Statements like this need to be worded very carefully. In many people's minds, saying something like "most people don't need antidepressants" quickly becomes "antidepressants are useless". Many people who may benefit from them get scared away.
Speaking as someone who has been on/off antidepressants for GAD+OCD for the better part of a decade, I've had countless people tell me that antidepressants are useless and just placebo pills pushed by Big Pharma. But for me, they are life changing. They turn me from someone who just sits indoors having panic attacks all day to someone who can live a relatively normal life. I've tried (and continue to have) therapy, but SSRIs are wonder drugs for myself and many other people.
The caveat is, you often need to try 2 or 3 different SSRIs before you find one that works for you, and if you're unlucky, you may not find one, or the side effects can be intolerable. For me, I tried fluoxetine and citalopram, neither of which really worked, but sertraline changed everything almost overnight. The only side effect I've experienced is weight gain, which isn't great, but is better than the alternative.
However, this is the UK which may have a different attitude to the drugs. Before and during initial treatment, I was provided with around 20 behavioural therapy sessions, and even now I still have quarterly drug reviews with a doctor. At no point did I feel like I was being pushed onto SSRIs, and they checked to make sure it wasn't something environmental that could be easily remedied before asking if I would like to consider medication.
For what we've been reading this last years, it's not like antidepressants are worthless, it's like antidepressants aren't doing what we think are doing.
The "depression is lack of serotonin" theories seem to have less and less base every day, but SSRIs don't only act on serotonin (just review their side effects).
I've done, mostly, vortioxetine and sertraline. For some of us, some SSRIs or SNRIs work. Some don't. Probably it's not because of the serotonin. They have weirdly different effects depending on the person. But there's something going on that we still don't understand. Both because we don't understand the whole mechanism of depression, nor WTF the SSRIs and SNRIs are doing in our mind and body.
I'm quite a difficult skeptic, and I have to admit it's difficult to make a difference between melancholy and mild depression, especially after all those years spent being mildly depressed.
Even if I hate the bootstrap argument, it still has an effect on me, despite my skepticism.
In the end, depression alters my perception of what is really good for my mental health. It's very common that patients are difficult to treat, not only because they might disagree with the diagnostic, but because they can't really understand or perceive their emotions and subtle state of mind. Depression is a bit like obesity, you go back to the cause without caring for the consequences.
I become a bit confused when my psychiatrist lets me choose if I want to keep taking those meds, instead of clearly telling me i should take them. But in my experience, those meds are good for me, even if they're not perfect.
Maybe I will stop then one day, and see what happens, but it might hurt more than I think it will.
Another +1 for Sertraline. It worked wonder for me after 2 years of depression (classified as mild to severe using some clinical test).
I've been taking it for 4 months, and since my life has gotten back to normal my doctor has advised tapering off of it, starting today. We'll see how it goes.
I thought it was standard procedure to advise trying tapering off if your life got back to normal, and see how it goes (at least that's how my doctor presented it). I guess that's not a worldwide standard though.
> Statements like this need to be worded very carefully.
I had a whole thing typed up, but deleted it, because I really only had one question: How would you word it differently?
To me it seems a carefully worded as possible, while still alerting to the fact that a class of drugs with terrible side effects are being massively overprescribed.
Maybe if antidepressants weren't pushed so hard by big pharma, people would respect their use more.
If I may,
it's like the recent trend to call everything rape and sexual assault. At some point I have to start naturally doubting the claim on its face. That doesn't imply I think these things don't happen, just that I don't think someone making a stupid dad joke should turn into the woman shouting sexual assault and I find myself questioning all accusations as a result.
---
I have no opinions on any specific person taking antidepressants, but it's not unreasonable for people to get weary when you can't throw a stick without hitting someone who has been diagnosed with something that's being medicated with antidepressants.
> Statements like this need to be worded very carefully. In many people's minds, saying something like "most people don't need antidepressants" quickly becomes "antidepressants are useless".
The statement is factually true and worded correctly.
This is not something you can claim. How could you possibly know that the SSRI is responsible for your recovery?
I'm not going to say that antidepressants are useless, but it is important to understand how placebo works. The key point is that placebo works and it is impossible for an individual to distinguish between a placebo and a life changing drug.
In antidepressant studies, SSRIs often outperform placebo to a degree. However, the placebo group has an excellent recovery rate! That means there are people who are clinically depressed, suicidal etc. who are then given a sugar pill as part of a study and make a full recovery.
