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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

#51

Post by alex_hitchins »

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…

I know exactly where you are coming from. Me too. Thank you be being honest and sharing your experience.

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#52

Post by alex_hitchins »

jdietrich wrote: post #34
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 I hadn't gotten a prescription for Prozac I probably would have killed myself by now. The majority of people with depression just get better of their own accord, for no obvious reason. The NNT for most antidepressants is ~7, meaning you need to give them to about seven patients for one patient to see a clinically-significant improvement. The evidence suggests that there's no significant relationship between SSRI…

> The majority of people with depression just get better of their own accord, for no obvious reason. The NNT for most antidepressants is ~7, meaning you need to give them to about seven patients for one patient to see a clinically-significant improvement.

Which is fine, as long as they stay alive long enough for natural changes to occur. If a prescription gives only hope, that could be enough to keep people strong enough to battle through another day, week, month, year.

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#53

Post by alex_hitchins »

kqr wrote: post #39
icantdrive55 wrote: post #12

Earlier quoted context omitted.

I am obviously confused, as usual. I'm not used to reading these studies. I'm looking at the study. I'm looking at the #3 graph under Tables and Functions Tab. It says amitriptyline is the best drug? Isn't that an older drug, or am I misreading the chart?

"Best" is a complicated concept. Yes, amitriptyline has the greatest efficacy, i.e. response rate in a clinical setting. It may still have poor effectiveness (how well it works in the real world) because it belongs to a class of medications which, if you use them, you have to exclude many types of common foods from your diet. It also has less safety margins in terms of overdosing than many modern alternatives. And th…

What foods should I avoid? I'm been taking Amitriptaline for 8 years now for pain management and wasn't given any advise on substances to avoid.

Although I'm on another Anti-Depressant, I certainly notices a positive effect from Amitriptaline that outweigh the bad effects.

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#54

Post by jdietrich »

tyrex2017 wrote: post #43
jdietrich wrote: post #34

Earlier quoted context omitted.

>If I hadn't gotten a prescription for Prozac I probably would have killed myself by now. The majority of people with depression just get better of their own accord, for no obvious reason. The NNT for most antidepressants is ~7, meaning you need to give them to about seven patients for one patient to see a clinically-significant improvement. The evidence suggests that there's no significant relationship between SSRI…

NNT might be 7 for one drug and one try, but the therapist will try several drugs and doses. I could imagine that NNT might significantly improve if you consider “use antidepressants” instead of “use 1 antidepressant 1 time”

Assuming that efficacy is randomly distributed, you're left with some very frustrating math. You'd need to try five drugs to have a better than 50/50 chance of getting a positive outcome. After seven drugs, there's still a 34% chance that none of them have worked. After fifteen drugs, there's still about a 10% chance that nothing has worked. I expect that most patients will give up on drug treatment well before that point.

I don't want to be overly negative about antidepressant drugs - they're a useful treatment for many patients - but I do feel that the popular perception of their efficacy is far greater than the reality. Many people seem to feel extremely disheartened when antidepressant drugs don't work for them, often believing that there must be something uniquely wrong with them. The language of psychiatry doesn't help, describing these people as "treatment-resistant" rather than "people we don't know how to treat".

If you try antidepressant drugs and they don't seem to do anything, don't keep taking them just because you think you're supposed to. Speak to your doctor about alternative drug and non-drug treatments. If you have access, try a range of psychotherapies. If your symptoms are relatively mild, look at lifestyle interventions. If your symptoms are particularly severe and/or chronic, give some serious thought to rTMS or ECT.

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#55

Post by tyu100 »

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…

This study, along with long-accepted clinical practice and the generic cheapness of most anti-depressants now, and the effectiveness of CBT/therapy if it's available to you, means you should really avoid self-medicating for major depression.

Why take risks with your health when there are lots of safe, cheap and efficacious treatments that can be monitored by your doctor?

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#56

Post by raducu »

ggm wrote: post #46
raducu wrote: post #40

Earlier quoted context omitted.

I don't understand the part about " an antagonist and a suppressant". Do you mean agonist-antagonist mechanism of action of some drugs that treat the same condition? As far as I know different drugs can work on serotonin/dopamine/norepinephrine but in different parts of the brain and produce different results.

