Here are some of my lay thoughts and opinions about antidepressant medication. By "antidepressant medication" I mean serotonin reuptake inhibitors.
Why doctors prescribe antidepressants "like candy". Do you wait until the person becomes dysfunctional at work and loses their job before you prescribe antidepressants? Do you wait for the person to self-medicate with alcohol or other substances before you give them antidepressants? Do you wait for them to attempt suicide before deciding they've "earned" their antidepressants? Back in the days of MAOIs and tricyclic antidepressants, patients had to "earn" their antidepressants because of the side-effect profiles of these medicines. But modern antidepressants have rather mild side-effect profiles. Hence doctors play it safe and prescribe antidepressants earlier, before the depression has taken its toll, rather than later.
Depression tends to get worse over time. Untreated depression causes the hippocampus to shrink. There are neuroplastic changes that occur with long-term untreated depression that make it harder to treat the depression. Hence why doctors like to nip it in the bud and treat it earlier rather than later.
What are the side-effects of antidepressants? The average person can expect diminished libido, sexual dysfunction, and diminished capacity for pleasure (anhedonia). These are both symptoms of depression and side-effects of antidepressant use.
Are antidepressants addictive? True antidepressants (SSRIs etc., not tranquilisers) are not addictive in the sense that there isn't drug-seeking behaviour, people don't get high off antidepressants, antidepressants don't have a street value, etc. However, antidepressants are physically dependence forming in the sense that abrupt withdrawl may lead to physical withdrawl symptoms (notably a very unpleasant feeling of electric shocks in the scalp). In the case of SSRIs these withdrawl symptoms are euphemistically referred to as a "discontinuation syndrome" rather than "withdrawl" so as to avoid a perception of these medicines as being addictive.
Should you use antidepressants, or rather "sit it out"? If antidepressants work for you, does it really matter? Why "wrestle" with the depression when a simple solution is available?
Are people who resort to using anti-depressants "weak"? Are people who take decongestants to treat a runny nose weak? No, they are people who decide to use what medicine has to offer in order to better their lot. This is not a sign of weakness, but rather, a sign of common sense.
Do antidepressants really work? They do really work, but only just. In clinical trials the margin between antidepressants and placebo is generally small (sometimes embarrassingly small). Also, antidepressants do not comprehensively treat depression, but merely relieve some of its symptoms. Most people who use them seem to feel that they do better on them than off them, so in that sense they work, but it's hit-and-miss. Many people will try several anti-depressants before they find one that "works".
Does it matter that they fare only slightly better than placebo? No. The n=1 trial - yourself - is what matters, not a statistic about how they work for the general population.
My old doctor put me on Prozac which seemed to work pretty well but now my new doctor says Cymbalta is so much better and I should rather use Cymbalta. What do you think? If it's not broken, don't fix it, and newer isn't always better.
My doctor put me on Zoloft and then added Wellbutrin to address some of the apathy issues caused by the Zoloft. I think I may better benefit from an Efexor/Wellbutrin combo though. What do you think? Beware the psychopharmacology treadmill. The perfect cocktail does not exist.
Is depression caused by a "chemical imbalance"? If it were really as simple as "depression is caused by having too little serotonin" then we would have a 100 % effective treatment for depression in the form of SSRIs - something which we do not currently have. All that can be said is that disruption of the transmission of various neurotransmitters has an antidepressant effect. That does not mean a depressed person has too little serotonin.
There is an antidepressant medicine in France, called tianeptine, which is a serotonin reuptake accelerator - it does the opposite of what SSRIs do. Explain that.
What is the role of therapy? Studies have shown that patients who combine medication with therapy have a better outcome than patients who use either modality alone. Therapy may seem like an expensive waste of time in the short run. The benefits are best assessed only after a few sessions. Does a single dose of antibiotics cure an infection?
Depressed patients often have a situational stressor (bad work environment, unfulfilling love life, difficult family relationships, financial problems, etc.) that contributes or even causes their depression. Therapy may equip you with coping skills to better handle these problems.
