Antidepressants and the Placebo Effect

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Discussion by: Red Dog

Antidepressants and the Placebo Effect

In The Folly of Fools Robert Trivers writes: “Depression seems especially sensitive to the placebo effect. Numerous studies have shown that genuine antidepressants account for about 25 percent of the improvement, while the placebo effect accounts for the remaining 75 percent. Believing you are getting something to help you is more than half the battle. After all, depression is marked by hopelessness, and placebos offer nothing if not hope. I always think about this when I am being given an antidepressant. I am told not to wait for an effect for at least three or four weeks—“it needs to build up.” In other words, expect no direct test of utility anytime soon, and the usual rule of regression to the mean—or, things get better after they have gotten worse—will give you all the evidence you later need. In the meantime, get with the program! The most recent meta-analysis (2010) reveals a striking (and very welcome) fact. Placebos work as well as antidepressants for mild depression, but for severe depression, there is a sharp bifurcation: real medicine shows strong benefits and placebos almost none.”

Trivers, Robert (2011-10-25). The Folly of Fools: The Logic of Deceit and Self-Deception in Human Life (pp. 73-74). Basic Books. Kindle Edition.

Since Trivers wrote this there has been another meta-analysis study, concluding more or less the same thing, that antidepressants work virtually the same as active placebos. (Note: an active placebo is something that has some noticeable side effect or requires some effort to use by the patient)

On the other hand there have been responses to these kinds of studies that cast doubt on the conclusions and methodology:

Study shows antidepressants useless for mild to moderate depression? Not exactly.

and

Do Antidepressants Work? The Effect of Publication Bias

I’ve known some people who swear by antidepressants and others who say they received no benefit from them.

For a change this is a topic where I don’t have a strong opinion. I can see both sides of the argument and I’m curious what other people think; both in terms of other scientific evidence and with personal experience for those who care to share if and how antidepressants did or didn’t work for them.

I will state one opinion up front though: while I’m not sure about the value of antidepressants for any specific individual I do feel that most psychiatrists in the US over prescribe them. It’s their go to drug from what I’ve seen and often based on very minimal amounts of data or patient interaction.

So what do you think? Are antidepressants useful and if so when and why?

125 COMMENTS

    • We’ve fixed that for you now, Red Dog.
      The mods.

      In reply to #1 by Red Dog:

      I messed up the first link in this topic, if you click on it you get a page not found error. Here is a link to that first meta-analysis study that concludes anti-depressants aren’t significantly more effective than active placebos:

      Active placebos versus antidepressants for depression.

  1. I’m totally unconvinced. maybe I don’t understand the condition well enough but to me mild depression relies on so much subjective analysis I don’t know how accurate any figures can realy be.

    my experience with living with someone who was prescribed seroxat was she went from a person suffering depression to a person dependant on seroxat suffering depression. attempts to stop made her worse, it turned out known side effects included deprression and suicidal tendencies and her doctor warned coming off them could make things worse. would you consider such an outcome if it were a drug for a life threatening situation? a drug that might shrink a tumour but then again might make it bigger and certainly will if you stop taking it?

    I have never personally taken meds for depression so can’t say for sure but I still think depression is far too complex a condition to look to drugs.

    diagnostics for example, presumibly it’s not a case of “feeling down” but where a condition impacts day to day life. a drug that helps you get out of bed and get to work may count as effective. the fact you do this may help you feel better.

    when it comes to mental conditions, I think the definition of the placebo effect becomes fuzzy. any number of factors, chemical or environmental could improve a mental situation so for me, I’m totally unconvinced. lots of chemicals affect brain function, as do all real life situations. teasing any meaningful data out of clinical trials stikes me as unreliable.

  2. They helped my wife dramatically. She suffered an abusive childhood and had fits of rage and severe depressive episodes. It took awhile to find the right combination of meds to work, but now she is very stable and very happy with her life. I haven’t a clue how much if any is a placebo, but I do know her life is much better than it was.

    • In reply to #4 by Skeptic:

      They helped my wife dramatically. She suffered an abusive childhood and had fits of rage and severe depressive episodes. It took awhile to find the right combination of meds to work, but now she is very stable and very happy with her life. I haven’t a clue how much if any is a placebo, but I do k…

      Thanks for sharing that.

    • In reply to #4 by Skeptic:

      They helped my wife dramatically. She suffered an abusive childhood and had fits of rage and severe depressive episodes. It took awhile to find the right combination of meds to work, but now she is very stable and very happy with her life. I haven’t a clue how much if any is a placebo, but I do k… I think there is more impact on people with bipolar – this may not have been what your wife suffered from. A few people I know(obviously just anecdotal evidence here) manage to be much more balanced in moods now with none of the down periods (which were much more extreme than any of my own periods of depression) and none of the extreme up times either.

      • I’m glad that the correct combo was found for your wife. You also deserve to be congratulated. Like my partner, who I may not be still here without the support she provided me, when I was at my lowest points. The easy way can be for people to walk away & you didn’t to your wife & neither did my partner.In reply to #15 by Paully from Aus:

        In reply to #4 by Skeptic:

        They helped my wife dramatically. She suffered an abusive childhood and had fits of rage and severe depressive episodes. It took awhile to find the right combination of meds to work, but now she is very stable and very happy with her life. I haven’t a clue how much if…

    • In reply to #4 by Skeptic:

      … right combination of meds to work

      Dosage timing is important – which makes me wonder, in context of the OP, if the newly touted idea of controlled medicinal dosage via implanted microchip would be feasible.

      Comes with fears of Big Brother, but I digress…

      • In reply to #24 by bluebird:

        In reply to #4 by Skeptic:

        … right combination of meds to work

        Dosage timing is important – which makes me wonder, in context of the OP, if the newly touted idea of controlled medicinal dosage via implanted microchip would be feasible.

        The placebo effect with a microchip would be even greater IMO, as it’s more invasive and would be perceived as being more therapeutic.

        • In reply to #36 by Nitya:

          The placebo effect with a micmicrochip would be even greater IMO, as it’s more invasive and would be perceived as being more therapeutic.

          Or make you think it is an alien implant ….

          I would not have anything implanted in my brain. That shouts electroshock destructive therapy. First science has to understand the consequences in a long long long trial.

          I refuse to accept anything that has no guarantees…as of yet

  3. Clearly AD’s can be very efficacious in some circumstances. My experience among friends and colleagues is that they tend to be overprescribed. At the smallest sign of discontentment (not just my opinion, this is how it was described to me) it’s the sought after solution to what often has not yet necessarily become a real problem. I can, rationally, somewhat understand this temptation. Why suffer when there seems to be a myriad of solutions, albeit chemical in nature?

    I found the story of David Foster Wallace interesting and instructive. For those not familiar DFW was a writer of immense talent. He was also a math and philosophy major and his well rounded erudition was quite evident. He also suffered from major depression. He was able to control his depression for the most part with Nardil, one of the older AD’s. At one point (in large part due to his relative happiness as his depression had become well controlled, though he still suffered from some side effects of taking the drug) he decided to wean himself off the drug. He did, though his depression raged back in a short period of time. Due to the tricky (and in large part still unknown) biomechanics of the affliction itself and the AD’s used to combat them, when he tried to get back on Nardil it no longer worked. Other therapies were attempted but DFW eventually succeeded in killing himself (suicidal thoughts having been present from the beginning of his depression).

    I’m not sure what the moral is here or if one exists but I thought I’d throw this into the discussion mix as a point of interest. For those interested check out his commencement speech given at Kenyon College – This Is Water – which can be easily found online with a quick Google search. He mentions his depression and the reasons he found for living, which sadly escaped him in his darkest moments.

  4. Well, even Robert Trivers says “numerous studies have shown that genuine antidepressants account for about 25 percent of the improvement, while the placebo effect accounts for the remaining 75 percent.” In other words there is a demonstrable clinical effect.

    • In reply to #6 by Nunbeliever:

      Well, even Robert Trivers says “numerous studies have shown that genuine antidepressants account for about 25 percent of the improvement, while the placebo effect accounts for the remaining 75 percent.” In other words there is a demonstrable clinical effect.

      Yes, that’s a good point, there seems to be some benefit, even from the research that Trivers quotes and even the later meta-analysis study I linked to above still said the difference was “small” but not zero. BTW, this is a bit of a tangent but the way I remembered the Trivers quote is an interesting example of Trivers’ ideas of selective memory. When I was quoting it to someone recently I was adamant that it showed zero difference between placebos and ADs. (My bias right now is that I think ADs don’t work except for severe depression) I was sure of it but the person I was talking to assured me I was wrong. I got the eBook from the library and I was all set to take it to her and triumphantly show the result. I even found the quote and said to myself “ah ha I knew I was right” and I had to read it twice before I realized “oh fuck I was wrong”.

  5. I haven’t read Trivers book as yet, though I have it on order and expect it to arrive in a week. That being said, I’ve read the negative review in the Guardian and I’ve watched a TEDx presentation. It would seem that the main criticism of his book is it’s conversational style as opposed to a more rigorous analysis. It would also appear the Trivers has a few quirks of his own. All in all, it sounds like my sort of book, quirks and all.

    Fortunately I have no personal experience with depression. A large percentage of people I know suffer from this condition and are committed to a future that involves taking antidepressants. I would hate to be locked into the lifetime prospect of taking drugs to alter my brain chemistry. But, I haven’t descended into those pits of despair and if I had, I’d probably jump at the chance to make it all go away.

    As an observer of sufferers, the condition seems to vary greatly in intensity. Some are brought so low that they can’t get out of bed or even take care of daily chores such as washing, dressing, shaving and cleaning up dishes. In other cases the afflicted seem to be suffering from anxiety in my opinion, rather than depression in the need of antidepressants.

    Anxiety is a condition with which I’m very familiar. Although I seem to be particularly plagued with this disorder, I choose to go it alone without resorting to any chemical substances ( legal or illegal). Placebo remedies abound in the treatment of anxiety and I have been offered the lot. I think the placebo effect in the treatment of an anxiety disorder would be huge! It’s a condition that is created by faulty thinking and the avenues for self deception would be vast!

    I would imagine that depression and anxiety respond to a similar family of drugs that simply differ in their strength. I’m not at all surprised that the placebo effect of clinical treatment is so apparent and this is one of those areas where I think you have to go with whatever works.

    • In reply to #9 by Nitya:

      I’ve read the negative review in the Guardian and I’ve watched a TEDx presentation. It would seem that the main criticism of his book is it’s conversational style as opposed to a more rigorous analysis.

      I’ll look for the Guardian review, I’m interested to see what it says. Trivers definitely has some quirks. You can tell by his writing style in the book but even more so in a lecture I found from him to a math class, I think at Rutgers. To be honest, I almost wondered at the beginning of the lecture “is he high?” (he’s open about liking to smoke pot). He was disorganized, couldn’t find his notes, and rambling a bit but once he got going, high or not I thought he was brilliant.

      I also read his collected papers recently and found the same kind of quirky style. He has an introduction to each paper and talks about the impact he hoped it would have and what actually happened and he’s never shy about saying that this or that colleague is full of it (I think he has some Klingon blood too).

      I agree his style, when he’s not writing a journal article, is conversational. Folly of Fools is not an academic book, it’s for a general science literate audience. But one thing I love about it is he is so honest about his own thoughts and hypocrisies. He shares stories where he was a jerk to his kids and where he makes a total ass out of himself over an attractive woman. Something I can definitely relate to.

    • In reply to #9 by Nitya:

      I haven’t read Trivers book as yet, though I have it on order and expect it to arrive in a week. That being said, I’ve read the negative review in the Guardian and I’ve watched a TEDx presentation. It would seem that the main criticism of his book is it’s conversational style as opposed to a more r…

      BTW, another interesting Youtube video is a short discussion between Chomsky and Trivers

      I would love to see the two of them together for an extended discussion. They have similar political leanings, both further left than most of the New Atheists but they are very different kinds of people. Chomsky is IMO the most rigorous non-conversational analytical speaker and writer I’ve ever seen. He chooses every single word carefully and at times when I listen to his lecture I can almost envision the structure of the talk as a tree diagram, everything is so organized. In that brief talk Chomsky asks Trivers at one point something like “fascinating so has that been verified or is that just speculation” and Trivers answers almost sheepishly (I may have been reading too much into it) “just speculation”.

      • In reply to #12 by Red Dog: and #11

        I saw the Chomsky video in the line-up as well, but went with the TEDx offering even though the production values of the video are very poor.

        Honesty about his own shortcomings was the main criticism made by the reviewer, ( Jenny Diski to my recollection). She seemed to feel that the input of his own failings was intrusive and undermined the credibility of his work. She also appeared to be making a value judgement on his worth as a person, though I could be reading between the lines. I don’t mind the personal aspect as it’s all storytelling and like everyone else, I respond to story telling and the personal aspect.

  6. I discovered that malnutrition is often the cause of disease . Did a lengthy endocrinology study to understand how the body works. I did so because I was suffering from suicidal depression. The kind that every day is a good day to die. Just did not do it because I was too depressed to bother. Just hoped the earth would suck me in.

