I was very young when my mom started Prozac but do remember how angry and sad she was before compared to after.
Years later there was a time when me and my sister noticed our mom was acting a bit strange -- more snappish and irritable than usual, and she even started dressing differently. Then at dinner she announced proudly that she had been off Prozac for a month. My sister and I looked at each other and at the same time went, "Ohhhh!" Mom was shocked that we'd noticed such a difference in her behavior and started taking the medication again.
I've been on the exact same dose as her for 15 years, and my 7-year-old son just started half that dose.
If I have a good day it's impossible to day whether that's due to Prozac. But since starting Prozac I have been much more likely to have good days than bad. So, since Prozac is cheap and I don't seem to suffer any side effects, I plan to keep taking it in perpetuity.
What I tell my kids is that getting depressed, feeling sad, feeling hopeless -- those are all normal feelings that everyone has from time to time. Pills can't or shouldn't keep you from feeling depressed if you have something to be depressed about. Pills are for people who feel depressed but don't have something to be depressed about -- they have food, shelter, friends, opportunities to contribute and be productive, nothing traumatic has happened, but they feel hopeless anyway -- and that's called Depression, which is different from "being depressed."
A later comment notes that it works well for some patients and not others. The argument is that drugs probably don't fix things very well unless the cause is mostly just bad brain chemistry. Some people have bad brain chemistry, others have "real" (usually more external - financial, relationships, actual life issues) problems they need to fix, and hiding from them by just taking a pill to help ignore them might not work so well.
(OK bad brain chemistry is also a real problem, but one that's fixable with a pill).
Also yes that's all a bit simplified.
There's a stigma against pills for a number of reasons, some good and some bad, the fact that often they don't work being one reason.
There is a case in between: sometimes the issues are too overwhelming and you can’t start fixing them until the pills give you the space you need to address them and get to a position where you can quit the pills.
The study found the average effect was no different from placebo. It’s plausible, based on anecdotes like the one you’re responding to, that Prozac is harmful for some people, helpful for others, with the expected benefit close to zero. If so, it might be necessary to just try it and see if it’s obviously helping, keep taking if so, stop if not.
This is, in fact, pretty much the exact procedure: try one type of treatment or medication, see if it's obviously helping, and if it isn't try a different treatment or medication. It's imprecise but it's the best we have.
The problem is that taking certain psychotropic medications changes your brain chemistry. It’s not as simple as it sounds. It’s not like trying on shoes. The brain is dynamic and drugs alter it, as does life experience, talk therapy, disease, aging, etc…
> If I have a good day it's impossible to day whether that's due to Prozac. But since starting Prozac I have been much more likely to have good days than bad. So, since Prozac is cheap and I don't seem to suffer any side effects, I plan to keep taking it in perpetuity.
I was acknowledging that the "good days" could be due to Prozac or could be a placebo effect, but since being on Prozac correlates with having significantly more good days, and I experience virtually no ill effects, I choose to continue with it.
Wow, a shockingly argumentative tone for someone who is just flat out wrong.
Beyond the response someone else commented explaining exactly where the comparison was mentioned, the anecdote itself is useful in offering an experience of someone who's life has been changed by the drug.
In any case, the study mentioned in the article is a meta-analysis about children, not adults, so there is no onus on OP to qualify anything about placebo or not.
To be fair, I didn't read that suggestion as being about a possible placebo effect, just that you can't attribute any one good day to the pill. It's like climate change- it undeniably exists, but you can't blame climate change for a single heat wave or freak storm.
You read it that way because that’s the sensible way to read it. Everyone suggesting you missed the plot is in turn making a rather large logical leap.
The dichotomy of such mental illness is people with more constitutional resilience just say "power through?" and they are absolutely correct, it is something they can power through.
Mentally ill folk literally cant, not in em. There are right answers to help them, but that's not the right one. It's kind of like telling someone who is color blind to squint real hard, won't ever help.
Myself, I'm someone very much in the power through category. It's the simplest and most straightforward answer surely. But if it were the answer that works in practice we'd have no homeless people, no drug addicts.
There are many mentally ill people who "power through", though. Some call it high-functioning depression.
There are different severities - a small depressive episode, a multi-year dysthymia or mixed (manic + depressive) episode.
I've been managing OK without meds, but maybe simply depression wasn't as severe as that of other folk. It's still a mental illness.
However, the effectiveness of Mindfulness based stress reduction and acceptance & commitment therapy show that those who can distance themselves from their thoughts have developed "mental resilience"
Exactly. And it's a combination usually. It's really hard to do constructive therapy when you are depressed. Stabilise with the meds and then tackle the root causes with therapy.
But some people just are very prone to depression and need the extra help.
You wouldn't say "don't give that kid ibuprofen, let them just deal with the pain"?
And SSRIs are not very strong. They do have some nasty side effects especially sexually but this is not relevant at that age so that makes it even more suitable for kids than adults.
I would be very cautious advising SSRIs for anyone, especially developing children, considering my own experience (on sertralin), which was complete disappearance of a libido, and massive weight gain, +40kg (70 -> 110) in ~10 months. 5 years later I still have not undone the damage from it.
Yeah but it's something that affects people differently. I took escitalopram and my libido was a bit reduced but mainly it became harder to orgasm. That was not all bad, it's nice to be able to last an hour and a half :) I was already heavy but didn't gain any more weight. I did lose some when I moved to other stuff though.
But these side-effects just need to be checked for (and the libido issue isn't relevant to under-teens anyway).
I've had recurring headaches my entire life. Have been to many neurologists, none have any idea what causes them, they just give me different pills to prevent them instead. This isn't unusual for headaches, quite often the cause is basically unknown. (If you ask people they'll give you a series of common things, eg water consumption, eating enough, etc, but it's just all unprovable folk medicine) Expecting everyone to "find the cause" is unreasonable.
If you have a headache, it's totally fine to take a painkiller. (If it happens on a regular basis, eg at least once a week, it can be a good idea to get those different pills from a neurologist, because the two main painkillers have bad side effects in the long run, but those different pills are just "masking" it in a different way)
I am not trying to say that you are never supposed to take medications long-term. I take medications, too. Unfortunately the causes are known (or rather, there is a diagnosis), but there is no treatment or cure.
What I am trying to say is that after the Nth time you would take the kid to the doctor to find out what causes the pain, instead of just giving them painkillers. It could easily be something treatable, or rather, curable.
Therapy is effective, but not always. sometimes, especially with children, there is no root cause in life to the depression beyond "genetics". Additional, therapy may simply be useless and unproductive without medication being used concurrently.
There's also simply death. I didn't feel like mentioning it, but I think its worth pointing out that without treatment, death is a very real possibility.
Do we know that, though? Historically the lives of most people were bleak and miserable. You don't really have much time to feel depressed when you have to work for 14 hours in a factory 6 days a week or lose your home and eventually die in the streets due to malnutrition and disease. People who couldn't take care of themselves and didn't have a support network just didn't live that long and/or were entirely erased from history...
We had/have a lot of reservations about it too, and discussed it at length with our pediatrician over months of observation. We decided what was more horrifying was hearing a 7-year-old — who has supportive family and friends, good health, no traumatic events, no major life changes going on, never worries where food/shelter is coming from — say he feels like "he shouldn't be on Earth anymore" and suddenly react with extreme physical anxiety to almost everything. It was bad enough that he couldn't really implement any of the coping skills he learned in therapy. His therapist hoped that medication would bring him to a baseline where he was able to benefit more from therapy. My family's historical success with Prozac also made the decision more palatable since depression appears to be hereditary.
There has been a phenomenal positive shift in his behavior since he started medication. All that said, another commenter pointed out that the study specifically says that Prozac is no better than placebo for depression, which is similar to but distinct from anxiety, which is what my son is being treated for. My mom and I were both diagnosed with depression, but anxiety may be more accurate -- I'm not sure.
I was one of those “medicating kids is a terrible idea” people, until I had kids with severe generalised anxiety. It took a lot to convince me to try it, but it made their lives better in such an obvious, immediate way. The whole experience made me a lot more humble about opinions I hold without relevant experience.
It's important to remember that not being a "medicating kids is a terrible idea" person doesn't mean one is a "every medication is a great idea" person. I'm probably like most people where in a perfect world I wouldn't medicate at all, and treat unfamiliar medications with some skepticism. But also I accept that I'm not (and am not interested in being) a medical expert, so if there is a medical need that I can't handle myself I'll take the advice of a clinician who has earned my trust with good reasoning.
> The whole experience made me a lot more humble about opinions I hold without relevant experience.
I wish there were a way to shortcut this process for society so that so many people didn't need to either go through a similar experience personally to have such an epiphany, or worse, never have it at all. (Speaking not only about medication for kids, but other polarizing issues as well.)
Children are intelligent and creative and this is normal.
Children speak like this and then I correct them. I explain it isn't helpful, explain why they are blessed, how their life could be worse, and provide them alternative phrases while they explain their emotional state.
Depression is caused by laziness and anxiety by hopelessness. My kids know that they aren't permitted to be lazy or say they are bored. They don't have anxiety because they have hope despite circumstances.
> Depression is caused by laziness and anxiety by hopelessness.
I wish this were true, but its not even close. I wonder how your kids will react when they move away, and you're not around to police their emotional expression. If they're like me, they will promptly collapse into paralysis and self-destruction.
I strongly suggest that you frequently give your kids long stretches of time (months) to practice regulating themselves, without your interference.
And if they have anxiety or depression, please let them see a professional. If my parents had noticed the signs earlier, they would have saved me decades of pain.
At this age I am teaching emotional regulation on a daily basis.
As for when they grow up, adults who cannot manage their emotions get fired or are sent to jail. It is critical to be slow to anger, quick to forgive, and work at building strong friendships.
You imply we aren't teaching emotional regulation on a daily basis? We have always placed a great deal of emphasis on talking about feelings and developing "tools for our toolboxes" to deal with them. Unfortunately those tools are largely inadequate when there isn't a rational cause for a debilitating emotional state.
People who have never experienced a particular challenge are quick to assume credit for its absence and assign moral failings to others who experience it. It's insufferable but common.
Imagine a millionaire who had millionaire parents lecturing his children on how they're not allowed to be poor. Lo! They're not! The lectures worked.
Anger seems to me to be one of the least understood emotions. In my opinion anger should be practised at every possible opportunity in order to cultivate as good as relationship to it as other emotions. Otherwise it will seem like it's out of your control due to not knowing its limits and how much of it you need due to it being suppressed. It is a necessary emotion for our wellbeing.
They're welcome to share their emotions but poor behavior isn't acceptable. Anger is fine. Yelling isn't. We'll talk it though. Tonight i got yelled at 3 times for not helping. I asked why I got yelled at. "Because I was angry". The anger wasn't justified but real so we discussed. I got a hug shortly after. No discipline. Just patience.
We take the same approach! While I don't agree that depression is laziness, we do teach that feeling sorry for yourself is akin to laziness. When we're disappointed about things not going the way we wanted we're allowed to grump about it for 5 minutes, but then it's time to brush ourselves off and move on.
> Depression is caused by laziness and anxiety by hopelessness.
Others have responded to the depression/laziness part -- I was wondering if you could clarify what you mean by anxiety being caused by hopelessness? To my way of thinking hopelessness and depression have a lot of overlap, but anxiety not so much... It's more like a feeling of dread.
Fear of the dentist is common but understanding that the inconvenience is required for the desired outcome, the reason for the suffering, there is a hope to look to allowing the suffering to have meaning.
> Depression is caused by laziness [...]. My kids know that they aren't permitted to be lazy.
Do you really believe this, or do you believe your children aren't depressed? Your comment is not in accordance with science. Depression is a complex topic. I'm having trouble imagining a way to be more wrong. Is this satire?
You can use me as an example! When I got diagnosed I was very physically active and also quite clean.
One of the hardest things for me with depression is the incredible guilt I have. What right do I have to be depressed when my life is objectively fine? Why should I get therapy when that might mean one less space for someone who is dealing with trauma or poverty or something else that gives them a "right" to be depressed? This causes a feedback loop of guilt leading to more depression and vice-versa.
Like I tell my kids, it's normal to sometimes feel depressed or hopeless. If you're dealing with a difficult circumstance then it's reasonable to have those feelings, and the only way to address those feelings is to deal with the circumstance. What's not normal is feeling depressed and hopeless for no logical reason at all.
I appreciate your sharing your experience. I think it's very valuable that human beings describe to each other their decision making, actions, and outcomes. Often, people attempt to dissuade the sharing of information, and I think that leads to us, as humans, being less able to form an accurate model of the world. I appreciate your pushing through that form of opposition.
It’s pretty tough to exercise or clean your house when getting out of bed feels like an insurmountable task.
Depression isn’t like an infection or cancer—it’s a diagnosis based on established criteria, as are most mental disorders. Experts may disagree on diagnosis or treatment, but that doesn’t make it useless.
By that logic, you might as well say autism is caused by avoiding eye contact—since there’s no blood test for it either.
Ahhh this explains a lot. You should learn about internalized ablism, and probably stop teaching vulnerable humans the same, under the guise of "emotional regulation".
Did somebody else tell you that your emotions need to be regulated this strictly? Did you learn that if you express your emotions you won't get any help? That is not a normal situation to be in.
I hope you can take your personal anecdotes and add them to a larger body of research and other people's experience to refine your understanding. If you're right that everyone who has Depression is actually just lazy, you'll see lots of support for that. If, instead, you find a lot of different experiences you might conclude that Depression is a pretty nuanced and complicated topic, which might both expand your understanding and help you bring more empathy to the suffering people around you.
You are very, very extremely inexperienced in this area, as anyone who deals with or has someone in their close family that deals with serious, life-threatening depression will tell you.
And that's okay!
I would encourage you to look at the number of comments from different people who have a history of dealing with this kind of thing for a long time.
I agree 100% and it is an uphill battle requiring significant effort. That is where discipline is required. Exercising that discipline will bring positive results. There is nothing other than self stopping someone from cleaning instead of crying under a blanket.
WTF? You cannot comment like this on HN, no matter what you're replying to or how wrong you think they are. We've had to ask you before to avoid abusive comments. We have to ban accounts to do this repeatedly, and it's only because the parent comment was pretty bad too that I'm not banning you this time. Please take a moment to remind yourself of the guidelines and avoid ever commenting like this again if you want to keep participating here. https://news.ycombinator.com/newsguidelines.html
> Depression is caused by laziness and anxiety by hopelessness. My kids know that they aren't permitted to be lazy or say they are bored. They don't have anxiety because they have hope despite circumstances.
This sounds horrible. If I weren't depressed or anxious, being told that I wasn't ever permitted to be lazy or say that I was bored would make me so; and, if I were, then being told that I was lazy and hopeless would make it worse.
You seem to have your mind thoroughly made up, which should raise a flag that you might be suffering from a bad case of Dunning-Kruger, and need to re-ask questions you think you already know the answers to.
I can't tell if you're being sarcastic or not but that is kind of the truth. A breakup is horrible, in its worst case it is similar to an untimely death and can come with grief and maybe even worse because the person is still alive and in your life so you're reminded by their absence even deeper and could experience jealousy, and the drip feed of interaction can elongate the time it takes you to move on with your life and find the person who is more right for you.
But while the sadness is real and shouldn't be ignored or suppressed, wallowing is unhelpful and you ought to move on with your life - just like if someone close to you dies, the deceased most likely would want you to be happy and continue living a good life and move on.
Objectively you're right, but I hope you think twice before saying to someone who has experienced a tragedy, "You need to move on." Similarly if you're in an argument with a friend or loved one and they are upset I hope you think twice before saying "You need to calm down" or, "You're overreacting." Objectively those may all be correct, but they are unhelpful, and are likely to have the opposite effect. They minimize the weight of the emotions. Most of us cannot just turn emotions on and off, much as we try and wish we could.
> Depression is caused by laziness and anxiety by hopelessness.
No offense, but teaching your kids this kind of nonsense is borderline abusive. It's so far away from so many people's experiences, and is just plain wrong. I hope you can recognize how damaging this could be for your kids down the road.
> Depression is caused by laziness and anxiety by hopelessness.
While pizzafeelsright gets heavily downvoted, I think their may be some (dark) truth behind it: if you weren't lazy, you would sommit suicide instead of living a depressed life. :-(
I also have a feeling that there might be another (dark) truth behind the link between anxiety and hopelessness.
With both my kids in 2nd grade and my wife also a public 2nd grade teacher, I consider myself pretty aware of what kids are being taught these days. They certainly are being gradually introduced to some of the problems of the world, but I think childhood development experts would all agree that's healthy. As for them being told they're the source or victim that's hardly the case. I'm sure there are a few isolated incidents that right-wing media love to bang on about, but not the experience for most.
> but I think childhood development experts would all agree that's healthy.
Could it be that we think it's healthy because we can just give meds to the kids that it affects?
How would someone even have the ability to say "it's healthy" - I'm struggling to think how it comes about. I think it's healthy for my kids to cry about a worm dying in the garden, but anything less than "anxiety about a dying planet"...
Put it another way: climate change messaging IS totally about anxiety and putting human as the cause, so we can (as adults) change our habits and save the planet. Could it be too much for kids though?
I grew up in the 80s and 90s. In school environmentalism was a big deal. We did conservation trips to these ecology parks, we were taught to recycle, and often watched films about animals that might die off due to climate change.
I only felt motivated to annoy my parents to recycle more. Since the effects were not directly in front of me a strong emotional reaction didn't occur.
Perhaps there are children who already have anxiety and latch onto climate change and other problems.
Not sure about you but I didn’t learn my native language phrase by phrase only. You learn the individual parts and concepts and construct sentences from that.
He learned it from being on Earth? And noticing that some people who used to be on Earth aren’t anymore? And it dawning on him that he doesn’t have to be either?
You seem to have a pretty narrow view of the world, especially about “privilege education.” FWIW I’ve never once heard anything about “white people bad” from my kiddo, about 10.
It’s also impossible to to talk about idk Columbus, slavery, Great Britain, or the founding of America (and like ya know, the treatment of native Americans) without ascribing some blame to the people responsible…who were by and large “white”. We also talk about how any judgement based on skin, appearance, gender, ethnicity, or religion, is flat out wrong.
The solution for suicidal thoughts is a drug known to induce suicidal thoughts?
You said elsewhere that there were "no known long-term side effects". Aside from that not being universally true for any drug I've ever personally researched, no side effect is more long-term than suicide.
As someone with bad mental health since I was ~5 and parents who refused to acknowledge it - I think you're making the right decision.
There is however also benefit in updating your priors as new research comes out. I won't say this particular research discounts your experience. But maybe some day your son will prefer a different medication.
Suicidal ideation at 7 years old is not normal kid behavior, neither is sudden and unprecedented paralyzing anxiety over the prospect of ordinary things like going to a friend's birthday party or trying a new playground.
Me and my mom are on identical doses of Prozac to treat very similar symptoms.
We consulted with a child therapist, a pediatrician, and a psychiatrist.
You are shockingly patient and nice to these people who are going out of their way to be judgmental jerks.
Kudos to you; you're inspiring me to find more grace in my life, but don't feel obligated to respond to these people who are trying only to bring people down.
It really does take a lot to be able to deal with all the comments they’re getting, and I know from my own experience that once you’re living a life of both seeing and experiencing struggles with mental health, it becomes something you adapt to rather quickly.
It's also horrifying to hear your 7-year old child talk about committing suicide when you have a deep family history of depression, anxiety, and suicide.
Why? If a kid has diabetes, would it be horrifying to treat it? Why would it be different for a neurochemistry issue that makes the same kid tired and sad all the time?
Because the problem's not a "neurochemistry issue" (that theory's been debunked and the "chemicals" in play have never been known), and the solution is "no better than placebo."
Can you provide a source for that theory having been debunked? I agree that data has been found that is at odds with the various neurochemical theories but am not aware of the neurochemistry link as a whole having been definitely debunked.
Whenever I read a comment like this, I’m always curious if the commenter did some basic searching of their own. Just searching “chemical imbalance debunked” yields a wide array of sources. So why ask? It seems almost like a form of Socratic questioning. You want to debate the point, but for whatever reason, are not doing so directly.
I'll take this sincerely, and ask you, is this really something you've a continuing curiosity about? I have a suspicion you understand what is taking place, but for whatever reason, are not expressing so directly. Are you asserting there is nothing more to discuss after one parses the search results for “chemical imbalance debunked”. The parent is quite clearly, at the minimum, meeting their parent's level of input, which essentially amounted to "this thing is debunked". As an onlooker and after a quick skim of the search query you suggested, I am still not exactly clear on what "neurochemistry issue [theory]" entails. What would help, is a more clear underpinning for what is being discussed, which your parent is suggesting, through question, before attempting to respond. I appreciate this personally!
Ah, well-put! I think we may be reacting differently to the same articles. My understanding is that while various neurochemical theories have not been proven as the general public seems to think, they have also not necessarily been disproven or debunked. Certainly it has not been proven that neurochemistry has no role at all.
I wouldn't recommend searching for "chemical imbalance debunked" unless you intend to confirm an existing bias. The internet will show you whatever you want, and there are enough people who distrust medical professionals that any search for "debunking" will be a minefield of fringe theories and grifters. I'd recommend someone start generally, searching for information about clinical depression, and then build on that to look at root causes and how the medical understanding of those root causes has changed over time.
One of the first search results for me was a paper published in Nature. Other top results were from respected institutions like the NIH and Harvard University. Hardly grifters or crazies.
The caveat you cite applies to basically any and all internet (or even media) consumption, and is therefore a non-argument.
Maybe chip on their shoulder, but the claim of conspiracy theorist is completely unwarranted. The impression you give off is that you decided upfront their sources are bad and you're going to knee-jerk reject their evidence no matter what.
Sad how people start frothing at the mouth during a relatively anodyne conversation. You don’t see it often on HN - more of a Reddit thing - but apparently it does happen.
drugging society is a method of proxying community responsibility , I personally completely understand why people react vitriolically to being told that drugs are not the solution , because without drugs we would have to help each other , and most people dont realize that cooperative multi tasking is the most efficient solution , or they give up because bad actors easily ruin functional cooperative societies , or they are lazy
This all started with someone asking for their sources, and the person hasn't given any except to say to Google... which means for all we know the person who then googled ended up in a situation with lots of conspiracy theories. Google famously gives personalized results to an extreme degree especially when you add in differences in search terms.
I will say if you search for "chemical imbalance debunked" as discussed, the first result for me is a paper that also says dyslexia cannot be proved to be a disorder. Which just from vibes feels really conspiratorial, even without making comments on the veracity of the academic paper.
The person who was asked for sources was a different person than the one who quipped that finding said sources yourself is trivial.
> Google... which means for all we know the person who then googled ended up in a situation with lots of conspiracy theories.
If people have low enough media literacy that they cannot distinguish between scientific research published in refereed journals and conspiracy theories, then I cannot help them and it is not my responsibility to pander to their lack of competence.
