Prozac 'no better than placebo' for treating children with depression, experts • Hacker News Board

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

#491

Post by ggreer » Sat, Nov 22, 2025, 7:27 PM UTC

robertakarobin wrote: post #458

ggreer wrote: post #339

Earlier quoted context omitted.

Your pediatrician is either mistaken or lying. Children and adolescents who take SSRIs for major depressive disorder show increased rates of suicidal ideation, suicidal behavior, and hostility towards others. These effects persist for at least 9 months after starting SSRIs.[1] Common side effects of long-term SSRI use in adults include weight gain, emotional numbing, loss of libido, and sexual dysfunction. It seems t…

I thought we were talking about long-term effects, i.e. ones that persist to and through adulthood? The sources in that Wiki article appear not to address that. The clinicians I've interacted with have always warned me of the possible side-effects of psychotropic medications, and said they should be notify immediately if the side-effects appear. I believe this is at least standard procedure, if not legally required?…

In addition to the increased rates of suicidal behavior and aggression in children (which we know lasts for at least 9 months, but don't know if it's longer because the study only ran for that long), the Wikipedia article talks about long term effects in adults, at least one of which you have. Why should it be less likely for children to end up with these same issues?

You are asking for evidence that does not exist because nobody has done good studies on it. That's too high of a bar. There are many drugs and life interventions that we don't have studies on regarding children, but that doesn't mean those things are safe for children. To use an example so ridiculous that we can both agree on it: There are no studies showing long term effects of fentanyl on children. Yet if some parent managed to get a fentanyl prescription for their kid, I think we would both be concerned.

Obviously I'm not implying that giving a child Prozac is as harmful as fentanyl. I'm saying that your line of reasoning proves too much. If someone did get their kid on a dangerous drug, and defended their decision by pointing out that there are no studies on children showing its long term harm, there is nothing you can say to that parent that others in this thread haven't already said to you. That should give you pause.

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

#492

Post by nuancebydefault » Sat, Nov 22, 2025, 7:28 PM UTC

jacobgkau wrote: post #130

kstrauser wrote: post #126

Earlier quoted context omitted.

Why? If a kid has diabetes, would it be horrifying to treat it? Why would it be different for a neurochemistry issue that makes the same kid tired and sad all the time?

Because the problem's not a "neurochemistry issue" (that theory's been debunked and the "chemicals" in play have never been known), and the solution is "no better than placebo."

"neurochemistry issue debunked" is a very weak argument about the (in)effectiveness of proper drugs for treatment of mental illness. It's not exactly known how they work but I am 100 percent sure SSRIs often have a very positive, even life changing effect. Moreover, every approved drug is tested 'double blind' exactly because the placebo effect has such a big biasing effect on subjectively appreciated outcomes. Only when ruling out pure placebo effect, a drug can be approved.

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

#493

Post by TylerLives » Sat, Nov 22, 2025, 7:42 PM UTC

undeveloper wrote: post #475

EtienneDeLyon wrote: post #473

Earlier quoted context omitted.

A seven-year old child is being given a brain-altering drug? I am very happy such drugs did not exist when I was seven years old.

the alternative is depression. brain altering drugs seem preferrable

Is that the only alternative?

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

#494

Post by wkat4242 » Sat, Nov 22, 2025, 7:53 PM UTC

quantum_magpie wrote: post #489

wkat4242 wrote: post #484

Earlier quoted context omitted.

Exactly. And it's a combination usually. It's really hard to do constructive therapy when you are depressed. Stabilise with the meds and then tackle the root causes with therapy. But some people just are very prone to depression and need the extra help. You wouldn't say "don't give that kid ibuprofen, let them just deal with the pain"? And SSRIs are not very strong. They do have some nasty side effects especially sex…

I would be very cautious advising SSRIs for anyone, especially developing children, considering my own experience (on sertralin), which was complete disappearance of a libido, and massive weight gain, +40kg (70 -> 110) in ~10 months. 5 years later I still have not undone the damage from it.

Yeah but it's something that affects people differently. I took escitalopram and my libido was a bit reduced but mainly it became harder to orgasm. That was not all bad, it's nice to be able to last an hour and a half :) I was already heavy but didn't gain any more weight. I did lose some when I moved to other stuff though.

But these side-effects just need to be checked for (and the libido issue isn't relevant to under-teens anyway).

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

#495

Post by roughly » Sat, Nov 22, 2025, 8:29 PM UTC

nominalprose wrote: post #194

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…

I recently started giving my 11 year old SAM-e, available over the counter and much faster acting than SSRIs for serotonin support. He's been much happier and more regulated since taking it. I'd encourage folk to read up on the literature around SAM-e and consider it as a lower risk alternative to try first, that may in fact work better.

