Ask HN: Is Wikipedia's antidepressant page objective?

[sirobg]

https://en.wikipedia.org/wiki/Antidepressant

The page contains several positive sentences about antidepressants. 3 random examples:

- Reviews of antidepressants generally find that they benefit adults with depression.

- For children and adolescents, fluvoxamine is effective in treating a range of anxiety disorders. Fluoxetine, sertraline, and paroxetine can also help with managing various forms of anxiety in children and adolescents.

- Unlike social anxiety and PTSD, some TCAs antidepressants, like clomipramine and imipramine, have shown efficacy for panic disorder.

But most of the page feels doubtful, or even against the use of these drugs.

For example, the introduction is really scary in itself. You can read that:

- There is an increased risk of suicidal thinking and behavior when taken by children, adolescents, and young adults.

- Other researchers also conclude that anti-depressants ultimately do more harm than good, indicating that they cause permanent neuronal damage, apoptosis and disrupt numerous adaptive processes regulated by serotonin.

- The placebo effect may account for most or all of the drugs' observed efficacy

And all these points are really poorly counterbalanced.

I think one could argue the page tends to discourage the take of antidepressants.

But still, doctors all over the world are prescribing them.

Is Wikipedia accurate here?

If so, why are doctors prescribing them? I heard a lot of takes gravitating around: "pharmaceutical industry makes a lot of money with them, so they push the use of these drugs", but it seems to conspiracy-theory-ish to be true.

Is Wikipedia inaccurate here?

If so, why? Can we trust Wikipedia objectivity?

[nullindividual]

> Is Wikipedia accurate here?

SSRIs are a crapshoot (<50% respond). I don't know if/how the industry pushes them (they're cheap, no one 'pushes' generics).

Nothing you quoted is incorrect, with possibly the exception of:

- Reviews of antidepressants generally find that they benefit adults with depression.

SSRIs have more recently been shown to be less effective than previously thought.

https://www.nytimes.com/2022/04/21/well/antidepressants-ssri...

> over the course of two years, the changes in quality of life reported by Americans with depression who took antidepressants versus the changes reported by those with the same diagnosis who did not take the medications.

> The paper found no significant differences in the changes in quality of life reported by the two groups, which suggests that antidepressant drugs may not improve long-term quality of life.

SSRIs can also activate Bipolar disorder.

[sirobg → nullindividual]

So if I follow you here, Wikipedia is relatively accurate, correct?

Then in your opinion, why are these medications so widely spread?

Lack of alternative?

[toast0 → sirobg]

People with a problem want a solution to their problem. Even if it's a placebo effect, or reversion to mean, or whatever, having done something and seeing results is empowering. Most of these drugs have some effect on the person, whether or not it's what was intended or if it's helpful, is another story, but you can take the drug, see that it's doing something, and be hopeful that it's doing the right thing.

Other options like talk therapy are labor intensive, inconsistent, and has limited availability. Finding a pill that works for you can also be labor intensive if you have to try a lot of them and titrate the dosage, but if you can, then it's relatively simple to take it on the schedule, and have infrequent follow up visits; doctors who prescribe these drugs also have limited availability, although some primary care doctors will prescribe some of the ones considered to be safer.

[sirobg → toast0]

You definitely got a point.

I think this shows that the problem is mainly that we don't have a good solution to treat anxiety/depression and so on, yet.

It is basically the conclusion of the NYT article shared above.

Here is the paywall free link: https://archive.ph/mNKCH

> If one thing is clear, it’s that we need more careful research on how best to help the more than 16 million Americans who currently suffer from depression

[richardjam73 → sirobg]

Some alternatives are often illegal in many jurisdictions and also are new and don't have as much research behind them. Psilocybin, Ketamine etc.

Some alternatives are greatly intrusive such as ECT.

Therapists are often expensive and there are not enough of them.

Some alternatives are just new and it takes time to roll them out. For example TMS. There are also other new non SSRI drugs as well.

[ambyra]

I don’t think Wikipedia should be used to steer a decision. It just aggregates information on a topic.

Regarding drug use, it’s up to the parents. If the parents are unable to tolerate their child’s behavior, they’re more likely to accept giving their child drugs. If they’re on drugs themselves, they’ll be more likely to give them to their child. If they’re more “hands off” they’re more likely.

Is it better to have a wild, moody, potentially suicidal child or a baked potato? Some parents prefer the baked potato.

[sirobg → ambyra]

If it accurately aggregates information on a topic, it should instead be a great tool to steer a decision, don't you think?

Regarding the opposition between a potentially suicidal child and a baked potato, in fact wiki introduction says that antidepressants could make suicidal behavior even worst:

> There is an increased risk of suicidal thinking and behavior when taken by children, adolescents, and young adults

Also, if a baked potato is the outcome you get from antidepressants, it means that you think doctors behave a bit like the parents in your example, and prefer a potato than a problematic patient in their hands?

I might be naive, but I hope the majority of doctors want to do good and help patients, and do not just use the simplest way _for them_ to get rid of a problematic patient.

[ambyra → sirobg]

It is naive (in the USA, at least); doctors apply standards of care, even if they personally would not recommend them in a certain set of circumstances, to avoid lawsuits and generate income for the hospital. “My daughter killed herself bc she wasn’t prescribed medication/other intervention” (she could have killed herself regardless). A patient may sue a doctor who didn’t perform an unnecessary intervention, just because there is money on the table, and hospitals reward doctors who “perform”.

To avoid unnecessary interventions, you need the advice of a family friend who is also a doctor specializing in that particular field :)

[sirobg → ambyra]

You are most probably right. I was being too European/French centric.

I think here, suing a medical professional is less common. At least generalists, because they don't perform surgeries so their misjudgments/mistakes are probably less impactful and thus less obvious.

It's a bit sad and scary that this is a reality in the healthcare field, but I think you got a point.

The positive side of the story is that if you have a reason to trust the doctor you have in front of you (because he's a friend for example, as you said), you should get a good advice.

On the other hand, if the subject is controversial, like antidepressants seem to be, I suppose you would need several advices from several trusted sources, and in the end you might not even have a clear path forward.

[i8comments]

Wikipedia is generally neutral and objective.

Are you asking if antidepressants are good or if you should take them? Ask a doctor.

[sirobg → i8comments]

> Wikipedia is generally neutral and objective

Based on other answers and the content of this page, I think it's true, but the tone is clearly scarier than this NIH page [1], for example.

> Are you asking if antidepressants are good or if you should take them?

No I'm not.

> Ask a doctor.

Of course I did. And of course the problem is that the subject seems controversial. Not all professionals I asked gave the same answer, and there does not seem to be a clear good choice.

That's why I'm asking if this page is objective: to try to understand if this is rightfully scary or not.

[1] https://www.ncbi.nlm.nih.gov/books/NBK361016/

[andsoitis]

What do health organizations, like the NIH, AMA, and APA (or other, non-American organizations) have to say about antidepressants?

Similar to Wikipedia or divergent?

[sirobg → andsoitis]

https://www.ncbi.nlm.nih.gov/books/NBK361016/

I found this, for example.

Thankfully there is quite an overlap between Wiki's page and this one.

But to me, the tone feels way more reassuring in NIH's page than on the wiki one. There are a lot more positive points/sentences there.