Antidepressants and medical uncertainty
acesounderglass.com
acesounderglass.com
There are a number of medical problems, side effects, interactions, etc that only a very, very small number of people experience. Doctors, rightly, seem skeptical of anecdotes that haven't been borne out in large studies - they're likely to go with the most common explanation for something and usually be right.
But how do people who really are experiencing rare problems get the right care for them? Doing their own research, talking to doctor after doctor until someone believes them? Why should the medical community do research into problems that only affect a few people? Even if they do decide it's worth it, is it possible if the sample sizes are going to be small? Say I could volunteer to prove through experimentation that if you give me medication X, I get symptom Y, and when you give me a placebo, I don't get symptom Y, but no one else has ever experienced symptom Y from medication X, does anyone care?
All hard questions that I wish there were answers to.
In short, the nocebo effect is like the placebo effect but for side effects. If a patient consumes a lot of articles and anecdotes about negative side effects of a certain drug, they are far more likely to experience those side effects for themself, even if they receive placebo.
This is becoming a greater problem as more patients read up on side effects through the worst of the worst side effect stories shared on social media.
As an anecdotal data point, I'm a redhead with a periodic liver condition and a fast metabolism, and I don't metabolize medications normally. I take an antispasmodic for pain relief in doses that leave some people catatonic and it has little to no negative effects on me, over a decade of use. I've tried low doses of muscle relaxants that leave me reeling drunk for hours. Had two awful experiences on SSRIs, I will never try those again should I ever have the need of an antidepressant. I suspect there are sub-populations of people like me who are statistical outliers.
Apparently the only reason the link link between tick bits and the allergy was because the researcher studying the pheomenon got bitten by a tick and developed the allergy himself.
There's a great Radiolab episode on this.
1. we tend to overlay our own interpretation over what is described. Because that's pretty much the only way if we are to hope to do something about it.
2. In cases where something really unusual (meaning, not described in the literature) happens, modern medicine is an exercise in flying blind. Our profession is completely bound by best practices guidelines. The days of individual experimentation are long gone, and no one will ever forgive you for taking the off-path if there are negative consequences in this day and age.
I had a long discussion with a psychiatrist about this and they more or less acknowledged that it really isn't a science and is more of an art. You try this SSRI or that SSDI with a low dosage and see what happens. Then you Amp it up gently. If it works great. If it doesn't, then you dial it back and try something else. Slowly working to drugs with more and more adverse side effects until something works.
They have an idea of why it works but they don't really know precisely for every person.
In a different set of conditions I recall that Cognitive Behavioral Therapy has equivalent outcomes to medical intervention for ADHD at the 5 year mark, and afterwards wins as resistance to the medication is built. I wouldn't be surprised if similar outcomes are observed for depression.
This is particularly problematic when it comes to medicating children/teenagers who are much earlier in how their brains adapt to stimulus.
[1] https://focus.psychiatryonline.org/doi/full/10.1176/appi.foc...
I started taking Zoloft and my whole life changed. Anxiety and panic attacks completely dissappeared. Zero side effects. Happiness and joy all around.
I get worried sometimes though about what's happening in my brain chemistry. Hopefully irreversable damage isn't occuring. But I suppose that damage is better than the alternative. I also wonder, since I feel so good, if I should try weaning off the Zoloft.
But I can't risk going back into that place of darkness. Life is not worth living when you feel like that.
On the contrary, untreated depression is far more likely to produce long-term damage than a well-studied medication that has been in use for several decades. Untreated depression really does a number on the brain and body, not to mention the downstream effects of reduced exercise, socialization, sleep, and other problems that come from depression.
> I also wonder, since I feel so good, if I should try weaning off the Zoloft.
Be careful and only proceed with the help of a psychiatrist.
Depressive relapse is very common in patients who decide to discontinue their medication. The scary part is that the depression often returns very slowly over a long period of time, which the patient may not fully notice until they are deep within another depressive episode.
I am one of the lucky cases where I experience basically zero side effects and it's been 2 years so far. I have heard of the horror story side effects like getting really overweight, not being able to bone, feeling fatigued, constantly napping etc. But I have never felt any of that. These last two years have been the best of my life.
I always have this concern though that these meds must be doing something sketchy to my brain chemistry.
But it makes sense that the constant terror of anxiety could also produce some neural pathways and brain chemistry that would be very bad...
The reality is that most (but not all, obviously) people don't have terrible side effects from modern antidepressants.
It's difficult because most people who take antidepressants without issue simply don't talk about it. Partially because they don't feel like advertising their mental health struggles, but also because there simply isn't much to talk about when you simply take a medication and it just works.
> I always have this concern though that these meds must be doing something sketchy to my brain chemistry.
Given how long they've been in use and how widespread they are, we would have seen any blatant negative effects by now. SSRIs have been in use since the 80s and the antidepressants before that were far less selective.
