Good News About Anti-Depressants:

I've heard first-hand stories of people scared off from anti-depressants by exaggerated fears about their alleged dangers (promoted by some serious scientists, but more by Scientologists and others with ideological, not scientific, objections), and other first-hand stories from those whose lives were miraculously turned around by them. So, I'm glad to see that there is good news about their safety and effectiveness:

The researchers found that the risk of attempted suicide was 60 percent lower in the month after treatment began and that it continued to decline. While the overall risk for suicide was higher for adolescents than adults, the reduction in risk was about the same for both groups. When the researchers specifically examined 10 of the newest antidepressants, such as Prozac -- the ones that have come under the most suspicion -- they found that the risk was even lower.

What the article doesn't say is how these results, and other positive results reported, diverge from placebo results. If anyone has access to the data, feel free to post it in comments.

AppSocREs (mail):
I was treated for situational depression with Paxil several years ago after the death of a parent and researched the drug considerably so I speak from both experience and knowledge. In my case, and most cases, the drug is beneficial at reducing the effects of depression -- particularly "anxious" as opposed to "sad" depression. There are major side effects. The ones I experienced are: [1] essentially complete loss of libido (which gave me fascinating insights into the minds of teenage girls), [2] disruption of sleep patterns, [3] elimination of the pain killing effects of codeine (I found this out the hard way after a root canal gone wrong, but it's well-documented in the medical literature.), and [4] extraordinarily vivid dreams (In my case, a literally glorious addition to my life that more than made up for the sex, but the nightmares some users of Paxil experience are literally horrific and life-damaging.)

The thing of which many potential users of Paxil are unaware is that the drug is highly addictive and -- based on my personal experience -- some of the affects on the brain/mind are permanent. It is often an extremely long and difficult process to stop taking Paxil. Gradually reduced dosages, under fairly close (weekly visits) medical supervision is advisable: suicide attempts are common. Some people's withdrawal experiences are so bad they decide to stay on the drug. In my case I experienced depression and extreme emotional lability. I had never cried before, but found myself sobbing in public for hardly any reason. These effects pased in six months. All the other effects are gone but I still have incredible dreams and an immunity to the narcotic effects of codeine. Other ex-users have experienced similar phenomena. This is not surprising, since Paxil has some similarities to MDMA which is known to have permanent effects on the mind/brain. (It's a Schedule I substance, probably because it's not patentable.)
1.1.2006 11:47am
Bruce Hayden (mail) (www):
How can you call the Scientologists not scientific. After all, they were founded by a science fiction writer. How much closer to science do you want?
1.1.2006 12:04pm
Henry Bowman:
The above comment on Paxil is interesting. I have read anecdotal comments that agree with much of what is written. My daughter, in her early teens, was suicidal about 18 months ago. She entered a special program at the local high school for kids with similar problems, plus she has been on Zoloft over that same time period. She has improved remarkably and, in my view, now has completely normal behavior. Side effects do not seem noticeable, though she would be better at addressing that issue than I.

It is not possible to state definitively whether the Zoloft is responsible in whole or in part for her current good mental attitude, as the school program she is in has been exceptionally good, in my view. My guess is that the Zoloft definitely has helped in her case.
1.1.2006 12:51pm
Steven Taylor (www):

Plus, they have "science" in their name.

Pretty solid bona fides, if you ask me.
1.1.2006 1:12pm
Chico's Bail Bonds (mail):
Steven, you forgot to mention that they also have "ology" in their name. "Science" and "ology" — how could anything go wrong?
1.1.2006 1:43pm
Defending the Indefensible:
Would it be out of line to point out that MDMA is potentially a more effective short-term treatment of depression than Paxil? Under proper clinical supervision, it may help people deal with very deep-seated issues such as post-traumatic stress disorder.
1.1.2006 2:25pm
Simon Spero (mail):
The journal containing the articles cited isn't available online yet, but from the description of the main study in the WaPo story, it seems that the researchers were comparing suicide attempts for the same individual, before and after treatment. Placebo affect would seem to be orthogonal.

