
There is little research into the long-term effects of using antidepressants - DiabloD3
https://www.theguardian.com/society/2017/may/06/dont-know-who-am-antidepressant-long-term-use
======
pc2g4d
I was also put on antidepressants as a teenager and am trying to get off them
after well over a decade. It's a tricky task to distinguish the withdrawal
effects (which can be extreme) from the difficult emotions that come with
rediscovering how to face the world without the drugs. It really feels like a
part of my personality was frozen in time when I went on the drugs, and that
as I come off them slowly that part of me has thawed. And that can be painful,
but also extremely rewarding. It forced me to acknowledge truths about myself
that I resisted for many years. It forced me to be more real with people in my
life. It's the realization that I was depressed for actual emotional reasons
and not just because of some putative neurochemical imbalance, the idea of
which in such huge numbers makes absolutely no evolutionary sense. A trait
this common is not a disorder---it's a survival mechanism.

~~~
jakebasile
I'm glad you are feeling better but while some people's problems do come from
emotional sources, please don't act like the chemical imbalances in the brains
of other people aren't a disorder. I promise you, I and others like me have
tried our damndest to "feel better".

~~~
pharrington
OP is not telling you to "feel better" \- he is saying he was only able to
tackle his depression after taking a more holistic approach to monitoring and
changing his brain operation.

Emotions are, quite literally, certain chemical states in animals with nervous
systems of at least a certain complexity. That's where the "chemical
imbalance" mantra falls apart - at best, it adds no information, and even
worse, its used to peddle drugs which are developed without coherent and
_predictable_ models of the neurology involved in the symptoms/diseases
they're supposed to treat.

Medical doctors get at least one objective measure of your blood pressure
before prescribing blood pressure medicine. When was the least time you heard
of a psychiatrist only prescribing meds after performing an MRI?

~~~
kolinko
What new information would current state fMRI give them?

If I'm not mistaken, a person that is depressed due to environment will have
similar fMRI as a person who has messed up biology (not just neurotransmitters
btw).

Also, even with acute depression, antidepressants may help to get the patient
on track.

~~~
pharrington
[https://www.nih.gov/news-events/nih-research-
matters/brain-s...](https://www.nih.gov/news-events/nih-research-
matters/brain-scan-may-predict-best-depression-treatment)

The objective outcomes differ with different treatments even in cases of
subjective success. The specific neurology (protein levels, chemical ratios,
etc) should determine how exactly you intend to alter it.

------
jakebasile
I'll tell you, with 100% conviction, that I would not be alive today without
prescription antidepressants and mood stabilizers. Of course there are side
effects, and it can take a while to find the right drug or combination of
drugs for your particular brain chemistry. In most cases, I've considered the
side effects worth the improvement to my life. Even with them, I'm still not
completely "normal". These symptoms are with me for the rest of my life
barring some amazing medical discovery.

Mental health issues as a whole are difficult to bring up, even to a doctor. I
actually worry about writing this on my real account. It's looked down on as
if "you just can't handle life" so you "just feel sad". Chemotherapy is also a
very unpleasant experience, but I don't think there would be much interest in
an article about some imagined overprescription of chemotherapy.

~~~
glenda
Antidepressants are overprescribed (just like how Ritalin was like 15-20 years
ago) because they work so well that doctors reach for a pill as their first
course of action while ignoring other less life altering options.

Some people also find themselves with side-effects like suicidal thoughts or
loss of sexual functions that can be devastating, and in some cases will last
beyond the use of the medicine.

~~~
_acme
Do you have any evidence for the efficacy of antidepressants that others,
including their manufacturers, do not? In fact, SSRIs/SNRIs are not
particularly effective -- at least no more effective than placebo.

~~~
glenda
My comment on the effectiveness of antidepressants is in reference to the way
many doctors seem to view these drugs, not based on any particular studies or
evidence.

------
seibelj
Anti-depressants literally saved my life. I tried to manage my anxiety /
depression for years with diet, exercise, therapy, mindfulness, and meditation
without great success. 2 weeks of lexapro was a night and day difference.
Don't be afraid of medication if other options fail.

