[HN Gopher] Prozac 'no better than placebo' for treating childre...
___________________________________________________________________
Prozac 'no better than placebo' for treating children with
depression, experts
Author : pseudolus
Score : 168 points
Date : 2025-11-21 00:02 UTC (22 hours ago)
(HTM) web link (www.theguardian.com)
(TXT) w3m dump (www.theguardian.com)
| shswkna wrote:
| From the article:
|
| > They can also increase suicidal ideation.
|
| A very close family member committed suicide, after Prozac dosage
| adjustments made his brain chemistry go haywire.
|
| This happened 30 years ago, and it has been known to us that
| Prozac can cause this, since then.
|
| The Guardians headline is way, way understating the real
| situation here.
| carsoon wrote:
| The problem with suicidal depression is that if someone has
| created the thought pattern that death is best, then removing
| the symptoms of depression (lethargy, lack of energy, no
| willpower) now gives the person the ability to actually follow
| through with the act.
|
| Medications almost always target symptoms and never address
| root causes.
| shswkna wrote:
| Yes, this is what happens.
| kittensmittens5 wrote:
| No it's not.
| kittensmittens5 wrote:
| Completely made up idea here.
| kayodelycaon wrote:
| Yup. Depression medication can significantly help the
| emotional symptoms, but that takes longer to be effective.
|
| I'm bipolar and a lot of the medication I take does not
| become fully effective for months. For me, my medication
| slowly became more effective over years as my brain no longer
| had to compensate for hardware problems.
| fragrom wrote:
| This is what my psychiatrist more or less warned me about
| when I went on medication; that a lot of people who are
| suicidal lack the energy and ability to plan their suicide,
| and medications can sometimes undo those particular symptoms
| and people manage to end themselves.
|
| I'm not sure what kinds of studies have been done about it,
| but I've had a few therapists same similar ideas. If it's not
| a studied phenomenon, then it has folks that believe it
| exists.
| doubled112 wrote:
| Sometimes willpower improves before mood.
| autumnstwilight wrote:
| I'd like to make the point that even if this does occur, it
| doesn't mean, "therefore this medication shouldn't be
| used/is worse than doing nothing," just that awareness and
| caution is needed.
|
| I went through a frankly terrible few months on my current
| meds because they removed the emotional numbness before
| removing the bad feelings. However, once that was over they
| effectively gave me my life back after 10+ years of
| continual exhaustion and brain fog.
| DANmode wrote:
| Almost like depression is an acute toxicity caused by
| physiological variance (or infection related) detox
| inefficiency!
| DANmode wrote:
| This gets even more interesting when you realize many
| SSRIs are antibacterials.
| JumpCrisscross wrote:
| It gets less interesting when one notices that social
| animals are much more prone to depression.
|
| Inflammation and depression are linked. Infection causes
| inflammation. It doesn't follow that depression is caused
| by infection.
| DANmode wrote:
| Correct.
|
| It's caused by inflammation,
|
| one of the causes being: detox inefficiency.
| JumpCrisscross wrote:
| > _It's caused by inflammation_
|
| No, it's not. Depression can be influenced by
| inflammation.
|
| This thread is a good example of the GIGO pitfalls that
| researching with chatbots entails.
| DANmode wrote:
| Yeah, "linked to" is better than "caused by" here, for
| sure.
|
| Not often this kind of thing comes up on HN, so I was
| replying in haste at a stoplight!
|
| I'll ignore the slight, which you should know better
| than.
| amanaplanacanal wrote:
| It seems pretty common for people to read "linked to" and
| interpret that as "caused by". It feels like media had
| kind of pushed that for a long time.
| purple_turtle wrote:
| Can you link any evidence supporting this claim? This
| term sounds like a standard-issue woo.
| DANmode wrote:
| Replied to your other request too: see other comments,
| ask for what's missing for you.
| Modified3019 wrote:
| I'm not quite following the previous conversation here,
| but your comment brings to mind that one theory of a
| possible "function" of depression, is as a "sickness
| behavior" to help isolate a sick animal from others to
| protect the group. A sheep or cow getting sick and going
| off on its own is a common thing.
|
| I'm not sure if it has a technical name or if it's been
| rigorously studied, but it's a common observation which
| even I've seen (and reported to growers I work for).
|
| A casual mention here:
| http://www.sheep101.info/201/behavior.html
| Retric wrote:
| Depression is likely to have many possible underlying
| causes.
|
| It's a description of a persistent set of symptoms not
| necessarily any specific biological process.
| DANmode wrote:
| Correct.
|
| and one of the leading causes is what I described.
| SketchySeaBeast wrote:
| You really have to unpack "detox inefficiency" because
| even a google search comes back with nothing.
| DANmode wrote:
| When your normal lymphatic processes (and glymphatic
| processes) are slowed, or near-halted.
| criddell wrote:
| It might be worth using those words rather than _detox
| inefficiency_ because the latter conjures thoughts of woo
| peddlers.
| DANmode wrote:
| Yes,
|
| it turns out toxins (environmental, die-off and waste of
| cells from infection, dietary, lifestyle) are important
| to everyone,
|
| not just vegans in Sandler movies.
| purple_turtle wrote:
| Can you link any evidence supporting this claim?
| DANmode wrote:
| Beyond the links in other comments?
| SketchySeaBeast wrote:
| Is there a known correlation between lymphedema and
| depression?
| Modified3019 wrote:
| Calling it lymphatic impairment would be more
| straightforward.
| DANmode wrote:
| Lymphatic inefficiency, maybe.
|
| Impairment sounds too permanent, when this is often an
| intermittent, "on average" sort of issue - not a complete
| freeze.
| fsckboy wrote:
| > _Depression is likely to have many possible underlying
| causes_
|
| including adaptive evolutionary procreative success
| mapontosevenths wrote:
| What is "detox inefficiency"?
|
| EDIT - I ask because the only results I get when
| searching are a Harvard article debunking it. I'd rather
| hear the opinion of someone that actually believes in it
| before I read about why it's all malarky. I believe in
| arguing against the best version of someones argument.
|
| https://www.health.harvard.edu/staying-healthy/the-
| dubious-p...
| DANmode wrote:
| https://my.clevelandclinic.org/health/body/glymphatic-
| system
|
| PS Thanks for keeping this a good place to be!
|
| https://news.ycombinator.com/newsguidelines.html
|
| More for the avid reader:
|
| 1.) https://pmc.ncbi.nlm.nih.gov/articles/PMC7698404/
|
| 2.) https://pubmed.ncbi.nlm.nih.gov/40012567/
|
| 3.) https://pubmed.ncbi.nlm.nih.gov/36498538/
| purple_turtle wrote:
| Your first linked page has no word "depression" on it
| DANmode wrote:
| It wasn't intended to.
|
| It was just the best "every man" link I could provide for
| understanding how efficacy of toxin-clearing (toxicity)
| could be related to depression, other struggles with
| homeostasis.
|
| Did you grasp the connection?
| pixelready wrote:
| Finding everyone's cow is expensive and time consuming:
| https://antidepressantcow.org/2020/02/the-story-of-the-
| antid...
|
| But is the only true cure to the suffering. We'd have to
| undergo a massive reorganization of society (and upset a few
| hefty profit margins) to prioritize that, so we settle for
| the messy symptom management we have.
| cornstalks wrote:
| That story doesn't work for people with depression who
| otherwise have very good lives.
|
| I grew up in a stable household with a loving family and
| both parents present and supportive. I've never had
| financial hardship, either as a kid depending on my parents
| to provide or as an adult providing for myself and family.
| I did very well in school, had plenty of friends, never had
| enemies, never got bullied or even talked bad about in
| social circles (so far as I know...). I have no traumatic
| memories.
|
| I could go on and on, but despite having a virtually
| perfect life on paper, I have _always_ struggled with
| depression and suicidal ideation. It wasn't until my wife
| sat down and forced me to talk to a psychiatrist and start
| medication that those problems actually largely went away.
|
| In other words, I don't think there's a metaphorical "cow"
| that could have helped me. It's annoying we don't
| understand what causes depression or how antidepressants
| help, and their side effects suck. But for some of us, it's
| literally life saving in a way nothing else has ever been.
| hirvi74 wrote:
| First of all, I want to write that I am glad you found
| something that worked so that you are able to remain here
| with us.
|
| Though, I am curious about the, "otherwise have very good
| lives" part.
|
| Whose definition are you using? It seems the criteria you
| laid out fits a "very good life" in a sociological sense
| -- very important, sure. You could very well have the
| same definition, and perhaps that is what I am trying to
| ask. Would you say you were satisfied in life? Despite
| having a good upbringing, were you (prior to medication)
| content or happy?
|
| I am by no means trying to change your opinion nor
| invalidate your experiences. I just struggle to
| understand how that can be true.
|
| As someone that has suffered with deep depressive bouts
| many times over, I just cannot subscribe to the idea that
| depression is inherently some sort of disorder of the
| brain. In fact, I am in the midst of another bout now.
| One that's lasted about 3 or so years.
|
| To me, I have always considered emotions/states like
| depression and anxiety to be signals. A warning that
| something in one's current environment is wrong -- even
| if consciously not known or difficult to observe. And if
| anyone is curious, I have analyzed this for myself, and I
| believe the etiology of my issues are directly linked to
| my circumstances/environment.