    I was given a variety of antidepressants . They had some awful side effects that made it worse. I asked the doctor why I was depressed when I had everything good going on in my life. That I had no real reason to be so depressed.
    He said that it was a chemical imbalance. I asked what chemical ? He said “we don’t know, it could be several” , serotonin uptake, dopamine, on and on. So if we don’t know, why give me any drugs? He never asked me about my nutrition or my hormone levels. Never asked for blood tests or anything like that before prescribing drugs.

    I decided that to save myself I needed to learn what the doctor did not tell me. I discovered that depression along with a host of other diseases is caused by lack of Magnesium . A diet that does not contain enough of this will lead to depression and a host of other problems like insomnia,and fibromyalgia . Also low levels of the hormone progesterone can lead to depressive mania.

    Needless to say I started taking supplements of Magnesium and I got well. If I stop taking it, within a week I start to feel bad. this helped me with restless leg problems at night and leg cramps. It may not help people who have brain lesions and that is the cause of their depression. But it will help people who are depressed and do not get enough magnesium from food.

    I have extensive links to share, but these are by the NIH in the USA. Studies that show that it is beneficial specially when their meds did not work.What is best is that it has no side effects.

    I would hate to have to take the drugs I was given initially , for the rest of my life. I rather take Magnesium . I take 2500mg a day and it has kept me normal and healthy. I am not recommending this as a cure or saying it is a cure. A cure would imply that depression is a disease . It is not, it is an elemental insufficiency.

    http://www.ncbi.nlm.nih.gov/pubmed/16542786

    http://www.ncbi.nlm.nih.gov/pubmed/19944540

  7. As someone who suffered through depression for about 5 years, I really don’t care if the drugs prescribed worked for me or we’re purely placebo. I am concerned for others as the placebo effect works only for some people.
    I doubt it is purely placebo as I know some people who were helped with some medications but not others.
    What worked for me was combinations of medication, some counselling and supportive friends and family to help me.
    I am happy for further studies to be done as this can only help, of course.

  8. So what do you think? Are antidepressants useful and if so when and why?

    Yes. The end result, whether 25/75 drug/placebo doesn’t matter. If the result is alleviation of symptoms, then by definition, it is useful.

    I suffered with PTSD, undiagnosed for years. Could have, should have been dead. When the bucket overflowed, the drugs saved me. Don’t care if it was placebo. I’m here reveling in life, now drug free and leaping tall buildings. This may not work for everyone as humans all react in different ways to different stimuli. I understood the chemistry of nor-adrenaline re-uptake inhibition and the effects on my brain. Did my due diligence. So maybe because I understood how it worked and what would be the effect caused by the drug, that maybe I got a bit more placebo, but I don’t particular care.

    Yippeeeee

    • In reply to #16 by David R Allen:

      So what do you think? Are antidepressants useful and if so when and why?
      Yes. The end result, whether 25/75 drug/placebo doesn’t matter. If the result is alleviation of symptoms, then by definition, it is useful.I understood the chemistry of nor-adrenaline re-uptake inhibition and the effects on my brain. Did my due diligence. So maybe because I understood how it worked and what would be the effect caused by the drug, that maybe I got a bit more placebo.

      In my case Understanding it is what convinced me it was the wrong approach, besides spending a year as a drug Guinea Pig due to the side effects of the meds. Not one single med was without symptoms. It was horrible it was like chemotherapy and it did not improve. And there is no placebo effect , like oh I think it’s working … No it was making me crazier and neurotic. Suicidal and not afraid to die and take many risks I would not have taken if not under the medication.

      These meds have the potential of altering the brain in ways that are not understood. It is a russian roulette . I find that people who are hooked on these meds, believe they will not get better without them. Some meds cause more depression and more people commit suicide while using anti depression meds than those who do not.

      It makes no sense to give a drug before testing for deficiencies.

      The real placebo effect is the therapy . Group or single. It helps to talk to people and have some support.

      • In reply to #17 by GFZ:

        I’d recommend talking as therapy for anxiety, as well. That’s what I do! I talk and talk and talk! I work through why I feel the way I do, and I appreciate the empathy of others. Anxiety manifests itself in a range of physical symptoms. It can be itchy skin, insomnia, dry eyes, tooth ache, headache, all the types of things alternate remedies are supposed to address. It becomes very difficult to know what is real and what is imagined because the feeling is real! It’s identical to an actual complaint.

        I suppose I’ve outed myself as a complete nutcase by these stage, and I may feel compelled to delete this post in the near future, but there you have it, warts and all!

        • In reply to #18 by Nitya:

          In reply to #17 by GFZ:

          I’d recommend talking as therapy for anxiety, as well. That’s what I do! I talk and talk and talk! I work through why I feel the way I do, and I appreciate the empathy of others. Anxiety manifests itself in a range of physical symptoms. It can be itchy skin, insomnia, dry ey…

          Not a nutcase. Then again, I’m not exactly a model of sanity either ;-)

          I agree, talking to someone can be amazingly helpful. And in the US at least with the insurance companies there is a lot better support for getting some medication than for getting therapy. Not a surprise given that the US is a for profit system I guess, there is a much better markup on drugs than services.

          In my experience it also may take some time to find the right person you feel you can trust. That would be my one bit of advise to people getting a therapist: don’t be afraid to fire the first one or even several until you get one you are compatible with.

          • *In reply to #19 by Red Dog

            Talking to friends is usually enough to diffuse an escalating feeling of anxiety, though sometimes the level can swell to Woody Allen proportions. At these times it’s better to seek help from a professional. I’ve done this twice and it was very successful. We are allocated six, hour long sessions a year as part of our national health scheme. As I was in need of treatment at the end of the year I could have continued on at the start of the following year and had twelve sessions in toto. Fortunately the six sessions was enough to return to normal.

            I probably need to reiterate that I’ve never suffered from depression. I’m invariably upbeat even when feeling anxious. The conditions are obviously related but there’s a difference.

      • In reply to #17 by GFZ:

        In reply to #16 by David R Allen:

        So what do you think? Are antidepressants useful and if so when and why?
        Yes. The end result, whether 25/75 drug/placebo doesn’t matter. If the result is alleviation of symptoms, then by definition, it is useful.I understood the chemistry of nor-adrenaline re-upt…

        Yep. We all react differently. I got a winner. It didn’t work for you. The “Talking Cure” is also a good adjunct. I suspect that by talking it over with a trained person, your brain probably rationalizes (unconsciously maybe} and lays do new neural pathways that lessen the bad connections, and promote the good.

        Never go quietly into that dark night.

    • In reply to #16 by David R Allen:

      So what do you think? Are antidepressants useful and if so when and why?

      Yes. The end result, whether 25/75 drug/placebo doesn’t matter. If the result is alleviation of symptoms, then by definition, it is useful.

      I suffered with PTSD, undiagnosed for years. Could have, should have been dead. Wh…

      That’s cool. It’s especially good that you were able to get off them. That is what I’m afraid of that they can form a dependency, that there might be a short term placebo-effect improvement but then you are stuck addicted to some drug and essentially after a while you end up right back where you were. Very glad that didn’t happen for you and that they helped.

  9. I don’t think it has to be a professional therapist it can be anyone willing to listen. When my father died I think I would have gone insane if it had not been for this group on another forum. The key is to find a group that is specifically related to what you are going through.
    People that have not lost a parent can’t understand what it is like. So they need to be in the same boat as you are to be able to work this out.

    Talking to a therapist sometimes wraps you up into yourself and you can’t see the big picture. When you share with other people in the same situation, you are able to gain a better perspective. It was hard to find groups or therapists who can deal with this without offering god as a cure. Watch out for those…

    • In reply to #23 by GFZ:

      I don’t think it has to be a professional therapist it can be anyone willing to listen.

      I used to think that as well. For a long time. But I’ve changed my mind and the Trivers stuff about self deception was a big reason. Not that the training per se is so important. In fact I think that being a therapist is still much more of an art than a science. I worked in a psych hospital for a while and I even was a therapist and ran a few groups a long time ago and man did I suck at it. And I tried to get better by reading various approaches, etc. and it didn’t help much at all. Where as the people who were really good at it knew and read much less than I did. I came to believe, and still mostly do that the real core skills aren’t something you can learn from a book, you have to practice them and just like musical ability you’ve either got it or you don’t.

      So while I agree that it doesn’t have to be a professional I do think having someone who isn’t a friend is critical for the following reasons: We are all BS machines. We lie to each other and we lie to ourselves. And anyone that is a friend, even if you don’t like them that much, you will have an agenda, probably you won’t even be aware of it, but you will want to present an image to them. And thus starts the BS. The best therapists, of course this is just my personal experience so it could be different for others, but for me I really try not to feel a personal relation to them. They are my doctor not my friend because as soon as they become my friend even without my knowledge I want to present a certain idealized image to them rather than just being honest with them.

      And for me that is one of the most important benefits, when you have one person that you try to be totally honest with you suddenly can start realizing when you aren’t being honest with yourself.

    • In reply to #23 by GFZ:

      I don’t think it has to be a professional therapist it can be anyone willing to listen.

      I just want to amend what I said a bit. I don’t want to give the impression that I disagree with that because I don’t. I think friends and anyone that can listen are essential. They can be as or more important than a therapist. Also, it can be really hard to find a decent therapist. My point in the last comment was just that I think it can be valuable as well, besides having friends, to have someone who is just in the role of therapist as well.

      • In reply to #29 by Red Dog:

        In reply to #23 by GFZ:

        yes I know what you meant and you are right. Not discounting a pro that is actually good. But I am suspicious of them as most of you may be of chiropractics .I did not have very good experiences. As a child I was sent to a shrink because I was an atheist and my mother felt I was wrong in my thinking. And it was not really therapy but an attempt at brainwashing me. Fortunately I was always a smart kid and it did not take. However it left me a bad feeling about them.

        • In reply to #30 by GFZ:

          yes I know what you meant and you are right. Not discounting a pro that is actually good. But I am suspicious of them as most of you may be of chiropractics

          I think we are in violent agreement. There is nothing worse IMO when it comes to a doctor than a bad psychiatrist. In my experience even a bad MD still will know the basics, can prescribe what you need, etc. But a bad shrink can be less than useless. They can make things worse and it can feel really draining since you have to share things that are usually harder to talk about than most standard medical problems.

          To be honest, I can’t think of a single psychiatrist that I’ve known in person and didn’t think was either incompetent, a jerk, or both and that’s from working in mental health and as a patient. The good therapists I’ve had and known were always psychologists. It could be just my bad luck and if that isn’t it I have no idea why getting that extra qualification of an MD and psych specialty has such an effect but that has been my experience.

          I can understand why you would be leery of professionals, absolutely. Just saying if you can find a good one, and it will probably take effort to do so, then it can be quite useful.

          • In reply to #31 by Red Dog:

            In reply to #30 by GFZ:
            I think we are in violent agreement. There is nothing worse IMO when it comes to a doctor than a bad psychiatrist.

            I think that because they seem to want to solve most things with drugs the therapy aspect is secondary. A psychologist can’t prescribe and thus medication is secondary. So they put more effort into the session . It really matters that you have simpatico with a shrink. I judge their advice based on them and how they look. I am weary of hypocrites .

            I went to a traumatologist once to be checked for a pain I was having. He was a smoker and was smoking in the room. That is a bad example to give your patients and people in general. My father looked at me like saying “are you seeing this ?”

            The shrink I was sent to as a young teen also smoked in his office. I remember a conversation we had that imprinted itself in my memory like if it happened yesterday , my mother was worried that I was having sex and had told me that if I had sex before marriage that no one would want to marry me. She also told me that only women who have had sex and children can use tampons and had my pediatrician lie to me about it when I read to him the info in the tampon box saying a virgin can use them….. So my mother suspected I was having sex because she found some tampons hidden in my closet. She must have asked the shrink to give some talking to about the evils of losing your virginity…

            The shrink started by telling me a story about some speech he was giving at the University where he asked the students if anyone knew how many orgasms a woman can have in an hour. I wondered what the hell does this have to do with me? I suppose his example was to show that people did not know how many …so what?
            Then he told me a story about a woman who came in very distraught because she was to be married but was not a virgin and was afraid that her man would not want her . Instead of telling the woman that any man that rejects a woman because she is not a virgin, is not a man any one should be with, he told her to fake the whole thing. To get some pigs blood from the butcher and stain the sheets so it looks like she was deflowered. I have never heard such a crazy thing except as a joke !!

            This example illustrates how religion or religious customs can adversely affect the outcome of a therapy session.Just look at those who wish to change a homosexual back to straight with therapy. I can only imagine the horror these people are put through.
            This kind of therapies should not be allowed .

            It is important to me to find an atheist doctor, or therapist because at least I know they are not lying to themselves and they won’t lie to me.

          • In reply to #32 by GFZ:

            In reply to #31 by Red Dog:
            I think that because they seem to want to solve most things with drugs the therapy aspect is secondary. A psychologist can’t prescr…

            Pardon, the religious reference but Jesus Fucking Christ! I thought I had some stories about bad doctors but nothing compared to those. I hope that was a long time ago. I agree religion has a lot to do with it, I would add sexism as well. That shrink was a pig who had no business treating women.

