Comment by ghusto
8 hours ago
The hate on antidepressants is not because they're not effective, but rather that they're abused by psychiatrists. Ideally, a professional will prescribe them as a necessary helper to becoming (more) mentally healthy whilst tackling the root cause. Most of the time however, it's more of a "here, take these indefinitely".
It's like if we took sleeping pills every time we had trouble sleeping. Having said that, I just realised I have the impression that's exactly what people do in the USA?
I suffer from severe crippling OCD and anxiety. Years of therapy and psychoanalysis have failed to find any cause, and, if anything, made it worse. The best explanation has been it's probably because I'm autistic, and these things tend to happen to autistics.
Luckily, sertraline was an almost instant cure.
I can come off it for periods, but it tends to reoccur after a while. So, it does mean I have to take a drug indefinitely, but is that really a problem? It turns my life into one worth living.
The reason we can't take sleeping pills daily is because they stop working in fairly short order. But if, like antidepressants (typically), they didn't lose their effectiveness over time, would there even be a problem with using sleeping pills if you had trouble sleeping?
I'm not an expert so maybe someone else can clarify further, but in relation to sleep medications I've heard that they should not be used for more than two weeks, or they can permanently fuck up your sleep cycle.
They also give you low quality sleep, because they just knock you out. It's not a natural kind of sleep.
At least that's how it was a while ago. Maybe the situation has improved.
I used ambien for sleep and provigil for mindfullness (the go/no go packets) during long deployments in the military and it took me years to get back to anything normal after leaving the Army. These are very powerful medications.
Bit off-topic, but melatonin taken at right doses appears to work very well. (commonly prescribed doses are 10-30x too much and likely cause tolerance). See the post https://slatestarcodex.com/2018/07/10/melatonin-much-more-th...
I’ve heard this before that common doses are unnecessarily high but why is that? Patents?
7 replies →
Agree. But sometimes there is no "root cause", the brain is still a mystery. If you had been depressed even when you knew there was nothing to worry about, you would see it differently, because then you deduce that the black cloud is produced within.
Chemistry trumps psychology. Good enough chemistry enables cognitive treatments. But to fix the wrong chemistry you need chemistry.
The neurotransmitter model of mental illness is largely incorrect. It's much more complex than just "Depressives have less serotonin, therefore lets give a reuptake-inhibitor to keep serotonin in the brain".
The creator of the Serotonin hypothesis admitted it was wrong, and he shifted to melatonin's precursor later in his career. The challange with any research in this area is Serotonin and Melatonin both affect biological functions by gradient activity not lock and key receptor models. This pair is how plants and animals respond to seasonal changes which vary year to year. Serotonin is the warm and light lide melatonin is for cool and or dark.
My personal preference is to always suggest getting actual daylight on your retina for 20 min three times a week. Not through glasses, including eyeglasses, but can be through eyelids. That loads transferatin, as in transfer, this loads the enzyme that make serotonin. This then allows the body a better chance to make the intermediate between Serotionin and Melatonin, and is the one believed to help. But the patents have expired so it is like an orphan drug now.
https://pmc.ncbi.nlm.nih.gov/articles/PMC3779905/
> Chemistry trumps psychology
To nitpick: The mind is applied biochemistry. Psychology intervenes in the chemistry, like many other activities do. The goal of that is to solve the root cause so that your future levels will be maintained at the right level, instead of just forcing the level by sourcing the respective chemicals externally.
A good rule of thumb in biology and particular any kind of hormone production and balance is "use it or lose it" - if you start regularly receiving something externally, internal production will scale back and atrophy in response, in many cases permanently.
Psychology can change neurochemistry but only in certain limited ways. Many people are on antidepressants long term because that's the only thing that works for them. Taking antidepressants is already stigmatized enough. People should just do what makes them feel best over the long run. Your rule of thumb does not trump hard-won personal experiences.
We don't really know how SSRIs work, but there's some evidence that it's through desensitizing serotonin receptors, not directly addressing the lack of serotonin. If so, "use it or lose it" doesn't apply; long-term adaptation is the point, and SOMETIMES does persist after quitting.
>A good rule of thumb in biology and particular any kind of hormone production and balance is "use it or lose it" -
Very basic and very often wrong rule, so take it with a grain of salt.