|
| > I don't think there's a metaphorical "cow" that could
| have helped me.
|
| The smart-ass in me can't help but suggest that maybe
| medication was your cow?
| cornstalks wrote:
| > _Whose definition are you using?_
|
| To be honest, I've never really thought about it... I
| suppose I mean in both a sociological and self
| fulfillment way.
|
| > _Would you say you were satisfied in life? Despite
| having a good upbringing, were you (prior to medication)
| content or happy?_
|
| I would say "yes" overall. Aside from the depression
| (typically manifesting as a week or two of me emotionally
| spiraling down to deep dark places every month or so), I
| was very happy and satisfied. That's what makes the
| depression so annoying for me. It makes no sense compared
| to my other aspects of life.
|
| > _In fact, I am in the midst of another bout now. One
| that 's lasted about 3 or so years._
|
| *fist bump*
|
| > _To me, I have always considered emotions /states like
| depression and anxiety to be signals. A warning that
| something in one's current environment is wrong -- even
| if consciously not known or difficult to observe. And if
| anyone is curious, I have analyzed this for myself, and I
| believe the etiology of my issues are directly linked to
| my circumstances/environment._
|
| I think that's a great hypothesis so long as it's not a
| blanket applied to _everyone_ (which I don 't think
| you're doing, to be clear; I mention this only because it
| is what motivated my original response to the other
| commenter).
|
| I don't want to go into private details of family members
| without their permission, but I will say that given the
| pervasive depression in my family and mental health
| issues like schizophrenia and bipolar disorders (neither
| of which I have, thank goodness), I feel like there's
| something biologically... wrong (for lack of a better
| word?)... with us, particularly since you can easily
| trace this through my mother's side.
|
| > _The smart-ass in me can 't help but suggest that maybe
| medication was your cow?_
|
| Ha fair. I interpreted the story to be about depression
| being a symptom of your situation (job, health, etc.) and
| if you just fixed that then there's no need for
| medication. That definitely makes sense in some (many?
| most?) situations. But not all, unfortunately.
| jrflowers wrote:
| > I don't think there's a metaphorical "cow" that could
| have helped me.
|
| The medication is the cow for you. In this story your
| support system figured out what would work best for you,
| which was medication, and facilitated that.
|
| It's a story about a doctor that serves patients in rural
| Cambodia. Help from the local community would look
| different in Borey Peng Huoth, for example.
| coffeecat wrote:
| Take my baseless speculation for what it's worth, but
| could it be that you were depressed because your life was
| too easy? We humans are meant to struggle through
| adversity. Can you really appreciate your financial
| security if you've never faced financial insecurity, or
| appreciate companionship if you've never experienced
| loneliness?
| cornstalks wrote:
| It's a reasonable question but I doubt it. We weren't
| affluent at all and I worked my butt off for everything.
| And that's good, because I agree that if things are too
| easy it turns into a curse.
| pronouncedjerry wrote:
| very interesting. would you be comfortable sharing what
| therapy uncovered as the cause for you?
| wincy wrote:
| I mean sometimes. For me it was multivariate for sure.
| Biggest problem - wife and kid. Helped a ton. My specific
| wife, really. I doubt someone else would have helped me. I
| had a lot of self defeating thought patterns she helped me
| fix.
|
| Second - light. Lots of light, specifically in winter time.
| Like this https://www.benkuhn.net/lux/
|
| I had a horrible time with school because as finals rolled
| around in the fall semester I'd get extremely depressed and
| anxious.
| mrguyorama wrote:
| People would very likely still develop depression in
| whatever utopia you could imagine.
|
| For starters, everybody has a different utopia, so no
| matter how you change society it "won't work" for someone.
|
| And depression isn't sadness.
| squishington wrote:
| My understanding is that the optimal scenario is taking an
| SSRI in combination with therapy. The SSRI adds flexibility
| for the brain to respond to therapy and envisage new
| possibilities. If you don't include therapy, you've just
| established a new baseline to habituate to.
| Modified3019 wrote:
| This is a good thing to know, but should also be noted that
| the same thing can happen with simply naturally recovering
| from a depressive episode.
|
| The phenomenon should not be considered a reason to not
| medicate (which I don't think you are implying, but some may
| take that as the conclusion). Instead it's definitely
| something important to explicitly make people aware of.
|
| Depression or the feeling so much mental _agony_ that the
| idea of escaping with death becomes comforting, is a signal
| that something is wrong.
|
| Realizing this has been important with weathering my own
| occasional dealings with severe[0]depression, once I realize
| "something is wrong", I can start the annoyingly slow process
| of trial and error making changes to correct things. This
| turns depression from "how reality is" into "this is just
| feedback on my body's state". It turns things getting worse
| into either a "this is either a transient state or the wrong
| solution".
|
| [0] Which I define as the point where any passive ideation
| (fantasies of dying) starts to enter the gradient of becoming
| _involuntary_. As opposed to regular negative thoughts which
| can (and should) be brushed away as easily as a fly landing
| on me. Curiously, once I noticed it also affected my ability
| to experience color. While I could technically see colors, it
| was like have a mental partial greyscale filter because there
| was no beauty in it, color was just a meaningless detail.
| jdietrich wrote:
| A sudden improvement in mood is one of the key warning
| signs for suicide. Often it's genuinely just a sudden
| improvement, but sometimes it is a byproduct of the relief
| people experience when they commit to ending their life. If
| you know someone who is severely depressed, you should
| watch them _very carefully_ if they suddenly seem carefree.
|
| >once I noticed it also affected my ability to experience
| color
|
| A small amount of evidence does support the notion that
| depressed people literally see the world as being less
| vibrant.
|
| https://pubmed.ncbi.nlm.nih.gov/34689697/
|
| https://cdnsciencepub.com/doi/10.1503/jpn.200091
| ekianjo wrote:
| Suicidal ideation is a risk for many CNS drugs, and not unique
| to Prozac as far as I know. But yes this is a major risk factor
| that needs to be taken in account before such kind of
| treatments.
| EasyMark wrote:
| Isn't that a possibility with a lot of drugs though? I think it
| depends on the rate and not a "does or does not" type of
| questions. Now if the drug doesn't help more than a placebo
| that's clearly a huge negative, but if it has a high rate of
| success vs placebo then they will make adjustments and watch
| out for the side-effect (of course) letting patients know it's
| a possibility and to report if it starts happening.
| salemh wrote:
| The efficacy of anti-depressants has been consistently over-
| inflated, so generations were poisoned with side-effects:
| suicidal ideation, homicidal tendencies, etc.
|
| https://pubmed.ncbi.nlm.nih.gov/20616621/
|
| _Results: Meta-analyses of FDA trials suggest that
| antidepressants are only marginally efficacious compared to
| placebos and document profound publication bias that inflates
| their apparent efficacy. These meta-analyses also document a
| second form of bias in which researchers fail to report the
| negative results for the pre-specified primary outcome measure
| submitted to the FDA, while highlighting in published studies
| positive results from a secondary or even a new measure as
| though it was their primary measure of interest. The STAR_ D
| analysis found that the effectiveness of antidepressant
| therapies was probably even lower than the modest one reported
| by the study authors with an apparent progressively increasing
| dropout rate across each study phase.*
| EB66 wrote:
| I also had a close family member who committed suicide shortly
| after going on Prozac -- this also happened nearly 30 years
| ago. His young son later went on Prozac himself (several months
| after his fathers suicide) and immediately started
| demonstrating bizarre disinhibited anti-social behavior (e.g.,
| damaging property, stealing from friends, etc). He was
| immediately yanked off Prozac when he started articulating his
| own thoughts of suicide. The bizarre anti-social behavior
| improved after discontinuing Prozac.
|
| For some people, Prozac is a very dangerous drug. It is fully
| deserving of its FDA black label warning (which it didn't have
| 30 years ago).
| marcus_holmes wrote:
| > "But a new review of trial data by academics in Austria and the
| UK concluded that..."
|
| > "Mark Horowitz, an associate professor of psychiatry at
| Adelaide University and a co-author of the study,"
|
| Austria - cold, has mountains, but not Adelaide University
|
| Australia - hot, has kangaroos, and Adelaide University
|
| Is the Grauniad returning to form?
| aaronbrethorst wrote:
| Nature is healing.
| https://en.wikipedia.org/wiki/The_Guardian#References_in_pop...
| djohnston wrote:
| It's fascinating that otherwise intelligent people have no
| hesitation pumping their children's developing brains full of
| SSRIs and amphetamines at the behest of a professional class who
| is paid to distribute these medications.
| forgetfreeman wrote:
| It's even more fascinating when you have first hand experience
| with how much unmitigated guesswork goes into selecting
| psychiatric meds and their dosage.
| Aeglaecia wrote:
| it's somehow even more fascinating when you talk to dozens of
| people who were medicated as kids and get an idea of the real
| implications
| forgetfreeman wrote:
| ...or literally watched friends get over-medicated into
| committing suicide.
| mberning wrote:
| I used to share your opinion, and in a way I still do, but
| after having 3 children and seeing how horrible some of these
| behaviors and habits can get, I completely understand why
| people cave in to get some relief. The stress of dealing with
| severe behavioral issues day after day can easily destroy a
| marriage and family.