~~~
tcj_phx
> 2 weeks of lexapro was a night and day difference.

My girlfriend thought that lexapro had helped her years before she met me...

She escaped from the psychiatrists who only cared about making her feel worse
with their "anti-psychotics", and got her new medical providers to prescribe
lexapro instead. After a week she realized that her new rapid heartbeat was
certainly caused by the lexapro. She took her last benzo (class of "anxiety"
drug that makes anxiety worse over time), and it was all downhill from
there...

SSRIs were approved on the basis of fraudulent science. The legal profession
was recently able to secure a $3 million verdict against Glaxo Smith Klein - a
rather successful lawyer jumped in front of a train after a few days on Paxil.
Here's a writeup: [https://www.madinamerica.com/2017/05/change-in-chicago-
the-d...](https://www.madinamerica.com/2017/05/change-in-chicago-the-dolin-
verdict/)

~~~
Arizhel
>She took her last benzo (class of "anxiety" drug that makes anxiety worse
over time)

Can you elaborate here please?

~~~
tcj_phx
basically what tptacek said... Benzos' are sometimes useful for acute anxiety,
but this is not how they're commonly used.

Benzos: A Dance With the Devil - [https://www.madinamerica.com/2016/07/benzos-
a-dance-with-the...](https://www.madinamerica.com/2016/07/benzos-a-dance-with-
the-devil/)

Benzodiazepine category - [https://www.madinamerica.com/category/psychiatric-
drugs/benz...](https://www.madinamerica.com/category/psychiatric-
drugs/benzodiazepines/)

~~~
Arizhel
Wow, that's scary, the one about a grand mal seizure with Xanax in particular.
I used to take that, but only for occasional acute anxiety, never on a regular
basis. It seemed to help a lot, and unlike the SSRIs I've used, it didn't have
any obvious side-effects at all. I never took it long enough to get any build-
up though, just occasionally if I was having a really bad episode.

------
askvictor
There are plenty of anecdotes here, which are fine for those wanting to share
their story (I've been on two types of antidepressants myself). However, the
point of this article is that there is insufficient long-term data. Anecdotes
do not a longitudinal study make. And one of the major problems with
depression is that it's subjective. Antidepressants have major onset side-
effects, that take around a month to stabilise. So, you're feeling pretty
crappy, but take the pills in the belief they'll make you better, and you have
some strategies to deal with the nausea and other side-effects. In that onset
month, you're probably feeling even crappier than before. But then your
body/mind adjusts, the onset side-effects go away, and you feel better. So you
report that you feel better after one month. Which skews the data pretty
badly, as it's hard to be objective about how good/bad you're feeling at the
best of times, let alone when you're in a slump and/or feeling nauseous from
the drugs.

For all of those people who say that antidepressants saved or improved their
lives (or the life of a loved one), spare a thought for those where
antidepressants led a decrease in quality of life, or worse.

------
Gfdfgjjmbvcd
This hits home as my wife was admitted to a psychiatric ward today, again, for
major depression. I am lost, with a business to run, a full time job in
addition, two daughters, and struggles with minor depression and anxiety
myself.

She is on two antidepressants, Vyvanse (amphetamines), Provigil, and then
takes trazadone to sleep. Her Dr will first increase one, then after that
fails will add another or switch her. She's treated like a human Guinea pig.
No one has thought to question whether the medications contribute. No one has
looked at the problem holistically. Her diet is absolute shit, she doesn't
exercise, she really doesn't take care of herself at all. And the medical
professionals all tell her it's not her. She has a disease, she has a chemical
imbalance, it is completely out of her control.

Long story short, I see both sides. There most certainly IS personal
responsibility. Even more damaging though is the state of psychiatric and
mental health. It's learned, and reinforced, helplessness.

~~~
aedron
Man, that sounds rough. Puts some other problems into perspective. I feel for
you and hope you guys pull through. I say this as someone who has been through
worse stuff in my life than most people.

------
wu-ikkyu
I see a lot in here about the popular "chemical imbalance" theory, which is
worth noting is more of a big pharma sales pitch at this point in time than
actual objective science.