Insulin for example is the opposite. "lose it then use it" would be a general rule for type 2 diabetics where insulin resistance commonly due to weight gain is the primary problem. Losing the weight leads to better uptake and usage. For a type 1 "lose it then use it" you typically lose the ability to produce insulin to an an autoimmune disorder, then are stuck using insulin for the rest of your life.
The body itself typically attempts to main homeostasis, but at population scales this is something that is going to have a massive range of ways it shows up. Evolution, at grand scales, doesn't care if you survive as long as enough of your population survives and breeds. At the end of the day you might just be one of those people that was born broken and to work properly you need replacement parts/chemicals. A working medical system should be there to figure out which case is which.
>A good rule of thumb in biology and particular any kind of hormone production and balance is "use it or lose it" - if you start regularly receiving something externally, internal production will scale back and atrophy in response, in many cases permanently.
There are ways to "hack it".
For example, ~6 months ago I started trt (testosterone replacement). It was the best decision health wise ever. I feel way better psychologically, first time in my life I managed to stick with cardio training for so long (before 3 months was the most). There are other benefits too.
So what about the "loose it" part? Well there is a hormone called HCG one can take a twice a week to trick one's balls into producing some natural testosterone. Its use prevents atrophy and infertility.
If you view a world at a certain angle there is always something to worry about: 1. World in not perfect, it doesn't confirm to how we want it to be (and could not even in theory given that different people want it to be different) 2. The future cannot be predicted with 100% accuracy so even if all is perfect today you can worry that it will turn bad in the future.
When looking at the same reality one persons sees the situation as OK and another as a an endless and hopeless disaster it is hard to tell who is right. A depressed person would tell that most people around him are wrong and are optimistic only because they don't understand how bad all is.
That's incredibly reductive. I'm sure some people's depression can boil down to a matter of perspective, but it's naive to extrapolate that to everyone with depression.
I'm incredibly optimistic and am content with my position in life. My default state is being mindful of the present and I don't think about things too far into the future. I very rarely ever feel stressed out over things in life.
However, none of that changes the fact that I feel completely empty and find no joy in things. Interests are nearly non-existent, emotions dialed to 1, and the only thing I'm motivated to do is lay in bed staring at the ceiling... unless I'm on sertraline.
Admittedly that's just anecdotal, but I worked in a clinical neuroscience lab researching treatments for severe treatment-resistant depression (read: people who tried so many options including CBT that they even tried electroshock therapy). The only thing that helped those subjects was a regimen of personalized neuroimaging-guided transcranial magnetic stimulation for 10 minutes every hour for 10 hours every day for a week. Even then, it wasn't permanent. Some saw improvement for months, others only weeks.
For some people, it's not just a matter of "perspective".
10 replies →
> A depressed person would tell that most people around him are wrong and are optimistic only because they don't understand how bad all is.
Or because of a legitimate chemical imbalance or some other cognitive issue they can’t control alone. Right?
5 replies →
This is the "people with anxiety should just stop being worried" attitude that failed to help for centuries. Whether or not you believe SSRI's are clinically effective, denying the existence of mental health disorders is not helping.
No, anxiety and depression aren't simply a matter of perspective.
4 replies →
Depression and pessimism are not the same thing.
> Chemistry trumps psychology. Good enough chemistry enables cognitive treatments. But to fix the wrong chemistry you need chemistry.
It's not at all clear that chemistry is the root issue. The brain is a synaptic graph that does something. Some graphs can have weird paths that lead to pathologies (maybe bad feedback loops). Chemistry seems like fairly a blunt instrument for bludgeoning a "bad" graph into one that's "better".
Forced habits, like cognitive exercises from psychology, can sometimes rewire the graph by themselves because that's how the brain learns/adapts, but we still don't have a good grasp on how to do this truly effectively in many cases.
That said, the blunt instrument of chemistry can sometimes be useful, particularly if it enhances neuroplasticity, as I think psychedelic research is beginning to show.
Arguably specific chemical patterns don't emerge and persist on their own. Basic causality will indicate that something caused that pattern, whether it is a disorder or a traumatic event. Chemical processes are not random. Otherwise, carbon based life forms would have never lasted this long
The parent commenter describes seasonal Winter depression. If the problem was brain chemistry, wouldn't it be with them from birth until treatment? Who has Seasonal Type 1 Diabetes, or Seasonal Dwarfism, or Seasonal Missing-an-Eye-From-Birth? Depression generally isn't something children have from birth, it's something adults get temporarily.
