
Why Antidepressants Don't Live Up to the Hype - chaostheory
http://www.time.com/time/health/article/0,8599,1895672,00.html
======
asciilifeform
Actually, it is because research on antidepressants which _unambiguously make
you feel better_ \- namely, dopamine reuptake inhibitors - was outlawed.

What we're left with are the ones that only work in a mild, sometimes-sort of
way. And don't buy the notion that the purpose of an antidepressant is to
"correct chemical imbalances." No such imbalances have __ever __been
identified:

<http://www.etfrc.com/ChemicalImbalances.htm>

 _"How are the chemical imbalances which are the supposed basis for the
prescription of "antidepressants" diagnosed? Is exploratory neurosurgery
performed, using some technique that allows the surgeon to quantify synaptic
transmitter levels? No, the very idea is absurd. Is a spinal tap, then, done
to at least measure, on a gross scale, the distribution of neurotransmitter
metabolites? Of course not – how many people have undergone spinal taps before
receiving a prescription for Effexor®? Is blood at least drawn, to test
something? No. This diagnosis – the diagnosis of the most subtle of chemical
disorders in the most complex organ in the body – is made on the basis of the
patient's report of feeling sad and lethargic. Try to imagine a hematologist
diagnosing leukemia this way to get a sense of just how ridiculous this idea
is."_

 _"The principal reason for rejecting biopsychiatry (aside from the fact that
intellectual honesty demands its rejection) is that it locates the cause of
psychic suffering in people's "bad brains," and excludes the conditions of
modern life, or anything else, from consideration as the cause of such pain."_

The purpose of an antidepressant is to improve mood. No more, no less. And the
degree of doublespeak doctors find necessary to dance around our society's
puritanical views on pleasure just to be permitted to market the current,
wimpy antidepressants - is staggering.

~~~
tokenadult
AFTER EDIT:

 _research on antidepressants which unambiguously make you feel better -
namely, dopamine reuptake inhibitors - was outlawed_

Do you have a citation for a law or policy statement that shows that there is
indeed such an outlawing? I see Google Scholar citations that suggest that
research is ongoing, and there is more planned.

[http://www.ajp.psychiatryonline.org/cgi/content/abstract/163...](http://www.ajp.psychiatryonline.org/cgi/content/abstract/163/9/1594)

/AFTER EDIT

There are more than 100 countries in the world, and they would have to be
united in banning a certain direction of research for there to be no research
on that subject. But dopamine reuptake inhibitors, based on ongoing research
in various places, are a risky approach to treating major mood disorders.

"DRIs are notorious for their high abuse potential and ability to cause
addiction and dependence. Pure DRIs such as cocaine and combination releasers
such as amphetamine and methamphetamine are widely abused throughout the
world."

<http://en.wikipedia.org/wiki/Dopamine_reuptake_inhibitor>

"NDRIs approved to treat depression

"Here is the only NDRI that has been approved by the Food and Drug
Administration specifically to treat depression, with its generic, or
chemical, name followed by available brand names in parentheses:

    
    
        * Bupropion (Wellbutrin, Wellbutrin SR, Wellbutrin XL)" 
    

. . . .

"Safety concerns with NDRIs

"Bupropion can increase blood pressure in some people, so regular monitoring
is important. The risk of developing high blood pressure may increase if you
also use nicotine replacement therapy, such as a nicotine patch, to help you
stop smoking.

"There's a small chance that taking bupropion can cause a seizure if you've
had previous seizures, a head injury or a nervous system tumor, or if you've
had an eating disorder, such as bulimia or anorexia. Because of that, don't
take this medication if you have a history of seizures or eating disorders or
if you're abruptly discontinuing use of alcohol or sedatives. Be sure to tell
your doctor about your past medical issues.

"Also, because of potentially dangerous medication interactions, be sure your
doctor knows about any current or previous use of monoamine oxidase inhibitors
(MAOIs). Tell your doctor also if you have severe liver cirrhosis, because
Wellbutrin can cause liver problems. In addition, don't take Zyban while
you're being treated with any form of Wellbutrin."

<http://www.mayoclinic.com/health/antidepressants/MH00068>

~~~
asciilifeform
Notice how Wellbutrin - the _1970s state of the art_ \- is what we're stuck
with. Precisely because research has been curtailed - yes, internationally.
Progress stands still.