> just from vibes feels really conspiratorial
Just from vibes? Clearly you are a scientific luminary.
Yeah, the person making the claim never responded. But I was more responding to your comments, specifically:
"Just searching 'chemical imbalance debunked' yields a wide array of sources. So why ask?", and "One of the first search results for me was a paper published in Nature. Other top results were from respected institutions like the NIH and Harvard University. Hardly grifters or crazies."
Those both trivialize the process of finding sources and interpreting them. I picked my top result which was from nih.gov and gave an example of why it's hard for a lay-person to interpret journal entries because it uses field specific terms that come across as wrong or conspiratorial. Heck the paper itself references other papers on other journals that appear legitimate that argue for the chemical imbalance theory, eg an article from JAMA (Journal of the American Medical Association) from 1993. Just because the source has NIH in it or is in a journal does not guarantee correctness or reliability because time passes and new science is done. The link in question was of a paper from 2006, which we are now further from than the 2006 paper was from the 1993 paper.
I am not claiming to be a scientific luminary and even agree that the chemical imbalance theory that was espoused for years was probably incorrect for many issues. I was just arguing against thinking it's easy to investigate and source claims. It's much easier for the person who is making the claim to provide their sources, and preferably they have a large body of evidence behind them and are recent or even better a source that has done that leg work of reviewing it and distilling it down.
I think their rhetorical approach to this subject is bad and I have no respect for someone who tries to lead someone to a conclusion while being circumspect about their own biases. This is the internet; one should assume negative intent in these cases.
Argue? I considered it a conversation, before your very rude and unwarranted ad hominem.
It seems that you really have no clue what you’re talking about, and are merely lashing out due to your own immaturity and insecurity. Maybe you can find a doctor who will prescribe you a pill that will fix your personality defects. It would certainly be easier than acknowledging your (massive) intellectual and emotional deficits.
Probably because the commenter is not a medical professional and isn't qualified to judge the veracity of anything they find. "Do your own research" is a fucking plague on our modern world and is why the internet is like wall to wall grifters now.
By all means, Google whatever you like, but if you show up to a doctors office waving WebMD sheets in a medical professionals face, you are going to be mocked and you deserve it.
I witnessed a pair of doctors prescribe a family member an incredibly dangerous drug for an off label use. The company had been fined $500 million dollars for various illegal schemes to convince doctors to write such prescriptions, but I’m sure the doctors in question were unaware of this. When this family member began to exhibit textbook symptoms of an extremely dangerous (life threatening) condition which could only be caused by the drug in question, the doctors failed to notice, and in fact repeatedly increased the dosage, and added more drugs on top to treat the symptoms caused by the initial drug. It was not until I accompanied my relative to a doctor’s appointment and delivered a carefully designed incantation that they made the correct diagnosis and halted the prescriptions.
I both agree and disagree. The issue is not independent thinking and research - it’s the low media literacy of the average person that makes them vulnerable to frauds, grifters, and crazies.
With that said, the first few search results for the query were from the journal Nature, the NIH, and Harvard university. Hardly the loony or malicious caricature that you attempt to paint.
>Probably because the commenter is not a medical professional and isn't qualified to judge the veracity of anything they find.
The average medical professional is worst-placed to judge the veracity of any studies they find than the average engineer or mathematician who's done a solid statistics and probability course. Medical students are assessed on their ability to memorise and regurgitate facts, not on their ability to conduct statistical analysis.
I don't think we know if it's a neurochemistry issue. From what I understand what was debunked was the idea that they worked by blocking the reuptake of serotonin specifically.
There’s an interesting theory lately [0] that the antidepressant effect of SSRIs is actually unrelated to its effect on serotonin. Suppose, for the sake of argument, that this is completely true: serotonin has nothing to do with depression, increasing serotonin levels is useless for treating depression, and everything everyone has ever claimed about chemical imbalances causing depression is flat-out wrong.
If so, pharma companies should probably try to develop different drugs instead of new SSRIs. But it does not follow that a patient with depression ought not to take an SSRI. That would be like saying that taking aspirin for aches has been completely debunked because there is no connection between aches and aspirin’s anticoagulant effect.
"neurochemistry issue debunked" is a very weak argument about the (in)effectiveness of proper drugs for treatment of mental illness. It's not exactly known how they work but I am 100 percent sure SSRIs often have a very positive, even life changing effect. Moreover, every approved drug is tested 'double blind' exactly because the placebo effect has such a big biasing effect on subjectively appreciated outcomes. Only when ruling out pure placebo effect, a drug can be approved.
Please share your qualifications for making a statement like this- do you work in biology? Are you knowledgeable about the underlying biology here, and the limitations of medical publications?
Not that I agree or disagree with the underlying claim but a call to "credentialism" to dismiss someone's opinion is not as strong in 2025 as you think it is.
The last few years have been a proof that even the "experts" are following strong political or personal ideology.
Also we don't live in the 18th century anymore. A lot of knowledge (especially around medicine) is open to the world. People can read papers, understand research etc.
In this area, having credentials makes a difference. Experts matter.
Few if any non-medical people can read medical papers and make sense of what they say. There is simply far too much context to evaluate such papers, especially in the cases of complex medical conditions.
I have had a lot of Spinal and sleep issues. I have read almost all new literature on this niche subject and I have brought to my spine doctor some new therapy and treatments they had literally no idea about. Those treatments have changed my life.
As an engineer I read a lot of deep technical paper as my day job. Medical papers are comparatively relatively simple. The most complex part being usually the statistical data analysis.
We have pushed to a whole generation of people that only the "experts" can have opinion on some fields.
I encourage everyone to read papers and have opinions on some of those subjects.
We are in 2025. That type of gatekeeping needs to go away. AI if anything, is going to really help with this as well.
It's also good to work with your doctors (as you seem to have done), have a discussion, and mutually agree on a plan of treatment.
Experts don't know everything. But they probably know some things you don't, and can think of questions you might not to have even thought to ask. As the saying goes, "you don't know what you don't know". Experience matters.
There's also a lot of people out there without an academic background that don't know how to properly read journal papers. It's common to see folks do a quick search on PubMed, cherry-pick a single paper they agree with, and treat it as gospel - even if there's no evidence of repeatability. These skills are not something that many people outside STEM are exposed to.
Cherrypicking is bad, but worse is reading a paper and thinking you understand what it says, when you don't actually understand what it says. Or thinking that a paper and its data can be observed neutrally as a factual and accurate statement for what work was actually done.
My experience in journal club- basically, a group of grad students who all read a paper and then discuss it in person- taught me that most papers are just outright wrong for technical reasons. I'd say about 1 in 5 to 1 in 10 papers passes all the basic tests, and even the ones that do pass can have significant problems. For example, there is an increasing recognition that many papers in biology and medicine have fake data, or manipulated data, or corrupted data, or incorrectly labelled data. I know folks who've read papers and convinced themselvs the paper is good, when later the paper was retracted because the authors copied a few gels into the wrong columns...
By extending your statement you are essentially saying that the credentialed experts have a monopoly on knowledge in their fields? As anyone else reading a paper probably think he understands but actually doesn't? What a weird take.
The knowledge is out there. Yes there are a ton of bogus papers and a ton of bad research. Not everyone got the critical knowledge to figure this out but I also don't think this is only reserved to the "experts". They are also subject to groupthink and other political pressure to think a specific way.
At the end of the day, do your best own research and work with your "expert" to agree on a solution.
Pushing back on people reading paper is an anti-intellectual take (to use the same wording as another poster below).
But is that really what you are seeing in this HN comment thread? People who seem very well researched in the biochemicals and meta studies of Prozac? I don’t. :)
> We have pushed to a whole generation of people that only the "experts" can have opinion on some fields. I encourage everyone to read papers and have opinions on some of those subjects.
There's nothing wrong with having an opinion on something as a non-expert, as long as those opinions are not acted upon or relied upon as a source of reliable information. Read papers, watch YouTube, browse WebMD, satisfy your curiosity--knock yourself out. But don't undergo treatment without working with an actual expert! I'm not an expert on orbital mechanics, but I have played KSP and have formed various opinions about it. But nobody should be listening to me for advice on how to launch a rocket.
We need gatekeeping for a reason, especially in the medical field which is rife with miracle cures, snake oil, herbal remedies, detoxes, homeopathy, and other forms of quackery.
Believing my "research" is better than my specialist's education is a path back to the dark ages.
> Believing my "research" is better than my specialist's education is a path back to the dark ages.
Doing your research should not be in competition with your specialist's education. It should be complementary as yet another source of information.
I'm not saying experts are wrong but I also don't think they are particularly always right. They are human and they have strong groupthink. They will agree and disagree with some takes based on their personal or political beliefs.
> Believing my "research" is better than my specialist's education
If you get rid of the scare quotes, you can spend 10x or 100x as long as your doctor when researching something specific enough. That has many advantages, even without the training.
This just reads as Dunning Kruger-esque to me. You think that because you know how to read a technical paper in engineering, you're as or more competent than a doctor.
Yes, experts are wrong all the time, they have the disability of being human, but this seems like an extremely anti-intellectual take.
sorry but your take seems to be the anti-intellectual here.
You seem to think that the educated class got a monopoly on knowledge on that field, yet after that claim to know that experts are wrong all the time.
The anti-intellectual take is to give up on trying to understand as much as you can in a field because you don't have the right credentials to do so. Yes, medical papers are not that complicated to read.
That doesn't make you more competent than your doctor. But it probably makes you a better advocate for yourself than your doctor is.
My point is: Don't discount yourself reading papers and doing your own research. Then work with your "credentialed experts" to come to an agreement. Don't ever think that the "experts" got your best interest at heart.
Nobody who seriously read and understood the literature in a given field would issue a blanket dismissal of all the experts in that field. My experience is that reading papers and research leads one to understand WHY the professionals get it wrong - because you start to understand the nuances.
I'm not saying you issued such a dismissal, but the comment that started this thread did so.
I don't have a problem with reading papers and doing research, and I never once claimed that the "educated class" has or should have a monopoly on a field. You wouldn't know this, but for the first ten years of my career as a software person I was as a college dropout; I certainly am not someone who is going to get all hot and bothered about people having letters after their names.
That said, I have a tough time believing that spending an hour on Sci-Hub makes you better at diagnosis, yourself or otherwise, than someone who spent a decade being educated with decades of practicing. Thinking that you know better than trained experts because you have an understanding of the very beginning of a field is overwhelmingly tempting but is generally not based in reality. Usually the people who have actually been trained in the field know more about the field than a random person who read a few papers that they thought were "comparatively relatively simple".
I read papers all the time, usually formal methods, but sometimes other fields like medicine, and I will sometimes leave the medical paper thinking that it's "easier" than what I study, but I think that's just Dunning Kruger. I know more about formal methods, so I know a lot more about what I don't know, and thus I feel like it's harder. I don't know a ton about medicine, and since I don't know what I don't know it can feel like I know everything, and I have to fight this urge.
By all means, read about research in whatever ailment you have, I'm not really trying to discourage that, but I feel like dismissing experts in the field is almost the definition of "anti-intellectualism". If you find a study that you think is promising, bring it to your doctor. Hell, bring it to a dozen doctors, multiple opinions isn't a bad thing.
I just don't like the general "don't trust experts" thing that seems to be flying around certain circles now.
> People can read papers, understand research etc.
Then he should cite the papers, point out the research, etc. Rather than dismissing the entire discipline and all its practitioners with a wave of the "common-sense mental illness isn't real" wand.
These types of studies are published all the time and can easily be dismissed. Antidepressants are _only_ for major depression. Not mild or moderate. These studies that find no significance compared to a placebo are always tried in patients with all types of depression. Not just major.
It's so common it's a trope. "Antidepressants don't work" says the scientists testing antidepressants on things they're not supposed to work on.
Studies repeated with just major depression all conclude antidepressants are better than a placebo.
Click through the article to the study and you'll find they did not limit their study to must major
> Because the problem's not a "neurochemistry issue" (that theory's been debunked and the "chemicals" in play have never been known), and the solution is "no better than placebo."
It most certainly has not been debunked and mind altering chemicals most certainly do work.
SSRIs have _questionable_ efficacy but that's not the same as proven to have none, which is an exceptionally high bar.
If you don't have a serious model for what you are treating, then you are experimenting on your patients and hoping it works for unknown reasons. Not too different from folk remedies. Even worse, patients are essentially never informed that the doctor is throwing things at the wall hoping something sticks.
I've learned a lot through life, one thing I've learned is about detrimental long term physical and even social effects of antidepressants, and other medications like adderal. Both I used to take.
At this point in my life, if I realized my parents gave me an antidepressant prescription when I was SEVEN years old because I said something stupid WHEN I WAS SEVEN I'd be very disturbed and disappointed in them, I'd definitely give both of them a solid scolding.
Before you respond to this remember I'm talking about me. Not your kid or your friends kid or your cousins kid.
EDIT: Quick edit to add when I was a kid I was a total outcast, I was weird, anxious, and definitely often depressed. A lot of kids in my religious schooling systems were.
My kids go to a ordinary public school. They are very bright, cautious, and thoughtful, and generally pretty happy and upbeat. There is a strong correlation between academic intelligence and mental illness. Being depressed to the point of being suicidal and having a sunny disposition are not mutually exclusive at all. I absolutely agree that it would be disturbing and disappointing for a child to be medicated because of something stupid they said when they were seven. I think medication may be appropriate if they show a consistent pattern over several months of physiological symptoms and reactions that are consistent with depression or anxiety, and cannot be explained by external factors like trauma or major life changes.
> My kids go to a ordinary public school. They are very bright, cautious, and thoughtful, and generally pretty happy and upbeat. There is a strong correlation between academic intelligence and mental illness. Being depressed to the point of being suicidal and having a sunny disposition are not mutually exclusive at all.
If my parents said this to me the moment I realized what I was on and that I had to deal with coming off of it late in life I would be beside myself.
I'd probably also look up the doctor that encouraged my parents to put their seven year old on SSRIs so I could warn friends.
If my parents were like "uh well I had virtually no symptoms" I'd lose my mind!
Life sucks, I'm depressed all the time, kids are depressed all the time. There's material everywhere explaining a decline in general mental health. I'm happy and lucky that when my parents (or the one that was paying attention, who was certainly also depressed) noticed I was depressed or sad during a few events, some long lasting, they asked me about it, listened to me, and did their best to give me advice instead of giving up when I was seven and giving me drugs.
Remember when replying, this post has all been about myself, a victim of depression.
I'm a victim of depression too, and don't think it's fair that you say we "gave up." I would never give up on my child. You imply that we didn't talk to our son, listen to him, and do our best to give him advice before we discussed medication? Don't we all try to make the most well-informed decisions we can?
This decision was made collectively by me, my wife, our pediatrician, the child therapist, the psychiatrist, and for what it's worth also my son. We did extensive research. You may disagree with our decision, but please don't cast aspersions on how much we care.
You don't understand what having extreme anxiety at that age feels like.
As someone who lived through that, I refuse to let him. All of memories of school are just feeling anxious about everything, just tight and suffocated, always in a panic. I started living when I started taking anxiety pills at 39 years old, and I can see my 2 year old having the exact same anxiety ticks and fits I have.
I don't know at what age I'll medicate him, but I'll do it as soon as I notice he isn't coping and happy anymore.
Horrifying is forcing him to experience that because you can't comprehend us.
I'm sorry that you're dealing with this - it was my greatest fear at that point. That my daughter seems to not have my disposition and seems happy go lucky is the greatest thing ever. There's no rhyme or reason to my depression and anxiety, it's completely maladaptive and I'm relieved, that knock on wood, she stays happy and light while not having to shield herself from the horrors of the world.
How do you know an anxiety pill is treating symptoms only? What if the cause is physiological, and the pill treats that? It is entirely possible to sit in your therapist's office and mutually shrug because neither of you can find an underlying reason for your anxiety. Sometimes anxiety just is.
I had panic attacks every morning before school. God, I hated school. Mainly because of the other kids, and when I was older, because of both the kids and the teachers. I remember telling my IT teacher I am using Linux (I forgot why I told her) and she was very condescending. I have a lot of other stories but yeah, school was an anxiety-inducing nightmare.
I had severe anxiety/depression and majorly recovered from the anxiety component through a year of dilligent transcendental meditation. It changes the brain structure and neurochemistry.
I was on medication during that period and it complemented my practice, provided a stable base to apply meditation and other recovery protocols.
Often the cause is things that most people can handle, without being able to easily wield the tools to handle them. Having a pill that dulls the symptoms gives space to learn and become adept at the tools
Beyond obvious tumors/lesions/clots/abnormalities, we are not even close to being able to identify the cause of organic anxiety or mood disorders even if we wanted to.
We can say certain behaviors, experiences, illnesses and some genetic identifiers can trigger the conditions, but not the underlying cause. We can say things like some therapy and medication can help with the illness, but not the cause.
Not to trivialize therapy, but for many illnesses, not just mental, a portion of it can be described as ways of learning to live with the illness, not necessarily treating the underlying cause.
> Not to trivialize therapy, but for many illnesses, not just mental, a portion of it can be described as ways of learning to live with the illness, not necessarily treating the underlying cause.
Yeah, I feel like it's fair to describe the cognitive behavioral model. We're not necessarily looking for the cause of these thoughts and beliefs, tho they may come up, we're simply going to challenge them at face value and reinterpret the situation.
Medicine is advancing. We're increasingly able to understand and adjust dysfunctions that cause major, negative quality of life impacts. These dysfunctions have always existed, we're just getting better at finding ways to help people work through it.
This is empirically false; the rates of chronic physical and mental illnesses nowadays are are far higher than e.g. 50 years ago, and these are serious illnesses, not the kind of thing that could have been just not noticed.
The data is very clear that the rate of mental illnesses is increasing. Rates of severe mental illnesses like Schizophrenia are also increasing.
NONE of the current theories being experimented with on patients have a concrete, proven scientific basis with some such as the decades-long SSRI scam have actively harmed patients and created physical dependence/addiction and actively causing harm to patients and their families (eg, SSRI-induced suicides).
I trust science, but I don't trust scientists any more than I trust any other human with their money, career, and reputation on the line. I trust the FDA and pharmaceutical company ethics even less (eg, Bayer knowingly selling HIV-infested drugs to hemophiliacs, saying Oxycotin is non-addictive, or the revolving door that allows non-working SSRIs to be released and marketed as working despite all evidence to the contrary).
I had terrible anxiety as a child and what I experienced dramatically affected the core of who I am. It is engrained in me and I struggle with it daily, though after decades I have surpassed a good portion of it. If a small dose can help someone have a somewhat "normal" childhood, then its worth a try.
Because 7 years old is borderline too young to even make a depression diagnosis, and that kid's going to have his brain chemistry altered and essentially be addicted to a drug that he'll have to pay for for the rest of his life.
According to our pediatrician there are no known long-term effects of juvenile Prozac use. The effects may exist, but if they do they are of sufficiently low significance as to not have been detected yet. Interestingly the one possible effect she's aware of is that there may be a correlation with not growing as tall physically as one might otherwise. The data is not conclusive, but it gives me something to blame for topping out at 5'10" and never hitting 6' like my dad. :)
I appreciate how open and honest you have been in this discussion. While it might be that taking Prozac is the best choice for your child, I have to admit I would never let a pediatrician prescribe Prozac (or any other SSRI) - this is enough outside their normal training, I would want to consult with a specialist. Can't you get a referral to a pediatric psychiatrist of some sort?
Your pediatrician is either mistaken or lying. Children and adolescents who take SSRIs for major depressive disorder show increased rates of suicidal ideation, suicidal behavior, and hostility towards others. These effects persist for at least 9 months after starting SSRIs.[1]
Common side effects of long-term SSRI use in adults include weight gain, emotional numbing, loss of libido, and sexual dysfunction. It seems to me that anyone taking SSRIs when their brain is still developing would be more likely to have these side effects, and to have them persist after ceasing use.
It's anecdotal, but I know some people who were prescribed SSRIs during puberty. It's not possible to know how they would have turned out if they hadn't taken these drugs, but as adults I pity them. Their lack of sex drive causes relationship problems, which is especially sad since they do want children. They're starting to get older, so I doubt it'll ever happen.
I thought we were talking about long-term effects, i.e. ones that persist to and through adulthood? The sources in that Wiki article appear not to address that.
The clinicians I've interacted with have always warned me of the possible side-effects of psychotropic medications, and said they should be notify immediately if the side-effects appear. I believe this is at least standard procedure, if not legally required?
I do have a low libido. Can't say whether or not that's due to Prozac, but regardless it hasn't negatively affected my life, probably because it was low before I met my wife. If someone enters a relationship while their libido is at one level and then during the relationship it changes considerably then I can certainly see how that could be a major challenge. That's an important thing to weigh when evaluating medication.
In addition to the increased rates of suicidal behavior and aggression in children (which we know lasts for at least 9 months, but don't know if it's longer because the study only ran for that long), the Wikipedia article talks about long term effects in adults, at least one of which you have. Why should it be less likely for children to end up with these same issues?
You are asking for evidence that does not exist because nobody has done good studies on it. That's too high of a bar. There are many drugs and life interventions that we don't have studies on regarding children, but that doesn't mean those things are safe for children. To use an example so ridiculous that we can both agree on it: There are no studies showing long term effects of fentanyl on children. Yet if some parent managed to get a fentanyl prescription for their kid, I think we would both be concerned.
Obviously I'm not implying that giving a child Prozac is as harmful as fentanyl. I'm saying that your line of reasoning proves too much. If someone did get their kid on a dangerous drug, and defended their decision by pointing out that there are no studies on children showing its long term harm, there is nothing you can say to that parent that others in this thread haven't already said to you. That should give you pause.
This is one of the most shocking things I have ever read. There is a black box warning for Prozac:
‘Warning: Suicidality and Antidepressant Drugs
Increased risk of suicidal thinking and behavior in children, adolescents,
and young adults taking antidepressants for Major Depressive
Disorder (MDD) and other psychiatric disorders’
The fact that you were not informed about this should serve as proof that you cannot blindly trust what doctors tell you. They will absolutely kill you out of ignorance or incompetence, and never even realize their responsibility.
Note that the black box warning has nothing to do with long-term effects of the medication. It was added specifically because kids were killing themselves within weeks of starting the medication.
> This is one of the most shocking things I have ever read.
Good grief. I hope you're exaggerating for effect.
> Note that the black box warning has nothing to do with long-term effects of the medication
What are the long-term effects of suicide?
A 7-year-old kid doesn't understand what suicide really means. Putting them on something that encourages a behavior that they don't understand and has completely catastrophic results isn't a risk I would take with my children.
I respectfully submit you might feel differently about it if your child were suicidal. When someone has to be watching them 24/7 already for fear they'll hurt themselves, the black box warning is a lot less worrisome. SSRIs prevent more suicides by far than they cause. It's that first few weeks where they can have a paradoxical effect.