          • In reply to #33 by Red Dog:

            In reply to #32 by GFZ:
            Pardon, the religious reference but Jesus Fucking Christ! I thought I had some stories about bad doctors but no…

            No it’s ok I say that all the time, it serves as the perfect release statement. ;)

            Yes it was a long time ago I will be 50 in June so a good 35 years or so. This shrink also tried to hypnotize me by the way. Using some silver coin with something that looked like a mason symbol . I could not stop laughing , every time he started to do the “You are getting very sleepy” I would crack up laughing. It served as laughter therapy lmao!!

            I was also scared he would try something sexual with me, just had a bad feeling about him in general. He had the creepy feeling. Now if I go to a therapist and gives me the creeps, I never go back !!

          • Thanks for sharing your story, Gfz. I applaud your honesty and forthrightness. It adds much to this discussion.

            In reply to #32 by GFZ:

            In reply to #31 by Red Dog:

            In reply to #30 by GFZ:
            I think we are in violent agreement. There is nothing worse IMO when it comes to a doctor than a bad psychiatrist.

            I think that because they seem to want to solve most things with drugs the therapy aspect is secondary. A psychologist can’t prescr…

  10. After all, depression is marked by hopelessness, and placebos offer nothing if not hope.

    Anti depressants can also be used for PMS, OCD, OCD related behaviors, social anxiety and other anxiety disorders. These are not usually marked by “hopelessness.”

    I have been on and off antidepressants for years for several of the reasons above. I went back on them about a month ago and there is a big difference. I’m less likely to dwell on thoughts and I am calmer. The first change that I consistently notice is my eyes; they are actually open wider. At some point, I usually think that I’m fine and go off my meds. I’ve learned that I crash and it’s not a good idea. Unfortunately, I’m one of those individuals who has a biological tendency towards depression and anxiety.

    • In reply to #25 by QuestioningKat:

      . Unfortunately, I’m one of those individuals who has a biological tendency towards depression and anxiety.

      I think sensitive types are more prone to these conditions. :-) ( that what I tell myself, anyway).

        • In reply to #25 by QuestioningKat:*
          > . Unfortunately, I’m one of those individuals who has a biological tendency towards depression and anxiety.

        A biological tendency points to a biological cause. I would suggest you take a serious look into adding Magnesium to your diet. It is what regulates your moods, your sleep and as I stated before it’s deficiency IS the cause of these symptoms.

        Being biologically prone, means you probably don’t assimilate Magnesium from food. Or you are severely depleted

        Symptoms of magnesium deficiency include: hyperexcitability, dizziness, muscle cramps, muscle weakness and fatigue. Severe magnesium deficiency can cause hypocalcemia, low serum potassium levels (hypokalemia), retention of sodium, low circulating levels of parathyroid hormone (PTH), neurological and muscular symptoms (tremor, fasciculations, muscle spasms, tetany), loss of appetite, nausea, vomiting, personality changes and death from heart failure.Magnesium plays an important role in carbohydrate metabolism and its deficiency may worsen insulin resistance, a condition that often precedes diabetes, or may be a consequence of insulin resistance. Deficiency can cause irregular heart beat.

        A chronic lack of magnesium in the body yields many consequences – including low energy levels. Symptoms of magnesium deficiency include fatigue, weakness, anxiety,depression and irritability.

        http://umm.edu/health/medical/altmed/supplement/magnesium

        • In reply to #38 by GFZ:

          Is this legit? I think I may have a mild case of magnesium deficiency!

          I struck out on the nature and nurture input to the extent of my neuroticism. My mother was very highly strung and worried about me constantly during my life. While I was growing up I would worry about her, worrying about me.

          BTW the reason I avoid medication is that I’m afraid I also have an addictive personality. I was prescribed medication when I was in my twenties and stopped after a few weeks because I found myself scooping up any crumbs in the vanity basin after breaking the tablet.

          Isn’t this great? It’s like a therapy session!

          • In reply to #40 by Nitya:

            In reply to #38 by GFZ:
            Is this legit? I think I may have a mild case of magnesium deficiency!

            It is the most legit. Just look at the science. We were taught about this in school in chemistry and biology class. But we failed to apply it in favor of drugs.

            You don’t have to believe me. Just try it for your self Magnesium Glycinate won’t give you diarrhea and better absorbed. In fact you can get magnesium salts and take a bath in it your skin will absorb it readily and you will feel better instantly.

            I am skeptical about remedies and wives tales , but this is real and has real science behind it. My mother also is a neurotic wench that was helped by this. She was hooked to lorzepam to go to sleep for at least 40 years. It started to affect her memory and also it has serious side effects , it causes terrible back and leg pain that can lead to permanent damage. I got her on this and she was able to quit the lorazepam slowly but eventually did. My father had a series of problems like high blood pressure , severe anxiety and had schizophrenia (paranoid) to boot. Plus he was bi polar I think because he went from crying bouts to immense joy.
            He was the most benefitted by magnesium. I think that is what extended his life. And the lack of it is what killed him. It was a tragedy, we ran out of it and I was out of the country . I am convinced he had a relapse due to not having taken the mag for an extended period….

            Don’t let it happen to you. You can even get a blood test or a saliva test to measure it in your blood. It has no side effects and will not kill you .

            One way of detecting you have a deficiency is the need to eat chocolate. Dark chocolate is rich in magnesium. Or other foods that are rich.

            Here is a list of foods that are rich in magnesium, or are supposed to be but it depends where they were grown.

            http://www.healthaliciousness.com/articles/foods-high-in-magnesium.php

          • In reply to #41 by GFZ:

            dark chocolate is rich in magnesium

            As luck would have it, there’s a dark chocolate Easter egg on hand. Can you give me a clue about the therapeutic dose? After the egg I might be wise to try a supplement as I could envisage a future addicted to dark chocolate.

            Can you see the avenues opening up for someone to jump in with a religious solution, because I can? “All your problems would be solved if you just believed!” Fortunately believers are even more prone to disorders such as this, according to recent reports. Putting your life in the hands of a higher power is no guarantee of an untroubled life.

          • In reply to #42 by Nitya:

            In reply to #41 by GFZ:

            dark chocolate is rich in magnesium

            As luck would have it, there’s a dark chocolate Easter egg on hand. Can you give me a clue about the therapeutic dose? After the egg I might be wise to try a supplement as I could envisage a future addicted to dark chocolate.

            Yea don’t go nuts on the chocolate you can get diabetes , all in moderation . Which is why it is important to supplement because the amount you need is hard to get in the foods we eat. We don’t eat enough of them. Or they are expensive in comparison to junk foods or food type foods.

            Can you see the avenues opening up for someone to jump in with a religious solution, because I can? “All your problems would be solved if you just believed!”

            hahaha !! And they have trust me… but it is easy to dismiss because if there is nothing else certain , it is certain that someone somewhere is worse off than you. So they would need to justify them too and likely it is devout believers in a god that seem to find themselves in the worst of situations despite their fervent beliefs.

            My mother , a catholic turned jew turned catholic again, always prayed .She would tell me she prays for me day and night and she pleads with god to guide me and enlighten me. She also pleaded that the property my father left me would sell soon so I would not have so many worries and financial problems.god may also be an accountant ? lol

        • In reply to #38 by GFZ:

          In reply to #25 by QuestioningKat:*

          . Unfortunately, I’m one of those individuals who has a biological tendency towards depression and anxiety.

          A biological tendency points to a biological cause. I would suggest you take a serious look into adding Magnesium to your diet. It is what regulates yo…

          Yes, I’ve recently become aware of this and will take supplements and will consider having this tested. I have a tendency to be low in potassium and Vitamin D as well.

  11. In reply to #25 by QuestioningKat:

    First, I just want to be clear if what I’m about to say sounds a bit negative I’m just giving my honest reactions and I’m not doubting that they work for you and I’m very glad they do.

    Anti depressants can also be used for PMS, OCD, OCD related behaviors, social anxiety and other anxiety disorders. These are not usually marked by “hopelessness.”

    Which is one of the reasons I have serious doubts about how much they actually work at all as opposed to being a placebo. If you look at most pseudoscience/placebo cures: acupuncture for example, they start out for one specific set of ailments and soon the proponents are saying they work for just about everything.

    there is a big difference. I’m less likely to dwell on thoughts and I am calmer

    And that’s another reason I don’t think they are right for me. Not the dwelling part, that would definitely be good but the being calmer part. I’m not a calm person. I get excited and I get most excited when I’m working on something interesting and feel like I’m making progress. I pace and curse and talk to myself and type so fast and with such force I’ve worn out keyboards. I would rather have a life filled with bouts of sadness as long as it still had those peaks in it and without the peaks I’m not sure it’s even worth the effort.

  12. Speaking from experience, I can state for fact that anti-depressant medication is not necessary for most who are prescribed it. Those who suffer from real depression, which hinders their ability to lead a normal life and/or be of any value to society, these are the ones who truly need it. I took anti-depressants for about six months before losing my health insurance and being forced off of them. It was only then that I realized what they were really doing to me. I had become a docile, happiness zombie of sorts, and was oblivious to most of the problems that now rattle in my head once again. Speaking now in opinion, I say this; those who have a brain like mine, which perpetuates negative thinking and pessimism, don’t succumb to your own weakness. I may go through stages of negativity that affect my mental and physical stability from time to time, but I would rather feel that way too often than to never feel that way at all.

    • In reply to #45 by The89thSword:
      I can relate to that.

      My experience of medication for depression has been all in the last eight years. Now age 62, I was always a worker bee by necessity but bit of a dreamer by temperament. Trouble started when I was admitted to hospital with an 11-on-the-pain-scale lumbar region but no discernible cause. In an open ward, unable to stop screaming and moaning for long, I was soon kept quiet with high doses of oxycontin, oramorph and other stuff for the pain, while scans and tests were carried out. Those opioid drugs altered my brain by turning off my ability to focus on work as much and by appeasing and indulging my inner layabout tendency. Not recommended; especially long-term.

      I found that long-term pain brings with it frequent spells of fatigue and depression. For the latter I was prescribed a series of different ADs until eventually I found one that didn’t make me feel much worse. That one was called citalopram, and a daily tab of it did seem to mark a significant lifting of mood.

      The imponderables are such as: how much of the depression is caused by the oxy and other drugs prescribed, and how much to the now-chronic pain, or some combo?

      I too have been helped by psychologists, but definitely not by an acupuncturist; and neither by chiro.

      I hope all you fellow sufferers soon manage to bin the blues and to feel as chirpy as a newly-hatched chick.

    • In reply to #45 by The89thSword:

      I say this; those who have a brain like mine, which perpetuates negative thinking and pessimism, don’t succumb to your own weakness

      I kept thinking about this. I actually think that pessimism is mistaken for realism. I think it protects us from disappointment . It also rewards us with happy surprises when we are wrong and things work out. We tend to appreciate things more because of this.

      Negative thinking , is not the same as pessimism . Negative thinking is wasteful type thinking. Unless you use it to your advantage during analyzation of possible scenarios when you need to make a decision.

      For example, “I am probably going to miss my flight” This is pessimism thinking unless you know this because the taxi was late then it is realism. There is a possibility. Then you think negative thoughts. “I am surely going to miss my flight” . This is negative until you start to figure out what you will do in the event this is true and you do miss your flight. Once you have the flow chart of what to do after and if, you relax because everything has a solution if you try to think of one.

      I became an expert at doing that. your fellow Pessimist/Realist Negative thinker who uses it to her advantage instead of looking it as a weakness. You can call it mental preparedness for disasters. It is not a bad thing :)

      • In reply to #48 by GFZ:

        . For example, “I am probably going to miss my flight” This is pessimism thinking unless you know this because the taxi was late then it is realism. There is a possibility. Then you think negative thoughts. “I am surely going to miss my flight” . This is negative until you start to figure out what you will do in the event this is true and you do miss your flight. Once you have the flow chart of what to do after and if, you relax because everything has a solution if you try to think of one.

        I think this school of thought is attributed to Seneca?I definitely recommend it in any case. I assume that I’m going to be caught in traffic, miss the plane, catch a cold etc. and plan accordingly. When these events fail to come to pass, I’m very pleasantly surprised, instead of being angry and dismayed. It sounds so wrong! but it works. As a consequence, I’m constantly put into a happy frame of mind because things have turned out contrary to my expectations.

        • In reply to #49 by Nitya:

          In reply to #48 by GFZ:

          It sounds so wrong! but it works.As a consequence, I’m constantly put into a happy frame of mind because things have turned out contrary to my expectations.

          Yes, there was a study recently that claims that positive thinking is not only useless but harmful. It creates complacency and the subject does not reach their goal because in their mind they have already succeeded by positive visualization of the future.

