrote: post #108

I 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 sam…

That's what freaks me out about these drugs. You-on-the-pill becomes you, and you can't ever stop.

Sorry, I don't mean to second-guess your choices. There's clearly some very interesting issues here, and my experience is as someone who never felt they had any serious issues with mental health. But I do think that we have this culture where everyone is expected to be OK all the time. Do you worry at all that your son cues in to his parents relationship with the drug? I mean, say it was me, and I knew my parents took a pill so that they could "have a good day" but they didn't give me the have-a-good-day pill. I would think (perhaps subconsciously) that if I was having a bad day the drug could have made it into a good one. Having a bad day would be medical now, a reason to feel like you're sick or broken.

Re: Prozac 'no better than placebo' for treating children with depression, experts

#412

Post by hapless »

ckw wrote: post #272
robertakarobin wrote: post #237

Earlier quoted context omitted.

We were certainly informed of this. I didn't count it among the long-term health effects. I'm an educated and skeptical person but have never found any reason to distrust my physicians.

I have many reasons for distrusting physicians, but here's a particularly good one: the large drug companies have been fined repeatedly billions of dollars for illegal schemes to convince doctors to prescribe drugs off-label. From a justice department press release ( https://www.justice.gov/archives/opa/pr/pharmaceutical-giant... ): 'AstraZeneca LP and AstraZeneca Pharmaceuticals LP will pay $520 million to resolve a…

It remains legal to provide drugs off-label because physicians sometimes know better than federal regulators

It's horrible that A-Z would illegally market drugs for off-label uses -- I would not disagree for a minute with your reasoning! -- but we retain this "escape hatch" because it is important to patient health

without the off-label "escape hatch," we would not have, for example, the glp-1 class of anti-obesity drugs, or, buproprion for smoking cessation, the most effective drug ever found in its area.

We needed doctors working firsthand with patients, and building "anecdotal" (i.e. case-based) evidence to learn things that really matter on a population level

Re: Prozac 'no better than placebo' for treating children with depression, experts

#413

Post by Dylan16807 »

ryandrake wrote: post #239
hintklb wrote: post #198

Earlier quoted context omitted.

Sorry but strong disagree here. I have had a lot of Spinal and sleep issues. I have read almost all new literature on this niche subject and I have brought to my spine doctor some new therapy and treatments they had literally no idea about. Those treatments have changed my life. As an engineer I read a lot of deep technical paper as my day job. Medical papers are comparatively relatively simple. The most complex part…

> We have pushed to a whole generation of people that only the "experts" can have opinion on some fields. I encourage everyone to read papers and have opinions on some of those subjects. There's nothing wrong with having an opinion on something as a non-expert, as long as those opinions are not acted upon or relied upon as a source of reliable information. Read papers, watch YouTube, browse WebMD, satisfy your curios…

> Believing my "research" is better than my specialist's education

If you get rid of the scare quotes, you can spend 10x or 100x as long as your doctor when researching something specific enough. That has many advantages, even without the training.

> is a path back to the dark ages.

This is quippy but doesn't actually make sense.

Re: Prozac 'no better than placebo' for treating children with depression, experts

#414

Post by burnt-resistor »

jdietrich wrote: post #218
burnt-resistor wrote: post #70

Earlier quoted context omitted.

Yep. 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'…

It is highly likely that your mother was misdiagnosed as suffering from unipolar depression when she was in fact suffering from bipolar disorder. A sudden switch to mania is a common outcome, even in cases where the patient has no previous history of mania. It is crucially important to take a comprehensive history to rule out bipolar disorder, but many general practitioners (and some psychiatrists) reflexively prescr…

Please don't do unsolicited diagnosis over the internet. You're completely wrong. There is absolutely no history and she isn't bipolar at all.

Re: Prozac 'no better than placebo' for treating children with depression, experts

#415

Post by Dylan16807 »

ryandrake wrote: post #219
ksenzee wrote: post #207

Earlier quoted context omitted.