Death is a long term effect. And I am not exaggerating. I did not feel the need to list any of the myriad other potential long term effects because death seemed sufficiently serious.
Edit: in case the OP is reading, I should say also that the package insert won’t mention many other potential long term effects addressed in the literature, like extra pyramidal symptoms (akathisia, Parkinsonism, dystonia, tardive dyskinesia).
Another edit: ask GPT-5 ‘What are the long term side effects of Prozac use which aren’t addressed in the package insert?’ for a list.
It sounds to me like you're saying suicidality in children either doesn't exist, or shouldn't be treated, or should only be treated with talk therapy. If what you're saying instead is "this SSRI is especially dangerous" then ok, you and I just disagree about what information sources are reliable, and that's probably not a difference we can resolve. But if you're saying suicidality in children shouldn't be treated with medication, I'm curious whether you've ever met a six- or seven-year-old who wants to die. It is terrifying. It needs treatment. And talk therapy in children that age is honestly a joke. In the OP's place I would give my child an SSRI without any hesitation.
right which is why they are treating the depression (which leads to suicidal tendencies) which is a symptom of depression, with prozac. that's what the prozac is for. to prevent death
We were certainly informed of this. I didn't count it among the long-term health effects. I'm an educated and skeptical person but have never found any reason to distrust my physicians.
I have many reasons for distrusting physicians, but here's a particularly good one: the large drug companies have been fined repeatedly billions of dollars for illegal schemes to convince doctors to prescribe drugs off-label. From a justice department press release (https://www.justice.gov/archives/opa/pr/pharmaceutical-giant...):
'AstraZeneca LP and AstraZeneca Pharmaceuticals LP will pay $520 million to resolve allegations that AstraZeneca illegally marketed the anti-psychotic drug Seroquel for uses not approved as safe and effective by the Food and Drug Administration (FDA), the Departments of Justice and Health and Human Services’ Health Care Fraud Enforcement Action Team (HEAT) announced today. Such unapproved uses are also known as "off-label" uses because they are not included in the drug’s FDA approved product label.
[..]
The United States alleges that AstraZeneca illegally marketed Seroquel for uses never approved by the FDA. Specifically, between January 2001 through December 2006, AstraZeneca promoted Seroquel to psychiatrists and other physicians for certain uses that were not approved by the FDA as safe and effective (including aggression, Alzheimer’s disease, anger management, anxiety, attention deficit hyperactivity disorder, bipolar maintenance, dementia, depression, mood disorder, post-traumatic stress disorder, and sleeplessness). These unapproved uses were not medically accepted indications for which the United States and the state Medicaid programs provided coverage for Seroquel.
According to the settlement agreement, AstraZeneca targeted its illegal marketing of the anti-psychotic Seroquel towards doctors who do not typically treat schizophrenia or bipolar disorder, such as physicians who treat the elderly, primary care physicians, pediatric and adolescent physicians, and in long-term care facilities and prisons.
[..]
The United States contends that AstraZeneca promoted the unapproved uses by improperly and unduly influencing the content of, and speakers, in company-sponsored continuing medical education programs. The company also engaged doctors to give promotional speaker programs on unapproved uses for Seroquel and to conduct studies on unapproved uses of Seroquel. In addition, the company recruited doctors to serve as authors of articles that were ghostwritten by medical literature companies and about studies the doctors in question did not conduct. AstraZeneca then used those studies and articles as the basis for promotional messages about unapproved uses of Seroquel.
"Illegal acts by pharmaceutical companies and false claims against Medicare and Medicaid can put the public health at risk, corrupt medical decisions by health care providers, and take billions of dollars directly out of taxpayers’ pockets," said Attorney General Eric Holder. "This Administration is committed to recovering taxpayer money lost to health care fraud, whether it’s by bringing cases against common criminals operating out of vacant storefronts or executives at some of the nation’s biggest companies."
The United States also contends that AstraZeneca violated the federal Anti-Kickback Statute by offering and paying illegal remuneration to doctors it recruited to serve as authors of articles written by AstraZeneca and its agents about the unapproved uses of Seroquel. AstraZeneca also offered and paid illegal remuneration to doctors to travel to resort locations to "advise" AstraZeneca about marketing messages for unapproved uses of Seroquel, and paid doctors to give promotional lectures to other health care professionals about unapproved and unaccepted uses of Seroquel. The United States contends that these payments were intended to induce the doctors to prescribe Seroquel for unapproved uses in violation of the federal Anti-Kickback Statute.
'
The takeaway is that anytime a physician prescribes you a drug, at the very least you have to check that there hasn't been a gigantic fine levied against the drug maker for illegally tricking your doctor into prescribing it to you.
It remains legal to provide drugs off-label because physicians sometimes know better than federal regulators
It's horrible that A-Z would illegally market drugs for off-label uses -- I would not disagree for a minute with your reasoning! -- but we retain this "escape hatch" because it is important to patient health
without the off-label "escape hatch," we would not have, for example, the glp-1 class of anti-obesity drugs, or, buproprion for smoking cessation, the most effective drug ever found in its area.
We needed doctors working firsthand with patients, and building "anecdotal" (i.e. case-based) evidence to learn things that really matter on a population level
There is no effect which is more long term than death. It is incredible to me that this is not obvious. But if you want other potential long term effects:
Lower bone mineral density, increased risk of fractures, osteoporosis
Sexual dysfunction / PSSD (Post-SSRI Sexual Dysfunction)
extra pyramidal symptoms (akathisia, Parkinsonism, dystonia, tardive dyskinesia)
I, like every other person who hasn't been living under a rock, am abundantly aware of corruption in Big Pharma and medicine. If my mother and I have both taken a given well-known medication for decades and found it effectively treated a condition that may be hereditary with no negative side effects, and my son is demonstrating symptoms similar to mine and my mother's, is it unreasonable to tolerate my son trying the same medication? That's a far cry from committing to forcing him to take the medication his whole life, or trying some mystery drug with which I have no familiarity.
My deepest views on this subject are personal, subjective, and more controversial. I have watched several family members take antidepressants for upwards of four decades, and I myself suffered terrible depression throughout my childhood and teenage years. Despite my depression, I always avoided antidepressants for some ineffable reason-- a hunch, a nebulous suspicion, I'm not sure what to call it. Somewhere in my mid twenties my depression lifted and never returned. I look back on my life, which has been filled with hardship, and I feel positively disposed to the suffering. The suffering made me who I am. I feel strongly that my character would be diminished had I not experienced it.
On the other hand, I watched family members take these drugs, and their lives seem somehow dulled-- filled with banal tragedy, like staying in a bad marriage, or not being particularly interested in their grandchildren. I have a theory that the drugs make palatable that which otherwise wouldn't be, hence they stay in the bad marriage, the bad job, and they watch their bad TV and eat their bad food and everything is fine. I've also seen one of them go off the drugs, and for a couple months they were a much more vibrant person. I saw them express joy. I feel a low grade rage toward the industry that I've been deprived of this version of them. I do entertain the possibility that I'm imagining it all. Maybe things really would have been worse without the drugs. But I am glad no one ever insisted, or even strongly advocated I take them myself.
To be clear, nobody ever insisted or strongly advocated that I take medication — suggested maybe, but it was entirely my decision. And I completely agree about the importance of hitting "rock bottom." That's something I struggle with as a parent: wanting to make sure my kids have plenty of opportunities to fail, yet fail in a way that isn't irreversibly damaging. If at rock bottom I had simply killed myself rather than starting Prozac I wouldn't be around to have benefited from it.
A large part of me dislikes being on any sort of medication long-term, and think most people have the same dislike. I have gone off of Prozac a few times and always found that I gradually became frustrated and depressed again, and as you said the reason for the dislike is ineffable, so I chose to go back on. I'm fortunate to have a life with no bad marriage, no bad job, and very little trauma at all, which is also unfortunate since it means despite years of therapy and introspection and travel and hobbies and other varied experiences I've never been able to find any cause for the depression and therefore no way to fix it, other than medication. It makes me think of Captain Picard: "It is possible to commit no mistakes and still lose. That is not a weakness; that is life."
Medication does not remove the need for therapy. If they are stuck in a bad situation and do not have the tools to come out of it, then in therapy they can learn about the tools and techniques.
Medication avoids having that particular day where everything hits rock bottom and the only solution seems to be suicide.
For some people just therapy is not sufficient but need also medication.
Psychiatric illness is something where many people have misunderstandings. Since many people go through depressive episodes, they feel that their experience is the same as others who are facing chronic depression. And since it is not physically visible, it is also hard to empathize with.
No one says you can come out of heart disease or diabetes by just bearing it bravely. Somehow for psychiatric illness people assume that it is something that can be braved out.
How can you believe it's both "no better than placebo" but also that it's "going to have his brain chemistry altered and essentially be addicted to a drug". SSRIs are not considered addictive, though people can develop a dependence if it provides them significant improvement.
The whole point of the linked article is that the drug is no better at placebo at treating depression but also carries a host of known side effects, besides unknowns when it comes to long term use. They're not saying it's inert.
That's fair, though I never implied that there were no side effects. The part I was trying to point out in the quote was the mention of it being addictive which is not really supported, nor is that mentioned in the article.
Here’s a paper from last year: The nature and impact of antidepressant withdrawal symptoms and proposal of the Discriminatory Antidepressant Withdrawal Symptoms Scale (DAWSS) https://doi.org/10.1016/j.jadr.2024.100765
‘Highlights
•
Antidepressant withdrawal can be severe and protracted.
•
It produces characteristic physical and emotional symptoms.
•
All symptoms were more severe after stopping than before starting antidepressants.
•
We identified the 15 most discriminatory withdrawal symptoms in our sample.
•
Withdrawal did not differ between people with physical or mental health diagnoses.’
Mine too! Only 2 years old but I can already see the massive anxiety bursts in him.
If this guy has a non chemical cure, I'm all for it. In fact I'm actively researching children psychologists to stave off the meds as much as we can, the problem is that 99% of psychologists are quacks, so choosing them is tough.
There's only so many times a kid can get sent home from school for biting/kicking/punching before you realize you need some professional help and will do anything to help the poor kid. I wish you luck.
I'm very sorry to hear your story, and I'm really glad the medication has worked well for you and your family. It's early days, but it seems to be working well for ours too.
I also really admire the way you're dealing patiently with everyone in this thread arguing in bad faith, you have a lot more tolerance than I do! Hopefully it's not getting to you. Best wishes.
Sorry, I don't mean to second-guess your choices. There's clearly some very interesting issues here, and my experience is as someone who never felt they had any serious issues with mental health. But I do think that we have this culture where everyone is expected to be OK all the time. Do you worry at all that your son cues in to his parents relationship with the drug? I mean, say it was me, and I knew my parents took a pill so that they could "have a good day" but they didn't give me the have-a-good-day pill. I would think (perhaps subconsciously) that if I was having a bad day the drug could have made it into a good one. Having a bad day would be medical now, a reason to feel like you're sick or broken.
Prozac doesn't define me. It's just something I take to address a health condition, like an iron supplement for low iron levels or amoxicillin for strep throat. My kids learned about it because they saw me taking a pill every day and asked what it was. No biggie.
To be clear, Prozac is not a "feel-good" pill, it's a "gradually feel more stable" pill. It makes my lows less debilitatingly low and more manageable -- my lows are now largely logical responses to difficult events, as opposed to randomly happening for no reason at all. The effect is very gradual and subtle: you can't really evaluate it until after several weeks, and then the "evaluation" is a conversation about whether your affect has seemed generally more stable recently. An average person taking Prozac would probably notice no effect at all, good or bad. By contrast, a stimulant like Adderrall will have a noticeable effect on anyone within minutes.
My son never asked for Prozac or for a "feel-good" pill. My kids have heard of addiction before so we've talked about pills that do make you feel good and why they're dangerous, and also "dopamine drips" like brainrot on YouTube.
Such a simple concept, and for some reason so difficult to grasp for certain people. Usually the ones not coming across as particularly empathetic or open-minded.
I suppose the "good" news is that is just how life goes. Conceptually similar comparison to someone who is hungry and someone who isn't - the tendency towards snapishness is definitely there. Who someone is becomes unstable of long stretches of time (unless they are very boring), it results more from the present conditions that involve them than anything else.
The main issue with drugs is they are more likely to have unexpected or socially harmful side effects than most things.
Interestingly my son has an identical twin! I like to joke that one is the control and sleeps in the house and the other has to sleep in the storage shed out back, and when they're 18 we'll publish a paper comparing their emotional development. :)
I always thought DNA determined pretty much everything, and we raised them exactly the same, but they have distinct personalities and some different physical features, although of course they're much more similar than they are different. My other son shows some symptoms of anxiety but not as much, yet.
I am surprised by how many people seemingly independently come up with a completely indescriptive "bad day" label - for the lack of a better one.
Good that things are working out for you.
Recently found that, on top of meds (that started wearing off - after taking them for a couple years now following a challenging life situation), going to social latin dance classes for a couple hours almost every day after work helps quite a bit.
I’m thoroughly impressed with how you handled the comments in this subthread. As someone who was on and off antidepressants for years, I can say confidently that for every one person spewing vitriol and judgement at you for your parenting decision, there was someone else solemnly nodding and sending love to you and your family. People just don’t fucking get it unless they get it. Best of luck to you.
I recently started giving my 11 year old SAM-e, available over the counter and much faster acting than SSRIs for serotonin support. He's been much happier and more regulated since taking it. I'd encourage folk to read up on the literature around SAM-e and consider it as a lower risk alternative to try first, that may in fact work better.
Out of curiosity - do you know whether SAM-e can be taken safely with SSRIs? I went looking for this a bit back and didn’t find anything conclusive. I know there’s a handful of seratonergics to steer clear of, but I didn’t get a good answer about SAM-e.
> Pills are for people who feel depressed but don't have something to be depressed about -- they have food, shelter, friends, opportunities to contribute and be productive, nothing traumatic has happened, but they feel hopeless anyway
This warrants a whole different discussion, and I'll be down voted for it, but one that's never addressed: quality over quantity.
Pills are the individuals response to a society that feeds empty food, bland sterile shelter, fake friends, and meaningless jobs.
The natural human response to a lack of meaning is hopelessness, and this comes from our society. Pills helps individuals cope with continuing the meat grinder just a little while longer.
I had depression, and I cured it by finding meaning and beauty in the world. I get told "if you can cure it without pills, you never really had it" yeah cool, self fullfilling prophecy in that case innit. Can't cure it, because it doesn't exist without meds. It just comes out of "nowhere" and is here to stay.
I agree with your perspective but these things are on a spectrum. For very severe cases medication can be highly helpful and supportive, as they move to find their meaning and purpose. Each person’s situation is unique and I think blanket judgements are unhelpful.
> I cured it by finding meaning and beauty in the world.
That's incredibly fortunate and I'm very jealous of you. How would you recommend one goes about finding meaning and beauty? I'm fortunate to have had lots of unique experiences and traveled to lots of unique places and still haven't found the fulfillment that you seem to. That's basically what depression is: a debilitating feeling of lack of fulfillment, without any idea of what's missing.
I'm happiest when busy building and fixing things. It could be that if I was born 200 years ago into an agrarian society where day-to-day life was focused on building and fixing things to survive, then I would have felt very fulfilled and done quite well. What were gainful full-time jobs back then have been reduced to hobbies now, though: blacksmithing, cobbling, weaving, hunting, making furniture, etc. Hobbies don't fill the hole for me. Sure, a few artisans are still able to turn those into a living, but a large part of the job is marketing and the clients are largely the wealthy elite. I've enjoyed working in food service and construction but it's hard to support a family of 4 doing those. So my career has been in software engineering since that involves building and fixing and pays well, but it still doesn't fill the hole.
If this sounds whiny I'm painfully aware. What right do I have to complain about feeling unfulfilled when there are real problems in the world? And that's the very essence of major depression.
For what it's worth, I have dealt with pretty severe depression for most of my adult life. I am only starting to have periods of coming out when I realized that most of depressed feelings come from a place of ego. I have an identity of who I am and what I like, and I seek things in the external world which might provide meaning for me. For me, it's because I always sought value from the things around me, rather than believing that I am already enough. Every single day, I have to beat down my instincts that tell me that I am worthless and remind myself that there is more beauty in the world and it's actually absurd that I am letting society tear away from me my natural instincts to want to live and enjoy life. You have to really sit with these feelings though... like really really get to know your voice vs the internalized societal voice. I have developed "tests" that help me discern which voice is which, but it has helped a bit. Also working out and taking care of your body is a bonus, and just taking pride in like... doing things to lead a peaceful life is underrated.
Hope you feel better.
I hope you can understand that this and other comments about needing to find meaning and needing to sit with inner feelings... It feels patronizing. I have spent tremendous amounts of time and energy analyzing my feelings and looking for meaningful experiences. I've sought relief in meditation, religion, therapy, yoga, travel, art, etc. Most people probably have in one way or another. It's not rocket science to know those activities may be beneficial. They undoubtedly do help some people overcome feeling depressed. But feeling depressed is different from having depression.
I'm sorry it came off that way, I really didn't intend it to be, it was actually a self call out because I actually never learned as a child to sit with my inner feelings. I attribute that to being more sensitive and probably more intelligent than my siblings and acting as a buffer for my parents and basically only ever wanting to make other people happy, I never developed an inner world like other kids do.
Also I noticed... yoga, travel, art, those are still external. Even meditation can be if you approach it from a standpoint of like... one that is about forming your ego around it rather than being present... not sure if this makes sense. Like you can approach anything from a negative or place of wanting to 'fix' yourself, which ruins the experience imo. For me I would ruin things that were supposed to be fun because I would tell myself I should do this because it's good for me.
That being said, there are really low days still when I will feel absolutely nothing, I will think to myself... if this psychological pain is so intense, why should I keep going? I don't have answers for that. I genuinely just have to make it through the day. I understand that with the pressures of a family and kids, it's not one of those things where you can easily tap out, medication makes sense for that. I was just trying to share how I feel because honestly for me there isn't anyone in my life who I can relate with on this deep of a level... of these feelings, and it's really alienating in itself.
> So my career has been in software engineering since that involves building and fixing and pays well, but it still doesn't fill the hole.
A brief thought on this - I’ve found working in large software companies to be fairly unfulfilling, but working at smaller shops focused on delivering something other than software, or for which there’s some tangible connection to the real world, to be much more fulfilling. At its best, software engineering is indeed a craft and something you can take pride in and something where you can have a real impact on people’s lives by building things. A lot of that gets lost somewhere between the third roadmap meeting and the weekly scrum session to figure out how to prioritize product’s requests alongside paying down tech debt so we can improve ad unit performance, but the craft of software itself is still a creative act.
That's exactly the problem, "meaning in life" has no static definition and there is no possible way to explain it in general terms, even for people who proclaim to have "found" it.
Pills, on the other hand, are easy to understand. This is not to say that they are a viable substitute in any way, but it does explain why so many prefer substance treatments.
Meaning in life is hard and personal. Some might have no idea where to start.
But I'd argue (somewhat pointlessly as I'm not going to change anything) -- This is the role that society, traditions, family, etc. has: "to bring people up" swimming in the same stream, given a purpose and meaning, etc.
> I'm fortunate to have had lots of unique experiences and traveled to lots of unique places
For comparison I've barely traveled more than 1000kms. Never had a passport. Travel is not related.
> where day-to-day life was focused on building and fixing things to survive, then I would have felt very fulfilled and done quite well.
Incorrect assumption; It's not the building and busy-ness. And the experience doing hobbies supports that. Nothing fills that "hole".
The feeling, the "hole" you're missing, is a combi-mix of purpose/meaning/larger-picture. I know it because I also had it. Many people try politics to fill their hole too, which also doesn't work: political parties are not big enough.
I'm not going to try to persuade you to change your life, I'm going to talk about what did it for me, and you (and others) can spectate and speculate, take and leave whatever you want. I'm sure I'll get flagged anyway.
My great realization is that nothing is set in stone, everything changes at all times, and humans have survived it.
> a debilitating feeling of lack of fulfillment, without any idea of what's missing.
A good way to start out is to start thinking about: what is your mission? What is your tribe in the world stage? are there messages or lessons from the ancestors of your tribe?
Shy away from getting over-scientific. Simple broad points. The universe is in constant change and chaos. But humans have survived for a long time. We have "lizard" brains that give us reactions, then we have learned / ingrained behavior on top of that, through all this time we've encoded "how to survive" in our brains and throughout our history; we are a storytelling species, so what stories do we have from history (note: not about history, but from history).
Realising stories, like fairytales,(ie: Rumpelstiltskin) etc - ARE old stories that ENCODE information as a way to pass knowledge from culture to culture. WHAT information is in there? what are they trying to tell us? This is the tribe of "humans" telling us something from the past, which is actually absurdly interesting and fulfilling to try and learn from.
Yes this is all "woo-woo" stuff, none of this is going to be a revelation to you. I'll probably look like a quack, but You can have a ponder about it, and realise that there's a big group that you're a part of, and there is a bit of a cosmic mission, and history plays out every day.
this won't give you purpose or fill the hole, but I think you might start to chip away at some different things in your life,
(or you won't and I've just wasted 5 mins of your time, ¯\_(ツ)_/¯ who cares)
What do they do when they turn 15, realize they, say, have no sex drive, but have been on anti depressants for years and cannot take a break from life in order to now learn the emotional regulation skills they should have developed from 7-15? Antidepressants often mask issues which later manifest in unexpected ways, even if you don’t notice any immediate side effects.
The thing is, they work very well for that 15%. I suspect the eventual conclusion will be that depression is a syndrome with multiple causes rather than a single condition, and SSRIs treat one of the causes.
Edit: Mark Horowitz is one of the authors of both studies.
The NNT[1] of Prozac, and SSRIs in general, has been previously estimated around 6. Meaning that treatment is more helpful than a sugar pill in only 1 out of 6 cases (a dirty secret).
Meanwhile the NNH[2] is as low as 21, that is 1 in 21 cases will stop due to negative side effects.
I suspect the biggest, but not the only, problem with these supposedly weak SSRI/SNRI numbers we routinely see in clinical trials has to do with the definition of depression, with the diagnosis itself. For example it has some of the worst inter-rater reliability across the entire DSM (meaning that two doctors are least likely to both reach the same diagnosis in the same patient independently). So if you start from a poorly defined set, which likely encompasses some genuine affective disorders, people going through difficult times, undiagnosed personality disorders, dysthymic ADHDers, burned out ASDs, and God knows who else - yeah, you'll get poor performance data. Every psychiatrist knows intuitively that SSRIs/SNRIs do work, even if you have to trial a few. Also, without arguing about the number, that 15% is not exactly the same 15% for each drug.
Also, since we're here: the secret knowledge about depression (and affective disorders in general) is that it is an episodic illness, where episodes are measured in weeks or in months. Most people experience just one episode which will end whether or not any medical intervention is undertaken, although the intervention can greatly shorten the course and avoid a potential suicide. But some will not stop at one episode, and can go on to have multiple episodes, perhaps develop melancholic features or even suffer from a lifelong recurrence. It is in the latter groups where medication is the most effective.
