"In the United Kingdom, talk therapies or counselling in conjunction with medication are considered best practice. These therapies are not readily available through the health system in New Zealand, Dr Cartwright said"
Well, there you have it from the article. New Zealand's health care system doesn't provide best practice (as most health insurers in the United States have for years, and now must do under the Affordable Care Act). The best treatment plan for depression is some medicine that fits a particular patient hand-in-hand with talk therapy. There is a new review article in Annual Reviews of Psychology[1] that summarizes the research on best practices in treatment of depression, and that is the main conclusion: use medicines AND use talk therapy.
Actually, we do have free therapy. Anyone can go along to their free local talky place. A GP can refer you to a psychologist if you're so much inclined. Usually, a GP will strongly advice you to talk to someone whilst on medication, and the GP receives feedback from a therapist/psychologist. I am not sure what exactly she means.
Woah there.. citation required. There is limited therapy available for free, and often you have to convince someone that you are a high risk (ie likely suicide) before you'll get help.
The UK used to have talking therapies available on the National Health Service, but since the Conservative government cut the NHS budget I know of no-one who has been able to get them.
There's a major problem with waiting lists for sure, mental health on the NHS is very under-resourced. [Source: my mother is a cognitive behavioural therapist]
Indeed. Zoloft certainly made my sex life more complex! One of the biggest issues is that these medications take quite a while (8+ weeks) before you start to see results and can often take up to 6 months for side effects to go (if they go at all, they did for me thankfully).
Long time depression and PTSD sufferer here. Drugs help but are not the only answer which seems to be how they are seen in New Zealand. Talking about my problems (not just with professionals but also other sufferers) and my history helps more than the medication. I am on Sertraline (Zoloft) and some other meds and it certainly does help me however it is more of a "it makes things not so difficult" than "it makes me better". For example it makes me not get so upset/angry about things that I would do before. I used to go from 0 to 10 in a second, now it is very, very difficult to get me above an 8 in the anger scales. I am much calmer and that makes me happier.
Obviously these medications are still hugely unknown though and everyone does react differently. My personal advice for those suffering with depression (and any other mental health issue) is to get some talking therapy where you can. As I said it doesn't have to be a professional, often just somebody who kind-of-understands is a huge help!
I'm taking Zoloft for Obsessive-Compulsive Disorder and I totally agree. Medication and cognitive therapy are both important parts of a treatment whole.
NZ'er point of view here: in general, culturally, drugs are not seen as an answer; definitely not the "only answer", and probably more like the "last resort".
I think the point is that there is no control group as part of the study (at least, one was not indicated in the article). So, while the article throws around a lot of scary sounding statistics, the only conclusion that can be drawn based on the information given is that "depressed people are depressed". It would have been helpful if they compared the results to depressed people who were not taking any antidepressants.
Although I agree with your sentiment, both of your comments are flippant retorts. This is rude, and more importantly, unscientific. It’s not because something is obvious that it doesn’t deserve questioning. You can quote the methodology comment relation, or you can provide and actual explanation — but you can’t dismiss anyone, even when they appears to be making something as easy to explain as confusing depression and suicide.
I'm sure they did. In fact, I suspect that their actual paper has a control group, and gives us the rates for depressed people not on medication. However, non of that is in the linked article, and general purpose news sites do not have a good track record of accurately reporting on scientific studies.
The abstract mentions no control group at all and the only number mentioned was the amount of people on antidepressants who took the survey. Additionally, no claim of statistical relevance was made and all the results are simply reported from the survey.
This isn't really news. The side effects were made known to me years ago, and it was still better for me to take them. I used to have a mental illness condition that messed up my life for over a decade. I've learned and relied on a whole host of tools.
If you or someone you know is in need of help because of anxiety, depression, mania, etc GET HELP! There is very, very good help out there.
Send me a message if you don't know who to talk to. I know all about how scary it is to seek help, to admit that maybe you have a problem that might need medication. You are not alone, and you're not the first person to go through this. I know it can feel that way, but it's not.
Seriously, send me a message. I might be a stranger, but I don't want anyone to have to endure what I had to.
