Why do psychiatrists incorrectly explain how SSRIs work?

[TheBestUsernameEver]

Why do psychiatrists tell patients the method of action of SSRIs incorrectly?

The outdated view of how SSRIs work was that they prevent the reuptake of serotonin in your synapses, hence why they were called Selective Serotonin Reuptake Inhibitors.
This model turned out to be inaccurate.

Serotonin is a type of monoamine.
Monoamines are broken down by monoamine oxidases (a group of enzymes).
SSRIs work to prevent these enzymes from breaking down serotonin, thus increasing the amount of serotonin in your brain.

SSRIs were in fact developed from MAOIs.

I do not appreciate sources misinforming patients about how their medication works.

 

[motel rooms]

It's my understanding they don't know exactly how many commonly used psych meds work (& why they often don't work) because brain chemistry is just too complicated.

 

[Bleak]

It's my understanding they don't know exactly how many commonly used psych meds work (& why they often don't work) because brain chemistry is just too complicated.

It really is true and this is why I hate it when people compare taking psych meds to taking other types of medicine. "Don't you want to get better? Would you refuse insulin too if you were diabetic?" It's so dishonest and coercive.

 

[Cameron Diazepam]

My experience has been that doctors are used to authority and status. At a recent appointment I had one who remarked that most patients don't do their own research or search for treatments, they go with whatever is offered. Worst experience I had was trying to get benzodiazepines from a doctor who was insistent on SSRIs. When I insisted my anxiety was too severe for SSRIs alone, he first tried playing concerned parent ("I don't want you to become a pill popper!") and then played angry parent, saying I am not a colleague and have no right to question him, before booting me out.

The doctors probably also figure: screw it, if it works it works, who cares how. Like older relatives and computers.

 

[Lostandlooking]

When a medication works, people don't need explanations. The thing with antidepressants is; for some people they work, for some they don't.

No-one will try to explain to you the exact mechanism of a painkiller. You don't need an explanation because they just do their job.

There's a lot we don't understand about brain-chemistry. SSRI's elevate the level of serotonin in the brain. If the antidepressant helps your depression it doesn't mean there was a lack of serotonin. Or a chemical imbalance to begin with. It's a lot more complicated than that. As far as I know it plays a role in depression, mood etc. But we don't know how it works. Your serotonin levels don't correlate with your mood. People with low serotonin levels aren't necessarily depressed.

It's been a while since I read up on this stuff. So please correct me if there's new information to share.

In my case, they didn't work so I did some research. If they worked I probably wouldn't have cared how they worked.

There's also the marketing side of things of course. Selling this serotonin story to push pills.

 

[Ashu]

Why do psychiatrists tell patients the method of action of SSRIs incorrectly?

They don't know and/or they don't give a shit: pseudo-scientists and/or pseudo-doctors of the soul.

 

[little helpers]

and shrinks are always like "you got a deficit in brain serotonin".

alright I laughed. they too careless before they run their mouth at a neuro major. I can refute that with three hours of evidence, that their claim is BS and that no one knows how depression truly goes on in the brain just yet.

There's a lot we don't understand about brain-chemistry. SSRI's elevate the level of serotonin in the brain. If the antidepressant helps your depression it doesn't mean there was a lack of serotonin. Or a chemical imbalance to begin with. It's a lot more complicated than that. As far as I know it plays a role in depression, mood etc. But we don't know how it works. Your serotonin levels don't correlate with your mood. People with low serotonin levels aren't necessarily depressed.

It's been a while since I read up on this stuff. So please correct me if there's new information to share.

no you won't be corrected cuz you're correct.

but I got a theory about the behavioral side of things. in one sentence it's "you don't 'keep trying' under impossible circumstances cuz it costs more than it can possibly offer". you run too high a risk and there's not a reason the brain won't respond accordingly.

it's only a matter of disease when person is no longer under such circumstances but the behavior effects persist. but who can say our society is really "hopeful"? that we lead a life full of autonomy and oppertunities? that's how you get epidemic rates of major depression. it's not even pathological imo, it's screams and shouts of pain under a sick society.

