article on anti-depressants

[prplchknz]

Antidepressants work, so why do we shame people for taking them? | Mark Brown | Opinion | The Guardian

 

[Siúil a Rúin]

This is an interesting thread topic. I hope the thread takes off.

I feel no shame about depression or taking medication for it. I've been there, done that. I do have some mixed feelings about at least some of the pharmaceuticals because I've had some bad reactions to them. I also think that they are prescribed rather quickly without addressing diet or anything else. In my perspective it would be ideal for the medical field to refer more patients to a nutritionist and/or exercise help to go over the basics of lifestyle, and then if the depression is still persistent, to prescribe the pharmaceuticals. My brain has been exposed to a lot of imposed chemical processes, and even though I was quite depressed at the times they were prescribed, it ends up feeling a bit reckless to me. I'm not against all of it, and I don't think they are all useless or anything like that, though.

 

[Falcarius]

Falcarius was on anti-depressants and he is not embarrassed to admit it, but it never really help him to be honest as he was still seriously ill and it did not really solve the underlying problems.

If one has a job what makes them ill, then no anti-depressants are no going to helpful; it was only when he finally was made redundant that it actually felt like a relief, that he would not have to see all the people who were horrible to him nor world he have to worry about what the hell he was going to do when he was actually made redundant. Falcarius just stopped taking his medication a few weeks later (despite his doctor advising against it) and just decided to just do things that he enjoys and stay away from people who make him sad, and has basically done so since... that was like nearly 3 years ago.

So yeah anti-depressants can work but they are far from so magical cure that people who have never been on them see to think. In Falcarius case, it was cognitive behavioural therapy that was the most beneficial, and neither counselling or anti-depressants worked for him too well.

 

[Atomic Fiend]

I believed the stigma itself comes from the problem not of SSRI's themselves, but the wrong SSRI's for the patient. I've frequently heard stories (and have expierenced myself) being perscribed an antidepressent that flat out didn't work, or only made the depression worse. It's not uncommon to read anecdotes of patients feeling more suicidal from medications, before switching to another. Lexapro and Welbutrin worked better for me then Paxil and Zoloft, and abilify worked better then all of those personally, but the thing is to find that out I had to take each of those perscribed medications for a month, 2 weeks for them to actualy kick in, and some time after to see if they were working when they started working. Those aren't even all the SSRI's I've personally been on, probably 2/3rds infact. So yes when they worked, they did work indeeed, but finding the ones that worked is no picnic for the patient who is likely not only fighting there own mental illness but the situations as well. If those patients are facing financial issues, then that also limits how they can get their medicines, if they're uninsured. They're likely to drop the idea of SSRI's if the money isn't there, and the pills they did get weren't effective or worsened their mental state.

SSRI's may work, but they're very, very tricky.

 

[Tellenbach]

In 2008 Irving Kirsch and colleagues published a meta-analysis of published and unpublished trials of SSRIs that found overall a clinically significant difference between placebo and actual drug conditions only when people’s depression was severe. Kirsch and colleagues suggested those more depressed patients were less likely to respond to the placebo pills, meaning there was a bigger than normal advantage in that category for the actual antidepressants. Kirsch wasn’t saying that SSRIs weren’t doing anything, just that they weren’t doing very much and should be the final, not the first, option.

I read Kirsch's book; he's right. Anti-depressants work no better than active placebos (placebos that have a side effect similar to the anti-depressant). The most convincing evidence in the book was that current anti-depressants, past anti-depressants; drugs that increase serotonin levels, drugs that decrease serotonin levels, and drugs that have no effect on serontonin levels all perform at near identical levels.

I'd urge everyone on anti-depressants to read Kirsch's book first.

 

[Frosty]

I read Kirsch's book; he's right. Anti-depressants work no better than active placebos (placebos that have a side effect similar to the anti-depressant). The most convincing evidence in the book was that current anti-depressants, past anti-depressants; drugs that increase serotonin levels, drugs that decrease serotonin levels, and drugs that have no effect on serontonin levels all perform at near identical levels.

I'd urge everyone on anti-depressants to read Kirsch's book first.

Ok. Until Im done reading the book Ill stop taking my medication. See what happens- fun little experiment.