In one study, Gregory E. Simon of the Group Health Cooperative, a large, private nonprofit health insurance company based in Seattle, analyzed data from 65,103 patients who took antidepressants between Jan. 1, 1992, and June 30, 2003, comparing the rate of suicide attempts and death from suicide attempts before and after treatment began -- the first such study to track patients over time. Previous studies had examined reports of suicidal thoughts among patients.

The studies did not investigate which drugs caused increased sofa jumping.
1.1.2006 3:03pm
Brett Bellmore (mail):
Over a period of a couple of decades, slow enough that friends and family really didn't notice, I decended into a serious case of depression, which a divorce finally agravated to the point where I made at least one suicide attempt. What brought me out of it was not a prescribed anti-depressant, but instead a food supliment, SAMe (S-adenosylmethionine) which I began taking for my arthritis, and which has anti-depressant side effects. It was rather remarkable after a month of taking it, to realize that not only had I stopped limping, I'd also stopped having suicidal impulses. And rather enlightening about the chemical nature of my problem, that they reliably returned within a few days any time I stopped taking it...

Be warned, however, that it's supposed to interact badly with MAO inhibitors.
1.1.2006 3:28pm
Frank Drackmann (mail):
What does Chairman MAO have to do with suicide/depression?
1.1.2006 3:44pm
Fishbane (mail):
After a short-term but vicious money crisis involving the loss of my house and my fiance, I went on Zoloft for about 6 months. It was, on the whole, useful. The libido loss already mentioned is real, and somewhat disturbing. Another unfortunate effect that is harder to describe is a sort of change in consequence analysis. One concrete manifestation of this was that I cut myself a lot more when cooking (I enjoy cooking, and am a bit of a foodie). I still have scars on my fingers from being careless with a knife from that phase. I also nearly was hit by a car because I didn't pay attention. As I said, it is hard to describe, but it stopped when I stopped taking it, and in retrospect seems very strange.

I neither claim that this is a normal result, or an abnormal result. It is just my experience.
1.1.2006 4:24pm
Guest2 (mail):
Add me to the list of people whose lives were miraculously turned around by an antidepressant (in my case, Paxil). I also experienced most of the above-described side-effects, which I found to be manageable. Vivid dreams were a feature, not a bug. Limp noodle could be remedied by skipping a dose when sex was on the horizon. Another side effect that has been documented but is not mentioned above is weight-gain; skinny people suddenly find themselves becoming bloated. That for me was the toughest to get a grip on and counteract.
1.1.2006 5:44pm
Brett Bellmore (mail):
Monoamine oxidase inhibitors. They're a class of drugs including some anti-depressants. SAMe counteracts their effects.

Yeah, I got my scar collection, too, mostly from the discovery, (Which abruptly ended my one suicide attempt.) that physical pain lifted me out of my funk for a while.
1.1.2006 6:28pm
visitor (mail):
My understanding is that one of the suicide risks associated with antidepressants is in the case (which I had) where bipolar disorder is misdiagnosed as depression (many bipolar patients only come in when they are depressed, because they're too busy being manic otherwise, and so they present only depressed symptoms.)

Antidepressants, as many people will tell you, are stunningly effective (once you get the right dosage and drug.) For bipolar patients, the sudden removal of depressive symptoms can mean that the manic symptoms (which the ADs don't touch) become even more intense and long-lasting, and that can lead to suicide, not because you want to "stop the pain," but because you are so off your nut you think you can fly, you think you are immortal, whatever -- even if you didn't previously have such delusions and your manic phases were much "quieter."

In any case, doctors understand this better now, and are much more careful in monitoring patients in the early days, and prescribing other drugs to handle bipolar manic symptoms at the same time (e.g., abilify.)
1.1.2006 6:34pm
Fishbane (mail):
Yeah, I got my scar collection, too, mostly from the discovery, (Which abruptly ended my one suicide attempt.) that physical pain lifted me out of my funk for a while.