The disclosure section in the cited research article may indicate a financial interest in the authors being able to say that Prozac is not effective:
“ MAH and JM are co-applicants on the RELEASE and RELEASE + trials in Australia, funded by the Medical Research Future Fund (MRFF) and the National Health and Medical Research Council (NHMRC), evaluating hyperbolic tapering of antidepressants against care as usual. MAH reports being a co-founder of and consultant to Outro Health, a digital clinic which provides support for patients in the US to help stop no longer needed antidepressant treatment using gradual, hyperbolic tapering; and receives royalties for the Maudsley Deprescribing Guidelines. JM receives royalties for books about psychiatric drugs, and was a co-applicant on the REDUCE trial, funded by the National Institute of Health Research, evaluating digital support for patients stopping long-term antidepressant treatment. MP and RL have no conflicts of interest to declare.”
I would caution those in this thread who have never seen or treated patients in any psychiatric clinic or hospital let alone a pediatric one to be careful assuming that they have adequate experience to make sweeping judgements on the utility of antidepressants in children.
The problem with suicidal depression is that if someone has created the thought pattern that death is best, then removing the symptoms of depression (lethargy, lack of energy, no willpower) now gives the person the ability to actually follow through with the act.
Medications almost always target symptoms and never address root causes.
This is a good thing to know, but should also be noted that the same thing can happen with simply naturally recovering from a depressive episode.
The phenomenon should not be considered a reason to not medicate (which I don’t think you are implying, but some may take that as the conclusion). Instead it’s definitely something important to explicitly make people aware of.
Depression or the feeling so much mental agony that the idea of escaping with death becomes comforting, is a signal that something is wrong.
Realizing this has been important with weathering my own occasional dealings with severe[0]depression, once I realize “something is wrong”, I can start the annoyingly slow process of trial and error making changes to correct things. This turns depression from “how reality is” into “this is just feedback on my body’s state”. It turns things getting worse into either a “this is either a transient state or the wrong solution”.
[0] Which I define as the point where any passive ideation (fantasies of dying) starts to enter the gradient of becoming involuntary. As opposed to regular negative thoughts which can (and should) be brushed away as easily as a fly landing on me. Curiously, once I noticed it also affected my ability to experience color. While I could technically see colors, it was like have a mental partial greyscale filter because there was no beauty in it, color was just a meaningless detail.
A sudden improvement in mood is one of the key warning signs for suicide. Often it's genuinely just a sudden improvement, but sometimes it is a byproduct of the relief people experience when they commit to ending their life. If you know someone who is severely depressed, you should watch them very carefully if they suddenly seem carefree.
>once I noticed it also affected my ability to experience color
A small amount of evidence does support the notion that depressed people literally see the world as being less vibrant.
This is what my psychiatrist more or less warned me about when I went on medication; that a lot of people who are suicidal lack the energy and ability to plan their suicide, and medications can sometimes undo those particular symptoms and people manage to end themselves.
I'm not sure what kinds of studies have been done about it, but I've had a few therapists same similar ideas. If it's not a studied phenomenon, then it has folks that believe it exists.
I'd like to make the point that even if this does occur, it doesn't mean, "therefore this medication shouldn't be used/is worse than doing nothing," just that awareness and caution is needed.
I went through a frankly terrible few months on my current meds because they removed the emotional numbness before removing the bad feelings. However, once that was over they effectively gave me my life back after 10+ years of continual exhaustion and brain fog.
This theory is a science-free zone. It seems far more likely that the drug induced sudden, overwhelming suicidal thoughts than someone said "I feel the best I've ever felt and life is looking up. I think I'll kill myself and make all the good feelings go away".
Furthermore, if the latter were true, it would be an indication that depression was a symptom rather than a cause and the psychiatrist misdiagnosed and improperly treated the patient.
EDIT - I ask because the only results I get when searching are a Harvard article debunking it. I'd rather hear the opinion of someone that actually believes in it before I read about why it's all malarky. I believe in arguing against the best version of someones argument.
It was just the best “every man” link I could provide for understanding how efficacy of toxin-clearing (toxicity) could be related to depression, other struggles with homeostasis.
I’m not quite following the previous conversation here, but your comment brings to mind that one theory of a possible “function” of depression, is as a “sickness behavior” to help isolate a sick animal from others to protect the group. A sheep or cow getting sick and going off on its own is a common thing.
I’m not sure if it has a technical name or if it’s been rigorously studied, but it’s a common observation which even I’ve seen (and reported to growers I work for).
> but your comment brings to mind that one theory of a possible “function” of depression, is as a “sickness behavior” to help isolate a sick animal from others to protect the group. A sheep or cow getting sick and going off on its own is a common thing
It's one explanation of the phenomenon. I'm not remotely convinced by it, but that doesn't mean I think it's untrue.
What I do think we can conclude is that we have no evidence depression is caused by infection. (Singularly and universally, as OP implies.) With higher confidence I believe I can conclude that interrogating chatbots designed to keep your attention is a poor way to resolve this.
> we have no evidence depression is caused by infection
Besides talking to patients and reading case files.
You can wait another decade or three for someone to spend the money on a specific study that meets your individual criteria (I'm sure very high), for doing obvious things like:
1.) Treating known infections, testing for others,
and
2.) Addressing nutritional gaps, as well as tracking circadian/endocrine, and nervous symptoms (which often intertwine with depression symptoms!)
but I will not wait.
I'd prefer to no longer be depressed, and/or unwell.
So I'll do the obvious things – even if they're not obvious to you, yet.
Stopping back in, because I unironically came across someone's almost-surely AI assisted summary that does a better job than I have summarizing the processes being discussed:
==
===
Why the Sick Get Sicker
Most people think illness progresses because of pathogens, toxins, or genetics — but the deeper truth is that tension, stress, and breathing patterns control the trajectory of health more than anything else.
When the body is stressed, the breath changes.
When the breath changes, the lymph stagnates.
When the lymph stagnates, toxins accumulate.
When toxins accumulate, inflammation accelerates.
And that is how sick becomes sicker.
Here’s the breakdown:
1. Stress Immediately Changes Your Breathing Pattern
When the nervous system senses stress — emotional, physical, mental, or energetic — breathing becomes:
• shallow
• rapid
• high in the chest
• tight in the ribs
• limited in diaphragm expansion
This cuts oxygen supply, raises cortisol, and signals the body to brace.
Bracing = stagnation.
2. Your Breath Controls Your Lymphatic System
The lymphatic system is the body’s drainage system, and it has no pump of its own.
It relies entirely on:
• diaphragmatic breathing
• muscle movement
• fascia softness
• a calm nervous system
Shallow breathing = no diaphragm movement.
No diaphragm movement = lymph stagnation.
When lymph stagnates:
• waste can’t drain
• toxins recirculate
• inflammation builds
• swelling increases
• the immune system gets overwhelmed
This is why people in long-term stress decline rapidly.
You've contributed nothing curious to this thread whatsoever, just threw some doubt in, then buggered off during the replies – more or less communicating "stuff I can't directly or completely refute is AI slop".
That's....disappointing.
I saw this textpost made by someone else, and literally thought of you, JumpCrisscross.
But is the only true cure to the suffering. We’d have to undergo a massive reorganization of society (and upset a few hefty profit margins) to prioritize that, so we settle for the messy symptom management we have.
That story doesn’t work for people with depression who otherwise have very good lives.
I grew up in a stable household with a loving family and both parents present and supportive. I’ve never had financial hardship, either as a kid depending on my parents to provide or as an adult providing for myself and family. I did very well in school, had plenty of friends, never had enemies, never got bullied or even talked bad about in social circles (so far as I know…). I have no traumatic memories.
I could go on and on, but despite having a virtually perfect life on paper, I have always struggled with depression and suicidal ideation. It wasn’t until my wife sat down and forced me to talk to a psychiatrist and start medication that those problems actually largely went away.
In other words, I don’t think there’s a metaphorical “cow” that could have helped me. It’s annoying we don’t understand what causes depression or how antidepressants help, and their side effects suck. But for some of us, it’s literally life saving in a way nothing else has ever been.
First of all, I want to write that I am glad you found something that worked so that you are able to remain here with us.
Though, I am curious about the, "otherwise have very good lives" part.
Whose definition are you using? It seems the criteria you laid out fits a "very good life" in a sociological sense -- very important, sure. You could very well have the same definition, and perhaps that is what I am trying to ask. Would you say you were satisfied in life? Despite having a good upbringing, were you (prior to medication) content or happy?
I am by no means trying to change your opinion nor invalidate your experiences. I just struggle to understand how that can be true.
As someone that has suffered with deep depressive bouts many times over, I just cannot subscribe to the idea that depression is inherently some sort of disorder of the brain. In fact, I am in the midst of another bout now. One that's lasted about 3 or so years.
To me, I have always considered emotions/states like depression and anxiety to be signals. A warning that something in one's current environment is wrong -- even if consciously not known or difficult to observe. And if anyone is curious, I have analyzed this for myself, and I believe the etiology of my issues are directly linked to my circumstances/environment.
> I don’t think there’s a metaphorical “cow” that could have helped me.
The smart-ass in me can't help but suggest that maybe medication was your cow?
To be honest, I've never really thought about it... I suppose I mean in both a sociological and self fulfillment way.
> Would you say you were satisfied in life? Despite having a good upbringing, were you (prior to medication) content or happy?
I would say "yes" overall. Aside from the depression (typically manifesting as a week or two of me emotionally spiraling down to deep dark places every month or so), I was very happy and satisfied. That's what makes the depression so annoying for me. It makes no sense compared to my other aspects of life.
> In fact, I am in the midst of another bout now. One that's lasted about 3 or so years.
*fist bump*
> To me, I have always considered emotions/states like depression and anxiety to be signals. A warning that something in one's current environment is wrong -- even if consciously not known or difficult to observe. And if anyone is curious, I have analyzed this for myself, and I believe the etiology of my issues are directly linked to my circumstances/environment.
I think that's a great hypothesis so long as it's not a blanket applied to everyone (which I don't think you're doing, to be clear; I mention this only because it is what motivated my original response to the other commenter).
I don't want to go into private details of family members without their permission, but I will say that given the pervasive depression in my family and mental health issues like schizophrenia and bipolar disorders (neither of which I have, thank goodness), I feel like there's something biologically... wrong (for lack of a better word?)... with us, particularly since you can easily trace this through my mother's side.
> The smart-ass in me can't help but suggest that maybe medication was your cow?
Ha fair. I interpreted the story to be about depression being a symptom of your situation (job, health, etc.) and if you just fixed that then there's no need for medication. That definitely makes sense in some (many? most?) situations. But not all, unfortunately.
Take my baseless speculation for what it's worth, but could it be that you were depressed because your life was too easy? We humans are meant to struggle through adversity. Can you really appreciate your financial security if you've never faced financial insecurity, or appreciate companionship if you've never experienced loneliness?
It’s a reasonable question but I doubt it. We weren’t affluent at all and I worked my butt off for everything. And that’s good, because I agree that if things are too easy it turns into a curse.
> I don’t think there’s a metaphorical “cow” that could have helped me.
The medication is the cow for you. In this story your support system figured out what would work best for you, which was medication, and facilitated that.
It’s a story about a doctor that serves patients in rural Cambodia. Help from the local community would look different in Borey Peng Huoth, for example.
The story in the article that is being discussed here does not say that the doctor was explicitly not a member of the community that he served. You would have to just sort of make that part up and then come up with an explanation for how the doctor even knows that story if he wasn’t part of that community.
The doctor in the story exists in pretty recent history, which you would call modernity. If for some reason you’re using “modernity” as a way to say “systemic alienation of the individual” rather than “modernity” meaning “happening in the modern world” then yes, by your definition of that word, it is indeed a story about “modernity” being to blame for poor treatment for depression.
Part of the diagnosis procedure for major depressive disorder is ruling out physical conditions that can cause similar symptoms. No one is going to miss that the guy had his leg blown off.
I mean sometimes. For me it was multivariate for sure. Biggest problem - wife and kid. Helped a ton. My specific wife, really. I doubt someone else would have helped me. I had a lot of self defeating thought patterns she helped me fix.
My understanding is that the optimal scenario is taking an SSRI in combination with therapy. The SSRI adds flexibility for the brain to respond to therapy and envisage new possibilities. If you don't include therapy, you've just established a new baseline to habituate to.
This is true overall, but it only works for a limited set of patients. It's pretty likely that what we're calling depression is a different set of diseases that manifest with common symptoms, and SSRIs + therapy work wonders for some variants, but not others.
In fact, we actually do know this to be the case already: bipolar disorder also manifests with the same symptoms as depression for some time, and SSRIs + therapy are definitely not enough to treat bipolar disorder. Most likely there are other similar diseases that present with depressive symptoms that we have yet to identify distinctly and don't know how to treat effectively.
Yup. Depression medication can significantly help the emotional symptoms, but that takes longer to be effective.
I’m bipolar and a lot of the medication I take does not become fully effective for months. For me, my medication slowly became more effective over years as my brain no longer had to compensate for hardware problems.
I also had a close family member who committed suicide shortly after going on Prozac -- this also happened nearly 30 years ago. His young son later went on Prozac himself (several months after his fathers suicide) and immediately started demonstrating bizarre disinhibited anti-social behavior (e.g., damaging property, stealing from friends, etc). He was immediately yanked off Prozac when he started articulating his own thoughts of suicide. The bizarre anti-social behavior improved after discontinuing Prozac.
For some people, Prozac is a very dangerous drug. It is fully deserving of its FDA black label warning (which it didn't have 30 years ago).
Suicidal ideation is a risk for many CNS drugs, and not unique to Prozac as far as I know. But yes this is a major risk factor that needs to be taken in account before such kind of treatments.
Isn't that a possibility with a lot of drugs though? I think it depends on the rate and not a "does or does not" type of questions. Now if the drug doesn't help more than a placebo that's clearly a huge negative, but if it has a high rate of success vs placebo then they will make adjustments and watch out for the side-effect (of course) letting patients know it's a possibility and to report if it starts happening.
The efficacy of anti-depressants has been consistently over-inflated, so generations were poisoned with side-effects: suicidal ideation, homicidal tendencies, etc.
Results: Meta-analyses of FDA trials suggest that antidepressants are only marginally efficacious compared to placebos and document profound publication bias that inflates their apparent efficacy. These meta-analyses also document a second form of bias in which researchers fail to report the negative results for the pre-specified primary outcome measure submitted to the FDA, while highlighting in published studies positive results from a secondary or even a new measure as though it was their primary measure of interest. The STARD analysis found that the effectiveness of antidepressant therapies was probably even lower than the modest one reported by the study authors with an apparent progressively increasing dropout rate across each study phase.*
I can't bring myself to try an SSRI. I just cannot do it. I've got a prescription for an NDRI on my desk, and I still won't take it. I am not anti-psychiatry either. I take psychiatric medication for a different condition already. But something about anti-depressants just doesn't sit well with me.
As crazy as it may sound, I think a lot of my depression stems from living a life that is not true to myself and due to countless failed attempts to be someone I cannot never be. As far as I am concerned, depression is just a symptom of my situation and not some true disorder. For the sake of analogy, I would say it's like food poisoning. Yes, the GI issues are awful, but the body is responding appropriately.
> I've got a prescription for an NDRI on my desk, and I still won't take it. ... something about anti-depressants just doesn't sit well with me.
At first it sounded like your antipathy was with SSRIs specifically (which I largely share), but it seems like it's anti-depressants in general.
FWIW, I used to think similar to you, and roughly agree with the gist of your second paragraph, but I've come to think of antidepressants as useful in a specific way: people say "it's a crutch" as a negative thing (about a lot of things including antidepressants), but a crutch was very useful to me when recovering from a fracture, and helped me enormously with my progress; similarly, even if "depression is just a symptom of my situation", it can and does often lead to a cycle where the depression itself feeds into the situation and in turn sustains itself. An antidepressant that works for you is a good way to be able to see things more clearly, feel the motivation and insight that depression clouds out, and thus be able to break out of the cycle.
It doesn't have to be a "cure" that counters a disorder, it can be a tool that you use for its purpose and then throw away (and it does sound like you're well-motivated to do that).
there's a tool on your desk that might help you solve your problem; what does it matter if the problem is an "appropriate response of your body"? so is pain/anxiety/diarrhea
> stems from living a life that is not true to myself and due to countless failed attempts to be someone I cannot never be.
If this is their mindset, they might benefit from CBT more than medication.
I'm not against SSRI at all. But after taking them for a few months in my 20's, and experiencing how terrible the withdrawal symptoms are when stopping, I'd be very hesitant to ever start up on them again. I remember having to open up the lowest dose pill capsule and splitting the dose into very tiny increments to be able to wean off completely.
I'm the GP of this comment chain. I actually did a 16 week long trial of CBT with a professional where my symptoms were tracked during each week. I actually ended the 16 weeks worse than before I started.
I later learned that CBT can have that effect on people with ADHD, so I attribute that to being a possible explanation.
I still do therapy, but honestly, I think it's a waste of time and money. I predominantly do it for cathartic purposes and so other people/professionals will stop recommending it.
> terrible the withdrawal symptoms are when stopping
I tried one when I was in my early 20s too. I swore I would never take one again. Withdrawals weren't my issue really. It was the clarity I gained after getting off. I realized how awful I was to people around me. I had such blunted emotions, that I basically became devoid of empathy. I also learned that I needed high levels of anxiety to function, which the medication took away from me.
One needs to not work and be able to remain at home for about a week or so to see if the side-effects are manageable. One shouldn't simply continue on with operating machinery or working a job while titrating up a new psychiatric medication. Honestly, employers should offer medical time off for this.
SSRI can have annoyances (to stay polite) if you ever need a fix so much that you go that route, be sure to ask about them. Didn't help me really but I believe that sometimes, a bit of chemical (placebo or not) relief can help staying afloat enough to work your way back up quicker.
I understand your comment, my issues were due to life circumstances and not a low level neurological imbalance, and I too dismissed these treatments almost entirely, mostly because they felt like blanket solutions from medical professionals who didn't really listen to symptoms.
> medical professionals who didn't really listen to symptoms
Even if they did listen to me, what else can they do? They aren't going to apply to new jobs for me, find friends and hobbies for me, etc.. To the men with pills, every issue looks like a disorder.
Maybe that's just me, but flooding my brain with chemicals is a big step and I need doctors to really pay attention and not just use trial and error on me. That's what i meant/
> As crazy as it may sound, I think a lot of my depression stems from living a life that is not true to myself and due to countless failed attempts to be someone I cannot never be. As far as I am concerned, depression is just a symptom of my situation and not some true disorder.
It's true for some, but be wary of such a generalization.
It took many years of people telling me the same thing before I understood what they were saying: "Having an objectively crappy life is normal. Being depressed about it isn't."
(Almost) everyone will have problems - temporary or permanent. And while they may feel down about it for a while, or occasionally, most of them more or less recover their mental health and are not chronically depressed.
Because the majority of people have problems, it becomes easy for a depressed person to think "Ah, this is just due to problem X" or even "This is just because I want a life different from mine". Most people with problems also want a different life than what they have. But they're not depressed.
My mistake. I should have worded what I wrote differently. I meant to say "not some true disorder for me."
> Having an objectively crappy life is normal. Being depressed about it isn't.
Not sure I can agree on this though. Rates of depression are quite high in institutions like prisons, for example. Especially in solitary confinement. Of course, I am not in prison, but I do believe the environment plays a larger role in depression than many are willing to admit.
This is not my first rodeo with depression. I'm in my early 30s, and this is probably my 5th or 6th time. I won't go into the details of those periods, but I almost didn't make it through a few of them.
> Ah, this is just due to problem X
Why is this outside the realm of possibility though? I believe depression is just a catch-all term for negative states that are too abstract to treat. If one is in a bad environment or unsatisfied in life, then a doctor cannot really do much to treat that. However, pills can be given to make people numb enough to their circumstances that they no longer care. Though, perhaps that lack of care is enough that people can actually benefit?
I mean, with SSRIs, the lows of life are diminished as are the highs of life, one might gain significant weight, and have a host of other issues like low libido, erectile dysfunction, anorgimasa, etc., but at least they aren't depressed...
If anything, I think of antidepressants like opioids. Opioids do not treat pain -- the pain is still there -- one just can't feel it.
> "Having an objectively crappy life is normal. Being depressed about it isn't."
Sounds like a philosophy more than a science. What does "normal" even mean in this context? Are we talking about something measurable? For instance, if the number of people who were depressed about those circumstances doubled (or quadrupled) would it then be normal, and there would be no reason to treat it (because it's normal)?
If you have an objectively crappy life, but not just ignore it and instead are incapable of even noticing, that sounds a little like dysfunction to me. It's not some superpower, it's a micro-lobotomy.
> If you have an objectively crappy life, but not just ignore it and instead are incapable of even noticing
Noticing it is very different from being depressed about it.
> What does "normal" even mean in this context? Are we talking about something measurable?
Let's take a trivial example. Person A is depressed because he is unhappy that he doesn't make enough money to travel and buy nice cars. Now take all the people who are unhappy that they cannot afford to travel and buy nice cars. Most will not be depressed - they will merely be unhappy about it.
Person A isn't depressed because he can't travel and buy nice cars. He's depressed and he can't travel and buy nice cars. He's mistakenly coupling the two.
Another tell for these kinds of things: Ever know someone chronically depressed who blames it on X? Then somehow, X is resolved. There may be a temporary improvement, and they go back to being depressed again, only they now blame it on Y? Somehow Y gets resolved and some months later they're blaming it on Z.
Everyone has problems. Including those who are not depressed. Fixing X, Y, Z, AA, AB, and whatever else is not going to take care of the depression.
On the flip side, people who do not suffer from depression make the same mistake: They claim they are not depressed because they "choose" not to let the problems get to them. Self serving beliefs!
>Let's take a trivial example. Person A is depressed because he is unhappy that he doesn't make enough money to travel and buy nice cars. Now take all the people who are unhappy that they cannot afford to travel and buy nice cars. Most will not be depressed - they will merely be unhappy about it.
These two words are semantically the same in your context. Unhappy = depressed. Unless you can define something measurable, and if you did in the comment above I can't find it.
I suspect there is something measurable, but I don't see very much attempt at discerning what that is. And without it, this conversation is pointless.
I'm with you on this. People who pathologize themselves or others - assuming they're malfunctioning rather than acknowledging they might simply be living a life that doesn't fit - have a very limited way of looking at things.
Depression is almost never caused by actual life circumstance - just by your response and usually a delayed response.
Also you should try your SSRI prescription. They really aren't very strong drugs. You might get mild relief or if you're like me and the majority of people you will see no effect whatsoever. It's worth a try anyway. You won't get "high" or "dull" or any of that nonsense. At best it will lift your mood a bit. But more often than not, just won't do anything.