A few HN submissions recently are in the style "thinking about doing the thing is not doing the thing. Planning the thing is not doing the thing. <etc etc>. Only doing the thing is doing the thing". Comparing a brain to a large software project with bugs hiding in it, in that vein giving the computer 11 hours of 'sleep' each night is not debugging the code; overclocking or undervolting the CPU is not debugging the code; installing the latest updates and patches is not debugging the code. 'knowing there is nothing to worry about' is not debugging the code. Only debugging the code is debugging the code. Reading a badly explained idea on an internet comment and dismissing it with a mocking "thanks I'm cured" isn't debugging the code. Saying "I've tried everything" isn't debugging the code.
A more specific example, if you are going on a rollercoaster and you are experiencing physical and mental symptoms of worry - nervous, anxious, angry at the person pushing you to ride, twitching and trying to back away, eyes looking around searching for an exit, coming up with excuses to do something else instead, nervous shaking, dread tightness in the chest, affected breathing, perspiring, gritted teeth, etc. etc. then washing over all that with "I know there is nothing to worry about so this must be a problem of brain chemistry" seems a clearly incorrect conclusion.
Such a person clearly has a worry. Quite likely one that's out of proportion (e.g. "rollercoasters kill thousands of people every day!"). Possibly one that's completely incorrect (e.g. "going more than 10mph makes people's insides fall out!"). Quite likely a less clear and less obvious one - which could be anything, e.g. they saw a documentary about a rollercoaster which behaded a child and that's their only thought about rollercoasters; they saw a show about fighter pilots pulling high-G maneouvres and passing out and think that will happen to them on a big rollercoaster; they see the rollercoaster track and support flexing and don't understand that a some flexibility doesn't mean weakness; they went to a theme park as a child and older children bullied them into riding a scary ride and they wet themselves and figuratively died of shame and buried the memory; they were pushed into learning to drive at 15 by their wicked stepfather and this is pattern matching to the same kind of experience; etc. etc.
Saying "there is nothing to worry about, rollercoasters are safe enough and you know it, so your brain chemistry must be broken" isn't debugging the problem. It isn't even explaining the problem. Why would broken brain chemistry particularly affect them at a theme park, or in Winter, and not the rest of the time? How was this broken chemistry identified and measured and quantified and that hypothesis proven?
Likewise, just because the parent poster has tried sleeping and exercising and taking Vitamin D, doesn't address that humans evolved in Africa, connected to oceans and trees and tribal living, and not commuting to a fluourescent lit beige box filled with strangers writing JavaScript while being bombarded with news items about wars and genocides and stories of how everyone else is having a wonderful Christmas, earning more money than you, with a cost of living crises always on their mind, etc.
> "Good enough chemistry enables cognitive treatments."
Drugs can force people to carry on with a life that's making them miserable when they have no other available options to find out why and fix it. That isn't evidence that "there is no root cause"(!). Any more than turning it off and on again can let you get on with your job, but that doesn't show there's no root cause for a program locking up.
> "then you deduce that the black cloud is produced within."
And you have a lifetime of your prior experiences affecting your mood. When you remember that your aunt hit you when you swore at the dinner table, or you saw someone slip on ice and fall over and break their wrist, or watever, every life learning experience is "the mood is produced within".
> If the problem was brain chemistry, wouldn't it be with them from birth until treatment
Ha, of course it can be! Our brain chemistry is not stable through our life! Many children are born with epilepsy, but some people develop it later in life. epilepsy, like all neurological disorders are nature AND nurture, genes AND the environment.
Using your roller coaster analogy, there very well may be genes that control; how much fear someone experiences when riding a roller coaster. The problem society has is telling people that they all should be able to not have feear riding a roller coaster and if youa re too afraid to ride a roller coaster you should take xanax.
