I put off getting on the meds for at least 15 years longer than I should have done because of stories like this. They have been life changing lot positive for me with almost no downsides.
In addition, I’ve read more than one story like this where the person eventually decides it’s time to get back on the SSRIs after a year or two off.
Experiment, find what works for you, but these articles that are angry at big pharma and describe pills as primarily bad need to be seen very much as just localised experiences.
Have you tried psilocybin mushrooms or DMT? I'd been on meds for years treating depression and anxiety. A few mushroom and DMT experiences have basically cured my depression and anxiety and opened up a whole new way of looking at things.
The great thing about the SSRI I use is verified content (I'm sensitive to drugs..), its standardised (I'm still sensitive to drugs) and it has a high half-life (again, I am very sensitive to drugs and if I forget to take a dose in the morning I will notice it in the afternoon even with a half-life of a few days). With the stuff you're suggesting though, you either don't know what you get, you don't know how strong it is, or you're otherwise experimenting.
An accurate diagnosis was all it took. Its hindsight 20/20 but I wish I never went with the routes which didn't work. I recommend to follow conventional science first, and only if that is fully exhausted follow the path of unconventional science (full with pseudoscience, charlatans, illegal drugs, and what have you -- btw I used psilocybin and DMT when they were legal in my country, and the amount of marihuana and MDMA was well within the decriminalised amount).
TL;DR my advice, follow the scientific route, get professional help, get second opinions. If its costing you your savings even though you don't get immediate effect I have been there as well. I know that sucks, but it'll get you further than the dark route I sketched above.
With regards to those drugs parent mentioned lets wait till there's scientific consensus on these.
Plenty (most?) people take psychedelics without any kind of therapeutic or constructive intention -- they take them to party, to escape, as an antidote for boredom, etc. It's not surprising that such use of these powerful substances could have undesirable or even very negative effects -- though sometimes even such arguably reckless use still produces positive results.
Use of psychedelics in therapeutic and healing contexts tends to be very different. The intention tends to be very different, with a focus on healing or on a specific illness, symptom, or problem that the individual suffers from. There is often serious preparation for the journey, ranging from ways of purifying oneself (for psychedelic use in shamanic or other sacred contexts), to sessions of therapy (when this has been done in Western medical contexts).
The actual trips themselves also tend to be handled quite differently in healing/therapeutic contexts from recreational ones. In recreational contexts, people often do it at parties, with the lights on, or maybe watching movies, or maybe sometimes outside in nature. In therapeutic/healing context, the lights tend to be very low or off, sometimes blindfolds are used, and the focus internal. Music is often carefully selected to guide the journey. Sometimes people are asked to look at photos of loved one they've brought with them for this purpose. If things go wrong, trained support is available, and instructions are given on how to the experience in a constructive way, while in recreational settings the support is minimal and usually untrained, if it exists at all.
After the experience, the recreational user is usually on their own in terms of integrating and making sense of the experience, while in medical contexts there are often followup therapy sessions with trained professionals who can help in making sense of and constructively using whatever was uncovered during the trip, and perhaps the scheduling of further experiences with modified dosage, if needed.
I have no idea how your own psychedelic experiences were, but if they were more of the recreational kind, I am not very surprised that you didn't get much out of them.
The usage of drugs (recreational or not) without them being prescribed and without a trained, licensed professional guiding you is indeed something different than recreational usage for which the drugs I mentioned (psilocybin, MDMA, marihuana, DMT) and A.muscaria are not licensed for anywhere AFAIK.
The recreational drug usage of psilocybin was, for me, almost exclusively done in a safe, private setting though without bright light and with a careful choice of music. Because otherwise it hurts. For DMT and A.muscaria, it was exclusively done in such setting as well. I can guarantee you my focus was inward however it cannot be compared to a licensed, educated babysitter who's getting paid.
Like you said, people are different, the thing that works for one person doesn't necessarily need to be working for others. Antidepressants and other meds saved my life!
I was off medication for about 5 years before another bad depressive episode occurred. I was given Zoloft and that sent me into a noticeable hypomanic episode (3 days of being awake, productive and partially agitated). I was seeing a nurse practitioner who was fantastic. Eventually we settled on lamotrigine, which I've been on for about 4-5 years with no real issues. I've had 2 minor bouts of depression in the winter since starting on it. No manic episodes. It's really a bitch of a condition to treat.
> I'm wondering how long it took you to get diagnosed as bipolar 2, and who diagnosed it - GP, psych?
I think I can remember, that I've been experiencing these mood fluctuations since I was 12 years old (7th grade in school). I have never been consulted a psychiatrist or psychologist or any form of therapy till when I was 17 years old when it went quite severe, I went psychotic with anxiety and depression when I was in high school. My parents had figured out somehow and took me to a psychiatrist. So, coming to the point, I consulted him for some 2 years and he diagnosed me as bipolar 2. And I've been on and off on medications for the next 5 years then somehow I started taking the meds continuously for the last 4 years due to too much suffering. Now I'm 27, though I wouldn't say I'm too optimistic about life and people, somehow I'm moving on with day-to-day activities and finding my joy in it now and then.
I said, medications saved my life, because through that I can be able to function on day-to-day activities. People helped and some are still helping me absolutely!
