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Comment by cwkoss | Hacker News Reader

Doctors are frequently prescribing SSRIs where no study has shown them more effective for that indication than placebo.

Many doctors still believe the "correcting neurotransmitter imbalance" theory of SSRI action which appears to be on its way to being disproved.

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Absolute bullshit. To say there are no studies demonstrating better effectiveness than placebo is a tired old meme. It is true that SSRIs don’t have a profound effectiveness over placebo like some drugs.. but that does not make them useless. Current understanding is that they are effective, just not very much.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

This meta analysis has John Ionaddis as one of the coauthors (if you don’t know why this is interesting look it up).

Also nothing is easily “disproved” in medicine (or most science) so even if “neurotransmitter imbalance” is false, you’re still wrong nothing is on the way to being disproved. Furthermore, current understanding of SSRI effectiveness is not based on “correcting neurotransmitter imbalance”.

> more effective for that indication than placebo

I probably should have emphasized this portion of the statement. SSRI's definitely have lots of good studies on the indication of acute depression and MDD. However, many psychiatrists view SSRIs as a set-it-and-forget-it long-term solution to other chronic issues, which I find troubling.

Placebo effect is better than no treatment. That's why the compare new drugs to placebo rather than compare to no drug at all.

As someone who took SSRIs for 2 years this is a bullshit statement. They allowed me to feel something other than only depression and anxiety which allowed me to improve myself over time.

Please do not spread such misinformation without anything other than opinion.

Glad that it worked for you, really. But, for the sake of argument, this can't be the proof that they are better than placebo, right?

There is a theory floating around that part of the benefit of SSRIs is that they make the user feel differently, and by feeling different it is easier to change behavior. This is independent from whether the way SSRIs make the user feel is a more adaptive state to remain in continuously over long periods. If this is true, the "therapeutic delta" would wear off as user acclimates to that SSRIs effects.

SSRIs can cause unpleasant and even dangerous withdrawal symptoms when discontinuing long-term use, so there are real benefits to minimizing overprescription.

You can harp on many other depression meds, but I can assure you SSRI's do work and are fairly beneficial in early stages of an acute depression.

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