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.
The efficacy of anti-depressants has been consistently over-inflated, so generations were poisoned with side-effects: suicidal ideation, homicidal tendencies, etc.
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 STARD 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.*
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).
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.
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!
> 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.
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.
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.
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.
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.
> 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).
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
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.
Well, all the n number of times I have been depressed in the past have been resolved by a change in life circumstances, so perhaps I am just an outlier?
> SSRI prescription
I'm supposed to take an NDRI (Bupropion) and not an SSRI, which is kind of like Ritalin or cocaine. The problem is that I already take amphetamines every single day, so I am not sure why this is really the one my doctors settled on.
In fact, they told me that if my blood pressure increases anymore that I am to stop the medication immediately and then contact them. So, that's not really inspiring a lot of motivation in 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.
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.
My mistake. I should have worded what I wrote differently. I meant to say "not some true disorder for me."
> Having an objectively crappy life is normal. Being depressed about it isn't.
Not sure I can agree on this though. Rates of depression are quite high in institutions like prisons, for example. Especially in solitary confinement. Of course, I am not in prison, but I do believe the environment plays a larger role in depression than many are willing to admit.
This is not my first rodeo with depression. I'm in my early 30s, and this is probably my 5th or 6th time. I won't go into the details of those periods, but I almost didn't make it through a few of them.
> Ah, this is just due to problem X
Why is this outside the realm of possibility though? I believe depression is just a catch-all term for negative states that are too abstract to treat. If one is in a bad environment or unsatisfied in life, then a doctor cannot really do much to treat that. However, pills can be given to make people numb enough to their circumstances that they no longer care. Though, perhaps that lack of care is enough that people can actually benefit?
I mean, with SSRIs, the lows of life are diminished as are the highs of life, one might gain significant weight, and have a host of other issues like low libido, erectile dysfunction, anorgimasa, etc., but at least they aren't depressed...
If anything, I think of antidepressants like opioids. Opioids do not treat pain -- the pain is still there -- one just can't feel it.
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.
> medical professionals who didn't really listen to symptoms
Even if they did listen to me, what else can they do? They aren't going to apply to new jobs for me, find friends and hobbies for me, etc.. To the men with pills, every issue looks like a disorder.
I'm with you on this. People who pathologize themselves or others - assuming they're malfunctioning rather than acknowledging they might simply be living a life that doesn't fit - have a very limited way of looking at things.
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.
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.
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.
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.
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.
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."
I'm very sorry to hear your story, and I'm really glad the medication has worked well for you and your family. It's early days, but it seems to be working well for ours too.
I also really admire the way you're dealing patiently with everyone in this thread arguing in bad faith, you have a lot more tolerance than I do! Hopefully it's not getting to you. Best wishes.
> 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
This warrants a whole different discussion, and I'll be down voted for it, but one that's never addressed: quality over quantity.
Pills are the individuals response to a society that feeds empty food, bland sterile shelter, fake friends, and meaningless jobs.
The natural human response to a lack of meaning is hopelessness, and this comes from our society. Pills helps individuals cope with continuing the meat grinder just a little while longer.
I had depression, and I cured it by finding meaning and beauty in the world. I get told "if you can cure it without pills, you never really had it" yeah cool, self fullfilling prophecy in that case innit. Can't cure it, because it doesn't exist without meds. It just comes out of "nowhere" and is here to stay.
I’m thoroughly impressed with how you handled the comments in this subthread. As someone who was on and off antidepressants for years, I can say confidently that for every one person spewing vitriol and judgement at you for your parenting decision, there was someone else solemnly nodding and sending love to you and your family. People just don’t fucking get it unless they get it. Best of luck to you.
IMO, that's a common misconception. The fact that it seems this way can be attributed misunderstanding, bias in data, and perhaps a poor treatment choice. Sometimes, it's also the best healthcare can do for now.
Medical interventions for mental health issues aren't a forever-crutch. Plenty of people do taper off/change something about their prescriptions after a certain point, but we rarely ever hear those stories. What we do hear is plenty of people getting on meds/being on meds for a long time, which can bias us and make us think that most people who get on meds are on it for life.
I am surprised by how many people seemingly independently come up with a completely indescriptive "bad day" label - for the lack of a better one.
Good that things are working out for you.
Recently found that, on top of meds (that started wearing off - after taking them for a couple years now following a challenging life situation), going to social latin dance classes for a couple hours almost every day after work helps quite a bit.
Under-nourishment/malnutrition, traumatic incidents/events, genetics, societal conditions, bullying and abuse, and so many things are also all brain altering. Why do we not consider them so and turn a blind eye to all that?
I wish I could have taken something as a kid. I knew when I was 5 that something was wrong. I felt different from other kids (as least as they said they felt) and that continued through my late 20s when I started taking SSRIs. It was the best decision I've made. Ever.
But back to being a kid and thinking and feeling differently: It negatively impacted me. And the abuse only made it worse. If only I was put on drugs and/or sent to talk therapy.
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 :')
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.
I suspect the biggest, but not the only, problem with these supposedly weak SSRI/SNRI numbers we routinely see in clinical trials has to do with the definition of depression, with the diagnosis itself. For example it has some of the worst inter-rater reliability across the entire DSM (meaning that two doctors are least likely to both reach the same diagnosis in the same patient independently). So if you start from a poorly defined set, which likely encompasses some genuine affective disorders, people going through difficult times, undiagnosed personality disorders, dysthymic ADHDers, burned out ASDs, and God knows who else - yeah, you'll get poor performance data. Every psychiatrist knows intuitively that SSRIs/SNRIs do work, even if you have to trial a few. Also, without arguing about the number, that 15% is not exactly the same 15% for each drug.