> Also you should try your SSRI prescription. They really aren't very strong drugs. You might get mild relief or if you're like me and the majority of people you will see no effect whatsoever. It's worth a try anyway.
Well, all the n number of times I have been depressed in the past have been resolved by a change in life circumstances, so perhaps I am just an outlier?
> SSRI prescription
I'm supposed to take an NDRI (Bupropion) and not an SSRI, which is kind of like Ritalin or cocaine. The problem is that I already take amphetamines every single day, so I am not sure why this is really the one my doctors settled on.
In fact, they told me that if my blood pressure increases anymore that I am to stop the medication immediately and then contact them. So, that's not really inspiring a lot of motivation in me.
When I was a teen I was put on Prozac because I threatened to commit suicide.
The drug absolutely destroyed me. Within a few days of taking it, I was in a bizarre state of delirium where I would sleep something like 18 hours a day. When I wasn't asleep I would gnash my teeth at my parents. At school I would lash out at my classmates and randomly punch the walls of my classroom. I was taken off the drug after about five days but I didn't fully recover.
To this day, my emotions are severely blunted. I still have complete anhedonia and avolition. I can go on a roller coaster and feel not a shred of an adrenaline rush. Nothing. I struggle maintaining relationships with people because I have no innate "desire" to do so.
The drug is absolutely evil and should never be given to minors.
I don’t want to discount your experience, but attributing a lifetime of symptoms to 5 doses of SSRIs (when you were already exhibiting an unstable mental state) seems extreme.
We know SSRI's really do cause permanent sexual dysfunctional in a small minority of people, small enough that this side effect doesn't come up in traditional FDA tests.
If a side effect is extremely rare it would be impossible or at least impractical to prove in a population.
Grandparent could be right or wrong about how the drug affected them, maybe their brain suffered from other issues and the timing of the medications was purelycoincidental, but if they are correct, your dismissive response is exactly what we'd expect given when they are saying sounds unusual/ improbable.
> If a side effect is extremely rare it would be impossible or at least impractical to prove in a population.
This is also true for a non-existent side effect. I’m not trying to tell GP he is wrong, just that from a reader’s perspective, extraordinary claims require extraordinary evidence.
This isn't a good fit for the phrase "extraordinary claims require extraordinary evidence."
Grandparent's report is hard to verify, not extraordinary.
These drugs are approved based on statistical safety profiles in limited trial populations, not on a scientific consensus that absolutely nobody on Earth will ever experience a unique adverse reaction.
Also, I never said that you, the reader, had an obligation to change your worldview based on Grandparent's report.
Millions of people take SSRIs on a daily basis without these dramatic symptoms. Millions more tried them (for much longer periods than 5 days) and then desisted from treatment without major lifelong mental alterations. So yes, I would say GP’s experience is ‘extraordinary’, i.e., outside of the ordinary expectation
I really hope you do or you will talk to someone about yourself again. You deserve it. For example to a counselor/therapist who doesn't even prescribe medication, if you are not interested in that. Off the top of my head these symptoms could match at least a few diagnoses, most of which are treatable, but it's by far not enough information in this post.
How long were you on Prozac? The way you describe your experience it makes it sound like you were affected long term. Are you still on it or any other SSRI? Hope you eventually rediscover/redevelop your emotional functionality.
As someone who has been seriously depressed from an early age, I can tell you that it looks exactly like the DSM/ICD criteria - a lack of energy, loss of appetite, loss of interest in all activities, insomnia, feelings of worthlessness, suicidal thoughts and pervasive sadness and hopelessness.
Some people would rather believe that pediatric depression isn't real, rather than confront the reality of a loved and cared-for child who is constantly tearful, severely underweight, sleeps for three or four hours a night, spends most of their time staring into space and frequently talks about wanting to die.
Depression is an utterly dreadful illness and should not be confused with normal sadness or unhappiness.
Probably something like Boy Interrupted[0]. Sad story and something I can sympathize with having some of the same feelings very early on despite having a rather normal upbringing and siblings not showing signs of it.
And several of your comments before that were upvoted. Are we to regard those as suspicious?
Of the recent downvoted comments, one was a complaint about moderation that anyone who has paid attention to dang's track record here over more than a decade knows is baseless. (And if you think the top comment on any thread is a bad one, you can always choose to be a helpful contributor to the community and email us to let us know).
Of the other two of your downvoted comments, none were downvoted by the same users.
The choice is yours to make an effort to observe the guidelines and be a positive contributor to HN, or alternatively to keep using HN for political/ideological battle and complain to the moderators when things don't go your way, but it's clear what others in the community want to see.
> or alternatively to keep using HN for political/ideological battle
Which ones? The one about ML and programming languages? Or the one about asking a genuine question about an experience with childhood depression? Or the one observing that you and dang unevenly apply moderation rules? Or the one commenting about how you can't say the word for the literal definition of fascism on this site without getting downvoted? Or the one about dishwashers?
Where's my ideological battle?
You have no credibility. You unlike dang, don't do a good job. Go ahead and ban me or put me on a cool down to prove my point.
I've scanned your full list of comments and can find plenty that have an ideological flavor to them, and others that are in the flamewar style, but are not so clearly related to politics/ideology. I'm not interested in getting into an argument about which of your comments are ideological or not. That's not the issue. What is the issue is the hostile and inflammatory style of commenting towards other community members and HN as a whole.
It's notable in this instance:
- You posted a series of comments about controversial topics, having established a history of participating on HN with this persona of being a brave combatant for, I don't know, some worldview or philosophy that you seem to be fighting for;
- When a handful of your comments receive even a solitary downvote, you call in "the cops" (dang) to come to your aid, with a claim of "brigading";
- When we investigated and found that, no, there's no "brigading", some of those comments are not even net-downvoted anymore, and that any downvotes you're getting are to be expected given your combative style of commenting, you've responded with these incoherent attacks on moderation/moderators.
Whether we all agree that many of your flamewar-style comments really are, in fact, political/ideological, is not the point and seems to be a way for you to deflect from being held to account for your conduct.
What I'm saying to you is that people who care about making HN better have all kinds of ways of showing it, and it begins with making an effort to observe the guidelines, and it also involves engaging respectfully with other community members and the moderation system. We are always, always working to make HN better and our moderation approaches better, and we always welcome and engage with feedback, as dang has been doing with you in another subthread today. But we've both been doing this job long enough to sense when someone isn't really wanting to help make HN better at all.
> What is the issue is the hostile and inflammatory style of commenting towards other community members and HN as a whole.
Please.
> having established a history of participating on HN with this persona of being a brave combatant for, I don't know, some worldview or philosophy that you seem to be fighting for;
What? Just because I have a different worldview than you, doesn't mean I am fighting for or am a brave combatant of anything. But it's extremely telling that you think that, and revealing about your own views. And furthermore troubling that you are a moderator here.
Maybe you should read up on the clustering phenomena wiki and understand your own personal biases a little more.
My advice as a long time participant here: pay no attention to upvotes or downvotes. Sometimes they seem to be completely unrelated to whatever you said. Stay curious.
Absolutely. These random namedrops of drugs are irritating. People respond to different psychiatric medications in wilddly different ways. And actually, the majority do not respond at all. Throwing a random name of some random medication helps absolutely nobody. It will just make some desperate people seek "this one drug" that they heard about on the internet.
Nocebo can too. Apropos the featured article, I wonder if we should worry about that when we report in the popular media that antidepressants trigger suicides.
> It's too early to say. Obviously the idea is to get her off it if possible.
You understand that the people who sold you that drug have a vested interest in making sure it's not possible and/or that you & she think it's not possible, right?
I'm big on medications for brain stuff but uh yes, in the US, doctors get lots of kickbacks for prescribing drugs.
Usually this takes the form of "I'm prescribing you with <Brand> instead of generic" or "I'm prescribing you this specific drug from this class of drug"
> doctors get lots of kickbacks for prescribing drugs.
From your own source: "In 2024: $172 or more in general payments have been received by half of physicians."
Even if all of those payments count as kickbacks, a median of $172 in a year (significantly less than 0.1% of the median physician's annual pay) is not "a lot of kickbacks".
> > SSRIs never help because of boosting serotonin.
> That's a hell of a claim, which could use some evidence.
My experience with the chatbots is that they start with the conventional marketing tropes, but if you ask pointed questions they'll dig into the actual research.
This thread started with a generic question about why ECT seemed to help some patients. It had a really good reasoning about why SSRIs are still the first-line treatment for depression, even though the MAOIs were much better drugs.
The Big Picture
SSRIs flood serotonin globally, which can suppress
dopamine/norepinephrine and blunt mood.
Anti-serotonin strategies (receptor-specific antagonism,
reuptake enhancement, or targeted modulation) often
result in cleaner antidepressant effects with fewer
side effects.
This supports the criticism you mentioned: SSRIs may
“work” only because the brain adapts to the serotonin
disruption, whereas directly reducing or modulating
serotonin is more therapeutic.
The whole 'conversation' is pretty good, and would provide plenty of search terms for helping you figure out what science has actually figured out about depression.
There's a supplement seller that said his pregnenolone powder was made with a newer, cleaner process than is used by most of the pregnenolone supplement vendors, but I don't know if he's still using that supplier. The powders are a much better value than the capsules.
The chatbot is great as a first-line of research for many things, but something like this needs to be backed up by actual research to make a concrete claim. It will absolutely fabricate falsehoods or misrepresent truths based on an unknown number of stochastic factors behind any response. Shame on your for propagating a bunch of mumbo-jumbo that every reader must go verify for themselves if they want to substantiate or refute your claim - in response to a request for substantiation!
The SSRI's have always been terrible drugs. Apparently the trials before their approval found increased suicidality. Another response to this thread shared how his/her mother was given a "murderous impulse" with Prozac in 1989 [0].
Because this class of drugs was so heavily promoted for such a long time, the side effects have always been swept under the rug.
My comment above proposed that the 11yo girl's depression could actually be caused by precocious puberty. Another possibility is that she's a poor methylator (#MTHFR) who's poisoned by fortified flour and other sources of shelf-stable provitamins.
I haven't yet found a comprehensive SSRI-truth resource that makes SSRI advocates pause their advocacy, so I just shared the chatbot link. This was supposed to provide the father enough of the background terms and anti-SSRI thinking for him to search for his own resources.
Someone else posted a link to "The serotonin theory of depression: a systematic umbrella review of the evidence" [2022] at Nature [1]. This is okay, but it still dances around the core issue: whether ECT and Serotonin-enhancers sometimes benefit people because of how the brain responds to brain damage.
Puberty in general can be rough. I (a dude) had all kinds of bad thoughts and moods going through puberty and then one year it was just gone, grades improved dramatically, started making friends again, etc
I thought this was already known? I can’t recall exactly but there was some research pointing to SSRIs in general as not being particularly effective at all. They were just hyped a lot and became mainstream.
I wouldn't go that far, but there was a now-famous study (Princeton?) that showed that doing aerobic exercise for maybe 30 mins every day, about five days per week, was equally effective at alleviating depression symptoms.
There's one big problem with that - getting seriously depressed people to do 30 minutes of exercise (or anything else) five days a week. "Get more exercise" is excellent advice for someone who feels a bit down, but it's absolutely useless for someone who can barely summon up the strength to eat or brush their teeth.
It gets even harder if you offer them the alternative of just taking a pill. For widespread health policy, we should want the proportion of depressives who will never learn to manage it themselves because a pill is offered to be smaller than the proportion for whom the pill is effective. I had always assumed these pills were effective enough but studies like these make me wonder.
They are by no means mutually exclusive. If you want depressed people to get more exercise, then a really useful starting point is to give them a pill that could rapidly increase their energy and motivation. The idea that people will be stuck on those pills forever is just lazy psychiatry; ongoing maintenance treatment is often the best option for patients with a history of severe depression and a high risk of relapse, but antidepressants are equally useful as a stepping-stone towards self-management.
Bluntly, if someone is capable of actually starting and sticking with an exercise routine, then they aren't very depressed and should not be offered medication as a first-line treatment. Antidepressants are markedly less effective in patients with milder illnesses, so psychotherapy and lifestyle interventions are a far better initial treatment option. It's only when these treatments fail - or when engaging with them is severely impaired by the severity of the illness - that medication becomes the favoured option.
It’s always frustrating to see the implication that people just need to exercise to solve their mental health struggles. It might not be your intention, but it's a take I see a lot online from influencers.
I say this as someone who is extremely fit. I've worked out religiously since high school. While exercise is integral to me feeling somewhat normal and provides a short-term boost, that is just not how it works for everyone. Some of us have 'broken brains' that cardio can't fix.
Exercise manages my baseline, but sertraline is what helped me finally bridge the gap. It allowed me to regulate my emotions and anxiety in a way that no amount of exercise ever did. And the introspection from being on it helped me make lifelong changes.
To be honest, fearmongering from folks online is what stopped me from taking it sooner, but I wish I had. It was fairly life-changing.
My understanding with SSRIs and other depression meds is that they are hit and miss for anyone. I have a family member who, as a teen, suffered from severe depression and didn't want to live. Therapy wasn't able to help - it was actually the therapist who recommended more drastic measures such as medication. And so they tried Prozac and that worked. Having seen the reversal myself, it's hard to understand how this is placebo.
It is extremely hit and miss. My understanding is that for those with "shit life syndrome", prozac is generally ineffective, but for those with genetic predispositions it can be extremely helpful. the catch is that the two are not exclusive, and those with genetic predispositions to depression may never have it, and people with bad life circumstances may feel more stable mentally with prozac and better equipped to tackle life's challenges.
Clinical trials of antidepressants are weird because they're usually short-term (6-12 weeks), whereas practical use of antidepressants usually lasts years. I personally suspect that short-term trials show an exaggerated placebo effect, because the novelty doesn't have time to wear off.
SSRIs literally saved my life, no question about it. Night and day difference, from daily panic attacks destroying my life, happiness, and career, to being almost completely better in 2 weeks after starting. I tried exercise and diet and meditation and you name it, for years!, before I gave medication a go.
Do not care what the science says. It 100% worked for me. Please get help if you need it, tens of millions of people use this medicine successfully
Articles like this are part of the narrative that SSRIs in general are no better than placebo. Absolutely not true for me!
Same here, after struggling for 39 years, glp-1 + SSRI + ADHD meds have made me a normal productive human, and 2 years ago I had pretty much given up on the possibility.
Having a child forced me to fix my life, and I'm incredibly happy because of it.
For me? Not being hyper anxious all day (to the point that I just freeze and procrastinate all day), being able to sort of focus on the most important task (I'm still ADHD with 1000 unfinished projects, but at least I finish the things that have to be finished), eating healthy and enjoying exercising (100 lbs down and got quite good at tennis), not entering into a rage state due to anxiety overflow everytime I fight with my wife, being able to regulate my emotions, I could go on and on honestly.
As someone with ADHD, if your productivity was decreased or did not increase in the slightest, then I doubt a doctor would keep prescribing the medication. Such increases do not have to be astronomically large, but I do believe increasing the productivity of people with ADHD is absolutely part of the benefit.
I agree, but I think you’re misunderstanding my comment. I was replying to a snarky comment that seemed to imply that the effect of taking amphetamines is obvious and mundane.
The point I was trying to make is that the effect on someone with ADHD can be profound and transformative, not like going from 80 to 100 but rather from 0 to 100. You suddenly feel like a functional person (I say this as someone with ADHD).
I have tried prozac in my teens and zoloft in my 30s. Prozac made me dissociate pretty hard, I found myself between classes not knowing where I was coming from or going. Zoloft did nothing but give me the zaps when I came off it.
There have been some serious efforts made to reproduce the original groundbreaking results that showed how effective SSRIs were, without much success. Anecdotally, I know plenty of people who have benefited from them, so I would not say they are ineffective as a blanket statement. I do think it’s important to understand that nobody really knows how these drugs will impact any one individual, and it’s trial and error to find something that may help.
Had you tried a placebo without knowing that it was a placebo? No? Then your story's irrelevant to whether the medication's working (yes, even on you) any better than a placebo would.
Placebo works very well for many people too! That's precisely the thing. That's what makes these studies tricky.
If you're a doctor, and if Prozac helps your patients, then it's obviously excellent. You should keep writing prescriptions.
If you're a scientist, you obviously want to distinguish between "real" drugs and drugs that help because people believe they should. So, you do these kinds of tests.
And then, from the perspective of ethics, once you know it's just placebo, you kinda shouldn't keep giving it to people, even if it helps? Maybe? I don't know. That's the weird part.
> And then, from the perspective of ethics, once you know it's just placebo, you kinda shouldn't keep giving it to people, even if it helps?
That's a very big ethical question in the medical field. Placebos _do_ help, but only if people believe they will. So is it ethical to lie to a patient and give them a placebo knowing it's likely to help?
Spitballing here. I always understood stuff like this as "the system doesn't care about you, it cares about the masses." If the result is overwhelmingly looking no better than a placebo, then the small number of people it actually helps is sort of irrelevant. The exception might be cases where people are willing to drop a bomb of cash for lifesaving drugs for rare diseases (Pharma Bro got a lot of flack for massively jacking up the price of one of these drugs.) I don't know what implications such a study may have in a complex space. I imagine the drug will still be available for those who want to try, but far less prescribed as a sort of safe default. I doubt drug companies will care much for this, since the patent has long expired.
> Articles like this are part of the narrative that SSRIs in general are no better than placebo. Absolutely not true for me!
Does "placebo" mean "no effect" to some people? Placebo absolutely has an effect. Testimonies like this are on the level of "vaccines caused autism" pseudoscience and the serotonin theory of depression isn't even taught any more. It belongs in the bin of crackpot treatments like chiropractic. There is zero chance Prozac would receive FDA approval today.
I don't know if I'd call it "placebo" for me; prozac gave me the worst, most horrible pit of sadness I've ever had in my entire life. I couldn't stop feeling guilty over every single bad thing I have ever done, and it completely killed my appetite and that probably didn't do great for my mood either. I was only on it for about two months until I begged my doc to get me off of it. She told me that it's one of those things that doesn't affect everyone, but since I was already taking Wellbutrin it can have negative effects.
Never again. I'm taking Pristiq now and that has been considerably better.
I have overseen over 20 phase III clinical trials. Many of those clinical trials have failed to show statistical efficacy. In every single one of those trials there are patients who see dramatic and undeniable benefits. In the oncology field, we continue to treat such patients even when the statistics say, no benefit. And, sometimes those patients just stay better. My point is, when the trial shows "no better than placebo", it doesn't mean the treatment doesn't work. It might be that. But more likely it means we don't know how to define the population of folks for whom the treatment does work. Maybe it's a particular genetic background, maybe it's age, gender, serum CPR or Tau level. Maybe it's something else. This stuff is complicated and interesting. And we are still figuring it out.
As an adult, Prozac for me has been life changing and for the better. After suffering from anxiety and depression since childhood I have been able to get a new lease on life in my 40s. It is a drug that needs to be respected though, start on the lowest dose and give it months to settle. Find a doctor you trust and that will take time to discuss your situation. I feel that often this class of drugs is often prescribed without careful consideration and people are ramped up to higher dosages faster than they should be by doctors who are rushing to see the next patient.
The mass prescribing of SSRIs is going to be seen like leaches (well worse since leaches actually do help in some cases). The rock bottom levels of replication of results in physchiatry and these SSRIs, the whole area should be treated much more like snake oil than it is.
Maybe SSRIs work for some, but Paxil gave me serotonin syndrome and Prozac made my mom psychotically homicidal. I've tried every SSRI titrating on and off (except Paxil), but they all caused deal-breaking side-effects.
Yep. My dad recounted that in 1989, he had to restrain her because she (then age 40) had a psychotic episode described as a "murderous impulse" just after starting a brand new "wonder pill", Prozac. This was quite uncharacteristic for a tiny, docile woman who is often described as "sweet" and "nice" who never had any psychiatric symptoms before or since except a couple of brief times of situational depression. There's a lot of FUD and social ills washing in mass media rather than less biased peer-reviewed research that blames individuals, conflates preexisting conditions with medication side-effects, and clouds the issue of whether SSRIs increase suicide and/or violent psychosis or not.
Somehow, I doubt there is much motivation to look for economically inconvenient and unnerving side-effects in some demographics, especially if they're adults who can easily be blamed entirely for all of their own actions because it's "definitely not" due to a (formerly) profitable pill or a pseudoscientific profession that doesn't exactly know how the medications it prescribes work, who would benefit from or be harmed by them, or have any ability to measure the organ or system they're supposed treating.
It is highly likely that your mother was misdiagnosed as suffering from unipolar depression when she was in fact suffering from bipolar disorder. A sudden switch to mania is a common outcome, even in cases where the patient has no previous history of mania. It is crucially important to take a comprehensive history to rule out bipolar disorder, but many general practitioners (and some psychiatrists) reflexively prescribe SSRIs whenever they see a depressive episode, even where there is clear evidence of a personal history of hypomania or a family history of mania.
Thanks for sharing your mom's experience with big pharma's then-new wonder-drug.
> Somehow, I doubt there is much motivation to look for economically inconvenient and unnerving side-effects in some demographics,
Robert Whitaker examined the pharmaceutical industry's ideological capture of conventional psychiatry in his third book, Psychiatry Under the Influence.
This was inspired by the old SNL skit, Theodoric of York, Medieval Barber. The article is structured around my proposal of a Theodoric’s Principle of Medical Advancement, to explain why medical progress is so glacial.
Yup. There's too much institutional inertia to adopt evidence-based approaches.
I've tried 19 antidepressants over about 15 years. Stuck with mirtazapene-induced obesity that doesn't qualify for GLP-1 coverage, so I can either be fat, broke, or crushingly catatonic.
> I've tried 19 antidepressants over about 15 years. Stuck with mirtazapene [...]
Have you tried any anti-serotonin interventions? (chatbot in comment link below)
Mirtazapene is a "tetracyclic antidepressant". I think the development of antidepressants went MAOI -> Tricyclic -> tetracyclic -> SSRI. My chatbot transcript said the SSRI's are marginal drugs, but "SSRIs are much safer in overdose" than the earlier drugs.
My understanding is that the MAOIs were reasonably-effective at bringing people out of an acute depression, but they interacted with high-tyramine foods (fine cheese, etc) to cause high blood pressure. Reversible MAOIs are less problematic than the non-reversible ones. Methylene Blue [MB] is the most ubiquitous of the reversible MAOIs. I felt a definite warming effect with my first MB microdose (a fraction of a milligram), but I've never noticed anything from larger doses.
My own experience with SSRIs was very unpleasant. Sure, it worked to reduce my anxiety problems while I was on them for years. The first year I was off of them was the worst though. I didn't have that bad anxiety ever, as in constant panic and feeking of impeding doom. This made me realize that they aren't really an option of me. So began my long therapy journey. After 7 years of weekly therapy, a healthy work-life balance, and regular exercise I'm just feeling better than ever.
