I was very young when my mom started Prozac but do remember how angry and sad she was before compared to after.
Years later there was a time when me and my sister noticed our mom was acting a bit strange -- more snappish and irritable than usual, and she even started dressing differently. Then at dinner she announced proudly that she had been off Prozac for a month. My sister and I looked at each other and at the same time went, "Ohhhh!" Mom was shocked that we'd noticed such a difference in her behavior and started taking the medication again.
I've been on the exact same dose as her for 15 years, and my 7-year-old son just started half that dose.
If I have a good day it's impossible to day whether that's due to Prozac. But since starting Prozac I have been much more likely to have good days than bad. So, since Prozac is cheap and I don't seem to suffer any side effects, I plan to keep taking it in perpetuity.
What I tell my kids is that getting depressed, feeling sad, feeling hopeless -- those are all normal feelings that everyone has from time to time. Pills can't or shouldn't keep you from feeling depressed if you have something to be depressed about. Pills are for people who feel depressed but don't have something to be depressed about -- they have food, shelter, friends, opportunities to contribute and be productive, nothing traumatic has happened, but they feel hopeless anyway -- and that's called Depression, which is different from "being depressed."
> If I have a good day it's impossible to day whether that's due to Prozac. But since starting Prozac I have been much more likely to have good days than bad. So, since Prozac is cheap and I don't seem to suffer any side effects, I plan to keep taking it in perpetuity.
I was acknowledging that the "good days" could be due to Prozac or could be a placebo effect, but since being on Prozac correlates with having significantly more good days, and I experience virtually no ill effects, I choose to continue with it.
Wow, a shockingly argumentative tone for someone who is just flat out wrong.
Beyond the response someone else commented explaining exactly where the comparison was mentioned, the anecdote itself is useful in offering an experience of someone who's life has been changed by the drug.
In any case, the study mentioned in the article is a meta-analysis about children, not adults, so there is no onus on OP to qualify anything about placebo or not.
We had/have a lot of reservations about it too, and discussed it at length with our pediatrician over months of observation. We decided what was more horrifying was hearing a 7-year-old — who has supportive family and friends, good health, no traumatic events, no major life changes going on, never worries where food/shelter is coming from — say he feels like "he shouldn't be on Earth anymore" and suddenly react with extreme physical anxiety to almost everything. It was bad enough that he couldn't really implement any of the coping skills he learned in therapy. His therapist hoped that medication would bring him to a baseline where he was able to benefit more from therapy. My family's historical success with Prozac also made the decision more palatable since depression appears to be hereditary.
There has been a phenomenal positive shift in his behavior since he started medication. All that said, another commenter pointed out that the study specifically says that Prozac is no better than placebo for depression, which is similar to but distinct from anxiety, which is what my son is being treated for. My mom and I were both diagnosed with depression, but anxiety may be more accurate -- I'm not sure.
I was one of those “medicating kids is a terrible idea” people, until I had kids with severe generalised anxiety. It took a lot to convince me to try it, but it made their lives better in such an obvious, immediate way. The whole experience made me a lot more humble about opinions I hold without relevant experience.
As someone with bad mental health since I was ~5 and parents who refused to acknowledge it - I think you're making the right decision.
There is however also benefit in updating your priors as new research comes out. I won't say this particular research discounts your experience. But maybe some day your son will prefer a different medication.
Children are intelligent and creative and this is normal.
Children speak like this and then I correct them. I explain it isn't helpful, explain why they are blessed, how their life could be worse, and provide them alternative phrases while they explain their emotional state.
Depression is caused by laziness and anxiety by hopelessness. My kids know that they aren't permitted to be lazy or say they are bored. They don't have anxiety because they have hope despite circumstances.
> Depression is caused by laziness and anxiety by hopelessness.
I wish this were true, but its not even close. I wonder how your kids will react when they move away, and you're not around to police their emotional expression. If they're like me, they will promptly collapse into paralysis and self-destruction.
I strongly suggest that you frequently give your kids long stretches of time (months) to practice regulating themselves, without your interference.
And if they have anxiety or depression, please let them see a professional. If my parents had noticed the signs earlier, they would have saved me decades of pain.
At this age I am teaching emotional regulation on a daily basis.
As for when they grow up, adults who cannot manage their emotions get fired or are sent to jail. It is critical to be slow to anger, quick to forgive, and work at building strong friendships.
> Depression is caused by laziness [...]. My kids know that they aren't permitted to be lazy.
Do you really believe this, or do you believe your children aren't depressed? Your comment is not in accordance with science. Depression is a complex topic. I'm having trouble imagining a way to be more wrong. Is this satire?
I agree 100% and it is an uphill battle requiring significant effort. That is where discipline is required. Exercising that discipline will bring positive results. There is nothing other than self stopping someone from cleaning instead of crying under a blanket.
Do you have a kid? Because they are humans who see and listen and hear and think on their own and don’t need to hear a phrase to come up with it, but also who definitely hear all sorts of things you don’t know about.
It's also horrifying to hear your 7-year old child talk about committing suicide when you have a deep family history of depression, anxiety, and suicide.
Medicine is advancing. We're increasingly able to understand and adjust dysfunctions that cause major, negative quality of life impacts. These dysfunctions have always existed, we're just getting better at finding ways to help people work through it.
Why? If a kid has diabetes, would it be horrifying to treat it? Why would it be different for a neurochemistry issue that makes the same kid tired and sad all the time?
Because the problem's not a "neurochemistry issue" (that theory's been debunked and the "chemicals" in play have never been known), and the solution is "no better than placebo."
Please share your qualifications for making a statement like this- do you work in biology? Are you knowledgeable about the underlying biology here, and the limitations of medical publications?
Not that I agree or disagree with the underlying claim but a call to "credentialism" to dismiss someone's opinion is not as strong in 2025 as you think it is.
The last few years have been a proof that even the "experts" are following strong political or personal ideology.
Also we don't live in the 18th century anymore. A lot of knowledge (especially around medicine) is open to the world. People can read papers, understand research etc.
In this area, having credentials makes a difference. Experts matter.
Few if any non-medical people can read medical papers and make sense of what they say. There is simply far too much context to evaluate such papers, especially in the cases of complex medical conditions.
I have had a lot of Spinal and sleep issues. I have read almost all new literature on this niche subject and I have brought to my spine doctor some new therapy and treatments they had literally no idea about. Those treatments have changed my life.
As an engineer I read a lot of deep technical paper as my day job. Medical papers are comparatively relatively simple. The most complex part being usually the statistical data analysis.
We have pushed to a whole generation of people that only the "experts" can have opinion on some fields.
I encourage everyone to read papers and have opinions on some of those subjects.
We are in 2025. That type of gatekeeping needs to go away. AI if anything, is going to really help with this as well.
It's also good to work with your doctors (as you seem to have done), have a discussion, and mutually agree on a plan of treatment.
Experts don't know everything. But they probably know some things you don't, and can think of questions you might not to have even thought to ask. As the saying goes, "you don't know what you don't know". Experience matters.
There's also a lot of people out there without an academic background that don't know how to properly read journal papers. It's common to see folks do a quick search on PubMed, cherry-pick a single paper they agree with, and treat it as gospel - even if there's no evidence of repeatability. These skills are not something that many people outside STEM are exposed to.
Cherrypicking is bad, but worse is reading a paper and thinking you understand what it says, when you don't actually understand what it says. Or thinking that a paper and its data can be observed neutrally as a factual and accurate statement for what work was actually done.
My experience in journal club- basically, a group of grad students who all read a paper and then discuss it in person- taught me that most papers are just outright wrong for technical reasons. I'd say about 1 in 5 to 1 in 10 papers passes all the basic tests, and even the ones that do pass can have significant problems. For example, there is an increasing recognition that many papers in biology and medicine have fake data, or manipulated data, or corrupted data, or incorrectly labelled data. I know folks who've read papers and convinced themselvs the paper is good, when later the paper was retracted because the authors copied a few gels into the wrong columns...
But is that really what you are seeing in this HN comment thread? People who seem very well researched in the biochemicals and meta studies of Prozac? I don’t. :)
> We have pushed to a whole generation of people that only the "experts" can have opinion on some fields. I encourage everyone to read papers and have opinions on some of those subjects.
There's nothing wrong with having an opinion on something as a non-expert, as long as those opinions are not acted upon or relied upon as a source of reliable information. Read papers, watch YouTube, browse WebMD, satisfy your curiosity--knock yourself out. But don't undergo treatment without working with an actual expert! I'm not an expert on orbital mechanics, but I have played KSP and have formed various opinions about it. But nobody should be listening to me for advice on how to launch a rocket.
We need gatekeeping for a reason, especially in the medical field which is rife with miracle cures, snake oil, herbal remedies, detoxes, homeopathy, and other forms of quackery.
Believing my "research" is better than my specialist's education is a path back to the dark ages.
Can you provide a source for that theory having been debunked? I agree that data has been found that is at odds with the various neurochemical theories but am not aware of the neurochemistry link as a whole having been definitely debunked.
Whenever I read a comment like this, I’m always curious if the commenter did some basic searching of their own. Just searching “chemical imbalance debunked” yields a wide array of sources. So why ask? It seems almost like a form of Socratic questioning. You want to debate the point, but for whatever reason, are not doing so directly.
I'll take this sincerely, and ask you, is this really something you've a continuing curiosity about? I have a suspicion you understand what is taking place, but for whatever reason, are not expressing so directly. Are you asserting there is nothing more to discuss after one parses the search results for “chemical imbalance debunked”. The parent is quite clearly, at the minimum, meeting their parent's level of input, which essentially amounted to "this thing is debunked". As an onlooker and after a quick skim of the search query you suggested, I am still not exactly clear on what "neurochemistry issue [theory]" entails. What would help, is a more clear underpinning for what is being discussed, which your parent is suggesting, through question, before attempting to respond. I appreciate this personally!
Ah, well-put! I think we may be reacting differently to the same articles. My understanding is that while various neurochemical theories have not been proven as the general public seems to think, they have also not necessarily been disproven or debunked. Certainly it has not been proven that neurochemistry has no role at all.
Probably because the commenter is not a medical professional and isn't qualified to judge the veracity of anything they find. "Do your own research" is a fucking plague on our modern world and is why the internet is like wall to wall grifters now.
By all means, Google whatever you like, but if you show up to a doctors office waving WebMD sheets in a medical professionals face, you are going to be mocked and you deserve it.
I witnessed a pair of doctors prescribe a family member an incredibly dangerous drug for an off label use. The company had been fined $500 million dollars for various illegal schemes to convince doctors to write such prescriptions, but I’m sure the doctors in question were unaware of this. When this family member began to exhibit textbook symptoms of an extremely dangerous (life threatening) condition which could only be caused by the drug in question, the doctors failed to notice, and in fact repeatedly increased the dosage, and added more drugs on top to treat the symptoms caused by the initial drug. It was not until I accompanied my relative to a doctor’s appointment and delivered a carefully designed incantation that they made the correct diagnosis and halted the prescriptions.
I wouldn't recommend searching for "chemical imbalance debunked" unless you intend to confirm an existing bias. The internet will show you whatever you want, and there are enough people who distrust medical professionals that any search for "debunking" will be a minefield of fringe theories and grifters. I'd recommend someone start generally, searching for information about clinical depression, and then build on that to look at root causes and how the medical understanding of those root causes has changed over time.
I don't think we know if it's a neurochemistry issue. From what I understand what was debunked was the idea that they worked by blocking the reuptake of serotonin specifically.
You don't understand what having extreme anxiety at that age feels like.
As someone who lived through that, I refuse to let him. All of memories of school are just feeling anxious about everything, just tight and suffocated, always in a panic. I started living when I started taking anxiety pills at 39 years old, and I can see my 2 year old having the exact same anxiety ticks and fits I have.
I don't know at what age I'll medicate him, but I'll do it as soon as I notice he isn't coping and happy anymore.
Horrifying is forcing him to experience that because you can't comprehend us.
I'm sorry that you're dealing with this - it was my greatest fear at that point. That my daughter seems to not have my disposition and seems happy go lucky is the greatest thing ever. There's no rhyme or reason to my depression and anxiety, it's completely maladaptive and I'm relieved, that knock on wood, she stays happy and light while not having to shield herself from the horrors of the world.
How do you know an anxiety pill is treating symptoms only? What if the cause is physiological, and the pill treats that? It is entirely possible to sit in your therapist's office and mutually shrug because neither of you can find an underlying reason for your anxiety. Sometimes anxiety just is.
Often the cause is things that most people can handle, without being able to easily wield the tools to handle them. Having a pill that dulls the symptoms gives space to learn and become adept at the tools
Because 7 years old is borderline too young to even make a depression diagnosis, and that kid's going to have his brain chemistry altered and essentially be addicted to a drug that he'll have to pay for for the rest of his life.
According to our pediatrician there are no known long-term effects of juvenile Prozac use. The effects may exist, but if they do they are of sufficiently low significance as to not have been detected yet. Interestingly the one possible effect she's aware of is that there may be a correlation with not growing as tall physically as one might otherwise. The data is not conclusive, but it gives me something to blame for topping out at 5'10" and never hitting 6' like my dad. :)
I appreciate how open and honest you have been in this discussion. While it might be that taking Prozac is the best choice for your child, I have to admit I would never let a pediatrician prescribe Prozac (or any other SSRI) - this is enough outside their normal training, I would want to consult with a specialist. Can't you get a referral to a pediatric psychiatrist of some sort?
This is one of the most shocking things I have ever read. There is a black box warning for Prozac:
‘Warning: Suicidality and Antidepressant Drugs
Increased risk of suicidal thinking and behavior in children, adolescents,
and young adults taking antidepressants for Major Depressive
Disorder (MDD) and other psychiatric disorders’
The fact that you were not informed about this should serve as proof that you cannot blindly trust what doctors tell you. They will absolutely kill you out of ignorance or incompetence, and never even realize their responsibility.
Note that the black box warning has nothing to do with long-term effects of the medication. It was added specifically because kids were killing themselves within weeks of starting the medication.
> This is one of the most shocking things I have ever read.
Good grief. I hope you're exaggerating for effect.
Death is a long term effect. And I am not exaggerating. I did not feel the need to list any of the myriad other potential long term effects because death seemed sufficiently serious.
Edit: in case the OP is reading, I should say also that the package insert won’t mention many other potential long term effects addressed in the literature, like extra pyramidal symptoms (akathisia, Parkinsonism, dystonia, tardive dyskinesia).
Another edit: ask GPT-5 ‘What are the long term side effects of Prozac use which aren’t addressed in the package insert?’ for a list.
We were certainly informed of this. I didn't count it among the long-term health effects. I'm an educated and skeptical person but have never found any reason to distrust my physicians.
There is no effect which is more long term than death. It is incredible to me that this is not obvious. But if you want other potential long term effects:
Lower bone mineral density, increased risk of fractures, osteoporosis
Sexual dysfunction / PSSD (Post-SSRI Sexual Dysfunction)
extra pyramidal symptoms (akathisia, Parkinsonism, dystonia, tardive dyskinesia)
How can you believe it's both "no better than placebo" but also that it's "going to have his brain chemistry altered and essentially be addicted to a drug". SSRIs are not considered addictive, though people can develop a dependence if it provides them significant improvement.
The whole point of the linked article is that the drug is no better at placebo at treating depression but also carries a host of known side effects, besides unknowns when it comes to long term use. They're not saying it's inert.
Here’s a paper from last year: The nature and impact of antidepressant withdrawal symptoms and proposal of the Discriminatory Antidepressant Withdrawal Symptoms Scale (DAWSS) https://doi.org/10.1016/j.jadr.2024.100765
‘Highlights
•
Antidepressant withdrawal can be severe and protracted.
•
It produces characteristic physical and emotional symptoms.
•
All symptoms were more severe after stopping than before starting antidepressants.
•
We identified the 15 most discriminatory withdrawal symptoms in our sample.
•
Withdrawal did not differ between people with physical or mental health diagnoses.’
Mine too! Only 2 years old but I can already see the massive anxiety bursts in him.
If this guy has a non chemical cure, I'm all for it. In fact I'm actively researching children psychologists to stave off the meds as much as we can, the problem is that 99% of psychologists are quacks, so choosing them is tough.
There's only so many times a kid can get sent home from school for biting/kicking/punching before you realize you need some professional help and will do anything to help the poor kid. I wish you luck.