2 replies →
Also they are often prescribed as a life-long solution, instead of a temporary stop-gap to get through some bad state of mind while, as you said, "tackling the root cause". At some point they will potentially stop working which requires switching meds and often the next one won't work as well, plus, leaving the user stuck with withdrawal symptoms for unspecified amount of time (potentially years) and anti-depressant pushers don't usually warn about this, or even acknowledge it when confronted with "since stopping I have symptom x, y, z".
Source: multiple friends, family and forums (while researching how to help friends & family get off of various SSRIs).
They allow me to function. I've gone through various dosages of various types to find the ones that work best for me, but they have never stopped working. They also allowed me to stick with CBT therapy, and after 20 years my therapist told me I didn't need him anymore ("Call if that changes").
Your second paragraph reveals a biased motive behind your opinion.
I'm really tired of reading anti-medicine testimonials from people who had anecdotal bad results. Yes, penicillin won't stop antibiotic-resistant strains of some germs, and in fact may kill people like me if we take heavy doses. That's worse than what you're describing for SSRIs; does that mean doctors shouldn't prescribe it?
> but rather that they're abused by psychiatrists
Doctors of all countries have been under a lot of pressure by patients and health administrators to "fix the issue and quick". The last thing that your doctor wants is giving you pills so you go away, but that's what the context very strongly incentivize. You want doctors to stop abusing pills, stop asking them for immediate fix. Give them less patients, more time and more resources to deal with the health of the population. Also, prevention.
>Also, prevention.
Prevention is one of those things that when we actually attempt to fix it would have to completely change the world you live in.
Humans are social creatures and a huge part of our mental health is dependant on the society around us. If the actual problem is "wow capitalism is really broken and showing us ads 24/7 that say were not good enough is killing us", then taking a pill is a valid solution because changing the system will take generations or very violent wars.
It's a symptom of the "health care" insurance industry. Many people end up paying a specialist doctor's co-pay when they see a psychiatrist. Some plans limit you to a maximum number of sessions you can have (6, in my case) per year. Talk therapy eats up sessions and co-pays like Pac-Man eats dots. One doctor expected me to come in twice a week. Americans don't get all the PTO and/or excused sick time they want to accommodate such a schedule.
With that said, does anywhere have enough specialists to cover as many sessions as would be needed for as many people would seem to need it?
"It's like if we took sleeping pills every time we had trouble sleeping. Having said that, I just realised I have the impression that's exactly what people do in the USA?"
Not that my personal experience is actually a statistically significant sample, but I don't know anybody who takes sleeping pills. Or maybe I do, but they haven't told me. I've also never heard heavy sleeping pill use is one of the stereotypes about Americans. There are an estimated 342 million people in the United States, so impressions aren't always meaningful.
Most forms of depressions have no "root cause" you can fix. Sometimes they have amplifiers or triggers, you might be able to work around, but that also demands first to reach a point where the patient is able to work on something.
Wellbutrin can/should(?) be taken indefinitely and there's nothing wrong with that, it doesn't pose big long term health risks. As I understand it the issue is with SSRIs (they do pose health risks, obviously there's nothing wrong with taking them if it is a net positive for you).
The US is heavily over-medicated, for sure. The pharma reps are very intimate with our doctors and it expresses as one might expect. If you go to the doc with nearly any significant complaint, you will very likely come away with some drugs. But it is not all doctors; people want easy fixes that do not require any change in habits. Not an easy problem to solve, systemically.
>people want easy fixes that do not require any change in habits
Because it's easy to say change your habits when the problems are systematic as you say. Cutting yourself off social media, or stopping watching the news isn't easy. Being bullied/stressed about work and not having other work options isn't easily dealt with. Being bombarded with advertising telling you that you suck is not something you can personally deal with.
The US especially has this idea that we're all rugged individualists and any problem we have is our own and not one created by the larger society around us and therefor communal solutions are bad, and you should toughen up.
> like if we took sleeping pills every time we had trouble sleeping
Yes, that's normal in the US. I have multiple family members who take Ambien (zolpidem) before bed every night.
Which knowing the side effects of Ambien is pretty bonkers.
I know zero people that have ever taken Ambien.
https://www.cdc.gov/nchs/products/databriefs/db462.htm
Seems like daily users would be less than 10%.
> I have the impression that's exactly what people do in the USA?
It's not a great idea to make general assumptions about such a large and diverse country. Some drugs may be over prescribed, I have no idea if Ambien is one of them, but trying to fit 340 million people across 50 states into the same box isn't going to be very accurate.