So, I'd buy that they don't fix your brain. They definitely reduced anxiety for me and I can see the value for stabilizing people so they can do the heaking work in therapy.
My experience as well. SSRI and other similar drugs for anxiety remove a strong signal to your brain and bring other issues or signal.
But the issue is that nobody wants to really look at the cause. We are all trying to treat the symptoms with those quick-fix pills.
The cause is deep in our society. We are too stressed, lost touch with each others, work on meaningless jobs (or downright negative jobs for society.. if you work at Meta or TikTok, yes your job is in fact a negative for society).
I have also been on a journey for the last 5 years on working on myself and bringing those things back in my life and I have been feeling better than ever:
- A lot of outdoor time and exercise.
- Take the time to build a community of friends that genuinely care for each other
- Work on some projects that you feel help humanity and each other (or volunteer).
- Build things you are proud of. Build a legacy
All of those removed almost all anxiety and depression. It is not an easy journey but I'm shocked how few people even consider making those changes
I hear this story over and over again and it makes me sad. Medication for depression, anxiety, or adhd should be used to enable the work with a therapist, not to make life bearable without working on the underlying problems. Been there, done that. Wasted a couple of otherwise good years on not doing the work.
Its not just children, its adults too. Because of the FOIA we have seen the studies these drug companies made disappear and this applies to probably every single antidepressants. Keep in mind the placebo effect happens in about 30% of people which are the people that think it works and then eventually stops working.
Swapping one problem for another. Religion sounds like the worst place for someone who is mentally vulnerable. It's like pulling out your credit card in a shopping mall full of salesmen who are under tremendous pressure to make big sales asap
For whose mental health? My point is that religion brings its own shared of issues. And by religion here I mean organised religion. Religions that don't involve rituals or gatherings with other people in hierarchical settings are different (but I assume most people are after rituals and gatherings with other people in well defined settings imo rather than the actual metaphysical beliefs).
- That wave of christianism, ironically called christian science, was the cause of mental distress and deaths of tons of children due to the parents religious views. Religious based neglect is a common form of religious based abuse too.
The first 3 links you’ve provided discuss mental health as it relates to geography, not religion. To be sure, religion is associated with those geographic areas, but so are numerous other factors like race, income, etc etc.
The next links are closer to target, they talk about religious objections to medical treatments and the adverse affects upon kids. Nobody should deny this is a real problem, but fortunately it is a very small problem. ( One of the studies found only 172 fatalities over 20 years, and even estimated 10% of the kids may have died anyway.). So I’ll grant that is a real problem, but not one that affects many people. With luck, perhaps it will get better over time.
The next study is interesting, but again very limited. It has 6k subjects, but these are only with religious mothers and only in the UK. This study cites prior study that concluded “ an individual's religiosity is consistently, positively related to their own mental health in US samples”.
The next study associated suicidal tendencies with a very narrow aspect of religion, and even then self reported:
“We recruited a relatively small sample that was geographically, racially, and socioeconomically homogenous. We also relied solely on self-report data.”
The next study does not seem to help your argument. It deals with religious beliefs in cancer patients and says “Higher levels of religiosity and spirituality are associated with reduced risk of suicidality and suicidal behaviors [29–31], including in advanced cancer patients “
The final link is just a case study about a single suicidal pastor. It concludes with a paragraph that says “Although there are studies showing that religious people are less prone to suicide…”
So I can’t say all that changes the findings of the many studies that conclude religion is good for mental health.
Here the context is prozac FOR CHILDREN, not in general. Yet some people make a point in commenting that SSRIs are ineffective in general because they believe in some big pharma conspiracy. This is spreading misinformation. The truth is that SSRIs are modestly more effective than a placebo for approximately >> one third of the individuals << who try them. In other words, SSRIs are effective for more than 60-66% of adults. Moreover, there are a few different types of SSRIs. It takes time to find the one that fits you.
Chemicals like this imho act like "global variables" for the neural network. Perhaps a bit like temperature in an LLM. They have an effect, but the effect is sort of holographic -- there's no way to predict/compute exactly what the effect will be, because it's a function of parameters that include all the training data, specifics of neuron function that depend on DNA and other environmental factors and so on. The effect might be beneficial, by some definition of beneficial, but it might not. Even a simple chemical like ethanol has a wide variety of effects on different people.
"Seasonal Affective Order, or SAD ... has been linked to vitamin D, otherwise known as the sunshine vitamin, because the skin absorbs it through exposure to sunlight."
As someone with MDD, reading these comments is depressing. It's full of people who don't even know what MDD is exists and that people should stop being sad.
Hacker News really does attract a specific type of person...
I'd really be curious about distribution of the result they see. The folklore is definitely that that there's vary high variance in how people respond to SSRIs, and not recommending them because the average value is low is pretty irresponsible.
This reads to me like over-prescription rather than lack of efficacy but I’m also not a doctor and won’t presume my kneejerk reaction is accurate.
We saw a similar whiplash with Ritalin after over-prescribing in the 90’s/2000’s. ADHD medication absolutely works, but for a lot of people it didn’t for this reason.
Effect size is strongly affected by severity - people who aren't very ill just don't have as much to gain compared to people who are gravely ill. Widening diagnostic criteria and more liberal prescribing will inevitably lead to a reduction in the observed effect size.
Antidepressants were bona-fide miracle drugs when we first started using them on desperately ill inpatients who experienced every moment as exquisite torture. We saw the most miserable lives completely transformed in a matter of weeks. They have become merely "sorta-kinda useful sometimes" now that we're mainly prescribing them to broadly functional people who are feeling a bit sub-par.
SSRIs are a pretty poor fit for the latter cohort, because SSRIs cause significant emotional blunting in the majority of patients, to the extent that some people hypothesise that emotional blunting is the fundamental beneficial effect. Feeling quite numb is an incredible improvement if you are constantly unbearably miserable. If you have a more normal range of emotional experience than relentless misery, it is likely a sideways move at best; if your core complaint is that you feel numb and apathetic, they're probably actively harmful.
SSRIs are very widely used because of their extraordinary safety, but they're often thoughtlessly prescribed by overworked primary care doctors. There are a wide range of antidepressants (and drugs that have antidepressant effects despite not being marketed as such) that are likely a better option for a large proportion of patients.
Even for people with legit ADHD, like myself, medication isn't always a home run. I think something like 10%-20% of people do not respond well to any medications. I personally am only a 'partial responder' in that I only really get an improvement in focus/concentration -- not really anything else. But hell, that is still better than life without medication.
Definitely didn’t mean to imply it’s a home run. I’m just saying it clearly and legitimately helps a ton of people.
My point is if you include more and more people who don’t need it because of over-prescription it’s going to appear as lower overall efficacy while still helping a lot of people in the pool.
Making up numbers: If only 20 out of 100 people actually have ADHD then out the gate you’ve ruled out helping 80% of the people. So if 15 of the remaining 20 see improvement in their daily lives that means 75% suddenly looks like 15%.
Diagnosing and treatment is never that clean, there will always be some people who don’t necessarily need a certain medication yet get it prescribed (or don’t when they need it! Especially women with ADHD) because doctors are fallible like anybody else, systemic issues, etc. But with a commonly prescribed medication like Adderall the problem is definitely more pronounced.
Anyway I’m curious enough to look more closely at the study, this is a very interesting topic. If Xanax is really not helping people that’s pretty serious.
> Depression is literally a lack of meaning and beauty.
actually, "depression" or major depressive disorder is literally a mental illness, which has a genetic link. it is not a "lack of meaning or beauty" -- to suggest every depressed person who killed themselves had no "meaning" for life is deeply disrespectful to every parent, child, sibling, partner that killed themselves.
Maybe because "Fixing society" (putting aside questions of what that even means...) is going to take a long, long time and a lot of effort. Which isn't to say we shouldn't continue to fix it (hint: we do!) but it doesn't mean we should just ignore other ways of helping our kids.
> we will impose experimental drugs on kids
What a terribly disengeuous way of putting it! "Imposing" implies there's not a choice. And all drugs are experimental in that we are constantly learning about the effects they have on us and adjusting our knowledge accordingly.
Nobody's saying it's "morally wrong" not to give your kids antidepressants - but nor is it morally wrong to give them to them.
What tends to be "morally wrong" is when parents are like "I'm not giving my kids those pills! There's no such thing as depression! Just go play outside some more!" - in other words, dismissing your children's feelings
I can agree, but I often think those commentors would probably be dismissing the parents diagnosis of the child expressing themselves, rather than dismissing the child.
Children are experiencing everything growing at once. They have preferences, they have new experience, everything is very close to "the first time this has ever happened" and so, can be a very big deal for them, at the time.
¯\_(ツ)_/¯ internet arguments about parenting, experiences, assholes, having one, putting it in others faces, etc. The internet is just talking to a bunch of people who have different ideas. I wouldn't take it too seriously, over half of it is bots or socially inept people anyway
Fluoxetine has received FDA approval to treat major depressive disorder (8 and older), obsessive-compulsive disorder (7 and older), panic disorder (with or without agoraphobia), [and] bulimia nervosa...
Antidepressants benefit specific populations, those that have a predominant "internal" stress/depression and not due to a profound external trauma. They will not help a child that is continuously bullied, but one that has inherited a depressive trend. This holds for children and adults, barring some differences due to age maturity. Saying "no difference from placebo" for a treatment that is used by hundreds of millions is poor science, if not misinformation and malice.
Not to get into the historic details but growing up there was lot of tension in my parent's house. When you're a kid you feel these things and are aware of the issues that cause them, but you haven't yet learned how to talk about them or the right words to describe the truth of them. Instead you internalize them.
The lack of learning constructive perspectives and ways for discussing emotions while young, may very much be a source of depression, the same way people say "he can't help it, he has ADHD".
I was about 16 and the doctor recommended this new SSRI called ... I think it was Paxil, The side effects, especially if you missed a dose are hard to describe. If you missed a dose you couldn't function at school, and everyone thought you were really stoned. Also, you could look at a pretty girl and just nothing. A 16 year old boy doesn't know why THAT's happening, neither does the girl, and it just makes things worse. Try having that conversation with your Dad, while doped out on the drugs he told you to take. Imagine the anxiety. It's really depressing. Better to be alone, and safe in one's bedroom and on the Internet... ( and that was 20 years ago ).
Around the same time there was Ritalin and maybe a few others came out.
The issues kids are facing, the feelings they are then given pills to erase are still there, even when numbed to them. The answer lies somewhere in familial stability and relearning respect?, and how to constructively frame life's difficulties and teach that to our kids.
I would never give my kids anything that altered their brain chemistry. Even as adults, the only way is through.
None of those drugs helped me personally in the 90s (Prozac, Zoloft, etc). What helped me personally was talking about my problems with other humans only to the learn we all are "crazy,(aka totally normal)" and the majority all deal with something similar. Anxiety, OCD, insecurity .. all are parts of the human condition we all deal with throughout our lives.
I used to share your opinion, and in a way I still do, but after having 3 children and seeing how horrible some of these behaviors and habits can get, I completely understand why people cave in to get some relief. The stress of dealing with severe behavioral issues day after day can easily destroy a marriage and family.
It's even more fascinating when you have first hand experience with how much unmitigated guesswork goes into selecting psychiatric meds and their dosage.
Fluoxetine is one of two medicines listed in WHO Model List of Essential Medicines for the treatment of depression since 2007 (use of other SSRIs are also allowed)[1]. The listing means it has proven to be safe and effective enough that WHO believes it should be readily available in every healthcare system. You will need much more than a Wikipedia article listing side effects for the entire drug class, without incidence rate, to convince people these drugs aren't what they seem.
Also relevant to this article, WHO since 2023 does not recommend Fluoxetine (or any antidepressants) for children younger than 12 years[2].
During my first manic episode I was handed sertraline. This pushed the mania full send and I lost a lot of time that I can't account for, things I did I can't remember but friends have recalled. Climbing the house to get in through the upstairs window whilst having the house key on me. Locking myself in my room for a week or two convinced I was the real world John Connor and Arnie was looking for me. Blowing all my savings on cocaine for me and anybody in my vicinity in a month. Going through a gram of mdma more than once in a night. Feeling like I was on a therapeutic dose of MDMA for a few months and thinking this was what SSRIs were meant to feel like. The list goes on.
I will admit I was semi cognizant of the distorted thinking/reality so played it down when talking to the psychiatrist I was urgently (+2 months into it) referred to for early psychosis intervention. I was eventually handed a dozen valium (which the doctor was incredibly hesitant to prescribe, for good reasons) which let me sleep and the mania lifted.
I'm terrified of SSRIs now. I have been diagnosed bipolar for a few years now (went private because in the UK unless you're a danger you're ignored). This week was the first session with a clinical psychologist in a bipolar group. Unsurprisingly almost everyone had a similar experience with SSRIs.
I'm speculating here but I'm pretty sure if you did an MRI on my brain you'd see lesions from the mixing of mdma and sertraline (I get myoclonic jerks to this day).
SSRIs are definitely not commonly recommended or normally used for treating bipolar disorder - especially not for people who are showing signs of a manic episode.
Unfortunately, this is one of the major limitations of our diagnosing abilities with mental illness: when someone presents with severe depressive symptoms and no other known history of mental illness, we have no real way of telling whether it should be classed as Major Depression, or whether it may be Bipolar disorder.
So, sadly, yours is a common story where people with bipolar disorder that initially manifests with a depressive episode get treated with SSRIs that then push them into their first manic episode. I've had a good friend go through something very similar (though, thankfully, less severe in terms of intensity of the manic episode).
If you were given SSRIs to handle the start of your manic episode, that to me seems like a gross mistake by your physician.
> I'm speculating here but I'm pretty sure if you did an MRI on my brain you'd see lesions from the mixing of mdma and sertraline (I get myoclonic jerks to this day).
Could you speak more to this? A family member was recently diagnosed with myoclonic jerks without a clear root cause, so treatment has been hit or miss so far. I’m trying to learn what I can to help inform them.
Every medication can have severe and permanent side effects, the question is how often that occurs for a particular drug, and how that stacks up against the quality-of-life improvement from taking that drug.
SSRIs are very bad, but antipsychotics are worse. There are many other reasons, but a demonstrative one is that there is a cumulative annual risk as high as 7% of developing a permanent movement disorder when on them.
It was really hard for my ex to have to choose between anti-psychs and the potential side effects, or exceedingly strong paranoia with incredibly lucid hallucinations - I did not envy her position
I think the reality is likely more nuanced than 'all good' or 'all bad.' While the side effects you linked are real risks that should be taken seriously, claiming these drugs are 'by no means safe,' cause 'mostly permanent' damage, or lack evidence is a pretty extreme generalization that doesn't align with the experience of millions of patients.
Speaking for myself, I took sertraline for years and it did wonders for my mental health. It didn't ruin my life or numb me, it gave me the ability to regulate my emotions when I previously struggled immensely with anger and crippling anxiety.
It’s possible for these drugs to be handed out too easily in some contexts and simultaneously be life-saving, effective treatments for those who genuinely need them. Suggesting they violate 'do no harm' ignores the massive harm caused by leaving severe mental health struggles untreated.
but no one bothers to take the time out to sit down and figure out WHY they feel sad and FIX THAT FOR THEM. That takes too much work.
Sometimes depression is this vague feeling that this world is just wrong. That Damocles' sword of mortality. The nagging sense of ultimate pointlessness. You can't really "fix" that. But having stuff to ignore it helps, like video games :')
>but no one bothers to take the time out to sit down and figure out WHY they feel sad and FIX THAT FOR THEM. That takes too much work
Out of curiosity, have you ever been depressed or do you know people with diagnosed depression?
I ask, because when I first visited a psychiatrist my life was going great - very good job, great financial situation (i think i could FIRE today), happy marriage, perfect health. It didn't save me from recurring self harm and suicidal ideation, and it doesn't explain why I had weeks when I couldn't even open my work email.
Sometimes your brain is just causing your trouble for no reason. Drugs work, or may work, and may save lives. I write this because I had a similar opinion before being personally affected, so I see where you're coming from.
Depression isn't just feeling sad. It's not necessarily caused by anything external. You cannot necessarily just "figure out why" you feel bad; that's really not how it usually works.
>It's not necessarily caused by anything external. Y
Then how could a drug fix it? We're positing that there is not only a mechanism causing it, but that this mechanism can be manipulated external to their own self/agency/whatever.
I think that it is at least as absurd to posit that you can come up with one chemical substance or another that will alleviate their depression when you dismiss the idea of coming up with a sequence of words spoken to them that might alleviate their depression. It's the conceit that we have a better idea of how their brains work chemically than we do of how their brains work cognitively.
Many things that are not necessarily caused by anything external can be fixed by drugs. I don't understand your point.
If the problem is brain not working correctly (because some organ is not doing it's job properly) then no sequence of words will make the brain physically fix itself, just like no sequence of words will cure a heart attack.
Of course it depends, and many people just need a correct therapy. I'm not dismissing talking and figuring out the root cause.
> You cannot necessarily just "figure out why" you feel bad
Well, of course, if you anesthetize someone they can't feel anything. If you cut off the physical pathways of ""feeling sad"" then they can't feel sad, but is that really the same as "fixing" the reason for why they were feeling sad in the first place?
Unless the reason was that the physical causes are running haywire and making someone feel sad when they otherwise wouldn't, but how often is that just uhh a lazy scapegoat? "Oh this person has no reason to feel sad, something must be wrong in their brain"
> Well, of course, if you anesthetize someone they can't feel anything.
Not what the post you replied to was talking about.
> Unless the reason was that the physical causes are running haywire and making someone feel sad when they otherwise wouldn't, but how often is that just uhh a lazy scapegoat? "Oh this person has no reason to feel sad, something must be wrong in their brain"
That's basically the definition of clinical depression. Doctors try quite hard to make sure it's not a scapegoat.
If someone is sad for a specific, identifiable and tractable reason, then they are experiencing a categorically different phenomenon to someone who just feels sad all of the time regardless of their life circumstances.
One of the key diagnostic criteria for melancholic depression - what we might lazily and inaccurately call biological or "real" depression - is mood unreactivity. Someone with severe melancholic depression could win the lottery one week, lose all of their family in a plane crash the next, and feel literally nothing about either event.
Some people with atypical depression (or normal sadness that has been mis-diagnosed as depression) can respond rapidly and dramatically to a change in their circumstances. For many others with depression, there is no external why - something has gone fundamentally wrong in the functioning of their brain. Trying to help those people with talk therapy or exercise or companionship would be as futile as using those things to treat hepatitis or gangrene.
> Trying to help those people with talk therapy or exercise or companionship would be as futile as using those things to treat hepatitis or gangrene.
I get what you want to say, but to nitpick the analogy: If the "treatment" for gangrene is amputation, then that's not really "fixing" anything. That's just the scorched earth strategy of destroying the afflicted along with the affliction. Like lobotomies. What do people think of them now?
> Someone with severe melancholic depression could win the lottery one week, lose all of their family in a plane crash the next, and feel literally nothing about either event.
Why SHOULD someone feel a specific feeling about any event? If you're subconsciously aware of the ultimate pointlessness of any event, if you're aware that feelings won't change what happened, you won't. You'd move on and handle the new reality in the means available to you.
I'm not saying that medicine should never be used and there's never a "chemical" cause to sadness (or any "wrong" feeling), just that it may be used too often as a lazy escape for the "helpers".
>Like lobotomies. What do people think of them now?
Lobotomy was in fact an effective treatment (albeit with extremely severe side-effects), but we now have much better and safer treatments available. The abandonment of lobotomy was fundamentally driven by the invention of effective antidepressants, antipsychotics and mood stabilisers. Neurosurgery is still offered to an extremely small proportion of patients suffering from very severe and treatment-resistant depression and OCD.
well, yes, it did work. the side effects are horrible, and often the disease was better than the cure, but it worked, similar to how being dead also is extremely effective for managing depression.
I was very young when my mom started Prozac but do remember how angry and sad she was before compared to after.
Years later there was a time when me and my sister noticed our mom was acting a bit strange -- more snappish and irritable than usual, and she even started dressing differently. Then at dinner she announced proudly that she had been off Prozac for a month. My sister and I looked at each other and at the same time went, "Ohhhh!" Mom was shocked that we'd noticed such a difference in her behavior and started taking the medication again.
I've been on the exact same dose as her for 15 years, and my 7-year-old son just started half that dose.
If I have a good day it's impossible to day whether that's due to Prozac. But since starting Prozac I have been much more likely to have good days than bad. So, since Prozac is cheap and I don't seem to suffer any side effects, I plan to keep taking it in perpetuity.
What I tell my kids is that getting depressed, feeling sad, feeling hopeless -- those are all normal feelings that everyone has from time to time. Pills can't or shouldn't keep you from feeling depressed if you have something to be depressed about. Pills are for people who feel depressed but don't have something to be depressed about -- they have food, shelter, friends, opportunities to contribute and be productive, nothing traumatic has happened, but they feel hopeless anyway -- and that's called Depression, which is different from "being depressed."
Your anecdote has nothing to do with whether it's better than a placebo or not.
A later comment notes that it works well for some patients and not others. The argument is that drugs probably don't fix things very well unless the cause is mostly just bad brain chemistry. Some people have bad brain chemistry, others have "real" (usually more external - financial, relationships, actual life issues) problems they need to fix, and hiding from them by just taking a pill to help ignore them might not work so well.
(OK bad brain chemistry is also a real problem, but one that's fixable with a pill).
Also yes that's all a bit simplified.
There's a stigma against pills for a number of reasons, some good and some bad, the fact that often they don't work being one reason.
There is a case in between: sometimes the issues are too overwhelming and you can’t start fixing them until the pills give you the space you need to address them and get to a position where you can quit the pills.
The study found the average effect was no different from placebo. It’s plausible, based on anecdotes like the one you’re responding to, that Prozac is harmful for some people, helpful for others, with the expected benefit close to zero. If so, it might be necessary to just try it and see if it’s obviously helping, keep taking if so, stop if not.
This is, in fact, pretty much the exact procedure: try one type of treatment or medication, see if it's obviously helping, and if it isn't try a different treatment or medication. It's imprecise but it's the best we have.
The problem is that taking certain psychotropic medications changes your brain chemistry. It’s not as simple as it sounds. It’s not like trying on shoes. The brain is dynamic and drugs alter it, as does life experience, talk therapy, disease, aging, etc…
That’s a statement of fact, but not intrinsically a problem. Being alive changes your brain chemistry.
His anecdote explicitly mentions the possibility of it being a placebo.
No it doesn't. It doesn't contain the word "placebo." Can you quote where it "explicitly mentions" what you're saying it does?
> If I have a good day it's impossible to day whether that's due to Prozac. But since starting Prozac I have been much more likely to have good days than bad. So, since Prozac is cheap and I don't seem to suffer any side effects, I plan to keep taking it in perpetuity.
I was acknowledging that the "good days" could be due to Prozac or could be a placebo effect, but since being on Prozac correlates with having significantly more good days, and I experience virtually no ill effects, I choose to continue with it.