I recently started giving my 11 year old SAM-e, available over the counter and much faster acting than SSRIs for serotonin support. He's been much happier and more regulated since taking it. I'd encourage folk to read up on the literature around SAM-e and consider it as a lower risk alternative to try first, that may in fact work better.
The thing is, they work very well for that 15%. I suspect the eventual conclusion will be that depression is a syndrome with multiple causes rather than a single condition, and SSRIs treat one of the causes.
Edit: Mark Horowitz is one of the authors of both studies.
The NNT[1] of Prozac, and SSRIs in general, has been previously estimated around 6. Meaning that treatment is more helpful than a sugar pill in only 1 out of 6 cases (a dirty secret).
Meanwhile the NNH[2] is as low as 21, that is 1 in 21 cases will stop due to negative side effects.
As an adult, Prozac for me has been life changing and for the better. After suffering from anxiety and depression since childhood I have been able to get a new lease on life in my 40s. It is a drug that needs to be respected though, start on the lowest dose and give it months to settle. Find a doctor you trust and that will take time to discuss your situation. I feel that often this class of drugs is often prescribed without careful consideration and people are ramped up to higher dosages faster than they should be by doctors who are rushing to see the next patient.
I thought this was already known? I can’t recall exactly but there was some research pointing to SSRIs in general as not being particularly effective at all. They were just hyped a lot and became mainstream.
I wouldn't go that far, but there was a now-famous study (Princeton?) that showed that doing aerobic exercise for maybe 30 mins every day, about five days per week, was equally effective at alleviating depression symptoms.
There's one big problem with that - getting seriously depressed people to do 30 minutes of exercise (or anything else) five days a week. "Get more exercise" is excellent advice for someone who feels a bit down, but it's absolutely useless for someone who can barely summon up the strength to eat or brush their teeth.
It gets even harder if you offer them the alternative of just taking a pill. For widespread health policy, we should want the proportion of depressives who will never learn to manage it themselves because a pill is offered to be smaller than the proportion for whom the pill is effective. I had always assumed these pills were effective enough but studies like these make me wonder.
They are by no means mutually exclusive. If you want depressed people to get more exercise, then a really useful starting point is to give them a pill that could rapidly increase their energy and motivation. The idea that people will be stuck on those pills forever is just lazy psychiatry; ongoing maintenance treatment is often the best option for patients with a history of severe depression and a high risk of relapse, but antidepressants are equally useful as a stepping-stone towards self-management.
Bluntly, if someone is capable of actually starting and sticking with an exercise routine, then they aren't very depressed and should not be offered medication as a first-line treatment. Antidepressants are markedly less effective in patients with milder illnesses, so psychotherapy and lifestyle interventions are a far better initial treatment option. It's only when these treatments fail - or when engaging with them is severely impaired by the severity of the illness - that medication becomes the favoured option.
When I was a teen I was put on Prozac because I threatened to commit suicide.
The drug absolutely destroyed me. Within a few days of taking it, I was in a bizarre state of delirium where I would sleep something like 18 hours a day. When I wasn't asleep I would gnash my teeth at my parents. At school I would lash out at my classmates and randomly punch the walls of my classroom. I was taken off the drug after about five days but I didn't fully recover.
To this day, my emotions are severely blunted. I still have complete anhedonia and avolition. I can go on a roller coaster and feel not a shred of an adrenaline rush. Nothing. I struggle maintaining relationships with people because I have no innate "desire" to do so.
The drug is absolutely evil and should never be given to minors.
Additionally, there's very little - if any - evidence they actually work the way they're purported to.
There are countless heartbreaking stories of people who were prescribed these drugs not knowing what they were subscribing to. In many cases, the effects of those drugs are worse than the symptoms they are supposed to alleviate. With "I Don't Wanna Be Me" there's even a song by Type O Negative (from Peter Steele's own experience with Prozac) about the devastating effects SSRIs can have on a person's life.
These drugs are handed out like candy while the physicians prescribing them often point-blank deny any side effects or even attribute those to the illness they are meant to treat.
I'd go as far as to say that prescribing these drugs for any but the most severe or otherwise untreatable cases violates the "First, do no harm." ethical principle of medicine.
During my first manic episode I was handed sertraline. This pushed the mania full send and I lost a lot of time that I can't account for, things I did I can't remember but friends have recalled. Climbing the house to get in through the upstairs window whilst having the house key on me. Locking myself in my room for a week or two convinced I was the real world John Connor and Arnie was looking for me. Blowing all my savings on cocaine for me and anybody in my vicinity in a month. Going through a gram of mdma more than once in a night. Feeling like I was on a therapeutic dose of MDMA for a few months and thinking this was what SSRIs were meant to feel like. The list goes on.
I will admit I was semi cognizant of the distorted thinking/reality so played it down when talking to the psychiatrist I was urgently (+2 months into it) referred to for early psychosis intervention. I was eventually handed a dozen valium (which the doctor was incredibly hesitant to prescribe, for good reasons) which let me sleep and the mania lifted.
I'm terrified of SSRIs now. I have been diagnosed bipolar for a few years now (went private because in the UK unless you're a danger you're ignored). This week was the first session with a clinical psychologist in a bipolar group. Unsurprisingly almost everyone had a similar experience with SSRIs.
I'm speculating here but I'm pretty sure if you did an MRI on my brain you'd see lesions from the mixing of mdma and sertraline (I get myoclonic jerks to this day).
Every medication can have severe and permanent side effects, the question is how often that occurs for a particular drug, and how that stacks up against the quality-of-life improvement from taking that drug.
I also had a close family member who committed suicide shortly after going on Prozac -- this also happened nearly 30 years ago. His young son later went on Prozac himself (several months after his fathers suicide) and immediately started demonstrating bizarre disinhibited anti-social behavior (e.g., damaging property, stealing from friends, etc). He was immediately yanked off Prozac when he started articulating his own thoughts of suicide. The bizarre anti-social behavior improved after discontinuing Prozac.
For some people, Prozac is a very dangerous drug. It is fully deserving of its FDA black label warning (which it didn't have 30 years ago).
The problem with suicidal depression is that if someone has created the thought pattern that death is best, then removing the symptoms of depression (lethargy, lack of energy, no willpower) now gives the person the ability to actually follow through with the act.
Medications almost always target symptoms and never address root causes.
This is a good thing to know, but should also be noted that the same thing can happen with simply naturally recovering from a depressive episode.
The phenomenon should not be considered a reason to not medicate (which I don’t think you are implying, but some may take that as the conclusion). Instead it’s definitely something important to explicitly make people aware of.
Depression or the feeling so much mental agony that the idea of escaping with death becomes comforting, is a signal that something is wrong.
Realizing this has been important with weathering my own occasional dealings with severe[0]depression, once I realize “something is wrong”, I can start the annoyingly slow process of trial and error making changes to correct things. This turns depression from “how reality is” into “this is just feedback on my body’s state”. It turns things getting worse into either a “this is either a transient state or the wrong solution”.
[0] Which I define as the point where any passive ideation (fantasies of dying) starts to enter the gradient of becoming involuntary. As opposed to regular negative thoughts which can (and should) be brushed away as easily as a fly landing on me. Curiously, once I noticed it also affected my ability to experience color. While I could technically see colors, it was like have a mental partial greyscale filter because there was no beauty in it, color was just a meaningless detail.
A sudden improvement in mood is one of the key warning signs for suicide. Often it's genuinely just a sudden improvement, but sometimes it is a byproduct of the relief people experience when they commit to ending their life. If you know someone who is severely depressed, you should watch them very carefully if they suddenly seem carefree.
>once I noticed it also affected my ability to experience color
A small amount of evidence does support the notion that depressed people literally see the world as being less vibrant.
This is what my psychiatrist more or less warned me about when I went on medication; that a lot of people who are suicidal lack the energy and ability to plan their suicide, and medications can sometimes undo those particular symptoms and people manage to end themselves.
I'm not sure what kinds of studies have been done about it, but I've had a few therapists same similar ideas. If it's not a studied phenomenon, then it has folks that believe it exists.
I'd like to make the point that even if this does occur, it doesn't mean, "therefore this medication shouldn't be used/is worse than doing nothing," just that awareness and caution is needed.
I went through a frankly terrible few months on my current meds because they removed the emotional numbness before removing the bad feelings. However, once that was over they effectively gave me my life back after 10+ years of continual exhaustion and brain fog.
EDIT - I ask because the only results I get when searching are a Harvard article debunking it. I'd rather hear the opinion of someone that actually believes in it before I read about why it's all malarky. I believe in arguing against the best version of someones argument.
It was just the best “every man” link I could provide for understanding how efficacy of toxin-clearing (toxicity) could be related to depression, other struggles with homeostasis.
I’m not quite following the previous conversation here, but your comment brings to mind that one theory of a possible “function” of depression, is as a “sickness behavior” to help isolate a sick animal from others to protect the group. A sheep or cow getting sick and going off on its own is a common thing.
I’m not sure if it has a technical name or if it’s been rigorously studied, but it’s a common observation which even I’ve seen (and reported to growers I work for).
But is the only true cure to the suffering. We’d have to undergo a massive reorganization of society (and upset a few hefty profit margins) to prioritize that, so we settle for the messy symptom management we have.
That story doesn’t work for people with depression who otherwise have very good lives.
I grew up in a stable household with a loving family and both parents present and supportive. I’ve never had financial hardship, either as a kid depending on my parents to provide or as an adult providing for myself and family. I did very well in school, had plenty of friends, never had enemies, never got bullied or even talked bad about in social circles (so far as I know…). I have no traumatic memories.
I could go on and on, but despite having a virtually perfect life on paper, I have always struggled with depression and suicidal ideation. It wasn’t until my wife sat down and forced me to talk to a psychiatrist and start medication that those problems actually largely went away.
In other words, I don’t think there’s a metaphorical “cow” that could have helped me. It’s annoying we don’t understand what causes depression or how antidepressants help, and their side effects suck. But for some of us, it’s literally life saving in a way nothing else has ever been.
Take my baseless speculation for what it's worth, but could it be that you were depressed because your life was too easy? We humans are meant to struggle through adversity. Can you really appreciate your financial security if you've never faced financial insecurity, or appreciate companionship if you've never experienced loneliness?
It’s a reasonable question but I doubt it. We weren’t affluent at all and I worked my butt off for everything. And that’s good, because I agree that if things are too easy it turns into a curse.
> I don’t think there’s a metaphorical “cow” that could have helped me.
The medication is the cow for you. In this story your support system figured out what would work best for you, which was medication, and facilitated that.
It’s a story about a doctor that serves patients in rural Cambodia. Help from the local community would look different in Borey Peng Huoth, for example.
First of all, I want to write that I am glad you found something that worked so that you are able to remain here with us.
Though, I am curious about the, "otherwise have very good lives" part.
Whose definition are you using? It seems the criteria you laid out fits a "very good life" in a sociological sense -- very important, sure. You could very well have the same definition, and perhaps that is what I am trying to ask. Would you say you were satisfied in life? Despite having a good upbringing, were you (prior to medication) content or happy?
I am by no means trying to change your opinion nor invalidate your experiences. I just struggle to understand how that can be true.
As someone that has suffered with deep depressive bouts many times over, I just cannot subscribe to the idea that depression is inherently some sort of disorder of the brain. In fact, I am in the midst of another bout now. One that's lasted about 3 or so years.
To me, I have always considered emotions/states like depression and anxiety to be signals. A warning that something in one's current environment is wrong -- even if consciously not known or difficult to observe. And if anyone is curious, I have analyzed this for myself, and I believe the etiology of my issues are directly linked to my circumstances/environment.
> I don’t think there’s a metaphorical “cow” that could have helped me.
The smart-ass in me can't help but suggest that maybe medication was your cow?
To be honest, I've never really thought about it... I suppose I mean in both a sociological and self fulfillment way.
> Would you say you were satisfied in life? Despite having a good upbringing, were you (prior to medication) content or happy?
I would say "yes" overall. Aside from the depression (typically manifesting as a week or two of me emotionally spiraling down to deep dark places every month or so), I was very happy and satisfied. That's what makes the depression so annoying for me. It makes no sense compared to my other aspects of life.
> In fact, I am in the midst of another bout now. One that's lasted about 3 or so years.
*fist bump*
> To me, I have always considered emotions/states like depression and anxiety to be signals. A warning that something in one's current environment is wrong -- even if consciously not known or difficult to observe. And if anyone is curious, I have analyzed this for myself, and I believe the etiology of my issues are directly linked to my circumstances/environment.
I think that's a great hypothesis so long as it's not a blanket applied to everyone (which I don't think you're doing, to be clear; I mention this only because it is what motivated my original response to the other commenter).
I don't want to go into private details of family members without their permission, but I will say that given the pervasive depression in my family and mental health issues like schizophrenia and bipolar disorders (neither of which I have, thank goodness), I feel like there's something biologically... wrong (for lack of a better word?)... with us, particularly since you can easily trace this through my mother's side.
> The smart-ass in me can't help but suggest that maybe medication was your cow?
Ha fair. I interpreted the story to be about depression being a symptom of your situation (job, health, etc.) and if you just fixed that then there's no need for medication. That definitely makes sense in some (many? most?) situations. But not all, unfortunately.
I mean sometimes. For me it was multivariate for sure. Biggest problem - wife and kid. Helped a ton. My specific wife, really. I doubt someone else would have helped me. I had a lot of self defeating thought patterns she helped me fix.
My understanding is that the optimal scenario is taking an SSRI in combination with therapy. The SSRI adds flexibility for the brain to respond to therapy and envisage new possibilities. If you don't include therapy, you've just established a new baseline to habituate to.
Yup. Depression medication can significantly help the emotional symptoms, but that takes longer to be effective.
I’m bipolar and a lot of the medication I take does not become fully effective for months. For me, my medication slowly became more effective over years as my brain no longer had to compensate for hardware problems.
Isn't that a possibility with a lot of drugs though? I think it depends on the rate and not a "does or does not" type of questions. Now if the drug doesn't help more than a placebo that's clearly a huge negative, but if it has a high rate of success vs placebo then they will make adjustments and watch out for the side-effect (of course) letting patients know it's a possibility and to report if it starts happening.
Suicidal ideation is a risk for many CNS drugs, and not unique to Prozac as far as I know. But yes this is a major risk factor that needs to be taken in account before such kind of treatments.
The efficacy of anti-depressants has been consistently over-inflated, so generations were poisoned with side-effects: suicidal ideation, homicidal tendencies, etc.
Results: Meta-analyses of FDA trials suggest that antidepressants are only marginally efficacious compared to placebos and document profound publication bias that inflates their apparent efficacy. These meta-analyses also document a second form of bias in which researchers fail to report the negative results for the pre-specified primary outcome measure submitted to the FDA, while highlighting in published studies positive results from a secondary or even a new measure as though it was their primary measure of interest. The STARD analysis found that the effectiveness of antidepressant therapies was probably even lower than the modest one reported by the study authors with an apparent progressively increasing dropout rate across each study phase.*
Clinical trials of antidepressants are weird because they're usually short-term (6-12 weeks), whereas practical use of antidepressants usually lasts years. I personally suspect that short-term trials show an exaggerated placebo effect, because the novelty doesn't have time to wear off.
Probably something like Boy Interrupted[0]. Sad story and something I can sympathize with having some of the same feelings very early on despite having a rather normal upbringing and siblings not showing signs of it.
As someone who has been seriously depressed from an early age, I can tell you that it looks exactly like the DSM/ICD criteria - a lack of energy, loss of appetite, loss of interest in all activities, insomnia, feelings of worthlessness, suicidal thoughts and pervasive sadness and hopelessness.
Some people would rather believe that pediatric depression isn't real, rather than confront the reality of a loved and cared-for child who is constantly tearful, severely underweight, sleeps for three or four hours a night, spends most of their time staring into space and frequently talks about wanting to die.
Depression is an utterly dreadful illness and should not be confused with normal sadness or unhappiness.
My advice as a long time participant here: pay no attention to upvotes or downvotes. Sometimes they seem to be completely unrelated to whatever you said. Stay curious.
Absolutely. These random namedrops of drugs are irritating. People respond to different psychiatric medications in wilddly different ways. And actually, the majority do not respond at all. Throwing a random name of some random medication helps absolutely nobody. It will just make some desperate people seek "this one drug" that they heard about on the internet.