If anything, the research points to SSRIs being helpful in repairing or reversing damage caused by depression.
I think these are the sorts of questions that would be useful to know when really mass-prescribing drugs to humanity. To be clear, I'm not suggesting that the drugs are inherently harmful to offspring - but it seems like something that would be good to know. If the parents have a chemical dependency, what does that mean for the children?
Is it possible that antidepressants have some extremely subtle transgenerational epigenetic effects? Maybe, but comparing healthy patients to SSRI-treated remitted depressed patients is a bit of a red herring anyway. The real comparison would be between SSRI-treated patients and untreated depressed patients, because healthy people aren't prescribed SSRIs. We do know untreated depression is very harmful to people and their families, so speculating about immeasurably small negative effects of SSRIs while ignoring the massive and very real cost of untreated depression would be a mistake.
I see it very differently, as you are focusing entirely on the parents and completely ignoring the children. If the untreated patients weren't going to have kids, the question is only whether or not the children are happy. If the children of parents with antidepressants are more likely to require antidepressants themselves, I'd say that's indicative of a serious problem.
I'm not aware of any evidence that this is the case. Do you have any evidence, or are you speculating worst case scenarios?
Regardless, I think it's shortsighted and in poor taste to suggest that there is a problem with parents on SSRIs having children, particularly without any evidence to support your claims.
SSRIs vs Untreated depression is a false dichotomy. There are many treatments for depression.
I wonder how many of those side effects might be from people put on antidepressants who may not actually be chronically depressed.
I've known people who have been prescribed antidepressants after going through periods of depression, rather than it being an ongoing chronic problem and they have sometimes had some troubling personality changes that lasted even after stopping them.
But I have met people who have taken them long term because of chronic depression that seem a lot better on them.
I really do feel like we take too much of a 'one size fits all' approach when it comes to mental health. Every person's mind and brain are unique.
I know, as humans, we like to put a factual, observable cause to things, but I really don't think mental health always works like that.
Two people who may be suffering from long term depression or any other, mental health issue(I personally dislike this term greatly, but can't really think of a better one.), may have very different reasons and causes for their depression and the same approach may not be helpful to both.
It's great we have access to medications that are helpful in improving people's lives, but I do wonder sometimes if we should focus more on addressing why someone's experiencing these mental states that are causing problems, rather than just working on correcting it.
I can't speak too much about it suppose, I don't really know.
But I had a good friend who I feel like was neglected by the system and didn't get the help that would have been good for him.
His mom was going through cancer treatments and he didn't take it well. He got pretty depressed and didn't get out of bed for a couple of years. He started getting these worries about getting the urge to walk into traffic.
So he went and tried to get some help. He was immediately prescribed seroquil, Zoloft, ativan and some other things.
And...I have no other way to put it...it fucked him up...
I'd get phone calls from him randomly asking what time of day it was, he'd forget things that happened moments before, he hallucinated watching new tron movie 3 times in a 4 hour period...the movie's like two and a half hours long or something, he managed to unplug my internet around 1am so, he wouldn't have even been able to finish it the first time.
It was really sad seeing what happened to him and I couldn't help but feel like maybe if someone had just talked to him for a while before prescribing him those drugs, they could have helped him without him ending up like that.
The problems with ADs, is that people feel better, they think they're cured, but no, it's because the meds are working, and treatment should not be stopped.
I now understand I have a chronic condition and I need to treat it as such. It would be awesome to be off antidepressants in the future and I'm trying to train my mind with meditation and other healthy practices but I don't fool myself with thinking that alone will be enough.
And you know what? I'm fine. I'm glad antidepressants exist because otherwise I wouldn't be here anymore.
Out of curiosity, why even have the desire to get off the meds? do you experience side effects?
The only side effect I have from taking Venlafaxine is my libido is crap but I can live with that.
I'm a Buddhist (even if a crappy one, that's debatable) and in some circles, taking antidepressants feels like "cheating". I was just researching this topic a few hours ago and it seems that's not taboo anymore and even various teachers have come forward and shared they too were on Prozac or other drugs. That was a relief. I'm lucky that in my community that isn't seen as cheating at all but there's that innate feeling that, if I'm trying to control my mind, that an antidepressant would be messing with that, or hindering my practice.
I don't think like that anymore. Even if it was cheating, I'd rather be alive and only get some benefits from meditation in this life rather than be dead.
So yeah, coming off meds is a bit subjective for me but I'm coming to terms with that. Life is better this way.
I'm not Buddhist but I've studied a bit and I do meditate. Isn't it not best to "try to control the mind"? From what I've learned, it seems like the opposite of what to aim for.
