do ssri really work?

[RememberWhatUCameFor]

It turns out that between 65 and 80% of people on antidepressants are depressed again within a year. I had thought that I was freakish for remaining depressed while on these drugs. In fact, Kirsch explained to me in Massachusetts, I was totally typical. These drugs are having a positive effect for some people – but they clearly can't be the main solution for the majority of us, because we're still depressed even when we take them. At the moment, we offer depressed people a menu with only one option on it. I certainly don't want to take anything off the menu – but I realised, as I spent time with him, that we would have to expand the menu.

This led Professor Kirsch to ask a more basic question, one he was surprised to be asking. How do we know depression is even caused by low serotonin at all? When he began to dig, it turned out that the evidence was strikingly shaky. Professor Andrew Scull of Princeton, writing in the Lancet, explained that attributing depression to spontaneously low serotonin is "deeply misleading and unscientific". Dr David Healy told me: "There was never any basis for it, ever. It was just marketing copy."

Is everything you think you know about depression wrong?

In this extract from his new book, Johann Hari, who took antidepressants for 14 years, calls for a new approach

www.theguardian.com

i recently read this article (was linked here)

 

[CURSED again]

I despise them - doctors make you take them without advising about side effects (which can be horrendous and devastating) - they can permanently alter you for the worse -

 

[Baskol1]

They can work, but it really depends, many are unfortunately relatively useless, and do more harm than good. But we should not demonize them either,some people need them, and it helps some people.

 

[Shamana]

No most large scale unbiased studies show they don't really work and come with massive side effects and addiction. The whole thing is hundred billion dollar industry that works for a few and ruins the lives of others.

 

[mathieu]

I think they work, at least for some people. They have helped me at times.

 

[RememberWhatUCameFor]

No most large scale unbiased studies show they don't really work and come with massive side effects and addiction. The whole thing is hundred billion dollar industry that works for a few and ruins the lives of others.

i heard the pharmacy companies are less likely to publish studies with an unwanted outcome?

I think they work, at least for some people. They have helped me at times.

how do you know its not a placebo effect?

 

[Jean Améry]

Define 'work'. If you mean fix a biological problem in the brain then no. If it means improve someone's subjective feeling of well-being: for some people yes but that's mainly due to the placebo-effect.

If it works (lowering the feeling of being depressed) I personally wouldn't care whether it was due to the placebo-effect (the brain healing itself) or some other reason.

 

[EmptySteph62]

I found one that helps a bit, but not as much as I was led to believe they would, and it was a challenging and frustrating journey to find ones that helped. Wouldn't recommend unless you still have hope and are willing to put in several months of searching for the right one.

 

[RememberWhatUCameFor]

what is your opinion on this?

The makers of antidepressants like Prozac and Paxil never published the results of about a third of the drug trials that they conducted to win government approval, misleading doctors and consumers about the drugs' true effectiveness, a new analysis has found.
In published trials, about 60 percent of people taking the drugs report significant relief from depression, compared with roughly 40 percent of those on placebo pills. But when the less positive, unpublished trials are included, the advantage shrinks: the drugs outperform placebos, but by a modest margin, concludes the new report, which appears Thursday in The New England Journal of Medicine.
Previous research had found a similar bias toward reporting positive results for a variety of medications; and many researchers have questioned the reported effectiveness of antidepressants. But the new analysis, reviewing data from 74 trials involving 12 drugs, is the most thorough to date. And it documents a large difference: while 94 percent of the positive studies found their way into print, just 14 percent of those with disappointing or uncertain results did.

Antidepressant Studies Unpublished (Published 2008)

The makers of some antidepressants never published the results of about a third of the drug trials that they conducted to win government approval, a new study suggests.

www.nytimes.com

 

[CURSED again]

I knew about that - the drug companies are terrible (that's my opinion). People really need to be more aware of all the pitfalls. The site rxisk.org is very good and i tried to tell people about the possible problems with these drugs and everyone argued with me even though i now have to endure the after effects of them (its partly why i want to ctb). People cannot assume that medical business care mostly about whats good for the patient. They are puppets. Btw how much radiation you are exposed to by ct scans etc is not regulated in the U.S. (only breast ct has strict guidelines). You can get wide varying levels of radiation at same hospital for same procedure depending on which tech is operating the system & doctors love to order lots ct scans (like candy) these days. There are statistics regarding how many people get cancers from overuse of ct scans, etc.

