posted
I have gotten a lot of flack for stating my opinion on the efficacy of antidepressants in the past. I'm fairly sure that this is due to a piece I wrote which was very critical. While the numbers in that piece are not inaccurate, it was written a long time ago and since then I have improved my editorial standards (hopefully!) and would not have written that piece the same way.
To reflect this, I have added "This is an editorial" on the top of the post. No other post on my site has this distinction.
It is mildly annoying to have every thread I start on medical topics (even on completely unrelated topics) hijacked by that discussion. So I thought I'd share for the curious is a new piece I wrote on the subject that I feel does a better job representing both sides of the debate.
posted
I appreciate the effort to be more balanced, and there are things to be concerned about. Informed consent is a big issue, and vital to the patient's right to know.
However, this new article is not really balanced, and many of the original critiques still apply. The most noticeable is the comments about suicidal ideation. Doubling a 2% risk of thinking about it, while showing no (or little) increase in attempting it, is not the risk you make it out to me. Particularly when you consider the positive effect it has on the lives of people who are effected positively.
Especially when you consider the long term risk of suicide of people experiencing long term depression, particularly severe depression. They have not just an increased risk of suicidal ideation but an actual increase of suicide attempts.
I won't beat you up about it. As you said, you have been repeatedly criticized on your stance, and I doubt anything further I would say would change your mind, either about the meds OR the advisability of presenting this info in the format you have chosen.
Posts: 15082 | Registered: Jul 2001
| IP: Logged |
quote:Still, antidepressants can, for seriously depressed people, be literally life saving.
This is the BIG truth of anti-depressants. For people who are seriously depressed, there is now a drug, or class of drugs, that provides sufficient relief in a reasonable enough time frame to earn the label "life saving."
Experience with serious depression would convince anyone that effective medications are an essential part of any treatment.
They shouldn't be the ONLY thing.
And there's enough evidence about side effects of these drugs to demand that care be exercised by those who prescribe them and by those who take them.
Frankly, anyone who comes away from the experience and the literature drawing any conclusion but the above had better have a great deal of clinical proof on their side if they don't want to be considered an axe-grinder.
Posts: 22497 | Registered: Sep 2000
| IP: Logged |
posted
Unfortunately, that isn't what comes though on that page.
I personally know people who have gone off those types of meds and ended up dying because of it, usually within a few months. Yes, there are risks. But they work VERY well for people who are clinically depressed, in conjunction with other forms of treatment.
Posts: 15082 | Registered: Jul 2001
| IP: Logged |
quote:Experience with serious depression would convince anyone that effective medications are an essential part of any treatment.
Conditional on what you are classifying as "serious depression", I don't believe that I agree with that.
CBT can cure serious depression without antidepressants. CBT + antidepressants has been shown to be more effective in a majority of cases, but there can be cases where antidepressants are problematic and it would be inaccurate to regard CBT alone as something that is not a potentially effective treatment.
Also, there is support in the literature that various forms of exercise are as good or better a treatment for some types of depression as pharmacological antidepressants.
Posts: 10177 | Registered: Apr 2001
| IP: Logged |
quote:Experience with serious depression would convince anyone that effective medications are an essential part of any treatment.
Are you really claiming that every treatment should include antidepressants? That's a pretty extreme stance, and one that I certainly don't agree with.
Posts: 16551 | Registered: Feb 2003
| IP: Logged |
posted
Every treatment for depression? No, absolutely not.
Every treatment for serious depression — severe depressive disorders, really — well, probably in every case where there is not a significantly adverse reaction to antidepressants.
Posts: 15421 | Registered: Aug 2005
| IP: Logged |
posted
I think it's also important to consider the number of cases where depression is misdiagnosed, particularly in regards to Bipolar Disorder.
Bipolar II, in particular, is highly misdiagnosed, namely because the hypomanic episodes aren't seen as a BAD thing for most people- increased productivity, less need for sleep- when compared to the severe depressed states, that's a welcome relief. I went nine years being told I had Major Depressive Disorder, and was on and off SSRIs for most of that time (starting in junior high school). A visit to the hospital last fall and some lengthy sessions with both a psychologist (as a therapist) and a psychiatrist (as the primary prescriber of medicines) finally got me on the medications that have made a radical difference in my life- An antidepressant (Wellbutrin) combined with a mood stabilizer (Lamictal), treating a diagnosis of Bipolar II with emphasis on the major depressive episodes. Yes, those medications both have serious side effects. Serious headaches, shakes, muscle twitches, strange and sometimes scary dreams, and Lamictal in particular carries a risk of a rash that can be fatal- but they're worth it. I can't possibly emphasize that enough. Even the sexual side effects from the SSRI class of drugs aren't a big deal for those who derive serious benefit from the medication, no matter how much the media and other sources claim they're life-disrupting to the point of being damaging.
