Would this mean SSRIs are essentially bunk?
for me they’ve never done shit. there is strong evidence they work for depression though. I may be misremembering, but I thought I remembered they weren’t exactly even sure why they worked and only suspected it was the seratonin.
what I’ve got usually presents as dhysthmia which is chronic, persistent low-grade depression. mine dips into severe episodes only rarely. I’ve been seesawing from there into major depressive stuff for months. usually the major ones only last 2-3 weeks. it does feel lately like I’m really losing the battle though. I’m not in danger, or dangerous, but my life’s clearly falling apart in a lot of areas and my ability to pull myself out of it like I always do seems very hindered.
it’s made worse by the few people in my life not realizing how unable I am at dealing with some of this stuff at this present moment. i need help but i dont have much of a support network and i dont even know what help i need. i tried to hire an assistant a few months ago but it didnt work. I think my therapist tends to brush off my reporting of the situation because I do catastrophize a lot and am a bit dramatic but I’m absolutely serious and it is NOT the depression talking when I say this is having a severe and very real impact on my life. I’m in so much physical pain on top of it all, that I can’t seem to get fixed. everything feels hopeless and I’m sick of people saying “thats the depression talking” because for me it really IS hopeless and I don’t see a clear path out.
my long term prognosis is poor, I’m very certain of it. right now I’m trying to map out the next 5,10,20 years and planning on not living much past 60. it’s grim but I know the stats. even if you dont kill yourself (I will not because to me it feels like admitting defeat or succumbing to the illness and I’m stubborn to a fault) it has a severe impact on your overall health and depressed people on avg lose a huge chunk of their avg life expectancy.
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There has been contentious debate over how much evidence there is for the effectiveness of SSRIs over placebo in treating depression. Depression is highly placebo-responsive, so even if SSRIs aren’t superior to placebo, taking an SSRI can work for treating depression based on placebo effect alone, but with lots of side effects.
I think the most common opinion from people without a vested interest in SSRIs (ie. pharma companies, docs/researchers paid by pharma companies, psychiatrists who’ve always used them and don’t want to be wrong, etc.) is along the lines of this
SSRIs might have statistically significant effects on depressive symptoms, but all trials were at high risk of bias and the clinical significance seems questionable. SSRIs significantly increase the risk of both serious and non-serious adverse events. The potential small beneficial effects seem to be outweighed by harmful effects.
Here are some reactions to the article I posted above in favor of SSRIs
Many of us know that taking paracetamol can be helpful for headaches, and I don’t think anyone believes that headaches are caused by not enough paracetamol in the brain. The same logic applies to depression and medicines used to treat depression.
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Can’t do this topic without citing the OG jimmy rustler:
Bold claim right off the top in the abstract that’s sure to ruffle some feathers:
The serotonin theory is as close as any theory in the history of science to having been proved wrong. Instead of curing depression, popular antidepressants may induce a biological vulnerability making people more likely to become depressed in the future.
He gives a nice history of the work in this area to lead off the article though which is definitely worth reading.
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is this really controversial? my own studying has led me to conclude this long ago and I don’t touch SSRI’s typically unless it’s urgent.
a big part of my despair started the last two years when I started shopping for specialists and quickly realized they have no idea why or how they’re prescribing stuff and generally give you a med because it fits X symptoms and the side effects are beneficial to me because of Y reasons and we’ll just wait and see. 8 weeks later, that didnt work? lets bump dose or add something else! rinse/repeat. it’s not science, it’s trial and error. when I see new docs now I get extremely annoyed when they go down this road and I’m now being labeled as a hostile/uncooperative patient now.
Dr Michael Bloomfield, Consultant Psychiatrist and UKRI Principal Clinical Research Fellow, Translational Psychiatry Research Group Head, UCL
There is consistent evidence that antidepressant medicines can be helpful in the treatment of depression and can be life-saving.
Prof Allan Young, Director, Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London
Paid lectures and advisory boards for the following companies with drugs used in affective and related disorders: Astrazenaca, Eli Lilly, Lundbeck, Sunovion, Servier, Livanova, Janssen, Allegan, Bionomics, Sumitomo Dainippon Pharma, COMPASS, Sage
Consultant to Johnson & Johnson
Consultant to Livanova
Received honoraria for attending advisory boards and presenting talks at meetings organised by LivaNova. Principal Investigator in the Restore-Life VNS registry study funded by LivaNova.
UK Chief Investigator for Novartis MDD study
The use of these medicines is based on clinical trial evidence which informs their use for patients. This review does not change that.
Prof David Curtis, Honorary Professor, UCL Genetics Institute
It is very clear that people suffering from depressive illness do have some abnormality of brain function, even if we do not yet know what this is, and that antidepressants are effective treatments for severe depression whereas interventions such as exercise and mindfulness are not. It is important that people with severe depression are not discouraged from receiving appropriate treatments, which can make a huge difference to them and those around them.
Spokesperson for the Royal College of Psychiatrists
Antidepressants are an effective, National Institute for Health and Care Excellence (NICE)-recommended treatment for depression
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Do you ever wonder if you’re too smart and your ability to improvise kludges to get through life makes your situation seem less serious when you talk to people about it because they can’t understand how crazy of a balancing act you are pulling off to make it to the next month?
My impression is similar to @goreo’s but it’s just my opinion. I don’t follow this area too closely or have any expertise in psychiatry.
