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."
A later comment notes that it works well for some patients and not others. The argument is that drugs probably don't fix things very well unless the cause is mostly just bad brain chemistry. Some people have bad brain chemistry, others have "real" (usually more external - financial, relationships, actual life issues) problems they need to fix, and hiding from them by just taking a pill to help ignore them might not work so well.
(OK bad brain chemistry is also a real problem, but one that's fixable with a pill).
Also yes that's all a bit simplified.
There's a stigma against pills for a number of reasons, some good and some bad, the fact that often they don't work being one reason.
There is a case in between: sometimes the issues are too overwhelming and you can’t start fixing them until the pills give you the space you need to address them and get to a position where you can quit the pills.
The study found the average effect was no different from placebo. It’s plausible, based on anecdotes like the one you’re responding to, that Prozac is harmful for some people, helpful for others, with the expected benefit close to zero. If so, it might be necessary to just try it and see if it’s obviously helping, keep taking if so, stop if not.
This is, in fact, pretty much the exact procedure: try one type of treatment or medication, see if it's obviously helping, and if it isn't try a different treatment or medication. It's imprecise but it's the best we have.
The problem is that taking certain psychotropic medications changes your brain chemistry. It’s not as simple as it sounds. It’s not like trying on shoes. The brain is dynamic and drugs alter it, as does life experience, talk therapy, disease, aging, etc…
> 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.
I said "it worked for an adult" because it did. It works. In adults. The article says it doesn't work well in adolescents, not adults. I work in mental health, I assure you fluoxetine works very well, but most drugs are not tested on non-adult populations. So this is a study on a population not normally tested to enhance the dataset we have about fluoxetine. More studies will try to replicate this result, and we'll have even more data about where it works and where it doesn't.
Exactly. And it's a combination usually. It's really hard to do constructive therapy when you are depressed. Stabilise with the meds and then tackle the root causes with therapy.
But some people just are very prone to depression and need the extra help.
You wouldn't say "don't give that kid ibuprofen, let them just deal with the pain"?
And SSRIs are not very strong. They do have some nasty side effects especially sexually but this is not relevant at that age so that makes it even more suitable for kids than adults.
I would be very cautious advising SSRIs for anyone, especially developing children, considering my own experience (on sertralin), which was complete disappearance of a libido, and massive weight gain, +40kg (70 -> 110) in ~10 months. 5 years later I still have not undone the damage from it.
The dichotomy of such mental illness is people with more constitutional resilience just say "power through?" and they are absolutely correct, it is something they can power through.
Mentally ill folk literally cant, not in em. There are right answers to help them, but that's not the right one. It's kind of like telling someone who is color blind to squint real hard, won't ever help.
Myself, I'm someone very much in the power through category. It's the simplest and most straightforward answer surely. But if it were the answer that works in practice we'd have no homeless people, no drug addicts.
There are many mentally ill people who "power through", though. Some call it high-functioning depression.
There are different severities - a small depressive episode, a multi-year dysthymia or mixed (manic + depressive) episode.
I've been managing OK without meds, but maybe simply depression wasn't as severe as that of other folk. It's still a mental illness.
However, the effectiveness of Mindfulness based stress reduction and acceptance & commitment therapy show that those who can distance themselves from their thoughts have developed "mental resilience"
Therapy is effective, but not always. sometimes, especially with children, there is no root cause in life to the depression beyond "genetics". Additional, therapy may simply be useless and unproductive without medication being used concurrently.
There's also simply death. I didn't feel like mentioning it, but I think its worth pointing out that without treatment, death is a very real possibility.
I wish I could have taken something as a kid. I knew when I was 5 that something was wrong. I felt different from other kids (as least as they said they felt) and that continued through my late 20s when I started taking SSRIs. It was the best decision I've made. Ever.
But back to being a kid and thinking and feeling differently: It negatively impacted me. And the abuse only made it worse. If only I was put on drugs and/or sent to talk therapy.
Under-nourishment/malnutrition, traumatic incidents/events, genetics, societal conditions, bullying and abuse, and so many things are also all brain altering. Why do we not consider them so and turn a blind eye to all that?
I'm very sorry to hear your story, and I'm really glad the medication has worked well for you and your family. It's early days, but it seems to be working well for ours too.
I also really admire the way you're dealing patiently with everyone in this thread arguing in bad faith, you have a lot more tolerance than I do! Hopefully it's not getting to you. Best wishes.
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.
It's important to remember that not being a "medicating kids is a terrible idea" person doesn't mean one is a "every medication is a great idea" person. I'm probably like most people where in a perfect world I wouldn't medicate at all, and treat unfamiliar medications with some skepticism. But also I accept that I'm not (and am not interested in being) a medical expert, so if there is a medical need that I can't handle myself I'll take the advice of a clinician who has earned my trust with good reasoning.
> The whole experience made me a lot more humble about opinions I hold without relevant experience.
I wish there were a way to shortcut this process for society so that so many people didn't need to either go through a similar experience personally to have such an epiphany, or worse, never have it at all. (Speaking not only about medication for kids, but other polarizing issues as well.)
Not sure about you but I didn’t learn my native language phrase by phrase only. You learn the individual parts and concepts and construct sentences from that.
He learned it from being on Earth? And noticing that some people who used to be on Earth aren’t anymore? And it dawning on him that he doesn’t have to be either?
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.
The solution for suicidal thoughts is a drug known to induce suicidal thoughts?
You said elsewhere that there were "no known long-term side effects". Aside from that not being universally true for any drug I've ever personally researched, no side effect is more long-term than suicide.
Suicidal ideation at 7 years old is not normal kid behavior, neither is sudden and unprecedented paralyzing anxiety over the prospect of ordinary things like going to a friend's birthday party or trying a new playground.
Me and my mom are on identical doses of Prozac to treat very similar symptoms.
We consulted with a child therapist, a pediatrician, and a psychiatrist.
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.
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."
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.
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 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.
There’s an interesting theory lately [0] that the antidepressant effect of SSRIs is actually unrelated to its effect on serotonin. Suppose, for the sake of argument, that this is completely true: serotonin has nothing to do with depression, increasing serotonin levels is useless for treating depression, and everything everyone has ever claimed about chemical imbalances causing depression is flat-out wrong.
If so, pharma companies should probably try to develop different drugs instead of new SSRIs. But it does not follow that a patient with depression ought not to take an SSRI. That would be like saying that taking aspirin for aches has been completely debunked because there is no connection between aches and aspirin’s anticoagulant effect.
"neurochemistry issue debunked" is a very weak argument about the (in)effectiveness of proper drugs for treatment of mental illness. It's not exactly known how they work but I am 100 percent sure SSRIs often have a very positive, even life changing effect. Moreover, every approved drug is tested 'double blind' exactly because the placebo effect has such a big biasing effect on subjectively appreciated outcomes. Only when ruling out pure placebo effect, a drug can be approved.
> Moreover, every approved drug is tested 'double blind' exactly because the placebo effect has such a big biasing effect on subjectively appreciated outcomes. Only when ruling out pure placebo effect, a drug can be approved.
Pretty weird the article we're commenting on about Prozac being no better than placebo for children is just now coming out when it was already approved for use in children, then.
> 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."
It most certainly has not been debunked and mind altering chemicals most certainly do work.
SSRIs have _questionable_ efficacy but that's not the same as proven to have none, which is an exceptionally high bar.
I've learned a lot through life, one thing I've learned is about detrimental long term physical and even social effects of antidepressants, and other medications like adderal. Both I used to take.
At this point in my life, if I realized my parents gave me an antidepressant prescription when I was SEVEN years old because I said something stupid WHEN I WAS SEVEN I'd be very disturbed and disappointed in them, I'd definitely give both of them a solid scolding.
Before you respond to this remember I'm talking about me. Not your kid or your friends kid or your cousins kid.
EDIT: Quick edit to add when I was a kid I was a total outcast, I was weird, anxious, and definitely often depressed. A lot of kids in my religious schooling systems were.
My kids go to a ordinary public school. They are very bright, cautious, and thoughtful, and generally pretty happy and upbeat. There is a strong correlation between academic intelligence and mental illness. Being depressed to the point of being suicidal and having a sunny disposition are not mutually exclusive at all. I absolutely agree that it would be disturbing and disappointing for a child to be medicated because of something stupid they said when they were seven. I think medication may be appropriate if they show a consistent pattern over several months of physiological symptoms and reactions that are consistent with depression or anxiety, and cannot be explained by external factors like trauma or major life changes.
> My kids go to a ordinary public school. They are very bright, cautious, and thoughtful, and generally pretty happy and upbeat. There is a strong correlation between academic intelligence and mental illness. Being depressed to the point of being suicidal and having a sunny disposition are not mutually exclusive at all.
If my parents said this to me the moment I realized what I was on and that I had to deal with coming off of it late in life I would be beside myself.
I'd probably also look up the doctor that encouraged my parents to put their seven year old on SSRIs so I could warn friends.
If my parents were like "uh well I had virtually no symptoms" I'd lose my mind!
Life sucks, I'm depressed all the time, kids are depressed all the time. There's material everywhere explaining a decline in general mental health. I'm happy and lucky that when my parents (or the one that was paying attention, who was certainly also depressed) noticed I was depressed or sad during a few events, some long lasting, they asked me about it, listened to me, and did their best to give me advice instead of giving up when I was seven and giving me drugs.
Remember when replying, this post has all been about myself, a victim of depression.