| monero-xmr wrote:
| SSRIs literally saved my life, no question about it. Night and
| day difference, from daily panic attacks destroying my life,
| happiness, and career, to being almost completely better in 2
| weeks after starting. I tried exercise and diet and meditation
| and you name it, _for years!_ , before I gave medication a go.
|
| Do not care what the science says. It 100% worked for me. Please
| get help if you need it, tens of millions of people use this
| medicine successfully
|
| Articles like this are part of the narrative that SSRIs in
| general are no better than placebo. Absolutely not true for me!
| fgonzag wrote:
| Same here, after struggling for 39 years, glp-1 + SSRI + ADHD
| meds have made me a normal productive human, and 2 years ago I
| had pretty much given up on the possibility.
|
| Having a child forced me to fix my life, and I'm incredibly
| happy because of it.
| ipnon wrote:
| Pharmacology and chemistry can really make the world a better
| place.
| djohnston wrote:
| Evidently not for children with depression. But yes
| chemistry is great.
| floundy wrote:
| Who would have figured that microdosing amphetamines all day
| leads to increased productivity?
| zer00eyz wrote:
| See: The dot com boom and its recovery into Web 2.0
|
| It was so pervasive at the time that the references to it
| spilled over into SF Bay Area hip hop culture...
| pessimizer wrote:
| Massive amounts of cocaine did the same for the housing
| bubble in the 2000s.
| MattRix wrote:
| This seems a little snarky. For someone with ADHD it's not
| as much about "increased" productivity but rather non-zero
| productivity.
| hirvi74 wrote:
| As someone with ADHD, if your productivity was decreased
| or did not increase in the slightest, then I doubt a
| doctor would keep prescribing the medication. Such
| increases do not have to be astronomically large, but I
| do believe increasing the productivity of people with
| ADHD is absolutely part of the benefit.
| MattRix wrote:
| I agree, but I think you're misunderstanding my comment.
| I was replying to a snarky comment that seemed to imply
| that the effect of taking amphetamines is obvious and
| mundane.
|
| The point I was trying to make is that the effect on
| someone with ADHD can be profound and transformative, not
| like going from 80 to 100 but rather from 0 to 100. You
| suddenly feel like a functional person (I say this as
| someone with ADHD).
| hirvi74 wrote:
| Doctors. That is why they prescribe it.
| thebigspacefuck wrote:
| What's normal anyway?
| IAmBroom wrote:
| I think that's a shorthand for "not dysfunctional and
| neurotically impaired".
| fgonzag wrote:
| For me? Not being hyper anxious all day (to the point that
| I just freeze and procrastinate all day), being able to
| _sort_ of focus on the most important task (I 'm still ADHD
| with 1000 unfinished projects, but at least I finish the
| things that have to be finished), eating healthy and
| enjoying exercising (100 lbs down and got quite good at
| tennis), not entering into a rage state due to anxiety
| overflow everytime I fight with my wife, being able to
| regulate my emotions, I could go on and on honestly.
| gexla wrote:
| Spitballing here. I always understood stuff like this as "the
| system doesn't care about you, it cares about the masses." If
| the result is overwhelmingly looking no better than a placebo,
| then the small number of people it actually helps is sort of
| irrelevant. The exception might be cases where people are
| willing to drop a bomb of cash for lifesaving drugs for rare
| diseases (Pharma Bro got a lot of flack for massively jacking
| up the price of one of these drugs.) I don't know what
| implications such a study may have in a complex space. I
| imagine the drug will still be available for those who want to
| try, but far less prescribed as a sort of safe default. I doubt
| drug companies will care much for this, since the patent has
| long expired.
| thomassmith65 wrote:
| This seems like bias against the placebo effect.
| BlackjackCF wrote:
| I think it's important to note the headline that it's
| specifically about children. Maybe Prozac is effective for
| adults but not kids in that range?
| funkychicken wrote:
| Hopefully people don't see articles like this (for depression)
| and think the results are the same for anxiety disorders.
| IAmBroom wrote:
| THIS!
|
| SSRIs have been proven to be very effective against anxiety
| disorders, which in many ways mimic depression, but have
| different pathologies and causes.
|
| Also, they saved me.
| flatline wrote:
| I have tried prozac in my teens and zoloft in my 30s. Prozac
| made me dissociate pretty hard, I found myself between classes
| not knowing where I was coming from or going. Zoloft did
| nothing but give me the zaps when I came off it.
|
| There have been some serious efforts made to reproduce the
| original groundbreaking results that showed how effective SSRIs
| were, without much success. Anecdotally, I know plenty of
| people who have benefited from them, so I would not say they
| are ineffective as a blanket statement. I do think it's
| important to understand that nobody really knows how these
| drugs will impact any one individual, and it's trial and error
| to find something that may help.
| thebigspacefuck wrote:
| You should have tried placebo first
| chemotaxis wrote:
| Placebo works very well for many people too! That's precisely
| the thing. That's what makes these studies tricky.
|
| If you're a doctor, and if Prozac helps your patients, then
| it's obviously excellent. You should keep writing
| prescriptions.
|
| If you're a scientist, you obviously want to distinguish
| between "real" drugs and drugs that help because people believe
| they should. So, you do these kinds of tests.
|
| And then, from the perspective of ethics, _once you know it 's
| just placebo_, you kinda shouldn't keep giving it to people,
| even if it helps? Maybe? I don't know. That's the weird part.
| sitharus wrote:
| > And then, from the perspective of ethics, once you know
| it's just placebo, you kinda shouldn't keep giving it to
| people, even if it helps?
|
| That's a very big ethical question in the medical field.
| Placebos _do_ help, but only if people believe they will. So
| is it ethical to lie to a patient and give them a placebo
| knowing it's likely to help?
| carabiner wrote:
| > Articles like this are part of the narrative that SSRIs in
| general are no better than placebo. Absolutely not true for me!
|
| Does "placebo" mean "no effect" to some people? Placebo
| absolutely has an effect. Testimonies like this are on the
| level of "vaccines caused autism" pseudoscience and the
| serotonin theory of depression isn't even taught any more. It
| belongs in the bin of crackpot treatments like chiropractic.
| There is zero chance Prozac would receive FDA approval today.
| jacobgkau wrote:
| Had you tried a placebo without knowing that it was a placebo?
| No? Then your story's irrelevant to whether the medication's
| working (yes, even on you) any better than a placebo would.
| lemming wrote:
| Our 11 year old daughter was seriously depressed recently. N=1,
| but fluoxetine was life changing (and potentially life saving)
| for her, at least.
| thebigspacefuck wrote:
| Placebo can be life changing
| biff1 wrote:
| Nocebo can too. Apropos the featured article, I wonder if we
| should worry about that when we report in the popular media
| that antidepressants trigger suicides.
| abraxas wrote:
| Absolutely. These random namedrops of drugs are irritating.
| People respond to different psychiatric medications in
| wilddly different ways. And actually, the majority do not
| respond at all. Throwing a random name of some random
| medication helps absolutely nobody. It will just make some
| desperate people seek "this one drug" that they heard about
| on the internet.
| tcj_phx wrote:
| Do you have a plan to get her off, or is she on the maintenance
| drug for life?
|
| Sometimes girls get depressed when their periods start. Girls
| often don't ovulate regularly, which can cause problems until
| their cycle stabilizes. Sometimes pediatricians don't allow
| girls' cycles to stabilize. The doctor says to the girl,
| "you're a woman now, so we're going to regulate your irregular
| period with birth control."
|
| Women often get depressed due to the progestins used in all the
| birth control prescriptions.
|
| SSRIs never help because of boosting serotonin. When someone
| benefits, it's from the drug's other physiological effects.
| EasyMark wrote:
| Puberty in general can be rough. I (a dude) had all kinds of
| bad thoughts and moods going through puberty and then one
| year it was just gone, grades improved dramatically, started
| making friends again, etc
| lemming wrote:
| _Do you have a plan to get her off, or is she on the
| maintenance drug for life?_
|
| It's too early to say. Obviously the idea is to get her off
| it if possible.
|
| _SSRIs never help because of boosting serotonin._
|
| That's a hell of a claim, which could use some evidence.
| tcj_phx wrote:
| > > SSRIs never help because of boosting serotonin.
|
| > That's a hell of a claim, which could use some evidence.
|
| My experience with the chatbots is that they start with the
| conventional marketing tropes, but if you ask pointed
| questions they'll dig into the actual research.
|
| This thread started with a generic question about why ECT
| seemed to help some patients. It had a really good
| reasoning about why SSRIs are still the first-line
| treatment for depression, even though the MAOIs were much
| better drugs.
|
| https://chatgpt.com/share/69207aa3-26a0-8005-8dda-8199da153
| f... The Big Picture SSRIs flood
| serotonin globally, which can suppress
| dopamine/norepinephrine and blunt mood. Anti-
| serotonin strategies (receptor-specific antagonism,
| reuptake enhancement, or targeted modulation) often
| result in cleaner antidepressant effects with fewer
| side effects. This supports the criticism you
| mentioned: SSRIs may "work" only because the brain
| adapts to the serotonin disruption, whereas directly
| reducing or modulating serotonin is more
| therapeutic.