> They're always interspersed with really good days, maybe too good -- heaps of planning and ideas, unbridled optimism etc. It's hard to know what's considered to be the baseline for normal mood fluctuations.
Oh, my friend! This is the hardest part for me to understand really which is the emotional threshold and where will it lead me to. I really don't know, sorry!
In other words, brushing this aside as "just a bunch of individuals" isn't useful, nor is it satisfying anyone's intellectual curiosity.
Psychiatric medications, in many cases, do genuinely affect different people differently. This has been well known for a long time. It also contributes to the contrast between anecdotal clinical experience and what are often dismal statistical performances.
The difficulty is with people who feel that they have a grievance with the pharmaceutical companies and the medications themselves, when they actually have a grievance with the doctors who directed their care.
If it gets one person like me who was under the impression that SSRIs make you a zombie, to try them, then it’s useful.
If anything, we just need to spend a bit more time talking to folks about the possible side effects of the medications.
Aside: my understanding is that aspirin is no longer recommended (in mainstream medecine [in the UK]) to be used in a preventative way.
a) not a choice they personally made (coercion by the school system or authorities or parents).
b) they were lied to about the effects and side effects.
c) they were prescribed 'off-label' which means essentially with no proven efficacy.
When you say "Experiment, find what works for you" keep in mind how offensive that is to people who feel they were lied/coerced into a taking drugs that in some cases ruined their lives.
There are people who were either medicated at a young age or forced to take medication through legal proceedings. Of those, most will have experienced the same hit-or-miss phenomenon with psychiatric medication. In some cases, however, this means that they were forced to take medications that had debilitating side-effects or didn't particularly work, and experienced serious stress trauma due to their ongoing helplessness in the situation.
I do not expect them to be any less capable than anyone else, as a result, of understanding that other people are not them. I do not expect them to be offended when other people describe experiences that are not theirs.
You're responding to the advice of someone who has taken medications voluntarily and had control over the process; this person is writing in response to an article by a man who, for all his bad experiences, was ALSO taking medications voluntarily.
The statement that you single out as objectionable is actually nearly universal advice, and reflects my own experience with medications and mental health problems.
If your comments about "how offensive that is" are based in your own experience as someone who was coercively medicated, I would be interested in hearing an explanation of why you find them objectionable. If they are not, however, I seriously question the value of your interjection into the conversation.
I am attempting to be gentle and moderate in my response and I apologize if it seems harsh to you.
Some off label uses have little to no research behind them, but some are well studied.
Right, like suggesting people find employment is offensive to people who have experienced slavery.
I also have plenty of rage at big pharma, but that’s more around enabling bad therapists to prescribe medicine without providing the appropriate support. They obviously have every incentive to make sure that anyone who sees a psychiatrist has some medicine that could apply.
This is kind of my point, though—if in my case I do NOT have a treatable chemical imbalance, if the medication is certainly not successful, is there any good way to tell?
Consider the possibility that you have had bad doctors diagnosing and prescribing for you. Also, there are a lot of therapists that don't (can't) prescribe, maybe it's a good idea to seek help in that direction?
My advice to those suffering from depression/anxiety would be to do their research and decide which treatment method they prefer, and to reevaluate once in a while how it is working, keeping in mind that it's very easy to get into a 'bubble' and discard or discredit potential treatment options. No one, no matter how smart, is able to overcome biased thinking.
In my opinion, there are only a few options that have substantial evidence going for them (by the so-called mainstream science): various SSRIs, combinations and uncommon antidepressants, cognitive-behavior therapy and mindfulness-based therapy. One should balance exploitation (taking whatever one thinks works better at a given moment) and exploration (taking one option that one hasn't tried yet) to maximize the chances of successful treatment.
However, I largely agree with what you are saying, everyone is going to have different reactions to these medicines. They're all "dirty" (note that SSRIs are far more specific in effects than previous generations of antidepressants) in terms of the vast number of effects neurotransmitters have in our brain, so it's understandable that they wouldn't work the same for everyone.
I still go around evangelising them, because I just can't bear to imagine all the people who get put off by the (horrible) start and horror stories, and live in purgatory for years with no light at the end of the tunnel. Because, as far as I can see, side-effects usually just mean the dosage is wrong, or the drug-combo is wrong.
Took me about nine months to wean off venlaflaxine, started the Prozac bridge in the middle and grateful that I eventually used the bridge. Feeling better now.
Good luck to you.
It is going to take effort, either way. There's no magic stick which can be waved to fix the issues at hand.
Best wishes for the future.
Obviously, starting and stopping drugs is always rough, but I have tried living without them, and I see no benefits. You do generally get side-effects to some degree (I have very dry skin at the moment) - but if you have even the most trivial depression, you'll probably find you prefer them to even a light episode. Also, they aren't a silver bullet. I still have depressive days, from time to time - but the difference is, it's not my life anymore. I can hold down jobs, have relationships, etc.
While these anecdotes may be of value to the storyteller, they are at best worthless if you are serious about understanding your options in mental health. Evidence-based psychiatry is messy, but good people are working hard to build credible evidence, and not just for pills. "Everything is biased by pharma money" is often said by people on the sidelines. Psychiatric services researchers know better.
Interested in meditation vs medication for depression? Start with a systematic review in a reputable journal, like this: https://goo.gl/yN1asm
I also want to point out that the author of that book she speaks highly of also happened to be the Presiden of the publication. I think not mentioning this fact make the article even less credible.
