[HN Gopher] Antidepressants and medical uncertainty
___________________________________________________________________
Antidepressants and medical uncertainty
Author : luu
Score : 62 points
Date : 2021-04-04 18:34 UTC (1 days ago)
(HTM) web link (acesounderglass.com)
(TXT) w3m dump (acesounderglass.com)
| Protostome wrote:
| I've been on Zoloft on and off for the past 10 years, and over
| the years I've come to notice its not-so-subtle effects.
|
| I would start by saying that overall, Zoloft has been a life
| saver for me. I was living with a debilitating level of OCD which
| interfered with all aspects of my life - from parenting to work.
|
| Personally, I suffered from 2 major side effects:
|
| 1. Fatigue/Drowsiness - I started falling asleep everywhere and
| am tired during most of the afternoon. SSRIs are known to affect
| the brain's ability to induce REM sleep, which in turn have a
| negative effect not only on our/my wakefulness but also on
| memory, cognitive skills and mood.
|
| 2. My sexual drive was completely obliterated. I can go for weeks
| without any sexual experience, which is very unusual for a guy my
| age. To my frustration, even when I had periods when I took time
| off the drug, my libido didn't really change and remain low. I
| did some research online and found out that this phenomenon has a
| name - PSSD (Post SSRI Sexual Dysfunction).
| kjrose wrote:
| One of the biggest surprises to me when I was taking advanced
| psychopathology courses was how little certainty there was around
| antidepressants and much of the drugs used to treat psychological
| disorders. For some people they work absolutely amazingly. For
| others it can actually have precisely the opposite intended
| effect. And for some it can have literally no effect.
|
| I had a long discussion with a psychiatrist about this and they
| more or less acknowledged that it really isn't a science and is
| more of an art. You try this SSRI or that SSDI with a low dosage
| and see what happens. Then you Amp it up gently. If it works
| great. If it doesn't, then you dial it back and try something
| else. Slowly working to drugs with more and more adverse side
| effects until something works.
|
| They have an idea of why it works but they don't really know
| precisely for every person.
| lumost wrote:
| There is a profound negative consequence to this that long-term
| patient outcomes aren't very good with pharmaceutical
| interventions.
|
| In a different set of conditions I recall that Cognitive
| Behavioral Therapy has equivalent outcomes to medical
| intervention for ADHD at the 5 year mark, and afterwards wins
| as resistance to the medication is built. I wouldn't be
| surprised if similar outcomes are observed for depression.
|
| This is particularly problematic when it comes to medicating
| children/teenagers who are much earlier in how their brains
| adapt to stimulus.
| kjrose wrote:
| Oh absolutely. Medication should be a last option or an
| emergency option for most cases.
| Simulacra wrote:
| Neuroscience and depression is so fascinating because the idea
| that you have a chemical imbalance in your brain is, still, a
| theory. I'm more intrigued by the studies coming out about
| Ketamine, psybicilin, marijuana therapies, as a new angle to
| augment antidepressants and other prescriptions. I truly believe
| the switch is in there somewhere and through science we'll find
| it, so that mental illness can be corrected where appropriate.
| PragmaticPulp wrote:
| > the idea that you have a chemical imbalance in your brain is,
| still, a theory.
|
| The idea that psychiatry believes depression to be a "chemical
| imbalance" is a myth. It's a common strawman argument against
| psychiatry or SSRIs, but the truth is that the field of
| psychiatry doesn't put much weight on "chemical imbalance"
| takes.
|
| More information in this article:
| https://www.psychiatrictimes.com/view/debunking-two-chemical...
|
| > I'm more intrigued by the studies coming out about Ketamine,
| psybicilin, marijuana therapies, as a new angle to augment
| antidepressants and other prescriptions.
|
| Ketamine is interesting as a short-term rescue for severe
| cases, but it's not a long-term solution. Some doctors are
| trialing long-term maintenance therapy, but the effects tend to
| wane over time and tolerance is a major issue. Most providers
| who use ketamine will use it to kick-start regular treatment.