          When I read this I was , yea this is cool I’m not insane after all …I found more articles, Our fascination with positive thinking is destroying ambition and turning us into a society of mindless worshippers drones. I can’t find the article I want to share but in the search I found many people think like this.

          http://allnurses.com/general-nursing-student/positive-thinking-useless-762309.html

          http://www.huffingtonpost.com/matthew-hutson/positive-thinking-leads-t_b_4771401.html

          Also the same for when things go as expected. For example “I am going to be late miss the flight, taxi late, traffic it’s done deal. ” You never wished for a miracle and got disappointed . You simply accept the way things are you knew this was going to happen so now you focus on the next task, the solution. Once you get there you don’t have to figure it out. You have a plan. It’s all good.

          Positive and negative thoughts are the same thing just thoughts, but one is a lie the other is a possibility .

          will be interesting to read about Caligula’s advisor thanks for that !

  13. The worse thing that anti depressants did to me besides not remove the depression, was that they took away my inspiration. I am an artist and very creative. I also write music. During the time I was on these meds, I had no inspiration . It was as if I was never an artist. Before that I could write song after song. My songs were best when I was going through emotional turmoil .These meds keep you in a limbo zone. You don’t feel happy and you don’t feel sad. You feel nothing .

    I have spoken to other artists who also claim that the meds took away their inspiration. They said that they prefer to have ups a and downs than nothing at all. I understand that too. Much of the artists work is inspired by emotions. When your emotions become impaired the inspiration does not come.

    It is better to find the reason for this depression , like malnutrition . And the reason for pain. The worst part of pain meds, they cause you to lose minerals namely calcium and magnesium . This creates more pain. It is a vicious circle.

    It is true that most people do not need antidepressants and they are prescribed like if they were candy. There are real cause for depression and the most known is magnesium deficiency. There are so many studies about this that doctors should first prescribe magnesium before they give out the other drugs.

    Long term use of opiates causes irreversible damage. Being a sufferer of chronic pain I know that it made it worse. Then you get addicted. It is hard to quit. People need to put two and two together about nutrition and the brain. Do the research and refuse meds that do not guarantee relief without symptoms. Ask the doctor to explain how these drugs work. If the doctor says we don’t know yet, don’t be a lab rat for the big phama .Ask for blood tests to measure your magnesium levels. Try to be as skeptical about these drugs as you are about gods.

    • In reply to #47 by GFZ:

      The worse thing that anti depressants did to me besides not remove the depression, was that they took away my inspiration. I am an artist and very creative. I also write music. During the time I was on these meds, I had no inspiration . It was as if I was never an artist. Before that I could write s…

      That is my biggest fear exactly. I’m not an artist or professional musician but I did try writing music a long time ago and when I do things for work that I think of as creative, writing or designing software for example, it feels to me very much like the same kind of activity as composing music and I’m afraid that these meds would block that kind of creative thinking.

  14. in Reply to #50 GFZ

    I think the study on positive thinking can be found on this site. I’ve definitely read it recently, as I was pleased to see that it confirmed what I’d been practising for the last thirty years or so.

    • In reply to #51 by Nitya:

      in Reply to #50 GFZ
      I think the study on positive thinking can be found on this site. I’ve definitely read it recently, as I was pleased to see that it confirmed what I’d been practising for the last thirty years or so.

      What is ironic about it is that the most positive thinkers are the most depressed and on meds.

      Of course I am not talking about realistic positive thinking. Like when you are rock climbing and suddenly you get stuck no way up or dawn or at least down without pain… At that moment you need to say to yourself “I can do this just let me think” the good thing is because all your life you played out these scenarios in your mind , you CAN do it. You are not telling your self a lie that it’s all going to turn out ok. You are pushing yourself to think harder.

      I think I started to think this way because my mother’s answer to everything was “All we can do is leave it in god’s hands”.
      Of course I knew his hands were not going to hold being that they were invisible and made of air. So I tended to worry and plan for the worst. As a result I was always the problem solver. She relied on my being a strong person but never said so in so many words.

      I will share this story from when I was 9 years old. I grew up in Mexico City and we had maids. My father was separated from my mom so he was not there and mom was at work or somewhere I was alone with the maids who I considered my friends.
      One of them suffered from severe varicose veins in her lower legs and they burst.

      I saw the bloody footsteps toward the garden where I think she went to bleed out because she was afraid of getting fired maybe. I got her to come inside and sit on a stool. The floor was soon a large puddle of very dark blood. I went for a bucket to hold the blood there was a huge puddle on the floor already.
      I remembered that once I played out this scenario that if this happened what I would do !!!

      I grabbed my jump rope and tied a tourniquet around her leg to stop the bleeding. Then tried to find an adult to come take her to the hospital. A friend of mom came and he almost fainted from the blood but helped me clean it up and then took her to the hospital.

      It is never a bad thing to plan for the worst. You just might save a life if you include a solution no matter how old you are. Or young….apparently

      I carry tools and and jumper cables an extra tire beside the spare and a battery plus a hydraulic jack in my vehicle. Also a blanket and water bottles as well as a solar charger for the phone… as standard. But on longer trips I take food and other necessities . I don’t use them much but when I had I was glad to have them. ;)

      Don’t you think that positive thinking based on leaving it in the hands of god is depressing?

      • In reply to #52 by GFZ:

        . Don’t you think that positive thinking based on leaving it in the hands of god is depressing?

        That sort of thinking doesn’t encourage the development of any problem solving strategies, does it?

        BTW Fantastic story! I can’t match that though I can be relied on to arrive on time, ha ha!

        • In reply to #53 by Nitya:

          In reply to #52 by GFZ:
          I can be relied on to arrive on time

          And I can wager that I know how you manage that ?

          Probably the same as I do, set your watch at least 5 minutes ahead . If I have to get up early, get up before the alarm goes off or don’t sleep. Reliability is a virtue. You should be proud and also angry at those who are consistently late.

          That sort of thinking doesn’t encourage the development of any problem solving strategies, does it?

          No, it is the same as giving up. Specially with the pathetic track record god has for helping. It goes against “god will help you if you help yourself.” It does not say give up do nothing god will help you.

          I think this particular sentence is a disclaimer.

          • In reply to #54 by GFZ:

            In reply to #53 by Nitya:

            In reply to #52 by GFZ:
            I can be relied on to arrive on time

            And I can wager that I know how you manage that ?

            Probably the same as I do, set your watch at least 5 minutes ahead . If I have to get up early, get up before the alarm goes off or don’t sleep. Reliability is…

            Actually, I factor in about an hour “getting lost time”. It’s a bit like the over-engineered cathedrals of old. Works on the same principle.

      • In reply to #52 by GFZ:

        What is ironic about it is that the most positive thinkers are the most depressed and on meds. Of course I am not talking about realistic positive thinking

        I think this is an interesting question and one where it’s easy to make a mistake by embracing any one position as an absolute. In general I think people would consider me a pessimistic person. I always try to anticipate what can go wrong and plan for the worst case scenario. Part of that comes from engineering and knowing that if you don’t do that it’s going to come back to haunt you, the best way to avoid problems is to anticipate them.

        At the same time I can see how always focusing on the negative, I think this is something I do wrong actually, can be self defeating. There are times when you need to imagine some positive result and really push yourself to make that result come about and dwelling on all the ways you might fail won’t help. It’s a very fine and blurry line.

        Self deception is according to Trivers a big issue here as well. One of the reasons we practice self deception is that often being more confidant can be correlated with being more successful. There is some data that women are more attracted to men who seem more confidant for example.

        Actually, that reminds me of another example where IMO it can be counter productive to be too negative: when you are leading a team. There is a great Star Trek episode where one of the crew gets mentally attached to Captain Picard. She can read his thoughts and one of the things she realizes is that often when he makes some command decision he isn’t nearly as confidant about it as he pretends to be. I thought that was a great scene and in my experience leading people it’s very true, you often need to pretend you are more confidant of the chances for the team to succeed, e.g., to win a proposal or to make a deadline, than you really are because people believing they can succeed will make success more likely.

  15. In reply to #55 by Nitya:

    I factor in about an hour

    Yea that beats me for sure, I don’t like being late but being too early sucks.. people are like “the date is an hour from now, please take a seat” …and I will be “But I am here now” … once I arrived a week early to the airport. The only time mind you, I blame it on needing reading glasses and not using them. The lady at the counter looked at me like “You fool !! ” … I had a prior bad feeling about this so I asked my friend to wait for me until I checked in in case something went wrong…

  16. Took a while to figure out why (relatively modern) “christian music” falls flat on my ears – it has no more feeling than a composition about a hunk of slate, or a pink unicorn.

    What a waste of notes, languishing on the staff.

  17. The worse thing that anti depressants did to me besides not remove the depression, was that they took away my inspiration. I am an artist and very creative.

    Actually they help me scrape myself up off the floor and get me moving. Then again I have more issues with generalized anxiety.

    Many artists are actually bipolar and could be misdiagnosed especially if they are quieter more introverted types.

    I think people here are confusing issues with attitude and personality with actual biological depression. I agree that antidepressants are over perscribed, but I don’t think we need to get Tom Cruise about it.

    • In reply to #63 by QuestioningKat:

      I agree that antidepressants are over perscribed, but I don’t think we need to get Tom Cruise about it.

      I don’t think any of the comments here were what I would characterize as going Tom Cruise. Then again I do happen to be jumping up and down on my couch as I type this so maybe you have a point ;-)

      But seriously, I think all the comments have been pretty rational. As long as people say “they don’t work for me” or “they had this bad side effect for me” that’s rational. Claiming that they don’t work for anyone or that they are part of some conspiracy by the Pharmaceutical industry to just make money by getting us all addicted or to keep the “sheeple” in line would be Tom Cruise level but I haven’t seen such comments on this thread.

      And I’m glad they work for you and don’t doubt that they do. This is IMO one of those topics where we really need to emphasize how different each individual is. That is actually part of my big criticism with much of the mental health profession in the US is that they often don’t do that in my experience. They have a few diagnostic boxes (based on very minimal scientific theory, empirical data, or objective testing criteria) and they try to shoe horn people into one of those boxes and don’t pay nearly enough attention to the individual.

  18. Richard and all –

    I’ve never entered a comment into any forum before, but felt compelled to enter one here. I’m a practicing psychiatrist, treating both children and adults. Here’s what I’ve learned in 15 years of experience of a front-line clinician (NOT a researcher). The reason this is important to add is I NEVER have seen these points made or even suggested in any literature, medical or lay-person:

    1. First off, antidepressants work for depression, anxiety disorders, the depressive limb of bipolar disorder, etc. Doesn’t matter mild, moderate, or severe, if the substrate is “biological”. Course, everything is biological ultimately. But what I’m talking about is primarily genetic factors, though even for some environmental causes antidepressants are hugely effective.

    2. The primary reason for the disparity between what we front-line clinicians see and what the “research” shows (what is best described as the “parallel universe” of academics) is, ironically, due to the incompetence and lack of humility of psychiatrists. This is primarily due frankly to their insecurity in terms of feeling they are not “real scientists”, so they overcompensate in pathological ways, frankly.

    3. Lack of humility has caused psychiatrists to react in desperation to the fact we really have no idea how depression (or any other psychiatric disorder, for that matter — remember, once it is understood, it becomes “neurology”, not psychiatry). They talk about hypotheses like the “monoamine hypothesis of depression”, which are useful, but we keep losing sight of it being nothing more than a hypotheses.

    4. This desperation has caused an (unhealthy) embrace of “evidence-based medicine”, which works well for objective illness, but terribly for “subjective illness”. The problem is the rating scales, in a word, suck. Look up the Hamilton Depression Scale. Remember, response needs to be 50% alleviation of symptoms for it to count in studies. Understand that probably more important than subjective measures are objective ones, i.e. functionality. We frankly are in the “function better” business, not the “feel better” business. The good news is, once you function better, you usually feel better. Almost always, folks around depressed loved ones notice changes before they notice them themselves.

    5. Crappy rating scales have led to the erroneous, curiously persistent belief that antidepressants take “weeks to work.” They don’t, they take days. Also, everyone responds differently to different meds, so judicious trial-and-error needs to be followed. (What is the last study that involved switches between multiple antidepressants to determine effect? Don’t you think placebo effect would work for ANY antidepressant)? Talk to anyone who works in the inpatient setting: you couldn’t “fix” anyone in 5-6 days otherwise, “hospital setting” or not.

    6. Also, recall that researchers tend not to be much in the way of “people-people”, and therefore have a difficult time discerning improvement and aren’t the best ones to be designing these scales or practices of measurement.

    I don’t mean to bash researchers: we need all the help we can get, and research has led to the development of some of the most effective medications in all of medicine. Another point: we don’t need to know the mechanism of action for medicine to be effective: ask any anesthesiologist. And another: the person who describes responding to magnesium, or vitamin B, or orange juice: you may be absolutely right. But you certainly don’t rely on the “literature” to know it works, so why would one do so for antidepressants either?

    Sorry for the essay. In short, antidepressants work great. It’s the average psychiatrist who doesn’t know how to use them well or evaluate their effects (not due to stupidity, usually, but naivety, lack of real-world experience, and hubris). Oh, and therapy works great too. And probably magnesium for some folks. I wish that my peeps (other psychiatrists) would learn to think more scientifically.