I think the biggest issue I had with finding the right medications was that I relied on my family doctor to make the decisions about which ones were right for me. He's just a general practitioner, not a specialist. Anyone who's going to be on any kind of mood- or mind-altering drug for an extended period of time needs to be talking to a psychiatrist, not a regular doctor. As far as side effects are concerned, there are any number of sources as to what those are for any given medication- including that sheet they give you every time you fill a prescription for one.
Personally, as far as therapy goes, I think CBT should be tried alone first- if that doesn't show improvement, add medication to the treatment. There may be rare cases where medication alone is sufficient, but that's probably mostly minor depression, not major depression. Exercise has only been shown to make a serious difference in mild to moderate depression- before suicidal ideation has begun.
Just my two cents.
Posts: 1591 | Registered: Jul 2005
| IP: Logged |
quote:Personally, as far as therapy goes, I think CBT should be tried alone first- if that doesn't show improvement, add medication to the treatment.
Start therapy THEN move to antidepressants is far more preferable usually than start antidepressants THEN move to therapy.
BUT.
There are always circumstances where the opening salvo, so to speak, should be a combination of both.
Posts: 15421 | Registered: Aug 2005
| IP: Logged |
posted
It's important to remember that, when prescribed in conjunction with therapy, antidepressions are a means to an end, and not an end in and of themselves. Even having several close relatives and friends diagnosed with various mental disorders, I have never seen antidepressants recommended in any way except as a temporary relief until the therapy can make significant progress. Or, in my mother's case, as a temporary crutch to lean on while her repressed memories of childhood abuse come back.
I'm curious as to the relationship between antidepressants and suicide ideation, though. What was the precise correlation? It seems to me that the kinds of people who would take antidepressants would be at greater risk for suicide ideation and even suicide attempts than the average populace. Could this account for the link?
Posts: 196 | Registered: Jun 2009
| IP: Logged |
posted
It should also be noted that SSRIs can have an extremely positive effect in cases of anxiety or panic disorder, which can be not only debilitating but physically very painful. In my case I attribute my total cessation of symptoms to medicine alone (my initial therapist was an analyst, which is to say worthless, and it wasn't until some time later that I got into CBT which allowed me to do without meds).
Posts: 4600 | Registered: Mar 2000
| IP: Logged |
quote:Personally, as far as therapy goes, I think CBT should be tried alone first- if that doesn't show improvement, add medication to the treatment.
Start therapy THEN move to antidepressants is far more preferable usually than start antidepressants THEN move to therapy.
BUT.
There are always circumstances where the opening salvo, so to speak, should be a combination of both.
I'd say the reverse, usually. It takes weeks to build up a therapeutic level of some of these modern drugs, and usually they are prescribed as soon as a diagnosis is made, because waiting can be deadly. Far more deadly than the possible side effects.
Patients progress and/or side effects should be monitored, of course. But sometimes it takes a while for people to get into serious therapy, and waiting until then to start antidepresents can be a horrible idea.
Posts: 15082 | Registered: Jul 2001
| IP: Logged |
posted
For myself, depression shuts down my ability to consider alternatives to the situation. When I try, it's like a gray, terrifying fog has decended over the future and no alternatives exist to what I'm facing.
So for me, the SSRI was the first step so I could deal with the problem and make the changes I needed to get out of the situation. I have no idea how CBT would have helped - depression seems rather stoic to me to start with. Posts: 2283 | Registered: Dec 2003
| IP: Logged |
posted
I think it is important to keep in mind that depression is a chemical imbalance, not a mental thing for some people. Without the drugs, therapy may not be able to work for some people. I have known people who are really against the idea of drugs, been in therapy for a few years and had no improvement. They had made all the lifestyle changes (sleeping schedules, eating, working out), did the mental exercises to change how they thought, but they just couldn't pull out of it.
Tinros, I know someone who they are still debating the diagnosis (different than person above). The bipolar meds work beautifully for him, but he has never had anything that sounds manic. The closest they can come up with is panic attacks. In the end, they decided, diagnosis doesn't matter, results do. His brother though has had manic attacks which are not happy, but imagine a very depressed person on a whole lot of caffeine. Moving around a lot, talking fast but all about how much his life sucks. I have friends who I have seen in full manic (diagnosed officially and on meds) and watching this guy, I was like, omigosh- ignore the words he is saying and no one would argue he was manic. But because he was still unhappy at the time, he refused to accept the idea of bipolar.
Posts: 2223 | Registered: Mar 2008
| IP: Logged |
posted
scholarette, that's one of the reasons no one saw me as having hypomanic episodes. Hypomania commonly manifests in two ways: the better mood/increased productivity, or serious irritability. For me, it was the latter. I never really had the improved mood that tends to go along with what people think of as mania.
Posts: 1591 | Registered: Jul 2005
| IP: Logged |
quote:I think it is important to keep in mind that depression is a chemical imbalance, not a mental thing for some people.
I think it's also important to realize that for some people, it's very much a mental thing, and can be dealt with without drugs.