We're in some wacky second generation New Age where everything illogical is the the obvious solution, just for the sake of breaking with the old.
There's really many people for whom literally no amount of talking, meditation or working out (Internet's favourites) will help. Yes, for them, before they can even start thinking about successful therapy (etc.), the chemical imbalance is so strong they need to bring their bodies to the baseline (or close to it).
Again, militantly opposing SSRIs creates very dangerous situation where people in need can end up getting hurt or dead.
The problem with SSRIs isn't that they can't be useful, it's that the medical industry is full of people who don't seem to know how to use them. They just wanted to throw a pill at the problem and get me out of their office as fast as they could to extract maximum profit out of my visits.
But that's me. What works for me may not work for you. Unfortunately, a lot of it is trail and error, along with a lot of hard work, to figure out what is the best treatment for each individual. It sucks that this is the case.
At I wrote once upon a time: "There is no silver bullet. Pragmatism trumps opinion. If, and I stress, if what you are doing is working for you, then I wish you good fortune, and would never tell you you're doing it the wrong way."
For every story of someone successfully discontinuing psychoactive there is one that ends in disaster.
It appears to be about 11% in the US, 7% in the UK. So, 63% more in the US, but still a reasonably small fraction of the population. Or, if 11% is sizable, so is 7%.
The question is how many suffer depression without medication, and how many remain on antidepressants after recovering, as an insurance policy. Is there less suffering in Korea? Or more stigma against using antidepressant drugs?
One example of a cause that's not just 'you might have depression' is 'you might be transgender'. One of the most common experiences of trans women is severely suppressed emotions prior to recognizing their dysphoria and before HRT. Some of my favorite things to read on the internet are stories from trans women about the first time they cried (and then usually cried again because they were so happy about it), the first time they laughed uncontrollably, or the first time they felt passion/anger. Super hartwarming stuff.
Also your own sources contradict the claim "Autistic people were never thought to lack emotions".
I'm lucky to be alive really. I try to remember all this suffering at the hands of doctors and the pharma industry that could have been avoided. I will have trust a so called mental health professional again, especially if they are drug pushers. The conflict of interest was readily apparent throughout the whole ordeal both when taking antidepressants and benzodiazepines. It's funny how we demonize some drug dealers while having insurance coverage for others. And all this without a single shred of proof that these medicines work, that there is even such a thing as a chemical imbalance. Because there isn't. If this is what mental health doctors call facts, the entire establishment has failed and derailed into nothing more than making humongous profits from getting people addicted to the drugs they push. It's fucking disgusting.
Depression treatment doesn't depend on "chemical imbalance" as an explanation either. Research on whether antidepressants work proceeds alongside research on why they work, if they do--usually studies on the efficacy of drugs are completely independent of mechanism. They study clinical outcomes, not neurochemical or larger structural brain issues.
So even if we had no idea why antidepressants (potentially) work, we could still know that they do work based on clinical outcomes. And it's not exactly true that we have no clue at all. The past 20 or so years the monoamine hypothesis hasn't been the main avenue of research into the neurobiology of depression. These days, it's at best considered one possible factor, not the defining and only factor. There's a lot of research into the structural changes that follow depression and recovery. For instance it's now known that serotonin helps regulate the expression of BDNF, which in turn regulates the growth and repair of brain cells and synapses. So it may well be that serotonin triggers large-scale "repairs" in the brain in areas related to emotional processing, such as the amygdala. Here you can see that the focus isn't so much on individual levels of "chemicals" in the brain as on the structure of the brain and how different natural and exogenous factors affect that.
all over the world, terapies works better than antidepressants, with infinitely less undesirable side effects for patient and society. yet in the US it is very common to treat depression (and many other conditions) with drugs alone.
arguments against drugs is not favor of "don't do anything". that argument would be extremely dumb.
just to give some perspective on how badly interpreted the data is in your argument: brain-splitting surgery, which is still used for epilepsy, also shows a cure for several other conditions, yet nowadays you would be a criminal for even suggesting it for things it was widely used 20 years ago.
I'm really reluctant to get into any further discussion though because it seems like you're arguing against things I never said, and bringing up irrelevant, but extremely invasive and side-effect prone procedures like hemispherectomy as if that proves that data about antidepressants is bunk, which is just a complete non sequitur. It would be like bringing up bloodletting or lobotomy as if that proves that the data about modern vaccines NOT causing autism is bunk. Just a complete logical disconnect.
The sudden flood of emotions has been weird, but familiar. I can't imagine going decades without.
I find it is completely the opposite for emotions with anti-depressants. They don't suppress them but allow me to feel a wider range than just null, fear, anger, and despair. There also are some therapeutic components as well and they aren't a panacea. For one I have become more outspoken as I find repressing my emotions is a depression trigger.
I recall that melancholia was a real diagnosis a long time ago.
My personal view is that in some cases physical exercise can be helpful. I have family that are on Wellbutrin etc., and others that studiously avoid any drugs.
Nefazodone is available as 50 mg, 100 mg, 150 mg, 200 mg, and 250 mg tablets for oral ingestion.
Why would she take such a big dosage of antidepressants? Could she try to reduce the dosage?
But I recognize that for others it can be crucially necessary.
This may be the case, and there may be corroborative evidence for such a conclusion that we are not told about.