    • In reply to #67 by NigelB:

      Richard and all –

      I’ve never entered a comment into any forum before, but felt compelled to enter one here. I’m a practicing psychiatrist, treating both children and adults. Here’s what I’ve learned in 15 years of experience of a front-line clinician (NOT a researcher). The reason this is impor…

      Just wanted to thank you for that comment. Thought it was excellent and although my mental health work experience is much less than yours (and was a long time ago) for what it’s worth my experience was absolutely in agreement with yours.

  19. After last year’s car crash when a man mistook his side of the road for ours, my sister and her partner (who’s baby was killed) were prescribed such drugs. Neither took to them fondly, they complained of sleeplessness and a druggy feeling of being not ones self, and an alcohol-esque stupor. I myself (driver of the car hit by the speeding reckless driver) have not been a customer of any peddler of normality pills. Thus I can offer little more than my witnessing of the strong and instant rejection of such medication by my family members.

    Edit: I do not seek to unilaterally condemn the medications, and it should be noted these were prescriptions following trauma, not the usual gradual onset of say, depression. It might well be another topic, the fact that identical drugs make it into the bodies of those who are depressed, and those who were hit head-on at 60mph in a car crash. I share many previous poster’s views, suggesting the scope of human ailments is more broad, and often less needy of the pharmaceutical barrage on offer. The trust placed in many “Get back to work, human!” pills, troubles me somewhat.

    Pharma is a formidable industry. I worry that those in the U.S might be paying big, big money for what they’ve been told they “need”. U.K and AUS in stead have to worry our governments are paying for too many undeserving drugs. I’m glad also that many poor nations’ citizens don’t know of, or feel a need for, such an industry’s medications as they couldn’t afford them anyway, and they’ve frankly more pressing issues to physically deal with.

    I feel the need to remind our U.S. friends that any ailment is treated for free, including medication, in many countries. “Free market at all cost” Capitalism gets ugly, fast.

  20. The problem is the rating scales, in a word, suck.

    I see your point. Much of it looks self reporting – at a glance. I think all scales, especially pain, suck. My 94 year old father woke up in the middle of the night wanting to be driven to the hospital. He’s the type that won’t go to doctors so you know it’s serious. When we get to the hospital and they ask him to rate his pain he said it was between a 4 and a 5! Say what? I tried to explain to the physician that he’s not the type to go to the doctor, he was in extreme pain, and his rate should be higher. He explained that he could only write down what my father stated. Here I realized that my Dad’s scale for a 10 is based on his experience of being in WWII. A ten would probably be someone shot down with a blown up leg bleeding to death on the battlefield.

  21. Hey folks again. Couple more comments related to the practice of psychiatry, related again to tunnel vision of some psychiatrists that have led folks to understandably be very skeptical of the field.

    Antidepressants, when they work, should have zero or absolutely minimal side effects. Side effects are noted virtually immediately in general. Feeling like a zombie, drunkeness (more often caused by benzodiapines, which may have been prescribed for the car crash victim, which are distinctly NOT antidepressants), agitation are all reasons to stop. Try a different antidepressant. Or not. The point is, you have no idea if it will work or not unless you try. These meds are NOT addictive and don’t change things permanently. But you are right, some absolutely don’t jive with some people. Feeling like you are emotionally numb is unacceptable. However, if you truly have depression, one of the dozen or so meds and other treatments is overwhelmingly likely to work.

    Also: part of what is convincing for folks who work in our field is the response of folks who really have it bad. Like following serious suicide attempts, not eating literally for days, hearing voices telling you to kill yourself (which happens in bad depression), thinking the mafia is after you, etc. These people can absolutely have ALL these symptoms go away. And it don’t take weeks. It stands to reason if these folks can have ALL their symptoms go away, so can someone with mild depression. I guess you sort of have to see how “medical” depression can look to believe it, but we are talking about symptoms as obvious as a appendicitis. And not wish washy, “subjective feelings” but objective ones a kindergartner couldn’t miss.

    Oh, and if you have a parent with Alzheimer’s who is attacking their family members and accusing them of stealing all their belongings, watch how quick an antipsychotic works in the ER or hospital to melt that stuff away… Don’t take 2-4 weeks as the literature also purports. This is a measurement problem, not a clinical one.

    Finally, i don’t get paid for prescribing meds. Nor do I want to necessarily. If I could get everybody well with therapy, I’d choose that in a heartbeat. But therapy doesn’t work for high blood pressure (also an poorly understood brain dysfunction usually), and doesn’t work for diabetes. There is this natural tendency to think your brain can’t fail medically like any other organ, but that is an illusion.

    • In reply to #71 by NigelB:

      hearing voices telling you to kill yourself (which happens in bad depression), thinking the mafia is after you, etc.

      I thought hearing voices was virtually always considered a sign of schizophrenia. Of course psychiatric diagnosis is IMO as much an art as a science but I thought that was pretty well established. If that’s changed I would be interested in seeing something written up that confirms that hearing voices can be considered a sign of depression.

      Just to be clear I’m not saying that someone who hears voices can absolutely never be diagnosed with severe depression. Psychology and Psychiatry are so inexact you can find exceptions to anything. But from what I know that is one of the few symptoms that is almost always associated with schizophrenia not depression.

      • In reply to #74 by Red Dog:

        In reply to #71 by NigelB:

        hearing voices telling you to kill yourself (which happens in bad depression), thinking the mafia is after you, etc.

        I thought hearing voices was virtually always considered a sign of schizophrenia.

        Yes but there are many types of this disorder. My father suffered from paranoid schizophrenia. He was always worried people were out to get him. In some cases he was right though. He suffered from extreme anxiety due to this. Nothing worked to change his behavior and thinking except Risperdal. It was like magic how it changed him totally. But the down side of this med is the same as others. It rendered him a zombie with even less interest to participate in life. It was amazing how docile he became . He was like how I had always wanted my father to be. A kind gentle man with a great sense of humor. That is who he really was but schizophrenia robbed him of the ability.

        Hearing voices is also schizophrenia which surprises me that people who claim to hear gods voice don’t end up in a padded room .
        I can hear voices of angels and god and jesus and I am totally sane?

        he also had shock treatments done to him when he was younger for the depression, I found the appointment cards when I was going through his things after he died. He had an brain MRI done here after I hospitalized him and they found lesions in his brain likely caused by the electroshock. This is a destructive therapy and it is obvious it did not work…

        http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml

        http://psychcentral.com/disorders/schizophrenia/

      • In reply to #74 by Red Dog:

        Red Dog,

        Full credit and thanks to you for this thread.

        Depression is such a common and debilitating condition. Talking about it and sharing experiences with others helps a lot though. I can just still recall earlier less enlightened times when any hint of mental illness was considered shameful and kept hidden. Not helpful for the sufferer.

        I feel sure that, as Nigel says, anti-depressants can be effective; when you find the right one. My GP was of this opinion; he warned me that we might need to try a few before we got the right one. Citalopram was right for me, as it turned out, but only after I had been instructed to try a series of others for about a month each. If I had known that it should only take a few days to test them then I could have been spared some anguish. The problem was that the other ADs I tried actually made me feel much worse. My GP wanted me to persist with them, saying I would ‘feel worse before you feel better’, unfortunately I actually felt worse before I felt worser (!)

        Thanks to all the commenters here for sharing their knowledge and relevant perspectives, for the benefit of us all.

        • In reply to #83 by inquisador:

          In reply to #74 by Red Dog:

          Red Dog,

          Full credit and thanks to you for this thread.

          Thanks. I agree that it can be really interesting and helpful to hear other people’s experiences. Sort of like a virtual group therapy session.

        • In reply to #83 by inquisador:

          . IThanks to all the commenters here for sharing their knowledge and relevant perspectives, for the benefit of us all.

          I’m still not sure about the wisdom of posting on this thread! ;-) I think I may have confirmed a few suspicions that I’m a complete nutter, or at least introduced a seed of doubt that may not have been there in the first place. Time will tell.

          • In reply to #90 by Nitya:

            I’m a complete nutter or at least introduced a seed of doubt that may not have been there in the first place.

            Well if it any consolation , I do not think there is anyone perfectly sane Living on this planet . If you are not nuts you can turn into one, religion has the formula for that one….

          • In reply to #92 by GFZ:

            In reply to #90 by Nitya:

            I’m a complete nutter or at least introduced a seed of doubt that may not have been there in the first place.

            Well if it any consolation , I do not think there is anyone perfectly sane Living on this planet . If you are not nuts you can turn into one, religion has the fo…

            Thank god that one hasn’t been thrown into the mix! ;-)

  22. Wow I can’t stop myself. Many meds described here are not antidepressants. Valium, Klonopin, Xanax, serax, Ativan, are benzos, and have the same mechanism as alcohol, and are equally addictive, they have their place, but a small one. And they are lousy meds for depression, as they are CNS depressants!

      • In reply to #120 by This Is Not A Meme:

        In reply to #73 by NigelB:

        My wife is an anesthesiologist, and she says the only people with really good pain tolerance are WW2 vets!

        One of the upsides of PTSD.

        does.not.compute.

        Maybe I missed it – was there an inference those vets have PTSD?

        News to me that there is an upside to PTSD, let alone more. Citations, please. Centennial of WWI – this comes to mind.

  23. I think the weirdest thing I’ve found out about placebos is that they can still work even if the recipient knows they’re placebos. It was on a Horizon episode in February about the power of placebos, here in the UK (here’s what I’m talking about).

    If you’re wondering, here’s a video of the program itself. You can watch from the 41-minute mark to get to the part about placebos not needing deception, but it’s worth looking at the whole thing for more information on placebos, because much of it is weirder than you think.

  24. In Reply NigelB #71

    .I guess you sort of have to see how “medical” depression can look to believe it, but we are talking about symptoms as obvious as a appendicitis. And not wish washy, “subjective feelings” but objective ones a kindergartner couldn’t miss.

    This is true in the case of acute anxiety as well. In an earlier post I mentioned some rather wishy-washy symptoms that can accompany anxiety. The state of acute anxiety can come with alarming symptoms at times. The worst experience for me was when I had an agonising toothache. I was positive that the suspected tooth had an abscess and ended up sitting in the dentist’s chair expecting an extraction on that day. After the dentist examined the tooth and took X-rays, he informed me that there was nothing wrong with the tooth at all. The experience was completely self-inflicted!

    A similar incident occurred on another occasion when I was under a great deal of stress. I had all the symptoms of a UTI. These symptoms intensified over a few days and I was eventually forced to seek treatment. After simply making the decision to seek treatment the symptoms began to subside. I was prescribed a course of antibiotics and seconds after swallowing the first capsule ALL the symptoms disappeared. The analysis of my sample showed that there was no sign of an infection at all.

    Knowing that this can happen, has made me extremely aware of the signs of anxiety in other people. I have a special radar that enables me to detect the slightest hint of self deception and I’m very aware of the placebo effect at work. When anxiety prone people like me report amazing cures as a result of a dubious alternate remedy, I have to resist the impulse to put them straight.

  25. Yes, when you’ve got significant anxiety/depression/whatever, or you have a loved one who has it, you can see that it is a different animal from having the blues or being kind of anxious.

    As far as psychotic symptoms: these are categorized as hallucinations (usually auditory) or delusions (e.g. Government is out to get you, you have a chip implanted in your brain,whatever). Psychotic symptoms happen for all kinds of reasons: schizophrenia, depression, bipolar disorder, LSD, even a bad infection. It is a common misconception psychosis = schizophrenia which is a particularly nasty degenerative condition that robs folks of their socialization skills and desires and motivation, and ability to take care of themselves.

    However, all psychosis responds to the same treatment: antipsychotics. Psychiatry is treatment of symptoms, not diseases. If we knew what the diseases really were they would be considered in the realm of neurology (think of neurosyphilis and Parkinson’s, both originally classified as psychiatric illnesses). Due to a need to have a common language, as well as the misconception that naming something helps you understand it, we have the bible of psychiatry, the DSM, which is reality is a significantly flawed work in progress.

    None of this is to say the placebo effect isn’t real or important, it just doesn’t explain psychiatric meds.

    To respond to the comment below, my favorite moment in med school was an ophthalmologist barking at a med student who insisted that an illness COULDNT be temporal arteritis because a particular lab result was negative: “dammit, you think this is a science?! You’ve got a hell of a lot to learn!”

  26. There is truth in brain over body, you can most definitely make yourself sick and cause your self to have pain as well as to control pain with your mind. I think this is what makes us prone to believe in supernatural or other similar imaginary beings and placebos . We have a very strong capacity for self delusion. Which affects us at the physical level.

    I disagree with the idea that psychosis necessarily means schizophrenia. Many people with this disorder do not show psychosis as a manifestation of the disorder.
    I was worried about this disorder being hereditary . The only way something can be hereditary is by being a genetic trait of some sort. In other words a physical cause that has to do with how the brain is wired. But there is no evidence to suggest this is true. When I asked the psychiatrists if schizophrenia was hereditary , they said it is not known but there is a chance one could be prone to developing it, if it is in the family. However many things can cause the brain to fail . I don’t want to believe that I could be prone to this disorder. I am constantly checking for symptoms that are similar to what my father displayed.

