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Comment by slibhb | Hacker News Reader

Well, placebos work fairly well for depression. And it's not like doctors can prescribe them...

So the solution is prescribing something that has a lot of unpleasant side-effects for a lot of people? Medication that if you don't take will have SEVERE withdrawal symptoms?

I suddenly became allergic to SSRIs and had to go off of them cold turkey. I didn't have any withdrawal problems at all so it's not a universal issue.

Wow, just wow. Quitting them cold turkey 0 problems, incredible.

I'm not trying to minimize the problems other people have had with withdrawal at all, just saying that it's possible to have a variety of different outcomes being on and off of them.

SSRIs have mild side effects after the first few weeks. Withdrawal varies but is generally manageable if you taper slowly.

I'm open to alternatives but I'm convinced that antidepressants help people.

I wonder why you say 'SEVERE' so severely. It doesn't sound like you have any direct experience of this. I had to come off them and it wasn't a problem. My biggest fear, and it was huge, was that the depression would return. It didn't.

Because it's pretty damned severe with SNRIs. You probably only tried some SSRIs. Turns out not all medications are identical.

Yep, never taken SNRIs - for me it was straight prozac. Side effects while on it weren't pretty though.

I had horrible withdrawal effects coming off lexapro/escitalopram, it was literally the worst experience of my life. I spent a month with maxed-out anxiety, feeling like I was going to die any moment, waking up at night with electric shocks running through my body, etc. I wouldn’t wish it on my worst enemy.

OK, that's an SSRI which is what I had to come off (prozac), with no major issues.

I'm not at all claiming it's a fun ride for everyone, just giving my one data point that it's not inevitably awful for absolutely everyone. Sorry you had to deal with it!

Anecdotal. n+1.

I'm not sure what you're saying?

> It doesn't sound like you have any direct experience of this

It doesn't matter if I have personal experience with this although I do. A very bad personal experience with the mental health service that was provided as well as the side effects I was talking about.

> I had to come off them and it wasn't a problem.

This just comes off as ignorant, there is established literature on the withdrawal effects. I was not speculating or spreading FUD. They are real, documented and more common than your anecdotal lucky experience

So your bad experience is data, my ok experience is anecdote and is worth less than yours. Gotcha.

'I had no problem' means that bad problems aren't inevitable, which opposed the totally unqualified 'SEVERE' claim - they aren't always 'SEVERE'. That doesn't discount anyone's experiences when things do go bad as I acknowledged here https://news.ycombinator.com/item?id=32169654 - I'm not dissing anyone's experiences.

You keep missing the point, there's a reason every doctor who prescribes these drugs will also make sure to taper you off because if you suddenly come off them there will be consequences. Now I'm not gonna troll the literature to figure out what the exact numbers are.

It's not about you dissing anyone's experience, it is about you ignoring the reality of this issue just because you were lucky.

Yes, they taper you off. This is to prevent the reactions being potentially SEVERE. In some cases they will still be SEVERE (yours), in other cases they won't (mine). I don't dispute that and I never did.

So what are we disagreeing on?

They can however prescribe basically harmless pills that do more or less nothing. Low dose vitamin pills are sometimes used for this purpose.

Whether or not it's ethical for a doctor to tell a depression patient that the depression is caused by a treatable vitamin deficiency is another matter. Then again, maybe it really is caused by a lack of micronutients. After all we really don't understand depression very well.

The AMA says they can if the patient is informed of and agrees to their use. But wouldn't that significantly impact their effectiveness?

Why wouldn't doctors be able to prescribe placebos?

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