 

[fjijity]

how do you know you are correct?

 

[LittleJem]

I read it might be that the meds work because they increase neuron growth/BDNF...Brain Derived Neurotrophic Factor. Get me

Psychiatrists. Never met one I like.

 

[rationaltake]

It's my understanding they don't know exactly how many commonly used psych meds work (& why they often don't work) because brain chemistry is just too complicated.

I think you're right. Which is one of the reasons why I've refused all meds for my various conditions. With bipolar in particular it's very much a case of chuck anything at it and see what happens. I've heard of someone with bipolar being on eight different meds at once. And the meds still don't stop high or low episodes! Somebody I met had kidney problems due to lithium.

 

[noaccount]

In general, they think that it's okay to give us over-simplified or inaccurate explanations for how drugs work, or omit or deny information about adverse affects, because they think that users/survivors of psychiatry are incompetent out of the gate, or can't be trusted to make our own decisions, or they just don't care, they just want our compliance, they just want to sell a product, etc.

I hadn't heard about this particular bit of chemistry and admit I don't fully understand the difference between those two mechanisms of action. Do you have a source on this? (I did try a quick google search and the results weren't helpful, I'd like to know more about this.)

It really is true and this is why I hate it when people compare taking psych meds to taking other types of medicine. "Don't you want to get better? Would you refuse insulin too if you were diabetic?" It's so dishonest and coercive.

Exactly, and also - whose version of "better"? I mean unless a diabetic person has decided they want to CTB, they usually *want* to avoid going into a coma, so they generally want drugs to that effect. If you've decided you don't want a psych drug - it's entirely someone else's bullshit idea of "what version of you I'D LIKE BETTER" that they're pushing, if they pressure you to take the drug anyway.

 

[radicalfreedom]

Where are you getting your data? Like could you cite a source?

SSRIs do in fact have strong binding affinity to the seratonin transporter. And they generally have no activity on monoamine oxidase. No one has been lying about the pharmacology of SSRIs, except whoever it is that told you the operate on monoamine oxidase. Here's a good article describing the pharmacology of some SSRIs https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4047306/. As you can see, they bind to the Seratonin Transporter (SERT) not to MAO.

It *is* true that the monoamine hypothesis of depression has come into serious question, and it's not at all clear that the effect of SSRIs is directly from increase in intersynaptic seratonin levels. And it is definitely the case that many psychiatrists present the classic monoamine hypothesis as clinical fact, when it's highly dubious. But that's not because anyone is wrong about the chemical effects of SSRIs, but rather because we don't know the mechanism by which those effects translate into antidepressant effects.

 

[Kennish]

I went to the leading ocd psychologist in Denmark. He researches in the brain and have written books about it. He said to me that no medicine will help mental illness. None at all. The medicine can't help your brain.

I don't know if I believe it. But it made me a bit scared since I don't feel any of the medicine I've ever tried has helped.

Maybe he's right, maybe he's not.

I read it might be that the meds work because they increase neuron growth/BDNF...Brain Derived Neurotrophic Factor. Get me

Psychiatrists. Never met one I like.

Me neither. Well I met one. Only talked to him once, never got in treatment at his place. But all others I don't like. Especially a guy at the psych ward. He was the biggest asshole ever. What a douche.

 

[LittleJem]

Medication can help people. Prozac is helping me and it helped from Day 1. I was bedridden b4 Prozac. Today I am tired of life but not suicidal. Don't let psychiatrists put you off meds... I did my own research too...

 

[Depressed Cat]

Psychiatrists in my country don't explain how these medicines work. They just prescribe them and expect us to take them.

I do some research before taking them, though. A combination of Li, an SSRI, a tetracyclic antidepressant and a benzo has helped me recover in the past from deep, suicidal depression.

 

[TheBestUsernameEver]

Psychiatrists in my country don't explain how these medicines work. They just prescribe them and expect us to take them.

I do some research before taking them, though. A combination of Li, an SSRI, a tetracyclic antidepressant and a benzo has helped me recover in the past from deep, suicidal depression.

