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Comparative efficacy and acceptability of 21 antidepressant drugs

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Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#21

Post by djsumdog »

> meta-analysis

I knew a lot of other grad students, myself included, who would throw anything with meta-analysis in the introduction in the trash. You cannot deal with controls across completely different studies in meaningful ways.

I'm also hesitant about anything that tries to claim things definitively without question. Science is about continually questioning your axioms. Without doubt[1] there is no progress.

As someone who has been on various anti-depressants, I will say that some of them "worked" .. but the side effects were quite high. Working only lasted the first few weeks with several different SSRIs. Eventually the side effects ended up being worse than the treatment.

I found the most effective thing for me was simply a really good therapist. She did try to recommend drugs to me again after I had quit, but she did respect my wishes to not be on them. I feel that having someone who really showed me my options and truly helped examine negative thinking patterns helped a lot more than the drugs ever did.

That being said, I know people who say they'd be in serious trouble or dead without SSRIs. It's a tough line to talk about. I personally would rather not ever be on them again. Dulling the pain for me also meant dulling life.

There are trade offs and we need to talk about them and have full discussions on the consequences of mind alternating drugs. When things are written into pure absolutes, it is a means of killing real discussion and dialogue.

[1]: https://khanism.org/science/doubt/

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#22

Post by tlrobinson »

smt88 wrote: post #11

This is consistent with my understanding, but: - how serious are the side effects? - how well would harmless placebo pills work in their place? I currently believe that there needs to be a safe, placebo-like option for people without severe illnesses. For those who are severe (and can tolerate side effects as serious as suicidality), it still seems to be a good idea to prescribe them.

"placebo-like option"

How would that work? Do placebos work even if people know they're placebos? Could doctors just start prescribing a placebo called Fauxzac and it would work some of the time?

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#23

Post by fernly »

random_throw wrote: post #5

Key bit: "In head-to-head studies, agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine, and vortioxetine were more effective than other antidepressants (range of ORs 1·19–1·96), whereas fluoxetine, fluvoxamine, reboxetine, and trazodone were the least efficacious drugs (0·51–0·84)."

Also significant, the next sentence,

"For acceptability, agomelatine, citalopram, escitalopram, fluoxetine, sertraline, and vortioxetine were more tolerable than other antidepressants (range of ORs 0·43–0·77), whereas amitriptyline, clomipramine, duloxetine, fluvoxamine, reboxetine, trazodone, and venlafaxine had the highest dropout rates."

It appears that agomelatine[1] and vortioxetine[2] are effective and well-tolerated. Good to know.

[1] https://en.wikipedia.org/wiki/Agomelatine : "...avoids the weight gain, sexual dysfunction, and severe withdrawal associated with the most commonly used classes of antidepressants..."

[2] https://en.wikipedia.org/wiki/Vortioxetine : "...Incidence of sexual dysfunction is higher in patients taking vortioxetine than in people taking placebos but appears to be lower than in people taking most other antidepressants..."

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#24

Post by comex »

tlrobinson wrote: post #22
smt88 wrote: post #11

This is consistent with my understanding, but: - how serious are the side effects? - how well would harmless placebo pills work in their place? I currently believe that there needs to be a safe, placebo-like option for people without severe illnesses. For those who are severe (and can tolerate side effects as serious as suicidality), it still seems to be a good idea to prescribe them.

"placebo-like option" How would that work? Do placebos work even if people know they're placebos? Could doctors just start prescribing a placebo called Fauxzac and it would work some of the time?

> Do placebos work even if people know they're placebos?

Sometimes, yes! See: https://www.health.harvard.edu/blog/placebo-can-work-even-kn...

But they're probably more effective if you don't know.

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#25

Post by evincarofautumn »

amputect wrote: post #8

I think that the United States is getting better about dealing with mental health, but we still have a long way to go. This is a little soap-boxy and anecdotal, and I apologize if it's inappropriate here. If I hadn't gotten a prescription for Prozac I probably would have killed myself by now. And I definitely would have destroyed my marriage and most of my important friendships. That's not an over-dramatization, it's…

Likewise, if storebought doesn’t do the trick, some people (myself and my partner included) have better luck with the recreational variety—mushrooms were the thing that kicked me in the psychological ass and started me on the path to recovery from alcoholism (which was partly self-medicating for anxiety). To be clear, this is absolutely not something I’d recommend lightly. Taking (who knows how strong) mushrooms or LSD isn’t exactly the most precise or reliable way to go about it, and there are attendant risks.