I'm a victim of depression too, and don't think it's fair that you say we "gave up." I would never give up on my child. You imply that we didn't talk to our son, listen to him, and do our best to give him advice before we discussed medication? Don't we all try to make the most well-informed decisions we can?
This decision was made collectively by me, my wife, our pediatrician, the child therapist, the psychiatrist, and for what it's worth also my son. We did extensive research. You may disagree with our decision, but please don't cast aspersions on how much we care.
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.
This is empirically false; the rates of chronic physical and mental illnesses nowadays are are far higher than e.g. 50 years ago, and these are serious illnesses, not the kind of thing that could have been just not noticed.
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
Beyond obvious tumors/lesions/clots/abnormalities, we are not even close to being able to identify the cause of organic anxiety or mood disorders even if we wanted to.
We can say certain behaviors, experiences, illnesses and some genetic identifiers can trigger the conditions, but not the underlying cause. We can say things like some therapy and medication can help with the illness, but not the cause.
Not to trivialize therapy, but for many illnesses, not just mental, a portion of it can be described as ways of learning to live with the illness, not necessarily treating the underlying cause.
> Not to trivialize therapy, but for many illnesses, not just mental, a portion of it can be described as ways of learning to live with the illness, not necessarily treating the underlying cause.
Yeah, I feel like it's fair to describe the cognitive behavioral model. We're not necessarily looking for the cause of these thoughts and beliefs, tho they may come up, we're simply going to challenge them at face value and reinterpret the situation.
I had terrible anxiety as a child and what I experienced dramatically affected the core of who I am. It is engrained in me and I struggle with it daily, though after decades I have surpassed a good portion of it. If a small dose can help someone have a somewhat "normal" childhood, then its worth a try.
If you're horrified that we are in a world and society where a 7yo has been put in a position where antidepressants help them, yeah, that's understandable. If you're horrified that a kid is taking them, that the parents sought medical intervention for "just a kid", then, I'd say you're reacting to the concept of a kid on antidepressants than actually listening to the OP and their family's history and story.
Often, people react to the concept of a thing rather than the ground reality of life and its complexities of lived experience. Most people also extrapolate (in either direction) others' lived experiences based on their learnings, understandings, pasts and future ambitions. In this case especially, there's also added stigma around mental health, antidepressants and the locus of personal responsibility when it comes to mental health issues.
The _concept_ of a child on antidepressants suspends trust in parents, that's often assumed and unquestioned depending, depending on the child's age. Maybe close to 18yo? Supportive parents. 7yo? Horrible parents. I'd argue it also tends to suspend critical thinking and introduces an unshakeable bias, that a child of 7yo _never [ever]_ needs antidepressants. Why? What makes you say that? What's your evidence and reasoning?
If you feel so horrified by that, can you consider for a moment that the parents recognize the weight and gravity of this decision too? That they had to really think this through, pursue more thorough medical advice than usual, make a judgement call, and have to live through this decision throughout all their lives?
OP's response to multiple comments indicates that they did not make this decision lightly and without making sure that this was the better thing to do overall. I commend OP's openness and honesty in talking about it. It's certainly inspiring to see a parent care for their child's mental health, and not dismissing that to be "oh, the kid's just young and moody, they'll feel better tomorrow."
PS. We (as a society) are always learning more and newer things about mental health and treatments. It might look like we know a lot. Perhaps. But we also don't know so much!
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. :)
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.
I’m thoroughly impressed with how you handled the comments in this subthread. As someone who was on and off antidepressants for years, I can say confidently that for every one person spewing vitriol and judgement at you for your parenting decision, there was someone else solemnly nodding and sending love to you and your family. People just don’t fucking get it unless they get it. Best of luck to you.
Interestingly my son has an identical twin! I like to joke that one is the control and sleeps in the house and the other has to sleep in the storage shed out back, and when they're 18 we'll publish a paper comparing their emotional development. :)
I always thought DNA determined pretty much everything, and we raised them exactly the same, but they have distinct personalities and some different physical features, although of course they're much more similar than they are different. My other son shows some symptoms of anxiety but not as much, yet.
Sorry, I don't mean to second-guess your choices. There's clearly some very interesting issues here, and my experience is as someone who never felt they had any serious issues with mental health. But I do think that we have this culture where everyone is expected to be OK all the time. Do you worry at all that your son cues in to his parents relationship with the drug? I mean, say it was me, and I knew my parents took a pill so that they could "have a good day" but they didn't give me the have-a-good-day pill. I would think (perhaps subconsciously) that if I was having a bad day the drug could have made it into a good one. Having a bad day would be medical now, a reason to feel like you're sick or broken.
Prozac doesn't define me. It's just something I take to address a health condition, like an iron supplement for low iron levels or amoxicillin for strep throat. My kids learned about it because they saw me taking a pill every day and asked what it was. No biggie.
To be clear, Prozac is not a "feel-good" pill, it's a "gradually feel more stable" pill. It makes my lows less debilitatingly low and more manageable -- my lows are now largely logical responses to difficult events, as opposed to randomly happening for no reason at all. The effect is very gradual and subtle: you can't really evaluate it until after several weeks, and then the "evaluation" is a conversation about whether your affect has seemed generally more stable recently. An average person taking Prozac would probably notice no effect at all, good or bad. By contrast, a stimulant like Adderrall will have a noticeable effect on anyone within minutes.
My son never asked for Prozac or for a "feel-good" pill. My kids have heard of addiction before so we've talked about pills that do make you feel good and why they're dangerous, and also "dopamine drips" like brainrot on YouTube.
IMO, that's a common misconception. The fact that it seems this way can be attributed misunderstanding, bias in data, and perhaps a poor treatment choice. Sometimes, it's also the best healthcare can do for now.
Medical interventions for mental health issues aren't a forever-crutch. Plenty of people do taper off/change something about their prescriptions after a certain point, but we rarely ever hear those stories. What we do hear is plenty of people getting on meds/being on meds for a long time, which can bias us and make us think that most people who get on meds are on it for life.
Such a simple concept, and for some reason so difficult to grasp for certain people. Usually the ones not coming across as particularly empathetic or open-minded.
I suppose the "good" news is that is just how life goes. Conceptually similar comparison to someone who is hungry and someone who isn't - the tendency towards snapishness is definitely there. Who someone is becomes unstable of long stretches of time (unless they are very boring), it results more from the present conditions that involve them than anything else.
The main issue with drugs is they are more likely to have unexpected or socially harmful side effects than most things.
I am surprised by how many people seemingly independently come up with a completely indescriptive "bad day" label - for the lack of a better one.
Good that things are working out for you.
Recently found that, on top of meds (that started wearing off - after taking them for a couple years now following a challenging life situation), going to social latin dance classes for a couple hours almost every day after work helps quite a bit.
> 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
This warrants a whole different discussion, and I'll be down voted for it, but one that's never addressed: quality over quantity.
Pills are the individuals response to a society that feeds empty food, bland sterile shelter, fake friends, and meaningless jobs.
The natural human response to a lack of meaning is hopelessness, and this comes from our society. Pills helps individuals cope with continuing the meat grinder just a little while longer.
I had depression, and I cured it by finding meaning and beauty in the world. I get told "if you can cure it without pills, you never really had it" yeah cool, self fullfilling prophecy in that case innit. Can't cure it, because it doesn't exist without meds. It just comes out of "nowhere" and is here to stay.
I agree with your perspective but these things are on a spectrum. For very severe cases medication can be highly helpful and supportive, as they move to find their meaning and purpose. Each person’s situation is unique and I think blanket judgements are unhelpful.
> I cured it by finding meaning and beauty in the world.
That's incredibly fortunate and I'm very jealous of you. How would you recommend one goes about finding meaning and beauty? I'm fortunate to have had lots of unique experiences and traveled to lots of unique places and still haven't found the fulfillment that you seem to. That's basically what depression is: a debilitating feeling of lack of fulfillment, without any idea of what's missing.
I'm happiest when busy building and fixing things. It could be that if I was born 200 years ago into an agrarian society where day-to-day life was focused on building and fixing things to survive, then I would have felt very fulfilled and done quite well. What were gainful full-time jobs back then have been reduced to hobbies now, though: blacksmithing, cobbling, weaving, hunting, making furniture, etc. Hobbies don't fill the hole for me. Sure, a few artisans are still able to turn those into a living, but a large part of the job is marketing and the clients are largely the wealthy elite. I've enjoyed working in food service and construction but it's hard to support a family of 4 doing those. So my career has been in software engineering since that involves building and fixing and pays well, but it still doesn't fill the hole.
If this sounds whiny I'm painfully aware. What right do I have to complain about feeling unfulfilled when there are real problems in the world? And that's the very essence of major depression.
For what it's worth, I have dealt with pretty severe depression for most of my adult life. I am only starting to have periods of coming out when I realized that most of depressed feelings come from a place of ego. I have an identity of who I am and what I like, and I seek things in the external world which might provide meaning for me. For me, it's because I always sought value from the things around me, rather than believing that I am already enough. Every single day, I have to beat down my instincts that tell me that I am worthless and remind myself that there is more beauty in the world and it's actually absurd that I am letting society tear away from me my natural instincts to want to live and enjoy life. You have to really sit with these feelings though... like really really get to know your voice vs the internalized societal voice. I have developed "tests" that help me discern which voice is which, but it has helped a bit. Also working out and taking care of your body is a bonus, and just taking pride in like... doing things to lead a peaceful life is underrated.
Hope you feel better.