 

[Tellenbach]

Ok. Until Im done reading the book Ill stop taking my medication. See what happens- fun little experiment.

That is one of the experiments. More depressed people recover on their own without anti-depressants than those using anti-depressants. I don't remember the exact numbers, but it's something like 82% vs 62%.

 

[Frosty]

That is one of the experiments. More depressed people recover on their own without anti-depressants than those using anti-depressants. I don't remember the exact numbers, but it's something like 82% vs 62%.

Id like to see those exact numbers if you have them.

 

[burningranger]

Hmm...to post or not to post....I'm vehemently against anti-depressants. I took them for just a little while, and they "cured" me of everything I was going through (including the immense rashes I was having that almost looked like that herpes-family thing I forget the name).

Anti-depressants are good for extreme cases for very very short-term relief. Anything other than that and they fuck you up. Of course there is absolutely NO shame in taking them. But they are often just clogging up the system....putting people in a haze and COVERING UP what is actually the problem with the person in question. This is a very touchy subject for many...but I think there's so much stuff in terms of mental health that is misdiagnosed out there, that it's pratically a case of human cruelty.

I don't think there is ONE person in the world on antidepressants that a) doesn't NEED to make changes in their lives and that's why they feel so down b) couldn't benefit from cognitive-behavioural therapy.


But sooooooo many people STILL believe ANY health problem is random. The body/mind is ONE whole mechanism that is meant to cue us on how our life,behaviour and environment is affecting us....so that we can make the necessary adjuestments...whether mentally...emotionally....behaviourally....nutritionally...etc It's not just some nuisance skin suit we carry around all the time....but see how many of us ACTUALLY take care of our health.....most of us don't even regard proper nutrition as an absolute necessity....how could we be open to the idea that - if you care for your body you'll be fine; if you do random shit to yourself in life....things are bound to happen. You can't just ignore the fact you have a body or a mind.

But in a society that despite it's supposed scientific advancement STILL doesn't recognize something utterly fucking BASIC like the direct correlation between EMOTIONS, THOUGHT PATTTERNS and SOMATIC RESPONSES/EVERYTHING THAT HAPPENS IN THE FUCKING BODY.....it's no wonder we turn to things that shut all of that down...cover it up with a fog and forget the body's innate intelligence when dealing with anything.

 

[Tellenbach]

Id like to see those exact numbers if you have them.

Sure thing. Gimme about a week.

 

[Frosty]

Sure thing. Gimme about a week.

You can do better than that. You made a point- back it up so we can discuss.

 

[Tellenbach]

You can do better than that. You made a point- back it up so we can discuss.

You can read one of Kirsch's articles here:

Antidepressants and the Placebo Effect

On the basis of 234 studies, no clinically relevant differences in efficacy or effectiveness were detected for the treatment of acute, continuation, and maintenance phases of MDD. No differences in efficacy were seen in patients with accompanying symptoms or in subgroups based on age, sex, ethnicity, or comorbid conditions… Current evidence does not warrant recommending a particular second-generation antidepressant on the basis of differences in efficacy

The most commonly prescribed antidepressants are SSRIs, drugs that are supposed to selectively target the neurotransmitter serotonin. But there is another antidepressant that has a very different mode of action. It is called tianeptine, and it has been approved for prescription as an antidepressant by the French drug regulatory agency. Tianeptine is an SSRE, a selective serotonin reuptake enhancer. Instead of increasing the amount of serotonin in the brain, it is supposed to decrease it. If the theory that depression is caused by a deficiency of serotonin were correct, we would expect to make depression worse. But it doesn’t. In clinical trials comparing the effects of tianeptine to those of SSRIs and tricyclic antidepressants, 63% of patients show significant improvement (defined as a 50% reduction in symptoms), the same response rate that is found for SSRIs, NDRIs, and tricyclics, in this type of trial (Wagstaff, Ormrod, & Spencer, 2001). It simply does not matter what is in the medication – it might increase serotonin, decrease it, or have no effect on serotonin at all. The effect on depression is the same.

What do you call pills, the effects of which are independent of their chemical composition? I call them “placebos.”

Meanwhile, I'll search for those stats you want.