>You often need to try 2 or 3 different SSRIs
That makes it even murkier. SSRIs take a long time to work, and if you try several of them that's going to take months to years. There's a high probability that in that time, you might naturally recover. You have the combined benefit of placebo and waiting in addition to the effects of the SSRI. You tried 2 SSRIs that didn't work. What makes you so confident that it was the third?
Again, I'm not saying SSRIs are useless. But it's important that we rely on controlled studies to make these determinations. Personal experience and anecdotes are beyond worthless; for example they are the reason why homeopathy is a $20 billion dollar industry even though it is actually provably useless.
I can tell this thread is going to be a nightmare but whatever I really want to share my experience in case there are people similar to me that need to hear this: I cannot emphasise enough how much Escitalopram (lexapro) has helped me with issues I didn't even know I had until I started taking it. At which point I realised I was living in a constant state of anxiety up to that point, and I probably should have been on it a long time ago, but I never ever thought I reached the criteria for being "medicated" so fwiw I think it's also possible to underrate your own feelings and think you don't need them when you do.
Agree. I have watched a family member suffer mental health, anxiety issues. When she turned 18 she was finally able to get the doctor to prescribe meds. It was a life-changer for her.
So chalk that up as another Lexapro win (that was not forced by some drug company on the patient).
Me too! I used to be anxious about everything going on in my life. When I started Lexapro and it finally started working, I realized, "Wow, is that what normalcy feels like?" It's been a lifesaver.
I know someone who insists that her life was saved by escitalopram. However, please be aware that SSRIs are not necessarily free to try, physiologically nor socially speaking. I tried it at the recommendation of my doctor for anxiety. It did not help, and the side effects (lack of empathy, weight gain despite loss of appetite, and others) worsened my situation and strained friendships.
However, my real issues began when I tried to _stop_ taking it. I've experienced opiate withdrawal from pain medication, which was enough to make me sympathetic toward heroin addicts, but SSRI withdrawal was by far the worst I've ever experienced. I used SSRIs for 3 months, but it took 6+ months to wean myself off of them due to debilitating "brain zaps". I got the lowest dosage pills and shaved them onto a milligram scale. I crushed them and dissolved them into a titration solution so that i could wean myself more slowly. I read about psychiatrist claims that SSRI withdrawal "brain zaps", which, it turns out, are known to affect some people, are benign because they "only last a fraction of a second". That may be true for a single zap, but when they occur once every five, ten, or twenty seconds, it's a different story. When these "zaps" occurred, not only was it disorienting, but it felt like I missed half a second of time, and when they got bad, a substantial brain fog set in. They destroyed my focus, and i couldn't get much work done. Driving became dangerous: I would simply miss the existence of entire cars, and I had a few close calls before I realized what was going on and refused to drive any longer while in that state. Weaning more slowly would keep the zaps at bay, but once they began on a given day, it was too late, and my day was over: taking more escitalopram at that point would help, but only gradually over the course of the day.
My withdrawal reaction isn't shared by most, but from my research, it also isn't so rare. I fully recognize that SSRI meds help many people, but be wary about trying them "just to see if it helps," and be aware that once your body gets accustomed to them, coming off of them may not be the experience that your doctor described.
Just another +1. Also for me the "activation dose" was 15mg, and I spent almost a year taking 10mg a day thinking it didn't work, before moving to 15mg and my life changed.
For anyone else with anxiety issues, silexan[0] and l-theanine[1] are cheap and worth a look-in
I use this too, a very low dose to just alleviate my anxiety. If I don't take it, stress often leads to severe anxiety for me. The same way it leads to ulcers or other things for other people.
A small dose of it serves as a safety net for me. I still get it but it doesn't get out of control.
I've tried to do without in the past but eventually when I get in a rough patch things get bad and this drug is only affective after taking it for a few months. So just taking it when it's most needed is not an option.
That's exactly what happened to me. I began to take it when the pandemic hit and latter decided to stop. But it was transformative in the sense that it made me aware of how handicapping my anxiety was. My doctor didn't want me to stop tho. I clearly match the criteria to stop (stable for an year), while he still recommended that I continued. He didn't veto my stopping either, but it was my decision.
I'm a bit nervous about these articles clearly centred on the USA which seems to have an epidemic of private drug companies pushing all kinds of stuff via doctors who may or may not be getting backhanders to push certian drugs.
I'm not saying this isn't partially true in Europe but the USA definitely comes across as choosing drugs as the first resort for many things that you wouldn't in Europe.