Nocebo can too. Apropos the featured article, I wonder if we should worry about that when we report in the popular media that antidepressants trigger suicides.
Do you have a plan to get her off, or is she on the maintenance drug for life?
Sometimes girls get depressed when their periods start. Girls often don't ovulate regularly, which can cause problems until their cycle stabilizes. Sometimes pediatricians don't allow girls' cycles to stabilize. The doctor says to the girl, "you're a woman now, so we're going to regulate your irregular period with birth control."
Women often get depressed due to the progestins used in all the birth control prescriptions.
SSRIs never help because of boosting serotonin. When someone benefits, it's from the drug's other physiological effects.
> It's too early to say. Obviously the idea is to get her off it if possible.
You understand that the people who sold you that drug have a vested interest in making sure it's not possible and/or that you & she think it's not possible, right?
I'm big on medications for brain stuff but uh yes, in the US, doctors get lots of kickbacks for prescribing drugs.
Usually this takes the form of "I'm prescribing you with <Brand> instead of generic" or "I'm prescribing you this specific drug from this class of drug"
> > SSRIs never help because of boosting serotonin.
> That's a hell of a claim, which could use some evidence.
My experience with the chatbots is that they start with the conventional marketing tropes, but if you ask pointed questions they'll dig into the actual research.
This thread started with a generic question about why ECT seemed to help some patients. It had a really good reasoning about why SSRIs are still the first-line treatment for depression, even though the MAOIs were much better drugs.
The Big Picture
SSRIs flood serotonin globally, which can suppress
dopamine/norepinephrine and blunt mood.
Anti-serotonin strategies (receptor-specific antagonism,
reuptake enhancement, or targeted modulation) often
result in cleaner antidepressant effects with fewer
side effects.
This supports the criticism you mentioned: SSRIs may
“work” only because the brain adapts to the serotonin
disruption, whereas directly reducing or modulating
serotonin is more therapeutic.
The whole 'conversation' is pretty good, and would provide plenty of search terms for helping you figure out what science has actually figured out about depression.
There's a supplement seller that said his pregnenolone powder was made with a newer, cleaner process than is used by most of the pregnenolone supplement vendors, but I don't know if he's still using that supplier. The powders are a much better value than the capsules.
The chatbot is great as a first-line of research for many things, but something like this needs to be backed up by actual research to make a concrete claim. It will absolutely fabricate falsehoods or misrepresent truths based on an unknown number of stochastic factors behind any response. Shame on your for propagating a bunch of mumbo-jumbo that every reader must go verify for themselves if they want to substantiate or refute your claim - in response to a request for substantiation!
Puberty in general can be rough. I (a dude) had all kinds of bad thoughts and moods going through puberty and then one year it was just gone, grades improved dramatically, started making friends again, etc
Not to get into the historic details but growing up there was lot of tension in my parent's house. When you're a kid you feel these things and are aware of the issues that cause them, but you haven't yet learned how to talk about them or the right words to describe the truth of them. Instead you internalize them.
The lack of learning constructive perspectives and ways for discussing emotions while young, may very much be a source of depression, the same way people say "he can't help it, he has ADHD".
I was about 16 and the doctor recommended this new SSRI called ... I think it was Paxil, The side effects, especially if you missed a dose are hard to describe. If you missed a dose you couldn't function at school, and everyone thought you were really stoned. Also, you could look at a pretty girl and just nothing. A 16 year old boy doesn't know why THAT's happening, neither does the girl, and it just makes things worse. Try having that conversation with your Dad, while doped out on the drugs he told you to take. Imagine the anxiety. It's really depressing. Better to be alone, and safe in one's bedroom and on the Internet... ( and that was 20 years ago ).
Around the same time there was Ritalin and maybe a few others came out.
The issues kids are facing, the feelings they are then given pills to erase are still there, even when numbed to them. The answer lies somewhere in familial stability and relearning respect?, and how to constructively frame life's difficulties and teach that to our kids.
I would never give my kids anything that altered their brain chemistry. Even as adults, the only way is through.
My own experience with SSRIs was very unpleasant. Sure, it worked to reduce my anxiety problems while I was on them for years. The first year I was off of them was the worst though. I didn't have that bad anxiety ever, as in constant panic and feeking of impeding doom. This made me realize that they aren't really an option of me. So began my long therapy journey. After 7 years of weekly therapy, a healthy work-life balance, and regular exercise I'm just feeling better than ever.
So, I'd buy that they don't fix your brain. They definitely reduced anxiety for me and I can see the value for stabilizing people so they can do the heaking work in therapy.
My experience as well. SSRI and other similar drugs for anxiety remove a strong signal to your brain and bring other issues or signal.
But the issue is that nobody wants to really look at the cause. We are all trying to treat the symptoms with those quick-fix pills.
The cause is deep in our society. We are too stressed, lost touch with each others, work on meaningless jobs (or downright negative jobs for society.. if you work at Meta or TikTok, yes your job is in fact a negative for society).
I have also been on a journey for the last 5 years on working on myself and bringing those things back in my life and I have been feeling better than ever:
- A lot of outdoor time and exercise.
- Take the time to build a community of friends that genuinely care for each other
- Work on some projects that you feel help humanity and each other (or volunteer).
- Build things you are proud of. Build a legacy
All of those removed almost all anxiety and depression. It is not an easy journey but I'm shocked how few people even consider making those changes
My understanding with SSRIs and other depression meds is that they are hit and miss for anyone. I have a family member who, as a teen, suffered from severe depression and didn't want to live. Therapy wasn't able to help - it was actually the therapist who recommended more drastic measures such as medication. And so they tried Prozac and that worked. Having seen the reversal myself, it's hard to understand how this is placebo.
Here the context is prozac FOR CHILDREN, not in general. Yet some people make a point in commenting that SSRIs are ineffective in general because they believe in some big pharma conspiracy. This is spreading misinformation. The truth is that SSRIs are modestly more effective than a placebo for approximately >> one third of the individuals << who try them. In other words, SSRIs are effective for more than 60-66% of adults. Moreover, there are a few different types of SSRIs. It takes time to find the one that fits you.
I'd really be curious about distribution of the result they see. The folklore is definitely that that there's vary high variance in how people respond to SSRIs, and not recommending them because the average value is low is pretty irresponsible.
None of those drugs helped me personally in the 90s (Prozac, Zoloft, etc). What helped me personally was talking about my problems with other humans only to the learn we all are "crazy,(aka totally normal)" and the majority all deal with something similar. Anxiety, OCD, insecurity .. all are parts of the human condition we all deal with throughout our lives.
I can't bring myself to try an SSRI. I just cannot do it. I've got a prescription for an NDRI on my desk, and I still won't take it. I am not anti-psychiatry either. I take psychiatric medication for a different condition already. But something about anti-depressants just doesn't sit well with me.
As crazy as it may sound, I think a lot of my depression stems from living a life that is not true to myself and due to countless failed attempts to be someone I cannot never be. As far as I am concerned, depression is just a symptom of my situation and not some true disorder. For the sake of analogy, I would say it's like food poisoning. Yes, the GI issues are awful, but the body is responding appropriately.
> I've got a prescription for an NDRI on my desk, and I still won't take it. ... something about anti-depressants just doesn't sit well with me.
At first it sounded like your antipathy was with SSRIs specifically (which I largely share), but it seems like it's anti-depressants in general.
FWIW, I used to think similar to you, and roughly agree with the gist of your second paragraph, but I've come to think of antidepressants as useful in a specific way: people say "it's a crutch" as a negative thing (about a lot of things including antidepressants), but a crutch was very useful to me when recovering from a fracture, and helped me enormously with my progress; similarly, even if "depression is just a symptom of my situation", it can and does often lead to a cycle where the depression itself feeds into the situation and in turn sustains itself. An antidepressant that works for you is a good way to be able to see things more clearly, feel the motivation and insight that depression clouds out, and thus be able to break out of the cycle.
It doesn't have to be a "cure" that counters a disorder, it can be a tool that you use for its purpose and then throw away (and it does sound like you're well-motivated to do that).
I'm with you on this. People who pathologize themselves or others - assuming they're malfunctioning rather than acknowledging they might simply be living a life that doesn't fit - have a very limited way of looking at things.
there's a tool on your desk that might help you solve your problem; what does it matter if the problem is an "appropriate response of your body"? so is pain/anxiety/diarrhea
> stems from living a life that is not true to myself and due to countless failed attempts to be someone I cannot never be.
If this is their mindset, they might benefit from CBT more than medication.
I'm not against SSRI at all. But after taking them for a few months in my 20's, and experiencing how terrible the withdrawal symptoms are when stopping, I'd be very hesitant to ever start up on them again. I remember having to open up the lowest dose pill capsule and splitting the dose into very tiny increments to be able to wean off completely.
> As crazy as it may sound, I think a lot of my depression stems from living a life that is not true to myself and due to countless failed attempts to be someone I cannot never be. As far as I am concerned, depression is just a symptom of my situation and not some true disorder.
It's true for some, but be wary of such a generalization.
It took many years of people telling me the same thing before I understood what they were saying: "Having an objectively crappy life is normal. Being depressed about it isn't."
(Almost) everyone will have problems - temporary or permanent. And while they may feel down about it for a while, or occasionally, most of them more or less recover their mental health and are not chronically depressed.
Because the majority of people have problems, it becomes easy for a depressed person to think "Ah, this is just due to problem X" or even "This is just because I want a life different from mine". Most people with problems also want a different life than what they have. But they're not depressed.
> "Having an objectively crappy life is normal. Being depressed about it isn't."
Sounds like a philosophy more than a science. What does "normal" even mean in this context? Are we talking about something measurable? For instance, if the number of people who were depressed about those circumstances doubled (or quadrupled) would it then be normal, and there would be no reason to treat it (because it's normal)?
If you have an objectively crappy life, but not just ignore it and instead are incapable of even noticing, that sounds a little like dysfunction to me. It's not some superpower, it's a micro-lobotomy.
> If you have an objectively crappy life, but not just ignore it and instead are incapable of even noticing
Noticing it is very different from being depressed about it.
> What does "normal" even mean in this context? Are we talking about something measurable?
Let's take a trivial example. Person A is depressed because he is unhappy that he doesn't make enough money to travel and buy nice cars. Now take all the people who are unhappy that they cannot afford to travel and buy nice cars. Most will not be depressed - they will merely be unhappy about it.
Person A isn't depressed because he can't travel and buy nice cars. He's depressed and he can't travel and buy nice cars. He's mistakenly coupling the two.
Another tell for these kinds of things: Ever know someone chronically depressed who blames it on X? Then somehow, X is resolved. There may be a temporary improvement, and they go back to being depressed again, only they now blame it on Y? Somehow Y gets resolved and some months later they're blaming it on Z.
Everyone has problems. Including those who are not depressed. Fixing X, Y, Z, AA, AB, and whatever else is not going to take care of the depression.
On the flip side, people who do not suffer from depression make the same mistake: They claim they are not depressed because they "choose" not to let the problems get to them. Self serving beliefs!
SSRI can have annoyances (to stay polite) if you ever need a fix so much that you go that route, be sure to ask about them. Didn't help me really but I believe that sometimes, a bit of chemical (placebo or not) relief can help staying afloat enough to work your way back up quicker.
I understand your comment, my issues were due to life circumstances and not a low level neurological imbalance, and I too dismissed these treatments almost entirely, mostly because they felt like blanket solutions from medical professionals who didn't really listen to symptoms.
Depression is almost never caused by actual life circumstance - just by your response and usually a delayed response.
Also you should try your SSRI prescription. They really aren't very strong drugs. You might get mild relief or if you're like me and the majority of people you will see no effect whatsoever. It's worth a try anyway. You won't get "high" or "dull" or any of that nonsense. At best it will lift your mood a bit. But more often than not, just won't do anything.
> Also you should try your SSRI prescription. They really aren't very strong drugs. You might get mild relief or if you're like me and the majority of people you will see no effect whatsoever. It's worth a try anyway.
One needs to not work and be able to remain at home for about a week or so to see if the side-effects are manageable. One shouldn't simply continue on with operating machinery or working a job while titrating up a new psychiatric medication. Honestly, employers should offer medical time off for this.
Antidepressants benefit specific populations, those that have a predominant "internal" stress/depression and not due to a profound external trauma. They will not help a child that is continuously bullied, but one that has inherited a depressive trend. This holds for children and adults, barring some differences due to age maturity. Saying "no difference from placebo" for a treatment that is used by hundreds of millions is poor science, if not misinformation and malice.
SSRIs literally saved my life, no question about it. Night and day difference, from daily panic attacks destroying my life, happiness, and career, to being almost completely better in 2 weeks after starting. I tried exercise and diet and meditation and you name it, for years!, before I gave medication a go.
Do not care what the science says. It 100% worked for me. Please get help if you need it, tens of millions of people use this medicine successfully
Articles like this are part of the narrative that SSRIs in general are no better than placebo. Absolutely not true for me!
Same here, after struggling for 39 years, glp-1 + SSRI + ADHD meds have made me a normal productive human, and 2 years ago I had pretty much given up on the possibility.
Having a child forced me to fix my life, and I'm incredibly happy because of it.
For me? Not being hyper anxious all day (to the point that I just freeze and procrastinate all day), being able to sort of focus on the most important task (I'm still ADHD with 1000 unfinished projects, but at least I finish the things that have to be finished), eating healthy and enjoying exercising (100 lbs down and got quite good at tennis), not entering into a rage state due to anxiety overflow everytime I fight with my wife, being able to regulate my emotions, I could go on and on honestly.
As someone with ADHD, if your productivity was decreased or did not increase in the slightest, then I doubt a doctor would keep prescribing the medication. Such increases do not have to be astronomically large, but I do believe increasing the productivity of people with ADHD is absolutely part of the benefit.
I agree, but I think you’re misunderstanding my comment. I was replying to a snarky comment that seemed to imply that the effect of taking amphetamines is obvious and mundane.
The point I was trying to make is that the effect on someone with ADHD can be profound and transformative, not like going from 80 to 100 but rather from 0 to 100. You suddenly feel like a functional person (I say this as someone with ADHD).
I have tried prozac in my teens and zoloft in my 30s. Prozac made me dissociate pretty hard, I found myself between classes not knowing where I was coming from or going. Zoloft did nothing but give me the zaps when I came off it.
There have been some serious efforts made to reproduce the original groundbreaking results that showed how effective SSRIs were, without much success. Anecdotally, I know plenty of people who have benefited from them, so I would not say they are ineffective as a blanket statement. I do think it’s important to understand that nobody really knows how these drugs will impact any one individual, and it’s trial and error to find something that may help.
Had you tried a placebo without knowing that it was a placebo? No? Then your story's irrelevant to whether the medication's working (yes, even on you) any better than a placebo would.
Placebo works very well for many people too! That's precisely the thing. That's what makes these studies tricky.
If you're a doctor, and if Prozac helps your patients, then it's obviously excellent. You should keep writing prescriptions.
If you're a scientist, you obviously want to distinguish between "real" drugs and drugs that help because people believe they should. So, you do these kinds of tests.
And then, from the perspective of ethics, once you know it's just placebo, you kinda shouldn't keep giving it to people, even if it helps? Maybe? I don't know. That's the weird part.
> And then, from the perspective of ethics, once you know it's just placebo, you kinda shouldn't keep giving it to people, even if it helps?
That's a very big ethical question in the medical field. Placebos _do_ help, but only if people believe they will. So is it ethical to lie to a patient and give them a placebo knowing it's likely to help?
Spitballing here. I always understood stuff like this as "the system doesn't care about you, it cares about the masses." If the result is overwhelmingly looking no better than a placebo, then the small number of people it actually helps is sort of irrelevant. The exception might be cases where people are willing to drop a bomb of cash for lifesaving drugs for rare diseases (Pharma Bro got a lot of flack for massively jacking up the price of one of these drugs.) I don't know what implications such a study may have in a complex space. I imagine the drug will still be available for those who want to try, but far less prescribed as a sort of safe default. I doubt drug companies will care much for this, since the patent has long expired.
> Articles like this are part of the narrative that SSRIs in general are no better than placebo. Absolutely not true for me!
Does "placebo" mean "no effect" to some people? Placebo absolutely has an effect. Testimonies like this are on the level of "vaccines caused autism" pseudoscience and the serotonin theory of depression isn't even taught any more. It belongs in the bin of crackpot treatments like chiropractic. There is zero chance Prozac would receive FDA approval today.
but no one bothers to take the time out to sit down and figure out WHY they feel sad and FIX THAT FOR THEM. That takes too much work.