But as presented, it's just a set of circumstances, presumably correlated. If both parents suffered depression, author might reasonably be supposed to have a strong genetic predisposition.
> Shortly after I started seeing him, my new doctor had me read the book Anatomy of an Epidemic by Robert Whitaker.
Robert Whitaker's theses in that book have repeatedly been scientifically disproven. It's anti-science drivel.
> The pharmaceutical industry also says that mental illness represents a physical problem with the brain that needs to be fixed. There are no studies that prove that this is true.
This statement is untrue. Literally three seconds of googling showed me this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4471964/
Which basically says that when we deplete the body of certain neurotransmitters, people get depressed. That sounds like a pretty clear statement that there are biological processes at play in mental illness.
"The serotonin hypothesis of depression has not been clearly substantiated. Indeed, dogged by unreliable clinical biochemical findings and the difficulty of relating changes in serotonin activity to mood state, the serotonin hypothesis eventually achieved “conspiracy theory” status, whose avowed purpose was to enable industry to market selective serotonin reuptake inhibitors (SSRIs) to a gullible public."
Anything, drug or non-drug, that has any effect on the senses will have roughly the same effect. E.g. hot therapy, cold therapy, meditation, float therapy, aromatherapy, massage, acupuncture, etc. There's nothing at all special about serotonin, it just happens to sit at the intersection of several different areas of pseudoscience and a lot of marketing dollars. The research that lead to the monoamine hypothesis in the first place was faked.
Like other neurotransmitters, serotonin is specifically synthesized in a specific brain region, the raphe nuclei. (Dopamine is from the substantia nigra)
Brain circuits have lots of overlap but they definitely have specialization. Case in point, genes associated with serotonin processing have SNPs for depression-like illnesses.
Sapolsky gives one of the better lectures on the specific features associated with abnormal serotonin, dopamine, or neuropinephrine signaling, and their associated symptomology. Ultimately it's the job of the psychiatrist to figure out what's out of balance based on behavior.
"Now, if your baby dies at 10am, your doctor can diagnose you with a mental illness at 10.01am and start drugging you straight away."
While this is meant as an attack on the modern absence of the “grief exception”, where grief reactions are used to rule out depressive symptoms, it’s at best a staggering exaggeration, at worst an active fabrication to support a narrative. Grief is complex and the medical community is still not agreed on how to deal with it, but the idea that you can be diagnosed with a mental health issue after showing symptoms for one minute is ludicrous. People typically require weeks of symptoms to be officially diagnosed, to suggest otherwise can only damage the perception of medical professionals.
It's a nuanced critique that's worth reading - it's in agreement with a good deal of what Hari writes rather than just being a hatchet job. My take from it (as someone with an MA Honours in experimental psychology and a neuroscience MSc) is that in those parts of the book Hari is criticising outdated practices and opinions in the field that hardly exist any more, if at all.
Having said that, the pharmaceutical industry does have a lot to answer for...
The book doesn't even have a thesis. Good job not even reading enough of the Wikipedia article to plausibly pretend to have read it.
Also, did you even read the link you posted? It says exactly the opposite of what you're claiming it says. The conclusion is literally, "Simple biochemical theories that link low levels of serotonin with depressed mood are no longer tenable."
Your statement represents a logical fallacy. I can also prove that depleting a car of gasoline causes it not to run, but fixing the fuel situation won't make all non-running cars functional. Just look at the more recent research that shows a connection between our microbiome and mood disorders to see that depression is often far more complex than the simple neurotransmitter model favored by big pharma.
The causes of depression are varied and what works for some won't work for others. As someone else that lost a decade of my life to the numbness of anti-depressants, I've seen first-hand the psychiatric industry's strong preference for directing patients towards medication-based approaches. Taking medication was the worst mistake I've ever made in my life and I believe that more people need to hear messages like the one in this article. In particular, I very much wish that I, like the woman in the article, had started meditation much earlier as it has become, by far, the most effective thing I've done to deal with my depression.
For many people this isn't an option - medication is required to even get them to a stable enough baseline for other treatment options to be effective.
Views like this are very unhelpful and help to perpetuate shame, which can prevent people that need help from seeking it because the treatment doesn't line up with the views, morals, and general opinions of the people around them.
No, my view is a hard-earned perspective that I've gained through personally having the system fail me. I lost a decade of my life to the medication-first mentality and I resent your implication that trying to help others avoid the same outcome is in any way dangerous.
I do concede that drugs work for some people, but views like yours that lead to over-medication are what is truly dangerous. What we need is well-rounded advice that allows patients to make informed decisions about their road to recovery. Medication is one possible path, but it's not the only path and it's not without it's downsides. It can ruin lives just as much as it can save lives, and people need to know that. It permanently alters brain chemistry, so it's an irrevocable choice, unlike almost all other approaches.
I resent bad medical advice offered on a public forum. An absolute position in anything is always bad advice when the facts are not known. Parents let their children down, I'm not suddenly going to eschew all parenting because of it.
> What we need is well-rounded advice that allows patients to make informed decisions about their road to recovery. Medication is one possible path, but it's not the only path and it's not without it's downsides.
I think we're actually on the same page, then. Recovery is complicated and we all need to do our best supporting everyone in whatever unique journey leads to their recovery. Medication and therapy (along with family, meditation etc.) are all critical to the process and you don't always get the choice of one without the other. I'm sorry that medication and mental health professionals let you down.