Also, as many have found out, Prozac is cheaper than therapy or CBT which is what some people might benefit from to actually help them resolve the vicious circle of depression.
And also pushing directly to the consumer via commercial advertising, which is very unusual.
Not sure which way is right though. Maybe people have a right to know about which drugs are available, unscreened by a doctor who may not have your best interests in mind (for example they have to meet a budget, or they have religious opinions.)
> I'm a bit nervous about these articles clearly centred on the USA which seems to have an epidemic of private drug companies pushing all kinds of stuff via doctors who may or may not be getting backhanders to push certian drugs.
It's not only in the US, France as an antidepressant epidemic, studies have shown anywhere from 30% to 60% of people taking them don't actually need them. They're prescribed too easily.
I went through a phase in my life a few years ago where I tried most antidepressants available in my European country. All were prescribed to me at varying doses by a psychiatrist working in our public health system.
Almost every single antidepressant gave me withdrawal symptoms (extremely intense mood swings and brain zaps) when I tried decreasing the dose. I mentioned this to my psychiatrist, who advised me to split the pills in order to slowly decrease the dosage. Even splitting the pills and taking a quarter of a pill less every 2 weeks was giving me withdrawal symptoms. I resorted to carefully dissolving the medication in water and volumetrically dosing to get the right rate of tapering off. This scenario happened to me with both Sertraline and Fluoxetine. The "newer" antidepressants like Escitalopram and Vortioxetine gave me less withdrawal symptoms, but they also had more severe side-effects whilst on the medication. Obviously this is all anecdotal, but my hope is that doctors would put greater emphasis on the possible adverse effects of antidepressants to patients. No other class of medication has been so... rough? for me. Glad to be medication-free now.
Pretty short article, this quote sums it up: "When the results of all trials submitted to America’s medicines regulator between 1979 and 2016 were scrutinised by independent scientists, it turned out that antidepressants had a substantial benefit beyond a placebo effect in only 15% of patients."
"Results: Medication vs placebo differences varied substantially as a function of baseline severity. Among patients with HDRS scores below 23, Cohen d effect sizes for the difference between medication and placebo were estimated to be less than 0.20 (a standard definition of a small effect). Estimates of the magnitude of the superiority of medication over placebo increased with increases in baseline depression severity and crossed the threshold defined by the National Institute for Clinical Excellence for a clinically significant difference at a baseline HDRS score of 25.
Conclusions: The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial. "
Short version: if your depression is mild, antidepressants may not work better than a placebo (though placebos are not exactly nothing). If it's severe, there is more of a chance it'll really help,
From my personal experience, I can definitely attest to them helping, though they are not by any means a magic bullet.
It can on one hand be argued antidepressants aren't necessary for anyone. You can argue that and be correct. This is because antidepressants don't actually cure depression, but lessen the symptoms and enable severe depression to be cured through behavioral changes.
It's a line of reasoning that is technically true but really sort of missing the point.
The problem with treating depressed people is to get them to actually do the things that will help them. That can be incredibly difficult without medication.
> The problem with treating depressed people is to get them to actually do the things that will help them. That can be incredibly difficult without medication.
The problem with talking about doing "things that will help them" is that we don't really have a lot of effective clinical interventions. Even the most common interventions (SSRIs, Congnitive Behavioral Therapy, physical exercise, etc.) are not really that effective at treating depression and have little to no effect in large parts of the affected population. That being said, these treatments _do_ work for some people so they should definitely not be dismissed out of hand (although it may in some cases be regression to the mean more than anything else, i.e. if you get better after a while on your own but have undergone treatments of one form or another you may erroneously believe your most recent treatment was effective).
I was about to write that there clearly are huge differences betwween the US and the rest of the world, but it seems some European countries have caught up with the US, especially Iceland, with more than 140 daily doses per 1000 adults [1]. Interestingly Iceland frequently has one of the top positions in the world happiness report [2].
I think antidepressants are getting the spotlight because some (many) were approved with only a slim <10% improvement over a placebo... I think the same could be said about the congestion medication phenylephrine [1] (edit: added specific drug name. edit 2: added link)
I get the feeling that drug approval laxed for a good while and let these slip through
Correct, and also, antidepressants are used for more reasons that to remedy depression (though that may well be their primary purpose). E.g. I use them to combat GAD, though it stems from ASD.
For most other drugs the effectiveness is openly disclosed to patents. Also most other drugs have fewer, rarer, less severe side effects. And most other drugs can be stopped and started much more easily...