    The thing about this disorder is that the more brilliant you are the better you can manage it and hide it. My father was like that, a brilliant man who we thought was just difficult to deal with. It wasn’t until later when he started to display the typical symptoms like lack of personal hygiene and mismatched clothes and living in a hoarders nest and getting in trouble with the law.

    He had an OCD too of hoarding things like scrub brushes and organized them in a row based on color and size. He did this with everything. He had 100 brooms but never swept a thing. When I hospitalized him in a mental hospital he fooled the doctors into thinking nothing was wrong with him and that his family wanted to take away everything from him.

    I had to take pictures of his living conditions an write a full essay on his past behavior. Once they saw the pics they agreed he was a text book case. Specially because he was so brilliant and fooled them as he had fooled everyone. But I think he suspected that he had something like this because a while back before all this went down , he asked me if I knew about a medicine called Risperdal.

    The doctors also said to me that the people that ask themselves if they are crazy usually are not. And the crazy ones deny being crazy. I suppose that is a relief but I am sure people are aware of their level of insanity.

    I would like to know for sure if this is a hereditary disorder . Apparently manic depressions is also thought to be hereditary . If it is, it would be nice to know the mechanism. It is different for everyone.

  27. GFZ -

    It is multifactorial. There is a real genetic component, but it is caused by a lot of different genes interacting together. There are also other factors that we just don’t know about, and one day we may find out that it is triggered in susceptible people by infection, autoimmune illness, who knows. It hits the vast majority of the time in ones late teens… So just because there is a herditary component, there is still a very low probability on getting the illness… You are very likely in the clear :-)

    Great point about brains ability to fool oneself – the smarter you are, the better you rationalize it… Nobody can be talked out of delusions, no matter how smart. All these psychiatric disorders have a hereditary component, but a lot of times folks inherit only a little bit of it, as it were, so kids of bipolar parents often end up a bit on the energetic, creative, amped up side, without usually the full-blown case. By the way, psychosis in schizophrenia usually bizarre (eg chip in ones brain), depression often negative (voices to hurt self), and grandiose in bipolar disorder (voice of god telling one he is the savior). And ultimately, we all have some of this stuff. If it doesn’t interfere with your life, it really doesn’t qualify as a disorder – who cares?!

    • In reply to #80 by NigelB:

      By the way, psychosis in schizophrenia usually bizarre (eg chip in ones brain),

      My experience with actual schizophrenics is pretty limited but in that experience I was actually surprised at how often this wasn’t the case. Again, this is just a hand full of patients I interacted with, the psych hospital I worked at was private so only people with good insurance were admitted and most of them weren’t schizophrenics but of the few that I knew many of them were in most ways very comfortable with their voices most of the time.

      I remember one woman in particular who was very rational. She knew that the voices weren’t real most of the time but at the same time she would also have to admit that they were in some ways as real to her as any other person she knew. Once she got to know and trust a staff person (which took a lot of time) she would talk about “her voices” the way you or I would talk about a friend and the things her voices told her were often supportive, friendly, and amusing.

  28. I think that the electroshock my father received for depression caused a lesion in his brain which was the root of his developing the disorder. The brain is in a constant rewiring mode so it would make sense that it also compensates for damaged regions. Sometimes the result is not a good one. Unless the brain somehow knows what to do in an autonomic process. Like a tree growing a new branch where the old was cut off.

    Depending on the region damaged is the kind of symptoms of psychosis displayed. Also noted is the post partum depression that people used to think was a mental illness but it turned out to be caused by low levels of progesterone after having very high levels during pregnancy. Low levels of progesterone can cause psychosis. Many women are given antidepressants when what they need is progesterone. The combination of this hormone and magnesium are imperative for proper brain function.

    This is why it is almost dangerous to go to psychiatrist when you feel like this the same with going to see the gynecologist. Because feeling something points to anything.

    You should go to an Endocrinologist . And have a battery of tests to discard a misdiagnosis.

    I recommend this book : The Multiple Roles of a Remarkable Hormone. by Dr John Lee MD

  29. In reply to #81 by GFZ:

    I think that the electroshock my father received for depression caused a lesion in his brain which was the root of his developing the disorder.

    I apologize to any clinicians reading this, I know I’ve taken a few cheap shots at the profession and I want to say IMO being a mental health professional is a very difficult, thankless, job. But having said that I can’t resist sharing one more example of something that really bothered me.

    When I saw ECT (Electro Convulsive Therapy aka shock treatments) it was decades ago. Two people have told me that it’s more humane now. But what I saw of it really sickened me. The process itself was barbaric more like torture than therapy. And the patients were terrified of it. And I felt like a jerk trying to soothe their fears because all the while I was thinking how rational they were to be terrified of it and how if I were facing it I would do anything I could to get the hell out of that place before it was done to me.

    The effect of an ECT treatment was to turn the patient essentially into a zombie. Whatever personality they had was gone the next day. They were like the walking dead. So yes, if they were manic or suicidal or schizophrenic those symptoms were gone because zombies don’t show any symptoms at all. And it also destroyed their short term memory. They had no memory of the treatment or usually what had happened the day of the treatment and sometimes longer.

    And the worst thing was that — at least at the time — there was no established theory about how ECT was supposed to help psych patients. ECT was first used because some doctor noticed that epileptics were seldom schizophrenics. So someone had the bright idea “hey, let’s induce seizures in schizophrenics and see what happens!” And according to some clinicians it seemed to work — although in my opinion what they called relief of symptoms I considered turning people into zombies — so they kept on doing it. But at the time (the 1970′s) there was not even a preliminary theory (e.g., the way there is theoretical support for SSRI’s and Serotonin) for why the “therapy” worked.

    As I said a couple of people have told me it’s more humane now and that it works when meds don’t work but if I or someone I loved was facing it, actually someone I loved was facing it and I did everything I could to talk her out of it and even though she was the kind of person that I normally couldn’t talk out of anything for once I’m happy to say she listened to me.

  30. Hey Red Dog –

    No need to apologize to clinicians! Again its our own fault in many ways the public is so skeptical, and I don’t pretend to have all the answers, just view points based on what I’ve seen.

    I did want to share my experience seeing many patients receiving ECT, though I fully respect your point of view and certainly can’t speak to your own experience.

    In my point of view, ECT has gotten a terrible name despite being perhaps the most effective treatment for refractory depression. Yes, it was discovered by accident, as virtually all the other psych meds (antidepressants, lithium), and even many medical medications such as penicillin. And nobody knows how it really works (though there are some theories). But, I’d point out again that we don’t know how many medications work, including anesthetics. But we know they work. Someday, we’ll figure it out, but not yet!

    It is actually in the vast majority of cases an extremely safe procedure in which the only significant known risk we worry about is the risk of anesthesia, just like any other surgery. The procedure takes about 15 minutes or less, and consists of being briefly put under by an anesthesiologist and receiving the electric current for a few seconds. It causes a seizure, but no body symptoms because of the muscle paralytic. A person wakes up in a few minutes and can be briefly confused. They then go home. The only common side effect is loss of memory for the immediate time surrounding the treatment, though there have been some reports of longer term (and obviously more concerning) memory loss. In the past, it was conducted without muscle relaxant, and they would actually hold you down to control the seizure, which as you might imagine was a much rougher treatment.

    However, ECT works when meds don’t. Folks shouldn’t end up with any zombie symptoms (though again, I certainly can’t speak to your experience and am humble enough not to suggest it couldn’t happen). It is the treatment of choice for folks who are so severely depressed they don’t eat, are catatonic (like can’t move or just exhibit odd posturing), can’t tolerate meds, or who are so severely suicidal their life is at constant risk. Many folks swear by it — I’m sure if you check online you’ll find forums that attest to this fact.

    Also, no one should be forced to undergo any treatment they don’t wish to. But, even given the stigma, concerns, and press about ECT, you might imagine how much someone is suffering to even entertain the thought of ECT.

    Not to be confused with frontal lobotomy, which was truly a barbaric procedure, by the way, which is no longer done, thankfully.

    • In reply to #87 by NigelB:

      Hey Red Dog –

      No need to apologize to clinicians! Again its our own fault in many ways the public is so skeptical, and I don’t pretend to have all the answers, just view points based on what I’ve seen.

      I did want to share my experience seeing many patients receiving ECT, though I fully respect y…

      So now three people have told me it’s more humane ;-) Thanks for the input, you have a lot better and more recent experience than I do. Also, I know from Trivers memories get corrupted, my experience seeing ECT is not something I remember fondly and it’s possible I’m remembering it as worse than it really was.

    • In reply to #87 by NigelB:

      Hey Red Dog –

      No need to apologize to clinicians! Again its our own fault in many ways the public is so skeptical, and I don’t pretend to have all the answers, just view points based on what I’ve seen.

      It may be safe as in you might not die from it but it is not a proven science. This damages parts of the brain and it is not similar to epilepsy .I know one person who had an aneurism in their brain and had to have it removed or ligated . After that she ended up with seizures . No medication worked to stop them from happening.She was one of the first patients to receive a a Vagus Nerve stimulator .
      https://www.epilepsy.org.uk/info/treatment/vns-vagus-nerve-stimulation

      It is a wire that goes from the implant/ trigger and with the use of a magnet it send a current to the area that has the seizures and is successful at stopping it although not always. She also has MS poor thing…I saw how it worked, she passed a magnet over the implant and that would turn it on. This particular treatment is targeted with precision . It is a neurologist who does this not a psychiatrist.

      I also know personally people who have had the shock treatment recently for depression and anger management , it did not work. We are assuming here that it is some kind of magic bullet like the drugs… It is not.

      So you found a drug that works, that is great but taking any drugs like this long term can’t be good. Read the fine print from the meds. If you don’t get the insert from the box as in the USA, look it up on the internet.

      The results from shock treatment vary as well as the level of disorder. You can’t treat depression if the person’s life is miserable. You can dope them up so they don’t do harmful things, but until their life is not miserable no drug or shock treatment will cure the problem.

      On one hand we have depression caused by chemical/hormonal imbalance, on the other we have depression from lifestyle or poverty.
      You can’t treat that with drugs. The only way to really combat this , is helping them fix their life. that is the hardest part when helping someone recover.

      I am firmly against any therapy that relies in the destruction of healthy tissue. There is still too many unknowns and not enough real support for people. That is the real tragedy.

      • In reply to #89 by GFZ:

        In reply to #87 by NigelB:

        So you found a drug that works, that is great but taking any drugs like this long term can’t be good.

        So my long term usage of a Ventolin Inhaler can’t be good why exactly and on what grounds?

        All I am seeing here is the usual anti big-Pharma crap that I would expect to see on a facebook page.

        • In reply to #95 by veggiemanuk:

          In reply to #89 by GFZ:

          In reply to #87 by NigelB:

          So you found a drug that works, that is great but taking any drugs like this long term can’t be good.

          So my long term usage of a Ventolin Inhaler can’t be good why exactly and on what grounds?

          According to the people who make your inhaler, possible side effects include:

          “…worsening trouble breathing, coughing, and wheezing (paradoxical bronchospasm).
          If this happens, stop using VENTOLIN HFA and call your healthcare provider or get emergency help right away.
          This is more likely to happen with your first use of a new canister of medicine.
          heart problems, including faster heart rate and higher blood pressure.
          possible death in people with asthma who use too much VENTOLIN HFA.
          allergic reactions.

          Call your healthcare provider right away if you have any of the following symptoms of an allergic reaction:
          itchy skin
          swelling beneath your skin or in your throat
          rash
          worsening trouble breathing
          low potassium levels in your blood.
          worsening of other medical problems in people who also use VENTOLIN HFA, including increases in blood sugar.

          Common side effects of VENTOLIN HFA include:
          your heart feels like it is pounding or racing (palpitations)
          chest pain
          fast heart rate
          shakiness
          nervousness
          headache
          pain
          dizziness
          sore throat
          runny nose”

          Source: IMPORTANT SAFETY INFORMATION FOR VENTOL

          No drug that I’ve EVER heard of doesn’t have possible negative side effects and the longer you use it the greater the potential harm. It’s always a question of whether the potential harm outweighs the potential benefit and finding what works for each user.

          All I am seeing here is the usual anti big-Pharma crap that I would expect to see on a facebook page.

          I agree that rejection of some medicine just because a big corporation makes it and makes money off of it is irrational. However, I also think that ignoring the fact that big corporations make most of our medicine and that such corporations are driven first by profit is at least equally irrational.

          • In reply to #96 by Red Dog:

            In reply to #95 by veggiemanuk:

            According to the people who make your inhaler, possible side effects include:

            Yes, and these are known and published risks which any decent Doctor should be aware of before giving to their patient. They are not faults of the medication or it’s manufacturer.

            I can safely say that I owe my life to the Ventolin Inhaler as early as 11 years old and several times since, the effects are instant and way outstrip any potential risk. There is nothing quite like seeing someone slowly suffocating and gasping for air mid attack and then have instant relief after just one dose. And before it is mentioned, no, these are not placebo effects.