Why doctors prescribe antidepressants "like candy". Do you wait until the person becomes dysfunctional at work and loses their job before you prescribe antidepressants? Do you wait for the person to self-medicate with alcohol or other substances before you give them antidepressants? Do you wait for them to attempt suicide before deciding they've "earned" their antidepressants? Back in the days of MAOIs and tricyclic antidepressants, patients had to "earn" their antidepressants because of the side-effect profiles of these medicines. But modern antidepressants have rather mild side-effect profiles. Hence doctors play it safe and prescribe antidepressants earlier, before the depression has taken its toll, rather than later.
Depression tends to get worse over time. Untreated depression causes the hippocampus to shrink. There are neuroplastic changes that occur with long-term untreated depression that make it harder to treat the depression. Hence why doctors like to nip it in the bud and treat it earlier rather than later.
What are the side-effects of antidepressants? The average person can expect diminished libido, sexual dysfunction, and diminished capacity for pleasure (anhedonia). These are both symptoms of depression and side-effects of antidepressant use.
Are antidepressants addictive? True antidepressants (SSRIs etc., not tranquilisers) are not addictive in the sense that there isn't drug-seeking behaviour, people don't get high off antidepressants, antidepressants don't have a street value, etc. However, antidepressants are physically dependence forming in the sense that abrupt withdrawl may lead to physical withdrawl symptoms (notably a very unpleasant feeling of electric shocks in the scalp). In the case of SSRIs these withdrawl symptoms are euphemistically referred to as a "discontinuation syndrome" rather than "withdrawl" so as to avoid a perception of these medicines as being addictive.
Should you use antidepressants, or rather "sit it out"? If antidepressants work for you, does it really matter? Why "wrestle" with the depression when a simple solution is available?
Are people who resort to using anti-depressants "weak"? Are people who take decongestants to treat a runny nose weak? No, they are people who decide to use what medicine has to offer in order to better their lot. This is not a sign of weakness, but rather, a sign of common sense.
Do antidepressants really work? They do really work, but only just. In clinical trials the margin between antidepressants and placebo is generally small (sometimes embarrassingly small). Also, antidepressants do not comprehensively treat depression, but merely relieve some of its symptoms. Most people who use them seem to feel that they do better on them than off them, so in that sense they work, but it's hit-and-miss. Many people will try several anti-depressants before they find one that "works".
Does it matter that they fare only slightly better than placebo? No. The n=1 trial - yourself - is what matters, not a statistic about how they work for the general population.
My old doctor put me on Prozac which seemed to work pretty well but now my new doctor says Cymbalta is so much better and I should rather use Cymbalta. What do you think? If it's not broken, don't fix it, and newer isn't always better.
My doctor put me on Zoloft and then added Wellbutrin to address some of the apathy issues caused by the Zoloft. I think I may better benefit from an Efexor/Wellbutrin combo though. What do you think? Beware the psychopharmacology treadmill. The perfect cocktail does not exist.
Is depression caused by a "chemical imbalance"? If it were really as simple as "depression is caused by having too little serotonin" then we would have a 100 % effective treatment for depression in the form of SSRIs - something which we do not currently have. All that can be said is that disruption of the transmission of various neurotransmitters has an antidepressant effect. That does not mean a depressed person has too little serotonin.
There is an antidepressant medicine in France, called tianeptine, which is a serotonin reuptake accelerator - it does the opposite of what SSRIs do. Explain that.
What is the role of therapy? Studies have shown that patients who combine medication with therapy have a better outcome than patients who use either modality alone. Therapy may seem like an expensive waste of time in the short run. The benefits are best assessed only after a few sessions. Does a single dose of antibiotics cure an infection?
Depressed patients often have a situational stressor (bad work environment, unfulfilling love life, difficult family relationships, financial problems, etc.) that contributes or even causes their depression. Therapy may equip you with coping skills to better handle these problems.