Antidepressants and the Placebo Effect
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592645/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592645/)

Antidepressants versus placebo in major depression: an overview
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/)

~~~
kolinko
You picked two articles that fit your worldview, and ignored all the critique
around them. That's not objective science.

Also, even the first one of the articles you quoted clearly says in the
conclusion that there is an effect to antidepressants.

Here is one of the articles the critique of the critique you mentioned:
[http://www.nytimes.com/2011/07/10/opinion/sunday/10antidepre...](http://www.nytimes.com/2011/07/10/opinion/sunday/10antidepressants.html)

~~~
wu-ikkyu
>fit your worldview, and ignored all the critique around them. That's not
objective science.

^This is an accurate description of western psychiatry in general, ironically,
because 1) psychiatry is not objective science 2) psychiatry assumes
individual deviation from society's norms is the root of disorder, rather than
seriously considering the disorder of society's norms at large.

>In 2013, Frances said that "psychiatric diagnosis still relies exclusively on
fallible subjective judgments rather than objective biological tests

[https://en.wikipedia.org/wiki/Allen_Frances](https://en.wikipedia.org/wiki/Allen_Frances)

~~~
mmjaa
>1) psychiatry is not objective science 2) psychiatry assumes individual
deviation from society's norms is the root of disorder, rather than seriously
considering the disorder of society's norms at large.

I believe this is an accurate statement, and the reason for these two points
being so extant is that Psychiatry is, these days, more like a state-supported
official religion.

Its definitely not science. If you don't think the way society wants you to
think (i.e. religion), you are cast out from it: this is Psychiatrys' job.

~~~
SMOwens
>2) psychiatry assumes individual deviation from society's norms is the root
of disorder, rather than seriously considering the disorder of society's norms
at large.

Without making a comment which either agrees or disagrees with the above, I
would like to add that I believe those who downvoted comments such as this--
controversial and/or original ideas--might consider to instead offer a reason
why the comment is likely to be of low value.

For example, I can readily find evidence in support & in opposition to the
above comment, i.e. WebMD states a primary symptom of Paranoid Schizophrenia
to be a belief that the government is spying on you[1]. Another example: gay
rights activists of yesterday would be able to tell you of a time when their
sexual preference was considered a disorder.

So while the idea might be controversial, I don't believe it is inherently of
low value to add to the conversation.

>1) psychiatry is not objective science

There is a reasonable argument to be made that there is merit in being
critical of what we do, and don't call, science. Richard Feynman talked about
this fundamental, simple nature of the scientific method and the critical
component being that it provides a testable hypothesis that can be observed
and repeated, which shows us nature agrees with our theory[2]. As we all know,
this is very hard to produce in psychology, despite their best efforts to use
maths and stats to create studies which find strong correlations.

1-[http://www.webmd.com/schizophrenia/guide/schizophrenia-
paran...](http://www.webmd.com/schizophrenia/guide/schizophrenia-paranoia#1)
2-[https://www.youtube.com/watch?v=0KmimDq4cSU](https://www.youtube.com/watch?v=0KmimDq4cSU)

~~~
mmjaa
Indeed. It seems there is much to learn about how this pseudo-religion is used
by the powers that be in order to maintain control:

[https://www.madinamerica.com/2012/02/why-anti-
authoritarians...](https://www.madinamerica.com/2012/02/why-anti-
authoritarians-are-diagnosed-as-mentally-ill/)

------
peteretep
This is a terrible article.

It leads with a random three paragraph anecdote about coming off an SSRI. This
is a pretty well-known and well-documented phenomenon, and contributes nothing
to a discussion of their safety.

And then:

    
    
        > But many experts believe these drugs
        > do more good than harm
    

Followed by a quote of someone saying the opposite, and nothing more to back
that statement up _at all_.

    
    
        > Many SSRI users report blunted emotions
    

That's kind of the point

    
    
        > “They should be called anti-sex drugs
        > rather than antidepressant drugs,” says
        > Jon Jureidini, a *child* psychiatrist
    

Seriously? They're quoting a _paediatric psychiatrist_ on the effects on
libido of anti-depressants. Just a thought: if you're a child psychiatrist and
your patients are having lots of sex, there may be other issues affecting
their mental health.

The article gets no less sloppy. Clickbait is clickbait even when wrapped up
to look vaguely scientific.

------
baus
They don't talk about SNRIs like venlafaxine in the article, but I can say
from first had experience that the withdrawal symptoms from those are pretty
extreme. This is a difficult decision, but I've decided to not take SNRIs or
SSRIs to manage bipolar depression, although they are commonly prescribed
because I found the side effects to out weigh the benefits