            No drug that I’ve EVER heard of doesn’t have possible negative side effects and the longer you use it the greater the potential harm.

            Not so, whilst all drugs may have side effects, not all drugs have an ever increasing potential for harm. What you might find however is that as the body ages and develops newer complications the original drug may not be compatible any longer and this is not a fault with that drug.

          • In reply to #96 by Red Dog:

            In reply to #95 by veggiemanuk:

            possible death in people with asthma who use too much VENTOLIN HFA.
            allergic reactions.

            One can abuse water to death too and you would require to take far less over your daily limit than you would for a Ventolin overdose.

            ‘The oral median lethal dose of albuterol sulfate in mice is greater than 2000 mg/kg (approximately 6800 times the maximum recommended daily inhalation dose for adults on a mg/m2 basis or approximately 3200 times the maximum recommended daily inhalation dose for children on a mg/m2 basis). In mature rats, the subcutaneous median lethal dose of albuterol sulfate is approximately 450 mg/kg (approximately 3000 times the maximum recommended daily inhalation dose for adults on a mg/m2 basis or approximately 1400 times the maximum recommended daily inhalation dose for children on a mg/m2 basis). In small young rats, the subcutaneous median lethal dose is approximately 2000 mg/kg (approximately 14,000 times the maximum recommended daily inhalation dose for adults on a mg/m2 basis or approximately 6400 times the maximum recommended daily inhalation dose for children on a mg/m2 basis). The inhalation median lethal dose has not been determined in animals.’

            Source

          • In reply to #98 by veggiemanuk:

            In reply to #96 by Red Dog:

            In reply to #95 by veggiemanuk:

            possible death in people with asthma who use too much VENTOLIN HFA.
            allergic reactions.

            One can abuse water to death too and you would require to take far less over your daily limit than you would for a Ventolin overdose.

            ‘The oral medi…

            I wasn’t arguing that you shouldn’t use your inhaler. Of course you should. I use one too as a matter of fact. I was just replying to your earlier comment where you seemed to be implying (perhaps I misunderstood) that there were no potential risks from doing so. Clearly there are. It’s just that for you (and me) the benefits outweigh the risks.

            I think any knee jerk absolutist response here is wrong. Both the Tom Cruise one that says all psychoactive drugs are bad but also your position which seems to me to be that anyone who worries about the long term effects of psychoactive drugs or the potential for large corporate Pharmaceutical companies to put profit over health risks is just indulging in “anti big-Pharma crap”.

          • In reply to #98 by veggiemanuk:

            In reply to #96 by Red Dog:

            In reply to #95 by veggiemanuk:

            possible death in people with asthma who use too much VENTOLIN HFA.
            allergic reactions.

            You don’t understand Psychoactive drugs and neither do the makers. This is about antidepressants and drugs that affect the central nervous system.

            Depending on the drug you take long term is what will happen. Ventolin is one of the safest asthma meds. But there are several out there based on steroids and that are harmful.

            There are drugs that were thought to be safe however in the long run cause severe problems including death.

            Since this is about mental health, your argument is misplaced. You can’t stop asthma with a placebo nor an antidepressant.
            The class of painkillers called non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin and ibuprofen, can trigger asthma.

            There is no safe drug.

          • In reply to #100 by GFZ:

            In reply to #98 by veggiemanuk:

            In reply to #96 by Red Dog:

            In reply to #95 by veggiemanuk:

            You don’t understand Psychoactive drugs and neither do the makers.

            Neither do the makers? That’s one bold claim. I guess all those years of research were for naught?

          • In reply to #103 by veggiemanuk:

            In reply to #100 by GFZ:

            In reply to #98 by veggiemanuk:

            In reply to #96 by Red Dog:

            In reply to #95 by veggiemanuk:

            You don’t understand Psychoactive drugs and neither do the makers.

            Neither do the makers? That’s one bold claim. I guess all those years of research were for naught?

            All you need to do is read the PDR physicians desk reference and read the entire descriptions of a drug. Sometimes the long term damage is not known until it is too late. There are countless examples. Thalidomide sold over the counter and given to pregnant women !! It is still used today to treat cancers.

            Long term use of Psychoactive drugs are known to cause long term damage. This means that new drugs that have not been around enough have yet to show what they do in long term use. This means they do not know. And they say so in the PDR.

            http://www.mindfreedom.org/kb/psychiatric-drugs/antipsychotics/neuroleptic-brain-damage

            http://www.mindfreedom.org/kb/psychiatric-drugs/antipsychotics/neuroleptic-brain-damage/los-angeles-times-antipsychotics-shrink-brains

            There are various types of asthma and it affects people differently . It can be psychosomatic or it can be actually constriction of the alveoli in the lungs making it hard to breath. If there is mucus it becomes even harder to cough it up to clear the lungs from it.

            In these cases you need a real rescue inhaler or some kind of bronchial dilator/expectorant , there is no way to mentally make your lungs clear themselves from mucus and reduce the constriction .

            You may be able to calm the person and get them to stop freaking out for not being able to breath, but you can’t convince them it went away and now they can breath. This is the same as telling a paralyzed person they can walk. Some things are beyond placebo effects.

          • In reply to #100 by GFZ:

            There is no safe drug.

            This is something I point out to ‘alternative medicine’ fans. If it works, it’s not safe. If it’s safe, it doesn’t do anything.

        • In reply to #95 by veggiemanuk:

          In reply to #89 by GFZ:

          In reply to #87 by NigelB:

          So you found a drug that works, that is great but taking any drugs like this long term can’t be good.

          So my long term usage of a Ventolin Inhaler can’t be good why exactly and on what grounds?

          All I am seeing here is the usual anti big-Pharma cr…

          I’m loathe to generalise, but I feel the need to chip in with the observations I made regarding the long term use of a Ventolin inhaler and the use of steroids by my mother. ( I hasten to add that she lived to 88yrs). For a start, I’m sure it would be possible to have an example of the placebo effect with chronic asthma. My mother took the inhaler wherever she went; if she discovered that she had forgotten to pack it, this would initiate an immediate attack. She later began to travel with two inhalers just in case one ran out of puff when she needed it. There is a strong psychological component involved in Ventolin use I’m sure.

          My mother also suffered the consequences of long term use of steroids. This drug depleted the amount of calcium in her bones to dangerously low levels. The effects of steroids exacerbated the osteoporosis already present in her make up.

          • In reply to #102 by Nitya:

            In reply to #95 by veggiemanuk:

            In some people, an Asthma attack, as I am sure you already know can be triggered by anxiety and stress as well as other factors (For me it is physical exertion).

            As for the Steroid use, how much worse do you think her life would have been without it?

          • In reply to #104 by veggiemanuk:

            As for the Steroid use, how much worse do you think her life would have been without it?

            Oh I agree. It’s a constant process of weighing up the benefits with the possible side effects. ( as several posts have already stated).

            The point I was trying to make re Ventolin use, was that asthma is a condition very responsive to a psychological element. It wouldn’t surprise me for an instant if an inhaler filled with some inert substance had a positive effect.

          • In reply to #105 by Nitya:

            In reply to #104 by veggiemanuk:

            It wouldn’t surprise me for an instant if an inhaler filled with some inert substance had a positive effect.

            Subjectively I’m sure it would work for some but objectively I doubt it would improve the real symptoms especially in those like me whose asthma is triggered physically, though a study into this would be interesting to see.

          • In reply to #106 by veggiemanuk:

            Subjectively I’m sure it would work for some but objectively I doubt it would improve the real symptoms especially in those like me whose asthma is triggered physically, though a study into this would be interesting to see.

            I wouldn’t be at all surprised if experiments were to show the placebo effect at work EVEN in cases like your’s . I know it seems hard to imagine, but I wouldn’t underestimate the psychological influence on many conditions. ( with obvious exceptions such as broken bones etc.)

          • In reply to #107 by Nitya:

            I wouldn’t be at all surprised if experiments were to show the placebo effect at work EVEN in cases like your’s . I know it seems hard to imagine, but I wouldn’t underestimate the psychological influence on many conditions. ( with obvious exceptions such as broken bones etc.)

            I was thinking the same thing. Also, it’s difficult for any individual to really give an honest assessment of how much psychological issues may play a role in our health. So when someone says “asthma does have an emotional component for some patients but not for me” I tend to discount that a bit. My guess is that if you took a poll of asthma patients about if and how much psychological issues are a major factor in their particular illness the numbers you would get would be far less than what most doctors who know the disease would estimate is really the case. This fits right in with the research that Trivers summarizes, when it comes to self reporting most of us evaluate ourselves as more rational, smarter, more objective, etc. than we actually are.

  31. I’ve lost people to anti-depressants. Suicide is no placebo.

    Scientific illiteracy is a huge problem with psyche meds, and doctors get a bad rep for it. People go to the doctor to get a pill, with the same unenlightened mentality of a person seeking a magic elixer or homeopat5hic remedy. Doctors do their jobs as scientists, but people don’t know how to access them as a resource. The result has been a lot of death and tragedy. It’s hard enough to get data on people who killed themselves on these drugs, but personally I’ve known such casualties as well as people who killed their pets on these drugs, or did some other horrible act that would not have happened otherwise.

    I’m a biology nerd, an autodidact. As such I have particular distaste and appreciation for the widespread pretentious attitudes that flourish around the topic. People talk like they have degrees in organic chemistry when they spout out terms like SSRI and SSNRI, etc. This insecurity driven arrogance creates an emotional regard for these drugs, because everyone wants to fancy themselves a doctor and an expert. This encourages public enthusiasm for these addictive, crippling drugs.

    Protocols have changed as people dash themselves against the rocks, the insured consumer acting as guinea pigs. They no longer prescribe them as a response to bereavement depression. The current use of ant-depressants is as reckless and mistaken as the use of opiates in the 19th century, when pain was treated as a disease to be cured. Pain and depression are symptoms of underlying causes. People once took opiates until they died of a tooth infection, and now people engage in mentally harmful lifestyles while numbing the subsequent depression.

    If I were the dictator, I’d say such drugs should only be available to those who demonstrate a need through brain-scan or after exhausting all other routes. Currently there is no care given to patients after they report benefit from the drug, and this is wildly stupid. These drugs can induce delusions of being okay, and with all the different flavors of isomers and analogs, these drugs have an elegant potential which currently lost in the ham-fisted method of commercial distribution.

  32. Veggiemanuk, great point. It ultimately is a question of risks vs. benefits, as with all medication and treatments. In my experience, the general public tends to underestimate the risks of biological depression (risk of suicide, substance abuse, not to mention overall day-to-day functioning). They also tend to overestimate the risks (partially due to crummy research, as I already described), and partially due to people’s draw to conspiracy theory (i.e. medical providers are trying to exert mind-control over the public, or turn folks into zombies) and the media’s exploitation of this fear.

    One of the major hangups is acceptance of depression and psychiatric disorders as truly medical conditions, which they are in some cases, as real and as dangerous as an infection. I certainly understand that without this acceptance, the whole idea of medication makes no sense.

    The caveat is that they have to be responsibly prescribed, which they sometimes aren’t.

    I agree there are pluses and minuses to the pharmaceutical industry, just as for any other American capitalistic enterprise. The bad news is, they charge a lot, advertise a lot, and take advantage when they can (like any other business). The good news is, they’ve brought us life-saving treatments for disorders psychiatric and otherwise.

  33. in Reply # 109 GFZ

    In reference to the part of your comment about types of asthma, a chronic asthmatic can still experience an attack triggered by a perceived irritant. My mother suffered from all the classic symptoms seen on those gruesome posters in the surgery, but if should thought she had come into contact with an allergen she would start to wheeze. Eventually she was convinced that she was allergic to everything.

    • In reply to #110 by Nitya:

      in Reply # 109 GFZ

      In reference to the part of your comment about types of asthma, a chronic asthmatic can still experience an attack triggered by a perceived irritant. My mother suffered from all the classic symptoms seen on those gruesome posters in the surgery, but if should thought she had com…

      Yes I agree that there is no limit to what we can make ourselves think and subsequently induce an illness. Hypochondriac syndrome.
      it is also worse when you are told there is no cure. You believe that and your body follows.

      The asthma I was referring to is the precursor to emphysema. Where the lungs get coated with hard phlegm . Not the one that is induced by allergens .

      Speaking of allergens, being told you are allergic to dust is insane. Might as well live inside a plastic bubble….

      I think there must be also a placebo to cause an illness not just to cure it. It works both ways.

  34. Difficult to say or answer (as I am no doctor), but a patient with deep depression once, 16 years ago, I have had a reactive depression for some circumstance in my life that happened to be related with pregnancy-not any post giving birth depression, it never occured me that there could be any happier time in someone´s life than having a baby– (and it really seems that many people comment they have depression but they don´t really know what they are talking about I guess).
    When there is no alternative but medicine what can a patient with depression rely on? (psychotherapy too).
    I remember very well I was even lethargic and afraid of sleep because of nightmares and the first thing medication may have helped may have been in supressing deep sleep- what helped to control nightmare ?- and to “disinhibit ” thoughts- as if I was mad with “uncontrolled” thought.
    A second different medication helped to bear the incommensurable anguish I felt every morning but a few months later I could not support this medication either. Of course a long talk with someone can make a small difference and time will probably reestablish the normal functioning of blocked neurotransmissors, I guess.