I hope you can understand that this and other comments about needing to find meaning and needing to sit with inner feelings... It feels patronizing. I have spent tremendous amounts of time and energy analyzing my feelings and looking for meaningful experiences. I've sought relief in meditation, religion, therapy, yoga, travel, art, etc. Most people probably have in one way or another. It's not rocket science to know those activities may be beneficial. They undoubtedly do help some people overcome feeling depressed. But feeling depressed is different from having depression.
> So my career has been in software engineering since that involves building and fixing and pays well, but it still doesn't fill the hole.
A brief thought on this - I’ve found working in large software companies to be fairly unfulfilling, but working at smaller shops focused on delivering something other than software, or for which there’s some tangible connection to the real world, to be much more fulfilling. At its best, software engineering is indeed a craft and something you can take pride in and something where you can have a real impact on people’s lives by building things. A lot of that gets lost somewhere between the third roadmap meeting and the weekly scrum session to figure out how to prioritize product’s requests alongside paying down tech debt so we can improve ad unit performance, but the craft of software itself is still a creative act.
That's exactly the problem, "meaning in life" has no static definition and there is no possible way to explain it in general terms, even for people who proclaim to have "found" it.
Pills, on the other hand, are easy to understand. This is not to say that they are a viable substitute in any way, but it does explain why so many prefer substance treatments.
Meaning in life is hard and personal. Some might have no idea where to start.
But I'd argue (somewhat pointlessly as I'm not going to change anything) -- This is the role that society, traditions, family, etc. has: "to bring people up" swimming in the same stream, given a purpose and meaning, etc.
> I'm fortunate to have had lots of unique experiences and traveled to lots of unique places
For comparison I've barely traveled more than 1000kms. Never had a passport. Travel is not related.
> where day-to-day life was focused on building and fixing things to survive, then I would have felt very fulfilled and done quite well.
Incorrect assumption; It's not the building and busy-ness. And the experience doing hobbies supports that. Nothing fills that "hole".
The feeling, the "hole" you're missing, is a combi-mix of purpose/meaning/larger-picture. I know it because I also had it. Many people try politics to fill their hole too, which also doesn't work: political parties are not big enough.
I'm not going to try to persuade you to change your life, I'm going to talk about what did it for me, and you (and others) can spectate and speculate, take and leave whatever you want. I'm sure I'll get flagged anyway.
My great realization is that nothing is set in stone, everything changes at all times, and humans have survived it.
> a debilitating feeling of lack of fulfillment, without any idea of what's missing.
A good way to start out is to start thinking about: what is your mission? What is your tribe in the world stage? are there messages or lessons from the ancestors of your tribe?
Shy away from getting over-scientific. Simple broad points. The universe is in constant change and chaos. But humans have survived for a long time. We have "lizard" brains that give us reactions, then we have learned / ingrained behavior on top of that, through all this time we've encoded "how to survive" in our brains and throughout our history; we are a storytelling species, so what stories do we have from history (note: not about history, but from history).
Realising stories, like fairytales,(ie: Rumpelstiltskin) etc - ARE old stories that ENCODE information as a way to pass knowledge from culture to culture. WHAT information is in there? what are they trying to tell us? This is the tribe of "humans" telling us something from the past, which is actually absurdly interesting and fulfilling to try and learn from.
Yes this is all "woo-woo" stuff, none of this is going to be a revelation to you. I'll probably look like a quack, but You can have a ponder about it, and realise that there's a big group that you're a part of, and there is a bit of a cosmic mission, and history plays out every day.
this won't give you purpose or fill the hole, but I think you might start to chip away at some different things in your life,
(or you won't and I've just wasted 5 mins of your time, ¯\_(ツ)_/¯ who cares)
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.
Out of curiosity - do you know whether SAM-e can be taken safely with SSRIs? I went looking for this a bit back and didn’t find anything conclusive. I know there’s a handful of seratonergics to steer clear of, but I didn’t get a good answer about SAM-e.
What do they do when they turn 15, realize they, say, have no sex drive, but have been on anti depressants for years and cannot take a break from life in order to now learn the emotional regulation skills they should have developed from 7-15? Antidepressants often mask issues which later manifest in unexpected ways, even if you don’t notice any immediate side effects.
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.
I suspect the biggest, but not the only, problem with these supposedly weak SSRI/SNRI numbers we routinely see in clinical trials has to do with the definition of depression, with the diagnosis itself. For example it has some of the worst inter-rater reliability across the entire DSM (meaning that two doctors are least likely to both reach the same diagnosis in the same patient independently). So if you start from a poorly defined set, which likely encompasses some genuine affective disorders, people going through difficult times, undiagnosed personality disorders, dysthymic ADHDers, burned out ASDs, and God knows who else - yeah, you'll get poor performance data. Every psychiatrist knows intuitively that SSRIs/SNRIs do work, even if you have to trial a few. Also, without arguing about the number, that 15% is not exactly the same 15% for each drug.
Also, since we're here: the secret knowledge about depression (and affective disorders in general) is that it is an episodic illness, where episodes are measured in weeks or in months. Most people experience just one episode which will end whether or not any medical intervention is undertaken, although the intervention can greatly shorten the course and avoid a potential suicide. But some will not stop at one episode, and can go on to have multiple episodes, perhaps develop melancholic features or even suffer from a lifelong recurrence. It is in the latter groups where medication is the most effective.
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.
This theory is a science-free zone. It seems far more likely that the drug induced sudden, overwhelming suicidal thoughts than someone said "I feel the best I've ever felt and life is looking up. I think I'll kill myself and make all the good feelings go away".
Furthermore, if the latter were true, it would be an indication that depression was a symptom rather than a cause and the psychiatrist misdiagnosed and improperly treated the patient.
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.
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.
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.
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.
Part of the diagnosis procedure for major depressive disorder is ruling out physical conditions that can cause similar symptoms. No one is going to miss that the guy had his leg blown off.
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.
This is true overall, but it only works for a limited set of patients. It's pretty likely that what we're calling depression is a different set of diseases that manifest with common symptoms, and SSRIs + therapy work wonders for some variants, but not others.
In fact, we actually do know this to be the case already: bipolar disorder also manifests with the same symptoms as depression for some time, and SSRIs + therapy are definitely not enough to treat bipolar disorder. Most likely there are other similar diseases that present with depressive symptoms that we have yet to identify distinctly and don't know how to treat effectively.
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.
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).
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.
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.
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.*
The disclosure section in the cited research article may indicate a financial interest in the authors being able to say that Prozac is not effective:
“ MAH and JM are co-applicants on the RELEASE and RELEASE + trials in Australia, funded by the Medical Research Future Fund (MRFF) and the National Health and Medical Research Council (NHMRC), evaluating hyperbolic tapering of antidepressants against care as usual. MAH reports being a co-founder of and consultant to Outro Health, a digital clinic which provides support for patients in the US to help stop no longer needed antidepressant treatment using gradual, hyperbolic tapering; and receives royalties for the Maudsley Deprescribing Guidelines. JM receives royalties for books about psychiatric drugs, and was a co-applicant on the REDUCE trial, funded by the National Institute of Health Research, evaluating digital support for patients stopping long-term antidepressant treatment. MP and RL have no conflicts of interest to declare.”
I would caution those in this thread who have never seen or treated patients in any psychiatric clinic or hospital let alone a pediatric one to be careful assuming that they have adequate experience to make sweeping judgements on the utility of antidepressants in children.
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).
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.
I'm the GP of this comment chain. I actually did a 16 week long trial of CBT with a professional where my symptoms were tracked during each week. I actually ended the 16 weeks worse than before I started.
I later learned that CBT can have that effect on people with ADHD, so I attribute that to being a possible explanation.
I still do therapy, but honestly, I think it's a waste of time and money. I predominantly do it for cathartic purposes and so other people/professionals will stop recommending it.
> terrible the withdrawal symptoms are when stopping
I tried one when I was in my early 20s too. I swore I would never take one again. Withdrawals weren't my issue really. It was the clarity I gained after getting off. I realized how awful I was to people around me. I had such blunted emotions, that I basically became devoid of empathy. I also learned that I needed high levels of anxiety to function, which the medication took away from me.
I think I had a somewhat similar experience: before antidepressants, I was
practically non-verbal; later, I had the typical brain fog/emotional blunting --
still unable to communicate with the therapist; after adjusting to meds, by the
time that I can put the problem into a coherent sentence, I can usually fix it
anyway, so what is the therapist for? Is it really just rubber duck debugging,
where the duck has a medical degree?
One thing I wasn't able to figure out was ADHD -- I didn't really believe I had
it, as my psychiatrist was sure it's not the problem -- everything was explained
with depression/anxiety/geniune lack of motivation. Now that I finally have a
prescription for stims, seems like it was the other way around: most of the time
I would have a feedback loop where my typical fuckups would trigger a downward
spiral, and it's almost not a thing anymore; being able to get shit done is just
generally such a pleasant experience!
TLDR My depression also wasn't a "true depression" in a sense, but you still
need to fix some underlying issue, which is much easier when your thoughts are
not all "I'm a failure" shaped
for me, medication was closer to therapy than what I imagined (magic chemical that makes depression disappear) -- a drug changing my thought process (long term and on a deep level, unlike recreational drugs) helped me see myself as something malleable, instead of the idea of somewhat rigid "true self" I had before; from there it was much easier to start doing the DIY equivalent of CBT, as I stopped considering some of the feelings/ideas to be somehow inherent to my personality
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.
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.
> medical professionals who didn't really listen to symptoms
Even if they did listen to me, what else can they do? They aren't going to apply to new jobs for me, find friends and hobbies for me, etc.. To the men with pills, every issue looks like a disorder.