(Hi-jacking the top comment, but yours is lacking that key detail:)
There are several molecules available, all have side effects, very different; amusingly, they are generally complementary: one makes you gain weight, another loose — so talk about that kind of detail with your psychiatrist. Loss of sexual appetite is common for the most popular; its non-existent (with anecdotal mentions of improvement) for the second most popular. Any issue, any secondary effect that you encounter, digestion, head-aches, can hopefully be compensated for.
Don’t ask me for names, I couldn’t spell those for the life of me.
Source: dating a shrink; that’s my everyday dinner talk. Not sure I’m 100% confortable with dudes detailing their limpness with my girl all day. However, can 100% attest that she doesn’t remotely care, unless its publishable (it’s not); more importantly, after loosing six close friends to suicide, all medicated, each improperly, it’s not even a question to me: talk. Journal it if you have to. Plus, it’s better than her second choice anyway (urologist).
The "most popular" ones you're referring to are SSRIs (selective serotonin reuptake inhibitors), which work by binding to 5-HT2 receptors in your brain and preventing (unsurprisingly) the reuptake of serotonin, leading to more serotonin present in the synapses. Serotonin is generally associated with positive mood, but it also delays orgasm, so patients taking SSRIs frequently report anorgasmia, or inability to reach orgasm.
I suspect the "second most popular" you refer to would be bupropion, tradename Welbutrin, which is mildly stimulating, and thus pro-sexual.
I agree with this 100%, if you need them you should take them.
That said, just because you need them at one point in your life doesn't mean you will always need them. I was on various things for around 9 years before making a serious attempt to see if I still needed them. Tapering was a long difficult process, but it's been almost a year now and I'm glad to be off. I'll certainly go back on if I need to, but for now I don't.
So, the big issue my girlfriend had was they put her on anti-depressants for a year and a half.
I have very very severe depression, and how I've learned to cope is using a combination of CBT and anti-d's. The latter, I only take when a bad episode has started, and I come off them within about three or so months.
This avoids the "discontinuation syndrome" and gives me enough of a solid base to overcome the depressive episode using CBT and life changes.. I use them like a band-aid, basically, and it keeps the "dirt" out while my mind heals.
Cheers to you, well said. As someone for whom SSRIs have helped mitigate serious OCD and MDD, I salute you. No drug is perfect, but the depth of suffering that millions of people would be subjected to without our modern pharmaceutical toolkit is incalculably worse than the side effects.
What I find worrying about anti-depressants and how used is the approach. Somebody has low levels of serotonin and the anti-depressants increase this. Soon as they stop taking them there body goes even lower than they were before as no artificial stimulus.
So why they don't use controlled environment drugs to lower levels of serotonin and when they stop taking them then they are naturally going to have higher levels.
See in the past many people would at weekends go for a drink, this was the norm, drink is a depressant, but in groups the effects balance out as your amongst friends and you associate any negative feeling to a hangover/the drink. Once you remove a logical reason for being down then people have no crutch to blame it on other than themselves and that begins the downward spiral.
Also many people who are depressed do not sleep well, be it pain of other reasons and sadly those reasons get ignored as easier to give them the new asprin known as anti-depressants.
Also serotonin is part of a cyclic system related to melatonin, which helps us sleep so can see a correlation right there. But do they prescribe melatonin, no. Why not - well because that is natural and hard to copyright, this means no drug company wants to invest in a low-profit easy copyable approach and on top of that nobody pays for medical trials so it does not get upon approved prescription lists.
Sadly many natural approaches medicine wise are ignored as they have not gone thru medical trials to get approval for prescription and that is all down to no drug company can make profit out of them and none of them want to pay for a trial that others can use as no copyright upon the drugs.
Rather sad situation when you step back and look into the details and very depressing.
People with depression do not generally have low serotonin levels, and it's unlikely low serotonin is the cause of chronic depression. If it was, serotonin agonists would be effective much faster than the 4-8 weeks they currently take. There's some evidence that increased serotonin levels modulate glutamate after about 4 weeks, and glutamate antagonists like Ketamine are effective on depression more rapidly than serotonin agonists (as quick as 40m in some studies).
Also the depression effect of alcohol is completely different to chronic depression, any mood effects you feel during a hangover are likely related to reduced dopamine.
Sleep is very important though, and, in Australia at least, melatonin is commonly prescribed for sleep issues that have a psychiatric cause.