|
| The whole 'conversation' is pretty good, and would provide
| plenty of search terms for helping you figure out what
| science has actually figured out about depression.
|
| A simple pregnenolone supplement can sometimes be magical,
| because of the steroidogenesis cascade: https://en.wikipedi
| a.org/wiki/Steroid#/media/File:Steroidoge...
|
| There's a supplement seller that said his pregnenolone
| powder was made with a newer, cleaner process than is used
| by most of the pregnenolone supplement vendors, but I don't
| know if he's still using that supplier. The powders are a
| much better value than the capsules.
|
| hth.
| flatline wrote:
| The chatbot is great as a first-line of research for many
| things, but something like this needs to be backed up by
| actual research to make a concrete claim. It will
| absolutely fabricate falsehoods or misrepresent truths
| based on an unknown number of stochastic factors behind
| any response. Shame on your for propagating a bunch of
| mumbo-jumbo that every reader must go verify for
| themselves if they want to substantiate or refute your
| claim - in response to a request for substantiation!
| blast wrote:
| https://www.nature.com/articles/s41380-022-01661-0
| jacobgkau wrote:
| > It's too early to say. Obviously the idea is to get her
| off it if possible.
|
| You understand that the people who sold you that drug have
| a vested interest in making sure it's not possible and/or
| that you & she think it's not possible, right?
| amanaplanacanal wrote:
| You think the pediatrician is getting a kickback for
| prescribing it?
| mrguyorama wrote:
| I'm big on medications for brain stuff but uh yes, in the
| US, doctors get lots of kickbacks for prescribing drugs.
|
| Usually this takes the form of "I'm prescribing you with
| <Brand> instead of generic" or "I'm prescribing you _this
| specific_ drug from this class of drug "
|
| https://openpaymentsdata.cms.gov/
| potsandpans wrote:
| Genuine question (which I accept may be too personal to
| answer): what does depression in someone that young look like?
|
| How is it different from the expected hormonal changes that an
| adolescent is expected to go through?
| 0134340 wrote:
| Probably something like Boy Interrupted[0]. Sad story and
| something I can sympathize with having some of the same
| feelings very early on despite having a rather normal
| upbringing and siblings not showing signs of it.
|
| 0: https://en.wikipedia.org/wiki/Boy_Interrupted
| potsandpans wrote:
| It's incredible that my last four comments are down voted to
| -1, for engaging in genuine dialog across topics.
|
| @dang it's hard to believe that I'm not being brigaded.
| amanaplanacanal wrote:
| My advice as a long time participant here: pay no attention
| to upvotes or downvotes. Sometimes they seem to be
| completely unrelated to whatever you said. Stay curious.
| jdietrich wrote:
| As someone who has been seriously depressed from an early
| age, I can tell you that it looks exactly like the DSM/ICD
| criteria - a lack of energy, loss of appetite, loss of
| interest in all activities, insomnia, feelings of
| worthlessness, suicidal thoughts and pervasive sadness and
| hopelessness.
|
| Some people would rather believe that pediatric depression
| isn't real, rather than confront the reality of a loved and
| cared-for child who is constantly tearful, severely
| underweight, sleeps for three or four hours a night, spends
| most of their time staring into space and frequently talks
| about wanting to die.
|
| Depression is an utterly dreadful illness and should not be
| confused with normal sadness or unhappiness.
| cc-d wrote:
| The FDA is such a joke.
| forgetfreeman wrote:
| Use more words.
| khannn wrote:
| FDA, what a joke
| AnimalMuppet wrote:
| Um, that's _fewer_ words.
| khannn wrote:
| FDA = Joke
| Forgeties79 wrote:
| This reads to me like over-prescription rather than lack of
| efficacy but I'm also not a doctor and won't presume my kneejerk
| reaction is accurate.
|
| We saw a similar whiplash with Ritalin after over-prescribing in
| the 90's/2000's. ADHD medication absolutely works, but for a lot
| of people it didn't for this reason.
| hirvi74 wrote:
| Even for people with legit ADHD, like myself, medication isn't
| always a home run. I think something like 10%-20% of people do
| not respond well to any medications. I personally am only a
| 'partial responder' in that I only really get an improvement in
| focus/concentration -- not really anything else. But hell, that
| is still better than life without medication.
| Forgeties79 wrote:
| Definitely didn't mean to imply it's a home run. I'm just
| saying it clearly and legitimately helps a ton of people.
|
| My point is if you include more and more people who don't
| need it because of over-prescription it's going to appear as
| lower overall efficacy while still helping a lot of people in
| the pool.
|
| Making up numbers: If only 20 out of 100 people actually have
| ADHD then out the gate you've ruled out helping 80% of the
| people. So if 15 of the remaining 20 see improvement in their
| daily lives that means 75% suddenly looks like 15%.
|
| Diagnosing and treatment is never that clean, there will
| always be some people who don't necessarily need a certain
| medication yet get it prescribed (or don't when they need it!
| Especially women with ADHD) because doctors are fallible like
| anybody else, systemic issues, etc. But with a commonly
| prescribed medication like Adderall the problem is definitely
| more pronounced.
|
| Anyway I'm curious enough to look more closely at the study,
| this is a very interesting topic. If Xanax is really not
| helping people that's pretty serious.
| jdietrich wrote:
| Effect size is strongly affected by severity - people who
| aren't very ill just don't have as much to gain compared to
| people who are gravely ill. Widening diagnostic criteria and
| more liberal prescribing will inevitably lead to a reduction in
| the observed effect size.
|
| Antidepressants were bona-fide miracle drugs when we first
| started using them on desperately ill inpatients who
| experienced every moment as exquisite torture. We saw the most
| miserable lives completely transformed in a matter of weeks.
| They have become merely "sorta-kinda useful sometimes" now that
| we're mainly prescribing them to broadly functional people who
| are feeling a bit sub-par.
|
| SSRIs are a pretty poor fit for the latter cohort, because
| SSRIs cause significant emotional blunting in the majority of
| patients, to the extent that some people hypothesise that
| emotional blunting is the fundamental beneficial effect.
| Feeling quite numb is an _incredible improvement_ if you are
| constantly unbearably miserable. If you have a more normal
| range of emotional experience than relentless misery, it is
| likely a sideways move at best; if your core complaint is that
| you feel numb and apathetic, they 're probably actively
| harmful.
|
| SSRIs are very widely used because of their extraordinary
| safety, but they're often thoughtlessly prescribed by
| overworked primary care doctors. There are a wide range of
| antidepressants (and drugs that have antidepressant effects
| despite not being marketed as such) that are likely a better
| option for a large proportion of patients.
| hirvi74 wrote:
| I can't bring myself to try an SSRI. I just cannot do it. I've
| got a prescription for an NDRI on my desk, and I still won't take
| it. I am not anti-psychiatry either. I take psychiatric
| medication for a different condition already. But something about
| anti-depressants just doesn't sit well with me.
|
| As crazy as it may sound, I think a lot of my depression stems
| from living a life that is not true to myself and due to
| countless failed attempts to be someone I cannot never be. As far
| as I am concerned, depression is just a symptom of my situation
| and not some true disorder. For the sake of analogy, I would say
| it's like food poisoning. Yes, the GI issues are awful, but the
| body is responding appropriately.
| burnt-resistor wrote:
| One needs to not work and be able to remain at home for about a
| week or so to see if the side-effects are manageable. One
| shouldn't simply continue on with operating machinery or
| working a job while titrating up a new psychiatric medication.
| Honestly, employers should offer medical time off for this.
| sundarurfriend wrote:
| > I've got a prescription for an NDRI on my desk, and I still
| won't take it. ... something about anti-depressants just
| doesn't sit well with me.
|
| At first it sounded like your antipathy was with SSRIs
| specifically (which I largely share), but it seems like it's
| anti-depressants in general.
|
| FWIW, I used to think similar to you, and roughly agree with
| the gist of your second paragraph, but I've come to think of
| antidepressants as useful in a specific way: people say "it's a
| crutch" as a negative thing (about a lot of things including
| antidepressants), but a crutch was very useful to me when
| recovering from a fracture, and helped me enormously with my
| progress; similarly, even if "depression is just a symptom of
| my situation", it can and does often lead to a cycle where the
| depression itself feeds into the situation and in turn sustains
| itself. An antidepressant that works for you is a good way to
| be able to see things more clearly, feel the motivation and
| insight that depression clouds out, and thus be able to break
| out of the cycle.
|
| It doesn't have to be a "cure" that counters a disorder, it can
| be a tool that you use for its purpose and then throw away (and
| it does sound like you're well-motivated to do that).
| anuramat wrote:
| > not some true disorder
|
| there's a tool on your desk that might help you solve your
| problem; what does it matter if the problem is an "appropriate
| response of your body"? so is pain/anxiety/diarrhea
| cj wrote:
| > stems from living a life that is not true to myself and due
| to countless failed attempts to be someone I cannot never be.
|
| If this is their mindset, they might benefit from CBT more
| than medication.