Maybe that's just me, but flooding my brain with chemicals is a big step and I need doctors to really pay attention and not just use trial and error on me. That's what i meant/
> 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.
My mistake. I should have worded what I wrote differently. I meant to say "not some true disorder for me."
> Having an objectively crappy life is normal. Being depressed about it isn't.
Not sure I can agree on this though. Rates of depression are quite high in institutions like prisons, for example. Especially in solitary confinement. Of course, I am not in prison, but I do believe the environment plays a larger role in depression than many are willing to admit.
This is not my first rodeo with depression. I'm in my early 30s, and this is probably my 5th or 6th time. I won't go into the details of those periods, but I almost didn't make it through a few of them.
> Ah, this is just due to problem X
Why is this outside the realm of possibility though? I believe depression is just a catch-all term for negative states that are too abstract to treat. If one is in a bad environment or unsatisfied in life, then a doctor cannot really do much to treat that. However, pills can be given to make people numb enough to their circumstances that they no longer care. Though, perhaps that lack of care is enough that people can actually benefit?
I mean, with SSRIs, the lows of life are diminished as are the highs of life, one might gain significant weight, and have a host of other issues like low libido, erectile dysfunction, anorgimasa, etc., but at least they aren't depressed...
If anything, I think of antidepressants like opioids. Opioids do not treat pain -- the pain is still there -- one just can't feel it.
> "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!
>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.
These two words are semantically the same in your context. Unhappy = depressed. Unless you can define something measurable, and if you did in the comment above I can't find it.
I suspect there is something measurable, but I don't see very much attempt at discerning what that is. And without it, this conversation is pointless.
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.
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.
Well, all the n number of times I have been depressed in the past have been resolved by a change in life circumstances, so perhaps I am just an outlier?
> SSRI prescription
I'm supposed to take an NDRI (Bupropion) and not an SSRI, which is kind of like Ritalin or cocaine. The problem is that I already take amphetamines every single day, so I am not sure why this is really the one my doctors settled on.
In fact, they told me that if my blood pressure increases anymore that I am to stop the medication immediately and then contact them. So, that's not really inspiring a lot of motivation in me.
> 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.
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.
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.
And several of your comments before that were upvoted. Are we to regard those as suspicious?
Of the recent downvoted comments, one was a complaint about moderation that anyone who has paid attention to dang's track record here over more than a decade knows is baseless. (And if you think the top comment on any thread is a bad one, you can always choose to be a helpful contributor to the community and email us to let us know).
Of the other two of your downvoted comments, none were downvoted by the same users.
The choice is yours to make an effort to observe the guidelines and be a positive contributor to HN, or alternatively to keep using HN for political/ideological battle and complain to the moderators when things don't go your way, but it's clear what others in the community want to see.
> or alternatively to keep using HN for political/ideological battle
Which ones? The one about ML and programming languages? Or the one about asking a genuine question about an experience with childhood depression? Or the one observing that you and dang unevenly apply moderation rules? Or the one commenting about how you can't say the word for the literal definition of fascism on this site without getting downvoted? Or the one about dishwashers?
Where's my ideological battle?
You have no credibility. You unlike dang, don't do a good job. Go ahead and ban me or put me on a cool down to prove my point.
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.
> 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?
> > 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!
The SSRI's have always been terrible drugs. Apparently the trials before their approval found increased suicidality. Another response to this thread shared how his/her mother was given a "murderous impulse" with Prozac in 1989 [0].
Because this class of drugs was so heavily promoted for such a long time, the side effects have always been swept under the rug.
My comment above proposed that the 11yo girl's depression could actually be caused by precocious puberty. Another possibility is that she's a poor methylator (#MTHFR) who's poisoned by fortified flour and other sources of shelf-stable provitamins.
I haven't yet found a comprehensive SSRI-truth resource that makes SSRI advocates pause their advocacy, so I just shared the chatbot link. This was supposed to provide the father enough of the background terms and anti-SSRI thinking for him to search for his own resources.
Someone else posted a link to "The serotonin theory of depression: a systematic umbrella review of the evidence" [2022] at Nature [1]. This is okay, but it still dances around the core issue: whether ECT and Serotonin-enhancers sometimes benefit people because of how the brain responds to brain damage.
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
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.
I don’t want to discount your experience, but attributing a lifetime of symptoms to 5 doses of SSRIs (when you were already exhibiting an unstable mental state) seems extreme.
We know SSRI's really do cause permanent sexual dysfunctional in a small minority of people, small enough that this side effect doesn't come up in traditional FDA tests.
If a side effect is extremely rare it would be impossible or at least impractical to prove in a population.
Grandparent could be right or wrong about how the drug affected them, maybe their brain suffered from other issues and the timing of the medications was purelycoincidental, but if they are correct, your dismissive response is exactly what we'd expect given when they are saying sounds unusual/ improbable.
> If a side effect is extremely rare it would be impossible or at least impractical to prove in a population.
This is also true for a non-existent side effect. I’m not trying to tell GP he is wrong, just that from a reader’s perspective, extraordinary claims require extraordinary evidence.
This isn't a good fit for the phrase "extraordinary claims require extraordinary evidence."
Grandparent's report is hard to verify, not extraordinary.
These drugs are approved based on statistical safety profiles in limited trial populations, not on a scientific consensus that absolutely nobody on Earth will ever experience a unique adverse reaction.
Also, I never said that you, the reader, had an obligation to change your worldview based on Grandparent's report.
I really hope you do or you will talk to someone about yourself again. You deserve it. For example to a counselor/therapist who doesn't even prescribe medication, if you are not interested in that. Off the top of my head these symptoms could match at least a few diagnoses, most of which are treatable, but it's by far not enough information in this post.
How long were you on Prozac? The way you describe your experience it makes it sound like you were affected long term. Are you still on it or any other SSRI? Hope you eventually rediscover/redevelop your emotional functionality.
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.
It’s always frustrating to see the implication that people just need to exercise to solve their mental health struggles. It might not be your intention, but it's a take I see a lot online from influencers.
I say this as someone who is extremely fit. I've worked out religiously since high school. While exercise is integral to me feeling somewhat normal and provides a short-term boost, that is just not how it works for everyone. Some of us have 'broken brains' that cardio can't fix.
Exercise manages my baseline, but sertraline is what helped me finally bridge the gap. It allowed me to regulate my emotions and anxiety in a way that no amount of exercise ever did. And the introspection from being on it helped me make lifelong changes.
To be honest, fearmongering from folks online is what stopped me from taking it sooner, but I wish I had. It was fairly life-changing.
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.
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.
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?
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.
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.
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.
It is extremely hit and miss. My understanding is that for those with "shit life syndrome", prozac is generally ineffective, but for those with genetic predispositions it can be extremely helpful. the catch is that the two are not exclusive, and those with genetic predispositions to depression may never have it, and people with bad life circumstances may feel more stable mentally with prozac and better equipped to tackle life's challenges.
I have overseen over 20 phase III clinical trials. Many of those clinical trials have failed to show statistical efficacy. In every single one of those trials there are patients who see dramatic and undeniable benefits. In the oncology field, we continue to treat such patients even when the statistics say, no benefit. And, sometimes those patients just stay better. My point is, when the trial shows "no better than placebo", it doesn't mean the treatment doesn't work. It might be that. But more likely it means we don't know how to define the population of folks for whom the treatment does work. Maybe it's a particular genetic background, maybe it's age, gender, serum CPR or Tau level. Maybe it's something else. This stuff is complicated and interesting. And we are still figuring it out.
I don't know if I'd call it "placebo" for me; prozac gave me the worst, most horrible pit of sadness I've ever had in my entire life. I couldn't stop feeling guilty over every single bad thing I have ever done, and it completely killed my appetite and that probably didn't do great for my mood either. I was only on it for about two months until I begged my doc to get me off of it. She told me that it's one of those things that doesn't affect everyone, but since I was already taking Wellbutrin it can have negative effects.
Never again. I'm taking Pristiq now and that has been considerably better.
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.
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.
Yup. There's too much institutional inertia to adopt evidence-based approaches.
I've tried 19 antidepressants over about 15 years. Stuck with mirtazapene-induced obesity that doesn't qualify for GLP-1 coverage, so I can either be fat, broke, or crushingly catatonic.
> I've tried 19 antidepressants over about 15 years. Stuck with mirtazapene [...]
Have you tried any anti-serotonin interventions? (chatbot in comment link below)
Mirtazapene is a "tetracyclic antidepressant". I think the development of antidepressants went MAOI -> Tricyclic -> tetracyclic -> SSRI. My chatbot transcript said the SSRI's are marginal drugs, but "SSRIs are much safer in overdose" than the earlier drugs.
My understanding is that the MAOIs were reasonably-effective at bringing people out of an acute depression, but they interacted with high-tyramine foods (fine cheese, etc) to cause high blood pressure. Reversible MAOIs are less problematic than the non-reversible ones. Methylene Blue [MB] is the most ubiquitous of the reversible MAOIs. I felt a definite warming effect with my first MB microdose (a fraction of a milligram), but I've never noticed anything from larger doses.
The mass prescribing of SSRIs is going to be seen like leaches (well worse since leaches actually do help in some cases). The rock bottom levels of replication of results in physchiatry and these SSRIs, the whole area should be treated much more like snake oil than it is.
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
I hear this story over and over again and it makes me sad. Medication for depression, anxiety, or adhd should be used to enable the work with a therapist, not to make life bearable without working on the underlying problems. Been there, done that. Wasted a couple of otherwise good years on not doing the work.