I find it interesting that the article doesn’t describe a single harm from the drugs, instead focusing on alleged weak efficacy.
My theory is that the article is playing into a vaguely Protestant ethos that drugs are Bad and Unnatural and thus suspect, and (implicitly) that suffering is actually good to some extent and that alleviating it through “artificial” means is unnatural. This attitude is ubiquitous in the US and I assume UK (where Economist originates) as well. Even artificial sweeteners are ridiculously scrutinized and suspect for the same reason.
If some or even many people are taking what the article calls “useless” drugs, how is that, absent serious side effects, bad?
Article seems to be a bit short on numbers in general, and surely this is a complex topic, but this part stood out to me:
> Doctors rarely talk to patients about stopping the drugs because they fear this could lead to a return of depressive symptoms. But for many people it may be safe to stop. Even among long-term users with several past episodes of depression, a recent trial in Britain showed that 44% of patients could stop taking pills safely.
Those don't exactly seem like hugely encouraging numbers.
What this suggests to me is that what we diagnose as "depression" has multiple causes, and current antidepressants are fairly effective at treating at least one of them.
It's as if we had a single category for "breathing trouble" and consistently treated it with antibiotics. Sometimes it's bacterial pneumonia and that works very well. Often it's emphysema or lung cancer, and antibiotics don't help.
I’ve never been on antidepressants but I had a period in my life where I went through a long depression. Inevitably I came to accept I was depressed because my body was telling me something in my life just wasn’t right, and I suspected what it was but didn’t really make an effort to do something about it. Once I made necessary changes things started getting better with time and eventually I got back to normal. However, if I had been on meds I doubt I would have had this sort of introspection and probably would not have bothered changing anything as long as I felt good. I think a lot of people are resistant to real change and antidepressants just help them cope indefinitely.
Prescription of antidepressants really should be coupled with therapy (and often is), which if done right should prompt plenty of introspection. Also in those with severe depression, functioning is so low it can be difficult to even engage in therapy or make life changes without other treatment first.
I think you make an interesting broader point though. Clinically there is not enough consideration of life circumstances when evaluating depression, in my opinion. Obviously something like a death in the family is taken into account, but from what I've seen baseline quality of life is not a huge consideration in whether depressive symptoms are clinically meaningful. I suspect antidepressants would be more effective if this were better teased out.
In any event, there are certainly interesting philosophical and policy questions here, but for an individual that suspects depression, they should seek professional help regardless. A good clinician is not going to just prescribe meds and then tell the patient they're done.
I’m someone who has dealt with mental health issues over the course of my life.
The main causes are the following:
1) Illicit drug use.
2) Stress/anxiety/fear/grief
The answer is to accept the hard truths and understand what is the root cause of your depression. Is it lack of friends and family? Lack of hope for the future? Lack of enjoyment in things that previously made you happy? Belief that somehow success/truth comes at the expense of enjoyment of life (“ignorance is bliss”). Is it past trauma? A job/relationship you hate? Body/health issues? Aging? Feeling like you’ve achieved all your dreams but you’re more unhappy than ever? Bullying? Feeling unsatisfied? Unfulfilled? Shame about past behaviors?
All of these problems have solutions. Figure out what is at the core of your problem, and then treat it. Every problem is different.
For me, I realized I was harboring an incredible amount of pent up rage and resentment. The rage was so deep that it was all I could think about. Then I realized, I had to forgive the people who’d wronged me. And forgive them I did. I genuinely forgave them, in my own mind. And just like that, all my happiness came back to me. Suddenly I was free.
Also, I believe that almost all of our problems can be traced back to fear. So stop worrying. It’s a waste of energy.
There are some mental health issues that do require hospitalization and a short stint of medication to get people back on their feet and able to function. But I don’t believe in long term medication. Drugs are not the answer.
>The answer is to accept the hard truths and understand what is the root cause of your depression. Is it lack of friends and family? Lack of hope for the future? Lack of enjoyment in things that previously made you happy? Belief that somehow success/truth comes at the expense of enjoyment of life (“ignorance is bliss”). Is it past trauma? A job/relationship you hate? Body/health issues? Aging? Feeling like you’ve achieved all your dreams but you’re more unhappy than ever? Bullying? Feeling unsatisfied? Unfulfilled? Shame about past behaviors?
some of these things (body/health issues, bad job/relationship, lack of friends) are causes which can be fixed with direct action. Some (aging, past behaviors, trauma, lack of family) can't be, but can be somewhat mitigated and be made less depressing with therapy. Others (lack of hope, anhedonia, lack of fulfillment) are not the cause of depression but the symptoms. to lump these all together seems strange to me.