|
| I'm not against SSRI at all. But after taking them for a few
| months in my 20's, and experiencing how terrible the
| withdrawal symptoms are when stopping, I'd be very hesitant
| to ever start up on them again. I remember having to open up
| the lowest dose pill capsule and splitting the dose into very
| tiny increments to be able to wean off completely.
| JumpCrisscross wrote:
| > *depression is just a symptom of my situation and not some
| true disorder+
|
| There is a great Bojack Horseman episode in which Diane
| struggles with the idea of taking antidepressants for similar
| reasons.
|
| If it's depression, that's closer to allergies, chronic
| inflammation or a broken bone healed wrong than vomiting after
| food poisoning.
| abraxas wrote:
| Depression is almost never caused by actual life circumstance -
| just by your response and usually a delayed response.
|
| Also you should try your SSRI prescription. They really aren't
| very strong drugs. You might get mild relief or if you're like
| me and the majority of people you will see no effect
| whatsoever. It's worth a try anyway. You won't get "high" or
| "dull" or any of that nonsense. At best it will lift your mood
| a bit. But more often than not, just won't do anything.
| jacobgkau wrote:
| > Also you should try your SSRI prescription. They really
| aren't very strong drugs. You might get mild relief or if
| you're like me and the majority of people you will see no
| effect whatsoever. It's worth a try anyway.
|
| Someone else in the thread's testifying with personal
| experience that there were significant withdrawl symptoms
| after only a few months:
| https://news.ycombinator.com/item?id=45999622#46008522
|
| Are they lying, or are you misrepresenting something?
| jimbobimbo wrote:
| It is true. Withdrawals from SSRIs are no joke and can take
| a long time.
| BeetleB wrote:
| > As crazy as it may sound, I think a lot of my depression
| stems from living a life that is not true to myself and due to
| countless failed attempts to be someone I cannot never be. As
| far as I am concerned, depression is just a symptom of my
| situation and not some true disorder.
|
| It's true for some, but be wary of such a generalization.
|
| It took many years of people telling me the same thing before I
| understood what they were saying: "Having an objectively crappy
| life is normal. Being depressed about it _isn 't_."
|
| (Almost) everyone will have problems - temporary or permanent.
| And while they may feel down about it for a while, or
| occasionally, most of them more or less recover their mental
| health and are not chronically depressed.
|
| Because the majority of people have problems, it becomes easy
| for a depressed person to think "Ah, this is just due to
| problem X" or even "This is just because I want a life
| different from mine". Most people with problems also want a
| different life than what they have. But they're not depressed.
| NoMoreNicksLeft wrote:
| > "Having an objectively crappy life is normal. Being
| depressed about it isn't."
|
| Sounds like a philosophy more than a science. What does
| "normal" even mean in this context? Are we talking about
| something measurable? For instance, if the number of people
| who were depressed about those circumstances doubled (or
| quadrupled) would it then be normal, and there would be no
| reason to treat it (because it's normal)?
|
| If you have an objectively crappy life, but not just ignore
| it and instead are incapable of even noticing, that sounds a
| little like dysfunction to me. It's not some superpower, it's
| a micro-lobotomy.
| BeetleB wrote:
| > If you have an objectively crappy life, but not just
| ignore it and instead are incapable of even noticing
|
| Noticing it is very different from being depressed about
| it.
|
| > What does "normal" even mean in this context? Are we
| talking about something measurable?
|
| Let's take a trivial example. Person A is depressed because
| he is unhappy that he doesn't make enough money to travel
| and buy nice cars. Now take all the people who are unhappy
| that they cannot afford to travel and buy nice cars. Most
| will not be depressed - they will merely be unhappy about
| it.
|
| Person A isn't depressed because he can't travel and buy
| nice cars. He's depressed _and_ he can 't travel and buy
| nice cars. He's mistakenly coupling the two.
|
| Another tell for these kinds of things: Ever know someone
| chronically depressed who blames it on X? Then somehow, X
| is resolved. There may be a temporary improvement, and they
| go back to being depressed again, only they now blame it on
| Y? Somehow Y gets resolved and some months later they're
| blaming it on Z.
|
| Everyone has problems. Including those who are not
| depressed. Fixing X, Y, Z, AA, AB, and whatever else is not
| going to take care of the depression.
|
| On the flip side, people who do not suffer from depression
| make the same mistake: They claim they are not depressed
| because they "choose" not to let the problems get to them.
| Self serving beliefs!
| agumonkey wrote:
| SSRI can have annoyances (to stay polite) if you ever need a
| fix so much that you go that route, be sure to ask about them.
| Didn't help me really but I believe that sometimes, a bit of
| chemical (placebo or not) relief can help staying afloat enough
| to work your way back up quicker.
|
| I understand your comment, my issues were due to life
| circumstances and not a low level neurological imbalance, and I
| too dismissed these treatments almost entirely, mostly because
| they felt like blanket solutions from medical professionals who
| didn't really listen to symptoms.
| burnt-resistor wrote:
| Maybe SSRIs work for some, but Paxil gave me serotonin syndrome
| and Prozac made my mom psychotically homicidal. I've tried every
| SSRI titrating on and off (except Paxil), but they all caused
| deal-breaking side-effects.
| rrrrrrrrrrrryan wrote:
| Homicidal?
| burnt-resistor wrote:
| Yep. My dad recounted that in 1989, he had to restrain her
| because she (then age 40) had a psychotic episode described
| as a "murderous impulse" just after starting a brand new
| "wonder pill", Prozac. This was quite uncharacteristic for a
| tiny, docile woman who is often described as "sweet" and
| "nice" who never had any psychiatric symptoms before or since
| except a couple of brief times of situational depression.
| There's a lot of FUD and social ills washing in mass media
| rather than less biased peer-reviewed research that blames
| individuals, conflates preexisting conditions with medication
| side-effects, and clouds the issue of whether SSRIs increase
| suicide and/or violent psychosis or not.
|
| Check out one of the modern black box warnings of fluoxetine
| (Prozac) that only addresses a subset of side-effects,
| suicide in children and young adults: https://dailymed.nlm.ni
| h.gov/dailymed/fda/fdaDrugXsl.cfm?set...
|
| Somehow, I doubt there is much motivation to look for
| economically inconvenient and unnerving side-effects in some
| demographics, especially if they're adults who can easily be
| blamed entirely for all of their own actions because it's
| "definitely not" due to a (formerly) profitable pill or a
| pseudoscientific profession that doesn't exactly know how the
| medications it prescribes work, who would benefit from or be
| harmed by them, or have any ability to measure the organ or
| system they're supposed treating.
| tcj_phx wrote:
| Thanks for sharing your mom's experience with big pharma's
| then-new wonder-drug.
|
| > Somehow, I doubt there is much motivation to look for
| economically inconvenient and unnerving side-effects in
| some demographics,
|
| Robert Whitaker examined the pharmaceutical industry's
| ideological capture of conventional psychiatry in his third
| book, _Psychiatry Under the Influence._
|
| https://robertwhitakerbooks.com/psychiatry-under-the-
| influen...
|
| I've written for the Mad in America Foundation's webzine.
| My latest piece was titled _Theodoric of Arizona: State-
| Sanctioned Pharma-Based Pseudo-Doctor:_
| https://www.madinamerica.com/2024/07/theodoric-arizona/
|
| This was inspired by the old SNL skit, _Theodoric of York,
| Medieval Barber._ The article is structured around my
| proposal of a _Theodoric's Principle of Medical
| Advancement,_ to explain why medical progress is so
| glacial.
| jdietrich wrote:
| It is highly likely that your mother was misdiagnosed as
| suffering from unipolar depression when she was in fact
| suffering from bipolar disorder. A sudden switch to mania
| is a common outcome, even in cases where the patient has no
| previous history of mania. It is crucially important to
| take a comprehensive history to rule out bipolar disorder,
| but many general practitioners (and some psychiatrists)
| reflexively prescribe SSRIs whenever they see a depressive
| episode, even where there is clear evidence of a personal
| history of hypomania or a family history of mania.
| verteu wrote:
| Sorry to hear it. I believe it's best practice to try different
| types of drugs (SNRI, atypical/Bupropion, etc).
| mhuffman wrote:
| They must have been pretty damn confident of the results to give
| depressed children a placebo.
| comex wrote:
| I think this is the paper in question?
|
| https://osf.io/preprints/psyarxiv/wk4et_v3
|
| Clinical trials of antidepressants are weird because they're
| usually short-term (6-12 weeks), whereas practical use of
| antidepressants usually lasts years. I personally suspect that
| short-term trials show an exaggerated placebo effect, because the
| novelty doesn't have time to wear off.
| tsoukase wrote:
| Antidepressants benefit specific populations, those that have a
| predominant "internal" stress/depression and not due to a
| profound external trauma. They will not help a child that is
| continuously bullied, but one that has inherited a depressive
| trend. This holds for children and adults, barring some
| differences due to age maturity. Saying "no difference from
| placebo" for a treatment that is used by hundreds of millions is
| poor science, if not misinformation and malice.
| RickJWagner wrote:
| Fortunately, there are well documented lifestyle adaptions that
| can sharply reduce depression.
|
| Religion is a good example.