 

[RememberWhatUCameFor]

I knew about that - the drug companies are terrible (that's my opinion). People really need to be more aware of all the pitfalls. The site rxisk.org is very good and i tried to tell people about the possible problems with these drugs and everyone argued with me even though i now have to endure the after effects of them (its partly why i want to ctb). People cannot assume that medical business care mostly about whats good for the patient. They are puppets. Btw how much radiation you are exposed to by ct scans etc is not regulated in the U.S. (only breast ct has strict guidelines). You can get wide varying levels of radiation at same hospital for same procedure depending on which tech is operating the system & doctors love to order lots ct scans (like candy) these days. There are statics regarding how many people get cancers from overuse of ct scans, etc.

didnt know that. fucked up

 

[Fragile]

that's one of the nastiest drugs there is, doctors just prescribe them without even mentioning about side effects or the low effectiveness they have, and if they don't work the first time, they just prescribe you yet another ssri with a different name. rinse and repeat until your anxiety is fucked beyond repair.

i've been prescribed with them for over 10 years, i fucking hate them because i'm in the lucky 80% of people who only suffer from side effects. i've also read that your depressions after them are even worse, even if they worked at first and i can confirm that's how those meds made me feel.

they are part of the reason why i think psychiatry is a scam and sometimes borderline evil.

 

[eve2004]

If they worked (placebo or not), there wouldn't be so many people here I think... I wonder sometimes if they simply prescribed caffeine pills, it would help more. It would at least energize those who feel too tired to do anything and that itself could lead to even a tiny bit more motivation to do something that may lead to feeling a tiny bit better...

I wonder also if caffeine would work for some people for anxiety. Sometimes my anxiety stems from one minor thing (ie being too tired to do something) and then escalates fast to wanting to CTB. Not necessarily that caffeine is the answer but it doesn't make sense to me that pills than sedate you should make you feel better. Its like your psych hospitalizing someone without good reason so they don't need to worry...

 

[k75]

I think they can work, but everyone is different and they won't work for everyone. And for some people, they are a horrible choice.
Prozac worked for me to a point, but I got to the highest dose they'll prescribe and still needed more, so we stopped it. Otherwise, I probably would have stayed on it.

I wonder also if caffeine would work for some people for anxiety. Sometimes my anxiety stems from one minor thing (ie being too tired to do something) and then escalates fast to wanting to CTB. Not necessarily that caffeine is the answer but it doesn't make sense to me that pills than sedate you should make you feel better. Its like your psych hospitalizing someone without good reason so they don't need to worry...

Caffeine is horrible for anxiety. It makes it worse.

 

[Misanthrope]

Drug companies are indeed terrible.

https://www.pharmaceutical-technology.com/features/biggest-pharmaceutical-lawsuits/

But so are a lot of large companies, as the dominant ethos is one of profit, not people, environment, or even a social conscience for the very communities that are the source of those very profits.

Anyway, they have also spun the chemical imbalance hypothesis to be presented like it is a fact. When it isn't. That more came out of marketing and misrepresenting findings on serotonin and the convenience of downplaying stigma. Also, everyone likes a quick fix to complicated problems.

https://pdfs.semanticscholar.org/f670/37b3c2ae7e17f211d399a18349fd6ae70a2b.pdf

If you don't have the energy to read much of that. It comes down this. If you are depressed and I give you chocolate and you report your mood is lifted. That is not proof that your depression is caused by a lack of chocolate or even cured by chocolate. Only that chocolate seemed to lift your mood.

SSRI's work on the same principle. Since depression is not at all understood in an objective manner like a disease may well be. Then the focus is on the reduction of symptomatology. This is not a great deal different to physical illness which is objectively understood but has no current cure. So the focus is on the reduction of symptomology to provide a better quality of life and functionality until a cure is discovered one day...

Sticking with the chocolate example. If you consistently eat chocolate at some point there are going to be ramifications. Maybe significant weight gain, even onset diabetes further down the line.

SSRI's are the same and the ramifications can be far more serious. Does that make them bad though? Well, only you can decide if rolling the dice on if a reduction in symptomology in the now vs potentially lasting consequences is worth it? Since biologically we are all different and comorbid conditions create even more variability. There is no certainty it will work for you, even if it works for someone else. Medicine is reliant on you being a guinea pig and simply seeing what happens. Then dealing with the outcome.