I think SSRIs must be analyzed separately for depression and anxiety disorders.
SSRIs are only marginally better than a placebo for depression. But they are incredibly beneficial for panic disorders and GAD (a bit anecdotal). Still, they will not "get rid of" panic disorders and GAD; only CBT or other therapies can do that. But SSRIs should not be dismissed easily for anxiety disorders, especially if the alternative is using Xanax or recreational drugs (including alcohol).
What these articles seem to ignore is that depression is only one disorder they're approved to treat. They're approved for GAD, OCD, and a host of other anxiety related disorders.
[+] [-] greymalik|3 years ago|reply
[+] [-] cameronh90|3 years ago|reply
Speaking as someone who has been on/off antidepressants for GAD+OCD for the better part of a decade, I've had countless people tell me that antidepressants are useless and just placebo pills pushed by Big Pharma. But for me, they are life changing. They turn me from someone who just sits indoors having panic attacks all day to someone who can live a relatively normal life. I've tried (and continue to have) therapy, but SSRIs are wonder drugs for myself and many other people.
The caveat is, you often need to try 2 or 3 different SSRIs before you find one that works for you, and if you're unlucky, you may not find one, or the side effects can be intolerable. For me, I tried fluoxetine and citalopram, neither of which really worked, but sertraline changed everything almost overnight. The only side effect I've experienced is weight gain, which isn't great, but is better than the alternative.
However, this is the UK which may have a different attitude to the drugs. Before and during initial treatment, I was provided with around 20 behavioural therapy sessions, and even now I still have quarterly drug reviews with a doctor. At no point did I feel like I was being pushed onto SSRIs, and they checked to make sure it wasn't something environmental that could be easily remedied before asking if I would like to consider medication.
[+] [-] tecleandor|3 years ago|reply
The "depression is lack of serotonin" theories seem to have less and less base every day, but SSRIs don't only act on serotonin (just review their side effects).
I've done, mostly, vortioxetine and sertraline. For some of us, some SSRIs or SNRIs work. Some don't. Probably it's not because of the serotonin. They have weirdly different effects depending on the person. But there's something going on that we still don't understand. Both because we don't understand the whole mechanism of depression, nor WTF the SSRIs and SNRIs are doing in our mind and body.
At least in my humble opinion.
[+] [-] jokoon|3 years ago|reply
Even if I hate the bootstrap argument, it still has an effect on me, despite my skepticism.
In the end, depression alters my perception of what is really good for my mental health. It's very common that patients are difficult to treat, not only because they might disagree with the diagnostic, but because they can't really understand or perceive their emotions and subtle state of mind. Depression is a bit like obesity, you go back to the cause without caring for the consequences.
I become a bit confused when my psychiatrist lets me choose if I want to keep taking those meds, instead of clearly telling me i should take them. But in my experience, those meds are good for me, even if they're not perfect.
Maybe I will stop then one day, and see what happens, but it might hurt more than I think it will.
[+] [-] Fradow|3 years ago|reply
I've been taking it for 4 months, and since my life has gotten back to normal my doctor has advised tapering off of it, starting today. We'll see how it goes.
I thought it was standard procedure to advise trying tapering off if your life got back to normal, and see how it goes (at least that's how my doctor presented it). I guess that's not a worldwide standard though.
[+] [-] JoeBtfsplk|3 years ago|reply
One caveat is that you should ideally use them to get out of a funk and then discontinue if possible.
At all times get a psych you who trust.
[+] [-] mrweasel|3 years ago|reply
I had a whole thing typed up, but deleted it, because I really only had one question: How would you word it differently?
To me it seems a carefully worded as possible, while still alerting to the fact that a class of drugs with terrible side effects are being massively overprescribed.
[+] [-] P5fRxh5kUvp2th|3 years ago|reply
If I may,
it's like the recent trend to call everything rape and sexual assault. At some point I have to start naturally doubting the claim on its face. That doesn't imply I think these things don't happen, just that I don't think someone making a stupid dad joke should turn into the woman shouting sexual assault and I find myself questioning all accusations as a result.
---
I have no opinions on any specific person taking antidepressants, but it's not unreasonable for people to get weary when you can't throw a stick without hitting someone who has been diagnosed with something that's being medicated with antidepressants.