By becoming more present we are able to better see the mind and its endless judgments for what they are. We can become more in tune with reality as it is (including our own minds) and this helps us act and think more wisely, instead of based on programming, perspectives, and expectations that we aren't even aware of. I'd also add that compassion is a really important ingredient.
All this to say I don't think anti-depressants are "cheating" in any sense :). Especially if they are the best tool you've found to help you live a good life. I'm really glad you have something that works for you. This stuff is no joke...
I do think we can find better tools and that the field is on the cusp of some really great steps forwards that we desperately need. For me personally, I've recently discovered that trauma has played a big role in my well-being over the past 10 years and I've trying to learn more about that. There are a lot of promising developments seeking to help people actually heal from trauma. I've been particularly excited by the work that MAPS, Saj Razvi, and many others have been involved with.
My own opinion... these are powerful tools. Critical to some. Overprescribed for most
And then within a month and a half of taking meds, the constant feeling of impending doom within my spine that was always there, gone.
I had side effects for the first month or two but they're long gone. I also had first sleeplessness and then fatigue, but I found taking meds at night made all the difference, making that issue a thing of the past.
I don't worry too much about my long term dependence on it: even if it lowered my life expectancy, which there isn't really any proof of, but even if it did, I'd take it as a fair trade-off.
I was fine for maybe 5-6 months. And one day I literally woke up with the familiar, heavy depression. It was very sudden and I knew I needed to resume treatment.
If you need treatment, it's good to get it and maintain it.
I wish I had started it earlier.
There are risks to some of these medications, but they mostly come from not tapering off properly. Cymbalta wrecked my memory for a few months for that reason.
If one doesn't work, try others before trying nothing.
CBD can be hepatotoxic so not a perfect solution even if it’s highly effective.
I ask this because I've struggled with depression my entire life. I took fluoxetine (prozac) in 2012 and had similar experience that you describe.
I stopped taking it because I really hated the idea of being a med all my life. After about a year, the depression was back. I never returned to prozac, but I've wondered year after year if I should. Nearly a decade later, I still don't know.
Why? I still have my doubts though whether or not the medication was doing anything. I had also coincidentally had a ton of success in life around that time. I had learned some new exciting skills, landed a sweet job in my dream city, and was socializing a ton and meeting people.
I reflect on that time (roughly 1.5 years worth) and to this day I can't really decide whether that joy was from the meds, or from learning something I was finally good at, landing a great job, feeling confidence from that and meeting people, etc.
The return of the depression did seem to correlate exactly with discontinuing the meds, but, it could also have been that the excitement of the year's events was beginning to wear off too.
Diabetics hate the idea taking insulin all their lives. Paraplegics hate the idea of using a wheelchair all their lives. What makes your chronic illness different?
I would start by saying that overall, Zoloft has been a life saver for me. I was living with a debilitating level of OCD which interfered with all aspects of my life - from parenting to work.
Personally, I suffered from 2 major side effects:
1. Fatigue/Drowsiness - I started falling asleep everywhere and am tired during most of the afternoon. SSRIs are known to affect the brain's ability to induce REM sleep, which in turn have a negative effect not only on our/my wakefulness but also on memory, cognitive skills and mood.
2. My sexual drive was completely obliterated. I can go for weeks without any sexual experience, which is very unusual for a guy my age. To my frustration, even when I had periods when I took time off the drug, my libido didn't really change and remain low. I did some research online and found out that this phenomenon has a name - PSSD (Post SSRI Sexual Dysfunction).
That said, it's strange that the author's doctors didn't notice this earlier. The topic of which antidepressants cause somnolence is hardly new research. Even the author's own doctor knew that Medication 2 was responsible for the daytime sleepiness. I suspect they may have underestimated the degree of fatigue reported by the patient.
From the article:
> I did in fact know that fatigue was a possible side effect of the medication, but I was taking it off label at a drastically lower dosage than is typically prescribed (<1/20th), so it didn’t seem very applicable
Counterintuitively, some medications are more sedating at lower doses than higher doses. Trazodone, for example, is frequently used for insomnia at low doses when taken only at night, but can also be an effective antidepressant at higher doses when taken multiple times per day.
Mirtazapine is another example of a medication that can be very sedating at lower doses but become activating at higher doses. Low doses primarily antagonize the histamine H1 receptor (similar to antihistamines like Benadryl), while higher doses activate a wider range of receptors that can become stimulatory.
With pharmacology, it's not safe to assume that a lower dose of a drug simply produces reduced effects relative to a full dose. The effects can change throughout the dosage range.
A number of medical professionals are shockingly unfamiliar with potential side effects of the drugs they prescribe.
My partner was prescribed Zoloft. The prescribing psychiatrist simply did not believe my partner when they told him that they were experiencing a lot of jaw-clenching / teeth grinding. He insisted it must be unrelated to the medication. There are studies going back at least 20 years documenting this side effect with SSRIs, affecting something like 1 in 6 patients.