Let me just be clear that my scars were from when I was on antidepressants, and not intentional. While I did have idle suicidal thoughts for a bit, I never came close to attempting it, nor have I ever suffered from self-injury-seeking behaviours.

For whatever reason, I simply became very careless when on Zoloft. Cutting vegetables, or (for one really bad cut requiring stitches) modifying a turbine* became a much more dangerous proposition for me. That wasn't the case before I started taking it or after I stopped. It manifested in other ways, too - hard to describe. It was a general obliviousness to consequences; that part of me that thinks ahead and performs risk analysis was suppressed.

In fact, there was one good outcome to the effect - I started a business which is still going strong, that I likely wouldn't have, had I done my normal bean-counterish look at the market (bespoke software development). Against all odds (especially considering how slapdash and underfunded we were, and starting right after the crash), it is actually a growing concern in a rather competitive marketplace.

Again, I don't know if I'm on the margin here or not - just describing the effect the drug had on me. I didn't realize that anything was odd about my accident-prone behaviour and general carelessness until someone pointed it out to me, and it became much more clear when I stopped taking it.

* That probably sounds like an odd thing to do to people who don't know me. I'm an ameteur engineering geek, robotics and communications in particular.
1.1.2006 7:31pm
I would be curious as to their effectiveness as opposed to more natural methods (e.g. counseling sessions). They always seemed to me kind of like breaking one's leg and rather than not walking and letting it heal, taking lots of painkillers and ignoring it.

In some cases I am sure they are useful - but for most people, are such strong drugs necessary? Would it not be better to confront the source of the depression and deal with it?
1.2.2006 12:13am
mouse (mail):
The fact that these psychoactives are strong enough to change the pain-reduction ability of narcotics should scare people. Got any citations for that supposedly well documented piece of knowledge?

Adolescents probably have brains still in development, unlike adults. Again, taking psychoactives is probably not without massive side effects in the long run.

One of the issues with SSRIs is that they decrease one's inhibitions in a particular way. One method by which they stop depression is by increasing one's likelihood to act impulsively. For many people, this makes them more suggestible and likely to interact with their normal surroundings and environment: ready to go out with friends, to participate in exercise, etc. But in some people--particularly adolescents-- it's much more likely to make them behave in ways which are unhealthy and appear "compulsive." More likely to take risks, more likely to overreact or become volatile, and therefore, for a small portion of the population, more likely to take steps that are life threatening (whether intentionally or not.)

The vivid dreams that some see as a feature, not a bug, are definitely a bug. They indicate a severe sleep disturbance that interferes with long term memory formation at the very least. Sleep disturbances interfere with consciousness in some profound ways. Talk to a sleep doc about what goes wrong when people are taking SSRIs. Fine motor skills fade; ability to recall words and use proper speech fades. Emotional detail fades. Emotional connection to reality fades. You aren't depressed anymore, but you don't feel anything else either.

One experience I had with Paxil was the progressive inability to tell if i'd woken up from the dream. The vividness lasted so long that even an hour after waking, I wasn't sure whether or not I was dreaming. Feelings like that will drive people far more insane than the depression they had previously.

A more exciting and frightening side effect I had with Zoloft nad Prozac but not Paxil was the FEAR that I would accidently kill or badly hurt myself. I cannot explain it any other way. I became terrified that if I was in a tall building, I'd accidently throw myself out the window and die. I became terrified to put on eye makeup because I was terrified I'd accidently poke my eye out. I became terrified of shaving my legs for accidently cutting my wrists. Again, I was not afraid that I *wanted* to harm myself, but that somehow I would be unable to control myself. The doc who prescribed the SSRIs was not shocked to hear me describe this terror to him. I was--I was sure that any sane person wouldn't say those things out loud anyway, and would lie to get off those meds.

btw, every study shown to date shows the same efficacy rate for drugs and therapy in depression and anxiety. To me, this indicates that therapy is better. To others, apparently, it indicates that the hard work of therapy is not necessary.
1.2.2006 2:45am
LINO_watcher (mail) (www):
Just throwing out a couple thoughts:

Not proven to be better than placebo? Some would consider this little more than a press release. The FDA has been regularly attacked for being in the pocket of Big Pharma.