Wow, with all that be careful that you don't end up with serotonin syndrome!

 

[Ta555]

The whole theory about anti-depressants working because they alter serotonin levels is actually quickly being discarded. New research is starting to show that that's not how they work (for those for whom they do work). If they worked by eliminating depression by altering serotonin levels then clear results would be seen within about 48 hours. The new theory/research is actually pointing to SSRI's encouraging new neuronal growth and that's why they take 4-6 weeks to work properly.
Many psychiatrists now are quietly sweeping the widely promoted 'chemical imbalance' theory under the rug after promoting it without evidence for decades.

 

[LittleBlackCat]

Medication can help people. Prozac is helping me and it helped from Day 1. I was bedridden b4 Prozac. Today I am tired of life but not suicidal. Don't let psychiatrists put you off meds... I did my own research too...

Hi. Have you had any side effects? I've been prescribed prozac, it will be my 3rd SSRI I'll be trying .. but I always find the side effects to be a killer.

 

[Sherri]

In the beginning of my treatment they insisted on me taking setraline, when I said it wasn't working they just said we can go up to 300mg which I never did. Prozac same thing, no effect, escitalopram only made me fat. And tried some more I can't remember, the only one that worked for me is one that is made primary for people with PTSD not very well known it's a new generation as my doc said. But after seeing so many Inwas so tired of their lies.

 

[t-rex]

Hi. Have you had any side effects? I've been prescribed prozac, it will be my 3rd SSRI I'll be trying .. but I always find the side effects to be a killer.

What side effects, if you don't mind my asking? The last SSRI I was on (Luvox) caused sexual dysfunctional/loss of sex drive, which kinda sucked. Switched to Cymbalta (an SNRI) and the problem went away.

The whole theory about anti-depressants working because they alter serotonin levels is actually quickly being discarded. New research is starting to show that that's not how they work (for those for whom they do work). If they worked by eliminating depression by altering serotonin levels then clear results would be seen within about 48 hours. The new theory/research is actually pointing to SSRI's encouraging new neuronal growth and that's why they take 4-6 weeks to work properly.
Many psychiatrists now are quietly sweeping the widely promoted 'chemical imbalance' theory under the rug after promoting it without evidence for decades.

Interesting, I hadn't heard that. Got any sources on that?

This is also what psilocybin (mushrooms) and ECT do, supposedly.

 

[Nevsky69]

In my country, the general practitioner prescribe these medicines without any explanation, and very easily. It is rare to find an elderly person (and many young people ) who does not have an antidepressant prescription (and benzos prescriptions). And rare is the doctor who agrees to give a serious justification of his decisions.

I have studied several of these medicines and encounter very poor their therapeutic justification. They are based on studies that are statistically not significant. But the pharmaceuticals are interested in having many chronical patients.

It is a fact that these medicines work on some people and not on others. It's considered everything as a brain chemistry problem without taking into account aspects such as social, cultural, personal history and other circumstances that also influence.

It is curious to read in the data sheet of many antidepressants that increase the risk of suicide without justifying it or with very poor justifications. Is the risk of suicide due to medication or due to the depression that this medicine does not solve?

 

[LADY007]

Why do psychiatrists tell patients the method of action of SSRIs incorrectly?

The outdated view of how SSRIs work was that they prevent the reuptake of serotonin in your synapses, hence why they were called Selective Serotonin Reuptake Inhibitors.
This model turned out to be inaccurate.

Serotonin is a type of monoamine.
Monoamines are broken down by monoamine oxidases (a group of enzymes).
SSRIs work to prevent these enzymes from breaking down serotonin, thus increasing the amount of serotonin in your brain.

SSRIs were in fact developed from MAOIs.

I do not appreciate sources misinforming patients about how their medication works.

There is something called Genomind Testing.....a swab test from your saliva is taken and analyzed and a breakdown of how most of the drugs will impact your particular body. There is a sliding scale regarding cost and income and I think some insurance covers it.