[+] [-] Bellamy|3 years ago|reply
[+] [-] aa-jv|3 years ago|reply
[deleted]
[+] [-] twawaaay|3 years ago|reply
The statement is factually true and worded correctly.
[+] [-] welshwelsh|3 years ago|reply
This is not something you can claim. How could you possibly know that the SSRI is responsible for your recovery?
I'm not going to say that antidepressants are useless, but it is important to understand how placebo works. The key point is that placebo works and it is impossible for an individual to distinguish between a placebo and a life changing drug.
In antidepressant studies, SSRIs often outperform placebo to a degree. However, the placebo group has an excellent recovery rate! That means there are people who are clinically depressed, suicidal etc. who are then given a sugar pill as part of a study and make a full recovery.
>You often need to try 2 or 3 different SSRIs
That makes it even murkier. SSRIs take a long time to work, and if you try several of them that's going to take months to years. There's a high probability that in that time, you might naturally recover. You have the combined benefit of placebo and waiting in addition to the effects of the SSRI. You tried 2 SSRIs that didn't work. What makes you so confident that it was the third?
Again, I'm not saying SSRIs are useless. But it's important that we rely on controlled studies to make these determinations. Personal experience and anecdotes are beyond worthless; for example they are the reason why homeopathy is a $20 billion dollar industry even though it is actually provably useless.
[+] [-] spookyuser|3 years ago|reply
[+] [-] JKCalhoun|3 years ago|reply
So chalk that up as another Lexapro win (that was not forced by some drug company on the patient).
[+] [-] viiralvx|3 years ago|reply
[+] [-] fassssst|3 years ago|reply
I lived like that for 15 years :(
[+] [-] snarg|3 years ago|reply
However, my real issues began when I tried to _stop_ taking it. I've experienced opiate withdrawal from pain medication, which was enough to make me sympathetic toward heroin addicts, but SSRI withdrawal was by far the worst I've ever experienced. I used SSRIs for 3 months, but it took 6+ months to wean myself off of them due to debilitating "brain zaps". I got the lowest dosage pills and shaved them onto a milligram scale. I crushed them and dissolved them into a titration solution so that i could wean myself more slowly. I read about psychiatrist claims that SSRI withdrawal "brain zaps", which, it turns out, are known to affect some people, are benign because they "only last a fraction of a second". That may be true for a single zap, but when they occur once every five, ten, or twenty seconds, it's a different story. When these "zaps" occurred, not only was it disorienting, but it felt like I missed half a second of time, and when they got bad, a substantial brain fog set in. They destroyed my focus, and i couldn't get much work done. Driving became dangerous: I would simply miss the existence of entire cars, and I had a few close calls before I realized what was going on and refused to drive any longer while in that state. Weaning more slowly would keep the zaps at bay, but once they began on a given day, it was too late, and my day was over: taking more escitalopram at that point would help, but only gradually over the course of the day.
My withdrawal reaction isn't shared by most, but from my research, it also isn't so rare. I fully recognize that SSRI meds help many people, but be wary about trying them "just to see if it helps," and be aware that once your body gets accustomed to them, coming off of them may not be the experience that your doctor described.
[+] [-] petesergeant|3 years ago|reply
For anyone else with anxiety issues, silexan[0] and l-theanine[1] are cheap and worth a look-in
0: https://astralcodexten.substack.com/p/lavenders-game-silexan... 1: https://examine.com/supplements/theanine/
[+] [-] GekkePrutser|3 years ago|reply
A small dose of it serves as a safety net for me. I still get it but it doesn't get out of control.
I've tried to do without in the past but eventually when I get in a rough patch things get bad and this drug is only affective after taking it for a few months. So just taking it when it's most needed is not an option.
[+] [-] ravishi|3 years ago|reply
[+] [-] petemir|3 years ago|reply
[+] [-] lbriner|3 years ago|reply
I'm not saying this isn't partially true in Europe but the USA definitely comes across as choosing drugs as the first resort for many things that you wouldn't in Europe.
Also, as many have found out, Prozac is cheaper than therapy or CBT which is what some people might benefit from to actually help them resolve the vicious circle of depression.
[+] [-] chrisseaton|3 years ago|reply
And also pushing directly to the consumer via commercial advertising, which is very unusual.
Not sure which way is right though. Maybe people have a right to know about which drugs are available, unscreened by a doctor who may not have your best interests in mind (for example they have to meet a budget, or they have religious opinions.)
[+] [-] lm28469|3 years ago|reply
It's not only in the US, France as an antidepressant epidemic, studies have shown anywhere from 30% to 60% of people taking them don't actually need them. They're prescribed too easily.