Wow, a shockingly argumentative tone for someone who is just flat out wrong.
Beyond the response someone else commented explaining exactly where the comparison was mentioned, the anecdote itself is useful in offering an experience of someone who's life has been changed by the drug.
In any case, the study mentioned in the article is a meta-analysis about children, not adults, so there is no onus on OP to qualify anything about placebo or not.
To be fair, I didn't read that suggestion as being about a possible placebo effect, just that you can't attribute any one good day to the pill. It's like climate change- it undeniably exists, but you can't blame climate change for a single heat wave or freak storm.
You read it that way because that’s the sensible way to read it. Everyone suggesting you missed the plot is in turn making a rather large logical leap.
Some people just need to have stuff spelled out for them.
The comment never said otherwise. They shared a personal story about how it worked for an adult.
A seven-year old child is being given a brain-altering drug? I am very happy such drugs did not exist when I was seven years old.
the alternative is depression. brain altering drugs seem preferrable
The dichotomy of such mental illness is people with more constitutional resilience just say "power through?" and they are absolutely correct, it is something they can power through.
Mentally ill folk literally cant, not in em. There are right answers to help them, but that's not the right one. It's kind of like telling someone who is color blind to squint real hard, won't ever help.
Myself, I'm someone very much in the power through category. It's the simplest and most straightforward answer surely. But if it were the answer that works in practice we'd have no homeless people, no drug addicts.
There are many mentally ill people who "power through", though. Some call it high-functioning depression.
There are different severities - a small depressive episode, a multi-year dysthymia or mixed (manic + depressive) episode.
I've been managing OK without meds, but maybe simply depression wasn't as severe as that of other folk. It's still a mental illness.
However, the effectiveness of Mindfulness based stress reduction and acceptance & commitment therapy show that those who can distance themselves from their thoughts have developed "mental resilience"
Exactly. And it's a combination usually. It's really hard to do constructive therapy when you are depressed. Stabilise with the meds and then tackle the root causes with therapy.
But some people just are very prone to depression and need the extra help.
You wouldn't say "don't give that kid ibuprofen, let them just deal with the pain"?
And SSRIs are not very strong. They do have some nasty side effects especially sexually but this is not relevant at that age so that makes it even more suitable for kids than adults.
I would be very cautious advising SSRIs for anyone, especially developing children, considering my own experience (on sertralin), which was complete disappearance of a libido, and massive weight gain, +40kg (70 -> 110) in ~10 months. 5 years later I still have not undone the damage from it.
Yeah but it's something that affects people differently. I took escitalopram and my libido was a bit reduced but mainly it became harder to orgasm. That was not all bad, it's nice to be able to last an hour and a half :) I was already heavy but didn't gain any more weight. I did lose some when I moved to other stuff though.
But these side-effects just need to be checked for (and the libido issue isn't relevant to under-teens anyway).
[dead]
> You wouldn't say "don't give that kid ibuprofen, let them just deal with the pain"?
Of course you would say that after the Nth time. You are supposed to find out what causes the pain, not mask it.
I've had recurring headaches my entire life. Have been to many neurologists, none have any idea what causes them, they just give me different pills to prevent them instead. This isn't unusual for headaches, quite often the cause is basically unknown. (If you ask people they'll give you a series of common things, eg water consumption, eating enough, etc, but it's just all unprovable folk medicine) Expecting everyone to "find the cause" is unreasonable.
If you have a headache, it's totally fine to take a painkiller. (If it happens on a regular basis, eg at least once a week, it can be a good idea to get those different pills from a neurologist, because the two main painkillers have bad side effects in the long run, but those different pills are just "masking" it in a different way)
I am not trying to say that you are never supposed to take medications long-term. I take medications, too. Unfortunately the causes are known (or rather, there is a diagnosis), but there is no treatment or cure.
What I am trying to say is that after the Nth time you would take the kid to the doctor to find out what causes the pain, instead of just giving them painkillers. It could easily be something treatable, or rather, curable.
You're talking about an adult, though, not a seven-year old child..
For a 7 year old? It's about as absurd/dystopian as somebody claiming their 3 year old was diagnosed with ADHD.
Is that the only alternative?
Therapy is effective, but not always. sometimes, especially with children, there is no root cause in life to the depression beyond "genetics". Additional, therapy may simply be useless and unproductive without medication being used concurrently.
There's also simply death. I didn't feel like mentioning it, but I think its worth pointing out that without treatment, death is a very real possibility.
>sometimes, especially with children, there is no root cause in life to the depression beyond "genetics".
I find this hard to believe. People in the past weren't depressed nearly as much, so whatever is causing it has to be environmental.
Do we know that, though? Historically the lives of most people were bleak and miserable. You don't really have much time to feel depressed when you have to work for 14 hours in a factory 6 days a week or lose your home and eventually die in the streets due to malnutrition and disease. People who couldn't take care of themselves and didn't have a support network just didn't live that long and/or were entirely erased from history...
People in the past couldn't get a diagnosis, so they had to settle for cirrhosis.
[dead]
> my 7-year-old son just started half that dose
This is horrifying.
We had/have a lot of reservations about it too, and discussed it at length with our pediatrician over months of observation. We decided what was more horrifying was hearing a 7-year-old — who has supportive family and friends, good health, no traumatic events, no major life changes going on, never worries where food/shelter is coming from — say he feels like "he shouldn't be on Earth anymore" and suddenly react with extreme physical anxiety to almost everything. It was bad enough that he couldn't really implement any of the coping skills he learned in therapy. His therapist hoped that medication would bring him to a baseline where he was able to benefit more from therapy. My family's historical success with Prozac also made the decision more palatable since depression appears to be hereditary.
There has been a phenomenal positive shift in his behavior since he started medication. All that said, another commenter pointed out that the study specifically says that Prozac is no better than placebo for depression, which is similar to but distinct from anxiety, which is what my son is being treated for. My mom and I were both diagnosed with depression, but anxiety may be more accurate -- I'm not sure.
You seem to be handling the naysayers pretty well. But, still wanted to compliment you for sharing and encourage you not to let them get to you.
It sounds like you made a wise decision given your personal and family history and your son is benefiting. Kudos.
I was one of those “medicating kids is a terrible idea” people, until I had kids with severe generalised anxiety. It took a lot to convince me to try it, but it made their lives better in such an obvious, immediate way. The whole experience made me a lot more humble about opinions I hold without relevant experience.
It's important to remember that not being a "medicating kids is a terrible idea" person doesn't mean one is a "every medication is a great idea" person. I'm probably like most people where in a perfect world I wouldn't medicate at all, and treat unfamiliar medications with some skepticism. But also I accept that I'm not (and am not interested in being) a medical expert, so if there is a medical need that I can't handle myself I'll take the advice of a clinician who has earned my trust with good reasoning.
> The whole experience made me a lot more humble about opinions I hold without relevant experience.
I wish there were a way to shortcut this process for society so that so many people didn't need to either go through a similar experience personally to have such an epiphany, or worse, never have it at all. (Speaking not only about medication for kids, but other polarizing issues as well.)
I'd be more interested in where your 7-year-old even learned phrases like "I feel like I shouldn't be on Earth anymore."
Yes, us too. Beats us. Sure wasn't around our house, and we can't imagine any family/friends/TV/whatever he may have learned it from.
Children are intelligent and creative and this is normal.
Children speak like this and then I correct them. I explain it isn't helpful, explain why they are blessed, how their life could be worse, and provide them alternative phrases while they explain their emotional state.
Depression is caused by laziness and anxiety by hopelessness. My kids know that they aren't permitted to be lazy or say they are bored. They don't have anxiety because they have hope despite circumstances.
> Depression is caused by laziness and anxiety by hopelessness.
I wish this were true, but its not even close. I wonder how your kids will react when they move away, and you're not around to police their emotional expression. If they're like me, they will promptly collapse into paralysis and self-destruction.
I strongly suggest that you frequently give your kids long stretches of time (months) to practice regulating themselves, without your interference.
And if they have anxiety or depression, please let them see a professional. If my parents had noticed the signs earlier, they would have saved me decades of pain.
At this age I am teaching emotional regulation on a daily basis.
As for when they grow up, adults who cannot manage their emotions get fired or are sent to jail. It is critical to be slow to anger, quick to forgive, and work at building strong friendships.
You imply we aren't teaching emotional regulation on a daily basis? We have always placed a great deal of emphasis on talking about feelings and developing "tools for our toolboxes" to deal with them. Unfortunately those tools are largely inadequate when there isn't a rational cause for a debilitating emotional state.
People who have never experienced a particular challenge are quick to assume credit for its absence and assign moral failings to others who experience it. It's insufferable but common.
Imagine a millionaire who had millionaire parents lecturing his children on how they're not allowed to be poor. Lo! They're not! The lectures worked.
Anger seems to me to be one of the least understood emotions. In my opinion anger should be practised at every possible opportunity in order to cultivate as good as relationship to it as other emotions. Otherwise it will seem like it's out of your control due to not knowing its limits and how much of it you need due to it being suppressed. It is a necessary emotion for our wellbeing.
It sounds like you're actually teaching your children to hide their emotions from you
They're welcome to share their emotions but poor behavior isn't acceptable. Anger is fine. Yelling isn't. We'll talk it though. Tonight i got yelled at 3 times for not helping. I asked why I got yelled at. "Because I was angry". The anger wasn't justified but real so we discussed. I got a hug shortly after. No discipline. Just patience.
We take the same approach! While I don't agree that depression is laziness, we do teach that feeling sorry for yourself is akin to laziness. When we're disappointed about things not going the way we wanted we're allowed to grump about it for 5 minutes, but then it's time to brush ourselves off and move on.
It is great that that works for you but I don't think you should assume that what works for you is applicable in every situation.
> Depression is caused by laziness and anxiety by hopelessness.
Others have responded to the depression/laziness part -- I was wondering if you could clarify what you mean by anxiety being caused by hopelessness? To my way of thinking hopelessness and depression have a lot of overlap, but anxiety not so much... It's more like a feeling of dread.
Anxiety is fear based often if the unknown.
Fear of the dentist is common but understanding that the inconvenience is required for the desired outcome, the reason for the suffering, there is a hope to look to allowing the suffering to have meaning.
> they have hope despite circumstances.
Maybe they act like being hopeful because they are afraid of you. If you were my parent, chances are I would.
> Depression is caused by laziness [...]. My kids know that they aren't permitted to be lazy.
Do you really believe this, or do you believe your children aren't depressed? Your comment is not in accordance with science. Depression is a complex topic. I'm having trouble imagining a way to be more wrong. Is this satire?
[flagged]
You can use me as an example! When I got diagnosed I was very physically active and also quite clean.
One of the hardest things for me with depression is the incredible guilt I have. What right do I have to be depressed when my life is objectively fine? Why should I get therapy when that might mean one less space for someone who is dealing with trauma or poverty or something else that gives them a "right" to be depressed? This causes a feedback loop of guilt leading to more depression and vice-versa.
Like I tell my kids, it's normal to sometimes feel depressed or hopeless. If you're dealing with a difficult circumstance then it's reasonable to have those feelings, and the only way to address those feelings is to deal with the circumstance. What's not normal is feeling depressed and hopeless for no logical reason at all.
I appreciate your sharing your experience. I think it's very valuable that human beings describe to each other their decision making, actions, and outcomes. Often, people attempt to dissuade the sharing of information, and I think that leads to us, as humans, being less able to form an accurate model of the world. I appreciate your pushing through that form of opposition.
It’s pretty tough to exercise or clean your house when getting out of bed feels like an insurmountable task.
Depression isn’t like an infection or cancer—it’s a diagnosis based on established criteria, as are most mental disorders. Experts may disagree on diagnosis or treatment, but that doesn’t make it useless.
By that logic, you might as well say autism is caused by avoiding eye contact—since there’s no blood test for it either.
I'm autistic by some measure. Eye contact is uncomfortable but I push myself. I avoid it most of the time but yet play the game and do my best.
I'm finally at the point where I'll keep eye contact until I've completed the social requirement.
Ahhh this explains a lot. You should learn about internalized ablism, and probably stop teaching vulnerable humans the same, under the guise of "emotional regulation".
Did somebody else tell you that your emotions need to be regulated this strictly? Did you learn that if you express your emotions you won't get any help? That is not a normal situation to be in.
Good luck and please be kinder to yourself.
This is a pretty nasty line to double down on.
I hope you can take your personal anecdotes and add them to a larger body of research and other people's experience to refine your understanding. If you're right that everyone who has Depression is actually just lazy, you'll see lots of support for that. If, instead, you find a lot of different experiences you might conclude that Depression is a pretty nuanced and complicated topic, which might both expand your understanding and help you bring more empathy to the suffering people around you.
I know several depressed people that exercise every day and live in a clean house.
That's unfortunate. Ask they why they are depressed and see if there is any way to fix it.
What people are trying to tell you is that in the case of clinical depression there isn't an easy fix because it's not caused by anything external.
I have a very good support system in my life. If it was possible for a friend to come along and just fix it then I wouldn't have depression.
You think they don't ask themselves that question all day, every day?
reddit.com/r/thanksimcured
You are very, very extremely inexperienced in this area, as anyone who deals with or has someone in their close family that deals with serious, life-threatening depression will tell you.
And that's okay!
I would encourage you to look at the number of comments from different people who have a history of dealing with this kind of thing for a long time.
I'm reading them. What responsibility does an individual have over their situation.
ADHD and some types of Depression are developmental / environmental.
You're asking a person missing a leg to "just run, bro".
Black swans do not exist. I have never seen one.
It's almost as if depression reduces your executive function, making it more difficult to exercise each day or consistently clean your house.
And then you feel worthless for not being able to do those things, reinforcing the depression.
I agree 100% and it is an uphill battle requiring significant effort. That is where discipline is required. Exercising that discipline will bring positive results. There is nothing other than self stopping someone from cleaning instead of crying under a blanket.
"If you have executive dysfunction, just discipline through it" is definitely a take.
This person just does not understand.
you have the causality reversed....
Go on
[flagged]
WTF? You cannot comment like this on HN, no matter what you're replying to or how wrong you think they are. We've had to ask you before to avoid abusive comments. We have to ban accounts to do this repeatedly, and it's only because the parent comment was pretty bad too that I'm not banning you this time. Please take a moment to remind yourself of the guidelines and avoid ever commenting like this again if you want to keep participating here. https://news.ycombinator.com/newsguidelines.html
> My kids know that they aren't permitted to be lazy or say they are bored.
Seems like a really great way to have your kids feel guilty about the way they feel and then not talk to you about it.
[dead]
> Depression is caused by laziness and anxiety by hopelessness. My kids know that they aren't permitted to be lazy or say they are bored. They don't have anxiety because they have hope despite circumstances.
This sounds horrible. If I weren't depressed or anxious, being told that I wasn't ever permitted to be lazy or say that I was bored would make me so; and, if I were, then being told that I was lazy and hopeless would make it worse.
You seem to have your mind thoroughly made up, which should raise a flag that you might be suffering from a bad case of Dunning-Kruger, and need to re-ask questions you think you already know the answers to.
"why do you feel sad about your girlfriend broke up with you, it happens all the time and you'll probably find someone else"
Attitude
I can't tell if you're being sarcastic or not but that is kind of the truth. A breakup is horrible, in its worst case it is similar to an untimely death and can come with grief and maybe even worse because the person is still alive and in your life so you're reminded by their absence even deeper and could experience jealousy, and the drip feed of interaction can elongate the time it takes you to move on with your life and find the person who is more right for you.
But while the sadness is real and shouldn't be ignored or suppressed, wallowing is unhelpful and you ought to move on with your life - just like if someone close to you dies, the deceased most likely would want you to be happy and continue living a good life and move on.
Objectively you're right, but I hope you think twice before saying to someone who has experienced a tragedy, "You need to move on." Similarly if you're in an argument with a friend or loved one and they are upset I hope you think twice before saying "You need to calm down" or, "You're overreacting." Objectively those may all be correct, but they are unhelpful, and are likely to have the opposite effect. They minimize the weight of the emotions. Most of us cannot just turn emotions on and off, much as we try and wish we could.
[flagged]
> Depression is caused by laziness and anxiety by hopelessness.
No offense, but teaching your kids this kind of nonsense is borderline abusive. It's so far away from so many people's experiences, and is just plain wrong. I hope you can recognize how damaging this could be for your kids down the road.
> Depression is caused by laziness and anxiety by hopelessness.
While pizzafeelsright gets heavily downvoted, I think their may be some (dark) truth behind it: if you weren't lazy, you would sommit suicide instead of living a depressed life. :-(
I also have a feeling that there might be another (dark) truth behind the link between anxiety and hopelessness.
7 year olds are second graders in school. They are exposed to plenty.
Many public schools have teachings about climate change, issues white people gave the world, native stolen land etc.
It could be easy for a kid to feel depressed when they're either the source or the victim of all the world's problems only being 7 years in
All this comment points out it’s you aren’t very familiar with second grades curriculums.
For me it shows he's trying to shoehorn in right wing talking points into this situation.
With both my kids in 2nd grade and my wife also a public 2nd grade teacher, I consider myself pretty aware of what kids are being taught these days. They certainly are being gradually introduced to some of the problems of the world, but I think childhood development experts would all agree that's healthy. As for them being told they're the source or victim that's hardly the case. I'm sure there are a few isolated incidents that right-wing media love to bang on about, but not the experience for most.
> but I think childhood development experts would all agree that's healthy.
Could it be that we think it's healthy because we can just give meds to the kids that it affects?
How would someone even have the ability to say "it's healthy" - I'm struggling to think how it comes about. I think it's healthy for my kids to cry about a worm dying in the garden, but anything less than "anxiety about a dying planet"...
Put it another way: climate change messaging IS totally about anxiety and putting human as the cause, so we can (as adults) change our habits and save the planet. Could it be too much for kids though?
At what age will you permit your kids to leave the walled garden you've created for them?
I don't give them a walled garden. I let them experience life how they do, and i protect them from predators until they can defend for themselves.
(so in this particular situation, maybe highschool / early adult)
From what I understand, some of these predators are knowledge?
I grew up in the 80s and 90s. In school environmentalism was a big deal. We did conservation trips to these ecology parks, we were taught to recycle, and often watched films about animals that might die off due to climate change.
I only felt motivated to annoy my parents to recycle more. Since the effects were not directly in front of me a strong emotional reaction didn't occur.
Perhaps there are children who already have anxiety and latch onto climate change and other problems.
Issues like what? Civilization? Ending slavery? Those aren't teachings, they are genocidal lies.
Not sure about you but I didn’t learn my native language phrase by phrase only. You learn the individual parts and concepts and construct sentences from that.
He learned it from being on Earth? And noticing that some people who used to be on Earth aren’t anymore? And it dawning on him that he doesn’t have to be either?
It sounds to me how a someone would describe feeling suicidal when they don't know the word for it.
Ya, when I'm sad I can come up with pretty creative language to express it. It does feel really tough to know that a seven year old feels like that :(
I’m with you on this. Granted my oldest is only 5, but anything profound my kids say can be traced back to something they heard
Teachers / schools / mandatory privilege education
You seem to have a pretty narrow view of the world, especially about “privilege education.” FWIW I’ve never once heard anything about “white people bad” from my kiddo, about 10.
It’s also impossible to to talk about idk Columbus, slavery, Great Britain, or the founding of America (and like ya know, the treatment of native Americans) without ascribing some blame to the people responsible…who were by and large “white”. We also talk about how any judgement based on skin, appearance, gender, ethnicity, or religion, is flat out wrong.
Come on, 7 year olds should have already learned to form phrases.
No, you see, this phrase must have appeared in his training set.
[dead]
[flagged]
The solution for suicidal thoughts is a drug known to induce suicidal thoughts?
You said elsewhere that there were "no known long-term side effects". Aside from that not being universally true for any drug I've ever personally researched, no side effect is more long-term than suicide.
I appreciate your candor in this. A respectful and on-going discussion and dialogue about this subject is really the best way forward for us all.
As someone with bad mental health since I was ~5 and parents who refused to acknowledge it - I think you're making the right decision.
There is however also benefit in updating your priors as new research comes out. I won't say this particular research discounts your experience. But maybe some day your son will prefer a different medication.
[flagged]
Suicidal ideation at 7 years old is not normal kid behavior, neither is sudden and unprecedented paralyzing anxiety over the prospect of ordinary things like going to a friend's birthday party or trying a new playground.
Me and my mom are on identical doses of Prozac to treat very similar symptoms.
We consulted with a child therapist, a pediatrician, and a psychiatrist.
You are shockingly patient and nice to these people who are going out of their way to be judgmental jerks.
Kudos to you; you're inspiring me to find more grace in my life, but don't feel obligated to respond to these people who are trying only to bring people down.
> You are shockingly patient
It’s the Prozac, obviously /s
It really does take a lot to be able to deal with all the comments they’re getting, and I know from my own experience that once you’re living a life of both seeing and experiencing struggles with mental health, it becomes something you adapt to rather quickly.
Did you stop reading before he described the extensive consultations with the pediatric psychologist?
It's also horrifying to hear your 7-year old child talk about committing suicide when you have a deep family history of depression, anxiety, and suicide.
Have some empathy.
Why? If a kid has diabetes, would it be horrifying to treat it? Why would it be different for a neurochemistry issue that makes the same kid tired and sad all the time?
Because the problem's not a "neurochemistry issue" (that theory's been debunked and the "chemicals" in play have never been known), and the solution is "no better than placebo."
Can you provide a source for that theory having been debunked? I agree that data has been found that is at odds with the various neurochemical theories but am not aware of the neurochemistry link as a whole having been definitely debunked.
Whenever I read a comment like this, I’m always curious if the commenter did some basic searching of their own. Just searching “chemical imbalance debunked” yields a wide array of sources. So why ask? It seems almost like a form of Socratic questioning. You want to debate the point, but for whatever reason, are not doing so directly.
I'll take this sincerely, and ask you, is this really something you've a continuing curiosity about? I have a suspicion you understand what is taking place, but for whatever reason, are not expressing so directly. Are you asserting there is nothing more to discuss after one parses the search results for “chemical imbalance debunked”. The parent is quite clearly, at the minimum, meeting their parent's level of input, which essentially amounted to "this thing is debunked". As an onlooker and after a quick skim of the search query you suggested, I am still not exactly clear on what "neurochemistry issue [theory]" entails. What would help, is a more clear underpinning for what is being discussed, which your parent is suggesting, through question, before attempting to respond. I appreciate this personally!
Ah, well-put! I think we may be reacting differently to the same articles. My understanding is that while various neurochemical theories have not been proven as the general public seems to think, they have also not necessarily been disproven or debunked. Certainly it has not been proven that neurochemistry has no role at all.
