
Expert reaction to study on the clinical effectiveness of sertraline - DanBC
https://www.sciencemediacentre.org/expert-reaction-to-study-on-the-clinical-effectiveness-of-the-antidepressant-sertraline/
======
Guthur
I've often wonder what the subtle differences to the human psyche are brought
on by the use of medication like this. It's very difficult to imagine that
it's so finely balanced that there is no effect beyond the reduction of
adverse anxiety.

My wife has been taking it for quite sometime and it's sometimes a struggle to
see how she moves past it. And while it is ancedotal I feel sometimes there
are things that should bother her but don't and I wonder if normal mental
anxiety is suppose to play some part in that. Hard to have any definitive
answer but I find it and interesting thought.

~~~
big_chungus
I was always a little freaked out by the idea that taking this sort of thing
could turn you into an entirely different person. I'm guessing this is doubly
odd for those without some kind of religious basis for the concept of a soul.

~~~
agar
I've heard others with that same fear, and sadly it stopped them from taking
advantage of a medicine that could significantly improve their quality of
life.

Depression and anxiety, even when mild, can be pernicious in their self-
preservation. Self-identifying with a symptom, and avoiding a potential cure
because "it could turn you into an entirely different person" by removing that
symptom, is often the disease talking.

SSRIs don't turn you into a different person. When working properly (i.e.,
right dose, right med), they simply give you more mental space to deal with
and work through problems. Who you become after working through your issues is
entirely up to you.

~~~
saryant
I avoided SSRIs for years based on this fear but after starting lexapro I can
safely say I have never felt more free.

YMMV of course.

~~~
mrguyorama
I also struggled with this worry, and also am infinitely better on Lexapro.

I still have anxiety, it just doesn't take complete control. I'm not a slave
to my anxiety anymore, I can push past it if I really want to do something,
something that in the past would have had me utterly paralyzed and broken.

It's not even a high dose.

------
lolc
Can somebody provide context on this study? It's sometimes interesting to get
a glimpse at the state of a field. Is it just that or is there more to it?

~~~
o09rdk
So, for several years the actual efficacy of antidepressants has been called
into question. There's lots of reasons for this, some related to the general
replicability crisis, but in general it followed from reanalyses of datasets
suggesting the efficacy of antidepressants is significantly lower than
previously thought, and some might not have any efficacy at all.

At the same time, there's been acknowledgment that the forms of illness
encountered in reality don't really map on well to diagnostic categories. So
rather than major depression and generalized anxiety disorder, it's more like
there are levels of general distress, and specific problems with low positive
emotion, or high negative emotion, or arousal. This has contributed to things
like the NIH RDoC initiative.

These two things have sort of combined to lead to a lot of questions about
what antidepressants are actually doing, in terms of how it's affecting
dimensions of mood and other areas of functioning, thought of in a more
detailed way. So in this study rather than targeting a specific diagnostic
population, they did a randomized controlled trial of a heterogeneous group of
patients, and then assessed antidepressant effects on distress and well-being
in a more detailed, comprehensive way than the typical diagnostic assessment.

The results aren't really surprising but are interesting to think about in the
context of these issues. For instance, it's not surprising that antidepressant
effects might manifest in well-being or anxiety measures, because general
anxiety and depression measures can be correlated as high as .8 or .9, and
well-being, while less correlated, still tends to tag along. From a
replicability standpoint it raises some interesting issues because there's
sort of a "fishing expedition" given all the measures, even though things were
preregistered, which is worth some discussion, but the effects are all in the
anticipated direction even if not significant, raising the question of whether
or not p-values really are the most important thing in general.

Overall the study is one piece, but it fits together with a more general body
of evidence suggesting that antidepressants are really fuzzy in their effects,
and might better be thought of as "antidistress" agents, or as having a
general calming effect. Not mind-blowing, but does contradict the way the meds
are typically portrayed in public discussion.

~~~
lolc
Thanks for the context! Now I can read the expert statements with more
understanding.