|
| Marijuana is not a treatment for depression and should not be
| viewed as such.
| loveistheanswer wrote:
| >the truth is that the field of psychiatry doesn't put much
| weight on "chemical imbalance" takes.
|
| Plenty of psychiatrists still assume mental illness of all
| sorts are primarily caused by chemical imbalance, which is
| why so many of them solely rely on chemicals to treat mental
| illness.
|
| "Schizophrenia is caused by a chemical imbalance and other
| changes in the brain."[1]
|
| [1]https://www.hopkinsmedicine.org/health/conditions-and-
| diseas...
| [deleted]
| PragmaticPulp wrote:
| My usual warning when these stories reach the front page: If you
| feel you might need medical help for a mental illness, please
| don't let stories like this dissuade you from seeking appropriate
| care. The author notes that the medications were effective at
| treating their condition. Too many people delay necessary
| treatment for years for fear of side effects, only to later
| discover that their underlying depression was far worse than any
| medication side effects. Medications aren't perfect, but
| untreated depression is no joke. The author's experience is also
| unlikely to match the average patient's, as their medications
| were also chosen to treat their very painful trigeminal
| neuralgia.
|
| That said, it's strange that the author's doctors didn't notice
| this earlier. The topic of which antidepressants cause somnolence
| is hardly new research. Even the author's own doctor knew that
| Medication 2 was responsible for the daytime sleepiness. I
| suspect they may have underestimated the degree of fatigue
| reported by the patient.
|
| From the article:
|
| > I did in fact know that fatigue was a possible side effect of
| the medication, but I was taking it off label at a drastically
| lower dosage than is typically prescribed (<1/20th), so it didn't
| seem very applicable
|
| Counterintuitively, some medications are more sedating at lower
| doses than higher doses. Trazodone, for example, is frequently
| used for insomnia at low doses when taken only at night, but can
| also be an effective antidepressant at higher doses when taken
| multiple times per day.
|
| Mirtazapine is another example of a medication that can be very
| sedating at lower doses but become activating at higher doses.
| Low doses primarily antagonize the histamine H1 receptor (similar
| to antihistamines like Benadryl), while higher doses activate a
| wider range of receptors that can become stimulatory.
|
| With pharmacology, it's not safe to assume that a lower dose of a
| drug simply produces reduced effects relative to a full dose. The
| effects can change throughout the dosage range.
| fwip wrote:
| > That said, it's strange that the author's doctors didn't
| notice this earlier.
|
| A number of medical professionals are shockingly unfamiliar
| with potential side effects of the drugs they prescribe.
|
| My partner was prescribed Zoloft. The prescribing psychiatrist
| simply _did not believe_ my partner when they told him that
| they were experiencing a lot of jaw-clenching / teeth
| grinding. He insisted it must be unrelated to the medication.
| There are studies going back at least 20 years documenting this
| side effect with SSRIs, affecting something like 1 in 6
| patients.
| kar5pt wrote:
| On top of that a lot of them are really unfamiliar with the
| withdrawal affects of ssri's. When I was tapering off of
| Paxil my psychiatrist seemed to think that withdrawals were
| just going to be a couple weeks of mild anxiety. In reality,
| each taper down took me over 3 months to get back to normal.
| dillondoyle wrote:
| I think another important warning here is don't stop taking
| your meds without talking to your doctor first.
|
| Author was very candid in that treatment really helped but
| doesn't mention if the taper was done with their Dr.
|
| A lot of people end up thinking 'I feel great I'm cured,' so
| they stop and then relapse - or worse trigger episodes
| including suicide. I've made the mistake of stopping other meds
| without talking to Dr beforehand.