 

[clown_17]

They also claim that depression is a deficiency of serotonin in the brain. This isn't true at all.

When we have a headache we don't take Tylenol because we're deficient in Tylenol do we?

Compare this to SSRIs. We take them because the seratonin has a dampening effect on our limbic system, the region of the brain that controls emotions.

 

[TheBestUsernameEver]

They also claim that depression is a deficiency of serotonin in the brain. This isn't true at all.

When we have a headache we don't take Tylenol because we're deficient in Tylenol do we?

Compare this to SSRIs. We take them because the seratonin has a dampening effect on our limbic system, the region of the brain that controls emotions.

I think you have a very simplistic view on how things work.

 

[noaccount]

Myth of the chemical imbalance -

cepuk.org

 

[clown_17]

I think you have a very simplistic view on how things work.

You're probably right. I'm not a smart person.

 

[hans0solo]

one thing not mentioned is that how we feel, our mood, our memories are not created 'out of thin air'. We live in a world that impacts us. Our mind is not the brain. the pills work on a part of our brain. But they don't alter our memories. They alter how we process. Many people here talk about a traumatic past and a traumatizing present. If someone gave you a million dollars and gave you a house in Tahiti, I think many people would deal with less suicidiality because money, housing, horrible cold weather, being poor, overworked are things that cause a lot of people misery. These issues are not fixed by a pill. But you might have a 'money imbalance' though :) So some of what we deal with is based in biology and neurology but not everything. Which is why much of what can help is things like exercise, meditation, touch, coping skills, psychedelics, learning interpersonal skills, learning boundaries, money, a support network, etc.

 

[uienringptr]

I've always wondered this too. I think maybe some of them, or dare I say most of them, don't know how they genuinely work. Like people said, I guess if they work we don't really ask why.

I had a temporary psychiatrist in outpatient give me meds which I refused to take because of the withdrawal if I decided I needed to stop and he told me there would be no withdrawal. I came back the next day with sources from people who had taken the med and there was severe withdrawal symptoms. He told me I can't trust them because he is the one with the degree. It was like arguing with a wall.

Maybe they don't know and/or don't care to explain and they don't want to admit they were wrong. I always wonder why psychiatrists (and really anyone in the mental health field) go into their profession. It seems some of them don't care too much about it.

 

[waitingforrest]

I'm not a medical professional so I don't know if someone accurate or not but there is one thing that still kind of bothers me.

I don't understand why whenever I take a new antidepressant, the psychiatrists always say that it may cause suicidal thoughts. I don't understand how a pill can cause suicidal thoughts. It implies that suicidal thoughts are only because of the mind and not other circumstances.

I wonder why the psychiatrists never seem to acknowledge that if someone's life is shit, they will think it is shit. Pill or not.

 

[TheBestUsernameEver]

I'm not a medical professional so I don't know if someone accurate or not but there is one thing that still kind of bothers me.

I don't understand why whenever I take a new antidepressant, the psychiatrists always say that it may cause suicidal thoughts. I don't understand how a pill can cause suicidal thoughts. It implies that suicidal thoughts are only because of the mind and not other circumstances.

I wonder why the psychiatrists never seem to acknowledge that if someone's life is shit, they will think it is shit. Pill or not.

I think that medication is largely misused by the medical community.
In fact, therapy is largely misused too, in my opinion.
Yes, you read that right.

Firstly, medication:

The role of medication is that it has always supposed to be prescribed alongside other forms of therapy and assistance. However, doctors (especially in general practice) routinely prescribe antidepressants while not referring for other input.
This is not satisfactory. Especially for service users whose depression is 'situational', for example as a result of financial concerns.

That being said, antidepressants do, in time, give you a lift and put you in a place where you feel more mentally able to overcome issues.

Therapy:

I have never understood why the majority of depression patients are referred for various forms of therapy before their issues are properly understood.

To illustrate my point, I was referred for CBT, and yet the main problem I had was financial concerns.
Surely some kind of financial advisor would have been of more practical use than a CBT therapist?
I would understand it if my depression were not 'situational'.

Just my two pence.