~~~
dsnuh
I've been on venlafaxine 75mg (prescribed 150mg, but didn't like the increased
side effects) for about a year now, I felt elevated mood a bit, but it did
little to address bipolar cycling in my case. Recently I was prescribed
Lamictal (lamotrigine) off label by my psychitrist as a mood stabilizer. I
have just this week come up to therapeutic doses. It has been a huge change. I
don't feel like I have experienced any additional side effects, and my mood is
much more even. If you've never tried it, you may want to do some research
online. Many bipolar patients have reported similar results.

~~~
_acme
Lamictal carries the potential for severe side effects, much more so than
SSRIs/SNRIs. Lamotrigine prescribing information has a black box warning about
life-threatening skin reactions, including Stevens–Johnson syndrome, DRESS
syndrome and toxic epidermal necrolysis.

------
lawnchair_larry
I wonder why people care whether or not somebody else _really needs_ them.

For arguments sake, let's say they don't. Suppose they can just man up and
learn to deal with their first world problems. What do you lose by them taking
something to make that easier?

Do you normally fix all of your other problems in the most difficult way?

We all seek ways to get an edge, if not against others, then at least to
reclaim some of our own time and well-being.

From their perspective, there are 3 kinds of people. There's the positive,
motivated guy who can't wait to get out of bed and go make his mark on the
world. Then, there is the similar character who has to take SSRIs or whatever
to keep that going. Then there is the lethargic person who has to fight every
day to pretend to give a shit, can't keep relationships together, doesn't get
promotions, and doesn't feel motivated to learn new skills or hobbies.

The last person doesn't really have the option of being person #1, but they
may have a choice between being #2 or #3. Since all three of them end up in
the ground after a few more decades anyway, why does it matter to others how
they get there? Maybe the last 10 years or so of their life will cause them
complications due to longterm use. It's hard to view that as a bad trade for
folks who were miserable and/or suicidal for the first 50.

~~~
omginternets
>What do you lose by them taking something to make that easier?

Going with your argument, one stands to lose on at least two fronts:

1\. severe side-effects

2\. potential long-term harm stemming from chronic use (as per the present
article)

>Do you normally fix all of your other problems in the most difficult way?

This is disingenuous. The argument is that fixing depression sans medication
is a _better_ (= safer, more effective) way.

Granted, this argument is _far_ from being obviously correct. Things also get
murkier when we admit that there are various forms of depression, but that's
not the point. The point is rather that you're arguing against a straw-man.

~~~
lawnchair_larry
Neither 1 nor 2 answer the question. Why do _you_ care if _they_ do it? You
suffer no side effects or long term harm.

~~~
omginternets
They certainly _do_ answer some of the questions you explicitly spelled out.
As for the rest:

1\. I generally care if people are being pushed towards (under|in)-effective
treatments. I want people to be guided towards the safest and most effective
treatments for ethical reasons.

2\. I worry that there are misaligned incentives between the drug consumers
and the drug suppliers.

------
panglott
The medical model of mental and behavioral problems is a lot better than the
moralistic model.

But physical health is also a poor metaphor for mental health, and this
article reveals some of the reasons why. Like the doctor comparing the
antidepressant use to insulin, even if the doctor was just trying to de-
stigmatize the anti-depressants.

But human minds and personalities grow and change in response to the
environment they're in and as part of normal aging and development.

~~~
psyc
I wish the biopsychosocial model would catch on. Maybe it needs a catchier
name.

~~~
kolinko
I'm building a browser game that educates people in this. There is nothing I
can publish yet, but shoot me an e-mail (kolinko@gmail.com), and I'd love to
discuss it in more detail.

(I hope I don't break any HN rules with this comment - there is no landing
page, and I don't have a public pitch I could share here yet).