> The hate on antidepressants is not because they're not effective,
But that’s exactly what many claim. Even this article is trying to claim that Vitamin D has 4.5X higher effect size than antidepressants (e.g. that they don’t work)
> It's like if we took sleeping pills every time we had trouble sleeping. Having said that, I just realised I have the impression that's exactly what people do in the USA?
USA is actually not the world leader in over medication in this domain, even though it’s popular and safe to hate on Americans. The rates of benzodiazepine and Z-drug prescription in some countries like France are substantially higher than the USA.
The "hate" on antidepressants is mostly from a place of "The kids are taking pills for things that aren't diseases and just need to get out more" and other stupid takes about how "back in my day we didn't have this much mental illness", which is why the hate is maintained even for things like ADHD medications which are so thoroughly proven scientifically that they are one of the best proven treatments humans have access to for any disease.
Similarly, SSRIs have much better evidence in treatments for many other situations, like anxiety, and yet the medicine itself is attacked, not using it to poorly treat a disorder we barely even begin to understand.
The "hate" is not based in science, despite the fact that SSRIs are objectively a mediocre treatment for depression.
We just don't really have much in terms of better treatments because we know so damn little about depression.
The medical community knows SSRIs are mediocre and have a low success rate at treating depression. They don't have better tools. Everything is a bad treatment for depression because "depression" is a loose collection of symptoms and statistics that we have really poor understanding of, and will certainly be broken up into the actual diseases that make it up when we figure them out, and we will be able to medicate those diseases more effectively.
Every single doctor that would prescribe you an SSRI for your depression will also prescribe vitamin D supplementation if your blood shows low levels.
Someday we will also have a situation where we are going to have to admit that for some subset of the population, their depression has no cause other than "Your life is utterly terrible, for reasons entirely outside of your control, and nothing I can do as a medical professional can fix that".
>The "hate" is not based in science
The lingering roots of Calvinism in the US cause us all kinds of problems.
"You were born broken because god made you that way, don't make yourself better, and hurry up and die" permeates huge parts of our culture. It's why lots of other cultures look at us and what we do with relative confusion.
you're not wrong that pharmaceutical crutches are overused. but as an outsider to these problems my 'ambient impression' was always one of haha antidepressants are for suckers. well, in my specific case, so what if i'm a sucker... they're super effective in fixing what appears to be a defective winter brain.
> It's like if we took sleeping pills every time we had trouble sleeping. Having said that, I just realised I have the impression that's exactly what people do in the USA?
I can't speak for USA but in parts of Europe a lot of people have PTSD that prevents normal sleep, so they end up on these pills, and then they end up with PTSD and worse insomnia caused by long term use of sleep meds.
I think it's just incentives. Easier to take a pill than to deal with horrible trauma. And that probably stays true forever.
The easiest way to deal with horrible trauma is to prevent said trauma in the next generation.
What is either revealing or terrifying is seeing how many people attempt to prevent that. Sexual abuse for example is pretty rampant in the US. Sexual education at a young age so people know they are being abused under no uncertain terms is a good solution for this.
And yet you will run into far too many people that under no uncertain terms want their children to be excused from sex abuse education. What deeply concerns me is when you see people with this position that you know where sexually abused themselves.
I don't know, people really suck.
> Ideally, a professional will prescribe them as a necessary helper to becoming (more) mentally healthy whilst tackling the root cause.
I wish people would stop saying this.
Our understanding of the brain is not sufficiently sophisticated to allow us to identify the "root cause" (whatever that means) of depression in most people. Indeed we have no reason to believe that there even is a root cause to most people's depression.
If you take antidepressants, go to therapy (or meditate or exercise or whatever), then go off them and still feel good, that's great.
And if you take antidepressants indefinitely because doing so improves your life, that's also great! Your life is improved! This isn't an "abuse" of the drugs.
No psychiatrist is making you do anything. They're advising you based on their clinical judgement and experience, but ultimately it's your decision to take the pills or not. If your goal is to go on antidepressants temporarily, any decent psychiatrist will support you in that (because, again, they understand that they can't make you take the pills one day longer than you want to).