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
For whose mental health? My point is that religion brings its own shared of issues. And by religion here I mean organised religion. Religions that don't involve rituals or gatherings with other people in hierarchical settings are different (but I assume most people are after rituals and gatherings with other people in well defined settings imo rather than the actual metaphysical beliefs).
- That wave of christianism, ironically called christian science, was the cause of mental distress and deaths of tons of children due to the parents religious views. Religious based neglect is a common form of religious based abuse too.
The first 3 links you’ve provided discuss mental health as it relates to geography, not religion. To be sure, religion is associated with those geographic areas, but so are numerous other factors like race, income, etc etc.
The next links are closer to target, they talk about religious objections to medical treatments and the adverse affects upon kids. Nobody should deny this is a real problem, but fortunately it is a very small problem. ( One of the studies found only 172 fatalities over 20 years, and even estimated 10% of the kids may have died anyway.). So I’ll grant that is a real problem, but not one that affects many people. With luck, perhaps it will get better over time.
The next study is interesting, but again very limited. It has 6k subjects, but these are only with religious mothers and only in the UK. This study cites prior study that concluded “ an individual's religiosity is consistently, positively related to their own mental health in US samples”.
The next study associated suicidal tendencies with a very narrow aspect of religion, and even then self reported:
“We recruited a relatively small sample that was geographically, racially, and socioeconomically homogenous. We also relied solely on self-report data.”
The next study does not seem to help your argument. It deals with religious beliefs in cancer patients and says “Higher levels of religiosity and spirituality are associated with reduced risk of suicidality and suicidal behaviors [29–31], including in advanced cancer patients “
The final link is just a case study about a single suicidal pastor. It concludes with a paragraph that says “Although there are studies showing that religious people are less prone to suicide…”
So I can’t say all that changes the findings of the many studies that conclude religion is good for mental health.
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.
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.
"Seasonal Affective Order, or SAD ... has been linked to vitamin D, otherwise known as the sunshine vitamin, because the skin absorbs it through exposure to sunlight."
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.
Its not just children, its adults too. Because of the FOIA we have seen the studies these drug companies made disappear and this applies to probably every single antidepressants. Keep in mind the placebo effect happens in about 30% of people which are the people that think it works and then eventually stops working.
As someone with MDD, reading these comments is depressing. It's full of people who don't even know what MDD is exists and that people should stop being sad.
Hacker News really does attract a specific type of person...
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.
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.
Maybe because "Fixing society" (putting aside questions of what that even means...) is going to take a long, long time and a lot of effort. Which isn't to say we shouldn't continue to fix it (hint: we do!) but it doesn't mean we should just ignore other ways of helping our kids.
> we will impose experimental drugs on kids
What a terribly disengeuous way of putting it! "Imposing" implies there's not a choice. And all drugs are experimental in that we are constantly learning about the effects they have on us and adjusting our knowledge accordingly.
Nobody's saying it's "morally wrong" not to give your kids antidepressants - but nor is it morally wrong to give them to them.
What tends to be "morally wrong" is when parents are like "I'm not giving my kids those pills! There's no such thing as depression! Just go play outside some more!" - in other words, dismissing your children's feelings
I can agree, but I often think those commentors would probably be dismissing the parents diagnosis of the child expressing themselves, rather than dismissing the child.
Children are experiencing everything growing at once. They have preferences, they have new experience, everything is very close to "the first time this has ever happened" and so, can be a very big deal for them, at the time.
¯\_(ツ)_/¯ internet arguments about parenting, experiences, assholes, having one, putting it in others faces, etc. The internet is just talking to a bunch of people who have different ideas. I wouldn't take it too seriously, over half of it is bots or socially inept people anyway
> Depression is literally a lack of meaning and beauty.
actually, "depression" or major depressive disorder is literally a mental illness, which has a genetic link. it is not a "lack of meaning or beauty" -- to suggest every depressed person who killed themselves had no "meaning" for life is deeply disrespectful to every parent, child, sibling, partner that killed themselves.
Fluoxetine has received FDA approval to treat major depressive disorder (8 and older), obsessive-compulsive disorder (7 and older), panic disorder (with or without agoraphobia), [and] bulimia nervosa...
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.
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.
I agree. I like the position of Dr. Josef Witt-Doerring, board-certified psychiatrist, who maintains that psych drugs are appropriate in certain circumstances. He says that if they were used only when appropriate (i.e., not as a response to an adverse life event and only after a trial of interventions like counseling, exercise, keto diet, gluten-free diet and evaluation for physiological disorders) they'd be used at about 5% of the rate that they used now.
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.
It's even more fascinating when you have first hand experience with how much unmitigated guesswork goes into selecting psychiatric meds and their dosage.
Fluoxetine is one of two medicines listed in WHO Model List of Essential Medicines for the treatment of depression since 2007 (use of other SSRIs are also allowed)[1]. The listing means it has proven to be safe and effective enough that WHO believes it should be readily available in every healthcare system. You will need much more than a Wikipedia article listing side effects for the entire drug class, without incidence rate, to convince people these drugs aren't what they seem.
Also relevant to this article, WHO since 2023 does not recommend Fluoxetine (or any antidepressants) for children younger than 12 years[2].
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).
SSRIs are definitely not commonly recommended or normally used for treating bipolar disorder - especially not for people who are showing signs of a manic episode.
Unfortunately, this is one of the major limitations of our diagnosing abilities with mental illness: when someone presents with severe depressive symptoms and no other known history of mental illness, we have no real way of telling whether it should be classed as Major Depression, or whether it may be Bipolar disorder.
So, sadly, yours is a common story where people with bipolar disorder that initially manifests with a depressive episode get treated with SSRIs that then push them into their first manic episode. I've had a good friend go through something very similar (though, thankfully, less severe in terms of intensity of the manic episode).
If you were given SSRIs to handle the start of your manic episode, that to me seems like a gross mistake by your physician.
> 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).
Could you speak more to this? A family member was recently diagnosed with myoclonic jerks without a clear root cause, so treatment has been hit or miss so far. I’m trying to learn what I can to help inform them.
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.
SSRIs are very bad, but antipsychotics are worse. There are many other reasons, but a demonstrative one is that there is a cumulative annual risk as high as 7% of developing a permanent movement disorder when on them.
It was really hard for my ex to have to choose between anti-psychs and the potential side effects, or exceedingly strong paranoia with incredibly lucid hallucinations - I did not envy her position
I think the reality is likely more nuanced than 'all good' or 'all bad.' While the side effects you linked are real risks that should be taken seriously, claiming these drugs are 'by no means safe,' cause 'mostly permanent' damage, or lack evidence is a pretty extreme generalization that doesn't align with the experience of millions of patients.
Speaking for myself, I took sertraline for years and it did wonders for my mental health. It didn't ruin my life or numb me, it gave me the ability to regulate my emotions when I previously struggled immensely with anger and crippling anxiety.
It’s possible for these drugs to be handed out too easily in some contexts and simultaneously be life-saving, effective treatments for those who genuinely need them. Suggesting they violate 'do no harm' ignores the massive harm caused by leaving severe mental health struggles untreated.
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.
>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.
> 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"
> Well, of course, if you anesthetize someone they can't feel anything.
Not what the post you replied to was talking about.
> 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"
That's basically the definition of clinical depression. Doctors try quite hard to make sure it's not a scapegoat.
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.
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."
(OK bad brain chemistry is also a real problem, but one that's fixable with a pill).
Also yes that's all a bit simplified.
There's a stigma against pills for a number of reasons, some good and some bad, the fact that often they don't work being one reason.
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.
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.
But some people just are very prone to depression and need the extra help.
You wouldn't say "don't give that kid ibuprofen, let them just deal with the pain"?
And SSRIs are not very strong. They do have some nasty side effects especially sexually but this is not relevant at that age so that makes it even more suitable for kids than adults.
Of course you would say that after the Nth time. You are supposed to find out what causes the pain, not mask it.
Mentally ill folk literally cant, not in em. There are right answers to help them, but that's not the right one. It's kind of like telling someone who is color blind to squint real hard, won't ever help.
Myself, I'm someone very much in the power through category. It's the simplest and most straightforward answer surely. But if it were the answer that works in practice we'd have no homeless people, no drug addicts.
There are different severities - a small depressive episode, a multi-year dysthymia or mixed (manic + depressive) episode.
I've been managing OK without meds, but maybe simply depression wasn't as severe as that of other folk. It's still a mental illness.
However, the effectiveness of Mindfulness based stress reduction and acceptance & commitment therapy show that those who can distance themselves from their thoughts have developed "mental resilience"
There's also simply death. I didn't feel like mentioning it, but I think its worth pointing out that without treatment, death is a very real possibility.
But back to being a kid and thinking and feeling differently: It negatively impacted me. And the abuse only made it worse. If only I was put on drugs and/or sent to talk therapy.
I also really admire the way you're dealing patiently with everyone in this thread arguing in bad faith, you have a lot more tolerance than I do! Hopefully it's not getting to you. Best wishes.
This is horrifying.
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.
It sounds like you made a wise decision given your personal and family history and your son is benefiting. Kudos.
I wish there were a way to shortcut this process for society so that so many people didn't need to either go through a similar experience personally to have such an epiphany, or worse, never have it at all. (Speaking not only about medication for kids, but other polarizing issues as well.)
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.
You said elsewhere that there were "no known long-term side effects". Aside from that not being universally true for any drug I've ever personally researched, no side effect is more long-term than suicide.
Me and my mom are on identical doses of Prozac to treat very similar symptoms.
