Some thoughts from someone who's been prescribed anti depressants in adolescence but never took them because I believed the doctor misdiagnosed:
* Do these drugs genuinely help or is it just a strong placebo response?
* If the anecdotal evidence increases the odds from 1 in 100 to 1 in 4, would this be considered normal in medicine?
Of course the symptoms could be attributed to the wrong thing here but they sound pretty horrific. My initial reaction was that in the future we'll look back at these drugs as barbaric, similar to how we view lobotomies today.
I take only a very small dose of paroxetine and if I don't take it for a few days, my girlfriend notices (long before withdrawal symptoms occur). Without it I'm more impatient, stubborn and less capable of self-reflection. When I take it I'm just a more pleasant person and with that my entire life becomes more pleasant, because many interactions with other people are more constructive and productive.
It is my firm conviction that a lot of people would benefit from small adjustments to their brain chemistry. I'm lucky to have found something that works for me.
I can't comment on anti-depressants, but for a similar case (ADHD meds), where societies attitudes regarding meds are similar.
ADHD has by far the most successful medical treatment of any mental illness. Something like 90% of cases get positive response out of medication, with 35-40% of people having all their symptoms handled.
My understanding is that for treatment of clinical depression, medication helps around 75% of cases, but that most people continue to have symptoms even when under medication due to the nature of the illness.
In both cases, though, treatment is understood to be a continuous process. You cannot be cured of these illnesses, you can only cope with the side effects.
The treatments are like a prosthetic leg: No matter how much you use it, removing it will bring you back to square one.
There's a lot of research showing the positive effects of medication (and in ADHD's case, the futility of non-medication-based treatments), but there's still a major fight for acknowledging the validity of this form of treatment. Major parts of the population do not think these illnesses are even real!
But it's all pretty dangerous. We have some understanding of how brains work around these illnesses thanks to the research gone into it, but there's a lot of complex interactions going on. Not that physical medicine is much different.
>There's a lot of research showing the positive effects of medication (and in ADHD's case, the futility of non-medication-based treatments), but there's still a major fight for acknowledging the validity of this form of treatment.
Is this really relevant considering the extremely rapid rise in prescription and use of ADHD medication?
In my anecdotal experience with friends who take these pills, they very quickly create a reliance on the substance and have significant side effects in the long term. I honestly believe they can be quite harmful to a person's mind.
Now, for ADHD there unfortunately aren't good non-medication treatments. But depression is a completely different matter - making lifestyle changes as simple as going for a hike every weekend can easily be as effective or more effective than any medication.
They can be harmful, but diagnosed ADHD/ADD is almost guaranteed to be harmful, maybe especially in todays society. More than doubled risk of depression is only one of the risks of the above diagnoses, and while many of the risks could be said to be more of a societal issue - at least in the beginning - they tend to cause actual health problems over time. Overprescription can always be an issue for any medication, but that's not really an issue with the medication itself is it ?
Maybe if the medication is 90% as fun as cocaine for large portion of the population. I've known precious few people with legitimately diagnosed ADHD, but I've known tons of people who use the medication as a stimulate for studying or just for fun at parties. No one is doing this with Effexor, at least no one bright. From what I understand it's doesn't effect the people with true ADHD the way it does the casual user. This isn't their fault, and I wouldn't take their crutch away. I fault big pharma and the tons of sketchy doctors out there.
I am a physician with training in neuroscience. There is no scientific consensus that stimulants help the problems you are talking about. There is some preliminary evidence that stimulants may make some problems worse (graduation rates).
You are over stating the case for what stimulants can do in ADHD. They probably do make kids more docile. They do not improve grades over a meaningful time span. They do not improve broad and important outcomes like graduation rate (there is some evidence that ADHD kids on stimulants have lower graduation rates than ADHD KIDS that aren't medicated), increase earnings, or decrease chance of going to prison.
As a sufferer myself, what he's claiming is along the lines of 'stopping blood loss has never been proven to meaningfully affect health'. The difference on and off meds is night and day, between 'brain-scrambled mess' and 'actual thinking human being'
I also was diagnosed with ADHD and took Ritalin then Adderall for years. I stopped taking them in medical school and actually got better grades.
Regardless of my personal experience or your personal experience the evidence does not show that stimulants increase grades in the medium or long term.
I am still trying to find the studies that indicate that stimulants might increase high school drop out. But there is pretty clear consensus that they don't increase grades over the long term.
People react quite differently to these mind-altering drugs -- and there are a lot of them, with different effects on different people.
They "worked" for someone I know when they were in a very dark place, but the price was a permanent dulling of their emotions, even after they stopped taking them.