I've been on Lexapro and done evidence-based therapy for years. They both have been helpful, but if I had to pick one, I'd immediately pick Lexapro. For me it is a miracle drug. And the miracle is, I can choose how I feel.
(I also added a small dose of Buspar to help with the sexual side-effects.)
If you're on the fence about trying an antidepressant, I really encourage you to talk to a psychiatrist. If you try it and hate it, then you can stop. But a lot of people try it and love it. And I think a lot more people would be willing to try it if the notion that this is somehow "wrong" were gone.
For further reading I recommend https://lorienpsych.com/2021/06/05/depression/. I don't agree with everything Scott Alexander says, but his writing about mental health specifically has been useful to me.
I was diagnosed a while back with a chronic neurological disorder. One that has a heavy effect on my mood and can conversely be triggered by my mood. The underlying cause is scientifically proven to be physiological. I lack a specific neurotransmitter due to inactive cells in my hypothalamus.
For a long time I wrote off my symptoms as being all in my head. And after a formal diagnosis, I am 100% certain they are all in my head because that's where my brain is. Symptoms are also unequivocally psychosomatic. What I'm feeling can influence my physical symptoms and rather abruptly at that. It's right in the definition of the illness. None of this means that disease is imaginary or not real or I can talk myself out of it. It's as physically irreversible as losing an arm. There are some very good treatments, but I will never ever be cured (barring a miraculous breakthrough).
While the causes of mood or personality disorders are less well understood, it seems entirely plausible that they can be just a physically inevitable. Every thought, feeling, sensory input and motor output is a physical process originating in your brain and your brain can malfunction if it's ill. And we can treat illness with medicine.
Sometimes the root problem is that your neurochemistry is FUBAR and no amount of counseling with overcome a biological cause.
Frankly, I see this as similar to telling diabetics that they should use just enough insulin to get them to learn to stop being diabetic. That’s possible for a few type 2 diabetics who could make lifestyle changes that got them back into good ranges. It’s completely useless for type 1 diabetics, or type 2 who can no longer go back.
I’m neither diabetic nor depressed. I don’t have a dog in this hunt. I’m just always astonished at “have you tried not being depressed?” Some people can “snap out of it”. Many times that number of people cannot.
> I’m just always astonished at “have you tried not being depressed?”
There's a lot of this attitude, at least in the USA, when it comes to mental illness in general. I have ADHD, it's a common trope/meme at this point of "Have you just tried focusing?" "Gee thanks, I'm cured!"
It's a form of institutional ableism, particularly prevalent in the US I think because of our hyper individualist culture. A lot of people tend to assume that you are just lazy, or not trying hard enough, as if it was just a matter of willpower.
Kind of frustrating, because those same people would never walk up to someone in a wheelchair and say "have you just tried walking?" but for some reason mental illnesses get a free pass to be ableist.
>in the US I think because of our hyper individualist culture.
Calvinism.
There's been a number of papers written about how pervasive Calvinistic ideas are in the medical community. This tracks with the New England area of the US pumped out the most doctors while medicine was 'growing up', and protestant christianity was the most common form there. When you view the creation of the US medical system with that view many of our screwed up systems make sense. A lack of willpower is a failure of man to be in touch with god, and not a problem a doctor should solve.
That was my experience with ADHD. In retrospect, I clearly struggled with it my entire life, with it starting to cause problems around middle school age. I started getting treatment a couple years ago and it was like someone flipped a light switch. Wait, this is what it's like for everyone else? They can just decide to start doing a necessary thing before it becomes a crisis?!
In before "of course things are easier when you're taking stimulants!", which is another dumb thing I hear too often. I feel basically nothing from taking Adderall, and not in the least stimulated or more alert or more awake or anything. I can just concentrate on boring things afterward.
1 reply →
Every time I have a yearly physical, my GP will ask if I have feelings of depression.
I know this road leads to SSRIs at the very least, so I always reply in the negative.
The parent comment hints to me that this might be a mistake. I do not want to become accustomed to an antidepressant, so perhaps my course of action was correct.
I was measured low on Vitamin D, which I've hopefully corrected, and I haven't always eaten fish regularly. Perhaps I should pay more attention to that.
