Antidepressants may not help many patients

[Sust]

Whoa... tensions always seem to get high with these mental health threads.

FWIW, No one really knows what these psych meds are doing. Well, that's not true. People have a guess but what does increasing synaptic serotonin levels have to do with increased hippocampal neurogenesis? For that matter, why would changes in that region have anything to do with feeling sad?
I'm only a lowly student and I love psych, but there are still a lot of unanswered questions with anti-depressants and until they're answered, people have to accept that we know the starting point and we know the end point, but we have no idea how we get from start to finish. Some might say that's a completely ludicrous/dangerous way to treat without a complete understanding(at least we have data from clinical trials), but when administered properly with proper physician oversight, there should be some benefit and at the very least no irreversiblly disproportionate harm done.

I cant think of a good example off the top of my head for blind treatment, but I heard from my pharm prof. that lipitor and all those "bad cholesterol" drugs have done wonders for bad cholesterol. However, the same number of people are STILL dying from heart attacks every year... so what happened to the hype? And what's with these fatty streak formations in our arteries when we're in our 20's that are going to gradually calcify like an eggshell as we age? Could it be that we don't fully understand cardiovascular pathology as much as we'd like to think? Would big pharm deceive me? Who knows... it could be anything.

IMO, bottom line is to take everything you read with a grain of salt(even scientific literature) and WORK WITH YOUR DOCTOR towards a MUTUALLY agreeable biopsychosocial treatment approach if and when you have a mental illness.
As of today there are no cures.

On a side note, living healthy is always a good idea

 

[spikespiegal]

While I'm sure there are thousands of people who'm these chemicals have helped, you can add me to the list of those who are convinced that doctors are are seriously over-prescribing this stuff. My ex GF, who was normally a bit high strung and suffered occasional and mild bouts of depression was persribed a small pharmacy by a physician's assistant - not even her primary care physician.

Within a few weeks I no longer knew the person I got engaged to. Her parents and friends immediatley blamed me for her massive change in personality and her lack of interest in anything other than immediate concerns. They should have blamed the pharmaceutical association of america.

If there's a diagnosed chemical inbalance by a psychiatrist - fine. Fix it. However, most of the people I see on this stuff are using it to dumb down the effects of a divorce, stress, bad financial decisions, etc.

 

[Jeff7]

Originally posted by: Sust
Whoa... tensions always seem to get high with these mental health threads.

They probably just forgot to take their meds.

 

[Auryg]

Originally posted by: moshquerade
I'm not a rocket scientist, and still I've been saying this time and time again: Antidepressants aren't a help for most people. In fact, they make the situation worse.

Another thing I firmly believe is that regular docs should not be able to prescribe antidepressants only Psychiatrists should. This would cut down on SSRIs being dispensed like a cure all for any little crisis someone is going through. I read and update medical histories and I see first hand how many people are on antidepressants. The amount of people taking them has exploded. It's not a good thing.

You're right; you're not a rocket scientist. Just where did that idea come from? Where did you get the idea of "most" from?

Antidepressants are overprescribed just like every other drug in America is. Deal with it. They've personally saved my life, and not in the way you think. Without them, I could barely stay awake. I tried every conceivable thing - more exercise, less exercise, varying levels and times of sleep, eating differently - even sleeping in a different place. I had more tests done on me than most people have done in a lifetime.

In the end - when there was nothing else to try, my doctor put me on an antidepressant. All of a sudden, my life totally changed around. Without them, I may have failed college by now, or maybe not even gotten in to the one I'm on.

And yes, there's been side effects. The first drug i was on was Lexapro, and it made me gain 40 pounds quite quickly (as in, a month or two). Thankfully that levelled off, but I couldn't drop the weight, so I'm on Wellbutrin now, and things are going just fine.

The point is - while some doctors prescribe too much, "most" (and I'm so kindly taking your words) prescribe them as a last resort, or to see if it's somehow linked to neurotransmitters. Mine had me even go to a psychologist (which was worthless for me). Just because you've never had a specific problem doesn't mean it doesn't exist. The brain is the most complex part of the body, and yet legions of people, including you, seem to think that it works with less problems than every other part of our bodies.