|
| I do think though we need more research and solutions for long
| term side effects AND withdrawal issues that for a long time
| weren't taken seriously. The 'zaps' etc
| seibelj wrote:
| A lot of these posts have been appearing on the front page. I
| post something like this when I see them - SSRIs (Lexapro for me)
| saved my life. Absolute night and day difference. Until you
| experience true anxiety and depression for years, you can't
| possibly understand what a game changer this medication is for
| those it works for. Don't let articles spook you - if you are
| suffering get help.
| zander312 wrote:
| I had crushing anxiety and panic attacks that were destroying my
| life. I almost smoked the business end of a 12 guage.
|
| I started taking Zoloft and my whole life changed. Anxiety and
| panic attacks completely dissappeared. Zero side effects.
| Happiness and joy all around.
|
| I get worried sometimes though about what's happening in my brain
| chemistry. Hopefully irreversable damage isn't occuring. But I
| suppose that damage is better than the alternative. I also
| wonder, since I feel so good, if I should try weaning off the
| Zoloft.
|
| But I can't risk going back into that place of darkness. Life is
| not worth living when you feel like that.
| PragmaticPulp wrote:
| > Hopefully irreversable damage isn't occuring. But I suppose
| that damage is better than the alternative.
|
| On the contrary, untreated depression is far more likely to
| produce long-term damage than a well-studied medication that
| has been in use for several decades. Untreated depression
| really does a number on the brain and body, not to mention the
| downstream effects of reduced exercise, socialization, sleep,
| and other problems that come from depression.
|
| > I also wonder, since I feel so good, if I should try weaning
| off the Zoloft.
|
| Be careful and only proceed with the help of a psychiatrist.
|
| Depressive relapse is very common in patients who decide to
| discontinue their medication. The scary part is that the
| depression often returns very slowly over a long period of
| time, which the patient may not fully notice until they are
| deep within another depressive episode.
| zander312 wrote:
| Thanks for the reply. That makes sense to me. I am totally
| fine with taking the meds forever.
|
| I am one of the lucky cases where I experience basically zero
| side effects and it's been 2 years so far. I have heard of
| the horror story side effects like getting really overweight,
| not being able to bone, feeling fatigued, constantly napping
| etc. But I have never felt any of that. These last two years
| have been the best of my life.
|
| I always have this concern though that these meds must be
| doing something sketchy to my brain chemistry.
|
| But it makes sense that the constant terror of anxiety could
| also produce some neural pathways and brain chemistry that
| would be very bad...
| PragmaticPulp wrote:
| > I am one of the lucky cases where I experience basically
| zero side effects and it's been 2 years so far.
|
| The reality is that most (but not all, obviously) people
| don't have terrible side effects from modern
| antidepressants.
|
| It's difficult because most people who take antidepressants
| without issue simply don't talk about it. Partially because
| they don't feel like advertising their mental health
| struggles, but also because there simply isn't much to talk
| about when you simply take a medication and it just works.
|
| > I always have this concern though that these meds must be
| doing something sketchy to my brain chemistry.
|
| Given how long they've been in use and how widespread they
| are, we would have seen any blatant negative effects by
| now. SSRIs have been in use since the 80s and the
| antidepressants before that were far less selective.
|
| If anything, the research points to SSRIs being helpful in
| repairing or reversing damage caused by depression.
| Judgmentality wrote:
| If antidepressants really are pervasive as you say, I'd
| be concerned about what it's doing to us as a species
| when it comes time to reproduce. Are the offspring of
| parents who regularly take anti-depressants any worse off
| than those who don't?
|
| I think these are the sorts of questions that would be
| useful to know when really mass-prescribing drugs to
| humanity. To be clear, I'm not suggesting that the drugs
| are inherently harmful to offspring - but it seems like
| something that would be good to know. If the parents have
| a chemical dependency, what does that mean for the
| children?
| PragmaticPulp wrote:
| All medications, including antidepressants, are studied
| for potential reproductive harm. This is taken very
| seriously in wake of the Thalidomide disaster in the 60s.