You really should give some modern SSRI like Escitalopram a chance. It has made my life so much better, and that of a lot of friends, too. The two most common complaints I have heard are:
1.) It's killing my libido 2.) It's too strong
For 1.) - yes, this is a very very common side effect. And it's logical - you simply get "triggered" less. Applies for me, too.
And 2.) is the same that a lot of people fail to understand: Then try a lower dosage!
Unlike most anti-depressants, where you have to constantly increase the dose because your brain just generates more receptors to fight back, SSRIs hardly wear off.
Also, relax about the "become accustomed" part. Should your Serotonin levels be too low, then they are too low. Just think about it like you think about table salt. It would be just as unhealthy to try to "get off" salt.
All of this being said: There are tons of different kinds of root causes for depression. A good rule of thumb is: Are you depressed because bad things happened to you? Then seek psychological therapy, and potentially combine this with medication in case it would be too painful to uncover the dark things. Are you depressed on a regular basis, but can not name any valid logical reason? Then your brain has a chemical problem, so stop treating it like this is an illness, but do what you would do if your car would turn on the "oil warning" lamp. You can not replace oil with therapy or willpower.
> I know this road leads to SSRIs at the very least, so I always reply in the negative.
Seems odd. Your doctor can't force you to take anything. If they say "do you want to try X?" just say "No". Not giving your doctor full medical context seems like a mistake - for example, maybe depression would be indicative of another issue, or maybe people who are depressed really shouldn't take a specific medication.
To each their own, and perhaps you have other reasons, but this seems like a less than ideal solution to a very trivial problem if the goal is just to not take an SSRI.
N=1, but last yearly physical my primary care doctor asked me if I ever had anxiety. I said yes, but that I wasn't really interested in treating it outside of lifestyle change. They asked if I wanted a prescription for prozac, without explaining anything about how to does it or titrate up or down or a time frame. I said I wasn't interested again, and that I particularly didn't want to take any medications that you can't just stop taking one day on a whim (a statement she didn't respond to).
She then proceeded to say "well I'll just write you the prescription anyway and you can do your research later and decide to fill it or not".
I was actually shocked by this interaction, and think about it often. She's a regular family doctor with the local hospital system, and this was just a regular checkup. I answered one question with a "yes, but it's manageable and I think I can handle it with lifestyle change" and then said no twice to medication and ended up with a prescription, which I ignored but don't appreciate having on my record, since it's a false indicator for future prescribing physicians.
2 replies →
Agreed. A friend of mine is a primary care doctor, and it's remarkable how often people come in for depression and after examination and labs it turns out their depression is heavily influenced by other issues, especially low testosterone or hypothyroid. A lot more people have issues with these than most people realize. There have also been people he has seen who were reporting depression, often where nearly every anti-depressant had been tried, where getting treatment for ADHD massively improved their case and was life changing. As much as people like to hate on Adderall nowadays, for people with ADHD it is miraculous.
Getting treatment for "depression" doesn't always mean SSRIs etc. Sometimes it means treating the underlying condition(s) that are having downstream affects. I would suggest everyone gets their Testosterone levels checked among other common things.
2 replies →
There are also SNRIs, which don't have the sexual side effects. I've done mostly SSRIs but in the last few years I've been on an SNRI called Pristiq and it's the best by far.
YMMV for sure - I was on an SNRI (Cymbalta) for a few months as an attempt to eliminate nerve pain. It all but destroyed my ability to climax both during and for maybe 6 months after getting off of it.
The brain zaps were also hell if I was even like an hour later than usual to take it
Why do you think SNRIs wouldn't have sexual side effects? They still inhibit the reuptake of serotonin just like SSRIs. That's the part that causes (certain) sexual side effects.
> I just realised I have the impression that's exactly what people do in the USA?
How would you have formed that impression? Whatever media and culture you’re consuming, or how you are interpreting it, is leading you to incorrect conclusions. You should examine that.
We all live in a cultural bubble but any time you find yourself thinking that millions of people somewhere else do something crazy, you should probably talk to someone from there.
Sleeping meds might be prescribed at a higher rate in the US, that wouldn’t surprise me due to the specific incentives in our health care system. But that’s a far cry from your impression.
Yeah some people pop a melatonin every night before bed
> The hate on antidepressants is not because they're not effective, but rather that they're abused by psychiatrists.