Sometimes depression is this vague feeling that this world is just wrong. That Damocles' sword of mortality. The nagging sense of ultimate pointlessness. You can't really "fix" that. But having stuff to ignore it helps, like video games :')
>but no one bothers to take the time out to sit down and figure out WHY they feel sad and FIX THAT FOR THEM. That takes too much work
Out of curiosity, have you ever been depressed or do you know people with diagnosed depression?
I ask, because when I first visited a psychiatrist my life was going great - very good job, great financial situation (i think i could FIRE today), happy marriage, perfect health. It didn't save me from recurring self harm and suicidal ideation, and it doesn't explain why I had weeks when I couldn't even open my work email.
Sometimes your brain is just causing your trouble for no reason. Drugs work, or may work, and may save lives. I write this because I had a similar opinion before being personally affected, so I see where you're coming from.
Depression isn't just feeling sad. It's not necessarily caused by anything external. You cannot necessarily just "figure out why" you feel bad; that's really not how it usually works.
> You cannot necessarily just "figure out why" you feel bad
Well, of course, if you anesthetize someone they can't feel anything. If you cut off the physical pathways of ""feeling sad"" then they can't feel sad, but is that really the same as "fixing" the reason for why they were feeling sad in the first place?
Unless the reason was that the physical causes are running haywire and making someone feel sad when they otherwise wouldn't, but how often is that just uhh a lazy scapegoat? "Oh this person has no reason to feel sad, something must be wrong in their brain"
>It's not necessarily caused by anything external. Y
Then how could a drug fix it? We're positing that there is not only a mechanism causing it, but that this mechanism can be manipulated external to their own self/agency/whatever.
I think that it is at least as absurd to posit that you can come up with one chemical substance or another that will alleviate their depression when you dismiss the idea of coming up with a sequence of words spoken to them that might alleviate their depression. It's the conceit that we have a better idea of how their brains work chemically than we do of how their brains work cognitively.
Many things that are not necessarily caused by anything external can be fixed by drugs. I don't understand your point.
If the problem is brain not working correctly (because some organ is not doing it's job properly) then no sequence of words will make the brain physically fix itself, just like no sequence of words will cure a heart attack.
Of course it depends, and many people just need a correct therapy. I'm not dismissing talking and figuring out the root cause.
If someone is sad for a specific, identifiable and tractable reason, then they are experiencing a categorically different phenomenon to someone who just feels sad all of the time regardless of their life circumstances.
One of the key diagnostic criteria for melancholic depression - what we might lazily and inaccurately call biological or "real" depression - is mood unreactivity. Someone with severe melancholic depression could win the lottery one week, lose all of their family in a plane crash the next, and feel literally nothing about either event.
Some people with atypical depression (or normal sadness that has been mis-diagnosed as depression) can respond rapidly and dramatically to a change in their circumstances. For many others with depression, there is no external why - something has gone fundamentally wrong in the functioning of their brain. Trying to help those people with talk therapy or exercise or companionship would be as futile as using those things to treat hepatitis or gangrene.
> Trying to help those people with talk therapy or exercise or companionship would be as futile as using those things to treat hepatitis or gangrene.
I get what you want to say, but to nitpick the analogy: If the "treatment" for gangrene is amputation, then that's not really "fixing" anything. That's just the scorched earth strategy of destroying the afflicted along with the affliction. Like lobotomies. What do people think of them now?
> Someone with severe melancholic depression could win the lottery one week, lose all of their family in a plane crash the next, and feel literally nothing about either event.
Why SHOULD someone feel a specific feeling about any event? If you're subconsciously aware of the ultimate pointlessness of any event, if you're aware that feelings won't change what happened, you won't. You'd move on and handle the new reality in the means available to you.
I'm not saying that medicine should never be used and there's never a "chemical" cause to sadness (or any "wrong" feeling), just that it may be used too often as a lazy escape for the "helpers".
>Like lobotomies. What do people think of them now?
Lobotomy was in fact an effective treatment (albeit with extremely severe side-effects), but we now have much better and safer treatments available. The abandonment of lobotomy was fundamentally driven by the invention of effective antidepressants, antipsychotics and mood stabilisers. Neurosurgery is still offered to an extremely small proportion of patients suffering from very severe and treatment-resistant depression and OCD.
Maybe SSRIs work for some, but Paxil gave me serotonin syndrome and Prozac made my mom psychotically homicidal. I've tried every SSRI titrating on and off (except Paxil), but they all caused deal-breaking side-effects.
Yep. My dad recounted that in 1989, he had to restrain her because she (then age 40) had a psychotic episode described as a "murderous impulse" just after starting a brand new "wonder pill", Prozac. This was quite uncharacteristic for a tiny, docile woman who is often described as "sweet" and "nice" who never had any psychiatric symptoms before or since except a couple of brief times of situational depression. There's a lot of FUD and social ills washing in mass media rather than less biased peer-reviewed research that blames individuals, conflates preexisting conditions with medication side-effects, and clouds the issue of whether SSRIs increase suicide and/or violent psychosis or not.
Somehow, I doubt there is much motivation to look for economically inconvenient and unnerving side-effects in some demographics, especially if they're adults who can easily be blamed entirely for all of their own actions because it's "definitely not" due to a (formerly) profitable pill or a pseudoscientific profession that doesn't exactly know how the medications it prescribes work, who would benefit from or be harmed by them, or have any ability to measure the organ or system they're supposed treating.
It is highly likely that your mother was misdiagnosed as suffering from unipolar depression when she was in fact suffering from bipolar disorder. A sudden switch to mania is a common outcome, even in cases where the patient has no previous history of mania. It is crucially important to take a comprehensive history to rule out bipolar disorder, but many general practitioners (and some psychiatrists) reflexively prescribe SSRIs whenever they see a depressive episode, even where there is clear evidence of a personal history of hypomania or a family history of mania.
Thanks for sharing your mom's experience with big pharma's then-new wonder-drug.
> Somehow, I doubt there is much motivation to look for economically inconvenient and unnerving side-effects in some demographics,
Robert Whitaker examined the pharmaceutical industry's ideological capture of conventional psychiatry in his third book, Psychiatry Under the Influence.
This was inspired by the old SNL skit, Theodoric of York, Medieval Barber. The article is structured around my proposal of a Theodoric’s Principle of Medical Advancement, to explain why medical progress is so glacial.
Chemicals like this imho act like "global variables" for the neural network. Perhaps a bit like temperature in an LLM. They have an effect, but the effect is sort of holographic -- there's no way to predict/compute exactly what the effect will be, because it's a function of parameters that include all the training data, specifics of neuron function that depend on DNA and other environmental factors and so on. The effect might be beneficial, by some definition of beneficial, but it might not. Even a simple chemical like ethanol has a wide variety of effects on different people.
Swapping one problem for another. Religion sounds like the worst place for someone who is mentally vulnerable. It's like pulling out your credit card in a shopping mall full of salesmen who are under tremendous pressure to make big sales asap
This reads to me like over-prescription rather than lack of efficacy but I’m also not a doctor and won’t presume my kneejerk reaction is accurate.
We saw a similar whiplash with Ritalin after over-prescribing in the 90’s/2000’s. ADHD medication absolutely works, but for a lot of people it didn’t for this reason.
Effect size is strongly affected by severity - people who aren't very ill just don't have as much to gain compared to people who are gravely ill. Widening diagnostic criteria and more liberal prescribing will inevitably lead to a reduction in the observed effect size.
Antidepressants were bona-fide miracle drugs when we first started using them on desperately ill inpatients who experienced every moment as exquisite torture. We saw the most miserable lives completely transformed in a matter of weeks. They have become merely "sorta-kinda useful sometimes" now that we're mainly prescribing them to broadly functional people who are feeling a bit sub-par.
SSRIs are a pretty poor fit for the latter cohort, because SSRIs cause significant emotional blunting in the majority of patients, to the extent that some people hypothesise that emotional blunting is the fundamental beneficial effect. Feeling quite numb is an incredible improvement if you are constantly unbearably miserable. If you have a more normal range of emotional experience than relentless misery, it is likely a sideways move at best; if your core complaint is that you feel numb and apathetic, they're probably actively harmful.
SSRIs are very widely used because of their extraordinary safety, but they're often thoughtlessly prescribed by overworked primary care doctors. There are a wide range of antidepressants (and drugs that have antidepressant effects despite not being marketed as such) that are likely a better option for a large proportion of patients.
Even for people with legit ADHD, like myself, medication isn't always a home run. I think something like 10%-20% of people do not respond well to any medications. I personally am only a 'partial responder' in that I only really get an improvement in focus/concentration -- not really anything else. But hell, that is still better than life without medication.
Definitely didn’t mean to imply it’s a home run. I’m just saying it clearly and legitimately helps a ton of people.
My point is if you include more and more people who don’t need it because of over-prescription it’s going to appear as lower overall efficacy while still helping a lot of people in the pool.
Making up numbers: If only 20 out of 100 people actually have ADHD then out the gate you’ve ruled out helping 80% of the people. So if 15 of the remaining 20 see improvement in their daily lives that means 75% suddenly looks like 15%.
Diagnosing and treatment is never that clean, there will always be some people who don’t necessarily need a certain medication yet get it prescribed (or don’t when they need it! Especially women with ADHD) because doctors are fallible like anybody else, systemic issues, etc. But with a commonly prescribed medication like Adderall the problem is definitely more pronounced.
Anyway I’m curious enough to look more closely at the study, this is a very interesting topic. If Xanax is really not helping people that’s pretty serious.
It’s fascinating that otherwise intelligent people have no hesitation pumping their children’s developing brains full of SSRIs and amphetamines at the behest of a professional class who is paid to distribute these medications.
It's even more fascinating when you have first hand experience with how much unmitigated guesswork goes into selecting psychiatric meds and their dosage.
I used to share your opinion, and in a way I still do, but after having 3 children and seeing how horrible some of these behaviors and habits can get, I completely understand why people cave in to get some relief. The stress of dealing with severe behavioral issues day after day can easily destroy a marriage and family.
I was very young when my mom started Prozac but do remember how angry and sad she was before compared to after.
Years later there was a time when me and my sister noticed our mom was acting a bit strange -- more snappish and irritable than usual, and she even started dressing differently. Then at dinner she announced proudly that she had been off Prozac for a month. My sister and I looked at each other and at the same time went, "Ohhhh!" Mom was shocked that we'd noticed such a difference in her behavior and started taking the medication again.
I've been on the exact same dose as her for 15 years, and my 7-year-old son just started half that dose.
If I have a good day it's impossible to day whether that's due to Prozac. But since starting Prozac I have been much more likely to have good days than bad. So, since Prozac is cheap and I don't seem to suffer any side effects, I plan to keep taking it in perpetuity.
What I tell my kids is that getting depressed, feeling sad, feeling hopeless -- those are all normal feelings that everyone has from time to time. Pills can't or shouldn't keep you from feeling depressed if you have something to be depressed about. Pills are for people who feel depressed but don't have something to be depressed about -- they have food, shelter, friends, opportunities to contribute and be productive, nothing traumatic has happened, but they feel hopeless anyway -- and that's called Depression, which is different from "being depressed."
Your anecdote has nothing to do with whether it's better than a placebo or not.
His anecdote explicitly mentions the possibility of it being a placebo.
No it doesn't. It doesn't contain the word "placebo." Can you quote where it "explicitly mentions" what you're saying it does?
> If I have a good day it's impossible to day whether that's due to Prozac. But since starting Prozac I have been much more likely to have good days than bad. So, since Prozac is cheap and I don't seem to suffer any side effects, I plan to keep taking it in perpetuity.
I was acknowledging that the "good days" could be due to Prozac or could be a placebo effect, but since being on Prozac correlates with having significantly more good days, and I experience virtually no ill effects, I choose to continue with it.
Wow, a shockingly argumentative tone for someone who is just flat out wrong.
Beyond the response someone else commented explaining exactly where the comparison was mentioned, the anecdote itself is useful in offering an experience of someone who's life has been changed by the drug.
In any case, the study mentioned in the article is a meta-analysis about children, not adults, so there is no onus on OP to qualify anything about placebo or not.
Some people just need to have stuff spelled out for them.
> my 7-year-old son just started half that dose
This is horrifying.
We had/have a lot of reservations about it too, and discussed it at length with our pediatrician over months of observation. We decided what was more horrifying was hearing a 7-year-old — who has supportive family and friends, good health, no traumatic events, no major life changes going on, never worries where food/shelter is coming from — say he feels like "he shouldn't be on Earth anymore" and suddenly react with extreme physical anxiety to almost everything. It was bad enough that he couldn't really implement any of the coping skills he learned in therapy. His therapist hoped that medication would bring him to a baseline where he was able to benefit more from therapy. My family's historical success with Prozac also made the decision more palatable since depression appears to be hereditary.
There has been a phenomenal positive shift in his behavior since he started medication. All that said, another commenter pointed out that the study specifically says that Prozac is no better than placebo for depression, which is similar to but distinct from anxiety, which is what my son is being treated for. My mom and I were both diagnosed with depression, but anxiety may be more accurate -- I'm not sure.
You seem to be handling the naysayers pretty well. But, still wanted to compliment you for sharing and encourage you not to let them get to you.
It sounds like you made a wise decision given your personal and family history and your son is benefiting. Kudos.
I appreciate your candor in this. A respectful and on-going discussion and dialogue about this subject is really the best way forward for us all.
I was one of those “medicating kids is a terrible idea” people, until I had kids with severe generalised anxiety. It took a lot to convince me to try it, but it made their lives better in such an obvious, immediate way. The whole experience made me a lot more humble about opinions I hold without relevant experience.
As someone with bad mental health since I was ~5 and parents who refused to acknowledge it - I think you're making the right decision.
There is however also benefit in updating your priors as new research comes out. I won't say this particular research discounts your experience. But maybe some day your son will prefer a different medication.
I'd be more interested in where your 7-year-old even learned phrases like "I feel like I shouldn't be on Earth anymore."
Yes, us too. Beats us. Sure wasn't around our house, and we can't imagine any family/friends/TV/whatever he may have learned it from.
Children are intelligent and creative and this is normal.
Children speak like this and then I correct them. I explain it isn't helpful, explain why they are blessed, how their life could be worse, and provide them alternative phrases while they explain their emotional state.
Depression is caused by laziness and anxiety by hopelessness. My kids know that they aren't permitted to be lazy or say they are bored. They don't have anxiety because they have hope despite circumstances.
> Depression is caused by laziness and anxiety by hopelessness.
I wish this were true, but its not even close. I wonder how your kids will react when they move away, and you're not around to police their emotional expression. If they're like me, they will promptly collapse into paralysis and self-destruction.
I strongly suggest that you frequently give your kids long stretches of time (months) to practice regulating themselves, without your interference.
And if they have anxiety or depression, please let them see a professional. If my parents had noticed the signs earlier, they would have saved me decades of pain.
At this age I am teaching emotional regulation on a daily basis.
As for when they grow up, adults who cannot manage their emotions get fired or are sent to jail. It is critical to be slow to anger, quick to forgive, and work at building strong friendships.
You have no clue of which you speak.
> Depression is caused by laziness [...]. My kids know that they aren't permitted to be lazy.
Do you really believe this, or do you believe your children aren't depressed? Your comment is not in accordance with science. Depression is a complex topic. I'm having trouble imagining a way to be more wrong. Is this satire?
No, not satire. How does science measure depression? There isn't a blood test and brain scans are inconclusive.
That said, I have not met a depressed person who exercises each day and lives in a clean house.
I know several depressed people that exercise every day and live in a clean house.
That's unfortunate. Ask they why they are depressed and see if there is any way to fix it.
You should shut your mouth and stop talking about things you know nothing about.
It's almost as if depression reduces your executive function, making it more difficult to exercise each day or consistently clean your house.
And then you feel worthless for not being able to do those things, reinforcing the depression.
I agree 100% and it is an uphill battle requiring significant effort. That is where discipline is required. Exercising that discipline will bring positive results. There is nothing other than self stopping someone from cleaning instead of crying under a blanket.
Do you have a kid? Because they are humans who see and listen and hear and think on their own and don’t need to hear a phrase to come up with it, but also who definitely hear all sorts of things you don’t know about.