I just hope in the future there’s more access to psychedelics (and analogues) in a safe, professional setting, because they’ve been shown to be another potentially useful tool in the antidepressant/anxiolytic/self-care kit.

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#26

Post by gliese1337 »

lawl wrote: post #16
gliese1337 wrote: post #15

As another person who is on antidepressants, and tried going off them for a while: well, duh. Yeah, I know, anecdotes aren't data, and I'm glad this is being verified by more reliable statistical methods, but this is not news to the many of us who might be dead or worse if someone hadn't said "you are sick--go see a doctor" and if that doctor hadn't said "you need medication--let's see if this works". Without antidep…

> well, it's amazing what you can do when you actually have enough neurotransmitters in your brain! This notion of chemical imbalance in the brain is wrong/misleading by the way.[0] > The fact that two efficacious classes of medications exert opposing effects on serotonin levels raises questions concerning a simplistic chemical imbalance model. [0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4522609/

Decent point. Have an upvote. I guess I'll just go with "when your brain is working properly", then.

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#27

Post by sjg007 »

djsumdog wrote: post #21

> meta-analysis I knew a lot of other grad students, myself included, who would throw anything with meta-analysis in the introduction in the trash. You cannot deal with controls across completely different studies in meaningful ways. I'm also hesitant about anything that tries to claim things definitively without question. Science is about continually questioning your axioms. Without doubt[1] there is no progress. As…

>I knew a lot of other grad students, myself included, who would throw anything with meta-analysis in the introduction in the trash. You cannot deal with controls across completely different studies in meaningful ways.

You probably need to rethink this. Meta-analysis can be quite stable and valid.

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#28

Post by anticnstrctv »

amputect wrote: post #8

I think that the United States is getting better about dealing with mental health, but we still have a long way to go. This is a little soap-boxy and anecdotal, and I apologize if it's inappropriate here. If I hadn't gotten a prescription for Prozac I probably would have killed myself by now. And I definitely would have destroyed my marriage and most of my important friendships. That's not an over-dramatization, it's…

Attitudes towards mental health in the US and the west in general are quite frustrating, and I hope they are improving. On the right there seems to be a tendency to deny nuanced views of mental illness from economic, religious, or simply conservative cultural motivations, or to push sedative (using this term metaphorically) medication as a panacea. On the left there are many influenced by the (understandable but deeply destructive) anti-psychiatry movements who both affirm mental illness and deny proper care. It is quite frustrating to see someone talk about their own "undiagnosed mental illness" while citing Foucault to disparage people you care about for seeking psychiatric methods that, as you described, saved their lives.

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#29

Post by analogmemory »

amputect wrote: post #8

I think that the United States is getting better about dealing with mental health, but we still have a long way to go. This is a little soap-boxy and anecdotal, and I apologize if it's inappropriate here. If I hadn't gotten a prescription for Prozac I probably would have killed myself by now. And I definitely would have destroyed my marriage and most of my important friendships. That's not an over-dramatization, it's…

> If you are reading this from a dark and bad place, please know that you're not alone. You have a lot of options, and I promise that if you take that first step, things can get better.

I really think they need to have some sort required of "Life Skills" class in high school. In which they teach you how to get help, how to ask for help, how to share your feelings with friends in a safe way. And your options if you do get into a deep dark way. Based on personal evidence, almost every adult gets depressed in some way and many don't know how to get help or deal with it in a healthy way.

I didn't learn any of that till my 30s. I nearly committed suicide multiple times. Our current society and the toxic religious one i grew up in taught me that a man needs to be strong and doesn't need to rely on others. Pray to God and just pull yourself up by your bootstraps mentality.

It's amazing how helpful it is to know that you are loved and cared for. And people want to help you. You just have to ask for it.

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#30

Post by [deleted] »

evincarofautumn wrote: post #25
amputect wrote: post #8

I think that the United States is getting better about dealing with mental health, but we still have a long way to go. This is a little soap-boxy and anecdotal, and I apologize if it's inappropriate here. If I hadn't gotten a prescription for Prozac I probably would have killed myself by now. And I definitely would have destroyed my marriage and most of my important friendships. That's not an over-dramatization, it's…

Likewise, if storebought doesn’t do the trick, some people (myself and my partner included) have better luck with the recreational variety—mushrooms were the thing that kicked me in the psychological ass and started me on the path to recovery from alcoholism (which was partly self-medicating for anxiety). To be clear, this is absolutely not something I’d recommend lightly. Taking (who knows how strong) mushrooms or L…

[deleted]
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