I don’t know how rampant that problem actually is, but I don’t think you should discount the impact of social stigma when it comes to mental health. It is only in the past 10 to 15 years, at least in the US, that mental health has entered the public dialogue in any meaningful sense. Historically it has been a source of massive shame with people expressing embarrassment at their loved ones suffering from mental health crises. And now we have a whole generation of influencers and politicians who are trying to tell people to pour out all their medications, reject doctors wholesale, take their specific brand of colloidal silver, and be free.
I just think this is a lot more complicated than “psychiatrists abuse the diagnosis.”
It's not like sleeping pills at all actually. Sleeping pills have a huge dependence and tolerance factor. Antidepressants, generally, do not. Once you find one that works, they keep working effectively forever.
It's actually like statins. Ideally, a doctor will recommend diet changes in addition to the pills. However, relying on lifestyle interventions almost never is effective, And the more we learn about it, the more we realize that cholesterol is mostly genetic based rather than diet based anyway. So the most effective thing they can do is say "here, take these indefinitely". And thank God they do because it saves thousands of lives annually.
For many people with depression, a neurochemical imbalance is the root cause. Just like with statins, addressing it means taking some pills.
> it's more of a "here, take these indefinitely"
And when you question this approach, the famous lecture comes: "but diabetes patients take insulin for life. You realize depression is a real condition and need to be treated right?"
> but rather that they're abused by psychiatrists
Well that but also they have poorly understood long term effects even after being discontinued (in some people, not others) and they don't work for everyone. The latter is probably most of the reason they get hated on. I don't recall the source but a given antidepressant only works for something like 1/3 or less of the population. So take a person not in a great place emotionally, who is also statistically not in a great place in life overall, subject them to an insufferable bureaucratic process, give them a drug that doesn't end up working for them, add in some pretty wild side effects, sprinkle on a few long term effects that persist after they discontinue the thing that didn't work to begin with, and of course you end up with a bad reputation.
The tl;dr is that our understanding of the brain and mood disorders kind of sucks.
"Imagine if we took insulin every time our pancreas failed to properly process sugar."
> It's like if we took sleeping pills every time we had trouble sleeping. Having said that, I just realised I have the impression that's exactly what people do in the USA?
I'm not sure if it is common but I've definitely taken my fair share of my dog's trazodone.
after being prescribed Mirtazapine, then Trazadone I realized I don't think I've had restful sleep as long as I can remember. I need a sleep study done probably but until that the quality of life from taking something that has virtually no negative side effects for me is insane.
meanwhile people are like "just take magnesium or melatonin lol"
Nobody should take this as medical advice, but from my own experience, nothing has made a bigger difference in my sleep quality than supplementing with magnesium glycinate. I didn't even start taking it for that purpose - I was taking it for something else and quickly noticed that it made the quality of my sleep significantly better. The only side effect from it is that sometimes I have strange dreams (not nightmares or anything, just odd).
Everyone should check with their doctor, but it's an inexpensive supplement and the effects (if any) show up pretty quickly, so IMO it's worth a shot.
The truth about antidepressants is that the majority of people with depression that respond to an antidepressant would also have responded to a placebo. This doesn't mean that their depression isn't real or that antidepressants "don't work". It just means that placebo has a relatively high response rate in trials for depression. The hate is (among other points) because they are only arguably, marginally, better than placebo, and antidepressants also have real side effects (activation syndrome, increased suicidality, sexual side effects, withdrawals, etc.) over placebo.
> The truth about antidepressants is that the majority of people with depression that respond to an antidepressant would also have responded to a placebo.
^ citation needed
What does "would have responded" mean? Are you saying that >50% of people with depression that are "helped" by antidepressant, would have been helped _to a similar extend_ with a placebo?
I believe that is indeed what they meant. The perception of being given a remedy is very powerful indeed, especially for issues ultimately linked to the mind.
That placebos can work should not be seen as undermining the severity or pain of the depression, but rather underline the power of tricking the mind into improvement.
> The hate is (among other points) because they are only arguably, marginally, better than placebo
Only true for some. Inarguably, well-proven false for others.
Likewise, placebos and aspirin are comparable at relieving those headaches where aspirin doesn't really solve the source, but that doesn't mean aspirin's well-documented effects are meaningless in general.