| https://pmc.ncbi.nlm.nih.gov/articles/PMC3426191/
| dboreham wrote:
| Chemicals like this imho act like "global variables" for the
| neural network. Perhaps a bit like temperature in an LLM. They
| have an effect, but the effect is sort of holographic -- there's
| no way to predict/compute exactly what the effect will be,
| because it's a function of parameters that include all the
| training data, specifics of neuron function that depend on DNA
| and other environmental factors and so on. The effect might be
| beneficial, by some definition of beneficial, but it might not.
| Even a simple chemical like ethanol has a wide variety of effects
| on different people.
| sharts wrote:
| I thought this was already known? I can't recall exactly but
| there was some research pointing to SSRIs in general as not being
| particularly effective at all. They were just hyped a lot and
| became mainstream.
| area51org wrote:
| I wouldn't go that far, but there was a now-famous study
| (Princeton?) that showed that doing aerobic exercise for maybe
| 30 mins every day, about five days per week, was equally
| effective at alleviating depression symptoms.
| jdietrich wrote:
| There's one big problem with that - getting seriously
| depressed people to do 30 minutes of exercise (or anything
| else) five days a week. "Get more exercise" is excellent
| advice for someone who feels a bit down, but it's absolutely
| useless for someone who can barely summon up the strength to
| eat or brush their teeth.
| jasonfarnon wrote:
| It gets even harder if you offer them the alternative of
| just taking a pill. For widespread health policy, we should
| want the proportion of depressives who will never learn to
| manage it themselves because a pill is offered to be
| smaller than the proportion for whom the pill is effective.
| I had always assumed these pills were effective enough but
| studies like these make me wonder.
| atbpaca wrote:
| Here the context is for children, not in general.
| robertakarobin wrote:
| I was very young when my mom started Prozac but do remember how
| angry and sad she was before compared to after.
|
| Years later there was a time when me and my sister noticed our
| mom was acting a bit strange -- more snappish and irritable than
| usual, and she even started dressing differently. Then at dinner
| she announced proudly that she had been off Prozac for a month.
| My sister and I looked at each other and at the same time went,
| "Ohhhh!" Mom was shocked that we'd noticed such a difference in
| her behavior and started taking the medication again.
|
| I've been on the exact same dose as her for 15 years, and my
| 7-year-old son just started half that dose.
|
| If I have a good day it's impossible to day whether that's due to
| Prozac. But since starting Prozac I have been much more likely to
| have good days than bad. So, since Prozac is cheap and I don't
| seem to suffer any side effects, I plan to keep taking it in
| perpetuity.
|
| What I tell my kids is that getting depressed, feeling sad,
| feeling hopeless -- those are all normal feelings that everyone
| has from time to time. Pills can't or shouldn't keep you from
| feeling depressed if you have something to be depressed about.
| Pills are for people who feel depressed but _don 't_ have
| something to be depressed about -- they have food, shelter,
| friends, opportunities to contribute and be productive, nothing
| traumatic has happened, but they feel hopeless anyway -- and
| that's called Depression, which is different from "being
| depressed."
| jacobgkau wrote:
| Your anecdote has nothing to do with whether it's better than a
| placebo or not.
| BeetleB wrote:
| His anecdote explicitly mentions the possibility of it being
| a placebo.
| jacobgkau wrote:
| No it doesn't. It doesn't contain the word "placebo." Can
| you quote where it "explicitly mentions" what you're saying
| it does?
| robertakarobin wrote:
| > If I have a good day it's impossible to day whether
| that's due to Prozac. But since starting Prozac I have
| been much more likely to have good days than bad. So,
| since Prozac is cheap and I don't seem to suffer any side
| effects, I plan to keep taking it in perpetuity.
|
| I was acknowledging that the "good days" could be due to
| Prozac or could be a placebo effect, but since being on
| Prozac correlates with having significantly more good
| days, and I experience virtually no ill effects, I choose
| to continue with it.
| some_guy_nobel wrote:
| Wow, a shockingly argumentative tone for someone who is
| just flat out wrong.
|
| Beyond the response someone else commented explaining
| exactly where the comparison was mentioned, the anecdote
| itself is useful in offering an experience of someone
| who's life has been changed by the drug.
|
| In any case, the study mentioned in the article is a
| meta-analysis about children, not adults, so there is no
| onus on OP to qualify anything about placebo or not.
| techietim wrote:
| > my 7-year-old son just started half that dose
|
| This is horrifying.
| kstrauser wrote:
| Why? If a kid has diabetes, would it be horrifying to treat
| it? Why would it be different for a neurochemistry issue that
| makes the same kid tired and sad all the time?
| jacobgkau wrote:
| Because the problem's not a "neurochemistry issue" (that
| theory's been debunked and the "chemicals" in play have
| never been known), and the solution is "no better than
| placebo."
| dekhn wrote:
| Please share your qualifications for making a statement
| like this- do you work in biology? Are you knowledgeable
| about the underlying biology here, and the limitations of
| medical publications?
| hintklb wrote:
| Not that I agree or disagree with the underlying claim
| but a call to "credentialism" to dismiss someone's
| opinion is not as strong in 2025 as you think it is.
|
| The last few years have been a proof that even the
| "experts" are following strong political or personal
| ideology.
|
| Also we don't live in the 18th century anymore. A lot of
| knowledge (especially around medicine) is open to the
| world. People can read papers, understand research etc.
| dekhn wrote:
| In this area, having credentials makes a difference.
| Experts matter.
|
| Few if any non-medical people can read medical papers and
| make sense of what they say. There is simply far too much
| context to evaluate such papers, especially in the cases
| of complex medical conditions.
| hintklb wrote:
| Sorry but strong disagree here.
|
| I have had a lot of Spinal and sleep issues. I have read
| almost all new literature on this niche subject and I
| have brought to my spine doctor some new therapy and
| treatments they had literally no idea about. Those
| treatments have changed my life.
|
| As an engineer I read a lot of deep technical paper as my
| day job. Medical papers are comparatively relatively
| simple. The most complex part being usually the
| statistical data analysis.
|
| We have pushed to a whole generation of people that only
| the "experts" can have opinion on some fields. I
| encourage everyone to read papers and have opinions on
| some of those subjects.
|
| We are in 2025. That type of gatekeeping needs to go
| away. AI if anything, is going to really help with this
| as well.
| tjohns wrote:
| I think it's good to read papers and be curious.
|
| It's also good to work with your doctors (as you seem to
| have done), have a discussion, and mutually agree on a
| plan of treatment.
|
| Experts don't know everything. But they probably know
| some things you don't, and can think of questions you
| might not to have even thought to ask. As the saying
| goes, "you don't know what you don't know". Experience
| matters.
|
| There's also a lot of people out there without an
| academic background that don't know how to properly read
| journal papers. It's common to see folks do a quick
| search on PubMed, cherry-pick a single paper they agree
| with, and treat it as gospel - even if there's no
| evidence of repeatability. These skills are not something
| that many people outside STEM are exposed to.
| dekhn wrote:
| Cherrypicking is bad, but worse is reading a paper and
| thinking you understand what it says, when you don't
| actually understand what it says. Or thinking that a
| paper and its data can be observed neutrally as a factual
| and accurate statement for what work was actually done.
|
| My experience in journal club- basically, a group of grad
| students who all read a paper and then discuss it in
| person- taught me that most papers are just outright
| wrong for technical reasons. I'd say about 1 in 5 to 1 in
| 10 papers passes all the basic tests, and even the ones
| that do pass can have significant problems. For example,
| there is an increasing recognition that many papers in
| biology and medicine have fake data, or manipulated data,
| or corrupted data, or incorrectly labelled data. I know
| folks who've read papers and convinced themselvs the
| paper is good, when later the paper was retracted because
| the authors copied a few gels into the wrong columns...
| tremon wrote:
| I hope you do realize that this comment thread is linked
| to an article that includes the words "Prozac no better
| than placebo" in its headline?
| dekhn wrote:
| Yes, I do. I don't consider articles in the regular press
| to be even remotely worth looking at due to their high
| rate of inaccuracy. Here's the paper that the article
| refers to: https://www.jclinepi.com/article/S0895-4356%28
| 25%2900349-X/f...
| robertakarobin wrote:
| Can you provide a source for that theory having been
| debunked? I agree that data has been found that is at
| odds with the various neurochemical theories but am not
| aware of the neurochemistry link as a whole having been
| definitely debunked.
| GOD_Over_Djinn wrote:
| Whenever I read a comment like this, I'm always curious
| if the commenter did some basic searching of their own.
| Just searching "chemical imbalance debunked" yields a
| wide array of sources. So why ask? It seems almost like a
| form of Socratic questioning. You want to debate the
| point, but for whatever reason, are not doing so
| directly.
| robertakarobin wrote:
| Ah, well-put! I think we may be reacting differently to
| the same articles. My understanding is that while various
| neurochemical theories have not been proven as the
| general public seems to think, they have also not
| necessarily been _disproven_ or debunked. Certainly it
| has not been proven that neurochemistry has no role at
| all.
| ToucanLoucan wrote:
| Probably because the commenter is not a medical
| professional and isn't qualified to judge the veracity of
| anything they find. "Do your own research" is a fucking
| plague on our modern world and is why the internet is
| like wall to wall grifters now.