 

[prplchknz]

I was prescribed anti-deprassants for years, they did nothing or had adverse affects so i no longer take them but i do take other psych meds. but just because they didn't work for me i'm not gonna dismiss them as useless because they do help some people. the article even mentions it's complicated on how they work.

 

[Tellenbach]

[MENTION=29687]Frosty[/MENTION]

This page discusses remission rates:

5 Myths About Depression Treatments

In March 2006, NIMH triumphantly announced that 50 percent of depressed people saw remission of symptoms after the first two STAR*D steps. However, NIMH failed to mention in its press release that in the same time it took to complete these first two steps—slightly over 6 months—previous research shows that depressed people receiving no treatment at all have a spontaneous remission rate of 50 percent.

But upon further analysis:

“I found a cumulative sustained recovery rate of 43 percent after four treatments, using a method similar to the authors but taking relapse rates into account.” However, even 43 percent turns out to be an inflated rate.

Even further analysis:

But even taking the STAR*D data as is, Pigott’s analysis revealed that less than 3 percent of the entire group of depressed patients who began the STAR*D study can be ascertained as having a sustained remission

So basically, 50% recover without ever taking antidepressants and anywhere from 3% to 50% recover while taking antidepressants.

 

[Frosty]

[MENTION=29687]Frosty[/MENTION]

This page discusses remission rates:

5 Myths About Depression Treatments



But upon further analysis:



Even further analysis:



So basically, 50% recover without ever taking antidepressants and anywhere from 3% to 50% recover while taking antidepressants.

In Defense of Antidepressants - NYTimes.com

This is the issue that I have with 'debunking' studies is that they tend to be limited. You take a small sample- one that probably ISNT reflective od the general population- and based on the results of that you are able to dismiss all the people who have benefitted from the treatment. I will never say that antidepressants are right for everyone- I dont take SSRIs. They dont work for me. They make me feel worse. If I never take another SSRI in my life it will be too soon. But thats my own limited perspective. I could link a thousand articles with data that I only half understand- people have DONE the research. And because of the subjective nature of psychological research- some of those opinions will be controversial- will be negative. As with any article written- for the public- the terms it is written in are going to be biased in whatever the direction the author hopes to sell to the reader. Yes- there is data there- Im not dismissing it- but its flawed data. And until you can tell me why it ISNT flawed- I dont think you, or anyone, has the right to dismiss- on entirety- the experiences of an entire group of people.

This isnt scientific. I fully intended to delve into whatever point you made- one by one- offering refutations and further questions that you probably cant answer and I will admit- I dont have the know how right now to ask. nut I think that the question comes down to- are you able to definitively say that every single person who thinks that they have been benefitted by an antidepressant would have been just as well served by a placebo? Based on one article from a biased studt from one man. I dont claim to know everything about antidepressants- I dont know if they work myself- but I admit that- can you?

Can you do that without just linking another article that has refutation after refutation already written about it?

I will try to get to this more later. But Im going to be busy the next few days- so it might not be until maybe monday. I will honestly try to look into all the viewpoints by then- while continuing to take my medication that- placebo or not (I very much think NOT since Ive tried many medications- some that I have REALLY WANTED and really BANKED on working when they HAVENT- until- after all that- I found a few that DID work- when I almost had no hope and wanted to be done with medication forever- when I HATED taking medications and was very reluctant to go on any more- I found some that honestly shockingly to me DID work)

(im not yelling by the way- just emphatic- some people think Im yelling when I do this but Im not- and honestly I have nothing against you personally that would require me yelling)

)- helps me. And probably has helped millions of people.

But I do promise to try to get back to you. And I seriously mean that.

 

[Tellenbach]

You take a small sample- one that probably ISNT reflective od the general population- and based on the results of that you are able to dismiss all the people who have benefitted from the treatment.

Kirsch takes a pretty comprehensive look at all the studies, not just one. Again, I think you should read the book before deciding.

And until you can tell me why it ISNT flawed- I dont think you, or anyone, has the right to dismiss- on entirety- the experiences of an entire group of people.

SSRIs are based on the theory that increasing serotonin levels relieve depression. As I pointed out in the quote above, medications that decrease serotonin levels are also sold as anti-depressants in France. If the theory is correct, the opposite should have happened. If the theory were correct, medications that have no effect on serotonin levels should not work, but they do...they all work and at near identical levels. This suggests that the serotonin theory of depression is nonsense and all medications based on this theory (that increasing serotonin levels relieve depression) are nonsense.

are you able to definitively say that every single person who thinks that they have been benefitted by an antidepressant would have been just as well served by a placebo?