All jabs at Scientology aside, if I were researching psychiatric medications I would read some of the doctors and scientists that have been crusading against them. Szasz comes to mind.

Personally, I wouldn't trust that pharmaceutical garbage as far as I could throw the people suggesting it. I would exhaust every non-pharmaceutical option that has literature behind it - exercise, sunlight, various foods and supplements (fish oil, whatever was mentioned earlier in the thread, etc), etc, etc, etc. There are all kinds of references in the literature about the serious side effects and incomplete, biased, and/or supressed testing that has gone on in this particular pharmaceutical area. Then there's the whole movement toward "diagnosis marketing" in the pharmaceutical industry and to an extent the psychiatric establishment. (Good LA Times editorial on that topic yesterday by Irwin Savodnik.)

Then there's the probably not statistically provable, but disturbingly high instance of psychiatric medication involvement in the school shooting incidents. Let's see - troubled kids are constant. Guns are a constant. What variables have changed in the past 10-20 years? Culture and the prevalence of psychiatric meds.

Anecdotally, an ex-girlfriend threw obects at me and threw a tantrum so severe I was concerned about sleeping in the same locale as her while under the influence of one of these brain candies. (I forget which flavor.)
1.2.2006 7:34am
Splunge (mail):
An interesting fact is that sleep deprivation is an effective and very fast-acting (hours to days) antidepressant. Can't use this particular treatment for very long, of course.
1.2.2006 8:52am
Freder Frederson (mail):
Personally, I wouldn't trust that pharmaceutical garbage as far as I could throw the people suggesting it. I would exhaust every non-pharmaceutical option that has literature behind it - exercise, sunlight, various foods and supplements (fish oil, whatever was mentioned earlier in the thread, etc)

As someone who has suffered from depression my whole life (at least as long as I can remember--I'm 44) and left it untreated until law school drove me to the lowest point in my life, I can assure you that SSRIs (Zoloft and Prozac), combined with therapy, literally saved my life. I have been on Zoloft or Prozac (had to switch due to insurance formulary--not any medical reason) for thirteen years now, and there is no doubt in my mind that the root cause of my depression is a chemical imbalance that the medications address that no amount of therapy would be able to solve, although therapy can help me work through the rough spots in my life, much as physical therapy can help those with physical disabilities. I have a chronic medical condition as much as someone with diabetes, high blood pressure, or high cholesterol does. It is treatable with medication in much the same way and just like those conditions it is not always treatable with lifestyle changes.

As for so-called "natural alternatives". The supplement market is almost completely unregulated, and some of those chemicals can be even more dangerous than the controlled substances that claim (mostly unsubstantiated) to treat the same conditions, especially when used without medical supervision. After all, rattlesnake venom is "all natural", yet no one claims that is good for you.

That said, there is no doubt that there is an epidemic of doctors whose speciality is not psychiatry prescribing anti-depressents and not properly monitoring their patients. Anyone who is prescribed these drugs should also be in therapy at least until the effects of the drugs are fully established and should be closely monitored to moderate the potential side effects and potential unhelpful effects. In fact the effects described by some of the posters above could have been alleviated by more careful monitoring by care providers.
1.2.2006 9:00am
zigzagzen (www):
Chemicals covering symptoms don't cure causes. Anti-depressants do not cure chemical imbalances. People get depressed because our civilisation is bankrupt and we all know it. We live lives that "fit in" with society and supress our own truth's to do so. That supression of truth may cause chemical, physical and emotional upsets. Only living by truth will cure depression.
1.2.2006 9:11am
Guest2 (mail):
I second Freder Frederson's post. His experience sounds almost exactly like mine.
1.2.2006 10:25am
Freder Frederson (mail):
Chemicals covering symptoms don't cure causes. Anti-depressants do not cure chemical imbalances. People get depressed because our civilisation is bankrupt and we all know it.

