Comparative efficacy and acceptability of 21 antidepressant drugs • Hacker News Board

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#81

Post by markroseman » Thu, Feb 22, 2018, 3:23 PM UTC

askvictor wrote: post #36

This analysis look at effects over 8 weeks. The first four weeks on antidepressants you're feeling terrible due to onset side effects (on top of your depression). Once that settles, you feel better. But there is no way to tell if you feel objectively better than before the medication started.

Statistically, rating scales typically used in these studies have been validated as showing effect, and clinical interviews can pick up a lot of things. That said, it's normally hard for you to be able to look back eight weeks and subjectively compare how you feel then and now. Usually it's not the person being treated, but those around them (family etc.), who notice the improvements first.

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#82

Post by markroseman » Thu, Feb 22, 2018, 3:28 PM UTC

tachyoff wrote: post #79

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…

I agree with all of this, and I can’t help but ask: when did we start ignoring people’s environment and their circumstances? I have tens of thousands of dollars of student loan debt (my monthly payment is basically a mortgage payment) and I’m not particularly satisfied at work. Is it any wonder I find it impossible to get out of bed? Now, I try to be careful because, sure, perhaps the depression was already there and…

We're not ignoring their environment. But unfortunately, most of the time drugs are quicker and easier for the prescribers, and therefore cheaper and more available for the patient, than extended psychotherapy, etc.

If the underlying problem is a psychosocial stressor, the meds won't fix that, though they might help you control the symptoms long enough that they give you the opportunity/resilience to address the stressor. And sometimes, while maybe not ideal, just controlling the symptoms is enough even for the long term.

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#83

Post by alex_hitchins » Thu, Feb 22, 2018, 3:34 PM UTC

mnw21cam wrote: post #73

alex_hitchins wrote: post #53

Earlier quoted context omitted.

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.

Basically, the foods you need to avoid are any that might cause constipation, because Amitriptyline kind of does that for you already. The parent post was possibly confusing Amitriptyline with a different drug. It is very weird to be mixing two different antidepressants. Depending on what your other antidepressant is, it could be dangerous. Were your two medications prescribed by the same doctor, and if not, have the…

Thank you for your concern. Yes, both medicines were prescribed by the same doctor, and there are others in the mix as well that mean Serotonin Syndrome is something I'm very aware of (Tramadol, Immigran). It's been a fixed dosage for a long time and I'm regularly seen by my GP, have LFT's twice a year etc. Just to note, the Amitriptaline isn't perscibed in my case for depression, it's taken in a smaller dose for it's neurapathic pain properties.

I find the ZoMorph blocked me up quite a bit, Fibrogel works well in this case.

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#84

Post by markroseman » Thu, Feb 22, 2018, 3:36 PM UTC

mnw21cam wrote: post #73

alex_hitchins wrote: post #53

Earlier quoted context omitted.

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.

Basically, the foods you need to avoid are any that might cause constipation, because Amitriptyline kind of does that for you already. The parent post was possibly confusing Amitriptyline with a different drug. It is very weird to be mixing two different antidepressants. Depending on what your other antidepressant is, it could be dangerous. Were your two medications prescribed by the same doctor, and if not, have the…

Being on more than one antidepressant is not unusual, and can even sometimes be optimal. Even ones acting on the same neurotransmitter often target different receptors and hence different symptoms. More often it's because doctors are better at adding drugs rather than taking away ones prescribed by other doctors "just in case."

Serotonin syndrome can be an issue with all kinds of things (most people aren't warned about being on a SSRI and having cough syrup for example), but is not very common in practice, and because it coincides with a change/increase in medication, often sorted out quickly, even if it's characterized as a "side effect" or "tolerability" problem and not actually recognized for what it is.

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#85

Post by dmitripopov » Thu, Feb 22, 2018, 3:43 PM UTC

I don't think that researches like this make sense at all. Each depression is unique in it's pathogenesis, there are no drugs that work for everyone. For example, a depression caused by a chronic desease or the one with deep roots in your childhood - a true research needs to evaluate all 21 drugs in each situation.

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#86

Post by SpikeDad » Thu, Feb 22, 2018, 4:05 PM UTC

I was worried as to the source of this study and the people who are claiming this "puts to rest the controversy of antidepressant drugs".

It's all psychologists who naturally benefit greatly from a public perception that medication is effective. If I had seen quotes from psychologists saying "This is better than therapy - I'm stopping therapy and giving them drugs" then I would be on the bandwagon with the rest.

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#87

Post by hestipod » Thu, Feb 22, 2018, 4:12 PM UTC

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'd like to expand a bit and reiterate that not everyone who suffers from depression has primary depression with no discernable cause. Most seriously depressed people in my experience have various situational causes (physical health, financial, social etc) and the depression is a side effect of those and not the main issue. Without tackling the root cause, drugs usually just cover, drag out, and add issues, yet the mental health system mostly uses these drugs as a blunt instrument and fail to address the cause. In the right circumstance, and right conditions, they CAN enable someone to get out of a rut and take actions they wouldn't have without so they do have a place after someone with unexplainable depression who has tried less invasive and risky options like lifestyle changes.

I am not encouraging people not to try medication if they feel it is a good option, simply asking people to realize A. It's not a cure without a plan to fix the cause and B. Not to follow the common victim blaming that often occurs when these simple "fixes" don't work for people (OP isn't doing that and I don't intend to sound as if I am saying so...in fact they made it clear it's not a magical fix suited for all) Drugs are a tool, not a cure, and need to be wielded responsibly and properly. Sadly I don't believe that happens a lot of the time.

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#88

Post by alz » Thu, Feb 22, 2018, 4:27 PM UTC

96 out of 522 trials identified as low risk of bias (18%)

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#89

Post by ac29 » Thu, Feb 22, 2018, 4:28 PM UTC

raducu wrote: post #56

ggm wrote: post #46

Earlier quoted context omitted.

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 -> 1…

This is a good analogy, because there are a lot of different biochemical pathways that can play roles in mental health. To add add to that, here's a good image of 4 of the ways a drug can effect activity at certain sites (not mental health specific, general pharmacology principles): https://commons.wikimedia.org/wiki/File:Inverse_agonist_3.sv...

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#90

Post by ChristianGeek » Thu, Feb 22, 2018, 4:48 PM UTC

hmhrex wrote: post #69

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…

This is the main reason I stayed away from medication for 12 years. That is until 3 weeks ago. I decided late 2017, after a major depressive episode, that I needed to get help after 12 years of dealing with this depression. I kept thinking that I had a handle on it, and then it coming back weeks, months or years later. I read The Depression Cure ( https://www.amazon.com/Depression-Cure-6-Step-Program-withou... ) abou…

I wish you the best. Definitely don’t be afraid to discuss alternatives with your doctor if you’re not happy with Zoloft...sometimes it takes a few tries before you find whaat works best for you.