It sounds to me how a someone would describe feeling suicidal when they don't know the word for it.
Ya, when I'm sad I can come up with pretty creative language to express it. It does feel really tough to know that a seven year old feels like that :(
Come on, 7 year olds should have already learned to form phrases.
No, you see, this phrase must have appeared in his training set.
It's also horrifying to hear your 7-year old child talk about committing suicide when you have a deep family history of depression, anxiety, and suicide.
Have some empathy.
No, it's not.
Medicine is advancing. We're increasingly able to understand and adjust dysfunctions that cause major, negative quality of life impacts. These dysfunctions have always existed, we're just getting better at finding ways to help people work through it.
Why? If a kid has diabetes, would it be horrifying to treat it? Why would it be different for a neurochemistry issue that makes the same kid tired and sad all the time?
Because the problem's not a "neurochemistry issue" (that theory's been debunked and the "chemicals" in play have never been known), and the solution is "no better than placebo."
Please share your qualifications for making a statement like this- do you work in biology? Are you knowledgeable about the underlying biology here, and the limitations of medical publications?
I hope you do realize that this comment thread is linked to an article that includes the words "Prozac no better than placebo" in its headline?
Yes, I do. I don't consider articles in the regular press to be even remotely worth looking at due to their high rate of inaccuracy. Here's the paper that the article refers to: https://www.jclinepi.com/article/S0895-4356%2825%2900349-X/f...
Not that I agree or disagree with the underlying claim but a call to "credentialism" to dismiss someone's opinion is not as strong in 2025 as you think it is.
The last few years have been a proof that even the "experts" are following strong political or personal ideology.
Also we don't live in the 18th century anymore. A lot of knowledge (especially around medicine) is open to the world. People can read papers, understand research etc.
In this area, having credentials makes a difference. Experts matter.
Few if any non-medical people can read medical papers and make sense of what they say. There is simply far too much context to evaluate such papers, especially in the cases of complex medical conditions.
Sorry but strong disagree here.
I have had a lot of Spinal and sleep issues. I have read almost all new literature on this niche subject and I have brought to my spine doctor some new therapy and treatments they had literally no idea about. Those treatments have changed my life.
As an engineer I read a lot of deep technical paper as my day job. Medical papers are comparatively relatively simple. The most complex part being usually the statistical data analysis.
We have pushed to a whole generation of people that only the "experts" can have opinion on some fields. I encourage everyone to read papers and have opinions on some of those subjects.
We are in 2025. That type of gatekeeping needs to go away. AI if anything, is going to really help with this as well.
I think it's good to read papers and be curious.
It's also good to work with your doctors (as you seem to have done), have a discussion, and mutually agree on a plan of treatment.
Experts don't know everything. But they probably know some things you don't, and can think of questions you might not to have even thought to ask. As the saying goes, "you don't know what you don't know". Experience matters.
There's also a lot of people out there without an academic background that don't know how to properly read journal papers. It's common to see folks do a quick search on PubMed, cherry-pick a single paper they agree with, and treat it as gospel - even if there's no evidence of repeatability. These skills are not something that many people outside STEM are exposed to.
Cherrypicking is bad, but worse is reading a paper and thinking you understand what it says, when you don't actually understand what it says. Or thinking that a paper and its data can be observed neutrally as a factual and accurate statement for what work was actually done.
My experience in journal club- basically, a group of grad students who all read a paper and then discuss it in person- taught me that most papers are just outright wrong for technical reasons. I'd say about 1 in 5 to 1 in 10 papers passes all the basic tests, and even the ones that do pass can have significant problems. For example, there is an increasing recognition that many papers in biology and medicine have fake data, or manipulated data, or corrupted data, or incorrectly labelled data. I know folks who've read papers and convinced themselvs the paper is good, when later the paper was retracted because the authors copied a few gels into the wrong columns...
But is that really what you are seeing in this HN comment thread? People who seem very well researched in the biochemicals and meta studies of Prozac? I don’t. :)
> We have pushed to a whole generation of people that only the "experts" can have opinion on some fields. I encourage everyone to read papers and have opinions on some of those subjects.
There's nothing wrong with having an opinion on something as a non-expert, as long as those opinions are not acted upon or relied upon as a source of reliable information. Read papers, watch YouTube, browse WebMD, satisfy your curiosity--knock yourself out. But don't undergo treatment without working with an actual expert! I'm not an expert on orbital mechanics, but I have played KSP and have formed various opinions about it. But nobody should be listening to me for advice on how to launch a rocket.
We need gatekeeping for a reason, especially in the medical field which is rife with miracle cures, snake oil, herbal remedies, detoxes, homeopathy, and other forms of quackery.
Believing my "research" is better than my specialist's education is a path back to the dark ages.
Can you provide a source for that theory having been debunked? I agree that data has been found that is at odds with the various neurochemical theories but am not aware of the neurochemistry link as a whole having been definitely debunked.
Whenever I read a comment like this, I’m always curious if the commenter did some basic searching of their own. Just searching “chemical imbalance debunked” yields a wide array of sources. So why ask? It seems almost like a form of Socratic questioning. You want to debate the point, but for whatever reason, are not doing so directly.
I'll take this sincerely, and ask you, is this really something you've a continuing curiosity about? I have a suspicion you understand what is taking place, but for whatever reason, are not expressing so directly. Are you asserting there is nothing more to discuss after one parses the search results for “chemical imbalance debunked”. The parent is quite clearly, at the minimum, meeting their parent's level of input, which essentially amounted to "this thing is debunked". As an onlooker and after a quick skim of the search query you suggested, I am still not exactly clear on what "neurochemistry issue [theory]" entails. What would help, is a more clear underpinning for what is being discussed, which your parent is suggesting, through question, before attempting to respond. I appreciate this personally!
Ah, well-put! I think we may be reacting differently to the same articles. My understanding is that while various neurochemical theories have not been proven as the general public seems to think, they have also not necessarily been disproven or debunked. Certainly it has not been proven that neurochemistry has no role at all.
Probably because the commenter is not a medical professional and isn't qualified to judge the veracity of anything they find. "Do your own research" is a fucking plague on our modern world and is why the internet is like wall to wall grifters now.
By all means, Google whatever you like, but if you show up to a doctors office waving WebMD sheets in a medical professionals face, you are going to be mocked and you deserve it.
I witnessed a pair of doctors prescribe a family member an incredibly dangerous drug for an off label use. The company had been fined $500 million dollars for various illegal schemes to convince doctors to write such prescriptions, but I’m sure the doctors in question were unaware of this. When this family member began to exhibit textbook symptoms of an extremely dangerous (life threatening) condition which could only be caused by the drug in question, the doctors failed to notice, and in fact repeatedly increased the dosage, and added more drugs on top to treat the symptoms caused by the initial drug. It was not until I accompanied my relative to a doctor’s appointment and delivered a carefully designed incantation that they made the correct diagnosis and halted the prescriptions.
So should I not have done my own research?
I wouldn't recommend searching for "chemical imbalance debunked" unless you intend to confirm an existing bias. The internet will show you whatever you want, and there are enough people who distrust medical professionals that any search for "debunking" will be a minefield of fringe theories and grifters. I'd recommend someone start generally, searching for information about clinical depression, and then build on that to look at root causes and how the medical understanding of those root causes has changed over time.
I don't think we know if it's a neurochemistry issue. From what I understand what was debunked was the idea that they worked by blocking the reuptake of serotonin specifically.
You don't understand what having extreme anxiety at that age feels like.
As someone who lived through that, I refuse to let him. All of memories of school are just feeling anxious about everything, just tight and suffocated, always in a panic. I started living when I started taking anxiety pills at 39 years old, and I can see my 2 year old having the exact same anxiety ticks and fits I have.
I don't know at what age I'll medicate him, but I'll do it as soon as I notice he isn't coping and happy anymore.
Horrifying is forcing him to experience that because you can't comprehend us.
I'm sorry that you're dealing with this - it was my greatest fear at that point. That my daughter seems to not have my disposition and seems happy go lucky is the greatest thing ever. There's no rhyme or reason to my depression and anxiety, it's completely maladaptive and I'm relieved, that knock on wood, she stays happy and light while not having to shield herself from the horrors of the world.
The main issue I see is that the anxiety pill is a way to treat the symptoms, not the cause.
Do you think that there is a way to treat the underlying cause and not the symptoms?
How do you know an anxiety pill is treating symptoms only? What if the cause is physiological, and the pill treats that? It is entirely possible to sit in your therapist's office and mutually shrug because neither of you can find an underlying reason for your anxiety. Sometimes anxiety just is.
Often the cause is things that most people can handle, without being able to easily wield the tools to handle them. Having a pill that dulls the symptoms gives space to learn and become adept at the tools
Why?
Because 7 years old is borderline too young to even make a depression diagnosis, and that kid's going to have his brain chemistry altered and essentially be addicted to a drug that he'll have to pay for for the rest of his life.
According to our pediatrician there are no known long-term effects of juvenile Prozac use. The effects may exist, but if they do they are of sufficiently low significance as to not have been detected yet. Interestingly the one possible effect she's aware of is that there may be a correlation with not growing as tall physically as one might otherwise. The data is not conclusive, but it gives me something to blame for topping out at 5'10" and never hitting 6' like my dad. :)
I appreciate how open and honest you have been in this discussion. While it might be that taking Prozac is the best choice for your child, I have to admit I would never let a pediatrician prescribe Prozac (or any other SSRI) - this is enough outside their normal training, I would want to consult with a specialist. Can't you get a referral to a pediatric psychiatrist of some sort?
This is one of the most shocking things I have ever read. There is a black box warning for Prozac:
‘Warning: Suicidality and Antidepressant Drugs
Increased risk of suicidal thinking and behavior in children, adolescents, and young adults taking antidepressants for Major Depressive Disorder (MDD) and other psychiatric disorders’
Read the package insert: https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/01...
The fact that you were not informed about this should serve as proof that you cannot blindly trust what doctors tell you. They will absolutely kill you out of ignorance or incompetence, and never even realize their responsibility.
Note that the black box warning has nothing to do with long-term effects of the medication. It was added specifically because kids were killing themselves within weeks of starting the medication.
> This is one of the most shocking things I have ever read.
Good grief. I hope you're exaggerating for effect.
Death is a long term effect. And I am not exaggerating. I did not feel the need to list any of the myriad other potential long term effects because death seemed sufficiently serious.
Edit: in case the OP is reading, I should say also that the package insert won’t mention many other potential long term effects addressed in the literature, like extra pyramidal symptoms (akathisia, Parkinsonism, dystonia, tardive dyskinesia).
Another edit: ask GPT-5 ‘What are the long term side effects of Prozac use which aren’t addressed in the package insert?’ for a list.
I'll raise my hand in agreement. This thread is definitely one of the most disturbing sub-threads I've ever read on HN.
It’s disturbing that a seven-year-old was treated for suicidality? Or it’s disturbing that people are opposed to such treatment?
We were certainly informed of this. I didn't count it among the long-term health effects. I'm an educated and skeptical person but have never found any reason to distrust my physicians.
This is such a blatant misrepresentation of the parent post that it feels almost bad faith.
The subject was specifically about long term brain chemistry changes.
People committing suicide after taking it, while incredibly sad, is completely unrelated.
There is no effect which is more long term than death. It is incredible to me that this is not obvious. But if you want other potential long term effects:
Lower bone mineral density, increased risk of fractures, osteoporosis
Sexual dysfunction / PSSD (Post-SSRI Sexual Dysfunction)
extra pyramidal symptoms (akathisia, Parkinsonism, dystonia, tardive dyskinesia)
emotional blunting / apathy
slowed thinking, brain fog
increased risk of gastrointestinal bleeding
QT prolongation
How can you believe it's both "no better than placebo" but also that it's "going to have his brain chemistry altered and essentially be addicted to a drug". SSRIs are not considered addictive, though people can develop a dependence if it provides them significant improvement.
The whole point of the linked article is that the drug is no better at placebo at treating depression but also carries a host of known side effects, besides unknowns when it comes to long term use. They're not saying it's inert.
A drug can have real effects while being no better than a placebo for doing something specific (what they're supposed to do).
Okay, so what makes you believe that about prozac (or SSRIs) then?
Here’s a paper from last year: The nature and impact of antidepressant withdrawal symptoms and proposal of the Discriminatory Antidepressant Withdrawal Symptoms Scale (DAWSS) https://doi.org/10.1016/j.jadr.2024.100765
‘Highlights
• Antidepressant withdrawal can be severe and protracted.
• It produces characteristic physical and emotional symptoms.
• All symptoms were more severe after stopping than before starting antidepressants.
• We identified the 15 most discriminatory withdrawal symptoms in our sample.
• Withdrawal did not differ between people with physical or mental health diagnoses.’
O cool. Do you have any appointments I can book for my kid?
Mine too! Only 2 years old but I can already see the massive anxiety bursts in him.
If this guy has a non chemical cure, I'm all for it. In fact I'm actively researching children psychologists to stave off the meds as much as we can, the problem is that 99% of psychologists are quacks, so choosing them is tough.
There's only so many times a kid can get sent home from school for biting/kicking/punching before you realize you need some professional help and will do anything to help the poor kid. I wish you luck.
I recently started giving my 11 year old SAM-e, available over the counter and much faster acting than SSRIs for serotonin support. He's been much happier and more regulated since taking it. I'd encourage folk to read up on the literature around SAM-e and consider it as a lower risk alternative to try first, that may in fact work better.
> My sister and I looked at each other and at the same time went, "Ohhhh!"
I suppose the next step would be to upgrade from single-blind to double-blind, so that your mom won't know which month is the placebo month...
A post on HN a couple years ago discussed research showing antidepressants only work for about 15% of patients: https://news.ycombinator.com/item?id=37671529
The thing is, they work very well for that 15%. I suspect the eventual conclusion will be that depression is a syndrome with multiple causes rather than a single condition, and SSRIs treat one of the causes.
Edit: Mark Horowitz is one of the authors of both studies.
The NNT[1] of Prozac, and SSRIs in general, has been previously estimated around 6. Meaning that treatment is more helpful than a sugar pill in only 1 out of 6 cases (a dirty secret).
Meanwhile the NNH[2] is as low as 21, that is 1 in 21 cases will stop due to negative side effects.
Source: https://www.aafp.org/pubs/afp/issues/2008/0315/p785.html
[1]Number Need to Treat, that is, number of patients you need to treat to prevent one additional bad outcome
[2]Number Needed to Harm, that is, number of patients you need to treat to generate side effects so bad that someone halts treatment
As an adult, Prozac for me has been life changing and for the better. After suffering from anxiety and depression since childhood I have been able to get a new lease on life in my 40s. It is a drug that needs to be respected though, start on the lowest dose and give it months to settle. Find a doctor you trust and that will take time to discuss your situation. I feel that often this class of drugs is often prescribed without careful consideration and people are ramped up to higher dosages faster than they should be by doctors who are rushing to see the next patient.
I thought this was already known? I can’t recall exactly but there was some research pointing to SSRIs in general as not being particularly effective at all. They were just hyped a lot and became mainstream.
I wouldn't go that far, but there was a now-famous study (Princeton?) that showed that doing aerobic exercise for maybe 30 mins every day, about five days per week, was equally effective at alleviating depression symptoms.
There's one big problem with that - getting seriously depressed people to do 30 minutes of exercise (or anything else) five days a week. "Get more exercise" is excellent advice for someone who feels a bit down, but it's absolutely useless for someone who can barely summon up the strength to eat or brush their teeth.
It gets even harder if you offer them the alternative of just taking a pill. For widespread health policy, we should want the proportion of depressives who will never learn to manage it themselves because a pill is offered to be smaller than the proportion for whom the pill is effective. I had always assumed these pills were effective enough but studies like these make me wonder.
They are by no means mutually exclusive. If you want depressed people to get more exercise, then a really useful starting point is to give them a pill that could rapidly increase their energy and motivation. The idea that people will be stuck on those pills forever is just lazy psychiatry; ongoing maintenance treatment is often the best option for patients with a history of severe depression and a high risk of relapse, but antidepressants are equally useful as a stepping-stone towards self-management.