And "we all know it" how? You are an expert on mental illness because you pull this universal truth out of your butt?
1.2.2006 10:26am
AppSocREs (mail):
mouse - The effect of Paxil on codeine's narcotic effect is straightforward. A chemical cycle in the body converts about 10% of the codeine to morphine which alleviates pain. Paxil interferes with this particular cycle. Do a web search and you can find the journal article on-line.

All drugs have side effects: That's no reason to ban aspirin, corticosteroids, pennicilin, etc. All of these can kill people ans all are misused. But just as is the case with antidepressants, their benefits outway their side effects and the occassional fatality. ( Lest you think the last sentence is glib, hundreds of people in this country die each year from using aspirin and NSAIDs, but no one in his right mind would think of trying to limit the manufacture, sale, or use of these drugs. )

to all those posts criticizing the pharmaceutical industry and anti-depressants - The evidence is overwhelming that anti-depressants work to alleviate depression and in persons with severe depression they are all that may work. Those who believe otherwise are in the same camp as those who believe emotionally distant mothers create homosexuals. Sasz is so thoroughly discredited at this point in time that anyone referencing him probably still credits the phlogiston theory of heat.
1.2.2006 10:36am
Some of the newer antidepressants - Effexor, Lexapro, Cymbalta - affect both serotonin and norepinephrine. They're effective on depression and also have effects on anxiety. Lexapro has been approved for Generalized Anxiety Disorder and Cymbalta is under review for GAD. Cymbalta also has pain killing effects, and is sometimes used in fibromyalgia - a pain syndrome with unexplained medical causes. All-in-all, these are pretty amazing drugs, especially when some of the off-label uses are taken into account - for example SSRIs don't always kill libido when men have premature ejaculation, but can instead help them last longer - urologists prescribe Zoloft for this a lot.