I grew up a little differently than most. Drug-dealing parents, foster care, hoarding, crime & violence, and much worse. I escaped it during the late 90s because I learned to do things other people couldn't (build websites), but I brought my trauma with me as an adult until - as the VP of a start-up that raised over $300MM - lost my shit and then disappeared for 2 years on a "spiritual journey" that included seeing over three dozen mental health professionals.
If it hadn't been for a chance recreational encounter with MDMA the day before my dad died of a sudden heart attack (which precipitated me losing my shit), I would have withdrew into drugs & alcohol instead of seeking the help I needed. I'm especially glad I didn't listen to all the people around me that offered bad advice ("you're fine, look how successful you are") because they couldn't possibly have known the extent of my problems.
Maybe you'd feel more at home at reddit.
With SSRIs it takes weeks to see an effect, but Serotonin levels are elevated within days why the delay? (There are theories, but all point to Serotonin as a secondary effect)
Also, antidepressants work in a minority of people (20%-25%), but Serotonin levels are effected in almost all users.
This has been shown in several studies that use MRI before and after treatment, and explains the lag time.
Depression spirals and is self-perpetuating, so it has a nasty tendency to stick, but assuming that all depression only stems from a simple chemical imbalance, with no correlation to anyone’s life situation (again, past or presence) is very simplistic.
I’m not arguing for the article, but against the opposite view that all depression is rooted in chemical instead of psychological causes.
It wasn't that long ago that people thought cancer patients were contagious.
You can just as well ask the other way around, what kind of world and experience is leading to such a detrimental biochemical mapping. The woman in the article describes this herself, she was called fat and ugly by her father throughout childhood. This has to do with social status, not brain chemistry. I find it quite frankly disturbing that the solution to such a learned insecurity should be just drugs.
Well perhaps because it works?
> We identified 28 552 citations and of these included 522 trials comprising 116 477 participants. In terms of efficacy, all antidepressants were more effective than placebo, with ORs ranging between 2·13 (95% credible interval [CrI] 1·89–2·41) for amitriptyline and 1·37 (1·16–1·63) for reboxetine.
Of course there's issues with publication bias, but this is the best evidence we have to work with. Psychotherapy ("talking") also works, and so the teaching I've received tells me to prescribe both in tandem, although the drugs "alone" do help. I'm a student doctor.
> I find it quite frankly disturbing that the solution to such a learned insecurity should be just drugs.
I think your implicit suggestion here is that the correct treatment is unlearning. I suggest that this is not always possible. The plausible mechanism is that damage during development might result in "built in" changes that can't be talked away.
Comparing them to placebo isn't appropriate, you need to compare them with an active placebo and only look at studies that continue longer than two years. Of which there are all of like 2 studies.
Active placebos are designed to cause detriment to the patient - to cause side effects to convince them they're not on the placebo. Getting ethics approval to do randomised trials in depressed patients is hard enough without harming your control group.
Patients on active placebos have reduced depression symptoms as compared with patients on non-active placebos.
Who besides you is saying "just drugs?" From what I've read, the greatest success comes from drugs and therapy.
A broken leg is way less complicated than the synapses that form your perception of yourself, and far better understood. You can't really conflate the two without committing a logical fallacy. Treating the broken leg and the brain changes as identical in complexity is akin to treating the construction of a rivet the same as the construction of a Boeing 737.
The fact is that you can change, and you can feel better, but you also have to put in the work to change yourself. It's the hardest thing you will ever do if you grew up in a dysfunctional family because it requires you to deny years of your experience in favor of the received wisdom of how the world really works, and not everyone can do this. But if you do the work the reward in the end is that you're not permanently crippled by addiction to psychiatric medication.
Change is really fucking hard and there's no silver bullet solution.
That being said, I would not be surprised if there is truth to what you said about that book.
This is an unscientific and inaccurate. The placebo and nocebo affects are real with actual health effects. Sometimes drugs don't make it to market because they have positive effects less effective than placebo.
Both compounds work with the serotonin system in the brain. I’m wouldn’t be surprised if SSRIs had a similar caveat, where life circumstances and personal narrative are another factor in the effectiveness of the drugs.
Another lesson from these new drugs is that the results are delivered and pretty durable even long after the drugs leave the patient, which has interesting implications as to how it induces these changes (again not strictly pharmacological).
Which is all to say that science is still learning more, and I hope will bridge the huge gap between pharmacology and psychology.
It's not reproducible because it's not medicine.
Let's acknowledge that my question also assumed the most favorable scenario for your argument. Most objective observers would agree there is a nonzero chance that the treatment was not totally based on placebo effect, but rather on undiscovered science. You do understand that, right? That not all science has been discovered, there are many things we do not know or understand, and yet are true. If we cling to what has been proven and refute anything else, we freeze all progress. I can think of nothing less scientific.
A more nuanced modern understanding that we have now is that the increased levels of neurotransmitters in the brain signal the neurons to form more synapses, and this increase in grey matter in key brain regions, over months, is what has been repeatedly shown to improve the condition.
Specifically, serotonin-induced synaptic plasticity changes in the anterior cingulate and orbital prefrontal cortex allow the old brain (limbic emotional areas) and new brain (neocortex) to communicate better.