Bluntly, if someone is capable of actually starting and sticking with an exercise routine, then they aren't very depressed and should not be offered medication as a first-line treatment. Antidepressants are markedly less effective in patients with milder illnesses, so psychotherapy and lifestyle interventions are a far better initial treatment option. It's only when these treatments fail - or when engaging with them is severely impaired by the severity of the illness - that medication becomes the favoured option.
Here the context is for children, not in general.
When I was a teen I was put on Prozac because I threatened to commit suicide.
The drug absolutely destroyed me. Within a few days of taking it, I was in a bizarre state of delirium where I would sleep something like 18 hours a day. When I wasn't asleep I would gnash my teeth at my parents. At school I would lash out at my classmates and randomly punch the walls of my classroom. I was taken off the drug after about five days but I didn't fully recover.
To this day, my emotions are severely blunted. I still have complete anhedonia and avolition. I can go on a roller coaster and feel not a shred of an adrenaline rush. Nothing. I struggle maintaining relationships with people because I have no innate "desire" to do so.
The drug is absolutely evil and should never be given to minors.
Drugs of the SSRI category (which Prozac belongs to) are by no means safe or well-tolerated. They have all sorts of severe, life-altering, mostly permanent side effects: https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_i...
Additionally, there's very little - if any - evidence they actually work the way they're purported to.
There are countless heartbreaking stories of people who were prescribed these drugs not knowing what they were subscribing to. In many cases, the effects of those drugs are worse than the symptoms they are supposed to alleviate. With "I Don't Wanna Be Me" there's even a song by Type O Negative (from Peter Steele's own experience with Prozac) about the devastating effects SSRIs can have on a person's life.
These drugs are handed out like candy while the physicians prescribing them often point-blank deny any side effects or even attribute those to the illness they are meant to treat.
I'd go as far as to say that prescribing these drugs for any but the most severe or otherwise untreatable cases violates the "First, do no harm." ethical principle of medicine.
During my first manic episode I was handed sertraline. This pushed the mania full send and I lost a lot of time that I can't account for, things I did I can't remember but friends have recalled. Climbing the house to get in through the upstairs window whilst having the house key on me. Locking myself in my room for a week or two convinced I was the real world John Connor and Arnie was looking for me. Blowing all my savings on cocaine for me and anybody in my vicinity in a month. Going through a gram of mdma more than once in a night. Feeling like I was on a therapeutic dose of MDMA for a few months and thinking this was what SSRIs were meant to feel like. The list goes on.
I will admit I was semi cognizant of the distorted thinking/reality so played it down when talking to the psychiatrist I was urgently (+2 months into it) referred to for early psychosis intervention. I was eventually handed a dozen valium (which the doctor was incredibly hesitant to prescribe, for good reasons) which let me sleep and the mania lifted.
I'm terrified of SSRIs now. I have been diagnosed bipolar for a few years now (went private because in the UK unless you're a danger you're ignored). This week was the first session with a clinical psychologist in a bipolar group. Unsurprisingly almost everyone had a similar experience with SSRIs.
I'm speculating here but I'm pretty sure if you did an MRI on my brain you'd see lesions from the mixing of mdma and sertraline (I get myoclonic jerks to this day).
Every medication can have severe and permanent side effects, the question is how often that occurs for a particular drug, and how that stacks up against the quality-of-life improvement from taking that drug.
> Every medication can have severe and permanent side effects
SSRIs are by an order of a magnitude worse than any other common medication in that respect.
Moreover, like I said there's little evidence these drugs actually achieve any quality-of-life improvement beyond a placebo effect.
And whether patients are properly informed of the risks (I was not)
From the article:
> They can also increase suicidal ideation.
A very close family member committed suicide, after Prozac dosage adjustments made his brain chemistry go haywire.
This happened 30 years ago, and it has been known to us that Prozac can cause this, since then.
The Guardians headline is way, way understating the real situation here.
I also had a close family member who committed suicide shortly after going on Prozac -- this also happened nearly 30 years ago. His young son later went on Prozac himself (several months after his fathers suicide) and immediately started demonstrating bizarre disinhibited anti-social behavior (e.g., damaging property, stealing from friends, etc). He was immediately yanked off Prozac when he started articulating his own thoughts of suicide. The bizarre anti-social behavior improved after discontinuing Prozac.
For some people, Prozac is a very dangerous drug. It is fully deserving of its FDA black label warning (which it didn't have 30 years ago).
The problem with suicidal depression is that if someone has created the thought pattern that death is best, then removing the symptoms of depression (lethargy, lack of energy, no willpower) now gives the person the ability to actually follow through with the act.
Medications almost always target symptoms and never address root causes.
This is a good thing to know, but should also be noted that the same thing can happen with simply naturally recovering from a depressive episode.
The phenomenon should not be considered a reason to not medicate (which I don’t think you are implying, but some may take that as the conclusion). Instead it’s definitely something important to explicitly make people aware of.
Depression or the feeling so much mental agony that the idea of escaping with death becomes comforting, is a signal that something is wrong.
Realizing this has been important with weathering my own occasional dealings with severe[0]depression, once I realize “something is wrong”, I can start the annoyingly slow process of trial and error making changes to correct things. This turns depression from “how reality is” into “this is just feedback on my body’s state”. It turns things getting worse into either a “this is either a transient state or the wrong solution”.
[0] Which I define as the point where any passive ideation (fantasies of dying) starts to enter the gradient of becoming involuntary. As opposed to regular negative thoughts which can (and should) be brushed away as easily as a fly landing on me. Curiously, once I noticed it also affected my ability to experience color. While I could technically see colors, it was like have a mental partial greyscale filter because there was no beauty in it, color was just a meaningless detail.
A sudden improvement in mood is one of the key warning signs for suicide. Often it's genuinely just a sudden improvement, but sometimes it is a byproduct of the relief people experience when they commit to ending their life. If you know someone who is severely depressed, you should watch them very carefully if they suddenly seem carefree.
>once I noticed it also affected my ability to experience color
A small amount of evidence does support the notion that depressed people literally see the world as being less vibrant.
https://pubmed.ncbi.nlm.nih.gov/34689697/
https://cdnsciencepub.com/doi/10.1503/jpn.200091
This is what my psychiatrist more or less warned me about when I went on medication; that a lot of people who are suicidal lack the energy and ability to plan their suicide, and medications can sometimes undo those particular symptoms and people manage to end themselves.
I'm not sure what kinds of studies have been done about it, but I've had a few therapists same similar ideas. If it's not a studied phenomenon, then it has folks that believe it exists.
I'd like to make the point that even if this does occur, it doesn't mean, "therefore this medication shouldn't be used/is worse than doing nothing," just that awareness and caution is needed.
I went through a frankly terrible few months on my current meds because they removed the emotional numbness before removing the bad feelings. However, once that was over they effectively gave me my life back after 10+ years of continual exhaustion and brain fog.
Sometimes willpower improves before mood.
Almost like depression is an acute toxicity caused by physiological variance (or infection related) detox inefficiency!
Depression is likely to have many possible underlying causes.
It’s a description of a persistent set of symptoms not necessarily any specific biological process.
>Depression is likely to have many possible underlying causes
including adaptive evolutionary procreative success
Correct.
and one of the leading causes is what I described.
You really have to unpack "detox inefficiency" because even a google search comes back with nothing.
When your normal lymphatic processes (and glymphatic processes) are slowed, or near-halted.
Can you link any evidence supporting this claim?
Beyond the links in other comments?
Calling it lymphatic impairment would be more straightforward.
Lymphatic inefficiency, maybe.
Impairment sounds too permanent, when this is often an intermittent, “on average” sort of issue - not a complete freeze.
Is there a known correlation between lymphedema and depression?
It might be worth using those words rather than detox inefficiency because the latter conjures thoughts of woo peddlers.
Yes,
it turns out toxins (environmental, die-off and waste of cells from infection, dietary, lifestyle) are important to everyone,
not just vegans in Sandler movies.
What is "detox inefficiency"?
EDIT - I ask because the only results I get when searching are a Harvard article debunking it. I'd rather hear the opinion of someone that actually believes in it before I read about why it's all malarky. I believe in arguing against the best version of someones argument.
https://www.health.harvard.edu/staying-healthy/the-dubious-p...
https://my.clevelandclinic.org/health/body/glymphatic-system
PS Thanks for keeping this a good place to be!
https://news.ycombinator.com/newsguidelines.html
More for the avid reader:
1.) https://pmc.ncbi.nlm.nih.gov/articles/PMC7698404/
2.) https://pubmed.ncbi.nlm.nih.gov/40012567/
3.) https://pubmed.ncbi.nlm.nih.gov/36498538/
Your first linked page has no word "depression" on it
It wasn’t intended to.
It was just the best “every man” link I could provide for understanding how efficacy of toxin-clearing (toxicity) could be related to depression, other struggles with homeostasis.
Did you grasp the connection?
This gets even more interesting when you realize many SSRIs are antibacterials.
It gets less interesting when one notices that social animals are much more prone to depression.
Inflammation and depression are linked. Infection causes inflammation. It doesn’t follow that depression is caused by infection.
I’m not quite following the previous conversation here, but your comment brings to mind that one theory of a possible “function” of depression, is as a “sickness behavior” to help isolate a sick animal from others to protect the group. A sheep or cow getting sick and going off on its own is a common thing.
I’m not sure if it has a technical name or if it’s been rigorously studied, but it’s a common observation which even I’ve seen (and reported to growers I work for).
A casual mention here: http://www.sheep101.info/201/behavior.html
Correct.
It’s caused by inflammation,
one of the causes being: detox inefficiency.
> It’s caused by inflammation
No, it’s not. Depression can be influenced by inflammation.
This thread is a good example of the GIGO pitfalls that researching with chatbots entails.
Yeah, “linked to” is better than “caused by” here, for sure.
Not often this kind of thing comes up on HN, so I was replying in haste at a stoplight!
I’ll ignore the slight, which you should know better than.
It seems pretty common for people to read "linked to" and interpret that as "caused by". It feels like media had kind of pushed that for a long time.
Can you link any evidence supporting this claim? This term sounds like a standard-issue woo.
Replied to your other request too: see other comments, ask for what’s missing for you.
Finding everyone’s cow is expensive and time consuming: https://antidepressantcow.org/2020/02/the-story-of-the-antid...
But is the only true cure to the suffering. We’d have to undergo a massive reorganization of society (and upset a few hefty profit margins) to prioritize that, so we settle for the messy symptom management we have.
That story doesn’t work for people with depression who otherwise have very good lives.
I grew up in a stable household with a loving family and both parents present and supportive. I’ve never had financial hardship, either as a kid depending on my parents to provide or as an adult providing for myself and family. I did very well in school, had plenty of friends, never had enemies, never got bullied or even talked bad about in social circles (so far as I know…). I have no traumatic memories.
I could go on and on, but despite having a virtually perfect life on paper, I have always struggled with depression and suicidal ideation. It wasn’t until my wife sat down and forced me to talk to a psychiatrist and start medication that those problems actually largely went away.
In other words, I don’t think there’s a metaphorical “cow” that could have helped me. It’s annoying we don’t understand what causes depression or how antidepressants help, and their side effects suck. But for some of us, it’s literally life saving in a way nothing else has ever been.
Take my baseless speculation for what it's worth, but could it be that you were depressed because your life was too easy? We humans are meant to struggle through adversity. Can you really appreciate your financial security if you've never faced financial insecurity, or appreciate companionship if you've never experienced loneliness?
It’s a reasonable question but I doubt it. We weren’t affluent at all and I worked my butt off for everything. And that’s good, because I agree that if things are too easy it turns into a curse.
very interesting. would you be comfortable sharing what therapy uncovered as the cause for you?
> I don’t think there’s a metaphorical “cow” that could have helped me.
The medication is the cow for you. In this story your support system figured out what would work best for you, which was medication, and facilitated that.
It’s a story about a doctor that serves patients in rural Cambodia. Help from the local community would look different in Borey Peng Huoth, for example.
First of all, I want to write that I am glad you found something that worked so that you are able to remain here with us.
Though, I am curious about the, "otherwise have very good lives" part.
Whose definition are you using? It seems the criteria you laid out fits a "very good life" in a sociological sense -- very important, sure. You could very well have the same definition, and perhaps that is what I am trying to ask. Would you say you were satisfied in life? Despite having a good upbringing, were you (prior to medication) content or happy?
I am by no means trying to change your opinion nor invalidate your experiences. I just struggle to understand how that can be true.
As someone that has suffered with deep depressive bouts many times over, I just cannot subscribe to the idea that depression is inherently some sort of disorder of the brain. In fact, I am in the midst of another bout now. One that's lasted about 3 or so years.
To me, I have always considered emotions/states like depression and anxiety to be signals. A warning that something in one's current environment is wrong -- even if consciously not known or difficult to observe. And if anyone is curious, I have analyzed this for myself, and I believe the etiology of my issues are directly linked to my circumstances/environment.
> I don’t think there’s a metaphorical “cow” that could have helped me.
The smart-ass in me can't help but suggest that maybe medication was your cow?
> Whose definition are you using?
To be honest, I've never really thought about it... I suppose I mean in both a sociological and self fulfillment way.
> Would you say you were satisfied in life? Despite having a good upbringing, were you (prior to medication) content or happy?
I would say "yes" overall. Aside from the depression (typically manifesting as a week or two of me emotionally spiraling down to deep dark places every month or so), I was very happy and satisfied. That's what makes the depression so annoying for me. It makes no sense compared to my other aspects of life.
> In fact, I am in the midst of another bout now. One that's lasted about 3 or so years.
*fist bump*
> To me, I have always considered emotions/states like depression and anxiety to be signals. A warning that something in one's current environment is wrong -- even if consciously not known or difficult to observe. And if anyone is curious, I have analyzed this for myself, and I believe the etiology of my issues are directly linked to my circumstances/environment.
I think that's a great hypothesis so long as it's not a blanket applied to everyone (which I don't think you're doing, to be clear; I mention this only because it is what motivated my original response to the other commenter).
I don't want to go into private details of family members without their permission, but I will say that given the pervasive depression in my family and mental health issues like schizophrenia and bipolar disorders (neither of which I have, thank goodness), I feel like there's something biologically... wrong (for lack of a better word?)... with us, particularly since you can easily trace this through my mother's side.
> The smart-ass in me can't help but suggest that maybe medication was your cow?
Ha fair. I interpreted the story to be about depression being a symptom of your situation (job, health, etc.) and if you just fixed that then there's no need for medication. That definitely makes sense in some (many? most?) situations. But not all, unfortunately.
I mean sometimes. For me it was multivariate for sure. Biggest problem - wife and kid. Helped a ton. My specific wife, really. I doubt someone else would have helped me. I had a lot of self defeating thought patterns she helped me fix.
Second - light. Lots of light, specifically in winter time. Like this https://www.benkuhn.net/lux/
I had a horrible time with school because as finals rolled around in the fall semester I’d get extremely depressed and anxious.
People would very likely still develop depression in whatever utopia you could imagine.
For starters, everybody has a different utopia, so no matter how you change society it "won't work" for someone.
And depression isn't sadness.
My understanding is that the optimal scenario is taking an SSRI in combination with therapy. The SSRI adds flexibility for the brain to respond to therapy and envisage new possibilities. If you don't include therapy, you've just established a new baseline to habituate to.
Yes, this is what happens.
No it's not.
Yup. Depression medication can significantly help the emotional symptoms, but that takes longer to be effective.
I’m bipolar and a lot of the medication I take does not become fully effective for months. For me, my medication slowly became more effective over years as my brain no longer had to compensate for hardware problems.
Isn't that a possibility with a lot of drugs though? I think it depends on the rate and not a "does or does not" type of questions. Now if the drug doesn't help more than a placebo that's clearly a huge negative, but if it has a high rate of success vs placebo then they will make adjustments and watch out for the side-effect (of course) letting patients know it's a possibility and to report if it starts happening.
Suicidal ideation is a risk for many CNS drugs, and not unique to Prozac as far as I know. But yes this is a major risk factor that needs to be taken in account before such kind of treatments.