The drug companies have over-sold the benefits of their drugs in some cases, and some supplements have shown some promise in depression - Omega-3 fatty acids, for example, are worth looking at - but the St. John's Wort debacle is a warning. Without the kind of testing that pharmaceuticals go through, the benefits of supplements are little more than rumors.
1.2.2006 12:21pm
Donald Allen (mail):
As I understand it, part of the reason that there is an increased risk of suicide when people start taking antidepressants is that depression has effects on both the mind and the body. Indivuduals with severe depression can have difficulty getting up the energy to do anything. They may have suicidal tendencies from their depression, but do not have the energy to act on these tendencies. The antidepressant effects of these drugs take a while to occur. However, many of the drugs are also stimulants. So a person may have an increase in energy level, but the drug may not be having an effect on the depression yet. A person may now have the energy to act on their suicidal tendencies. This would also explain why the risk of suicide decreases with further use of the drug since the drug is now treating the depression.
1.2.2006 1:02pm
I've never heard of injection of anti-depressants - they're all voluntarily self-administered. It's claimed that clinically depressed people are 'paralyzed' by their affliction and thus unable to take non-pharmaceutical steps to overcome it, but taking the pill is taking a volitional step to overcome. The difference is that they cognitively believe it will help, largely because we've been socially conditioned to believe in "silver bullet" solutions to problems.
1.2.2006 1:38pm
Mikeyes (mail):
As a practicing psychiatrist, I use these drugs all the time and have heard most of the comments about side effects and theraputic effects mentioned above. According to studies that I have read, 80% of all anti-depressants are prescribed by non-psychiatrists mostly because of the introduction of Prozac in the early '80s. Prior to that, all we had to offer were the tricyclic anti-depressants, MAOIs, and ECT. Prozac was much safer (in the sense that an overdose would not kill you) than the other treatments and the fear that giving a medication to an already depressed/suicidal patient was alleviated. In addition the side effects of the older treatments were much worse than mentioned above (severe dry mouth, heart effects, urinary retention, blurred vision, reaction to certain foods, etc.)
Cognitive Behavioral Therapy (CBT) was not available then and the studies showing its efficacy in mild to moderate depression (as opposed to severe depression which requires hospitalization) had not been completed. Since then there has been a significant change in the way depression (meaning Major Depressive Disorder) has been treated.
Most studies show that there is a significant difference between placebo and medication in the treatment of depression in adults. The problem is that the effect is only about 65% at best and that the parameters used are a lessening of symptoms based on a scale. This means that although patients get better, their illness may not be completely alleviated. In addition the patient set of 65% is different for each medication and for each dose of medication. I figured that it would take 15 years to go through all the possibilities as you have to give each dose of medication at least 6 weeks to determine if it will work.
The other problem we run into is making the diagnosis. At least 15% of patients with symptoms of depression severe enough to consult a physician have Bipolar Affective Disorder which only shows up as a depression. Often these patients will respond well to an antidepressant at first and then worsen later on. In addition the antidepressants can cause a "manic switch" which manifests itself either as mania or (more commonly) as agitation and irritability which are also seen in the more severe depressions. Unless a physician is aware and experienced with these symptoms, the wrong treatments may continue to be given and the patient will get worse.
So as you can see, antidepressants are useful in the treatment of depression but not universally so. Most of my patients are also in therapy (the studies show that the combination of medicaiton and therapy is most effective) and I have to see them regularly to make sure that a) I have made the right diagnosis, b) that the medication is working and c) that they are taking it. The issue of side effects is very important as are the issues of drug interactions, metabolism changes, drug and alcohol usage, and stress management. I wish you could just give a pill and the problem would go away, but that is not how it works.
My pet peeve is that the drug reps sell the drugs to Family Practice doctors as if a pill will cure the disease. Drug companies are guilty of a lot of things in this respect, mostly from the sales side, but they have developed methods of treating what was once a very hard to treat illness. The problem is that some physicians don't bother to make the diagnosis correctly and are using drugs that they know little about mostly on the advice of a salesman. I suppose that is a problem with medicine in general but there is little one can do other than ban drug reps from your office (I don't see them but I have partners who do) but then you lose the samples you can give to those who can't afford the drugs and that is a great loss.
The treatment of depression is no different than the treatment of any other disease. You have to listen to the patient, try to make the best diagnosis and treatment decisions, and work as a team with them to make sure that the optimal treatment is given. 100% results are often not reached, that's the way it is with chronic illnesses, but a patient's life can be hugely improved with good treatment. Medications have made a tremendous difference in physician's ability to treat depression as has the addition of CBT, but like all medical treatments, they have to be used correctly.
1.2.2006 2:02pm
Roger (mail):
However, many states will make it difficult, if not impossible to be admitted to the bar if you are the kind of nut that would go to a shrink or take anti-depressants. The bar can't afford mentally ill nuts. Likewise, if you are are in law school and think you need pills to survive, quit now, so that you don't ineffectively represent people (or support the Streamlined Procedures Act, or the executive's ability to detain people indefinitely).

(In my family and culture, you will be disowned if you take antidepressants.)
1.2.2006 9:54pm
Freder Frederson (mail):
However, many states will make it difficult, if not impossible to be admitted to the bar if you are the kind of nut that would go to a shrink or take anti-depressants. The bar can't afford mentally ill nuts. Likewise, if you are are in law school and think you need pills to survive, quit now, so that you don't ineffectively represent people (or support the Streamlined Procedures Act, or the executive's ability to detain people indefinitely).

That is pure ignorance and probably illegal if any state bars actually do prohibit people under the care of a psychiatrist from practicing law. I know for a fact that it was most certainly not an issue to the admittance to the practice of law in Georgia (if I remember rightly the only question regarding mental health was whether the applicant had ever been involuntarily admitted). I also received a secret clearance from the government after I assured them that my psychiatric treatment was not related to drug or alcohol abuse (the FBI interviewer laughed when I told him it was law school related). I think that now the government can only ask if a person has been involuntarily committed when vetting someone for a security clearance.