The brain and physical-mental-emotional-spiritual body are far more complex than a single physical lever being pulled and a single affect happening; neurotransmitters are the transaction layer, the currency, the current/flow itself.
Likewise, there isn't only a single mechanism or cause of dis-function or dis-ease - the only possibility isn't simply because of a lack of or too many neurotransmitters needing a counterbalance; this isn't to say people some people won't experience benefit from something as simple/basic, however to dismiss other possibilities is naive, and likewise if they can so simply be helped - I'd be curious to see what simple situational-environmental impact has lead them to feeling depressed or lethargic, and whether something like a yoga practice (up to practicing all 7 branches of yoga) would have a greater impact short-term and long-term -- vs. keeping someone in a holding pattern or making them worse; the problem here then is on a societal-economic level, whereby in the short-term it's cheaper to give someone $10 worth of pills every month vs. getting them into a routine with yoga or other; it's also lazy and an extension of how we still as a society treat people - and don't take care of everyone, and that you're lucky/fortunate if you are born into a healthy (physically-mentally-emotionally-spiritually) family with adequate supports and finances, reducing your chances of being negatively impacted by the stagnant, the status quo.
SSRIs/SSNRI's themselves force a change in function by being re-uptake inhibitors, meaning they cause more neurotransmitter to linger in an area - and this doesn't seem to be evenly distributed and/or there is more going on with coping mechanisms, otherwise you could 100% predict the behaviour changes via an increase or decrease. As the author points out, there is relatively short period of testing required for these medications - and they are heavily controlled for vs. when they hit the wild for distribution [and the list of problems there is far too long for me to get into here].
There can be coping mechanisms, blocks, setup by other functions of the brain - purposefully - as a way to protect oneself from something (the ego mind, for survival purposes), e.g. insufferable conditions/experience and overwhelm that the brain/mind can't handle, and so it goes on lock-down. These drugs/medications, from my own experience, and observations of/with others - if it is such a condition with something underlying/suppression/repression going on, protecting oneself from a variety of potential things (injury from physical pain, or other).
Did you know there's a higher rate of suicide (and suicide ideation) if you take certain medications vs. placebo? This can tie into the theory that these medications force changes against self-protective mechanisms. Likewise, it shouldn't be difficult or a stretch to understand someone could be protecting themselves (from consequences), by protecting others, by blocking overwhelming anger and impulses that they learned to suppress/repress to hurt others - resulting in them hurting others, and perhaps in super violent/extreme ways due to not having coping mechanisms blocking them from doing so.
Contrast drugs like SSRIs (et al) with what I will call medicines - like Ayahuasca, psilocybin (magic mushrooms), or MDMA (reference to recent MAPS.org recent study) - that instead of forcing change in mechanism by inhibiting, it floods the brain with higher levels of serotonin that the brain normally doesn't release or have on its own (or mimics closely the serotonin transmitter). Likewise with Ayahuasca ceremonies or MDMA-assisted psychotherapy (or recreational-therapeutic MDMA-assisted dance party with friends you trust in a good environment), there is a contextual setting that will make these safer or more impactful - allowing positive and social pathways to open up (or language pathways relating to talking) - vs. a doctor spending a very short period with them out of context of the life of the person, prescribing an SSRI or other to them and putting them back into their daily life.
I was severely fucked up in different ways because of doctors prescribing different SSRIs (and the like) starting at the age of 17, and the peak/tipping point at 21-22 after more unexpected (or unknown at the time) side-effects - is when I realized I can't trust those doctors, nor those medications, because the industry doesn't actually have a proper fucking clue about them, and it's all an experiment on each individual. The medications had a cascade and accumulative affect on symptoms/problems, making me permanently worse until I could start solving the underlying problems - which ended up being in part food related, in part hearing related, in part from underlying physical injuries I had that I didn't realize I had - and I'm simplifying, it's more complex than that - and hard to believe on the surface, which is why I am writing a book to explain as much detail as possible.
I'm 35 now and only recently had significant healing of physical injury that was an underlying problem since I was a child, through stem cell injections, and will return to the US soon for another treatment to heal more of the remaining physical pain.
I hope you can appreciate your literal "three seconds of Googling" allowing you to come to a conclusion is less trustworthy (on the surface anyhow) than someone who experienced how anti-depressant medications impacted them for 24 years - and then who considers that they had to recover from that experience. I don't disagree that it is complex - and therefore difficult to understand - especially because you have the interplay of what depression, anxiety, and other, can cause behaviourally in someone without the various impact and side-effects of medications.
It looks part of her recovery was finding people she could start building trust to, who then helped her learn about emotions, meditation, and other self-awareness and social-relationship building practices. She also connected to her "inner guide"(or God, whatever she feels most comfortable or comforted calling it) which could perhaps be labeled as intuition, or as an autonomous nervous system working together well on its own without logical mind being engaged; enough learning happened via mind and analysis, to start trusting herself autonomously (trust is or is a part of autonomy), allowing the body to relax, allowing the mind to relax - as there's a feedback loop between the two: the more physical stress - the more mental stress, the more mental stress - the more physical stress.