Are they a good tools: yes
Do they work: yes
Are they abused: yes
[+] [-] _visgean|3 years ago|reply
https://en.wikipedia.org/wiki/List_of_countries_by_antidepre...
here is that data with US included: https://www.businessinsider.com/countries-largest-antidepres... (tho i am not sure i would trust BI with anything..)
Certainly seems relevant to quite a few european countries. And even more relevant to developing countries to not follow us in that way..
[+] [-] elzbardico|3 years ago|reply
[+] [-] z33k|3 years ago|reply
Almost every single antidepressant gave me withdrawal symptoms (extremely intense mood swings and brain zaps) when I tried decreasing the dose. I mentioned this to my psychiatrist, who advised me to split the pills in order to slowly decrease the dosage. Even splitting the pills and taking a quarter of a pill less every 2 weeks was giving me withdrawal symptoms. I resorted to carefully dissolving the medication in water and volumetrically dosing to get the right rate of tapering off. This scenario happened to me with both Sertraline and Fluoxetine. The "newer" antidepressants like Escitalopram and Vortioxetine gave me less withdrawal symptoms, but they also had more severe side-effects whilst on the medication. Obviously this is all anecdotal, but my hope is that doctors would put greater emphasis on the possible adverse effects of antidepressants to patients. No other class of medication has been so... rough? for me. Glad to be medication-free now.
[+] [-] andreyk|3 years ago|reply
It's unclear what paper they refer to, as it is not linked. This article (https://www.ncbi.nlm.nih.gov/books/NBK361016/) has many citations to papers that cover this stuff. I think the important take away is in "Antidepressant drug effects and depression severity: a patient-level meta-analysis" (https://pubmed.ncbi.nlm.nih.gov/20051569/):
"Results: Medication vs placebo differences varied substantially as a function of baseline severity. Among patients with HDRS scores below 23, Cohen d effect sizes for the difference between medication and placebo were estimated to be less than 0.20 (a standard definition of a small effect). Estimates of the magnitude of the superiority of medication over placebo increased with increases in baseline depression severity and crossed the threshold defined by the National Institute for Clinical Excellence for a clinically significant difference at a baseline HDRS score of 25.
Conclusions: The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial. "
Short version: if your depression is mild, antidepressants may not work better than a placebo (though placebos are not exactly nothing). If it's severe, there is more of a chance it'll really help,
From my personal experience, I can definitely attest to them helping, though they are not by any means a magic bullet.
[+] [-] dsr_|3 years ago|reply
If you propose medical policy for millions, you can be an anonymous staffer at The Economist.
[Needs citations.]
[+] [-] unknown|3 years ago|reply
[deleted]
[+] [-] vmilner|3 years ago|reply
[+] [-] marginalia_nu|3 years ago|reply
It's a line of reasoning that is technically true but really sort of missing the point.
The problem with treating depressed people is to get them to actually do the things that will help them. That can be incredibly difficult without medication.
[+] [-] KvanteKat|3 years ago|reply
The problem with talking about doing "things that will help them" is that we don't really have a lot of effective clinical interventions. Even the most common interventions (SSRIs, Congnitive Behavioral Therapy, physical exercise, etc.) are not really that effective at treating depression and have little to no effect in large parts of the affected population. That being said, these treatments _do_ work for some people so they should definitely not be dismissed out of hand (although it may in some cases be regression to the mean more than anything else, i.e. if you get better after a while on your own but have undergone treatments of one form or another you may erroneously believe your most recent treatment was effective).
[+] [-] jansan|3 years ago|reply
[1] https://en.wikipedia.org/wiki/List_of_countries_by_antidepre...
[2] https://en.wikipedia.org/wiki/World_Happiness_Report#2022_Wo...
[+] [-] mikece|3 years ago|reply
[+] [-] ldoughty|3 years ago|reply
I get the feeling that drug approval laxed for a good while and let these slip through
[1] https://pubmed.ncbi.nlm.nih.gov/17264159/
[+] [-] Fnoord|3 years ago|reply
[+] [-] LatteLazy|3 years ago|reply
[+] [-] eduction|3 years ago|reply
My theory is that the article is playing into a vaguely Protestant ethos that drugs are Bad and Unnatural and thus suspect, and (implicitly) that suffering is actually good to some extent and that alleviating it through “artificial” means is unnatural. This attitude is ubiquitous in the US and I assume UK (where Economist originates) as well. Even artificial sweeteners are ridiculously scrutinized and suspect for the same reason.