To say that someone who suffers from depression shouldn't be practicing law is just plain ignorant and stupid. Should we bar people with high blood pressure too? Or how about people who are just jerks? That would get rid of about half the people in law school.
1.2.2006 10:30pm
Roger (mail):
Dear Mr. Frederson,

Setting aside the unnecessarily insulting nature of your reply (which I assume was caused by your drug dependency), I will address your concerns one by one.

First of all, whether or not a state can discriminate against the nuts that take anti-depressants is a bit of a gray area. The Supreme Court has never ruled on it, and various state courts have gone different ways on the issue. Connecticut has probably been the strictest about preventing people with mental defects from practicing, but they have bent a little bit and now allow nuts to practice, provided that they continuously prove that they have not gone completely off the deep end.

I had a clearance as well (but I don't brag about it), and they ask a lot more than just whether someone has been involuntarily committed. So do most bar exam applications. Whether an FBI agent laughed or not is irrelevant to your legal position, so I don't know why you mentioned it. Also, I am unsure why a security clearance is dispositive as to whether one is fit to practice law. A security clearance has little or nothing to do with whether one can represent clients competently. Perhaps you are a little too hung up on what the executive branch thinks about you to understand that there are other standards besides being about to read stuff that the executive branch tells you that you can read.

We do bar people that are just plain jerks. This is what the "character" portion of the bar exam is for.

I think that under some circumstances, people should be barred from admission if their physical constitution prohibits them from practicing.

Right now we are faced with the prospect of global terror destroying our way of life. To allow those with mental illnesses to detract from the quality of representation provided to people in our criminal justice system would, in my opinion, be worse than 9/11. To that end, it is not only in a state bar's inherent authority, but it does not offend equal protection, to exclude nuts from the bar.
1.2.2006 10:48pm
"The evidence is overwhelming that anti-depressants work to alleviate depression"

Yes, but the evidence is also overwhelming that a regular workout regimen would have an identical effect on a significant percentage of currently medicated patients.

Celexa definitely helped my illness, for a while. However, like mouse's experience with Paxil, it made me confused about whether I was asleep or awake, and made me constantly afraid to be near dangerous objects. It also made me disassociate, and if I forgot to take it, produced a fascinating but disturbing illusion in my field of vision if I took a sudden lateral step. Then, about 6 months after I started taking it, it suddenly over the course of a few hours stopped working, helping contribute to the worst 48 hours of my life (my brother had an identical experience - maybe there's a genetic aspect).

I'm sure antidepressants can be helpful in certain circumstances, but I'm plenty sympathetic to their critics. They are often prescribed unnecessarily, or are an effective but inferior alternative to therapy, lifestyle changes, etc.
1.3.2006 1:31am
CNS (mail):
It's interesting that, as I have been reading these comments, I am also in a chat room that has people talking about antidepressants. Well, amongst other psychopharmological topics; Ads just happen to be what's on board now.

It's easy to dis ADs and other brain-affecting medication when one has never been on/needed them, or has had a bad experience, or knows someone who has had a bad experience. However, I know folks who would not give up their meds unless they were pried out of their cold, dead hands. Because, well, they need them to live.

At a forum (which I help to moderate) for these meds/issues, we, the users, of these meds say that if you need to be on a psychoactive drug, then you probably need therapy as well, unless you've gotten to the point where things can be maintained by just taking the meds.

We don't like how docs often just throw the newest med at somebody; especially general practitioners. If someone needs this sort of medication, then a psychiatrist is always the best way to go. Meds have side effects; they always will, it just depneds on one's personal chemistry what they will be. I've had almost all the side effects listed in this thread at one time or another on one med or another (except the codeine thing; I've never had any effect from either codeine or hydrocodone).