Linking back to MDMA-assisted psychotherapy gaining benefit by tapping into language and memory pathways of post-traumatic experiences, there are other talk therapies like Innerchild Regression therapy which, in part, explores similarly early childhood relationships and learning to connect or reconnect to those - and understand them better, to process emotion that you may not have been able to before, due to an unsafe environment at the time - allowing those experiences/unhealed emotional wounds, to now start to come up and be healed-processed/learned from.
Anyway, I'm writing a book to share my full story, my experiences with healthcare, the problems I encountered and explain the solutions I propose. It will take me awhile. It will fill in a lot of details here to what I mentioned, perhaps making it easier to understand - or believe. I'm also beginning to put together applications for different stages of research, to be able to reference hard evidence relating to a protocol I've developed based on my understandings and experiences healing, recovering.
I’m currently on SSRIs and they actually do help me sleep, but it’s not really helping with the underlying problems.
As for SSRIs they are transformative for some people, and science doesn’t really understand the mechanism. They seem to think that there are secondary effects that are the reasons for the effectiveness of SSRIs on some people.
However, doctors seems to be too quick to prescribe SSRIs. I’ve read horror stories about people with some sort of iron-ferretin deficiency as their underlying problem and they were prescribed SSRIs instead of getting a simple iron test which would have pinpointed the cause of the symptoms.
These days you really need to do your own research and bring up all these points to your doctor.
I can say that there are non-medicative practices, along with diagnostic tools available to show concrete evidence relating to showing problems, that are transformative. The difficulty can be that if certain issues are not dealt with in parallel, or in a proper order may prevent/limit/block another therapy/practice/treatment from being beneficial/giving permanent improvement - that otherwise would be beneficial.
1) There's removing agitations from your physical body - in part, starting by getting a food sensitivity test (food panel) to check for up 184 foods that your body may be negatively responding to; also cutting out certain foods that may not show on these tests but may greatly impact you - like do you eat wheat or potato (sweet potato is fine)? Likewise, vitamin D3 liquid form is also good to take, as most of us are lacking it - 5000 to 8000 UI is good for most people, taking an initial 15-20k UI per day for a few days to load up; vitamin D3 is a steroid.
2) You/everyone should also get their hearing checked for imbalances, which can be used as a diagnostic tool to know what is going on; the brain/mind is a system of homeostasis, so it should be able to balance out to hear frequencies at even decibel levels in both ears. There's a sound therapy you can then do to unlock these behaviours, developmental blocks/delays - and resulting imbalances in sensory systems and how that can impact a person and their thinking/behaviours; this can also unlock and allow other sensory to balance out, that may be hyper- or hypo-sensitive. I know on the surface it can be difficult to believe that a sound therapy (listening to specially modified sound/the way its output) could be "magical" or so transformative, however I have my own personal experiences with such - and observing others rapid improvements. There is research as well.
3) Likewise, there's breaking down any ego mind coping mechanisms that may have solidified deeply over your lifetime - since childhood that could be causing a depressed state, or anxious, or other; ego dissolution is another term being used for this, which can be achieved in a few ways, some ways less or more rapid than others - like Ayahuasca ceremonies.
Relating specifically to sleep, it could be any amount of the above 3 influencing/impacting it enough to cause problems, or it could something in your living situation and environment as well - consumption of caffeine (stimulant) or alcohol/weed (depressants), it could be too much noise (or you're hypersensitive currently) - it could be a buildup of emotional . It could be too much energy built-up by not getting enough movement during the day or a few hours before bed.
It could be a weight issue as well or something like sleep apnea (which could be caused by or worsened by any of the above). It could be that you're trying to fall asleep when your body doesn't naturally want you to fall asleep, and then pressures from your day-to-day life of when you're expected/expecting to be awake are the problem/difficulty; the Ayurvedic clock can be interesting to look into to learn about these cycles better.
Also to point out that different medications may interfere with allowing a system to reach its normal, non-dis-eased and balanced state, once trying these treatments/practices. For Ayahuasca ceremonies for example, you shouldn't be on certain medications for at least 24-48 hours before the ceremony - different shamans have different guidelines they follow - otherwise it can be unsafe. If you eat wheat regularly, you may actually be addicted to wheat, which may be difficult to stop eating - otherwise you'll get more and more agitated because of withdrawal (another specific reason why you may have trouble falling asleep); Ayahuasca is showing to be good at breaking addictions.
Regarding your last sentence, from my experience the majority of doctors are terrible at critical thinking. I realized they are selected primarily for their memorization skills via testing, and not critical thinking. Indoctrination of old, stagnant knowledge via current academic systems, and human error are the crux of the problem.