 

[BrownTown]

Well in my PERSONAL (IE: i'm not gonna try to apply it to the rest of the world) experience with anti-depressive drugs they are pretty much a mixed bag. To some degree they can fix the problem, but they often seem to create just as many new problems, for one thing whenever you STOP taking them you can get fucked up, so at the very least you are dependent an drugs for the rest of your life (a place I would never like to be). As for other side effects, once you get high enough doses it seems you go from an overly emotional depressed person to a zombie, and its really not as easy as it might seem to find a good middle ground. I know with my mother it would be like one day shes a zombie the next day she is incredibly emotionally sensitive and then when you start swinging you want to stop taking the drugs on the good days and then that just causes you to overshoot way to far on the other side. When I say "you" I don't mean me though since I've never taken them, but thats what they do to people in my family. I have taken a couple Benzodiazapenes before, they are nice at stopping anxiety, but I also couldn't walk in a stright line and fealt freezing cold and didn't have a care in the world after taking one of those pills (which really shouldn't be that strong but apparently I wasn't used to it).

 

[spittledip]

A big problem with treating "mental illnesses" such as Major Depression with medication is that it is assumed that the problem is biological in nature. This is the case b/c the Medical Community took over the field of psychology in the 1970. And this not due to research, but rather opinion and political movements, including the infamous labeling of homosexuality as a mental disorder. I don't want to go into homosexuality and the DSM- I am merely referencing it as part of the political movement that helped to change the DSM and control of the field of Psychology.

So, when the ideology changed due to political movements, thinking about treatment changed as well. Since man was considered to mainly be a product of the various chemical reactions in his brain, the research focused on the brain and treatments focused on treating the same. Of course this is based upon the assumption that the brain activity caused the behavior/experience of the subjects rather than the experience of the subjects influencing the brain chemistry and activity.

I think a big part of the problem is that you have people who are totally against medication and totally for psychotherapy and other talk therapies, and people who are totally against psychotherapy and totally for medication. Both are tools and both can be used in tandem. Preferably, b/c playing with medication is dangerous and there are many unknowns, it should be handled much more carefully. But, there is money to be made and doctors to be paid for prescribing the medication.

I think the solution is to go to a psychologist first and only see a psychiatrist if the psychologist recommends doing so. If you see a psychiatrist first you will get medication b/c that is the role of a psychiatrist. There are a few old school psychiatrists left who do therapy as well, but those are more a thing of the past. actually, one of the best living therapists out there, Irving Yalom, is a psychiatrist. If you want to get a good understanding of psychotherapy and get some insight into your own life, he has a couple excellent books out. However, he is a dinosaur so you don't see many like him anymore.

another big problem is that it is hard to find gifted therapists. Taht is why many people with depression and other psychological issues get discouraged and just do the meds- they have had too many crappy therapists. I am guessing this is also why brief therapies such as cognitive behavioral became so popular in the 90s- very basic, easy to do, not much guesswork. A B C D and E and that's all. Of course that is another "tool" that really should not be used on its own, but should be part of the repertoire of a therapist... if a client needs that type of tool.

In the end, I guess some treatment is better than no treatment. However, that is not to say that you can't self-treat. The basis of all good therapy is self-knowledge.

 

[moshquerade]

Originally posted by: Auryg

Originally posted by: moshquerade
I'm not a rocket scientist, and still I've been saying this time and time again: Antidepressants aren't a help for most people. In fact, they make the situation worse.

Another thing I firmly believe is that regular docs should not be able to prescribe antidepressants only Psychiatrists should. This would cut down on SSRIs being dispensed like a cure all for any little crisis someone is going through. I read and update medical histories and I see first hand how many people are on antidepressants. The amount of people taking them has exploded. It's not a good thing.

You're right; you're not a rocket scientist. Just where did that idea come from? Where did you get the idea of "most" from?

Antidepressants are overprescribed just like every other drug in America is. Deal with it. They've personally saved my life, and not in the way you think. Without them, I could barely stay awake. I tried every conceivable thing - more exercise, less exercise, varying levels and times of sleep, eating differently - even sleeping in a different place. I had more tests done on me than most people have done in a lifetime.

In the end - when there was nothing else to try, my doctor put me on an antidepressant. All of a sudden, my life totally changed around. Without them, I may have failed college by now, or maybe not even gotten in to the one I'm on.