Out of curiosity - do you know whether SAM-e can be taken safely with SSRIs? I went looking for this a bit back and didn’t find anything conclusive. I know there’s a handful of seratonergics to steer clear of, but I didn’t get a good answer about SAM-e.

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

#496

Post by wetpaws » Sat, Nov 22, 2025, 8:29 PM UTC

EtienneDeLyon wrote: post #473

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…

A seven-year old child is being given a brain-altering drug? I am very happy such drugs did not exist when I was seven years old.

[dead]

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

#497

Post by roughly » Sat, Nov 22, 2025, 8:35 PM UTC

robertakarobin wrote: post #337

drekipus wrote: post #308

Earlier quoted context omitted.

> Pills are for people who feel depressed but don't have something to be depressed about -- they have food, shelter, friends, opportunities to contribute and be productive, nothing traumatic has happened, but they feel hopeless anyway This warrants a whole different discussion, and I'll be down voted for it, but one that's never addressed: quality over quantity. Pills are the individuals response to a society that fe…

> I cured it by finding meaning and beauty in the world. That's incredibly fortunate and I'm very jealous of you. How would you recommend one goes about finding meaning and beauty? I'm fortunate to have had lots of unique experiences and traveled to lots of unique places and still haven't found the fulfillment that you seem to. That's basically what depression is: a debilitating feeling of lack of fulfillment, withou…

> So my career has been in software engineering since that involves building and fixing and pays well, but it still doesn't fill the hole.

A brief thought on this - I’ve found working in large software companies to be fairly unfulfilling, but working at smaller shops focused on delivering something other than software, or for which there’s some tangible connection to the real world, to be much more fulfilling. At its best, software engineering is indeed a craft and something you can take pride in and something where you can have a real impact on people’s lives by building things. A lot of that gets lost somewhere between the third roadmap meeting and the weekly scrum session to figure out how to prioritize product’s requests alongside paying down tech debt so we can improve ad unit performance, but the craft of software itself is still a creative act.

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

#498

Post by amypetrik8 » Sat, Nov 22, 2025, 8:48 PM UTC

undeveloper wrote: post #475

EtienneDeLyon wrote: post #473

Earlier quoted context omitted.

A seven-year old child is being given a brain-altering drug? I am very happy such drugs did not exist when I was seven years old.

the alternative is depression. brain altering drugs seem preferrable

The dichotomy of such mental illness is people with more constitutional resilience just say "power through?" and they are absolutely correct, it is something they can power through.

Mentally ill folk literally cant, not in em. There are right answers to help them, but that's not the right one. It's kind of like telling someone who is color blind to squint real hard, won't ever help.

Myself, I'm someone very much in the power through category. It's the simplest and most straightforward answer surely. But if it were the answer that works in practice we'd have no homeless people, no drug addicts.

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

#499

Post by esseph » Sat, Nov 22, 2025, 9:05 PM UTC

pizzafeelsright wrote: post #358

esseph wrote: post #348

Earlier quoted context omitted.

You are very, very extremely inexperienced in this area, as anyone who deals with or has someone in their close family that deals with serious, life-threatening depression will tell you. And that's okay! I would encourage you to look at the number of comments from different people who have a history of dealing with this kind of thing for a long time.

I'm reading them. What responsibility does an individual have over their situation.

ADHD and some types of Depression are developmental / environmental.

You're asking a person missing a leg to "just run, bro".

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

#500

Post by staticman2 » Sat, Nov 22, 2025, 9:07 PM UTC

ryeights wrote: post #488

staticman2 wrote: post #462

Earlier quoted context omitted.

I've seen a post like this before on reddit. We know SSRI's really do cause permanent sexual dysfunctional in a small minority of people, small enough that this side effect doesn't come up in traditional FDA tests. If a side effect is extremely rare it would be impossible or at least impractical to prove in a population. Grandparent could be right or wrong about how the drug affected them, maybe their brain suffered…

> If a side effect is extremely rare it would be impossible or at least impractical to prove in a population. This is also true for a non-existent side effect. I’m not trying to tell GP he is wrong, just that from a reader’s perspective, extraordinary claims require extraordinary evidence.

This isn't a good fit for the phrase "extraordinary claims require extraordinary evidence."

Grandparent's report is hard to verify, not extraordinary.

These drugs are approved based on statistical safety profiles in limited trial populations, not on a scientific consensus that absolutely nobody on Earth will ever experience a unique adverse reaction.

Also, I never said that you, the reader, had an obligation to change your worldview based on Grandparent's report.