"Blood levels of serotonin are measurable -- and have been shown to be lower in people who suffer from depression – but researchers don't know if blood levels reflect the brain's level of serotonin.
"Also, researchers don't know whether the dip in serotonin causes the depression, or the depression causes serotonin levels to drop.
"Although it is widely believed that a serotonin deficiency plays a role in depression, there is no way to measure its levels in the living brain." -- (http://www.webmd.com/depression/features/serotonin)
In my personal experience this is so true but people don't realize that every medication is different and psychiatrists are relying on very little information for your first prescription.
What worked for me was 2 weeks on a medication, gauge the symptoms (some were absolutely terrible) and decide to move on to another one. After maybe 3 anti-depressants I found the correct one.
I don't really think we know much about how some of these medications work which can be unsettling but we do know they help some people. To me at least it was worth it.
Indeed. Fluoxetine (Prozac) was exactly what I needed for depression. Friends of mine, not so much. And for Parkinsonism, my personal cocktail is probably (the pharmacological equivalent of) a little bit sweeter and not quite so bubbly as what works for others with the "same" symptoms (which, by the way, resemble Huntington's more than they do "classic" Parkinson's disease). Brains are complicated.
The anti-depressants in general act as a safety net to stop you cratering while you go through the other therapy based treatments. They are just one part of the holistic solution to depression and anxiety (therapy, dietary changes, exercise and mindfulness being other parts).
Sadly too many doctor prescribe them as a cure without the additional steps needed to actually treat the underlying condition and help the patient make a recovery. Also insurance companies generally aren't willing to pay or will only pay for a certain number of sessions which doesn't help the situation.
That said there are a number of doctors that are starting to take a more holistic approach to the treatment of anxiety and depression so hopefully things will change.
As is typical, I would like to complain about the poor coverage of scientific papers, and lack of good referencing to the original publication.
I believe I have find the actual paper at [1]. This is the only paper that google scholar reports the referenced researcher, Claire Cartwright, as having published in 2014, and seems to be on topic.
EDIT: Re-reading the article, did they mention a single fact from the study that is not part of the abstract?
He about efficacy? How about they just don't work? How about the worst kind of data/study manipulation in the history of allopathical medicine?
Yes--I trusted drug companies to provide MD's with honest
forthright studies. Instead, they "cherry picked" studies,
and did horrid research. I don't let doctors off the hook
either; what about .5% better than control was impressive(
I made that number up, but I don't think I'm that far off.
I took tri, heterocyclic drugs over the years and nothing
even remotely worked for my condition.(A panic attack that
morphed into general anxiety--which after years of failed
treatments turned into Depression.
At this point--I am just livid over the deception. These
drugs were expensive, and so were the doctors visits. I
am now on drugs that control anxiety, but are extremely
addictive. I am embarrassed to mention what I'm addicted
too.
My point, beyond venting if you are clinicall depressed,
these drugs might work. I have never really been that
depressed--or I was told.
I do know one thing though that most MD's won't tell you.
If you have a breakdown(very common in the twenties). Time
will help your condition. Oh yea, if you think you are
Superman(physically and mentally) you probally have a breaking point. I thought I could handle anything better
than my peers; I was wrong. Of yea, try to take it easy
on the alcohol--it works, but you will become addicted.
And honestly, I'm not sure I would step foot in a Psychiatrists office if I could go back in time; at least
a for profit Doctor. They will drag you back in order to
get you prescription filled(It should be illegial).
Remember though--The adage "Time cures all ill's" worked, at
least for me. Aging is a strong medicine. I didn't accomplish what I set out for, but my interests changed as
I got older. If you feel bad, like someone literally yanked
the rug from your feet--I understand completely. Your friends will have just a vague notion of what you are going through, but there are people out there who know just how
difficult you life has become. Again--If you are reading
this, you will get better with time. I have no reason to
lie.
Instead, they "cherry picked" studies, and did horrid research.
You do realize how difficult it is to run clinical trials for psychiatric diseases? There is little doubt that there are drugs out there that work, that didn't have successful clinical trials and never made it to market?
It's really hard with anti-depressants to know if the reason you're feeling better is because you think the drug is going to make you feel better or because the drug is actually doing things. Then you feel worse and don't want to cut out the depressant because you think it's propping you up. It screws with your mind.