And yes, there's been side effects. The first drug i was on was Lexapro, and it made me gain 40 pounds quite quickly (as in, a month or two). Thankfully that levelled off, but I couldn't drop the weight, so I'm on Wellbutrin now, and things are going just fine.

The point is - while some doctors prescribe too much, "most" (and I'm so kindly taking your words) prescribe them as a last resort, or to see if it's somehow linked to neurotransmitters. Mine had me even go to a psychologist (which was worthless for me). Just because you've never had a specific problem doesn't mean it doesn't exist. The brain is the most complex part of the body, and yet legions of people, including you, seem to think that it works with less problems than every other part of our bodies.

Well and fine. As said, they do help some people, the severely depressed, it's just they aren't helping all the people on them. That is the message.

Where did I get the information from? Here:

http://news.google.com/news?hl...1&ie=UTF-8&sa=N&tab=wn

 

[jjones]

Well, that's depressing news.

 

[interchange]

I never trust a news report of a medical study (or a study of any kind actually). The results and conclusions are almost always improperly presented unless directly quoted from a reliable source (and still there's a chance of a misquote). And there is no analysis of how the study was conducted and who performed the study.

 

[OutHouse]

of course they dont work, they dont work for anybody they are placeboes. people need to realize that the root of their problems are thetans.

 

[allisolm]

Originally posted by: interchange
I never trust a news report of a medical study (or a study of any kind actually). The results and conclusions are almost always improperly presented unless directly quoted from a reliable source (and still there's a chance of a misquote). And there is no analysis of how the study was conducted and who performed the study.

This isn't a study but rather analysis of trial data from 35 or 47 (saw different #s in different articles) trials submitted to the US FDA, inluding results the drug companies didn't publish. That doesn't give me any insight into how valid the results are.

Here is the actual article in PLoS medicine.


From some of the news articles:
"Kirsch and colleagues used a technique called "meta-analysis", where they put together data on clinical benefit from all the trials submitted to the US Food and Drug Administration for four drugs: fluoxetine (Prozac), venlafaxine (Effexor), nefazodone (Serzone), and paroxetine (Seroxat / Paxil)."

"Method: Using freedom of information rules, researchers obtained a full set of trial data from the U.S. Food and Drug Administration, including results the drug companies had chosen not to publish."

The one thing that everyone seems to agree upon is that anitidepressants are overprescribed.

 

[alkemyst]

Originally posted by: moshquerade

Originally posted by: Auryg

Originally posted by: moshquerade
I'm not a rocket scientist, and still I've been saying this time and time again: Antidepressants aren't a help for most people. In fact, they make the situation worse.

Another thing I firmly believe is that regular docs should not be able to prescribe antidepressants only Psychiatrists should. This would cut down on SSRIs being dispensed like a cure all for any little crisis someone is going through. I read and update medical histories and I see first hand how many people are on antidepressants. The amount of people taking them has exploded. It's not a good thing.

You're right; you're not a rocket scientist. Just where did that idea come from? Where did you get the idea of "most" from?

Antidepressants are overprescribed just like every other drug in America is. Deal with it. They've personally saved my life, and not in the way you think. Without them, I could barely stay awake. I tried every conceivable thing - more exercise, less exercise, varying levels and times of sleep, eating differently - even sleeping in a different place. I had more tests done on me than most people have done in a lifetime.

In the end - when there was nothing else to try, my doctor put me on an antidepressant. All of a sudden, my life totally changed around. Without them, I may have failed college by now, or maybe not even gotten in to the one I'm on.

And yes, there's been side effects. The first drug i was on was Lexapro, and it made me gain 40 pounds quite quickly (as in, a month or two). Thankfully that levelled off, but I couldn't drop the weight, so I'm on Wellbutrin now, and things are going just fine.

The point is - while some doctors prescribe too much, "most" (and I'm so kindly taking your words) prescribe them as a last resort, or to see if it's somehow linked to neurotransmitters. Mine had me even go to a psychologist (which was worthless for me). Just because you've never had a specific problem doesn't mean it doesn't exist. The brain is the most complex part of the body, and yet legions of people, including you, seem to think that it works with less problems than every other part of our bodies.

Well and fine. As said, they do help some people, the severely depressed, it's just they aren't helping all the people on them. That is the message.