Also compare the side effects you listed with those of the wildly popular
SSRIs.

And yes, any hypothetical drug which _reliably_ makes you feel better will be
addictive in some sense of the word. Deal with it, and move on with life.
Addiction is only the bugaboo it is claimed to be when the thing you are
addicted to is _actually harmful._ Most people don't consider themselves "drug
addicts" for using caffeine, for example.

The focus should be on developing drugs which do the mood-lifting job, don't
produce tolerance, and don't damage your internal organs. There is no evil
spirit which manipulates the universe to make this goal impossible. It is
simply considered undesirable by our Puritan rulers (and the outposts they
have built inside our own heads.)

 _Reply to Edit:_

> Do you have a citation for a law or policy statement that shows that there
> is indeed such an outlawing? I see Google Scholar citations that suggest
> that research is ongoing, and there is more planned.

Check out the Federal Analogues Act (US) and its foreign equivalents. Any drug
which is chemically similar (with a very liberal definition of "chemically
similar" that provokes howls of laughter from chemists) to a currently banned
drug is instantly placed into "Schedule I" - "no medicinal use" - and is
outlawed, in such a way as to make research nearly impossible and certainly
unprofitable. But the real problem lies with our society's perception that a
drug which gives you pleasure is an unambiguous and unmitigated evil all in
itself, regardless of whether it has harmful side effects. Few of the research
drugs in the papers you've seen will be permitted on the market, for this
reason. Certainly none of the ones which _actually work_ will be.

By deliberately marketing antidepressants which only work subtly and
_sometimes_ , the pharmaceutical industry continues to uphold the ruse that
they are actually treating an ordinary disease, like leukemia. But _we know
how to build antidepressants which work on everyone_. It isn't being done
because if it were, the smoke would clear, and we would be forced to admit
that we are actually treating unhappiness. Unhappiness caused by stimuli which
_ought to_ make a sane person unhappy.

~~~
tokenadult
_But we know how to build antidepressants which work on everyone._

It took me a while in my offline personal life for the very evident
counterexample to come to mind. In fact, it is well known that human mood can
go wrong in two ways: by being too low (depression) but also by being too high
(mania). To date, there isn't any medication that reliably raises the mood of
individuals in normal mood states without subjecting some of those individuals
to severe risk of psychotic mania. Anyone proposing policy reform as to this
issue should be aware of this fact. Here are some reading references for HN
participants who would like to know more about the medical research on mood
disorders:

Depression: Causes and Treatment, 2nd Edition

[http://www.amazon.com/Depression-Treatment-Aaron-T-
Beck/dp/0...](http://www.amazon.com/Depression-Treatment-Aaron-T-
Beck/dp/0812219643)

(a very recent book, by the inventor of cognitive therapy)

or

[http://www.amazon.com/Manic-Depressive-Illness-Disorders-
Rec...](http://www.amazon.com/Manic-Depressive-Illness-Disorders-Recurrent-
Depression/dp/0195135792/)

(a very authoritative textbook with extensive references to primary research
literature).

------
tokenadult
This is an important article following up on the many studies of serotonin-
specific reuptake inhibitors (SSRIs) from the 1990s. It turns out, as usual,
that the drug companies were quick to publish studies favorable to their
products, and slower to publish studies unfavorable to their products. See the
excellent article by Peter Norvig, director of research at Google, on how to
interpret scientific research,

<http://norvig.com/experiment-design.html>

for more on this problem of publication bias.

There is a good body of research now suggesting that most patients with
depressed mood and related symptoms can be helped by cognitive therapy.

<http://www.aafp.org/afp/20060101/83.html>

<http://www.apa.org/divisions/div12/rev_est/cog_depr.html>

For many persons suffering from depression to the degree that it interferes
with work or with family relationships, the best approach will be to combine
medical treatment, possibly with the new first-line drugs (SSRIs) or possibly
with other drugs, and cognitive therapy to learn new patterns of thinking.

------
tlb
Summary: company funded studies claim drugs help X% of the population. More
rigorous federal studies show they might only help 2/3 * X%. The main
difference in the groups was including drug abusers in the federal group.

So what? A drug either helps you or it doesn't. If it helps you, you don't
care what fraction of other people it helps.

The value of X mainly determines how many drugs you'll need to try. If they
work for 50%, you'll have to try 2 drugs on average before finding one that
works. So you want to start with drugs with large values of X, but whether
it's 60% or 40% isn't a huge deal.

Furthermore, clever doctors can often guess right and prescribe different
drugs for different people. Studies that insist on giving the same drug to
everyone with depression are stupid, because they're administered much more
intelligently in the real world.

------
apmee
What's interesting is that antidepressants such as Prozac have a few
established, proven and well-documented side-effects, one of which is orgasm
inhibition:

<http://en.wikipedia.org/wiki/Ssri#Sexual_side_effects>

So I'd imagine that the men who are prescribed antidepressants for things like
premature ejaculation find that they very much do live up to (a different kind
of) hype.