Where I have significant contention. Is to make an informed decision is to be informed of risks. To be provided truthful information even if that information is, "We don't know how or why it works for some but this is its efficacy versus placebo. This is the worst known potential outcome. Are you wanting to take that risk?" if even the physician is being lied to by not having all the data then how can anyone make an informed decision? Professional or otherwise?

What usually happens is you present with depression. They sip from their branded Zoloft mug aware they have a heavy caseload, and write you a prescription for Zoloft and tell you to come back in two weeks. Not even bothering to rule out physical issues. This behaviour increasingly seems to be becoming more common due to time constraints. Which is of major concern if you have a developing thyroid issue, onset diabetes or a tumour in the brain that is growing with every day wasted. Or a myriad of other potential issues that produce depressive symptoms as one of the first warning signs. This may well then get lost amidst the side effects now altering brain chemistry.

My other contention is that applying a purely biological reductionist approach to everyone as a first response. Is pretty dismissive of environmental factors that may be ruining your life. Taking an SSRI is not going to help you if you are still being molested by your uncle, or live in a toxic environment that is constantly tearing down your self-esteem. Or being bullied at school. Or job stress makes you want to stab your own eyes out on a regular basis. Or a host of other things that are logically damaging to well being.

Another contention is that leaving people to languish on things because if you are a zombie, you are not technically in distress or making a nuisance of yourself; even if your life is slipping you by one year at a time. Is both wrong and not a meaningful quality of life outcome at that point.

I think the problem is we are dealing with broken systems content to make us collateral if it serves the bottom line. That bottom line is best served by keeping people uninformed in the first place.

 

[SkycladObserver]

Well it depends... I think its efficiency is highly overrated. It seems that it works differently well for different people. Finding right antidepressant may be a long journey for some people.

I have some experience with fluvoxamin and escitalopram. I started with fluvoxamin and it had no effect on me (except pernament headache :D ) Now I'm taking escitalopram. It has helped to cure my OCD for some extent. However it wasn't so significant anyway.

It has helped to lower my anxiety a little bit. Again, nothing significant.

It hasn't helped to cure my depression at all. It's getting worse each year. It may work to lower symptoms for some people. However I've never heared of anyone who's deppression was fully cured by SSRI's. Maybe the placebo effect have helped them more...

BTW Sorry for my english ;)

 

[Susannah]

I'll make this short, since you have got a well- balanced answer already. I say no. Don't go there. It's a long way, and troubling side effects, that might work for a few people.
Good luck:)

I think they work, at least for some people. They have helped me at times.

Good for you:)

 

[mathieu]

i heard the pharmacy companies are less likely to publish studies with an unwanted outcome?


how do you know its not a placebo effect?

I don't haha. Except so many meds don't work for me that it makes me think I'm not very vulnerable to the placebo effect.

 

[RememberWhatUCameFor]

@Misanthrope very interesting.

what is your opinion on this?


Sickness behavior is a coordinated set of adaptive behavioral changes that develop in ill individuals during the course of an infection.[1] They usually (but not necessarily)[2] accompany fever and aid survival. Such illness responses include lethargy, depression, anxiety, malaise, loss of appetite,[3][4] sleepiness,[5] hyperalgesia,[6] reduction in grooming[1][7] and failure to concentrate.[8] Sickness behavior is a motivational state that reorganizes the organism's priorities to cope with infectious pathogens.[8][9] It has been suggested as relevant to understanding depression,[10] and some aspects of the suffering that occurs in cancer.

t has been proposed that major depressive disorder is near-identical with sickness behavior, so raising the possibility that it is a maladaptive manifestation of sickness behavior due to abnormalities in circulating cytokines.[27][28][29] The mood effects caused by interleukin-6 following an immune response have been linked to increased activity within the subgenual anterior cingulate cortex,[31] an area involved in the etiology of depression.[32] Inflammation-associated mood change can also produce a reduction in the functional connectivity of this part of the brain to the amygdala, medial prefrontal cortex, nucleus accumbens, and superior temporal sulcus.[31]

Sickness behavior - Wikipedia

en.wikipedia.org

 

[eve2004]