------
pasbesoin
Whether you view the drugs, and their long-term use, as a benefit, or not,
here's how I see it. The pharmaceutical companies have these drugs approved.
And they are being prescribed and used, long-term.

So, what's the benefit for them in doing longitudinal studies? What's the
upside, versus the potential downside of discovering negative effects?

If you want longitudinal studies, you're going to have to look outside the
industry.

An essential reason we need to keep government research around and well-
funded.

------
a3n
First, everyone's depression is specifically their own. While there are groups
of people who react similar to each other, that doesn't at all negate the
experience of other different groups and their reactions.

I take an SSRI. It's worked well for me. If the cause of my depression is a
defect in the serotonin path, then I see no reason why I, with that particular
problem, should wean myself off my SSRI; I don't think SSRIs repair the
serotonin path, they just mitigate the defect (production or transmission).

If I had a defective leg, with no hope of repair or regeneration, I wouldn't
try to wean myself off my brace.

~~~
bitexploder
Same with ADHD and dopamine release. It is why amphetamines are so effective
at treating legitimate ADHD. Mundane chores everyone has to do go from
unimaginably difficult to start to moderately rewarding with the magic of a
brain releasing its pent up dopamine. It isn't even a dopamine production
problem for many with ADHD, the brain just won't release it like it does for
most people. You can train it to some extent, but the defect will always exist
in the ADHD brain.

------
nicolashahn
I was on various medications off and on over 6 years. I needed them before
that but they helped immensely once I had them.

However, I've found that they're unnecessary and even detrimental long term,
if you can tackle the underlying reason behind the depression (the side
effects can be huge). For me, it was a lifestyle change that involved better
diet and exercise (like everyone recommends), as well as associating myself
with people that I enjoyed being around and who encouraged me to be better and
disassociating myself from people who brought me down.

The most important piece, however, was that I was able to fundamentally change
my thoughts and perspective on life. Instead of telling myself "I'm a failure"
I tell myself "I found one way that doesn't work." Instead of "I hate myself"
it's "how can I make myself better?" Instead of "they don't actually like me"
it's "I don't care, because I don't need everyone's acceptance to be content."
I was able to do this mainly through reading various mindfulness books but
most importantly Stoic philosophy. "A Guide to the Good Life" was fundamental.
The rest came through general maturity through life experience, accepting the
world the way it is and coming to terms with it, as well as using that
knowledge to get what I want from it.

A combination of these things, plus finally becoming financially independent
and moving to a place that suits me better, has led me to believe that _for
me_ antidepressants are a _temporary_ tool to help you learn to manage
depression. There may be a chance that I need them again in the future but I
feel very secure where I am now, and more confident and happy than I have ever
been in my life previously.

What has led me to believe that the same also holds true _for most people_ is
that I've known many other depressed and medicated people before in my life.
What I find in almost all of them (who remain depressed and medicated) is that
they view the medication AS the fix, instead of the tool that helps you find
it. They _accept_ that the medication will bring them enough contentment to
live out the rest of their life. Because of this, they never try to change it.
They're living the same life they were, except now they aren't as miserable.

Maybe it was a good thing that the side effects were too much for me but I
wasn't able to live that way, they forced me to find a way to improve my
situation. I believe that many people just haven't been able to find the right
ways to change their life to live without medication. Of course, this doesn't
apply to the ones that _can 't_ fix their situation for whatever reason, but
the reality is that a lot of people are being medicated, and most of them do
have the power to change their lives to render medication unnecessary.

~~~
ilanco
> they view the medication AS the fix, instead of the tool that helps you find
> it

This. Professionals should explain that these medications are a tool to help
you manage rather than a "fix" you should be taking your whole life. It is
possible to figure this out on your own, like the OP did, but not everyone
can.