|
| Is it possible that antidepressants have some extremely
| subtle transgenerational epigenetic effects? Maybe, but
| comparing healthy patients to SSRI-treated remitted
| depressed patients is a bit of a red herring anyway. The
| real comparison would be between SSRI-treated patients
| and untreated depressed patients, because healthy people
| aren't prescribed SSRIs. We do know untreated depression
| is very harmful to people and their families, so
| speculating about immeasurably small negative effects of
| SSRIs while ignoring the massive and very real cost of
| untreated depression would be a mistake.
| Judgmentality wrote:
| > The real comparison would be between SSRI-treated
| patients and untreated depressed patients, because
| healthy people aren't prescribed SSRIs.
|
| I see it very differently, as you are focusing entirely
| on the parents and completely ignoring the children. If
| the untreated patients weren't going to have kids, the
| question is only whether or not the children are happy.
| If the children of parents with antidepressants are more
| likely to require antidepressants themselves, I'd say
| that's indicative of a serious problem.
| PragmaticPulp wrote:
| > If the children of parents with antidepressants are
| more likely to require antidepressants themselves, I'd
| say that's indicative of a serious problem.
|
| I'm not aware of any evidence that this is the case. Do
| you have any evidence, or are you speculating worst case
| scenarios?
|
| Regardless, I think it's shortsighted and in poor taste
| to suggest that there is a problem with parents on SSRIs
| having children, particularly without any evidence to
| support your claims.
| Judgmentality wrote:
| Everything I'm saying is speculation. I'm asking
| questions, not providing evidence one way or the other. I
| never said there was a problem.
| imwillofficial wrote:
| So it is now verboten to ask questions?
|
| SSRIs vs Untreated depression is a false dichotomy. There
| are many treatments for depression.
| bawolff wrote:
| You don't think having a parent with untreated depression
| is bad for child development?
| msrenee wrote:
| Some cases of depression and especially bipolar disorder
| seem to have a genetic component. Parents that are on
| SSRIs, SNRIs, antipsychotics and atypical antipsychotics
| are probably already much more likely to have children
| who have the same conditions and need antidepressants, as
| the underlying condition often has a genetic component.
| grawprog wrote:
| >The reality is that most (but not all, obviously) people
| don't have terrible side effects from modern
| antidepressants.
|
| I wonder how many of those side effects might be from
| people put on antidepressants who may not actually be
| chronically depressed.
|
| I've known people who have been prescribed
| antidepressants after going through periods of
| depression, rather than it being an ongoing chronic
| problem and they have sometimes had some troubling
| personality changes that lasted even after stopping them.
|
| But I have met people who have taken them long term
| because of chronic depression that seem a lot better on
| them.
|
| I really do feel like we take too much of a 'one size
| fits all' approach when it comes to mental health. Every
| person's mind and brain are unique.
|
| I know, as humans, we like to put a factual, observable
| cause to things, but I really don't think mental health
| always works like that.
|
| Two people who may be suffering from long term depression
| or any other, mental health issue(I personally dislike
| this term greatly, but can't really think of a better
| one.), may have very different reasons and causes for
| their depression and the same approach may not be helpful
| to both.
|
| It's great we have access to medications that are helpful
| in improving people's lives, but I do wonder sometimes if
| we should focus more on addressing why someone's
| experiencing these mental states that are causing
| problems, rather than just working on correcting it.
|
| I can't speak too much about it suppose, I don't really
| know.
|
| But I had a good friend who I feel like was neglected by
| the system and didn't get the help that would have been
| good for him.
|
| His mom was going through cancer treatments and he didn't
| take it well. He got pretty depressed and didn't get out
| of bed for a couple of years. He started getting these
| worries about getting the urge to walk into traffic.
|
| So he went and tried to get some help. He was immediately
| prescribed seroquil, Zoloft, ativan and some other
| things.
|
| And...I have no other way to put it...it fucked him up...