Everyone's body reacts differently. Most people's fever will reduce when given tylenol but we/they are definitely not there yet when it comes to mental/psychological symptom reduction medications. And a fever is very measureable while psychological symptoms are highly subjective. I think pain perception (physical or psychological) is subjective. Some people may have a fever and not feel pain while others may feel it. I think each individual's perception of psychological pain will lead to different psychological symptoms and none of this is very quantifiable to the same degree as fever or presence of inflammation/fracture/tumour/high blood sugar/ etc and other medical issues that are treated with medication. Even some medical issues can be treated without medication but doctors still prescribe them as a first line of action because they don't have time to follow up with the patient more regularly and work with them more often to find ways to resolve the issue.

I believe that nutrition can help or hinder a CERTAIN medical/psychological issues but doctors are definitely not trained enough nor have the time to take to discuss this. At best it may solve a problem, at worst, it may possibly simply reduce the amount of medication necessary. Even if its a tiny amount less meds in your body its still beneficial.

Are there any doctors on here? Psychiatrists? I'm sure there are but they aren't going to be so willing to reveal themselves.

 

[k75]

I think another important thing is that people need to advocate for themselves more. If you are offered a new medication, ask questions! If you are uncomfortable with the risks, speak up. If some stranger just handed you a random pilll, would you just swallow it? I doubt many people would. But call that person a doctor, and people will do pretty much anything, facts or not. It makes no sense.

I think if you are told nothing and just blindly take it, that's equally your fault. You have the internet, you have access to the doctor, pharmacist, and handouts given with the prescriptions. Sometimes it is harder to figure out, but there's really no excuse for anyone to claim they had no access to side effect education at all.

What usually happens is you present with depression. They sip from their branded Zoloft mug aware they have a heavy caseload, and write you a prescription for Zoloft and tell you to come back in two weeks. Not even bothering to rule out physical issues. This behaviour increasingly seems to be becoming more common due to time constraints. Which is of major concern if you have a developing thyroid issue, onset diabetes or a tumour in the brain that is growing with every day wasted. Or a myriad of other potential issues that produce depressive symptoms as one of the first warning signs. This may well then get lost amidst the side effects now altering brain chemistry.

I used to be very annoyed at how conservative my psychiatrist is. I wanted quick fixes and magic pills, and he always insists on running bloodwork and checking my thyroid and Vit D levels before touching my psych meds. I'd never encountered that before, and it just seemed like avoidance to me for the longest time. But now I realize it's such a logical approach! I do have issues in those areas, and they do affect depression. I had my thyroid removed, and I have chronically low Vit D levels. It takes longer, but I'm pretty glad those things get sorted out before the other stuff. Sometimes that's all it takes.

 

[RememberWhatUCameFor]

wow https://sanctioned-suicide.net/thre...nction-recognized-as-medical-condition.17801/

did you guys experienced any side effects?

 

[Shamana]

I found one that helps a bit, but not as much as I was led to believe they would, and it was a challenging and frustrating journey to find ones that helped. Wouldn't recommend unless you still have hope and are willing to put in several months of searching for the right one.

wow https://sanctioned-suicide.net/thre...nction-recognized-as-medical-condition.17801/

did you guys experienced any side effects?

I got this condition Unfortunately. It's one the reason why i'm here.

 

[eve2004]

I think another important thing is that people need to advocate for themselves more. If you are offered a new medication, ask questions! If you are uncomfortable with the risks, speak up. If some stranger just handed you a random pilll, would you just swallow it? I doubt many people would. But call that person a doctor, and people will do pretty much anything, facts or not. It makes no sense.

I think if you are told nothing and just blindly take it, that's equally your fault. You have the internet, you have access to the doctor, pharmacist, and handouts given with the prescriptions. Sometimes it is harder to figure out, but there's really no excuse for anyone to claim they had no access to side effect education at all.

I used to be very annoyed at how conservative my psychiatrist is. I wanted quick fixes and magic pills, and he always insists on running bloodwork and checking my thyroid and Vit D levels before touching my psych meds. I'd never encountered that before, and it just seemed like avoidance to me for the longest time. But now I realize it's such a logical approach! I do have issues in those areas, and they do affect depression. I had my thyroid removed, and I have chronically low Vit D levels. It takes longer, but I'm pretty glad those things get sorted out before the other stuff. Sometimes that's all it takes.