The efficacy of anti-depressants has been consistently over-inflated, so generations were poisoned with side-effects: suicidal ideation, homicidal tendencies, etc.
https://pubmed.ncbi.nlm.nih.gov/20616621/
Results: Meta-analyses of FDA trials suggest that antidepressants are only marginally efficacious compared to placebos and document profound publication bias that inflates their apparent efficacy. These meta-analyses also document a second form of bias in which researchers fail to report the negative results for the pre-specified primary outcome measure submitted to the FDA, while highlighting in published studies positive results from a secondary or even a new measure as though it was their primary measure of interest. The STARD analysis found that the effectiveness of antidepressant therapies was probably even lower than the modest one reported by the study authors with an apparent progressively increasing dropout rate across each study phase.*
I think this is the paper in question?
https://osf.io/preprints/psyarxiv/wk4et_v3
Clinical trials of antidepressants are weird because they're usually short-term (6-12 weeks), whereas practical use of antidepressants usually lasts years. I personally suspect that short-term trials show an exaggerated placebo effect, because the novelty doesn't have time to wear off.
Our 11 year old daughter was seriously depressed recently. N=1, but fluoxetine was life changing (and potentially life saving) for her, at least.
Genuine question (which I accept may be too personal to answer): what does depression in someone that young look like?
How is it different from the expected hormonal changes that an adolescent is expected to go through?
Probably something like Boy Interrupted[0]. Sad story and something I can sympathize with having some of the same feelings very early on despite having a rather normal upbringing and siblings not showing signs of it.
0: https://en.wikipedia.org/wiki/Boy_Interrupted
As someone who has been seriously depressed from an early age, I can tell you that it looks exactly like the DSM/ICD criteria - a lack of energy, loss of appetite, loss of interest in all activities, insomnia, feelings of worthlessness, suicidal thoughts and pervasive sadness and hopelessness.
Some people would rather believe that pediatric depression isn't real, rather than confront the reality of a loved and cared-for child who is constantly tearful, severely underweight, sleeps for three or four hours a night, spends most of their time staring into space and frequently talks about wanting to die.
Depression is an utterly dreadful illness and should not be confused with normal sadness or unhappiness.
It's incredible that my last four comments are down voted to -1, for engaging in genuine dialog across topics.
@dang it's hard to believe that I'm not being brigaded.
My advice as a long time participant here: pay no attention to upvotes or downvotes. Sometimes they seem to be completely unrelated to whatever you said. Stay curious.
Placebo can be life changing
Absolutely. These random namedrops of drugs are irritating. People respond to different psychiatric medications in wilddly different ways. And actually, the majority do not respond at all. Throwing a random name of some random medication helps absolutely nobody. It will just make some desperate people seek "this one drug" that they heard about on the internet.
Nocebo can too. Apropos the featured article, I wonder if we should worry about that when we report in the popular media that antidepressants trigger suicides.
Do you have a plan to get her off, or is she on the maintenance drug for life?
Sometimes girls get depressed when their periods start. Girls often don't ovulate regularly, which can cause problems until their cycle stabilizes. Sometimes pediatricians don't allow girls' cycles to stabilize. The doctor says to the girl, "you're a woman now, so we're going to regulate your irregular period with birth control."
Women often get depressed due to the progestins used in all the birth control prescriptions.
SSRIs never help because of boosting serotonin. When someone benefits, it's from the drug's other physiological effects.
Do you have a plan to get her off, or is she on the maintenance drug for life?
It's too early to say. Obviously the idea is to get her off it if possible.
SSRIs never help because of boosting serotonin.
That's a hell of a claim, which could use some evidence.
https://www.nature.com/articles/s41380-022-01661-0
> It's too early to say. Obviously the idea is to get her off it if possible.
You understand that the people who sold you that drug have a vested interest in making sure it's not possible and/or that you & she think it's not possible, right?
You think the pediatrician is getting a kickback for prescribing it?
I'm big on medications for brain stuff but uh yes, in the US, doctors get lots of kickbacks for prescribing drugs.
Usually this takes the form of "I'm prescribing you with <Brand> instead of generic" or "I'm prescribing you this specific drug from this class of drug"
https://openpaymentsdata.cms.gov/
> > SSRIs never help because of boosting serotonin.
> That's a hell of a claim, which could use some evidence.
My experience with the chatbots is that they start with the conventional marketing tropes, but if you ask pointed questions they'll dig into the actual research.
This thread started with a generic question about why ECT seemed to help some patients. It had a really good reasoning about why SSRIs are still the first-line treatment for depression, even though the MAOIs were much better drugs.
https://chatgpt.com/share/69207aa3-26a0-8005-8dda-8199da153f...
The whole 'conversation' is pretty good, and would provide plenty of search terms for helping you figure out what science has actually figured out about depression.A simple pregnenolone supplement can sometimes be magical, because of the steroidogenesis cascade: https://en.wikipedia.org/wiki/Steroid#/media/File:Steroidoge...
There's a supplement seller that said his pregnenolone powder was made with a newer, cleaner process than is used by most of the pregnenolone supplement vendors, but I don't know if he's still using that supplier. The powders are a much better value than the capsules.
hth.
The chatbot is great as a first-line of research for many things, but something like this needs to be backed up by actual research to make a concrete claim. It will absolutely fabricate falsehoods or misrepresent truths based on an unknown number of stochastic factors behind any response. Shame on your for propagating a bunch of mumbo-jumbo that every reader must go verify for themselves if they want to substantiate or refute your claim - in response to a request for substantiation!
Puberty in general can be rough. I (a dude) had all kinds of bad thoughts and moods going through puberty and then one year it was just gone, grades improved dramatically, started making friends again, etc
> "But a new review of trial data by academics in Austria and the UK concluded that..."
> "Mark Horowitz, an associate professor of psychiatry at Adelaide University and a co-author of the study,"
Austria - cold, has mountains, but not Adelaide University
Australia - hot, has kangaroos, and Adelaide University
Is the Grauniad returning to form?
Nature is healing. https://en.wikipedia.org/wiki/The_Guardian#References_in_pop...
Not to get into the historic details but growing up there was lot of tension in my parent's house. When you're a kid you feel these things and are aware of the issues that cause them, but you haven't yet learned how to talk about them or the right words to describe the truth of them. Instead you internalize them.
The lack of learning constructive perspectives and ways for discussing emotions while young, may very much be a source of depression, the same way people say "he can't help it, he has ADHD".
I was about 16 and the doctor recommended this new SSRI called ... I think it was Paxil, The side effects, especially if you missed a dose are hard to describe. If you missed a dose you couldn't function at school, and everyone thought you were really stoned. Also, you could look at a pretty girl and just nothing. A 16 year old boy doesn't know why THAT's happening, neither does the girl, and it just makes things worse. Try having that conversation with your Dad, while doped out on the drugs he told you to take. Imagine the anxiety. It's really depressing. Better to be alone, and safe in one's bedroom and on the Internet... ( and that was 20 years ago ).
Around the same time there was Ritalin and maybe a few others came out.
The issues kids are facing, the feelings they are then given pills to erase are still there, even when numbed to them. The answer lies somewhere in familial stability and relearning respect?, and how to constructively frame life's difficulties and teach that to our kids.
I would never give my kids anything that altered their brain chemistry. Even as adults, the only way is through.
My own experience with SSRIs was very unpleasant. Sure, it worked to reduce my anxiety problems while I was on them for years. The first year I was off of them was the worst though. I didn't have that bad anxiety ever, as in constant panic and feeking of impeding doom. This made me realize that they aren't really an option of me. So began my long therapy journey. After 7 years of weekly therapy, a healthy work-life balance, and regular exercise I'm just feeling better than ever.
So, I'd buy that they don't fix your brain. They definitely reduced anxiety for me and I can see the value for stabilizing people so they can do the heaking work in therapy.
My experience as well. SSRI and other similar drugs for anxiety remove a strong signal to your brain and bring other issues or signal.
But the issue is that nobody wants to really look at the cause. We are all trying to treat the symptoms with those quick-fix pills.
The cause is deep in our society. We are too stressed, lost touch with each others, work on meaningless jobs (or downright negative jobs for society.. if you work at Meta or TikTok, yes your job is in fact a negative for society).
I have also been on a journey for the last 5 years on working on myself and bringing those things back in my life and I have been feeling better than ever: - A lot of outdoor time and exercise. - Take the time to build a community of friends that genuinely care for each other - Work on some projects that you feel help humanity and each other (or volunteer). - Build things you are proud of. Build a legacy
All of those removed almost all anxiety and depression. It is not an easy journey but I'm shocked how few people even consider making those changes
My understanding with SSRIs and other depression meds is that they are hit and miss for anyone. I have a family member who, as a teen, suffered from severe depression and didn't want to live. Therapy wasn't able to help - it was actually the therapist who recommended more drastic measures such as medication. And so they tried Prozac and that worked. Having seen the reversal myself, it's hard to understand how this is placebo.
The placebo effect ( https://www.health.harvard.edu/newsletter_article/the-power-... )? (In the context we are discussing it, Prozac could be considered as an active placebo - https://en.wikipedia.org/wiki/Active_placebo ).
Here the context is prozac FOR CHILDREN, not in general. Yet some people make a point in commenting that SSRIs are ineffective in general because they believe in some big pharma conspiracy. This is spreading misinformation. The truth is that SSRIs are modestly more effective than a placebo for approximately >> one third of the individuals << who try them. In other words, SSRIs are effective for more than 60-66% of adults. Moreover, there are a few different types of SSRIs. It takes time to find the one that fits you.
> they believe in some big pharma conspiracy
See: the Sackler family
Also pfizergate featuring von der leyen.
I thought Prozac was for anxiety.
I'd really be curious about distribution of the result they see. The folklore is definitely that that there's vary high variance in how people respond to SSRIs, and not recommending them because the average value is low is pretty irresponsible.
None of those drugs helped me personally in the 90s (Prozac, Zoloft, etc). What helped me personally was talking about my problems with other humans only to the learn we all are "crazy,(aka totally normal)" and the majority all deal with something similar. Anxiety, OCD, insecurity .. all are parts of the human condition we all deal with throughout our lives.
They must have been pretty damn confident of the results to give depressed children a placebo.
I can't bring myself to try an SSRI. I just cannot do it. I've got a prescription for an NDRI on my desk, and I still won't take it. I am not anti-psychiatry either. I take psychiatric medication for a different condition already. But something about anti-depressants just doesn't sit well with me.
As crazy as it may sound, I think a lot of my depression stems from living a life that is not true to myself and due to countless failed attempts to be someone I cannot never be. As far as I am concerned, depression is just a symptom of my situation and not some true disorder. For the sake of analogy, I would say it's like food poisoning. Yes, the GI issues are awful, but the body is responding appropriately.
> I've got a prescription for an NDRI on my desk, and I still won't take it. ... something about anti-depressants just doesn't sit well with me.
At first it sounded like your antipathy was with SSRIs specifically (which I largely share), but it seems like it's anti-depressants in general.
FWIW, I used to think similar to you, and roughly agree with the gist of your second paragraph, but I've come to think of antidepressants as useful in a specific way: people say "it's a crutch" as a negative thing (about a lot of things including antidepressants), but a crutch was very useful to me when recovering from a fracture, and helped me enormously with my progress; similarly, even if "depression is just a symptom of my situation", it can and does often lead to a cycle where the depression itself feeds into the situation and in turn sustains itself. An antidepressant that works for you is a good way to be able to see things more clearly, feel the motivation and insight that depression clouds out, and thus be able to break out of the cycle.
It doesn't have to be a "cure" that counters a disorder, it can be a tool that you use for its purpose and then throw away (and it does sound like you're well-motivated to do that).
I'm with you on this. People who pathologize themselves or others - assuming they're malfunctioning rather than acknowledging they might simply be living a life that doesn't fit - have a very limited way of looking at things.
> not some true disorder
there's a tool on your desk that might help you solve your problem; what does it matter if the problem is an "appropriate response of your body"? so is pain/anxiety/diarrhea
> stems from living a life that is not true to myself and due to countless failed attempts to be someone I cannot never be.
If this is their mindset, they might benefit from CBT more than medication.
I'm not against SSRI at all. But after taking them for a few months in my 20's, and experiencing how terrible the withdrawal symptoms are when stopping, I'd be very hesitant to ever start up on them again. I remember having to open up the lowest dose pill capsule and splitting the dose into very tiny increments to be able to wean off completely.
> As crazy as it may sound, I think a lot of my depression stems from living a life that is not true to myself and due to countless failed attempts to be someone I cannot never be. As far as I am concerned, depression is just a symptom of my situation and not some true disorder.
It's true for some, but be wary of such a generalization.
It took many years of people telling me the same thing before I understood what they were saying: "Having an objectively crappy life is normal. Being depressed about it isn't."
(Almost) everyone will have problems - temporary or permanent. And while they may feel down about it for a while, or occasionally, most of them more or less recover their mental health and are not chronically depressed.
Because the majority of people have problems, it becomes easy for a depressed person to think "Ah, this is just due to problem X" or even "This is just because I want a life different from mine". Most people with problems also want a different life than what they have. But they're not depressed.
> "Having an objectively crappy life is normal. Being depressed about it isn't."
Sounds like a philosophy more than a science. What does "normal" even mean in this context? Are we talking about something measurable? For instance, if the number of people who were depressed about those circumstances doubled (or quadrupled) would it then be normal, and there would be no reason to treat it (because it's normal)?
If you have an objectively crappy life, but not just ignore it and instead are incapable of even noticing, that sounds a little like dysfunction to me. It's not some superpower, it's a micro-lobotomy.
> If you have an objectively crappy life, but not just ignore it and instead are incapable of even noticing
Noticing it is very different from being depressed about it.
> What does "normal" even mean in this context? Are we talking about something measurable?
Let's take a trivial example. Person A is depressed because he is unhappy that he doesn't make enough money to travel and buy nice cars. Now take all the people who are unhappy that they cannot afford to travel and buy nice cars. Most will not be depressed - they will merely be unhappy about it.
Person A isn't depressed because he can't travel and buy nice cars. He's depressed and he can't travel and buy nice cars. He's mistakenly coupling the two.
Another tell for these kinds of things: Ever know someone chronically depressed who blames it on X? Then somehow, X is resolved. There may be a temporary improvement, and they go back to being depressed again, only they now blame it on Y? Somehow Y gets resolved and some months later they're blaming it on Z.
Everyone has problems. Including those who are not depressed. Fixing X, Y, Z, AA, AB, and whatever else is not going to take care of the depression.
On the flip side, people who do not suffer from depression make the same mistake: They claim they are not depressed because they "choose" not to let the problems get to them. Self serving beliefs!
SSRI can have annoyances (to stay polite) if you ever need a fix so much that you go that route, be sure to ask about them. Didn't help me really but I believe that sometimes, a bit of chemical (placebo or not) relief can help staying afloat enough to work your way back up quicker.
I understand your comment, my issues were due to life circumstances and not a low level neurological imbalance, and I too dismissed these treatments almost entirely, mostly because they felt like blanket solutions from medical professionals who didn't really listen to symptoms.
> *depression is just a symptom of my situation and not some true disorder+
There is a great Bojack Horseman episode in which Diane struggles with the idea of taking antidepressants for similar reasons.
If it’s depression, that’s closer to allergies, chronic inflammation or a broken bone healed wrong than vomiting after food poisoning.
Depression is almost never caused by actual life circumstance - just by your response and usually a delayed response.
Also you should try your SSRI prescription. They really aren't very strong drugs. You might get mild relief or if you're like me and the majority of people you will see no effect whatsoever. It's worth a try anyway. You won't get "high" or "dull" or any of that nonsense. At best it will lift your mood a bit. But more often than not, just won't do anything.
> Also you should try your SSRI prescription. They really aren't very strong drugs. You might get mild relief or if you're like me and the majority of people you will see no effect whatsoever. It's worth a try anyway.
Someone else in the thread's testifying with personal experience that there were significant withdrawl symptoms after only a few months: https://news.ycombinator.com/item?id=45999622#46008522
Are they lying, or are you misrepresenting something?
It is true. Withdrawals from SSRIs are no joke and can take a long time.
One needs to not work and be able to remain at home for about a week or so to see if the side-effects are manageable. One shouldn't simply continue on with operating machinery or working a job while titrating up a new psychiatric medication. Honestly, employers should offer medical time off for this.
Antidepressants benefit specific populations, those that have a predominant "internal" stress/depression and not due to a profound external trauma. They will not help a child that is continuously bullied, but one that has inherited a depressive trend. This holds for children and adults, barring some differences due to age maturity. Saying "no difference from placebo" for a treatment that is used by hundreds of millions is poor science, if not misinformation and malice.