I have no horse in this race; I don't care if people take anti-depressants, but I do think people should be aware of the research behind these drugs. The book details some of the shenanigans used by the drug companies to get these drugs passed. I think you should be aware of those tactics.

 

[PumpkinMayCare]

Anti-depressants are really a big help for a lot of people, my own experience with three different anti-depressants wasn't good, however. I switched to Remeron after a fruitless try with another anti-depressant and aside from the excessive increase in appetite, they made feel empty inside or just apathetic to everything. After trying out those, I tried out some other anti-depressant, which doesn't seem to exist outside of Germany, that one however triggered my histamine-intolerance, so I had to taper them off. It also didn't make me feel better, nor worse. It just didn't have any effect, aside from histamine related symptoms... after these unsuccessful tries I decided to go without them and in the end I could get out of depression without them.

I think it's a shame that people still have to hide when they take anti-depressants. I wish this stigma would die off finally.

 

[prplchknz]

Anti-depressants are really a big help for a lot of people, my own experience with three different anti-depressants wasn't good, however. I switched to Remeron after a fruitless try with another anti-depressant and aside from the excessive increase in appetite, they made feel empty inside or just apathetic to everything. After trying out those, I tried out some other anti-depressant, which doesn't seem to exist outside of Germany, that one however triggered my histamine-intolerance, so I had to taper them off. It also didn't make me feel better, nor worse. It just didn't have any effect, aside from histamine related symptoms... after these unsuccessful tries I decided to go without them and in the end I could get out of depression without them.

I think it's a shame that people still have to hide when they take anti-depressants. I wish this stigma would die off finally.

I repped you this but thought it also needed to be said in the thread:

I agree I wish the stigma would die off aswell. Just because they don't work for us doesn't mean they don't work for others. I have people in my life who take antidepressants and do better on them and off like can actually get shit done, if they're on the right one.

 

[Peter Deadpan]

I don't think this is a black and white topic at all. I do however think that antidepressants are best used for those with extreme cases of mental illness (like bipolar or schizophrenia), or those who are in a crisis of situational depression and need extra help so that they are better able to care for themselves and commit to cognitive behavioral therapy and lifestyle changes like diet, exercise, and mindfulness.

Side note: I thought I had situational depression because of a series of very trying major sudden life changes that I experienced over a period of 2 years. I still have bouts of depression though so I am not sure if it's technically situational depression or if my brain chemistry has changed, but I am leaning toward the latter. Regardless, I personally feel that my situation is treatable through lifestyle changes alone, but there were times where I was in a crisis and needed medication in order to function in a reasonable manner (I briefly took Citalopram and also had Lorazepam on hand for emergencies). The former worked but affected my sex drive and ability to climax, and the latter was integral to my healing because I was having anxiety attacks related to complex-PTSD.

There is a good chance I will be starting treatment for ADHD in the next month or so, and I am not sure how that will affect my anxiety and depression, but my hope is that I will be able to stay more on top of things which will in turn reduce my stress and general feelings of failure and inadequacy which often trigger my anxiety and depression.

 

[ceecee]

I don't think this is a black and white topic at all. I do however think that antidepressants are best used for those with extreme cases of mental illness (like bipolar or schizophrenia), or those who are in a crisis of situational depression and need extra help so that they are better able to care for themselves and commit to cognitive behavioral therapy and lifestyle changes like diet, exercise, and mindfulness.

The biggest issue I have and have always had with anti-depressants are GP's and other non-psych docs prescribing them with no CBT or other psych input or referrals. Except emergency situations, ED docs and nurses should absolutely be stabilizing patients but also involving emergency psych protocols. This way a treatment plan can be established. Either that or it's treat the symptoms and out the door. That's stupid but many times it's that or out the door to jail. Even stupider. I think money and education should be dumped by the truck-full for mental illness, it's easily one of, if not the largest health issue this country faces.

Please no one stop taking their meds because of a few idiot posts in this thread. Big pharma is a whole other matter.