|
| I'd get phone calls from him randomly asking what time of
| day it was, he'd forget things that happened moments
| before, he hallucinated watching new tron movie 3 times
| in a 4 hour period...the movie's like two and a half
| hours long or something, he managed to unplug my internet
| around 1am so, he wouldn't have even been able to finish
| it the first time.
|
| It was really sad seeing what happened to him and I
| couldn't help but feel like maybe if someone had just
| talked to him for a while before prescribing him those
| drugs, they could have helped him without him ending up
| like that.
| jokoon wrote:
| > I also wonder, since I feel so good, if I should try weaning
| off the Zoloft.
|
| The problems with ADs, is that people feel better, they think
| they're cured, but no, it's because the meds are working, and
| treatment should not be stopped.
| throwaway99111a wrote:
| Exactly. Before I understood I had life-long condition, I
| tried to wean myself off multiple times over the last 2
| decades, only to come back to the original symptoms
| months/years later.
|
| I now understand I have a chronic condition and I need to
| treat it as such. It would be awesome to be off
| antidepressants in the future and I'm trying to train my mind
| with meditation and other healthy practices but I don't fool
| myself with thinking that alone will be enough.
|
| And you know what? I'm fine. I'm glad antidepressants exist
| because otherwise I wouldn't be here anymore.
| zander312 wrote:
| Well I am really glad you are here and i'm also glad they
| worked as well for you as they did for me.
|
| Out of curiosity, why even have the desire to get off the
| meds? do you experience side effects?
| throwaway99111b wrote:
| I think it's a desire to live free. I don't know how to
| explain it but the thought of depending on something
| sometimes gives me anxiety about my ability to function
| as a human being, to experience life as-is, etc.
|
| The only side effect I have from taking Venlafaxine is my
| libido is crap but I can live with that.
|
| I'm a Buddhist (even if a crappy one, that's debatable)
| and in some circles, taking antidepressants feels like
| "cheating". I was just researching this topic a few hours
| ago and it seems that's not taboo anymore and even
| various teachers have come forward and shared they too
| were on Prozac or other drugs. That was a relief. I'm
| lucky that in my community that isn't seen as cheating at
| all but there's that innate feeling that, if I'm trying
| to control my mind, that an antidepressant would be
| messing with that, or hindering my practice.
|
| I don't think like that anymore. Even if it was cheating,
| I'd rather be alive and only get some benefits from
| meditation in this life rather than be dead.
|
| So yeah, coming off meds is a bit subjective for me but
| I'm coming to terms with that. Life is better this way.
| imwillofficial wrote:
| I think of it like insulin for a diabetic. They aren't
| cheating, and neither are you. I'm also buddhist, and can
| say that it's unfair to yourself to compare yourself to
| austere monks old. We live in a modern world full of
| toxic chemicals, processed food, polluted air, and
| sedentary lifestyles. There are things you can do to
| improve your physical situation, and many things that are
| beyond your control. These things effect us, our body,
| mind, and soul. If this is what you need to achieve a
| baseline level of normal, then have gratitude that you
| found it! Use it as a platform to build your religious
| practice on. Go even deeper into peace and gratitude.
| dwaltrip wrote:
| > I'm trying to control my mind
|
| I'm not Buddhist but I've studied a bit and I do
| meditate. Isn't it not best to "try to control the mind"?
| From what I've learned, it seems like the opposite of
| what to aim for.
|
| By becoming more present we are able to better see the
| mind and its endless judgments for what they are. We can
| become more in tune with reality as it is (including our
| own minds) and this helps us act and think more wisely,
| instead of based on programming, perspectives, and
| expectations that we aren't even aware of. I'd also add
| that compassion is a really important ingredient.
|
| All this to say I don't think anti-depressants are
| "cheating" in any sense :). Especially if they are the
| best tool you've found to help you live a good life. I'm
| really glad you have something that works for you. This
| stuff is no joke...