I am a layman so probably use words inadvisably. Some drugs supress effects in the brain, some enhance. Yet both are seen to be deployed to try and treat depression. This is a very confusing signal. If the condition can present from either too much or not enough of something, what diagnostic determines which to try? What evidence do we have, of a mechanism to determine which except for "suck it and see"

I see, my intuition is that the brain is like a very complex analog amplifying station with different types of transistors, capacitors, resistors, whatever.

Drug A decreases 100ohm resistor values to 50 in a noise filter stage and "fixes" your problem with the radio.

Drug B has same 100ohm -> 50ohm effect, but in a different section of the radio and doesn't work.

Drug C increases the speaker resistance from 5ohm -> 10ohm and "fixes" your problem because you simply cannot hear the noise.

Drug D increases the microphone resistance from 5ohm -> 10ohm and the noise simply is not picked up.

Drugs A and B work the same way, drug C and D work the same way, but opposite to how drugs A and B work and they all provide the same net effect as far as I'm concerned.

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#57

Post by tyu100 »

icantdrive55 wrote: post #12
tyu100 wrote: post #4

Earlier quoted context omitted.

SSRIs are generally indicated for what's called mild/moderate depression, the most common form, not for the serious conditions that you highlighted. There were some older meta-studies that called into question their general efficacy vs. placebo even for mild/moderate depression but this new meta-study (with the additional previously unpublished data from their initial approval trials) looks like it has finally settle…

I am obviously confused, as usual. I'm not used to reading these studies. I'm looking at the study. I'm looking at the #3 graph under Tables and Functions Tab. It says amitriptyline is the best drug? Isn't that an older drug, or am I misreading the chart?

Right, so since a common problem with anti-depressants are the varied side effects of different classes (insomnia, weight loss/gain, sexual dysfunction, etc.. and etc..) a big part of going on an anti-depressant is you and your doctor finding a drug and a dose that shows both efficacy and a tolerable side effect profile.

This study generalizes this process by discussing both efficacy (how well the drug helps with depression) and the tolerability of the treatment, as measured by how long people tend to stay on the drug (the site is down right now so I forget the actual term used). Once the paper is accessible again have a look at some of the graphs that chart both of these measures. Generally, the drugs in the upper-right quadrants are better, showing both good efficacy and tolerability.

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#58

Post by aianus »

tyu100 wrote: post #55
evincarofautumn wrote: post #25

Earlier quoted context omitted.

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…

This study, along with long-accepted clinical practice and the generic cheapness of most anti-depressants now, and the effectiveness of CBT/therapy if it's available to you, means you should really avoid self-medicating for major depression. Why take risks with your health when there are lots of safe, cheap and efficacious treatments that can be monitored by your doctor?

Psychiatrists have a three month waiting list here in Canada and therapy is $100/h.

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#59

Post by evincarofautumn »

tyu100 wrote: post #55
evincarofautumn wrote: post #25

Earlier quoted context omitted.

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…

This study, along with long-accepted clinical practice and the generic cheapness of most anti-depressants now, and the effectiveness of CBT/therapy if it's available to you, means you should really avoid self-medicating for major depression. Why take risks with your health when there are lots of safe, cheap and efficacious treatments that can be monitored by your doctor?

I generally agree—I guess I just mean I wish there were a safer/tested way to take advantage of other serotonergics, after the first line of defense fails, for those who are less cavalier than I am about their neurochemistry.

Also in my case it wasn’t depression, so I can’t really speak to that, but SSRIs are also prescribed for anxiety disorders. I chose not to go on them when they were offered because I didn’t feel that the side effects were worth it, and they weren’t the correct treatment anyway because at the time I was mainly anxious due to alcohol withdrawal. (I’m lucky I didn’t have a seizure!)

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#60

Post by projektfu »

imperio59 wrote: post #35

Horrible side effects, no tests for diagnosis, no actual cures (have you heard of these drugs actually curing depression? No. Once you get on them you are basically on them for life...)... I think this "Science" of psychiatry has a long ways to go to actually get repeatable, scientifically proven results.

Yes, cures happen all the time. I'm an anecdote, but I was cured of depression using venlafaxine. Talk therapy was used at various times but it was not effective. I no longer take venlafaxine and I am not depressed. I will say that getting "off" of venlafaxine is troublesome and must be pursued gradually and slowly because the withdrawal is severe. Once I was cured it took about 9 months to go drug free.
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