Note that the black box warning has nothing to do with long-term effects of the medication. It was added specifically because kids were killing themselves within weeks of starting the medication. > This is one of the most shocking things I have ever read. Good grief. I hope you're exaggerating for effect.

I'll raise my hand in agreement. This thread is definitely one of the most disturbing sub-threads I've ever read on HN.

The specific thing they were shocked by was the claim of no long-term effects.

Are you disturbed by that claim? That's what you're raising your hand to.

Re: Prozac 'no better than placebo' for treating children with depression, experts

#416

Post by jrflowers »

parineum wrote: post #392
jrflowers wrote: post #59

Earlier quoted context omitted.

> I don’t think there’s a metaphorical “cow” that could have helped me. The medication is the cow for you. In this story your support system figured out what would work best for you, which was medication, and facilitated that. It’s a story about a doctor that serves patients in rural Cambodia. Help from the local community would look different in Borey Peng Huoth, for example.

I think that's a huge stretch. "Your community" isn't your doctor. This annecdote, to me, is cleariy an attempt to blame modernity for depression.

The story in the article that is being discussed here does not say that the doctor was explicitly not a member of the community that he served. You would have to just sort of make that part up and then come up with an explanation for how the doctor even knows that story if he wasn’t part of that community.

The doctor in the story exists in pretty recent history, which you would call modernity. If for some reason you’re using “modernity” as a way to say “systemic alienation of the individual” rather than “modernity” meaning “happening in the modern world” then yes, by your definition of that word, it is indeed a story about “modernity” being to blame for poor treatment for depression.

Re: Prozac 'no better than placebo' for treating children with depression, experts

#417

Post by [deleted] »

jasonfarnon wrote: post #200
jdietrich wrote: post #190

Earlier quoted context omitted.

There'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.

It 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.

[deleted]

Re: Prozac 'no better than placebo' for treating children with depression, experts

#418

Post by directevolve »

jacobgkau wrote: post #113
robertakarobin wrote: post #108

I 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 sam…

Your anecdote has nothing to do with whether it's better than a placebo or not.

The study found the average effect was no different from placebo. It’s plausible, based on anecdotes like the one you’re responding to, that Prozac is harmful for some people, helpful for others, with the expected benefit close to zero. If so, it might be necessary to just try it and see if it’s obviously helping, keep taking if so, stop if not.

Re: Prozac 'no better than placebo' for treating children with depression, experts

#419

Post by burnt-resistor »

tcj_phx wrote: post #83
burnt-resistor wrote: post #70

Earlier quoted context omitted.

Yep. 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'…

Thanks 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-in…

Yup. There's too much institutional inertia to adopt evidence-based approaches.

I've tried 19 antidepressants over about 15 years. Stuck with mirtazapene-induced obesity that doesn't qualify for GLP-1 coverage, so I can either be fat, broke, or crushingly catatonic.

Re: Prozac 'no better than placebo' for treating children with depression, experts

#420

Post by Dylan16807 »

Razengan wrote: post #164
area51org wrote: post #115

Earlier quoted context omitted.

Depression 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.

> You cannot necessarily just "figure out why" you feel bad Well, of course, if you anesthetize someone they can't feel anything. If you cut off the physical pathways of ""feeling sad"" then they can't feel sad, but is that really the same as "fixing" the reason for why they were feeling sad in the first place? Unless the reason was that the physical causes are running haywire and making someone feel sad when they ot…

> Well, of course, if you anesthetize someone they can't feel anything.

Not what the post you replied to was talking about.

> Unless the reason was that the physical causes are running haywire and making someone feel sad when they otherwise wouldn't, but how often is that just uhh a lazy scapegoat? "Oh this person has no reason to feel sad, something must be wrong in their brain"

That's basically the definition of clinical depression. Doctors try quite hard to make sure it's not a scapegoat.

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