|
| I do think we can find better tools and that the field is
| on the cusp of some really great steps forwards that we
| desperately need. For me personally, I've recently
| discovered that trauma has played a big role in my well-
| being over the past 10 years and I've trying to learn
| more about that. There are a lot of promising
| developments seeking to help people actually heal from
| trauma. I've been particularly excited by the work that
| MAPS, Saj Razvi, and many others have been involved with.
| colechristensen wrote:
| The meds were originally indicated as a temporary measure to
| help a person escape a mental state, not as a permanent
| fixture... prescribing and indications have changed, but
| there is still very much such a thing as a mental state
| treated by ssri drugs which is "cured".
| imwillofficial wrote:
| This isn't correct. Cured means the defect or underlying
| problem was solved, requiring no further treatment. The
| mental stated provided by SSRIs for some is called
| "treated" not "cured."
| gaoshan wrote:
| This highlights what I feel is the real issue with such
| medications... over prescription. You, clearly, need(ed) it and
| it was a literal life saver. I was also put on some of these
| medications and while they evened me out that meant they killed
| the highs as well as the lows. I feel like they altered my
| personality and not in only good ways (overall creativity took
| a hit... I was in a creative field at the time, libido took a
| massive hit). Now I see my daughter and (pretty much) all of
| her friends being given these medications for what seem like
| relatively superficial reasons and years after the initial,
| "Wow, I have less X" many of them are starting to wonder if it
| is worth it as they experience periodic "brain fog",
| disassociation and other possible side effects.
|
| My own opinion... these are powerful tools. Critical to some.
| Overprescribed for most
| rybosworld wrote:
| I weaned off my AD medication once a few years back. I felt
| guilty about needing a medication to keep my head straight.
|
| I was fine for maybe 5-6 months. And one day I literally woke
| up with the familiar, heavy depression. It was very sudden and
| I knew I needed to resume treatment.
|
| If you need treatment, it's good to get it and maintain it.
| diob wrote:
| I also started taking Zoloft (50mg once a day) this past year.
| I've had zero side effects, besides becoming way more mellow
| and less anxious. It's weird as hell but it's definitely
| changed my life for the better.
|
| I wish I had started it earlier.
| lordgroff wrote:
| My story with SSRIs is largely similar, anxiety and PTSD almost
| at zero. One of the things I didn't realize is that my base
| level of anxiety was through the roof. I thought that was
| "normal" and that times when my anxiety really kicked up a
| notch was anxiety.
|
| And then within a month and a half of taking meds, the constant
| feeling of impending doom within my spine that was always
| there, gone.
|
| I had side effects for the first month or two but they're long
| gone. I also had first sleeplessness and then fatigue, but I
| found taking meds at night made all the difference, making that
| issue a thing of the past.
|
| I don't worry too much about my long term dependence on it:
| even if it lowered my life expectancy, which there isn't really
| any proof of, but even if it did, I'd take it as a fair trade-
| off.
| imwillofficial wrote:
| It's crazy! I never realized I was anxious until I started
| anti-anxiety meds. Modern mental health is pure quackery in
| my experience so far. It's been "let's try it and see what
| happens"
| splithalf wrote:
| It's the same with all medicine. Pain medication,
| antibiotics and so on. Doctors try stuff until something
| works. You may have overly positive views of science if you
| don't think it's being made up as we go. The body/mind
| split is artificial too.
| splithalf wrote:
| TNSTAAFL-- the stoics were on to something. Also, research
| falls apart when it comes to rare events, otherwise we could
| predict and prevent mass shootings, which coincidentally might
| themselves be a side effect of psychiatric medication. If only
| there were more data points we could know things we don't know.
| dkarras wrote:
| Same, with escitalopram (lexapro in the US)
| mushbino wrote:
| This is my experience with Paxil. I can't say I would be here
| today if it weren't for that. Everyone has different brain
| chemistry and you have to try different things until you find
| something that works. Now, I can finally get out of bed and
| exercise which I never thought possible before.