I can say with certainty, however, that if you ever want to make your johnson have half the sensation, they absolutely do have an effect there.
The side effect of sexual dysfunction is sometimes used therapeutically - for example, citalopram (an SSRI) is also prescribed to treat premature ejaculation.
2 years ago I was struck by a car which resulted in a TBI that I still deal with from time to time. Early on I was prescribed different anti-depressants (and anti-seizure meds) as a prophylaxis and they were beyond terrible. I've probably tried 1/2 dozen and each one made life a chore. Overall numbness, sleeplessness, insomnia, minor depression, etc. In the end I decided I'd rather deal with the occasional debilitating headache than be on that sort of medication.
My heart goes out to the people with MDD that deal with these side effects as part of their daily routine.
While this may not be for everyone, I say skip these drugs. Instead talk about the crazy things that bother you with your family, friends, peers, etc.
9 out of 10 times they too will tell you they have suffered from something similar, which for me made me feel normal.
Overall this is what helped me deal with OCD, anxiety and depression. It wasn't some whiz bang drug - one you hear about on a PSA years later, saying "If you took this drug call us and we'll sue the pants off of the drug company for their negligence."
"60 percent complained of feeling emotionally numb" ... which is essentially what major depression is, interestingly enough.
It isn't surprising that these drugs would cause depression and suicidal thoughts / actions. What is surprising (or was at least) is the rate at which doctors prescribe these drugs (SSRI, SSNRI, Wellbutrin) after barely knowing someone for 15 to 20 minutes. Their insistence that they have an answer when they have no idea what these drugs do or how they work is literally driving people insane. These drugs should come with a warning (along with many other "mental health" drugs like benzodiazepines) not only on the label, but from every doctor who prescribes them.
But doctors and pharmaceutical companies make too much money to worry about ineffective, unstudied drugs such as these killing people and ruining lives. So forget that. Let's lie to people and tell them that help exists, it's in a pill, and that's all they need to feel better.
If you want help, talk to a friend, not a doctor (psychiatrist usually) whose main interest is to keep you hooked and coming back for more. After all, in this case too, you are the product.
I can't second this strongly enough. These drugs can be devastating when they're not right for you. And the standard for diagnosis is a glorified questionnaire.
Well, how can you really judge what that means without a control? For example,it's one thing to say that 40% of people taking X experience suicidal thoughts, quite another to say that 40% of people taking experience suicidal thoughts without having had them before. 40% (a made-up # here) would be quite good if it were lower than the rate of suicidal ideation among untreated depressives.
This is not new news, but thankfully it is finally getting more attention. I highly recommend a book to anybody who's interested in the topic of mental illness: Anatomy of an Epidemic by Robert Whitaker. A very well-researched and interesting read. Lays out the evidence that research actually supports that antidepressants and antipsychotics (neuroleptics) actually cause worse long term outcomes for patients, and almost in all cases cause what could be a one-time episode to become a chronic problem for the patient. They change the brain in such a way as to cause a dependency and increase the chance of relapse if the drug is withdrawn. Its the reason patients are often told they have to be on the drug for life, and why quitting the drugs is difficult.
I second this. This book should be required reading for anyone considering a pharmaceutical approach to depression - a path that has apparently been engineered to make life-long "customers". Changes in diet and exercise may not be profitable enough to warrant mass advertising, but do the research on it, and, most importantly, try that before walking through the revolving door of the "mental health" system.
56 comments
[ 0.20 ms ] story [ 135 ms ] threadWell, there you have it from the article. New Zealand's health care system doesn't provide best practice (as most health insurers in the United States have for years, and now must do under the Affordable Care Act). The best treatment plan for depression is some medicine that fits a particular patient hand-in-hand with talk therapy. There is a new review article in Annual Reviews of Psychology[1] that summarizes the research on best practices in treatment of depression, and that is the main conclusion: use medicines AND use talk therapy.
[1] http://www.annualreviews.org/doi/abs/10.1146/annurev.psych.1...
Obviously these medications are still hugely unknown though and everyone does react differently. My personal advice for those suffering with depression (and any other mental health issue) is to get some talking therapy where you can. As I said it doesn't have to be a professional, often just somebody who kind-of-understands is a huge help!