We consulted with a child therapist, a pediatrician, and a psychiatrist.
Have some empathy.
There’s an interesting theory lately [0] that the antidepressant effect of SSRIs is actually unrelated to its effect on serotonin. Suppose, for the sake of argument, that this is completely true: serotonin has nothing to do with depression, increasing serotonin levels is useless for treating depression, and everything everyone has ever claimed about chemical imbalances causing depression is flat-out wrong.
If so, pharma companies should probably try to develop different drugs instead of new SSRIs. But it does not follow that a patient with depression ought not to take an SSRI. That would be like saying that taking aspirin for aches has been completely debunked because there is no connection between aches and aspirin’s anticoagulant effect.
[0] See, for example, https://www.science.org/content/blog-post/trkb-bdnf-and-depr...
Pretty weird the article we're commenting on about Prozac being no better than placebo for children is just now coming out when it was already approved for use in children, then.
It most certainly has not been debunked and mind altering chemicals most certainly do work.
SSRIs have _questionable_ efficacy but that's not the same as proven to have none, which is an exceptionally high bar.
This is close minded dogma no better a religion.
I agree with this.
I've learned a lot through life, one thing I've learned is about detrimental long term physical and even social effects of antidepressants, and other medications like adderal. Both I used to take.
At this point in my life, if I realized my parents gave me an antidepressant prescription when I was SEVEN years old because I said something stupid WHEN I WAS SEVEN I'd be very disturbed and disappointed in them, I'd definitely give both of them a solid scolding.
Before you respond to this remember I'm talking about me. Not your kid or your friends kid or your cousins kid.
EDIT: Quick edit to add when I was a kid I was a total outcast, I was weird, anxious, and definitely often depressed. A lot of kids in my religious schooling systems were.
If my parents said this to me the moment I realized what I was on and that I had to deal with coming off of it late in life I would be beside myself.
I'd probably also look up the doctor that encouraged my parents to put their seven year old on SSRIs so I could warn friends.
These huge lists of side effects are haunting: https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_i... https://en.wikipedia.org/wiki/Fluoxetine
If my parents were like "uh well I had virtually no symptoms" I'd lose my mind!
Life sucks, I'm depressed all the time, kids are depressed all the time. There's material everywhere explaining a decline in general mental health. I'm happy and lucky that when my parents (or the one that was paying attention, who was certainly also depressed) noticed I was depressed or sad during a few events, some long lasting, they asked me about it, listened to me, and did their best to give me advice instead of giving up when I was seven and giving me drugs.
Remember when replying, this post has all been about myself, a victim of depression.
This decision was made collectively by me, my wife, our pediatrician, the child therapist, the psychiatrist, and for what it's worth also my son. We did extensive research. You may disagree with our decision, but please don't cast aspersions on how much we care.
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.
I trust a cohort of scientists significantly more than anonymous strangers online, and you should too.
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.
Do you think that there is a way to treat the underlying cause and not the symptoms?
We can say certain behaviors, experiences, illnesses and some genetic identifiers can trigger the conditions, but not the underlying cause. We can say things like some therapy and medication can help with the illness, but not the cause.
Not to trivialize therapy, but for many illnesses, not just mental, a portion of it can be described as ways of learning to live with the illness, not necessarily treating the underlying cause.
Yeah, I feel like it's fair to describe the cognitive behavioral model. We're not necessarily looking for the cause of these thoughts and beliefs, tho they may come up, we're simply going to challenge them at face value and reinterpret the situation.
Often, people react to the concept of a thing rather than the ground reality of life and its complexities of lived experience. Most people also extrapolate (in either direction) others' lived experiences based on their learnings, understandings, pasts and future ambitions. In this case especially, there's also added stigma around mental health, antidepressants and the locus of personal responsibility when it comes to mental health issues.
The _concept_ of a child on antidepressants suspends trust in parents, that's often assumed and unquestioned depending, depending on the child's age. Maybe close to 18yo? Supportive parents. 7yo? Horrible parents. I'd argue it also tends to suspend critical thinking and introduces an unshakeable bias, that a child of 7yo _never [ever]_ needs antidepressants. Why? What makes you say that? What's your evidence and reasoning?
If you feel so horrified by that, can you consider for a moment that the parents recognize the weight and gravity of this decision too? That they had to really think this through, pursue more thorough medical advice than usual, make a judgement call, and have to live through this decision throughout all their lives?
OP's response to multiple comments indicates that they did not make this decision lightly and without making sure that this was the better thing to do overall. I commend OP's openness and honesty in talking about it. It's certainly inspiring to see a parent care for their child's mental health, and not dismissing that to be "oh, the kid's just young and moody, they'll feel better tomorrow."
PS. We (as a society) are always learning more and newer things about mental health and treatments. It might look like we know a lot. Perhaps. But we also don't know so much!
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...
I always thought DNA determined pretty much everything, and we raised them exactly the same, but they have distinct personalities and some different physical features, although of course they're much more similar than they are different. My other son shows some symptoms of anxiety but not as much, yet.
Glad to see you have your priorities straight! :p
https://www.girlgeniusonline.com/comic.php?date=20090706
To be clear, Prozac is not a "feel-good" pill, it's a "gradually feel more stable" pill. It makes my lows less debilitatingly low and more manageable -- my lows are now largely logical responses to difficult events, as opposed to randomly happening for no reason at all. The effect is very gradual and subtle: you can't really evaluate it until after several weeks, and then the "evaluation" is a conversation about whether your affect has seemed generally more stable recently. An average person taking Prozac would probably notice no effect at all, good or bad. By contrast, a stimulant like Adderrall will have a noticeable effect on anyone within minutes.
My son never asked for Prozac or for a "feel-good" pill. My kids have heard of addiction before so we've talked about pills that do make you feel good and why they're dangerous, and also "dopamine drips" like brainrot on YouTube.
Medical interventions for mental health issues aren't a forever-crutch. Plenty of people do taper off/change something about their prescriptions after a certain point, but we rarely ever hear those stories. What we do hear is plenty of people getting on meds/being on meds for a long time, which can bias us and make us think that most people who get on meds are on it for life.
The main issue with drugs is they are more likely to have unexpected or socially harmful side effects than most things.
Good that things are working out for you.
Recently found that, on top of meds (that started wearing off - after taking them for a couple years now following a challenging life situation), going to social latin dance classes for a couple hours almost every day after work helps quite a bit.
This warrants a whole different discussion, and I'll be down voted for it, but one that's never addressed: quality over quantity.
Pills are the individuals response to a society that feeds empty food, bland sterile shelter, fake friends, and meaningless jobs.
The natural human response to a lack of meaning is hopelessness, and this comes from our society. Pills helps individuals cope with continuing the meat grinder just a little while longer.
I had depression, and I cured it by finding meaning and beauty in the world. I get told "if you can cure it without pills, you never really had it" yeah cool, self fullfilling prophecy in that case innit. Can't cure it, because it doesn't exist without meds. It just comes out of "nowhere" and is here to stay.
That's incredibly fortunate and I'm very jealous of you. How would you recommend one goes about finding meaning and beauty? I'm fortunate to have had lots of unique experiences and traveled to lots of unique places and still haven't found the fulfillment that you seem to. That's basically what depression is: a debilitating feeling of lack of fulfillment, without any idea of what's missing.
I'm happiest when busy building and fixing things. It could be that if I was born 200 years ago into an agrarian society where day-to-day life was focused on building and fixing things to survive, then I would have felt very fulfilled and done quite well. What were gainful full-time jobs back then have been reduced to hobbies now, though: blacksmithing, cobbling, weaving, hunting, making furniture, etc. Hobbies don't fill the hole for me. Sure, a few artisans are still able to turn those into a living, but a large part of the job is marketing and the clients are largely the wealthy elite. I've enjoyed working in food service and construction but it's hard to support a family of 4 doing those. So my career has been in software engineering since that involves building and fixing and pays well, but it still doesn't fill the hole.
If this sounds whiny I'm painfully aware. What right do I have to complain about feeling unfulfilled when there are real problems in the world? And that's the very essence of major depression.
A brief thought on this - I’ve found working in large software companies to be fairly unfulfilling, but working at smaller shops focused on delivering something other than software, or for which there’s some tangible connection to the real world, to be much more fulfilling. At its best, software engineering is indeed a craft and something you can take pride in and something where you can have a real impact on people’s lives by building things. A lot of that gets lost somewhere between the third roadmap meeting and the weekly scrum session to figure out how to prioritize product’s requests alongside paying down tech debt so we can improve ad unit performance, but the craft of software itself is still a creative act.
Pills, on the other hand, are easy to understand. This is not to say that they are a viable substitute in any way, but it does explain why so many prefer substance treatments.
Meaning in life is hard and personal. Some might have no idea where to start.
But I'd argue (somewhat pointlessly as I'm not going to change anything) -- This is the role that society, traditions, family, etc. has: "to bring people up" swimming in the same stream, given a purpose and meaning, etc.
For comparison I've barely traveled more than 1000kms. Never had a passport. Travel is not related.
> where day-to-day life was focused on building and fixing things to survive, then I would have felt very fulfilled and done quite well.
Incorrect assumption; It's not the building and busy-ness. And the experience doing hobbies supports that. Nothing fills that "hole".
The feeling, the "hole" you're missing, is a combi-mix of purpose/meaning/larger-picture. I know it because I also had it. Many people try politics to fill their hole too, which also doesn't work: political parties are not big enough.