|
| There are risks to some of these medications, but they mostly
| come from not tapering off properly. Cymbalta wrecked my memory
| for a few months for that reason.
| tylersmith wrote:
| To reinforce your point, I started Paxil many years ago and
| had terrible side effects that pushed me away from ssris
| altogether leading to a long struggle before giving in and
| trying Lexapro which has given me my life back.
|
| If one doesn't work, try others before trying nothing.
| rubicon33 wrote:
| Is it at all possible that there were other confounding
| factors?
|
| I ask this because I've struggled with depression my entire
| life. I took fluoxetine (prozac) in 2012 and had similar
| experience that you describe.
|
| I stopped taking it because I really hated the idea of being a
| med all my life. After about a year, the depression was back. I
| never returned to prozac, but I've wondered year after year if
| I should. Nearly a decade later, I still don't know.
|
| Why? I still have my doubts though whether or not the
| medication was doing anything. I had also coincidentally had a
| ton of success in life around that time. I had learned some new
| exciting skills, landed a sweet job in my dream city, and was
| socializing a ton and meeting people.
|
| I reflect on that time (roughly 1.5 years worth) and to this
| day I can't really decide whether that joy was from the meds,
| or from learning something I was finally good at, landing a
| great job, feeling confidence from that and meeting people,
| etc.
|
| The return of the depression did seem to correlate exactly with
| discontinuing the meds, but, it could also have been that the
| excitement of the year's events was beginning to wear off too.
| near wrote:
| Same story here. But in my case, Zoloft gave me really bad
| tinnitus that persisted even after stopping. I switched to
| Intuniv that got rid of the panic attacks but not the
| depression or the new tinnitus. Added Lexapro and that reversed
| the tinnitus and kept all the positive benefits of Zoloft.
| Brain chemistry is different for everyone, so it's worth trying
| more than one if the first doesn't work for you. It's truly
| life-changing when it works. No one should have to live with
| daily panic attacks.
| plutonorm wrote:
| I've tried 4 different SSRIs and none of them did anything.
| Ecstacy has no effect on me. Nor do magic mushrooms. Took me
| until I was 40 ish to find something that worked. Turns out my
| issue is too little gabba or at least over excitable neural
| tissue. Pregabalin fixes me. If I can't get that then CBD
| helps.
| splithalf wrote:
| Gabapentin is a very widely prescribed drug so arguably very
| safe, certainly safer than ssri, but you won't hear about
| this outcome from CBD:
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4314910/
|
| CBD can be hepatotoxic so not a perfect solution even if it's
| highly effective.
| carols10cents wrote:
| I find the "medical uncertainty" part of this more interesting
| than the "antidepressant" part.
|
| There are a number of medical problems, side effects,
| interactions, etc that only a very, very small number of people
| experience. Doctors, rightly, seem skeptical of anecdotes that
| haven't been borne out in large studies - they're likely to go
| with the most common explanation for something and usually be
| right.
|
| But how do people who really _are_ experiencing rare problems get
| the right care for them? Doing their own research, talking to
| doctor after doctor until someone believes them? Why _should_ the
| medical community do research into problems that only affect a
| few people? Even if they do decide it 's worth it, is it
| _possible_ if the sample sizes are going to be small? Say I could
| volunteer to prove through experimentation that if you give me
| medication X, I get symptom Y, and when you give me a placebo, I
| don 't get symptom Y, but no one else has ever experienced
| symptom Y from medication X, does anyone care?
|
| All hard questions that I wish there were answers to.
| yawnxyz wrote:
| reminds me of the history of patients with alpha-gal allergies
| (https://en.wikipedia.org/wiki/Alpha-gal_allergy) and how they
| were pretty much shunned / gaslit because only a few people had
| experienced the symptoms.
|
| Apparently the only reason the link link between tick bits and
| the allergy was because the researcher studying the pheomenon
| got bitten by a tick and developed the allergy himself.
|
| There's a great Radiolab episode on this.