That's exactly how it should be done! So glad there are good psychs out there and that you found one. Just because they are a psychiatric doctor doesn't mean that their sole practice has to revolve around dishing out SSRIs and other psych meds. They should just be more knowledgeable about medical conditions that could cause the symptoms we have and help investigate them and then treat those or refer to a specialist once they find something.

 

[Nem]

Meds work great...for the company that sells them. Meds are complete crap and if they help you the problem wasn't serious in the first place. A placebo is just as effective, seriously though meds are bad for you and drs are too stupid to accept that big pharma is a serious concern
Peace/hugs

 

[Sailfisher]

They don't know how they work or if they work, but when they work, they work... Clear enough?

 

[SkycladObserver]

wow https://sanctioned-suicide.net/thre...nction-recognized-as-medical-condition.17801/

did you guys experienced any side effects?

Yeah. Weight gain and already mentioned sexual disfunction.

 

[eve2004]

I am not a doctor nor in the medical profession. But we are consulting them for help and advice, indeed we need to advocate for ourselves. So we know this about SSRIs:
1) No one knows if and how each one work for an individual
2) there will most likely be weight gain causes by the meds manipulating other systems in your body. Results of that unknown at best.
3) Sexual dysfunction. Most likely permanent. Enough said.
4) other permanent negative cognitive are very likely
5) as with any other meds so not specific to SSRIs, not all long term effects are known, but the possibility of ill effects are high because its likely you'll have to take this ... forever.

There are more, but we should not be shy to say NO, I don't want to trade symptom reduction for this. We shouldn't be shy to decline recommendations or disagree with the doctor. They should be able to work with you to find a way to reduce the symptoms in a way that you are comfortable with. And they should find a way to look for the source of the problem if it's medical. And they don't NEED to dish out meds everytime they see you. They should be ok with just regular consultations to keep track of the symptoms, treat anything medical that arises, and if there is no change, not make the patient feel like a failure. No change sometimes is good. That's what I want from my psychiatrist.

I grateful for mine. For the most part he does that. But I feel guilty when I have to report "no change". I live in Canada so I can see mine as often as I need, usually once every two weeks. I know I'm lucky to at least have the support. And he does offer to try meds but does not make me feel bad for refusing. And is honest about the side effects, including how it seems to work with his own patients, not just studies.

The bottom line is we shouldn't be afraid to say no to the meds but still work with them in a way that is helpful to us.

 

[Oblivion Lover]

Very interesting article. I'd go even further than that and also say that all mood or personality disorders are unhealthy, but totally normal parts of a person's unique mind. They are only called disorders because they are not productive traits and society dislikes the way those people are, so saying those people are mentally ill will push them into seeking to change their personality, no matter how cruel that is (reminds me of conversion therapy). Those "disorders" should only be treated if the person wants to, and not with the objective to change their personality but to teach them how to control its negative aspects. I for example have been diagnosed with depression and anxiety, but I refused treatment for depression as I feel like it is a part of me. Being unhappy with the way this world works is not an illness.

 

[eve2004]

Very interesting article. I'd go even further than that and also say that all mood or personality disorders are unhealthy, but totally normal parts of a person's unique mind. They are only called disorders because they are not productive traits and society dislikes the way those people are, so saying those people are mentally ill will push them into seeking to change their personality, no matter how cruel that is (reminds me of conversion therapy). Those "disorders" should only be treated if the person wants to, and not with the objective to change their personality but to teach them how to control its negative aspects. I for example have been diagnosed with depression and anxiety, but I refused treatment for depression as I feel like it is a part of me. Being unhappy with the way this world works is not an illness.

I don't think most people taking meds are doing it for « personality » reasons or because they feel the way they are is not socially acceptable. I think what pushes most people to try the meds are intolerable psychological symptoms like for example constant/persistant suicidal ideation or inability to function and hold a job which is kind of necessary for most people to survive. Inability to feel anything or enjoy anything combined with hopelessness that the situation will ever get better is another reason (I'm just giving my own but there are tons of other symptoms/reasons). No matter how logical or illlogical the reason for having those feelings, they are still intolerable enough to drive people to try SSRIs and other things. I personally refused to try them but my depressive symptoms do go beyond just the personality aspect of the condition, and so I deal with the constant ctb thoughts and what to me feels like other intolerable issues.