Wow. Depressed people who were prescribed antidepressants for their depression are depressed? What a shocking revelation.
Although I agree with your sentiment, both of your comments are flippant retorts. This is rude, and more importantly, unscientific. It’s not because something is obvious that it doesn’t deserve questioning. You can quote the methodology comment relation, or you can provide and actual explanation — but you can’t dismiss anyone, even when they appears to be making something as easy to explain as confusing depression and suicide.
So likely there is no control group.
If you or someone you know is in need of help because of anxiety, depression, mania, etc GET HELP! There is very, very good help out there.
Send me a message if you don't know who to talk to. I know all about how scary it is to seek help, to admit that maybe you have a problem that might need medication. You are not alone, and you're not the first person to go through this. I know it can feel that way, but it's not.
Seriously, send me a message. I might be a stranger, but I don't want anyone to have to endure what I had to.
There are several molecules available, all have side effects, very different; amusingly, they are generally complementary: one makes you gain weight, another loose — so talk about that kind of detail with your psychiatrist. Loss of sexual appetite is common for the most popular; its non-existent (with anecdotal mentions of improvement) for the second most popular. Any issue, any secondary effect that you encounter, digestion, head-aches, can hopefully be compensated for.
Don’t ask me for names, I couldn’t spell those for the life of me.
Source: dating a shrink; that’s my everyday dinner talk. Not sure I’m 100% confortable with dudes detailing their limpness with my girl all day. However, can 100% attest that she doesn’t remotely care, unless its publishable (it’s not); more importantly, after loosing six close friends to suicide, all medicated, each improperly, it’s not even a question to me: talk. Journal it if you have to. Plus, it’s better than her second choice anyway (urologist).
This is a great combination for suicidal thoughts and numbness.
I'm on both, I've been told by multiple doctors that they're often prescribed together as the Buspirone can offset the side effects of Escitalopram
I suspect the "second most popular" you refer to would be bupropion, tradename Welbutrin, which is mildly stimulating, and thus pro-sexual.
That said, just because you need them at one point in your life doesn't mean you will always need them. I was on various things for around 9 years before making a serious attempt to see if I still needed them. Tapering was a long difficult process, but it's been almost a year now and I'm glad to be off. I'll certainly go back on if I need to, but for now I don't.
I have very very severe depression, and how I've learned to cope is using a combination of CBT and anti-d's. The latter, I only take when a bad episode has started, and I come off them within about three or so months.
This avoids the "discontinuation syndrome" and gives me enough of a solid base to overcome the depressive episode using CBT and life changes.. I use them like a band-aid, basically, and it keeps the "dirt" out while my mind heals.
So why they don't use controlled environment drugs to lower levels of serotonin and when they stop taking them then they are naturally going to have higher levels.
See in the past many people would at weekends go for a drink, this was the norm, drink is a depressant, but in groups the effects balance out as your amongst friends and you associate any negative feeling to a hangover/the drink. Once you remove a logical reason for being down then people have no crutch to blame it on other than themselves and that begins the downward spiral.
Also many people who are depressed do not sleep well, be it pain of other reasons and sadly those reasons get ignored as easier to give them the new asprin known as anti-depressants.
Also serotonin is part of a cyclic system related to melatonin, which helps us sleep so can see a correlation right there. But do they prescribe melatonin, no. Why not - well because that is natural and hard to copyright, this means no drug company wants to invest in a low-profit easy copyable approach and on top of that nobody pays for medical trials so it does not get upon approved prescription lists.
Sadly many natural approaches medicine wise are ignored as they have not gone thru medical trials to get approval for prescription and that is all down to no drug company can make profit out of them and none of them want to pay for a trial that others can use as no copyright upon the drugs.
Rather sad situation when you step back and look into the details and very depressing.
Also the depression effect of alcohol is completely different to chronic depression, any mood effects you feel during a hangover are likely related to reduced dopamine.
Sleep is very important though, and, in Australia at least, melatonin is commonly prescribed for sleep issues that have a psychiatric cause.
"Also, researchers don't know whether the dip in serotonin causes the depression, or the depression causes serotonin levels to drop.
"Although it is widely believed that a serotonin deficiency plays a role in depression, there is no way to measure its levels in the living brain." -- (http://www.webmd.com/depression/features/serotonin)
What worked for me was 2 weeks on a medication, gauge the symptoms (some were absolutely terrible) and decide to move on to another one. After maybe 3 anti-depressants I found the correct one.