If some or even many people are taking what the article calls “useless” drugs, how is that, absent serious side effects, bad?
[+] [-] Jordrok|3 years ago|reply
> Doctors rarely talk to patients about stopping the drugs because they fear this could lead to a return of depressive symptoms. But for many people it may be safe to stop. Even among long-term users with several past episodes of depression, a recent trial in Britain showed that 44% of patients could stop taking pills safely.
Those don't exactly seem like hugely encouraging numbers.
[+] [-] Zak|3 years ago|reply
It's as if we had a single category for "breathing trouble" and consistently treated it with antibiotics. Sometimes it's bacterial pneumonia and that works very well. Often it's emphysema or lung cancer, and antibiotics don't help.
[+] [-] xwdv|3 years ago|reply
[+] [-] caddemon|3 years ago|reply
I think you make an interesting broader point though. Clinically there is not enough consideration of life circumstances when evaluating depression, in my opinion. Obviously something like a death in the family is taken into account, but from what I've seen baseline quality of life is not a huge consideration in whether depressive symptoms are clinically meaningful. I suspect antidepressants would be more effective if this were better teased out.
In any event, there are certainly interesting philosophical and policy questions here, but for an individual that suspects depression, they should seek professional help regardless. A good clinician is not going to just prescribe meds and then tell the patient they're done.
[+] [-] lm28469|3 years ago|reply
The fact that they work and helped people isn't mutually exclusive with the fact that they're abused, over prescribed and have crazy side effects
[+] [-] gilded-lilly|3 years ago|reply
The main causes are the following:
1) Illicit drug use. 2) Stress/anxiety/fear/grief
The answer is to accept the hard truths and understand what is the root cause of your depression. Is it lack of friends and family? Lack of hope for the future? Lack of enjoyment in things that previously made you happy? Belief that somehow success/truth comes at the expense of enjoyment of life (“ignorance is bliss”). Is it past trauma? A job/relationship you hate? Body/health issues? Aging? Feeling like you’ve achieved all your dreams but you’re more unhappy than ever? Bullying? Feeling unsatisfied? Unfulfilled? Shame about past behaviors?
All of these problems have solutions. Figure out what is at the core of your problem, and then treat it. Every problem is different.
For me, I realized I was harboring an incredible amount of pent up rage and resentment. The rage was so deep that it was all I could think about. Then I realized, I had to forgive the people who’d wronged me. And forgive them I did. I genuinely forgave them, in my own mind. And just like that, all my happiness came back to me. Suddenly I was free.
Also, I believe that almost all of our problems can be traced back to fear. So stop worrying. It’s a waste of energy.
There are some mental health issues that do require hospitalization and a short stint of medication to get people back on their feet and able to function. But I don’t believe in long term medication. Drugs are not the answer.
[+] [-] TchoBeer|3 years ago|reply
some of these things (body/health issues, bad job/relationship, lack of friends) are causes which can be fixed with direct action. Some (aging, past behaviors, trauma, lack of family) can't be, but can be somewhat mitigated and be made less depressing with therapy. Others (lack of hope, anhedonia, lack of fulfillment) are not the cause of depression but the symptoms. to lump these all together seems strange to me.
[+] [-] m_a_g|3 years ago|reply
SSRIs are only marginally better than a placebo for depression. But they are incredibly beneficial for panic disorders and GAD (a bit anecdotal). Still, they will not "get rid of" panic disorders and GAD; only CBT or other therapies can do that. But SSRIs should not be dismissed easily for anxiety disorders, especially if the alternative is using Xanax or recreational drugs (including alcohol).
[+] [-] amai|3 years ago|reply
Cheap and basically no side effect: https://pubmed.ncbi.nlm.nih.gov/26984349/
Especially some B1 analogues like Benfotiamine and Sulbutiamine are promising: https://nootropicsexpert.com/sulbutiamine/ https://en.wikipedia.org/wiki/Vitamin_B1_analogues
[+] [-] bezier-curve|3 years ago|reply
[+] [-] swayvil|3 years ago|reply
They get a dog. Beautiful white german shepherd.
Dog is a bit wild. So they consult a "dog psychiatrist".
Psychiatrist puts dog on antidepressants.
Why not a few weeks of Doggy Dicipline Academy? It's common to get german shepherds a bit of training.
"Nope" says the psychiatrist. "That would be cruel".
They worship that psychiatrist. Dingalings.