------
jdavis703
I wonder how much of Sarah's issues were a "nocebo" response, thinking that
withdrawal would be bad. If so it might help if doctors and pharmacies
provided a "guided reduction" (e.g. you get 19mg one week, 18mg the next etc).
People might feel better just thinking that an "expert" has designed this
program.

~~~
askvictor
I don't know about Seroxat, but I've experienced undeniable symptoms
withdrawing from antidepressants: "brain zaps" that I had no idea about until
I started experiencing them, then found other people who had written of
experiencing them as well.

Additionally to those, I had a weird whooshing sound that I would hear
whenever I moved my eyes to the top left. Took me a while to figure out the
pattern/trigger (seemed random at first, and I thought I had something stuck
in my ear). Actually kind of fascinating, if scary.

That was on top of the nausea etc. And this was a 'guided' withdrawl (under
medical direction).

I don't discount that there might be a placebo/nocebo response in the side-
effects (both onset and withdrawl) as well (as with any medication)

------
Burnt_Foot
I've been on different forms of ssri, snris since the age of seven. I'm 32
now. It's debatable my parents used medication as a way of silencing me, as I
was lashing out and making suicide attempts and violent threats as a response
to my father's physical and sexual abuse.

Regardless, I've been on so long I don't believe I could function without
them. Every time I've gone off, whether cold turkey or under a psychiatrist's
supervision, I've fell into the deepest, even catatonic, depressions of my
life. Even had a psychotic break which required shock treatment.

I've been in therapy, ptsd groups, religiously exercised, meditation,
journaling, and a whole lot more, but the medication has always been there.
Both sides of my family have a history of suicide, alcoholism, depression, and
other mental illnesses.

I feel like an addict but also justify it, in that you wouldn't shame a
diabetic for taking insulin.

------
thanatropism
Ok, I can't resist this.

First, chunk of the reason why SSRIs and to a lesser extent benzodiazepines
are (perhaps) overprescribed is that they are _safe_ , at least in the short
term. In the bad old times antidepressants were _dangerous_ , let alone
antipsychotics and such.

There's some interesting literature pointing to lithium as the Stephen-Curry-
mit-Keith-Jarrett standard for long-term management of treatment-resistent
depression, but man, taking lithium sucks. If all I had was the garden variety
blues I would sure opt for the Zitalocipraoamezaxx they advertise on TV.

Second, I think people are over-eager to blame pharma and not the doctors.
These are tools, people, and power tools at that. Yes, some research released
by pharma is biased in that they do not release the unfavorable studies, but
there are plenty of blogs out there poring over the technicalia, as well as
sharing experiences in real patient care.

Maybe some of these things are overprescribed to the gen pop but they're still
useful to us.

Third, isn't funny that we're expected to be open-minded about recreational
drugs and puritannical about pharmaceuticals? Effectively in many parts of the
world now you can legally buy weed but cannot get Klonopin when needed unless
you work through the system somehow.

This should go without saying, but fourth: the goal of psychiatric treatment
is never to make you happy or realignm your chakras. A pdoc doesn't ask "are
you happy, are you sad", he asks "are you functional?" Meaning first: am I
able to work? (This is the first thing -- it's not good for someone mentally
ill to be homeless). Next: am I able to maintain and grow my personal
relationships? Is my sex life ok? Am I overall satisfied with my quality of
life and my ability to take and handle new challenges? If I can't get an
erection (meds sometimes impact that), that's something he can try and help.
If I'm questioning the usefulness of being a knowledge worker in a society
pumped by a bubble of BS? That's on me.

Your goals as a human being are still up to you.

------
notadoc
First try legitimate physical exercise, lifestyle changes, counseling.

~~~
bitexploder
Not trying to give you a hard time, this is of course good advice, but please
never tell that to anyone you care about in a depressive episode. Time and
place. Virtually every person with depression has been given this advice a
million times. If it were just that, they would have done it. It took me a
long time to accept that it just isn't that simple for people with long term
depression. That is a huge part of fighting it long term, but those habits are
hard to gain and easy to lose, putting someone back in the hole. People with
depression also just need people. Support, acknowledgement of their struggle,
listening, acceptance. I have a strong inclination to help people fix things.
My younger self had a hard time accepting there were things I could not fix or
figure out.

~~~
zamalek
It's also dangerous advice. Seek professional attention _first._

------
dabber
And of course the first ad in the article is for an antidepressant.

Drop the ad script in and forget it they said... Targeted ads they said...