I'm not going to try to persuade you to change your life, I'm going to talk about what did it for me, and you (and others) can spectate and speculate, take and leave whatever you want. I'm sure I'll get flagged anyway.
My great realization is that nothing is set in stone, everything changes at all times, and humans have survived it.
> a debilitating feeling of lack of fulfillment, without any idea of what's missing.
A good way to start out is to start thinking about: what is your mission? What is your tribe in the world stage? are there messages or lessons from the ancestors of your tribe?
Shy away from getting over-scientific. Simple broad points. The universe is in constant change and chaos. But humans have survived for a long time. We have "lizard" brains that give us reactions, then we have learned / ingrained behavior on top of that, through all this time we've encoded "how to survive" in our brains and throughout our history; we are a storytelling species, so what stories do we have from history (note: not about history, but from history).
Realising stories, like fairytales,(ie: Rumpelstiltskin) etc - ARE old stories that ENCODE information as a way to pass knowledge from culture to culture. WHAT information is in there? what are they trying to tell us? This is the tribe of "humans" telling us something from the past, which is actually absurdly interesting and fulfilling to try and learn from.
Yes this is all "woo-woo" stuff, none of this is going to be a revelation to you. I'll probably look like a quack, but You can have a ponder about it, and realise that there's a big group that you're a part of, and there is a bit of a cosmic mission, and history plays out every day.
this won't give you purpose or fill the hole, but I think you might start to chip away at some different things in your life, (or you won't and I've just wasted 5 mins of your time, ¯\_(ツ)_/¯ who cares)
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.
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
Also, since we're here: the secret knowledge about depression (and affective disorders in general) is that it is an episodic illness, where episodes are measured in weeks or in months. Most people experience just one episode which will end whether or not any medical intervention is undertaken, although the intervention can greatly shorten the course and avoid a potential suicide. But some will not stop at one episode, and can go on to have multiple episodes, perhaps develop melancholic features or even suffer from a lifelong recurrence. It is in the latter groups where medication is the most effective.
> 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.
Medications almost always target symptoms and never address root causes.
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.
>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
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 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.
Furthermore, if the latter were true, it would be an indication that depression was a symptom rather than a cause and the psychiatrist misdiagnosed and improperly treated the patient.
It’s a description of a persistent set of symptoms not necessarily any specific biological process.
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...
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.
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.
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.
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.
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.
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.
In fact, we actually do know this to be the case already: bipolar disorder also manifests with the same symptoms as depression for some time, and SSRIs + therapy are definitely not enough to treat bipolar disorder. Most likely there are other similar diseases that present with depressive symptoms that we have yet to identify distinctly and don't know how to treat effectively.
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.
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).
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.*
“ MAH and JM are co-applicants on the RELEASE and RELEASE + trials in Australia, funded by the Medical Research Future Fund (MRFF) and the National Health and Medical Research Council (NHMRC), evaluating hyperbolic tapering of antidepressants against care as usual. MAH reports being a co-founder of and consultant to Outro Health, a digital clinic which provides support for patients in the US to help stop no longer needed antidepressant treatment using gradual, hyperbolic tapering; and receives royalties for the Maudsley Deprescribing Guidelines. JM receives royalties for books about psychiatric drugs, and was a co-applicant on the REDUCE trial, funded by the National Institute of Health Research, evaluating digital support for patients stopping long-term antidepressant treatment. MP and RL have no conflicts of interest to declare.”
I would caution those in this thread who have never seen or treated patients in any psychiatric clinic or hospital let alone a pediatric one to be careful assuming that they have adequate experience to make sweeping judgements on the utility of antidepressants in children.
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.
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).
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
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.
I later learned that CBT can have that effect on people with ADHD, so I attribute that to being a possible explanation.
I still do therapy, but honestly, I think it's a waste of time and money. I predominantly do it for cathartic purposes and so other people/professionals will stop recommending it.
> terrible the withdrawal symptoms are when stopping
I tried one when I was in my early 20s too. I swore I would never take one again. Withdrawals weren't my issue really. It was the clarity I gained after getting off. I realized how awful I was to people around me. I had such blunted emotions, that I basically became devoid of empathy. I also learned that I needed high levels of anxiety to function, which the medication took away from me.
I think I had a somewhat similar experience: before antidepressants, I was practically non-verbal; later, I had the typical brain fog/emotional blunting -- still unable to communicate with the therapist; after adjusting to meds, by the time that I can put the problem into a coherent sentence, I can usually fix it anyway, so what is the therapist for? Is it really just rubber duck debugging, where the duck has a medical degree?
One thing I wasn't able to figure out was ADHD -- I didn't really believe I had it, as my psychiatrist was sure it's not the problem -- everything was explained with depression/anxiety/geniune lack of motivation. Now that I finally have a prescription for stims, seems like it was the other way around: most of the time I would have a feedback loop where my typical fuckups would trigger a downward spiral, and it's almost not a thing anymore; being able to get shit done is just generally such a pleasant experience!
TLDR My depression also wasn't a "true depression" in a sense, but you still need to fix some underlying issue, which is much easier when your thoughts are not all "I'm a failure" shaped
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.
Even if they did listen to me, what else can they do? They aren't going to apply to new jobs for me, find friends and hobbies for me, etc.. To the men with pills, every issue looks like a 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.
My mistake. I should have worded what I wrote differently. I meant to say "not some true disorder for me."
> Having an objectively crappy life is normal. Being depressed about it isn't.
Not sure I can agree on this though. Rates of depression are quite high in institutions like prisons, for example. Especially in solitary confinement. Of course, I am not in prison, but I do believe the environment plays a larger role in depression than many are willing to admit.
This is not my first rodeo with depression. I'm in my early 30s, and this is probably my 5th or 6th time. I won't go into the details of those periods, but I almost didn't make it through a few of them.
> Ah, this is just due to problem X
Why is this outside the realm of possibility though? I believe depression is just a catch-all term for negative states that are too abstract to treat. If one is in a bad environment or unsatisfied in life, then a doctor cannot really do much to treat that. However, pills can be given to make people numb enough to their circumstances that they no longer care. Though, perhaps that lack of care is enough that people can actually benefit?
I mean, with SSRIs, the lows of life are diminished as are the highs of life, one might gain significant weight, and have a host of other issues like low libido, erectile dysfunction, anorgimasa, etc., but at least they aren't depressed...
If anything, I think of antidepressants like opioids. Opioids do not treat pain -- the pain is still there -- one just can't feel it.
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.
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!
These two words are semantically the same in your context. Unhappy = depressed. Unless you can define something measurable, and if you did in the comment above I can't find it.
I suspect there is something measurable, but I don't see very much attempt at discerning what that is. And without it, this conversation is pointless.
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.
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.
> SSRI prescription
I'm supposed to take an NDRI (Bupropion) and not an SSRI, which is kind of like Ritalin or cocaine. The problem is that I already take amphetamines every single day, so I am not sure why this is really the one my doctors settled on.
In fact, they told me that if my blood pressure increases anymore that I am to stop the medication immediately and then contact them. So, that's not really inspiring a lot of motivation in me.
Someone else in the thread's testifying with personal experience that there were significant withdrawl symptoms after only a few months: https://www.hackerneue.com/item?id=45999622#46008522
Are they lying, or are you misrepresenting something?
How is it different from the expected hormonal changes that an adolescent is expected to go through?
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.
0: https://en.wikipedia.org/wiki/Boy_Interrupted
@dang it's hard to believe that I'm not being brigaded.
Of the recent downvoted comments, one was a complaint about moderation that anyone who has paid attention to dang's track record here over more than a decade knows is baseless. (And if you think the top comment on any thread is a bad one, you can always choose to be a helpful contributor to the community and email us to let us know).
Of the other two of your downvoted comments, none were downvoted by the same users.
The choice is yours to make an effort to observe the guidelines and be a positive contributor to HN, or alternatively to keep using HN for political/ideological battle and complain to the moderators when things don't go your way, but it's clear what others in the community want to see.
You're a ridiculous person.
> or alternatively to keep using HN for political/ideological battle
Which ones? The one about ML and programming languages? Or the one about asking a genuine question about an experience with childhood depression? Or the one observing that you and dang unevenly apply moderation rules? Or the one commenting about how you can't say the word for the literal definition of fascism on this site without getting downvoted? Or the one about dishwashers?
Where's my ideological battle?
You have no credibility. You unlike dang, don't do a good job. Go ahead and ban me or put me on a cool down to prove my point.
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.
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?
> 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.
Because this class of drugs was so heavily promoted for such a long time, the side effects have always been swept under the rug.
My comment above proposed that the 11yo girl's depression could actually be caused by precocious puberty. Another possibility is that she's a poor methylator (#MTHFR) who's poisoned by fortified flour and other sources of shelf-stable provitamins.
I haven't yet found a comprehensive SSRI-truth resource that makes SSRI advocates pause their advocacy, so I just shared the chatbot link. This was supposed to provide the father enough of the background terms and anti-SSRI thinking for him to search for his own resources.
Someone else posted a link to "The serotonin theory of depression: a systematic umbrella review of the evidence" [2022] at Nature [1]. This is okay, but it still dances around the core issue: whether ECT and Serotonin-enhancers sometimes benefit people because of how the brain responds to brain damage.
[0] https://www.hackerneue.com/item?id=46002561
[1] https://www.hackerneue.com/item?id=46008211
> "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?
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.
We know SSRI's really do cause permanent sexual dysfunctional in a small minority of people, small enough that this side effect doesn't come up in traditional FDA tests.
If a side effect is extremely rare it would be impossible or at least impractical to prove in a population.