SSRIs literally saved my life, no question about it. Night and day difference, from daily panic attacks destroying my life, happiness, and career, to being almost completely better in 2 weeks after starting. I tried exercise and diet and meditation and you name it, for years!, before I gave medication a go.
Do not care what the science says. It 100% worked for me. Please get help if you need it, tens of millions of people use this medicine successfully
Articles like this are part of the narrative that SSRIs in general are no better than placebo. Absolutely not true for me!
Same here, after struggling for 39 years, glp-1 + SSRI + ADHD meds have made me a normal productive human, and 2 years ago I had pretty much given up on the possibility.
Having a child forced me to fix my life, and I'm incredibly happy because of it.
Pharmacology and chemistry can really make the world a better place.
Yoir choice between the red pill, the blue pill or no pill is pretty obvious but this choice is highly subjective.
Evidently not for children with depression. But yes chemistry is great.
What’s normal anyway?
I think that's a shorthand for "not dysfunctional and neurotically impaired".
For me? Not being hyper anxious all day (to the point that I just freeze and procrastinate all day), being able to sort of focus on the most important task (I'm still ADHD with 1000 unfinished projects, but at least I finish the things that have to be finished), eating healthy and enjoying exercising (100 lbs down and got quite good at tennis), not entering into a rage state due to anxiety overflow everytime I fight with my wife, being able to regulate my emotions, I could go on and on honestly.
Who would have figured that microdosing amphetamines all day leads to increased productivity?
This seems a little snarky. For someone with ADHD it’s not as much about “increased” productivity but rather non-zero productivity.
As someone with ADHD, if your productivity was decreased or did not increase in the slightest, then I doubt a doctor would keep prescribing the medication. Such increases do not have to be astronomically large, but I do believe increasing the productivity of people with ADHD is absolutely part of the benefit.
I agree, but I think you’re misunderstanding my comment. I was replying to a snarky comment that seemed to imply that the effect of taking amphetamines is obvious and mundane.
The point I was trying to make is that the effect on someone with ADHD can be profound and transformative, not like going from 80 to 100 but rather from 0 to 100. You suddenly feel like a functional person (I say this as someone with ADHD).
See: The dot com boom and its recovery into Web 2.0
It was so pervasive at the time that the references to it spilled over into SF Bay Area hip hop culture...
Massive amounts of cocaine did the same for the housing bubble in the 2000s.
Doctors. That is why they prescribe it.
I have tried prozac in my teens and zoloft in my 30s. Prozac made me dissociate pretty hard, I found myself between classes not knowing where I was coming from or going. Zoloft did nothing but give me the zaps when I came off it.
There have been some serious efforts made to reproduce the original groundbreaking results that showed how effective SSRIs were, without much success. Anecdotally, I know plenty of people who have benefited from them, so I would not say they are ineffective as a blanket statement. I do think it’s important to understand that nobody really knows how these drugs will impact any one individual, and it’s trial and error to find something that may help.
Had you tried a placebo without knowing that it was a placebo? No? Then your story's irrelevant to whether the medication's working (yes, even on you) any better than a placebo would.
I think it’s important to note the headline that it’s specifically about children. Maybe Prozac is effective for adults but not kids in that range?
Hopefully people don’t see articles like this (for depression) and think the results are the same for anxiety disorders.
THIS!
SSRIs have been proven to be very effective against anxiety disorders, which in many ways mimic depression, but have different pathologies and causes.
Also, they saved me.
Placebo works very well for many people too! That's precisely the thing. That's what makes these studies tricky.
If you're a doctor, and if Prozac helps your patients, then it's obviously excellent. You should keep writing prescriptions.
If you're a scientist, you obviously want to distinguish between "real" drugs and drugs that help because people believe they should. So, you do these kinds of tests.
And then, from the perspective of ethics, once you know it's just placebo, you kinda shouldn't keep giving it to people, even if it helps? Maybe? I don't know. That's the weird part.
> And then, from the perspective of ethics, once you know it's just placebo, you kinda shouldn't keep giving it to people, even if it helps?
That's a very big ethical question in the medical field. Placebos _do_ help, but only if people believe they will. So is it ethical to lie to a patient and give them a placebo knowing it's likely to help?
This seems like bias against the placebo effect.
Spitballing here. I always understood stuff like this as "the system doesn't care about you, it cares about the masses." If the result is overwhelmingly looking no better than a placebo, then the small number of people it actually helps is sort of irrelevant. The exception might be cases where people are willing to drop a bomb of cash for lifesaving drugs for rare diseases (Pharma Bro got a lot of flack for massively jacking up the price of one of these drugs.) I don't know what implications such a study may have in a complex space. I imagine the drug will still be available for those who want to try, but far less prescribed as a sort of safe default. I doubt drug companies will care much for this, since the patent has long expired.
You should have tried placebo first
> Articles like this are part of the narrative that SSRIs in general are no better than placebo. Absolutely not true for me!
Does "placebo" mean "no effect" to some people? Placebo absolutely has an effect. Testimonies like this are on the level of "vaccines caused autism" pseudoscience and the serotonin theory of depression isn't even taught any more. It belongs in the bin of crackpot treatments like chiropractic. There is zero chance Prozac would receive FDA approval today.
> treating depression
Most of the "treatment" is apparently just telling people to stop feeling sad [0], or giving them drugs
[0] https://old.reddit.com/r/thanksimcured
but no one bothers to take the time out to sit down and figure out WHY they feel sad and FIX THAT FOR THEM. That takes too much work.
Sometimes depression is this vague feeling that this world is just wrong. That Damocles' sword of mortality. The nagging sense of ultimate pointlessness. You can't really "fix" that. But having stuff to ignore it helps, like video games :')
>but no one bothers to take the time out to sit down and figure out WHY they feel sad and FIX THAT FOR THEM. That takes too much work
Out of curiosity, have you ever been depressed or do you know people with diagnosed depression?
I ask, because when I first visited a psychiatrist my life was going great - very good job, great financial situation (i think i could FIRE today), happy marriage, perfect health. It didn't save me from recurring self harm and suicidal ideation, and it doesn't explain why I had weeks when I couldn't even open my work email.
Sometimes your brain is just causing your trouble for no reason. Drugs work, or may work, and may save lives. I write this because I had a similar opinion before being personally affected, so I see where you're coming from.
Depression isn't just feeling sad. It's not necessarily caused by anything external. You cannot necessarily just "figure out why" you feel bad; that's really not how it usually works.
> You cannot necessarily just "figure out why" you feel bad
Well, of course, if you anesthetize someone they can't feel anything. If you cut off the physical pathways of ""feeling sad"" then they can't feel sad, but is that really the same as "fixing" the reason for why they were feeling sad in the first place?
Unless the reason was that the physical causes are running haywire and making someone feel sad when they otherwise wouldn't, but how often is that just uhh a lazy scapegoat? "Oh this person has no reason to feel sad, something must be wrong in their brain"
>It's not necessarily caused by anything external. Y
Then how could a drug fix it? We're positing that there is not only a mechanism causing it, but that this mechanism can be manipulated external to their own self/agency/whatever.
I think that it is at least as absurd to posit that you can come up with one chemical substance or another that will alleviate their depression when you dismiss the idea of coming up with a sequence of words spoken to them that might alleviate their depression. It's the conceit that we have a better idea of how their brains work chemically than we do of how their brains work cognitively.
>Then how could a drug fix it?
Many things that are not necessarily caused by anything external can be fixed by drugs. I don't understand your point.
If the problem is brain not working correctly (because some organ is not doing it's job properly) then no sequence of words will make the brain physically fix itself, just like no sequence of words will cure a heart attack.
Of course it depends, and many people just need a correct therapy. I'm not dismissing talking and figuring out the root cause.
If someone is sad for a specific, identifiable and tractable reason, then they are experiencing a categorically different phenomenon to someone who just feels sad all of the time regardless of their life circumstances.
One of the key diagnostic criteria for melancholic depression - what we might lazily and inaccurately call biological or "real" depression - is mood unreactivity. Someone with severe melancholic depression could win the lottery one week, lose all of their family in a plane crash the next, and feel literally nothing about either event.
Some people with atypical depression (or normal sadness that has been mis-diagnosed as depression) can respond rapidly and dramatically to a change in their circumstances. For many others with depression, there is no external why - something has gone fundamentally wrong in the functioning of their brain. Trying to help those people with talk therapy or exercise or companionship would be as futile as using those things to treat hepatitis or gangrene.
> Trying to help those people with talk therapy or exercise or companionship would be as futile as using those things to treat hepatitis or gangrene.
I get what you want to say, but to nitpick the analogy: If the "treatment" for gangrene is amputation, then that's not really "fixing" anything. That's just the scorched earth strategy of destroying the afflicted along with the affliction. Like lobotomies. What do people think of them now?
> Someone with severe melancholic depression could win the lottery one week, lose all of their family in a plane crash the next, and feel literally nothing about either event.
Why SHOULD someone feel a specific feeling about any event? If you're subconsciously aware of the ultimate pointlessness of any event, if you're aware that feelings won't change what happened, you won't. You'd move on and handle the new reality in the means available to you.
I'm not saying that medicine should never be used and there's never a "chemical" cause to sadness (or any "wrong" feeling), just that it may be used too often as a lazy escape for the "helpers".
>Like lobotomies. What do people think of them now?
Lobotomy was in fact an effective treatment (albeit with extremely severe side-effects), but we now have much better and safer treatments available. The abandonment of lobotomy was fundamentally driven by the invention of effective antidepressants, antipsychotics and mood stabilisers. Neurosurgery is still offered to an extremely small proportion of patients suffering from very severe and treatment-resistant depression and OCD.
https://www.cambridge.org/core/journals/bjpsych-advances/art...
Maybe SSRIs work for some, but Paxil gave me serotonin syndrome and Prozac made my mom psychotically homicidal. I've tried every SSRI titrating on and off (except Paxil), but they all caused deal-breaking side-effects.
Sorry to hear it. I believe it's best practice to try different types of drugs (SNRI, atypical/Bupropion, etc).
Homicidal?
Yep. My dad recounted that in 1989, he had to restrain her because she (then age 40) had a psychotic episode described as a "murderous impulse" just after starting a brand new "wonder pill", Prozac. This was quite uncharacteristic for a tiny, docile woman who is often described as "sweet" and "nice" who never had any psychiatric symptoms before or since except a couple of brief times of situational depression. There's a lot of FUD and social ills washing in mass media rather than less biased peer-reviewed research that blames individuals, conflates preexisting conditions with medication side-effects, and clouds the issue of whether SSRIs increase suicide and/or violent psychosis or not.
Check out one of the modern black box warnings of fluoxetine (Prozac) that only addresses a subset of side-effects, suicide in children and young adults: https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?set...
Somehow, I doubt there is much motivation to look for economically inconvenient and unnerving side-effects in some demographics, especially if they're adults who can easily be blamed entirely for all of their own actions because it's "definitely not" due to a (formerly) profitable pill or a pseudoscientific profession that doesn't exactly know how the medications it prescribes work, who would benefit from or be harmed by them, or have any ability to measure the organ or system they're supposed treating.
It is highly likely that your mother was misdiagnosed as suffering from unipolar depression when she was in fact suffering from bipolar disorder. A sudden switch to mania is a common outcome, even in cases where the patient has no previous history of mania. It is crucially important to take a comprehensive history to rule out bipolar disorder, but many general practitioners (and some psychiatrists) reflexively prescribe SSRIs whenever they see a depressive episode, even where there is clear evidence of a personal history of hypomania or a family history of mania.
Thanks for sharing your mom's experience with big pharma's then-new wonder-drug.
> Somehow, I doubt there is much motivation to look for economically inconvenient and unnerving side-effects in some demographics,
Robert Whitaker examined the pharmaceutical industry's ideological capture of conventional psychiatry in his third book, Psychiatry Under the Influence.
https://robertwhitakerbooks.com/psychiatry-under-the-influen...
I've written for the Mad in America Foundation's webzine. My latest piece was titled Theodoric of Arizona: State-Sanctioned Pharma-Based Pseudo-Doctor: https://www.madinamerica.com/2024/07/theodoric-arizona/
This was inspired by the old SNL skit, Theodoric of York, Medieval Barber. The article is structured around my proposal of a Theodoric’s Principle of Medical Advancement, to explain why medical progress is so glacial.
Chemicals like this imho act like "global variables" for the neural network. Perhaps a bit like temperature in an LLM. They have an effect, but the effect is sort of holographic -- there's no way to predict/compute exactly what the effect will be, because it's a function of parameters that include all the training data, specifics of neuron function that depend on DNA and other environmental factors and so on. The effect might be beneficial, by some definition of beneficial, but it might not. Even a simple chemical like ethanol has a wide variety of effects on different people.
Fortunately, there are well documented lifestyle adaptions that can sharply reduce depression.
Religion is a good example. https://pmc.ncbi.nlm.nih.gov/articles/PMC3426191/
Swapping one problem for another. Religion sounds like the worst place for someone who is mentally vulnerable. It's like pulling out your credit card in a shopping mall full of salesmen who are under tremendous pressure to make big sales asap
RFK Jr dancing
This reads to me like over-prescription rather than lack of efficacy but I’m also not a doctor and won’t presume my kneejerk reaction is accurate.
We saw a similar whiplash with Ritalin after over-prescribing in the 90’s/2000’s. ADHD medication absolutely works, but for a lot of people it didn’t for this reason.
Effect size is strongly affected by severity - people who aren't very ill just don't have as much to gain compared to people who are gravely ill. Widening diagnostic criteria and more liberal prescribing will inevitably lead to a reduction in the observed effect size.
Antidepressants were bona-fide miracle drugs when we first started using them on desperately ill inpatients who experienced every moment as exquisite torture. We saw the most miserable lives completely transformed in a matter of weeks. They have become merely "sorta-kinda useful sometimes" now that we're mainly prescribing them to broadly functional people who are feeling a bit sub-par.
SSRIs are a pretty poor fit for the latter cohort, because SSRIs cause significant emotional blunting in the majority of patients, to the extent that some people hypothesise that emotional blunting is the fundamental beneficial effect. Feeling quite numb is an incredible improvement if you are constantly unbearably miserable. If you have a more normal range of emotional experience than relentless misery, it is likely a sideways move at best; if your core complaint is that you feel numb and apathetic, they're probably actively harmful.
SSRIs are very widely used because of their extraordinary safety, but they're often thoughtlessly prescribed by overworked primary care doctors. There are a wide range of antidepressants (and drugs that have antidepressant effects despite not being marketed as such) that are likely a better option for a large proportion of patients.
Even for people with legit ADHD, like myself, medication isn't always a home run. I think something like 10%-20% of people do not respond well to any medications. I personally am only a 'partial responder' in that I only really get an improvement in focus/concentration -- not really anything else. But hell, that is still better than life without medication.
Definitely didn’t mean to imply it’s a home run. I’m just saying it clearly and legitimately helps a ton of people.
My point is if you include more and more people who don’t need it because of over-prescription it’s going to appear as lower overall efficacy while still helping a lot of people in the pool.
Making up numbers: If only 20 out of 100 people actually have ADHD then out the gate you’ve ruled out helping 80% of the people. So if 15 of the remaining 20 see improvement in their daily lives that means 75% suddenly looks like 15%.
Diagnosing and treatment is never that clean, there will always be some people who don’t necessarily need a certain medication yet get it prescribed (or don’t when they need it! Especially women with ADHD) because doctors are fallible like anybody else, systemic issues, etc. But with a commonly prescribed medication like Adderall the problem is definitely more pronounced.
Anyway I’m curious enough to look more closely at the study, this is a very interesting topic. If Xanax is really not helping people that’s pretty serious.
The FDA is such a joke.
Use more words.
FDA, what a joke
Um, that's fewer words.
FDA = Joke
It’s fascinating that otherwise intelligent people have no hesitation pumping their children’s developing brains full of SSRIs and amphetamines at the behest of a professional class who is paid to distribute these medications.
It's even more fascinating when you have first hand experience with how much unmitigated guesswork goes into selecting psychiatric meds and their dosage.
it's somehow even more fascinating when you talk to dozens of people who were medicated as kids and get an idea of the real implications
...or literally watched friends get over-medicated into committing suicide.
I used to share your opinion, and in a way I still do, but after having 3 children and seeing how horrible some of these behaviors and habits can get, I completely understand why people cave in to get some relief. The stress of dealing with severe behavioral issues day after day can easily destroy a marriage and family.