|
| By all means, Google whatever you like, but if you show
| up to a doctors office waving WebMD sheets in a medical
| professionals face, you are going to be mocked and you
| deserve it.
| ckw wrote:
| I witnessed a pair of doctors prescribe a family member
| an incredibly dangerous drug for an off label use. The
| company had been fined $500 million dollars for various
| illegal schemes to convince doctors to write such
| prescriptions, but I'm sure the doctors in question were
| unaware of this. When this family member began to exhibit
| textbook symptoms of an extremely dangerous (life
| threatening) condition which could only be caused by the
| drug in question, the doctors failed to notice, and in
| fact repeatedly increased the dosage, and added more
| drugs on top to treat the symptoms caused by the initial
| drug. It was not until I accompanied my relative to a
| doctor's appointment and delivered a carefully designed
| incantation that they made the correct diagnosis and
| halted the prescriptions.
|
| So should I not have done my own research?
| dugidugout wrote:
| I'll take this sincerely, and ask you, is this really
| something you've a continuing curiosity about? I have a
| suspicion you understand what is taking place, but for
| whatever reason, are not expressing so directly. Are you
| asserting there is nothing more to discuss after one
| parses the search results for "chemical imbalance
| debunked". The parent is quite clearly, at the minimum,
| meeting their parent's level of input, which essentially
| amounted to "this thing is debunked". As an onlooker and
| after a quick skim of the search query you suggested, I
| am still not exactly clear on what "neurochemistry issue
| [theory]" entails. What would help, is a more clear
| underpinning for what is being discussed, which your
| parent is suggesting, through question, before attempting
| to respond. I appreciate this personally!
| brendoelfrendo wrote:
| I wouldn't recommend searching for "chemical imbalance
| debunked" unless you intend to confirm an existing bias.
| The internet will show you whatever you want, and there
| are enough people who distrust medical professionals that
| any search for "debunking" will be a minefield of fringe
| theories and grifters. I'd recommend someone start
| generally, searching for information about clinical
| depression, and then build on that to look at root causes
| and how the medical understanding of those root causes
| has changed over time.
| amanaplanacanal wrote:
| I don't think we know if it's a neurochemistry issue.
| From what I understand what was debunked was the idea
| that they worked by blocking the reuptake of serotonin
| specifically.
| potatocoffee wrote:
| Why?
| jacobgkau wrote:
| Because 7 years old is borderline too young to even make a
| depression diagnosis, and that kid's going to have his
| brain chemistry altered and essentially be addicted to a
| drug that he'll have to pay for for the rest of his life.
| potatocoffee wrote:
| O cool. Do you have any appointments I can book for my
| kid?
| fgonzag wrote:
| Mine too! Only 2 years old but I can already see the
| massive anxiety bursts in him.
|
| If this guy has a non chemical cure, I'm all for it. In
| fact I'm actively researching children psychologists to
| stave off the meds as much as we can, the problem is that
| 99% of psychologists are quacks, so choosing them is
| tough.
| potatocoffee wrote:
| There's only so many times a kid can get sent home from
| school for biting/kicking/punching before you realize you
| need some professional help and will do anything to help
| the poor kid. I wish you luck.
| pyth0 wrote:
| How can you believe it's both "no better than placebo"
| but also that it's "going to have his brain chemistry
| altered and essentially be addicted to a drug". SSRIs are
| not considered addictive, though people can develop a
| dependence if it provides them significant improvement.
| jacobgkau wrote:
| A drug can have real effects while being no better than a
| placebo for doing something specific (what they're
| supposed to do).
| pyth0 wrote:
| Okay, so what makes you believe that about prozac (or
| SSRIs) then?
| ckw wrote:
| Here's a paper from last year: The nature and impact of
| antidepressant withdrawal symptoms and proposal of the
| Discriminatory Antidepressant Withdrawal Symptoms Scale
| (DAWSS) https://doi.org/10.1016/j.jadr.2024.100765
|
| 'Highlights
|
| * Antidepressant withdrawal can be severe and protracted.
|
| * It produces characteristic physical and emotional
| symptoms.
|
| * All symptoms were more severe after stopping than
| before starting antidepressants.
|
| * We identified the 15 most discriminatory withdrawal
| symptoms in our sample.
|
| * Withdrawal did not differ between people with physical
| or mental health diagnoses.'
| jasonfarnon wrote:
| The whole point of the linked article is that the drug is
| no better at placebo at treating depression but also
| carries a host of known side effects, besides unknowns
| when it comes to long term use.
| robertakarobin wrote:
| According to our pediatrician there are no known long-
| term effects of juvenile Prozac use. The effects may
| exist, but if they do they are of sufficiently low
| significance as to not have been detected yet.
| Interestingly the one possible effect she's aware of is
| that there may be a correlation with not growing as tall
| physically as one might otherwise. The data is not
| conclusive, but it gives me something to blame for
| topping out at 5'10" and never hitting 6' like my dad. :)
| ckw wrote:
| This is one of the most shocking things I have ever read.
| There is a black box warning for Prozac:
|
| 'Warning: Suicidality and Antidepressant Drugs
|
| Increased risk of suicidal thinking and behavior in
| children, adolescents, and young adults taking
| antidepressants for Major Depressive Disorder (MDD) and
| other psychiatric disorders'
|
| Read the package insert: https://www.accessdata.fda.gov/d
| rugsatfda_docs/label/2011/01...
|
| The fact that you were not informed about this should
| serve as proof that you cannot blindly trust what doctors
| tell you. They will absolutely kill you out of ignorance
| or incompetence, and never even realize their
| responsibility.
| ksenzee wrote:
| Note that the black box warning has nothing to do with
| long-term effects of the medication. It was added
| specifically because kids were killing themselves within
| weeks of starting the medication.
|
| > This is one of the most shocking things I have ever
| read.
|
| Good grief. I hope you're exaggerating for effect.
| ryandrake wrote:
| I'll raise my hand in agreement. This thread is
| definitely _one of the_ most disturbing sub-threads I 've
| ever read on HN.
| ksenzee wrote:
| It's disturbing that a seven-year-old was treated for
| suicidality? Or it's disturbing that people are opposed
| to such treatment?
| wredcoll wrote:
| This is such a blatant misrepresentation of the parent
| post that it feels almost bad faith.
|
| The subject was specifically about long term brain
| chemistry changes.
|
| People committing suicide after taking it, while
| incredibly sad, is completely unrelated.
| robertakarobin wrote:
| We had/have a lot of reservations about it too, and discussed
| it at length with our pediatrician over months of
| observation. We decided what was more horrifying was hearing
| a 7-year-old -- who has supportive family and friends, good
| health, no traumatic events, no major life changes going on,
| never worries where food/shelter is coming from -- say he
| feels like "he shouldn't be on Earth anymore" and suddenly
| react with extreme physical anxiety to almost everything. It
| was bad enough that he couldn't really implement any of the
| coping skills he learned in therapy. His therapist hoped that
| medication would bring him to a baseline where he was able to
| benefit more from therapy. My family's historical success
| with Prozac also made the decision more palatable since
| depression appears to be hereditary.
|
| There has been a phenomenal positive shift in his behavior
| since he started medication. All that said, another commenter
| pointed out that the study specifically says that Prozac is
| no better than placebo for _depression_ , which is similar to
| but distinct from _anxiety_ , which is what my son is being
| treated for. My mom and I were both diagnosed with
| depression, but anxiety may be more accurate -- I'm not sure.
| jacobgkau wrote:
| I'd be more interested in where your 7-year-old even
| learned phrases like "I feel like I shouldn't be on Earth
| anymore."
| robertakarobin wrote:
| Yes, us too. Beats us. Sure wasn't around our house, and
| we can't imagine any family/friends/TV/whatever he may
| have learned it from.
| lawlessone wrote:
| It sounds to me how a someone would describe feeling
| suicidal when they don't know the word for it.
| pinkmuffinere wrote:
| Ya, when I'm sad I can come up with pretty creative
| language to express it. It does feel really tough to know
| that a seven year old feels like that :(
| throw-the-towel wrote:
| Come on, 7 year olds should have already learned to form
| phrases.
| throwaway314155 wrote:
| As someone with bad mental health since I was ~5 and
| parents who refused to acknowledge it - I think you're
| making the right decision.
|
| There is however also benefit in updating your priors as
| new research comes out. I won't say this particular
| research discounts your experience. But maybe some day your
| son will prefer a different medication.
| rsyring wrote:
| You seem to be handling the naysayers pretty well. But,
| still wanted to compliment you for sharing and encourage
| you not to let them get to you.
|
| It sounds like you made a wise decision given your personal
| and family history and your son is benefiting.
| fgonzag wrote:
| You don't understand what having extreme anxiety at that age
| feels like.
|
| As someone who lived through that, I refuse to let him. All
| of memories of school are just feeling anxious about
| everything, just tight and suffocated, always in a panic. I
| started living when I started taking anxiety pills at 39
| years old, and I can see my 2 year old having the exact same
| anxiety ticks and fits I have.
|
| I don't know at what age I'll medicate him, but I'll do it as
| soon as I notice he isn't coping and happy anymore.
|
| Horrifying is forcing him to experience that because you
| can't comprehend us.