Author was very candid in that treatment really helped but doesn't mention if the taper was done with their Dr.
A lot of people end up thinking 'I feel great I'm cured,' so they stop and then relapse - or worse trigger episodes including suicide. I've made the mistake of stopping other meds without talking to Dr beforehand.
I do think though we need more research and solutions for long term side effects AND withdrawal issues that for a long time weren't taken seriously. The 'zaps' etc
The idea that psychiatry believes depression to be a "chemical imbalance" is a myth. It's a common strawman argument against psychiatry or SSRIs, but the truth is that the field of psychiatry doesn't put much weight on "chemical imbalance" takes.
More information in this article: https://www.psychiatrictimes.com/view/debunking-two-chemical...
> I'm more intrigued by the studies coming out about Ketamine, psybicilin, marijuana therapies, as a new angle to augment antidepressants and other prescriptions.
Ketamine is interesting as a short-term rescue for severe cases, but it's not a long-term solution. Some doctors are trialing long-term maintenance therapy, but the effects tend to wane over time and tolerance is a major issue. Most providers who use ketamine will use it to kick-start regular treatment.
Marijuana is not a treatment for depression and should not be viewed as such.
Plenty of psychiatrists still assume mental illness of all sorts are primarily caused by chemical imbalance, which is why so many of them solely rely on chemicals to treat mental illness.
"Schizophrenia is caused by a chemical imbalance and other changes in the brain."[1]
[1]https://www.hopkinsmedicine.org/health/conditions-and-diseas...
Neurotransmitters secreted by lipid-bound sacs (cells) packed with protein and sugar, arranged in vicinity of each other based on chemical and electrical (chemical influx/action potential) pulses.
We abstract the chemistry from a machine-code level (raw, chaotic, biochemistry) up to medicine's version of brain C++ (neuroscience), and then brain Python (psychology).
And, so, sure, maybe mental illness isn't simple chemistry (only a matter of one or two neurotransmitters a little off-kilter), but everything happening in your brain right now is chemistry, and so deviations from normal must therefore be a matter of chemistry.
I would argue that calling it an imbalance or whatever is just a matter of semantics, but everything we see, and are, and do, and perceive is chemistry and changes in the chemistry (imbalances, whatever you want to call it) influence everything we see, and are, and do, and perceive.
At a low level with current technology, we can tweak individual neurotransmitters pharmacologically (SSRI). With things like CBT we can try to tweak the chemistry in a more complex manner, and at a higher level of abstraction (changing wiring of chemical and electro-chemical synapses via chemically-mediated long-term potentiation/depression).
So, I want to try to make the argument that it's less a matter of whether you address chemical imbalances or not, but rather at what level of abstraction you address the chemical imbalances.
I'm genuinely not trying to be a pedantic douchebag. I'm just trying to argue that it's all the same shit, just at different levels of abstraction.
That is a theory, not a scientific fact.
The current state of physics tells us we do not understand the fundamental nature of matter.
The current state of neuroscience tells us we do not understand the fundamental nature of consciousness either.
So saying "consciousness is just chemicals" is like saying "bankum is just gobledeygook"; the terms are not fully understood or defined on a fundamental level.
Some people say consciousness is just matter, others say matter is just consciousness.
I do find it peculiarly interesting that it is seemingly inherently impossible to isolate and control for consciousness as a scientific variable
If you don't have access to the source code, and you're just watching the program running, it's this magical thing that behaves in a way you're not entirely sure of. The software architecture is filtered through the UI, and so you can't be 100% sure exactly what's going on in there.
But, at the end of the day, regardless of the zeroes and ones, it's all just electricity flowing through logic gates on a silicon chip.
The program may mimic consciousness (and be indistinguishable from it in a practical sense - in which case, is it not conscious?), it may talk to you, it may display fantastical images, but at its heart is a silicon chip made of logic gates.
So, consciousness in a living thing may be something mystical and intangible when you're observing it, but drill a hole in the skull and biopsy the tissue, and it's just a collection of carbon, hydrogen, nitrogen, oxygen, and phosphorus molecules arranged in a particular structure that conveys electrical patterns.
Similarly, I can eat a sandwich and it's somehow turned into me and that's magical. But if I open a biochem textbook it starts looking less like magic, and more like a complex interplay of biochemical pathways. I can administer some carbon triple-bonded to nitrogen and boom the pathways grind to a halt. I can administer a molecule with a ring structure and a nitrogen and a methyl group, and boom it ramps into overdrive.
I think that the word consciousness is part of the problem. It's a tremendously vague and ephemeral word. It comprises personality, memory, behavior, etc., all of which are variables that can be pharmacologically and electrically manipulated.
Reality itself, well, iono. I'm sure they have a pill for that.
there is barely a comment of content. the conclusion feels weird and naive...