The modern ECT protocols have very high success levels with treatment resistant depression.
Sometimes SSRI's help depression because they increase allopregnanolone in the brain [0], not because of effects on serotonin.
[0] https://news.ycombinator.com/item?id=23859433
The first-generation anti-depressants, the MAOI's, were reasonably effective at getting people out of a funk. But they didn't combine well with fine cheese [1], so when the patents expired the industry moved on to less effective drugs.
[1] https://hn.algolia.com/?dateRange=all&page=0&prefix=true&que...
This MIA blog post says the evidence base for ECT is not very strong:
> No studies have found any evidence that ECT is better than placebo beyond the end of treatment. Nevertheless, all five meta-analyses relying on these studies have concluded that ECT is more effective than placebo, despite the studies’ multiple failings. Meanwhile evidence of persistent or permanent memory loss in 12% to 55% of patients has accumulated.
- https://www.madinamerica.com/2022/02/fear-loathing-ect-debat...
The data I've seen for ECT has it at an 80% effectiveness at long term remission.
Most anti-depressants do have people for who there is a addition of or increase in suicidal ideation, which is why its something prescribing doctors are expected to monitor. This is not dissimilar to heart drugs causing heart problems, etc - by design these drugs influence chemistry in the target region (and probably others because l o l multicellular organisms are complicated) so if they do induce something there's a chance it could be a not great response. So being approved shouldn't be a sign of anything nefarious - most medications have side effects MAOIs are still used today, as is lithium, neither covered by patents but the side effect profiles are much worse than many modern targeted drugs. its not just a "doesn't agree with fine cheese" its a "oh you accidentally ate too much cheese, turkey, ..., time to go to hospital" response. Similarly benzodiazepines are useful for some things (although tolerance and addiction problems mean they're avoided if possible), but those have a "whoops you had something with grapefruit? time to go to hospital" problem as well.
I'm dismissive of Allopathic Psychiatry because those doctors hurt my friend, and force her to take prescriptions to make her substance abuse problems worse. Really all she needs is sobriety, adequate nutrition, and a few basic medical interventions. But she's much more profitable as a ward who will never get better.
https://www.madinamerica.com/2022/02/malignant-gooderism/
Someone reached out to me about this piece... Said she got the postpartum depression -> postpartum psychosis, and considers the actual effects of some of the drugs she was forced to take 'torture'.
Benzo's hurt a lot of people, without actually fixing anyone's problems. The only use for a benzo is as a single-dose regimen, e.g. to help get a claustrophobic person into an MRI machine. Gamma-Hydroxybutyric Acid (GHB) is a great pro-GABA drug that crosses the blood brain barrier. It's now highly controlled because it can also be used nefariously (date rape drug). Why fix people's problems when you can create them?
> as is lithium
My friend called me up and said she'd bought herself some lithium. I strongly cautioned against it. 8 or 12 hours later she was despondent. I pointed out how she'd poisoned herself that morning and told her to throw the rest away.
She did the same with... 5HTP? Something to increase serotonin 'naturally'. She tried it multiple times, it wrecked her each time. I told her to throw that stuff away too, I think she finally did.
Depression is fundamentally a metabolic problem: sometimes nutritional, sometimes thyroid function, sometimes amplified by emotional stress, sometimes energetic ('people who are depressed are always [energetically] homolateral'). People get seasonal depression when the sun goes away for the winter. Supplemental red light can't be put in a pill (red light refreshes cytochrome c oxidase [mitochondria]). Etc.
ECT tries to reset people's brains, without doing anything else. It's a simplistic treatment that needs to be treated like calomel/quicksilver (mercury).
Palliative drugs never fix the problem. Sometimes they can be useful (Reversible MAOI's, such as Methylene Blue) while you figure out what's going on.
No one should be forcing her to take anything, so that's a problem. Also treatment for substance abuse is a challenge unrelated to issues like depression, and given addiction often is a cause of depression (due to environmental and obviously drug/alcohol interactions) treating addiction before depression is what should really have been happening. If the depression was caused by the substance abuse, then that might work - but then abuse is often a response to depression in which case the depression would still need to be treated.
> Benzo's hurt a lot of people, without actually fixing anyone's problems.
Agreed, benzos are super dangerous, and they should be prescribed only if other things fail, or for very specific reasons - I was using them for a while as my knees are shot and getting to sleep was challenging. But I'm one of those people who doesn't seem to develop addictions to drugs so I only had to deal with the obnoxious "getting to sleep" problems while coming off them. Similarly no issue with Vicodin/norco, but there's also a general problem of over prescription of opiates where simple anti-inflammatories would be sufficient.
> My friend called me up and said she'd bought herself some lithium.
Lithium is a drug you shouldn't be taking unless it's the only option as it has significant focus, etc issues. Just buying them yourself without a psychiatrist who is aware of what else has been tried would be super worrying.
> 5HTP
5HTP is glorified tryptophan, and like so many "natural", "herbal", "homeopathic", etc treatments has no evidence to support effectiveness.
Depression is not a nutrition or metabolic problem in the vast majority of cases - otherwise there would be actual data to back that statement up. People who dismiss it as being "eat better", or suggest B12 (which can cause short term improvements), light treatment (vitamin D deficiency causes a host of problems, but not severe depression) are basically saying a variation of "this is your fault for not looking after yourself better".
> ECT tries to reset people's brains, without doing anything else. It's a simplistic treatment that needs to be treated like calomel/quicksilver (mercury).
Modern studies do show it to be effective, the older "do it while awake" approach caused many problems which have lead to the long term stigma, but that doesn't magically mean modern treatments don't work.
> Palliative drugs never fix the problem.
Except they do, for many many people.
I'm sorry your friend was poorly or mistreated, but that isn't the case for everyone, and dismissing the treatments that do work for people is not helpful. Dismissing treatments that have been shown to work is similarly unhelpful.