Grandparent could be right or wrong about how the drug affected them, maybe their brain suffered from other issues and the timing of the medications was purelycoincidental, but if they are correct, your dismissive response is exactly what we'd expect given when they are saying sounds unusual/ improbable.
This is also true for a non-existent side effect. I’m not trying to tell GP he is wrong, just that from a reader’s perspective, extraordinary claims require extraordinary evidence.
Grandparent's report is hard to verify, not extraordinary.
These drugs are approved based on statistical safety profiles in limited trial populations, not on a scientific consensus that absolutely nobody on Earth will ever experience a unique adverse reaction.
Also, I never said that you, the reader, had an obligation to change your worldview based on Grandparent's report.
I haven't taken any antidepressants since.
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.
I say this as someone who is extremely fit. I've worked out religiously since high school. While exercise is integral to me feeling somewhat normal and provides a short-term boost, that is just not how it works for everyone. Some of us have 'broken brains' that cardio can't fix.
Exercise manages my baseline, but sertraline is what helped me finally bridge the gap. It allowed me to regulate my emotions and anxiety in a way that no amount of exercise ever did. And the introspection from being on it helped me make lifelong changes.
To be honest, fearmongering from folks online is what stopped me from taking it sooner, but I wish I had. It was fairly life-changing.
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.
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!
Having a child forced me to fix my life, and I'm incredibly happy because of it.
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).
It was so pervasive at the time that the references to it spilled over into SF Bay Area hip hop culture...
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.
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.
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?
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.
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.
Never again. I'm taking Pristiq now and that has been considerably better.
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.
> 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.
I've tried 19 antidepressants over about 15 years. Stuck with mirtazapene-induced obesity that doesn't qualify for GLP-1 coverage, so I can either be fat, broke, or crushingly catatonic.
> I've tried 19 antidepressants over about 15 years. Stuck with mirtazapene [...]
Have you tried any anti-serotonin interventions? (chatbot in comment link below)
Mirtazapene is a "tetracyclic antidepressant". I think the development of antidepressants went MAOI -> Tricyclic -> tetracyclic -> SSRI. My chatbot transcript said the SSRI's are marginal drugs, but "SSRIs are much safer in overdose" than the earlier drugs.
My understanding is that the MAOIs were reasonably-effective at bringing people out of an acute depression, but they interacted with high-tyramine foods (fine cheese, etc) to cause high blood pressure. Reversible MAOIs are less problematic than the non-reversible ones. Methylene Blue [MB] is the most ubiquitous of the reversible MAOIs. I felt a definite warming effect with my first MB microdose (a fraction of a milligram), but I've never noticed anything from larger doses.
My comments on this thread might be helpful: https://www.hackerneue.com/item?id=46000812
The mass prescribing of SSRIs is going to be seen like leaches (well worse since leaches actually do help in some cases). The rock bottom levels of replication of results in physchiatry and these SSRIs, the whole area should be treated much more like snake oil than it is.
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.
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
Religion is a good example. https://pmc.ncbi.nlm.nih.gov/articles/PMC3426191/
I can be persuaded, though. Can you show research?
- If you look at highly religious areas like the bible belt, they are often linked to worse mental health outcomes for those who don't the religious worldview such as queer people https://www.thetrevorproject.org/research-briefs/lgbtq-youth... https://pmc.ncbi.nlm.nih.gov/articles/PMC8724198 https://pmc.ncbi.nlm.nih.gov/articles/PMC10752621
- That wave of christianism, ironically called christian science, was the cause of mental distress and deaths of tons of children due to the parents religious views. Religious based neglect is a common form of religious based abuse too.
https://childrenshealthcare.org/victims https://pmc.ncbi.nlm.nih.gov/articles/PMC7545013 https://pubmed.ncbi.nlm.nih.gov/9521945/
- Having religious parents is often associated with conditions like anxiety or depression
https://pmc.ncbi.nlm.nih.gov/articles/PMC10719686
- Struggles of a religious nature causing mental health issues all the way up to suicidal ideation
https://www.sciencedirect.com/science/article/pii/S266691532... https://pmc.ncbi.nlm.nih.gov/articles/PMC4776639 https://www.researchgate.net/publication/371293385_SUICIDE_A...
The first 3 links you’ve provided discuss mental health as it relates to geography, not religion. To be sure, religion is associated with those geographic areas, but so are numerous other factors like race, income, etc etc.
The next links are closer to target, they talk about religious objections to medical treatments and the adverse affects upon kids. Nobody should deny this is a real problem, but fortunately it is a very small problem. ( One of the studies found only 172 fatalities over 20 years, and even estimated 10% of the kids may have died anyway.). So I’ll grant that is a real problem, but not one that affects many people. With luck, perhaps it will get better over time.
The next study is interesting, but again very limited. It has 6k subjects, but these are only with religious mothers and only in the UK. This study cites prior study that concluded “ an individual's religiosity is consistently, positively related to their own mental health in US samples”.
The next study associated suicidal tendencies with a very narrow aspect of religion, and even then self reported: “We recruited a relatively small sample that was geographically, racially, and socioeconomically homogenous. We also relied solely on self-report data.”
The next study does not seem to help your argument. It deals with religious beliefs in cancer patients and says “Higher levels of religiosity and spirituality are associated with reduced risk of suicidality and suicidal behaviors [29–31], including in advanced cancer patients “
The final link is just a case study about a single suicidal pastor. It concludes with a paragraph that says “Although there are studies showing that religious people are less prone to suicide…”
So I can’t say all that changes the findings of the many studies that conclude religion is good for mental health.
See: the Sackler family
https://www.health.harvard.edu/mind-and-mood/exercise-is-an-...
"Seasonal Affective Order, or SAD ... has been linked to vitamin D, otherwise known as the sunshine vitamin, because the skin absorbs it through exposure to sunlight."
https://www.va.gov/washington-dc-health-care/stories/combati...
"Consider adding some of these steps into your daily routine to improve your mood:"
"Spend time outside to get ample vitamin D ... Eat foods rich in vitamin D (salmon, eggs, tuna, etc.) Take vitamin D supplements"
Hacker News really does attract a specific type of person...
If those children just had a temporary sadness then the placebo would appear to work?
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.
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.
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.
But rather than fixing society, we will impose experimental drugs on kids. In some cases altering their lives irreversibily
It absolutely should be discussed and openly talked about
> we will impose experimental drugs on kids
What a terribly disengeuous way of putting it! "Imposing" implies there's not a choice. And all drugs are experimental in that we are constantly learning about the effects they have on us and adjusting our knowledge accordingly.
There isn't a choice if * Questing it is "morally wrong" as it's made out to be * It's the only solution.
What tends to be "morally wrong" is when parents are like "I'm not giving my kids those pills! There's no such thing as depression! Just go play outside some more!" - in other words, dismissing your children's feelings
Children are experiencing everything growing at once. They have preferences, they have new experience, everything is very close to "the first time this has ever happened" and so, can be a very big deal for them, at the time.
¯\_(ツ)_/¯ internet arguments about parenting, experiences, assholes, having one, putting it in others faces, etc. The internet is just talking to a bunch of people who have different ideas. I wouldn't take it too seriously, over half of it is bots or socially inept people anyway
actually, "depression" or major depressive disorder is literally a mental illness, which has a genetic link. it is not a "lack of meaning or beauty" -- to suggest every depressed person who killed themselves had no "meaning" for life is deeply disrespectful to every parent, child, sibling, partner that killed themselves.
https://www.ncbi.nlm.nih.gov/books/NBK459223/
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.
Also relevant to this article, WHO since 2023 does not recommend Fluoxetine (or any antidepressants) for children younger than 12 years[2].
[1]: https://iris.who.int/server/api/core/bitstreams/17642505-ecd...
[2]: https://list.essentialmeds.org/recommendations/313
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).
Surely the massive amounts of cocaine and MDMA bear some responsibility.
Unfortunately, this is one of the major limitations of our diagnosing abilities with mental illness: when someone presents with severe depressive symptoms and no other known history of mental illness, we have no real way of telling whether it should be classed as Major Depression, or whether it may be Bipolar disorder.
So, sadly, yours is a common story where people with bipolar disorder that initially manifests with a depressive episode get treated with SSRIs that then push them into their first manic episode. I've had a good friend go through something very similar (though, thankfully, less severe in terms of intensity of the manic episode).
If you were given SSRIs to handle the start of your manic episode, that to me seems like a gross mistake by your physician.
> 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
ssris actually block the serotonergic effects of mdma and similar.
Could you speak more to this? A family member was recently diagnosed with myoclonic jerks without a clear root cause, so treatment has been hit or miss so far. I’m trying to learn what I can to help inform them.
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.
It was really hard for my ex to have to choose between anti-psychs and the potential side effects, or exceedingly strong paranoia with incredibly lucid hallucinations - I did not envy her position
Speaking for myself, I took sertraline for years and it did wonders for my mental health. It didn't ruin my life or numb me, it gave me the ability to regulate my emotions when I previously struggled immensely with anger and crippling anxiety.
It’s possible for these drugs to be handed out too easily in some contexts and simultaneously be life-saving, effective treatments for those who genuinely need them. Suggesting they violate 'do no harm' ignores the massive harm caused by leaving severe mental health struggles untreated.
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 :')
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.
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.
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"
Not what the post you replied to was talking about.
> 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"
That's basically the definition of clinical depression. Doctors try quite hard to make sure it's not a scapegoat.
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.
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".
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...
https://en.wikipedia.org/wiki/Lobotomy