I've never complained. When you need, and I mean, NEED one of these meds, then most of us will only drop it when they get the really awful side effects. I've forgotten my own name, slept 16 hours a day, have some sort of skin condition, broken teeth, and more from my meds.

But I've hardly complained. After all, they were the right meds, and they did what was necessary--stabilize my moods. (I am bipolar, so that can be... difficult) I'm fine with what's happened, and didn't worry about it...why? Because I took the time to educate myself on what could happen. And why the meds were needed. And that is what I do every day--try to help others understand these meds.

Oh yeah--they're NOT quick fix meds. Never that. For most people, they're a lifelong thing. That should always be recognized and explained at the start.

On this subject, I could go on forever, but for now I'll just stop and hope I educated a little.
1.3.2006 2:38am
LINO_watcher (mail) (www):
I'm sure these kinds of drugs have helped people, and those people basically know who they are. I don't have a problem with people that are sufficiently informed giving their voluntary consent to be on them. But as many have said they are also thrown around unecessarily and misused.


No, people who disagree with some of the practices of the pharmacuetical industry, the psychiatric establishment, and others "aren't in the same camp as those who believe that emotionally distant mothers create homosexuals."

Szasz has been regularly attacked by various interests, as almost anyone that doesn't fully and completely tow the "party line" in medicine is. Can you explain how he has been "thoroughly discredited" or is that just your opinion?
1.3.2006 5:14am
Freder Frederson (mail):
Setting aside the unnecessarily insulting nature of your reply (which I assume was caused by your drug dependency), I will address your concerns one by one.

First of all, whether or not a state can discriminate against the nuts that take anti-depressants is a bit of a gray area.

You call me a nut and unstable and I am the one being insulting? The nature of my reply was justified because of your blanket condemnation of all "nuts" who go "shrinks" or take anti-depressents. You obviously have no understanding of mental illness in general or depression in particular. Apparently, seeking treatment for a real medical condition, would in your book bar someone from practicing law, while those who "dealt with their conditions like a man and quit complaining (maybe by self-medicating)" are perfectly okay.
1.3.2006 9:20am
Mikeyes (mail):
XX sez:

"Yes, but the evidence is also overwhelming that a regular workout regimen would have an identical effect on a significant percentage of currently medicated patients."

As far as I can tell, that statement is not born out by the literature but I think that there is a beneficial aspect to exercise in people who have mild to moderate depression.

What a lot of people who discuss depression fail to do is distinguish between severe depression, which is usually lifelong, genetically determined, and very hard to treat (not to mention dangerous as 15% of untreated persons with severe depression make a serious suicide attempt) and the more mild forms of the diseases. There are several forms of depression and each will need a different type of treatment.

As I mentioned in my prior note, diagnosing and treating depression is not an easy thing to do. A lot of the bad experiences with medications noted above may be due to misdiagnosis, poor dosing of meds (some patients are "microresponders", in other words they need very small doses of meds, while others are slow metabolizers), or a failure to follow through in a timely fashion. Just handing out a pill and expecting good results is not the best way to treat any kind of depression.

As for the bar not allowing a person to practice if they are in treatment, I have practiced in 10 states in my career, and this has never been an issue. On the other hand, FAA examiners will not allow you to fly a plane if you are taking a psychiatric medicine of any kind (including anti-depressants) and that is a strict, no exceptions rule that is clearly stated in the regulations. I would like to see the regulations that bar an attorney from practice if he or she has been treated for depression.
1.3.2006 10:06am
Houston Lawyer:
Depression runs in my family. It is real and can be debilitating. My mother suffered severe depression for decades before taking one of the SRRIs. My sister also takes one. Both are much better off for it. I didn't read the study but note that there is a substantial risk of suicide among the depressed anyway. So how many people don't commit suicide because they have taken these drugs? My brother committed suicide with no warning signs that he might do so. Could an SRRI have saved him? We'll never know.
1.3.2006 10:18am