Posts: 16551 | Registered: Feb 2003
| IP: Logged |
posted
mph- while that is true, it is far more likely for people to assume that people could just change if they wanted to, which is very detrimental to those who do need the drugs. Viewing it as just a mental thing makes people who need help not get it and also makes people who are still needing the drugs decide that they don't, which can have devastating consequences.
Posts: 2223 | Registered: Mar 2008
| IP: Logged |
posted
I think we need a different name for depression caused by chemical imbalance. Too easy for people who have never suffered from it to dismiss it. "Depressed? Just cheer up already!"
Posts: 7790 | Registered: Aug 2000
| IP: Logged |
quote:mph- while that is true, it is far more likely for people to assume that people could just change if they wanted to, which is very detrimental to those who do need the drugs.
In this very thread we've had people claim (or seem to) that depression should always be treated with drugs.
Posts: 16551 | Registered: Feb 2003
| IP: Logged |
quote:Originally posted by Chris Bridges: I think we need a different name for depression caused by chemical imbalance. Too easy for people who have never suffered from it to dismiss it. "Depressed? Just cheer up already!"
I have to admit, I'm a bit baffled by normal people's obsession with sadness. Most of the time, I don't even feel all that sad. I'm much more likely to feel very sad when I am, but for me, it's mostly the inability to envision change that bothers me.
Ok, and the irritablity is pretty bad. Though I suppose that's more a problem for the people around me. Posts: 2283 | Registered: Dec 2003
| IP: Logged |
quote:Originally posted by Kwea: I'd say the reverse, usually. It takes weeks to build up a therapeutic level of some of these modern drugs, and usually they are prescribed as soon as a diagnosis is made, because waiting can be deadly. Far more deadly than the possible side effects.
Patients progress and/or side effects should be monitored, of course. But sometimes it takes a while for people to get into serious therapy, and waiting until then to start antidepresents can be a horrible idea.
That is .. actually, a pretty good point. I am going to assume that you can even take that line in the case of anxiety and panic disorders as well as perhaps even generalized anxiety disorder.
Posts: 15421 | Registered: Aug 2005
| IP: Logged |
quote:Ok, and the irritablity is pretty bad. Though I suppose that's more a problem for the people around me.
My wife's problem was that everything was too much. A sink full of dirty dishes was overwhelming, a huge chore that just had to be done again and was ultimately futile.
Once she got on the right meds -- after trying several different dosages/combinations -- it took her several more months to completely relearn how to react to every day life.
Posts: 7790 | Registered: Aug 2000
| IP: Logged |
quote:Originally posted by Kwea: I'd say the reverse, usually. It takes weeks to build up a therapeutic level of some of these modern drugs, and usually they are prescribed as soon as a diagnosis is made, because waiting can be deadly. Far more deadly than the possible side effects.
Patients progress and/or side effects should be monitored, of course. But sometimes it takes a while for people to get into serious therapy, and waiting until then to start antidepresents can be a horrible idea.
That is .. actually, a pretty good point. I am going to assume that you can even take that line in the case of anxiety and panic disorders as well as perhaps even generalized anxiety disorder.
It all depends on how severe the problem is, mostly. I am not talking about normal depression, or mild depression. For a lot of THOSE types of cases, mph might be right.
I never said every person should automatically start popping pills if they might ned them eventually. I specifically said clinically depressed people should start meds first, and often times meds are the first line of defense of SERIOUS depression.
Do you know what the #1 reason people with mental disorders commit suicide? They take their meds, start feeling better, then stop taking them. Or they are never compliant in the first place.
Posts: 15082 | Registered: Jul 2001
| IP: Logged |
quote:Originally posted by Chris Bridges: My wife's problem was that everything was too much. A sink full of dirty dishes was overwhelming, a huge chore that just had to be done again and was ultimately futile.
That sounds familiar. And laundry. There's two of us; how can we go through a couple loads of laundry a week? How much are we wearing? We won't discuss what cooking dinner feels like some days.
But I think in the end, the worst part is how easy it is to lose my joy. For my birthday two months ago I asked for jewelry making supplies, and I have absolutely fallen in love with it. I was actually to the point with it that I was wondering if I'd been unhappy so long I didn't remember what real happy was or if I'd overshot it and was on to some sort of hyper-happy. Then the KGB portion of the downsizing started and that fast it was gone.
I still feel pretty good, but one stressor was enough to knock my mood down several pegs. And frankly, it hasn't gone back up to where it was since. When I'm working on a piece, I still feel great, but the mood doesn't carry over to where I'm grinning and humming little tunes for no reason anymore. At this point, the plan is to keep working on pieces until I'm good enough to sell them part time instead of working at the office. I'm just not cut out to deal with other people's drama all day.
Posts: 2283 | Registered: Dec 2003
| IP: Logged |
Printer-friendly view of this topic
![[Smile]](smile.gif)
![[Dont Know]](graemlins/dontknow.gif)
![[Razz]](tongue.gif)