Just glancing at this, many of the things you describe are the same things I experienced for ~25 years before testing positive for a rare disease. I saw over 30 doctors for the same primary symptoms and none of them were even close to figuring it out. Lots of head scratching. My last GP before the current one straight up said he was completely baffled and out of ideas. None of the treatments I was given worked at all. Treatment-resistant depression is one of the symptoms, and I was repeatedly treated for it to no effect in the same string-you-along manner you describe. Not saying this is definitely what’s happening to you but seems at least worth considering.
would you be able to say what the condition is? I’m grasping at straws here. my therapist has come to the conclusion I’ve got something weird and rare going on, and thinks some researchers would be interested, but doesn’t seem to have any ideas on what to do there. I struggle IMMENSELY being taken seriously by doctors.
I made the decision to get off of every single medication and drug, even alcohol, except the amount of THC i need to manage my pain, because I want to establish a baseline for whoever my next therapist/doctor is. these meds are super powerful and for me every time I start one I am absolutely fucked for 6-8 weeks. it’s an expensive and miserable process for me to start over and over and over and over again so i just want a blank slate if we’re gonna start from square 1 for the trillionth time.
I could tell you over PMs, but I dunno how much it will help you because it’s not what you have.
That seems like a reasonable response given the facts of your case. I was accused of being on drugs, faking it, making excuses, and lying about my symptoms.
Are you still in Southern Cal?
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idk these questions make me uncomfortable. after 5 years with my therapist she only just recently got me to acknowledge i’m smart at all. I am a bit polarized there. people frequently think a) I’m a total idiot or b) I’m a genius or something which are both ridiculous to me.
one thing that happens though that my therapist realized recently is the way I report things doesn’t mean the same when other people report them. for instance when I say “I am in pain” this means I am in a LOT of pain compared to what the typical person would report. like my 5/10 would likely be someone’s 9-10 on the scale. I don’t know why but I’ve always had a tremendous capacity for tolerating misery. it’s a strength I think but it leads to situations where shit gets reaaaaaaaaaaaally bad before anything happens.
i do often appear much better off than I’m actually doing though. this is because I learned around 18-19 (and again this year) is that exposing people to your struggles is a good way to lose friends fast so i mask.
yes
You might consider taking a look at Stanford’s Consultative Medicine program.
Disclosure: I did not go there for treatment, so it’s not an endorsement, just a thing I know about. Maybe take a look at the Isabel app too since you and your doctors / therapists are out of ideas.
My thing that no one could figure out pops right up on this app when I put all of the symptoms in.
thanks I’ll fiddle around with that.
my genetic study showed some extremely rare mutations that show some clues why the medications don’t work at all but no hint at underlying causes. I suspect that a likely culprit is C-PTSD which I think I have beyond a shadow of a doubt, but the treatment is being hindered by some comorbidity with something else. idk. maybe I was just a raging alcoholic in denial and need to give it time, but my depression predated the drinking by over a decade so I’d be absolutely shocked if cessation is gonna do anything. it’s been a month and I’ve been feeling slowly worse if anything else. it was a major coping tool I used.
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oh, shit, my therapist actually mentioned this thing at stanford. She started hinting at inpatient shit though, which I violently shut down. The moment I walk into a rehab center or any inpatient psychiatric thing I have completely given up. Fuck that, nope, no way.
One key for me was tying all of the symptoms together. Until I did that, I was just being sent to different specialists to treat individual symptoms. That might have even been fine if the treatments had been helpful. Taking down your entire medical history and looking at it broadly to see if it tells a story that’s been overlooked is an extremely time-consuming process. With the Stanford thing, they at least take the several weeks or whatever is required to really review your case.
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If you accept that there’s no easy or short-term fix for your issues, what are the alternatives?
me being against inpatient stuff isn’t because I want a quick or easy fix. I just find them to be pointless and invasive and stressful, and honestly, REALLY dehumanizing based on my experiences.
I’m capable of monitoring and following my treatment plans, I’m not THAT far gone.
a big source of my despair and crisis in february was something my therapist or some doctor said that I can’t quite remember. It made me idly remark “sometimes it feels like this is just always gonna be like this” and they not only didn’t disagree they nodded along. After I thought about it a while, I realized SHIT I’ve been fighting this same fight for going on 17 years now and I’ve not even come fucking close. why would trying the same things over and over accomplish anything else?
right now the only candidate for an alternative is TMS which i laughed at. that’s the electrical treatment. I was prescribed 36 sessions. they cost a fortune even after insurance. that isnt the reason I laughed, though, it’s the fact that they expect a guy that some days has issues leaving the house because he can’t find pants to wear, and struggles making the same weekly appointment he’s had for years, is somehow gonna be able to coordinate and attend 36 treatments that I assume cannot be missed or skipped at all. lol. impossible. and then, they don’t even know if it will work at all. often when it does work it’s not even permanent. plus, not that it’s a concern for me really, but it’s supposed to be pretty uncomfortable as well.
the real horrible thing is that there doesn’t seem to be any options anymore other than death or acceptance and me and the universe decided I’m not going to die. i came closer than I’d like a few weeks ago and don’t intend to repeat that.
eta: good lord it’s been closer to 20 years. always forget how old i am.
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I honestly feel that completely disconnecting from the internet going to be the only way out of this. I believe that a lot of us just aren’t wired to handle it and it completely sends our brain into permanent fight or flight. I can’t imagine and medication working well against that. I cut it out for a good length of time and nearly all my anxiety went away. It all came back when I was forced to jump back into it and it absolutely was not a coincidence.
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