~~~
anigbrowl
From personal experience, I can say that the compulsion (to have sex) remains
but the pleasure doesn't, resulting in a lot of frustration. I prefer the mood
swings. I'm pretty skeptical of this as a therapeutic option for p.e..

------
Zak
I've taken an interest in body chemistry and especially neurotransmitters over
the past year or so. One thing that I've noticed is that every drug I've come
across that acts as a neurotransmitter reuptake inhibitor has bizarre and
highly undesirable side effects not directly related (as far as anybody knows)
to increasing the levels of the neurotransmitter in question. I think very few
people should take drugs in this class, and they should be used as a last
resort, not the primary treatment for any condition.

If it is desirable to raise the level of a given neurotransmitter, I think
supplementation with precursors is a more favorable approach. For treating
depression, it is likely that raising serotonin and dopamine levels
simultaneously will have the desired effect. The appropriate precursors are
5-HTP and levodopa. To aid in production, it may be helpful to take vitamin
B-6. To help cause production in the brain instead of the rest of the body, it
is advisable to take an aromatic L-amino acid decarboxylase inhibitor that
does not cross the blood-brain barrier. EGCG (green tea extract) is effective
for this purpose, and may restore proper brain chemistry on its own.

This is not medical advice, and while all the chemicals I've mentioned are
available as dietary supplements, they have significant biological effects,
including the possibility of harmful side effects. Do your research, and don't
rely on advice from the health food store by itself. Wikipedia is a good
starting point (though, obviously, it shouldn't be the only source you
consult).

~~~
asciilifeform
A good outline of the process:

<http://yarchive.net/med/5-htp.html>

~~~
Zak
This is the first time I've seen the claim that B6 will significantly increase
serotonin production outside the brain when taken in combination with 5-HTP
and an AAAD inhibitor. It certainly does without the AAAD inhibitor, and it
seems possible that it would even with.

This backs up my previous point though - _do your research_ if you're
considering self-medication.

------
gaoshan
Whatever the effect, the withdrawal symptoms associated with addiction to big
brands like Effexor make beginning to take them something one should seriously
consider. I was on Effexor for 2 years and, while it did have a slight
positive net effect on me, in the end weaning myself off of it was difficult
and very uncomfortable. The addiction is so strong that even a doctor
supervised, long term (2 months) withdrawal regimen was a bad experience.

------
pchivers
I think this blog post (linked from the original article) is more interesting
than the article itself:

 _Antidepressants, Placebos and the Failure of Psychiatry_

[http://neuroskeptic.blogspot.com/2009/03/antidepressants-
pla...](http://neuroskeptic.blogspot.com/2009/03/antidepressants-placebos-and-
failure-of.html)