I realized I didn't actually mention underlying problems I encountered. As I child I would have been considered to have Asperger's - however I never was formally diagnosed, it wasn't really a thing back then. I was hypersensitive - though I didn't realize it at the time - it was only after medications caused me to become severely hypersensitive to sound (hyperacusis) that I realized sound was an issue. It turned out I had developed a hearing imbalance due to painful ear infections when I was a child - primarily in my right ear; it's not the hearing imbalance itself that is the problem, it's a tool to show signs of function. Likewise, when I was 5 or 6 years old I had an painful injury to my right big toe pad - which later on I realized my ego mind had created a coping mechanism to block me from that pain and/or from the emotion of the pain, and then my development continued abnormally with that block; until I did a number of Ayahuasca ceremonies which broke down my ego mind and its coping mechanism, reintroducing me to intolerable levels of pain from many sources. Through trying different healing practices I had been doing elimination diets relating to food, and eventually did food sensitivity testing, allowing me to refine and remove what foods I could eat - and by removing all of those foods, I would feel much better, and then introducing just one again allowed the contrast for me to realize just how much pain it was causing me in my GI tract. Acupuncture was another way to get energy flowing again properly. Yoga was another way getting my body healthier, of developing self-awareness by putting pressure on the systems that signal pain and such. I'm probably missing a few things, a bit tired now from writing. I should include the tipping point related to physical pain, and that lead me eventually to exploring and finding Ayahuasca ceremonies, is that 5+ years ago - the pain from LASIK eye surgery really fucked up my nervous system: a strong tension started down the right side of my neck, and my balance on the right side became notably worse; I had been practicing yoga for 5 or 6 years by that point, so I was very familiar with single-legged balance postures.
As for the hearing test,do I just request my doctor for one?
I’ve tried lots of accupuncture but never felt true relief. I went to some of the best accouncturists but no real relief.
Most of my anxiety seems to be somatic in form. My mind is hyper aware of sensations in my body and I get a lot of interrupting anxious thoughts that break my train of thought and cause an anxious symptoms.
The main somatic symptom is pressure on my chest which with meditation I’m able to dissolve a little a bit but can never fully open up, it takes too much time and patience and the sensations are too strong. There are also sensations on the left side of my head connect to the chest— mri was negative.
I think intense exercise might open up my chest but I don’t want to do too much damage to my knees.
I’ve started stretching everyday and hoping the head to kneees , hand to floor stretch might open up the chest more.
It feels like when I stretching, some of emotional tension in my body gets released. I really need to push myself a little more though.
You can send me info at firstname.lastname@example.org
We can continue the conversation there as well if you like .
Also, do you realize you just gave a very short, one-liner anecdote - "The fact is, for the vast majority of depressed people (including myself), anti-depressants work." - while calling my long post, an anecdote? Interesting to say the least.
I'm curious, if you're open and willing to share, what else you tried relating to helping depression prior to trying medication - and what life circumstances were you in or had happened previously?
a pretty clear statement that there are
biological processes at play in mental illness
I find the article somewhat troubling in that the author seems to imply that antidepressants are a big pharma conspiracy and are difficult to stop. I personally have had side effects - insomnia, sexual dysfunction, the "fog" the author mentions, although I wouldn't describe it as zombie-like. There are other possible side effects as well, like inducing the liver to release enzymes into the blood stream that imitate fatty liver/liver failure in blood tests, significant weight gain etc. However, I have not had all of these on all tablets - on some, yes, on others, nothing at all. Regarding stopping, the worst case was venlafaxine. I've heard people describe the experience as "brain zaps". It feels a little bit like an electric shock in the brain and is fairly unpleasant (this is with tapering down properly under medical supervision). However, on no antidepressant have I ever felt the need to take the tablet, or to take more of it than the prescribed dose and I have never felt taking a lower dose while stopping to be problematic - it does not resemble fighting addiction at all (I've known people who were addicts and for some of them their addiction killed them, so I have some basis to make this comparison).
Ultimately however, taking antidepressants is a trade off between how bad the side effects are (and I stress that in some cases there were none) and the benefit from the tablet (in some cases, none as well) versus the impact the problem (depression/anxiety/...) is having on your day to day life. In my case and I suspect in the author's case as well, at the time I started taking the tablets the benefits outweighed the side effects and allowed me to be a somewhat functioning member of society. By taking antidepressants I was able access other treatments such as CBT and benefit a little from them, as well as hold down a job. Also, it has to be said that when I first started having problems with my disorder I didn't have anywhere near the same emotional maturity or understanding of myself as I do today. I feel that this understanding has a significant effect on my ability to use things like mindfulness and CBT alone, without any other help - I am benefiting far more from it now. I also wonder if the author would have been so successful with meditation if they had used this and only this technique 24 years ago.
I suspect in many cases finding what works takes time and is a process that can't really be avoided. I'm uncomfortable because the author is implying it can be and moreover that antidepressants should always be avoided. I disagree. I'm glad the author found something that helps and I'd also recommend mindfulness, but I feel that sometimes people need help and antidepressants are one option and that people shouldn't discount them based on articles like this - instead they should have a thorough conversation with a medical professional (if necessary, more than one) about their options.
After almost 25 years of taking antidepressants,
I had no emotion left whatsoever. I felt dead and
wanted to be dead.
If you have no emotions, can you still want something? Why would you want to die?
I tend to understand this sentence in a way that means she was suffering. But isn't suffering the same as experiencing negative emotions?
Or is this supposed to mean that she had no good emotions left, only painful ones?
I think what she was saying when she said "no emotion left" is that the amplitude of that wave was nearly zero. The wave didn't go up or down much. When she said, "I want to be dead", she's saying that the the average value is down in the negatives.
there is just endless work, endless things that need to be done to keep yourself alive
and why do you bother when the reward is just more endless days like today? nothing to live for, nothing to care about, no energy to do anything but just sit around watching your body slowly fall apart
fighting against entropy is constant work and actually giving a shit about anything helps give you a reason to put in that work
and by "work" i don't just mean "your day job", I also mean things like "getting out of bed" or "feeding yourself" or "doing anything at all interesting"