Also, since we're here: the secret knowledge about depression (and affective disorders in general) is that it is an episodic illness, where episodes are measured in weeks or in months. Most people experience just one episode which will end whether or not any medical intervention is undertaken, although the intervention can greatly shorten the course and avoid a potential suicide. But some will not stop at one episode, and can go on to have multiple episodes, perhaps develop melancholic features or even suffer from a lifelong recurrence. It is in the latter groups where medication is the most effective.
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.
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.
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.
It is extremely hit and miss. My understanding is that for those with "shit life syndrome", prozac is generally ineffective, but for those with genetic predispositions it can be extremely helpful. the catch is that the two are not exclusive, and those with genetic predispositions to depression may never have it, and people with bad life circumstances may feel more stable mentally with prozac and better equipped to tackle life's challenges.
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.
I hear this story over and over again and it makes me sad. Medication for depression, anxiety, or adhd should be used to enable the work with a therapist, not to make life bearable without working on the underlying problems. Been there, done that. Wasted a couple of otherwise good years on not doing the work.
Fluoxetine has received FDA approval to treat major depressive disorder (8 and older), obsessive-compulsive disorder (7 and older), panic disorder (with or without agoraphobia), [and] bulimia nervosa...
88 comments
[ 3.6 ms ] story [ 98.1 ms ] thread> 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.
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 STARD 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.*
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).
> "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?
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!
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.
How is it different from the expected hormonal changes that an adolescent is expected to go through?
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.
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.
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.
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).
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
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.
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.
> SSRI prescription
I'm supposed to take an NDRI (Bupropion) and not an SSRI, which is kind of like Ritalin or cocaine. The problem is that I already take amphetamines every single day, so I am not sure why this is really the one my doctors settled on.
In fact, they told me that if my blood pressure increases anymore that I am to stop the medication immediately and then contact them. So, that's not really inspiring a lot of motivation in me.
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.
My mistake. I should have worded what I wrote differently. I meant to say "not some true disorder for me."
> Having an objectively crappy life is normal. Being depressed about it isn't.
Not sure I can agree on this though. Rates of depression are quite high in institutions like prisons, for example. Especially in solitary confinement. Of course, I am not in prison, but I do believe the environment plays a larger role in depression than many are willing to admit.
This is not my first rodeo with depression. I'm in my early 30s, and this is probably my 5th or 6th time. I won't go into the details of those periods, but I almost didn't make it through a few of them.
> Ah, this is just due to problem X
Why is this outside the realm of possibility though? I believe depression is just a catch-all term for negative states that are too abstract to treat. If one is in a bad environment or unsatisfied in life, then a doctor cannot really do much to treat that. However, pills can be given to make people numb enough to their circumstances that they no longer care. Though, perhaps that lack of care is enough that people can actually benefit?
I mean, with SSRIs, the lows of life are diminished as are the highs of life, one might gain significant weight, and have a host of other issues like low libido, erectile dysfunction, anorgimasa, etc., but at least they aren't depressed...
If anything, I think of antidepressants like opioids. Opioids do not treat pain -- the pain is still there -- one just can't feel it.
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.
Even if they did listen to me, what else can they do? They aren't going to apply to new jobs for me, find friends and hobbies for me, etc.. To the men with pills, every issue looks like a disorder.
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.
Religion is a good example. https://pmc.ncbi.nlm.nih.gov/articles/PMC3426191/
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."
I also really admire the way you're dealing patiently with everyone in this thread arguing in bad faith, you have a lot more tolerance than I do! Hopefully it's not getting to you. Best wishes.
This warrants a whole different discussion, and I'll be down voted for it, but one that's never addressed: quality over quantity.
Pills are the individuals response to a society that feeds empty food, bland sterile shelter, fake friends, and meaningless jobs.
The natural human response to a lack of meaning is hopelessness, and this comes from our society. Pills helps individuals cope with continuing the meat grinder just a little while longer.
I had depression, and I cured it by finding meaning and beauty in the world. I get told "if you can cure it without pills, you never really had it" yeah cool, self fullfilling prophecy in that case innit. Can't cure it, because it doesn't exist without meds. It just comes out of "nowhere" and is here to stay.
Medical interventions for mental health issues aren't a forever-crutch. Plenty of people do taper off/change something about their prescriptions after a certain point, but we rarely ever hear those stories. What we do hear is plenty of people getting on meds/being on meds for a long time, which can bias us and make us think that most people who get on meds are on it for life.
Good that things are working out for you.
Recently found that, on top of meds (that started wearing off - after taking them for a couple years now following a challenging life situation), going to social latin dance classes for a couple hours almost every day after work helps quite a bit.
But back to being a kid and thinking and feeling differently: It negatively impacted me. And the abuse only made it worse. If only I was put on drugs and/or sent to talk therapy.
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 :')
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.
Also, since we're here: the secret knowledge about depression (and affective disorders in general) is that it is an episodic illness, where episodes are measured in weeks or in months. Most people experience just one episode which will end whether or not any medical intervention is undertaken, although the intervention can greatly shorten the course and avoid a potential suicide. But some will not stop at one episode, and can go on to have multiple episodes, perhaps develop melancholic features or even suffer from a lifelong recurrence. It is in the latter groups where medication is the most effective.
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.
https://www.ncbi.nlm.nih.gov/books/NBK459223/