Where did I get the information from? Here:

http://news.google.com/news?hl...1&ie=UTF-8&sa=N&tab=wn

The facts of this are it's one branch of antidepressants. Second it equaled the afftect of placebos. These people had improved though.

Now this doesn't release the pharmaceutical companies from selling sugar water either.

These types of 'news' stories get spun too much and over-sensationalized though.

 

[interchange]

What I can gather:
1. SSRI drugs are more effective than placebo for severe depression
2. SSRI drugs are not proven to be more effective than placebo for less than severe depression

The problem that I have with the study is not the methods themselves, but that there needs to be a critical analysis of the studies that it uses for its basis. In other words, there may be valid scientific reasons why certain studies are not published by the drug companies other than unfavorable data.

Either way, SSRIs are only marginally effective. That has always been the case, and thus the calling out for overprescription. They do help many, but side effects and especially drug withdrawal issues can be severely contraindicating.

Something I find interesting is St. Johns Wort, which has been mostly looked at as effective for mild to moderate depression. I would have to find some true double-blind studies published in reputable journals to back it up, though.

 

[Superrock]

Antidepressants DO work. They are just overprescribed and are given to people that aren't sick enough for them to be effective.

 

[Modelworks]

Antidepressants are over prescribed, thats the main problem with them.
People go to a doctor complaining they are sad or upset with how their life is going and the first thing the doctor does is write a prescription.

Do they work.
Definitely.
I have had severe depression for 19 years now.
When I first became depressed when I was 17 I had 2 suicide attempts the first year, eventually ending up hospitalized for a 6 month stretch because they couldn't get the depression under control. I don't mean feeling sad all the time, I mean sitting in a corner, not caring to eat, bathe or anything else, just a screw the world, let me die, attitude.
For the first month in the hospital I was not even allowed to be alone , I had to be within arms reach of staff at all times.

It took many years to get things under control. I eventually went to college, studied electrical engineering, got a job and am now living a happy life.
I could not have done that without antidepressants. I currently take Effexor XR, been on it for the past 3 years. It works.

Only bad thing I can say about it, is that people that are placed on it need to be informed that while its not addictive like crack or cocaine, DO NOT stop it suddenly.
There has been a few times that I was off it for a day or two because I didn't get it refilled in time.
The result was awful, dizziness , nausea, can't sleep, trembling. Described by other people to be worse than crack withdrawal.
That information is not told to people that are started on the drug. You have to read it in the PDA or from other users.

Other than that the drug has enabled me to carry on with life, like a normal person, whatever that is

 

[moshquerade]

Originally posted by: Superrock
Antidepressants DO work. They are just overprescribed and are given to people that aren't sick enough for them to be effective.

I totally agree.

 

[erikistired]

Originally posted by: JohnCU
they just make you emotionless. or they do for me. if i don't take mine for a couple of days my emotions go haywire and come out all at once - like crying at a stupid sad song. also, paxil makes my cravings for alcohol go haywire.

i also told my dr about the sexual side effects and he said "just take viagra"

yeah, that's what they do for me too. other than the sexual stuff, that works just fine.

of course i get a headache if i lay off mine for a few days too, which is supposedly part of the withdrawal from lexapro.

 

[erikistired]

Originally posted by: alkemyst

Originally posted by: moshquerade
you think you have a clue? or are you of the "most posting" here?
if you do think you are more knowledgeable than "most posting" please... please do elaborate.

go look up some more 'news' to repost. I think having a mother in nursing my whole life, having 7 years college level biological/zoological study, and being a pharmacy major puts me a little more in the 'know' than you.

Not to mention I know people on anti-depressants who are definitely 'off' when they don't take them.

Much of those on anti-depressants don't really need them though, it's like those taking viagra as well. It's a crutch people think they need to have and doctors are more than happy to write out prescriptions for a buck as long as they can.

However; you go girl.

It seems a news article and a quick trip to wiki has you thinking you are the EXPERT though.

ALERT! ALERT!

alky is making up a past to fit his argument. i repeat, alky is making up a past to fit his argument.

ALERT! ALERT!