  35. This subject needs to be divided into two areas. Psychological problems that are caused by chemical imbalances in the brain, and problems that are caused by human experiences. If you graphed these two problems you will find a dumbbell curve, with an area of overlap in the middle. Thus, some problems are purely chemical. Some are purely psychosomatic, and some are a mix in the middle.

    Post traumatic stress disorder is an example of a mix. A life threatening traumatic event, non chemical, results in a psychosis that is chemical. Schizophrenia is chemical. Depression in the main is caused by the failure of the brain to mop up nor-adrenalin and serotonin. It doesn’t matter how much “Talking Cure” you get, if the chemistry remains out of whack, the patient feels depressed. So you are give a drug like Efexor, to mop up the excess nor-adrenalin and serotonin. This re-balances the mood, while the talking cure can reconfigure the brains plasticity to prevent it, or lessen the chance of a relapse.

    So if the psychosis is chemical, then placebo won’t cure it. If it is psychosomatic, then a placebo may be effective, if it is primed during the talking cure, to be the magic bullet. The more the Dr talks up the placebo, the better it works.

    • In reply to #113 by David R Allen:

      This subject needs to be divided into two areas. Psychological problems that are caused by chemical imbalances in the brain, and problems that are caused by human experiences. If you graphed these two problems you will find a dumbbell curve, with an area of overlap in the middle. Thus, some probl…

      If I’m understanding you correctly, I think I’m just restating what you said here but I like to make sure I understood before I comment: you are saying that there are essentially two components to any mental illness or problem: a physical part caused by things like too much or too little of a neurotransmitter and a behavioral part caused by negative experiences.

      I can understand why you think that way and I used to think that way as well. But after reading things like Trivers’ book I came to think it’s actually a lot more complicated than that. The placebo effect can have an impact on purely physical symptoms. It can facilitate healing and things that are completely beyond mental control such as the immune system. You can’t will your body to produce less or more disease fighting things like white blood cells but the placebo effect can impact such things in measurable ways.

      I think behavior, cognition, and the physical nature of the brain are all highly connected. It’s one of the flaws I see in a lot of writing by people who just emphasize things like neurons over all else like Patricia Churchland and Sam Harris. They look for very simplistic direct connections like empathy = oxytocin and it’s seldom if ever that simple.

      I think there are a lot of subtle interconnections between behavior/cognition and the physical state of your brain and any model that just divides them off as “this behavior/symptom is physical and this one is mental” is almost certain to turn out to be too simplistic.

  36. There is an assumption that because the feelings of depression are unpleasant there is a disease rather than dis-ease. The drug companies have a vested interest in maintaining a biological basis for depression as an illness creating a low Serotonin hypothesis now discredited but still repeated, like the vaccine causes autism scandal. To make the point Tianeptine is a drug that is equally effective or ineffective as an antidepressant but the mechanism of action is to reduce Serotonin.

    The PLOS Medcine research article – Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration study http://goo.gl/d35Nm is worth study.

    Other sources that may be relevant to this site include http://nichooper.com/2013/01/31/the-anti-depressant-fairy-tale/ & David Healey https://www.youtube.com/watch?v=A3YB59EKMKw describes how NICE Cochran etc are a marketing tool of the drug industry.
    As skeptics we need to be aware of the snake oil salesmen that sell an illness “depression” and then offer the cure perhaps this is familiar to us all
    “The church gives you the disease [guilt] then offers you a fake cure.” -Dr. Darrel W. Ray

    • In reply to #115 by Paul Woodcraft:

      There is an assumption that because the feelings of depression are unpleasant there is a disease rather than dis-ease. The drug companies have a vested interest in maintaining a biological basis for depression as an illness creating a low Serotonin hypothesis now discredited but still repeated, like…

      Have you looked at the second and third links I had above? The ones with the anchor text: “Study shows antidepressants useless for mild to moderate depression? Not exactly.” and “Do Antidepressants Work? The Effect of Publication Bias” I would be interested in hearing some reactions to those, either positive or negative.

  37. Publication bias affects all studies, however a significant problem with anti-depressant studies is that drug trials are usually for 6-8 weeks http://goo.gl/vhkrhl a period of time over which mood can change spontaneously. That is not to say that psychological approaches do not suffer the same fate see the AJP Validity of Clinical Trials of Antidepressants http://goo.gl/HjDyqP . However psychological studies are usually longer.
    When it comes to medical conditions the medical model seems to be the best approach. However taking an evolutionary Darwinian perspective towards the emotional / mental conditions we call depression and anxiety may create an alternative view as the medical model doesn’t appear to be working. Since the 1950s Antibiotics & Antidepressants have been widely used, the number of diagnosed infections like TB has reduces and some diseases have been eliminated. At the same time prescribing of antidepressant drugs has increased with no reduction in diagnosis if anything the opposite has occurred, with more people experiencing this condition. Perhaps we need to consider the basis on which we look at our psychological / emotional states as possibly something other than medical conditions at least until there is strong evidence either way.
    Unpleasant experience are not always bad for example in the physical world, fever, pain, nausea, vomiting and fatigue are not diseases, they are useful defences. Their expression is regulated by mechanisms shaped by natural selection. Most are aversive, so they seem like problems. However, people who lack an ability to experience pain or an ability to cough die young. If natural selection shaped these defences, then how can we so safely use drugs to block them? This may be equally true of depression http://wp.me/ppUXF-3gK

    The costs of expressing defences is low compared to the cost of not when it is needed. Natural selection has shaped defence mechanisms often expresses when they are not needed to ensure that they are always available when they are. The clinician can have a tendency to think that defences are abnormalities, instead of recognising them as adaptations. Both have special important applications in psychiatry. http://goo.gl/RCGfaJ

    Alzheimer’s, meningitis, brain tumours are physical brain diseases, which medical interventions if available would be a good thing. Whilst computer models are very poor in this context these could be described as diseases affecting the physical hardware. In contrast anxiety and depression are transient states, more akin to software, that are experienced by most people and generally reflect environmental factors. Most of us are removed from the natural environment where these emotional states have benefit for our ancestors. Natural selection now immortalised in the “Darwin Awards” would remove potential ancestors from the gene pool if they lacked the ability to recognise danger.

    We react to our internal environment, in particular thoughts “I would die from embarrassment if…” “Perhaps I have a terrible illness” as if these thoughts are life threatening or dangerous, our physiological state will respond just as our ancestors did on the savannah to an approaching lion. Escape from the lion reduces the threat stimuli and the physiological state quickly returns to equilibrium. However as modern humans we principally experience imagined threat which are body reacts to as if it were real and we further add to the emotional burden through self talk and self-criticism “I am stupid for feeling like this” “I shouldn’t feel depressed I must be weak” I should be happy as I have just had a wonderful baby, there must be something wrong with me” etc, so we amplify and add to our emotional state in a feedback loop.

    How often are we told, or say to those we care about “not to worry” or “don’t think about …” . These statement sounds good but are completely ineffective i.e. “don’t think of pink elephants!” what happens. As children we are given the message by adults that we should be able to control emotions “STOP CRYING OR I WILL GIVE YOU SOMETHING TO CRY ABOUT” Why did they say that? Presumably because they felt uncomfortable emotions of embarrassment etc. when we as a child are expressing our emotions. They don’t want to feel embarrassed so they want us to stop our emotions for them to feel better. As a child we learn from this that we should learn to control our emotions, like (as we perceive) our parents / adults can. However control of emotions is something that has yet to be shown is possible, possibly suppressing them is but that is another minefield long term.

    The most recent contextual views of our psychological / emotional state take a perspective more consistent with evolutionary principles as someone who has both experienced depression and worked as a clinician my experience is that seeing emotions as a part of the scenery of life rather than a threat to be fought has proved most helpful.

    I am conscious that I may not have put these ideas across very well so I would recommend looking at writings or U tube presentations by Russ Harris as someone who is a communicator of ideas or Kelly Wilson or Steve Hayes who are inveterate researchers.

    • In reply to #117 by Paul Woodcraft:

      Publication bias affects all studies, however a significant problem with anti-depressant studies is that drug trials are usually for 6-8 weeks http://goo.gl/vhkrhl a period of time over which mood can change spontaneously. That is not to say that psychological approaches do not suffer the same fate…

      That was all very interesting and I agree with pretty much everything you said. The one thing, I’m not even sure if this is a disagreement or just a different way of saying some of what you said is that I agree the illness model probably doesn’t work for most of us when it comes to psychology. We all feel like crap sometimes and we all want to be (and a rational analysis for virtually all of us tells us there is plenty of room to be) more productive and less self destructive.

      For a while I used that as just a rationalization that things like therapy were a waste of time. I then realized for reasons I’ve expressed elsewhere on this thread that on the contrary it was very beneficial both in that it fits in with what psychological theories and data we have (although we don’t have much that can count as definitive) and because (more importantly) from my own experience I can see the benefit of talking to someone and trying to be completely honest and objective.

      So I don’t really care that much if an illness model or a wellness model or a self actualization model turns out to be true. Well, that’s not true I actually think it will be very interesting to see how these things shake out in the future but I don’t feel like I need to wait for those answers to realize that talking therapy and possibly medication might help me and whether I”m mentally ill or just want to be even more awesome than I already am isn’t really that consequential.

  38. As an RN, I can say that I’ve seen many patients who have been put on antidepressants (especially citalopram) seemingly at the drop of a hat. For most of these people, I think that learning better coping skills would be far more effective in the long run than medication for the everyday disappointments, frustrations, worries and losses that are bothering them. That said, I have seen others who are truly disabled by depression and bipolar disorder and have been able to resume a nearly normal life only with the help of medications. Anecdotally, my husband suffers from severe bipolar disorder. His depressions are not just a few days or weeks of the “blues”. He stops eating, does not get out of bed, does not speak, and has no outward expression of emotion at all (a flat affect). This can last for a month or more. During one depressive episode he lost more than 40 pounds, and he wasn’t overweight to begin with. His manic episodes are characterized by extreme physical exertion, insomnia, irritability, non-stop talking, obsessions, and frenzied involvement in numerous “projects”. Neither his depressions or his manic episodes had anything to do with actual life circumstances – i.e., things that would upset a normal person do not bring on a depression in him, nor are his depressions lifted by good news or good fortune. The only thing that has made any difference at all in this destructive cycle is a combination of lamotrigine (an antiepileptic drug), bupropion, and aripiprazole. The difference these drugs have made has literally been lifesaving. Cognitive behavioral therapy and other psychiatric treatment made absolutely no difference because his condition is not an emotional dysfunction or a personality disorder but an organic brain disease. I think that a placebo effect is possible or even probable in people who feel “down” but who do not have major depression, as they are usually reacting more to life situations than suffering from a true disorder; but for people like my husband, medication literally makes the difference between life and death.

  39. Here is the problem with antidepressants. Upon the first office visit, the presenting problem is an oral report from the client. After discussion, the clinician reviews his checklist to see the severity of the complaint. If 6 of the things are checked off, the patient is diagnosed as depressed. After medicine is prescribed and therapy is offered, subsequent appointments involve self-reports from the client which becomes the only gauge for knowing if three is any improvement. Doc asks, “How do you feel this week?” Client says, “Better.” Let’s compare it to the heart doctor who measures blood pressure with an instrument. He prescribes meds and suggests diet and exercise. Months later, the instrument can measure BP again and you got an answer to the question, “Is this medicine working?”.

  40. I have been suffering from depression for about 2 years and have been on antidepressants for the period stated. It started suddenly, and was high in intensity. It started with really, really bad intrusive thoughts. I couldn’t stand be around a knives, because I thought I might use it on someone. As a result, the depression intensified. I experienced horrible thoughts, every 2-3 minutes,as well as suicidal thoughts.

    I was put on a SSRI-type antidepressant and saw results after 1 week. Although I still suffer from some sort of bad thought disorder sometimes, my symptoms have improved. I have lost 30kg in weight, so that, to me was an added bonus.
    Antidepressants work! There is no question in my mind.

    • In reply to #124 by spire123:

      I have been suffering from depression for about 2 years and have been on antidepressants for the period stated. It started suddenly, and was high in intensity. It started with really, really bad intrusive thoughts. I couldn’t stand be around a knives, because I thought I might use it on someone. As…

      Thanks for sharing that.

  41. Next time I go to the doctor’s I will ask for a placebo, as they are often as good as the real medicine and with fewer side-effects.

    More seriously, I did (and still do) suffer from depression and anxiety, and I took SSRIs for a few months. It made a slight difference, I think, but I was working away from home (as I usually do) and I forgot my pills, and I found myself pacing back and forth in the hotel room literally pulling at my hair in worry about what I’d do without them. Then – I found the pills in my jacket pocket. I threw them in the bin. If that’s what the pills were doing to me, I didn’t want anything to do with them any more. I’ve been quite a bit better ever since then.

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