| hintklb wrote:
| The main issue I see is that the anxiety pill is a way to
| treat the symptoms, not the cause.
|
| Do you think that there is a way to treat the underlying
| cause and not the symptoms?
| ksenzee wrote:
| How do you know an anxiety pill is treating symptoms
| only? What if the cause is physiological, and the pill
| treats that? It is entirely possible to sit in your
| therapist's office and mutually shrug because neither of
| you can find an underlying reason for your anxiety.
| Sometimes anxiety just is.
| burner23499 wrote:
| It's also horrifying to hear your 7-year old child talk about
| committing suicide when you have a deep family history of
| depression, anxiety, and suicide.
|
| Have some empathy.
| SkyPuncher wrote:
| No, it's not.
|
| Medicine is advancing. We're increasingly able to understand
| and adjust dysfunctions that cause major, negative quality of
| life impacts. These dysfunctions have always existed, we're
| just getting better at finding ways to help people work
| through it.
| nominalprose wrote:
| I recently started giving my 11 year old SAM-e, available over
| the counter and much faster acting than SSRIs for serotonin
| support. He's been much happier and more regulated since taking
| it. I'd encourage folk to read up on the literature around
| SAM-e and consider it as a lower risk alternative to try first,
| that may in fact work better.
| Razengan wrote:
| > _treating depression_
|
| Most of the "treatment" is apparently just telling people to stop
| feeling sad [0], or giving them drugs
|
| [0] https://old.reddit.com/r/thanksimcured
|
| but no one bothers to take the time out to sit down and figure
| out WHY they feel sad and FIX THAT FOR THEM. That takes too much
| work.
|
| Sometimes depression is this vague feeling that this world is
| just _wrong._ That Damocles ' sword of mortality. The nagging
| sense of ultimate pointlessness. You can't really "fix" that. But
| having stuff to ignore it helps, like video games :')
| area51org wrote:
| Depression isn't just feeling sad. It's not necessarily caused
| by anything external. You cannot necessarily just "figure out
| why" you feel bad; that's really not how it usually works.
| NoMoreNicksLeft wrote:
| >It's not necessarily caused by anything external. Y
|
| Then how could a drug fix it? We're positing that there is
| not only a mechanism causing it, but that this mechanism can
| be manipulated external to their own self/agency/whatever.
|
| I think that it is at least as absurd to posit that you can
| come up with one chemical substance or another that will
| alleviate their depression when you dismiss the idea of
| coming up with a sequence of words spoken to them that might
| alleviate their depression. It's the conceit that we have a
| better idea of how their brains work chemically than we do of
| how their brains work cognitively.
| Razengan wrote:
| > _You cannot necessarily just "figure out why" you feel bad_
|
| Well, of course, if you anesthetize someone they can't feel
| anything. If you cut off the physical pathways of ""feeling
| sad"" then they can't feel sad, but is that really the same
| as "fixing" the reason for why they were feeling sad in the
| first place?
|
| Unless the reason was that the physical causes are running
| haywire and making someone feel sad when they otherwise
| wouldn't, but how often is that just uhh a lazy scapegoat?
| "Oh this person has no reason to feel sad, something must be
| wrong in their brain"
| jdietrich wrote:
| If someone is sad for a specific, identifiable and tractable
| reason, then they are experiencing a categorically different
| phenomenon to someone who just feels sad all of the time
| regardless of their life circumstances.
|
| One of the key diagnostic criteria for melancholic depression -
| what we might lazily and inaccurately call biological or "real"
| depression - is mood unreactivity. Someone with severe
| melancholic depression could win the lottery one week, lose all
| of their family in a plane crash the next, and feel literally
| nothing about either event.
|
| Some people with atypical depression (or normal sadness that
| has been mis-diagnosed as depression) can respond rapidly and
| dramatically to a change in their circumstances. For many
| others with depression, there is no external _why_ - something
| has gone fundamentally wrong in the functioning of their brain.
| Trying to help those people with talk therapy or exercise or
| companionship would be as futile as using those things to treat
| hepatitis or gangrene.
| Zak wrote:
| A post on HN a couple years ago discussed research showing
| antidepressants only work for about 15% of patients:
| https://news.ycombinator.com/item?id=37671529
|
| The thing is, they work _very well_ for that 15%. I suspect the
| eventual conclusion will be that depression is a syndrome with
| multiple causes rather than a single condition, and SSRIs treat
| one of the causes.
|
| Edit: Mark Horowitz is one of the authors of both studies.
| CGMthrowaway wrote:
| The NNT[1] of Prozac, and SSRIs in general, has been previously
| estimated around 6. Meaning that treatment is more helpful than
| a sugar pill in only 1 out of 6 cases (a dirty secret).
|
| Meanwhile the NNH[2] is as low as 21, that is 1 in 21 cases
| will stop due to negative side effects.
|
| Source:
| https://www.aafp.org/pubs/afp/issues/2008/0315/p785.html
|
| [1]Number Need to Treat, that is, number of patients you need
| to treat to prevent one additional bad outcome
|
| [2]Number Needed to Harm, that is, number of patients you need
| to treat to generate side effects so bad that someone halts
| treatment
| atbpaca wrote:
| Here the context is prozac FOR CHILDREN, not in general. Yet some
| people make a point in commenting that SSRIs are ineffective in
| general because they believe in some big pharma conspiracy. This
| is spreading misinformation. The truth is that SSRIs are modestly
| more effective than a placebo for approximately >> one third of
| the individuals << who try them. In other words, SSRIs are
| effective for more than 60-66% of adults. Moreover, there are a
| few different types of SSRIs. It takes time to find the one that
| fits you.
| mkehrt wrote:
| I'd really be curious about distribution of the result they see.
| The folklore is definitely that that there's vary high variance
| in how people respond to SSRIs, and not recommending them because
| the average value is low is pretty irresponsible.
| slantedview wrote:
| My understanding with SSRIs and other depression meds is that
| they are hit and miss for anyone. I have a family member who, as
| a teen, suffered from severe depression and didn't want to live.
| Therapy wasn't able to help - it was actually the therapist who
| recommended more drastic measures such as medication. And so they
| tried Prozac and that worked. Having seen the reversal myself,
| it's hard to understand how this is placebo.
| thisislife2 wrote:
| The placebo effect (
| https://www.health.harvard.edu/newsletter_article/the-power-...
| )? (In the context we are discussing it, Prozac could be
| considered as an _active placebo_ -
| https://en.wikipedia.org/wiki/Active_placebo ).
| bgnn wrote:
| My own experience with SSRIs was very unpleasant. Sure, it worked
| to reduce my anxiety problems while I was on them for years. The
| first year I was off of them was the worst though. I didn't have
| that bad anxiety ever, as in constant panic and feeking of
| impeding doom. This made me realize that they aren't really an
| option of me. So began my long therapy journey. After 7 years of
| weekly therapy, a healthy work-life balance, and regular exercise
| I'm just feeling better than ever.
|
| So, I'd buy that they don't fix your brain. They definitely
| reduced anxiety for me and I can see the value for stabilizing
| people so they can do the heaking work in therapy.
| hintklb wrote:
| My experience as well. SSRI and other similar drugs for anxiety
| remove a strong signal to your brain and bring other issues or
| signal.
|
| But the issue is that nobody wants to really look at the cause.
| We are all trying to treat the symptoms with those quick-fix
| pills.
|
| The cause is deep in our society. We are too stressed, lost
| touch with each others, work on meaningless jobs (or downright
| negative jobs for society.. if you work at Meta or TikTok, yes
| your job is in fact a negative for society).
|
| I have also been on a journey for the last 5 years on working
| on myself and bringing those things back in my life and I have
| been feeling better than ever: - A lot of outdoor time and
| exercise. - Take the time to build a community of friends that
| genuinely care for each other - Work on some projects that you
| feel help humanity and each other (or volunteer). - Build
| things you are proud of. Build a legacy
|
| All of those removed almost all anxiety and depression. It is
| not an easy journey but I'm shocked how few people even
| consider making those changes
| gnarlouse wrote:
| RFK Jr dancing
| phkahler wrote:
| I thought Prozac was for anxiety.
| paul7986 wrote:
| None of those drugs helped me personally in the 90s (Prozac,
| Zoloft, etc). What helped me personally was talking about my
| problems with other humans only to the learn we all are
| "crazy,(aka totally normal)" and the majority all deal with
| something similar. Anxiety, OCD, insecurity .. all are parts of
| the human condition we all deal with throughout our lives.
| blastersyndrome wrote:
| When I was a teen I was put on Prozac because I threatened to
| commit suicide.
|
| The drug absolutely destroyed me. Within a few days of taking it,
| I was in a bizarre state of delirium where I would sleep
| something like 18 hours a day. When I wasn't asleep I would gnash
| my teeth at my parents. At school I would lash out at my
| classmates and randomly punch the walls of my classroom. I was
| taken off the drug after about five days but I didn't fully
| recover.
|
| To this day, my emotions are severely blunted. I still have
| complete anhedonia and avolition. I can go on a roller coaster
| and feel not a shred of an adrenaline rush. Nothing. I struggle
| maintaining relationships with people because I have no innate
| "desire" to do so.
|
| The drug is absolutely evil and should never be given to minors.
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