 

[moshquerade]

Originally posted by: fisher

Originally posted by: alkemyst

Originally posted by: moshquerade
you think you have a clue? or are you of the "most posting" here?
if you do think you are more knowledgeable than "most posting" please... please do elaborate.

go look up some more 'news' to repost. I think having a mother in nursing my whole life, having 7 years college level biological/zoological study, and being a pharmacy major puts me a little more in the 'know' than you.

Not to mention I know people on anti-depressants who are definitely 'off' when they don't take them.

Much of those on anti-depressants don't really need them though, it's like those taking viagra as well. It's a crutch people think they need to have and doctors are more than happy to write out prescriptions for a buck as long as they can.

However; you go girl.

It seems a news article and a quick trip to wiki has you thinking you are the EXPERT though.

ALERT! ALERT!

alky is making up a past to fit his argument. i repeat, alky is making up a past to fit his argument.

ALERT! ALERT!

this has never happened.

 

[Geekbabe]

A big piece of the problem imho is this...

there's depression that's situational in nature.. a death or 2 or 3 in a fairly short time frame,divorce, loss of a job,large fiscal reverses.. bad things can and do happen regularly often to very nice people.

Biochemical depression..which also happens quite frequently to many perfectly nice people.

What came first,the sitituational stressors or the biochemical depression? is this patient depressed because he lost his job or did he in fact lose his job because just getting up on time in the morning had become a struggle and he was performing poorly there.

Keep in mind that people don't usually go from highly functioning,energetic individuals to the point that getting out of bed and taking a shower is a major struggle over the course of a few days. Lots of people report that the onset of their illness was fairly gradual... and that they don't realise how sick they actually were till they start to recover.People can also become so deeply depressed that they become psychotic. Treating people before they get to these points and cause further life losses for themselves is very important.


Then there's the cascade effect..you pile enough major losses on top of a person and you might very well end up with depression.

A clinician faced with chicken/egg situations is going to opt for safety.. a short course of talking therapy,combined with anti-depressant medication.You never know which depressed person will actually act to take their own life, opting to try both talking therapy and medications seems sensible to me.

 

[jandrews]

OP, actually you are wrong, the article clearly states that the medication does help and did help more than the placebo there just wasnt much of a difference between the two people. Anyway, I have the feeling that they are prescribed too much already but I would like to see what they refer to as alternative treatments.

 

[Noobtastic]

A plethora of information is available documenting the effectiveness of anti-depressants, anti-psychotics, and mood stabilizers.

This only proves how poor our system is at dealing with issuing these drugs.

 

[Vic]

It's really not a chicken/egg scenario IMO so much as long-entrenched wrong beliefs about the human mind and how it works. The human brain is the most powerful self-programming analog massively parallel computer in the known universe. But it is still a machine. And not only can it break down or malfunction like a machine, but it can do that to itself. All those thoughts and ideas buzzing around in our heads are massively simultaneous electrochemical interactions taking place between the 100 billion+ neurons communicating with each other at 100 trillion+ different synapses. And sometimes things go wrong beyond the ability for a brain to self-program itself back to what is considered to be normal. Sometimes that occurs do to environment, sometimes it's a genetic defect, more likely it's a combination of both. But in the end, even though it's the most ridiculously complex machine we know of, it's still just a machine, and that's all there is to it.

 

[Sust]

Sometimes when you run out of perspective, it's good to hit the blogosphere
Of course, it's just another person's opinion, but at least there's a place to begin discussion.

 

[Auryg]

Originally posted by: interchange
What I can gather:
1. SSRI drugs are more effective than placebo for severe depression
2. SSRI drugs are not proven to be more effective than placebo for less than severe depression

The problem that I have with the study is not the methods themselves, but that there needs to be a critical analysis of the studies that it uses for its basis. In other words, there may be valid scientific reasons why certain studies are not published by the drug companies other than unfavorable data.

Either way, SSRIs are only marginally effective. That has always been the case, and thus the calling out for overprescription. They do help many, but side effects and especially drug withdrawal issues can be severely contraindicating.

Something I find interesting is St. Johns Wort, which has been mostly looked at as effective for mild to moderate depression. I would have to find some true double-blind studies published in reputable journals to back it up, though.

St. Johns Wort causes anxiety in everyone I've heard taking it; including myself (thought I could maybe get off the antidepressants and switch). It was a bad idea; before then I never knew what anxiety even felt like