| rscho wrote:
| TBF, (experienced) docs usually believe their patients even
| when they tell weird stuff, but:
|
| 1. we tend to overlay our own interpretation over what is
| described. Because that's pretty much the only way if we are to
| hope to do something about it.
|
| 2. In cases where something really unusual (meaning, not
| described in the literature) happens, modern medicine is an
| exercise in flying blind. Our profession is completely bound by
| best practices guidelines. The days of individual
| experimentation are long gone, and no one will ever forgive you
| for taking the off-path if there are negative consequences in
| this day and age.
| PragmaticPulp wrote:
| There's another layer to this which makes it all the more
| difficult: The nocebo effect.
|
| In short, the nocebo effect is like the placebo effect but for
| side effects. If a patient consumes a lot of articles and
| anecdotes about negative side effects of a certain drug, they
| are far more likely to experience those side effects for
| themself, _even if they receive placebo_.
|
| This is becoming a greater problem as more patients read up on
| side effects through the worst of the worst side effect stories
| shared on social media.
| flatline wrote:
| I always thought nocebo was a belief that the medicine would
| have not therapeutic effect, which is then borne out in
| reality. But the amplified side effects dovetail with my
| understanding.
|
| As an anecdotal data point, I'm a redhead with a periodic
| liver condition and a fast metabolism, and I don't metabolize
| medications normally. I take an antispasmodic for pain relief
| in doses that leave some people catatonic and it has little
| to no negative effects on me, over a decade of use. I've
| tried low doses of muscle relaxants that leave me reeling
| drunk for hours. Had two awful experiences on SSRIs, I will
| never try those again should I ever have the need of an
| antidepressant. I suspect there are sub-populations of people
| like me who are statistical outliers.
| wincy wrote:
| I don't remember what the test is, but there's genetic
| tests for common medication that show how likely it is to
| have a weird side effect. I once had a psychotic episode
| after taking Wellbutrin, despite having no history of
| psychosis (before or since!) My daughter got a genetic
| screen and a baseline interaction is a 1, with 10 being way
| off, I suppose. My daughter got a 9 for Wellbutrin. I
| assume I gave her that. Something about my chemistry just
| doesn't interact with that drug the way other people do.
| teekert wrote:
| There is this:
| https://www.labqualitydays.fi/en/news/pharmacogenetics-do-
| yo... just the first thing I found.
| kosyblysk2 wrote:
| 10% of people need antidepressants 90% of people are depressed
| for a good reason and should reflect on themselves instead of
| looking for an easy way out of their self-inflicted/not
| understood issues.
|
| "fitter, healthier and more productive a pig in a cage on
| antidepressants "
| The_rationalist wrote:
| Did you know that 40% of well being is determined by genetics?
| https://en.m.wikipedia.org/wiki/Well-being_contributing_fact...
| summm wrote:
| Maybe, but for most of these 90% there is not much they can
| improve themselves. The system does not work for many people.
| In former times they would have just started a revolution,
| nowadays the get pills...
| rybosworld wrote:
| This is a pretty ridiculous comment.
|
| Not only are you citing suspiciously rounded percentages (and
| we know what they say about percentages), you are potentially
| planting a dangerous idea in some people's heads. Many people
| that take antidepressants (myself included) are constantly
| doubting if they still need a drug. In my case, and in many
| cases, the answer is yes.
|
| Don't make people doubt themselves just because you felt the
| need to toss your amateur opinion in the ring.
| exdsq wrote:
| I am surprised you created an account just to say this drivel
| temp0826 wrote:
| Often the reasons can be hard or even impossible to face. The
| brain is amazing at hiding traumatic events. Sometimes these
| can be examined and processed with meditation and reflection;
| sometimes the big guns (psilocybin or ayahuasca) are the tool
| for the job. I do think traumas are worth examining and
| processing, but meds may be the most pertinent first step for
| some: even a short breath of fresh air that they can provide
| could be the difference between life and death
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