I don't really think we know much about how some of these medications work which can be unsettling but we do know they help some people. To me at least it was worth it.
Sadly too many doctor prescribe them as a cure without the additional steps needed to actually treat the underlying condition and help the patient make a recovery. Also insurance companies generally aren't willing to pay or will only pay for a certain number of sessions which doesn't help the situation.
That said there are a number of doctors that are starting to take a more holistic approach to the treatment of anxiety and depression so hopefully things will change.
I believe I have find the actual paper at [1]. This is the only paper that google scholar reports the referenced researcher, Claire Cartwright, as having published in 2014, and seems to be on topic.
EDIT: Re-reading the article, did they mention a single fact from the study that is not part of the abstract?
[1] http://www.psy-journal.com/article/S0165-1781(14)00083-3/abs...
Full text here if anyone fancies a read: http://ge.tt/55GwqzO1/v/0
Yes--I trusted drug companies to provide MD's with honest forthright studies. Instead, they "cherry picked" studies, and did horrid research. I don't let doctors off the hook either; what about .5% better than control was impressive( I made that number up, but I don't think I'm that far off.
I took tri, heterocyclic drugs over the years and nothing even remotely worked for my condition.(A panic attack that morphed into general anxiety--which after years of failed treatments turned into Depression.
At this point--I am just livid over the deception. These drugs were expensive, and so were the doctors visits. I am now on drugs that control anxiety, but are extremely addictive. I am embarrassed to mention what I'm addicted too.
My point, beyond venting if you are clinicall depressed, these drugs might work. I have never really been that depressed--or I was told.
I do know one thing though that most MD's won't tell you. If you have a breakdown(very common in the twenties). Time will help your condition. Oh yea, if you think you are Superman(physically and mentally) you probally have a breaking point. I thought I could handle anything better than my peers; I was wrong. Of yea, try to take it easy on the alcohol--it works, but you will become addicted.
And honestly, I'm not sure I would step foot in a Psychiatrists office if I could go back in time; at least a for profit Doctor. They will drag you back in order to get you prescription filled(It should be illegial).
Remember though--The adage "Time cures all ill's" worked, at least for me. Aging is a strong medicine. I didn't accomplish what I set out for, but my interests changed as I got older. If you feel bad, like someone literally yanked the rug from your feet--I understand completely. Your friends will have just a vague notion of what you are going through, but there are people out there who know just how difficult you life has become. Again--If you are reading this, you will get better with time. I have no reason to lie.
You do realize how difficult it is to run clinical trials for psychiatric diseases? There is little doubt that there are drugs out there that work, that didn't have successful clinical trials and never made it to market?
I can say with certainty, however, that if you ever want to make your johnson have half the sensation, they absolutely do have an effect there.
A single survey of depressed people taking pills doesn't prove anything. Note they did not do before/after. This is pseudo-science.
My heart goes out to the people with MDD that deal with these side effects as part of their daily routine.
Sort of related-- wear a fucking helmet.
9 out of 10 times they too will tell you they have suffered from something similar, which for me made me feel normal.
Overall this is what helped me deal with OCD, anxiety and depression. It wasn't some whiz bang drug - one you hear about on a PSA years later, saying "If you took this drug call us and we'll sue the pants off of the drug company for their negligence."
It isn't surprising that these drugs would cause depression and suicidal thoughts / actions. What is surprising (or was at least) is the rate at which doctors prescribe these drugs (SSRI, SSNRI, Wellbutrin) after barely knowing someone for 15 to 20 minutes. Their insistence that they have an answer when they have no idea what these drugs do or how they work is literally driving people insane. These drugs should come with a warning (along with many other "mental health" drugs like benzodiazepines) not only on the label, but from every doctor who prescribes them.
But doctors and pharmaceutical companies make too much money to worry about ineffective, unstudied drugs such as these killing people and ruining lives. So forget that. Let's lie to people and tell them that help exists, it's in a pill, and that's all they need to feel better.
If you want help, talk to a friend, not a doctor (psychiatrist usually) whose main interest is to keep you hooked and coming back for more. After all, in this case too, you are the product.