Someone else I know underwent extreme personality changes on a different antidepressant, becoming more aggressive and basically an asshole, and I had to beg them to stop taking it.
Your mileage may vary. They are very serious things.
The SSRIs have always been controversial. Some studies claim they're rarely more effective than placebos, but more often than not they're effective enough with a pretty safe profile, this article not withstanding.
The safe profile is one of the reasons they're probably over prescribed, along with the high profitability. Many doctors give them out like candy, even though many people probably don't suffer from the physiological ailments that the drugs target.
There is little debate, though, on the statistical efficacy of the older (less profitable, off patent) tricyclics and especially MAOI class of drugs. Unfortunately, the side effects of these drugs are far more serious. Most GPs will not even prescribe them, as only psychiatrists will have experience. But for someone with lifelong treatment resistant depression, they can be a God-send.
Asd as far as barbaric, realize that the most effective treatment for depression is still electric shock therapy.
Heh, as someone who was on SSRIs for a long time at high dosages, they definitely do something, but the issue is less whether the drugs do anything and more what you do during that time.
Personal experience with Sertraline - it doesn't make you happy or feel better or anything. It just numbs you, and you're really susceptible during this time. It's part of the reason why therapy is also really important in addition to the drugs to help get down to the core of what you're having issues with.
The old Zoloft "sad blob" to "happy blob" commercials are a real disservice to modern anti-depressant medicine since it is a very incomplete picture. Aside from glossing over the side effects of the medication, the pills themselves don't do much except stop the feeling of absoutely horribleness for awhile. They don't make you feel better - they don't make you feel much of anything. But things at least stop seeming hopeless after awhile, and hopefully you can begin to address the underlying issues.
In the case of true chemical imbalances like it's suspected I have, during this time you help find non-drug related coping mechanisms. Finding ways to help create a strong positive part of your life so the imbalances are offset and don't hit as hard. A lot of this comes just through therapy or at least a counselor while you work.
My first few times on SSRIs were the result of rather serious and dangerous break downs where those around me had pretty good reason to think I was a threat to myself. But these cases were mishandled pretty heavily since the doc just wrote a prescription for Sertraline and sent me on my way. Therapy wasn't even discussed, and our insurance at the time certainly didn't cover it since it was a non-essential medical procedure.
It wasn't until many years later and many changes of drugs later that I was finally in a position when I could do both therapy and have the drugs to assist that I actually made some progress -- the counselor and the psychiatrist worked in tandem; the counselor worked and would constantly try to see how I was when we lowered the dosage, the psychiatrist spent time making sure that the dosage was enough to keep me level, not pushing either way and consulting with the counselor to ensure they had a source of info that wasn't me.
I hope we find something better since looking back at the SSRI period, it was not a very good time in my life and I was lucky enough to get to a situation where I could get proper mental healthcare. I can't imagine how many others were just tossed on an SSRI without the proper monitoring and assistance necessary to actually make use of the effect, or worse, who weren't watched at all as the more dangerous side effects kicked in.
> In the case of true chemical imbalances like it's suspected I have, during this time you help find non-drug related coping mechanisms. Finding ways to help create a strong positive part of your life so the imbalances are offset and don't hit as hard. A lot of this comes just through therapy or at least a counselor while you work.
We wouldn't say the same if it was your arm was broken...
"You can just come up with non-surgical ways of coping with the fact your arm is broken"
Well keeping with your analogy we also wouldn't just sit there feeding the person pain killers and hope it works either, which is pretty much what SSRIs would be.
Brain chemistry and "fixing" it is more voodoo than science right now. There are many underlying causes of depression and it's pretty unlikely there's going to be a fix that's surgically precise and accounts for even a large number of cases with one solution.
My point wasn't that SSRIs are bad or don't work, but it does usually take more than just popping pills to mitigate and help depression. Pills aren't the full solution. They're part of a working solution but not the entirety of it.
They are almost all placebo response. The real effect is so small it's probably not useful clinically. They also cause suicidal ideation and sexual dysfunction is a large minority of patients.
There is no well done study I have heard of that supports your position. In general SSRIs have an effect size that is so low it is not clinically relevant. There are multiple meta analyses that demonstrate that.
* Do these drugs genuinely help or is it just a strong placebo response?
* If the anecdotal evidence increases the odds from 1 in 100 to 1 in 4, would this be considered normal in medicine?
Of course the symptoms could be attributed to the wrong thing here but they sound pretty horrific. My initial reaction was that in the future we'll look back at these drugs as barbaric, similar to how we view lobotomies today.
Edit: formatting