I wouldn't recommend searching for "chemical imbalance debunked" unless you intend to confirm an existing bias. The internet will show you whatever you want, and there are enough people who distrust medical professionals that any search for "debunking" will be a minefield of fringe theories and grifters. I'd recommend someone start generally, searching for information about clinical depression, and then build on that to look at root causes and how the medical understanding of those root causes has changed over time.
One of the first search results for me was a paper published in Nature. Other top results were from respected institutions like the NIH and Harvard University. Hardly grifters or crazies.
The caveat you cite applies to basically any and all internet (or even media) consumption, and is therefore a non-argument.
Look, I can tell you've got a chip on your shoulder about this and are probably a conspiracy theorist, so I'm not going to argue anymore.
Maybe chip on their shoulder, but the claim of conspiracy theorist is completely unwarranted. The impression you give off is that you decided upfront their sources are bad and you're going to knee-jerk reject their evidence no matter what.
Sad how people start frothing at the mouth during a relatively anodyne conversation. You don’t see it often on HN - more of a Reddit thing - but apparently it does happen.
drugging society is a method of proxying community responsibility , I personally completely understand why people react vitriolically to being told that drugs are not the solution , because without drugs we would have to help each other , and most people dont realize that cooperative multi tasking is the most efficient solution , or they give up because bad actors easily ruin functional cooperative societies , or they are lazy
This all started with someone asking for their sources, and the person hasn't given any except to say to Google... which means for all we know the person who then googled ended up in a situation with lots of conspiracy theories. Google famously gives personalized results to an extreme degree especially when you add in differences in search terms.
I will say if you search for "chemical imbalance debunked" as discussed, the first result for me is a paper that also says dyslexia cannot be proved to be a disorder. Which just from vibes feels really conspiratorial, even without making comments on the veracity of the academic paper.
[https://pmc.ncbi.nlm.nih.gov/articles/PMC1518691/]
The person who was asked for sources was a different person than the one who quipped that finding said sources yourself is trivial.
> Google... which means for all we know the person who then googled ended up in a situation with lots of conspiracy theories.
If people have low enough media literacy that they cannot distinguish between scientific research published in refereed journals and conspiracy theories, then I cannot help them and it is not my responsibility to pander to their lack of competence.
> just from vibes feels really conspiratorial
Just from vibes? Clearly you are a scientific luminary.
Yeah, the person making the claim never responded. But I was more responding to your comments, specifically:
"Just searching 'chemical imbalance debunked' yields a wide array of sources. So why ask?", and "One of the first search results for me was a paper published in Nature. Other top results were from respected institutions like the NIH and Harvard University. Hardly grifters or crazies."
Those both trivialize the process of finding sources and interpreting them. I picked my top result which was from nih.gov and gave an example of why it's hard for a lay-person to interpret journal entries because it uses field specific terms that come across as wrong or conspiratorial. Heck the paper itself references other papers on other journals that appear legitimate that argue for the chemical imbalance theory, eg an article from JAMA (Journal of the American Medical Association) from 1993. Just because the source has NIH in it or is in a journal does not guarantee correctness or reliability because time passes and new science is done. The link in question was of a paper from 2006, which we are now further from than the 2006 paper was from the 1993 paper.
I am not claiming to be a scientific luminary and even agree that the chemical imbalance theory that was espoused for years was probably incorrect for many issues. I was just arguing against thinking it's easy to investigate and source claims. It's much easier for the person who is making the claim to provide their sources, and preferably they have a large body of evidence behind them and are recent or even better a source that has done that leg work of reviewing it and distilling it down.
I think their rhetorical approach to this subject is bad and I have no respect for someone who tries to lead someone to a conclusion while being circumspect about their own biases. This is the internet; one should assume negative intent in these cases.
Argue? I considered it a conversation, before your very rude and unwarranted ad hominem.
It seems that you really have no clue what you’re talking about, and are merely lashing out due to your own immaturity and insecurity. Maybe you can find a doctor who will prescribe you a pill that will fix your personality defects. It would certainly be easier than acknowledging your (massive) intellectual and emotional deficits.
Probably because the commenter is not a medical professional and isn't qualified to judge the veracity of anything they find. "Do your own research" is a fucking plague on our modern world and is why the internet is like wall to wall grifters now.
By all means, Google whatever you like, but if you show up to a doctors office waving WebMD sheets in a medical professionals face, you are going to be mocked and you deserve it.
I witnessed a pair of doctors prescribe a family member an incredibly dangerous drug for an off label use. The company had been fined $500 million dollars for various illegal schemes to convince doctors to write such prescriptions, but I’m sure the doctors in question were unaware of this. When this family member began to exhibit textbook symptoms of an extremely dangerous (life threatening) condition which could only be caused by the drug in question, the doctors failed to notice, and in fact repeatedly increased the dosage, and added more drugs on top to treat the symptoms caused by the initial drug. It was not until I accompanied my relative to a doctor’s appointment and delivered a carefully designed incantation that they made the correct diagnosis and halted the prescriptions.
So should I not have done my own research?
I both agree and disagree. The issue is not independent thinking and research - it’s the low media literacy of the average person that makes them vulnerable to frauds, grifters, and crazies.
With that said, the first few search results for the query were from the journal Nature, the NIH, and Harvard university. Hardly the loony or malicious caricature that you attempt to paint.
>Probably because the commenter is not a medical professional and isn't qualified to judge the veracity of anything they find.
The average medical professional is worst-placed to judge the veracity of any studies they find than the average engineer or mathematician who's done a solid statistics and probability course. Medical students are assessed on their ability to memorise and regurgitate facts, not on their ability to conduct statistical analysis.
I don't think we know if it's a neurochemistry issue. From what I understand what was debunked was the idea that they worked by blocking the reuptake of serotonin specifically.
…so what?
There’s an interesting theory lately [0] that the antidepressant effect of SSRIs is actually unrelated to its effect on serotonin. Suppose, for the sake of argument, that this is completely true: serotonin has nothing to do with depression, increasing serotonin levels is useless for treating depression, and everything everyone has ever claimed about chemical imbalances causing depression is flat-out wrong.
If so, pharma companies should probably try to develop different drugs instead of new SSRIs. But it does not follow that a patient with depression ought not to take an SSRI. That would be like saying that taking aspirin for aches has been completely debunked because there is no connection between aches and aspirin’s anticoagulant effect.
[0] See, for example, https://www.science.org/content/blog-post/trkb-bdnf-and-depr...
"neurochemistry issue debunked" is a very weak argument about the (in)effectiveness of proper drugs for treatment of mental illness. It's not exactly known how they work but I am 100 percent sure SSRIs often have a very positive, even life changing effect. Moreover, every approved drug is tested 'double blind' exactly because the placebo effect has such a big biasing effect on subjectively appreciated outcomes. Only when ruling out pure placebo effect, a drug can be approved.
Please share your qualifications for making a statement like this- do you work in biology? Are you knowledgeable about the underlying biology here, and the limitations of medical publications?
Not that I agree or disagree with the underlying claim but a call to "credentialism" to dismiss someone's opinion is not as strong in 2025 as you think it is.
The last few years have been a proof that even the "experts" are following strong political or personal ideology.
Also we don't live in the 18th century anymore. A lot of knowledge (especially around medicine) is open to the world. People can read papers, understand research etc.
In this area, having credentials makes a difference. Experts matter.
Few if any non-medical people can read medical papers and make sense of what they say. There is simply far too much context to evaluate such papers, especially in the cases of complex medical conditions.
Sorry but strong disagree here.
I have had a lot of Spinal and sleep issues. I have read almost all new literature on this niche subject and I have brought to my spine doctor some new therapy and treatments they had literally no idea about. Those treatments have changed my life.
As an engineer I read a lot of deep technical paper as my day job. Medical papers are comparatively relatively simple. The most complex part being usually the statistical data analysis.
We have pushed to a whole generation of people that only the "experts" can have opinion on some fields. I encourage everyone to read papers and have opinions on some of those subjects.
We are in 2025. That type of gatekeeping needs to go away. AI if anything, is going to really help with this as well.
I think it's good to read papers and be curious.
It's also good to work with your doctors (as you seem to have done), have a discussion, and mutually agree on a plan of treatment.
Experts don't know everything. But they probably know some things you don't, and can think of questions you might not to have even thought to ask. As the saying goes, "you don't know what you don't know". Experience matters.
There's also a lot of people out there without an academic background that don't know how to properly read journal papers. It's common to see folks do a quick search on PubMed, cherry-pick a single paper they agree with, and treat it as gospel - even if there's no evidence of repeatability. These skills are not something that many people outside STEM are exposed to.
Cherrypicking is bad, but worse is reading a paper and thinking you understand what it says, when you don't actually understand what it says. Or thinking that a paper and its data can be observed neutrally as a factual and accurate statement for what work was actually done.
My experience in journal club- basically, a group of grad students who all read a paper and then discuss it in person- taught me that most papers are just outright wrong for technical reasons. I'd say about 1 in 5 to 1 in 10 papers passes all the basic tests, and even the ones that do pass can have significant problems. For example, there is an increasing recognition that many papers in biology and medicine have fake data, or manipulated data, or corrupted data, or incorrectly labelled data. I know folks who've read papers and convinced themselvs the paper is good, when later the paper was retracted because the authors copied a few gels into the wrong columns...
By extending your statement you are essentially saying that the credentialed experts have a monopoly on knowledge in their fields? As anyone else reading a paper probably think he understands but actually doesn't? What a weird take.
The knowledge is out there. Yes there are a ton of bogus papers and a ton of bad research. Not everyone got the critical knowledge to figure this out but I also don't think this is only reserved to the "experts". They are also subject to groupthink and other political pressure to think a specific way.
At the end of the day, do your best own research and work with your "expert" to agree on a solution.
Pushing back on people reading paper is an anti-intellectual take (to use the same wording as another poster below).
But is that really what you are seeing in this HN comment thread? People who seem very well researched in the biochemicals and meta studies of Prozac? I don’t. :)
> We have pushed to a whole generation of people that only the "experts" can have opinion on some fields. I encourage everyone to read papers and have opinions on some of those subjects.
There's nothing wrong with having an opinion on something as a non-expert, as long as those opinions are not acted upon or relied upon as a source of reliable information. Read papers, watch YouTube, browse WebMD, satisfy your curiosity--knock yourself out. But don't undergo treatment without working with an actual expert! I'm not an expert on orbital mechanics, but I have played KSP and have formed various opinions about it. But nobody should be listening to me for advice on how to launch a rocket.
We need gatekeeping for a reason, especially in the medical field which is rife with miracle cures, snake oil, herbal remedies, detoxes, homeopathy, and other forms of quackery.
Believing my "research" is better than my specialist's education is a path back to the dark ages.
> Believing my "research" is better than my specialist's education is a path back to the dark ages.
Doing your research should not be in competition with your specialist's education. It should be complementary as yet another source of information.
I'm not saying experts are wrong but I also don't think they are particularly always right. They are human and they have strong groupthink. They will agree and disagree with some takes based on their personal or political beliefs.
> Believing my "research" is better than my specialist's education
If you get rid of the scare quotes, you can spend 10x or 100x as long as your doctor when researching something specific enough. That has many advantages, even without the training.
> is a path back to the dark ages.
This is quippy but doesn't actually make sense.
This just reads as Dunning Kruger-esque to me. You think that because you know how to read a technical paper in engineering, you're as or more competent than a doctor.
Yes, experts are wrong all the time, they have the disability of being human, but this seems like an extremely anti-intellectual take.
sorry but your take seems to be the anti-intellectual here.
You seem to think that the educated class got a monopoly on knowledge on that field, yet after that claim to know that experts are wrong all the time. The anti-intellectual take is to give up on trying to understand as much as you can in a field because you don't have the right credentials to do so. Yes, medical papers are not that complicated to read.
That doesn't make you more competent than your doctor. But it probably makes you a better advocate for yourself than your doctor is.
My point is: Don't discount yourself reading papers and doing your own research. Then work with your "credentialed experts" to come to an agreement. Don't ever think that the "experts" got your best interest at heart.
Nobody who seriously read and understood the literature in a given field would issue a blanket dismissal of all the experts in that field. My experience is that reading papers and research leads one to understand WHY the professionals get it wrong - because you start to understand the nuances.
I'm not saying you issued such a dismissal, but the comment that started this thread did so.
I don't have a problem with reading papers and doing research, and I never once claimed that the "educated class" has or should have a monopoly on a field. You wouldn't know this, but for the first ten years of my career as a software person I was as a college dropout; I certainly am not someone who is going to get all hot and bothered about people having letters after their names.
That said, I have a tough time believing that spending an hour on Sci-Hub makes you better at diagnosis, yourself or otherwise, than someone who spent a decade being educated with decades of practicing. Thinking that you know better than trained experts because you have an understanding of the very beginning of a field is overwhelmingly tempting but is generally not based in reality. Usually the people who have actually been trained in the field know more about the field than a random person who read a few papers that they thought were "comparatively relatively simple".
I read papers all the time, usually formal methods, but sometimes other fields like medicine, and I will sometimes leave the medical paper thinking that it's "easier" than what I study, but I think that's just Dunning Kruger. I know more about formal methods, so I know a lot more about what I don't know, and thus I feel like it's harder. I don't know a ton about medicine, and since I don't know what I don't know it can feel like I know everything, and I have to fight this urge.
By all means, read about research in whatever ailment you have, I'm not really trying to discourage that, but I feel like dismissing experts in the field is almost the definition of "anti-intellectualism". If you find a study that you think is promising, bring it to your doctor. Hell, bring it to a dozen doctors, multiple opinions isn't a bad thing.
I just don't like the general "don't trust experts" thing that seems to be flying around certain circles now.
> People can read papers, understand research etc.
Then he should cite the papers, point out the research, etc. Rather than dismissing the entire discipline and all its practitioners with a wave of the "common-sense mental illness isn't real" wand.
I hope you do realize that this comment thread is linked to an article that includes the words "Prozac no better than placebo" in its headline?
Yes, I do. I don't consider articles in the regular press to be even remotely worth looking at due to their high rate of inaccuracy. Here's the paper that the article refers to: https://www.jclinepi.com/article/S0895-4356%2825%2900349-X/f...
These types of studies are published all the time and can easily be dismissed. Antidepressants are _only_ for major depression. Not mild or moderate. These studies that find no significance compared to a placebo are always tried in patients with all types of depression. Not just major.
It's so common it's a trope. "Antidepressants don't work" says the scientists testing antidepressants on things they're not supposed to work on.
Studies repeated with just major depression all conclude antidepressants are better than a placebo.
Click through the article to the study and you'll find they did not limit their study to must major
> Because the problem's not a "neurochemistry issue" (that theory's been debunked and the "chemicals" in play have never been known), and the solution is "no better than placebo."
It most certainly has not been debunked and mind altering chemicals most certainly do work.
SSRIs have _questionable_ efficacy but that's not the same as proven to have none, which is an exceptionally high bar.
This is close minded dogma no better a religion.
If you don't have a serious model for what you are treating, then you are experimenting on your patients and hoping it works for unknown reasons. Not too different from folk remedies. Even worse, patients are essentially never informed that the doctor is throwing things at the wall hoping something sticks.
You just described what psychiatrists do.
(I have many first-hand and second-hand experiences.)
> This is horrifying.
I agree with this.
I've learned a lot through life, one thing I've learned is about detrimental long term physical and even social effects of antidepressants, and other medications like adderal. Both I used to take.
At this point in my life, if I realized my parents gave me an antidepressant prescription when I was SEVEN years old because I said something stupid WHEN I WAS SEVEN I'd be very disturbed and disappointed in them, I'd definitely give both of them a solid scolding.
Before you respond to this remember I'm talking about me. Not your kid or your friends kid or your cousins kid.
EDIT: Quick edit to add when I was a kid I was a total outcast, I was weird, anxious, and definitely often depressed. A lot of kids in my religious schooling systems were.
My kids go to a ordinary public school. They are very bright, cautious, and thoughtful, and generally pretty happy and upbeat. There is a strong correlation between academic intelligence and mental illness. Being depressed to the point of being suicidal and having a sunny disposition are not mutually exclusive at all. I absolutely agree that it would be disturbing and disappointing for a child to be medicated because of something stupid they said when they were seven. I think medication may be appropriate if they show a consistent pattern over several months of physiological symptoms and reactions that are consistent with depression or anxiety, and cannot be explained by external factors like trauma or major life changes.
> My kids go to a ordinary public school. They are very bright, cautious, and thoughtful, and generally pretty happy and upbeat. There is a strong correlation between academic intelligence and mental illness. Being depressed to the point of being suicidal and having a sunny disposition are not mutually exclusive at all.
If my parents said this to me the moment I realized what I was on and that I had to deal with coming off of it late in life I would be beside myself.
I'd probably also look up the doctor that encouraged my parents to put their seven year old on SSRIs so I could warn friends.
These huge lists of side effects are haunting: https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_i... https://en.wikipedia.org/wiki/Fluoxetine
If my parents were like "uh well I had virtually no symptoms" I'd lose my mind!
Life sucks, I'm depressed all the time, kids are depressed all the time. There's material everywhere explaining a decline in general mental health. I'm happy and lucky that when my parents (or the one that was paying attention, who was certainly also depressed) noticed I was depressed or sad during a few events, some long lasting, they asked me about it, listened to me, and did their best to give me advice instead of giving up when I was seven and giving me drugs.
Remember when replying, this post has all been about myself, a victim of depression.
I'm a victim of depression too, and don't think it's fair that you say we "gave up." I would never give up on my child. You imply that we didn't talk to our son, listen to him, and do our best to give him advice before we discussed medication? Don't we all try to make the most well-informed decisions we can?
This decision was made collectively by me, my wife, our pediatrician, the child therapist, the psychiatrist, and for what it's worth also my son. We did extensive research. You may disagree with our decision, but please don't cast aspersions on how much we care.
You don't understand what having extreme anxiety at that age feels like.
As someone who lived through that, I refuse to let him. All of memories of school are just feeling anxious about everything, just tight and suffocated, always in a panic. I started living when I started taking anxiety pills at 39 years old, and I can see my 2 year old having the exact same anxiety ticks and fits I have.
I don't know at what age I'll medicate him, but I'll do it as soon as I notice he isn't coping and happy anymore.
Horrifying is forcing him to experience that because you can't comprehend us.
I'm sorry that you're dealing with this - it was my greatest fear at that point. That my daughter seems to not have my disposition and seems happy go lucky is the greatest thing ever. There's no rhyme or reason to my depression and anxiety, it's completely maladaptive and I'm relieved, that knock on wood, she stays happy and light while not having to shield herself from the horrors of the world.
The main issue I see is that the anxiety pill is a way to treat the symptoms, not the cause.
Do you think that there is a way to treat the underlying cause and not the symptoms?
How do you know an anxiety pill is treating symptoms only? What if the cause is physiological, and the pill treats that? It is entirely possible to sit in your therapist's office and mutually shrug because neither of you can find an underlying reason for your anxiety. Sometimes anxiety just is.
I had panic attacks every morning before school. God, I hated school. Mainly because of the other kids, and when I was older, because of both the kids and the teachers. I remember telling my IT teacher I am using Linux (I forgot why I told her) and she was very condescending. I have a lot of other stories but yeah, school was an anxiety-inducing nightmare.
I had severe anxiety/depression and majorly recovered from the anxiety component through a year of dilligent transcendental meditation. It changes the brain structure and neurochemistry.
I was on medication during that period and it complemented my practice, provided a stable base to apply meditation and other recovery protocols.
Often the cause is things that most people can handle, without being able to easily wield the tools to handle them. Having a pill that dulls the symptoms gives space to learn and become adept at the tools
Beyond obvious tumors/lesions/clots/abnormalities, we are not even close to being able to identify the cause of organic anxiety or mood disorders even if we wanted to.
We can say certain behaviors, experiences, illnesses and some genetic identifiers can trigger the conditions, but not the underlying cause. We can say things like some therapy and medication can help with the illness, but not the cause.
Not to trivialize therapy, but for many illnesses, not just mental, a portion of it can be described as ways of learning to live with the illness, not necessarily treating the underlying cause.
> Not to trivialize therapy, but for many illnesses, not just mental, a portion of it can be described as ways of learning to live with the illness, not necessarily treating the underlying cause.
Yeah, I feel like it's fair to describe the cognitive behavioral model. We're not necessarily looking for the cause of these thoughts and beliefs, tho they may come up, we're simply going to challenge them at face value and reinterpret the situation.
What if there is no rational cause?
No, it's not.
Medicine is advancing. We're increasingly able to understand and adjust dysfunctions that cause major, negative quality of life impacts. These dysfunctions have always existed, we're just getting better at finding ways to help people work through it.
This is empirically false; the rates of chronic physical and mental illnesses nowadays are are far higher than e.g. 50 years ago, and these are serious illnesses, not the kind of thing that could have been just not noticed.
That's your opinion, that is not the general opinion of the professionals in the field.
I trust a cohort of scientists significantly more than anonymous strangers online, and you should too.
The data is very clear that the rate of mental illnesses is increasing. Rates of severe mental illnesses like Schizophrenia are also increasing.
NONE of the current theories being experimented with on patients have a concrete, proven scientific basis with some such as the decades-long SSRI scam have actively harmed patients and created physical dependence/addiction and actively causing harm to patients and their families (eg, SSRI-induced suicides).
I trust science, but I don't trust scientists any more than I trust any other human with their money, career, and reputation on the line. I trust the FDA and pharmaceutical company ethics even less (eg, Bayer knowingly selling HIV-infested drugs to hemophiliacs, saying Oxycotin is non-addictive, or the revolving door that allows non-working SSRIs to be released and marketed as working despite all evidence to the contrary).
I had terrible anxiety as a child and what I experienced dramatically affected the core of who I am. It is engrained in me and I struggle with it daily, though after decades I have surpassed a good portion of it. If a small dose can help someone have a somewhat "normal" childhood, then its worth a try.
Why?
Because 7 years old is borderline too young to even make a depression diagnosis, and that kid's going to have his brain chemistry altered and essentially be addicted to a drug that he'll have to pay for for the rest of his life.
According to our pediatrician there are no known long-term effects of juvenile Prozac use. The effects may exist, but if they do they are of sufficiently low significance as to not have been detected yet. Interestingly the one possible effect she's aware of is that there may be a correlation with not growing as tall physically as one might otherwise. The data is not conclusive, but it gives me something to blame for topping out at 5'10" and never hitting 6' like my dad. :)
I appreciate how open and honest you have been in this discussion. While it might be that taking Prozac is the best choice for your child, I have to admit I would never let a pediatrician prescribe Prozac (or any other SSRI) - this is enough outside their normal training, I would want to consult with a specialist. Can't you get a referral to a pediatric psychiatrist of some sort?
Your pediatrician is either mistaken or lying. Children and adolescents who take SSRIs for major depressive disorder show increased rates of suicidal ideation, suicidal behavior, and hostility towards others. These effects persist for at least 9 months after starting SSRIs.[1]
Common side effects of long-term SSRI use in adults include weight gain, emotional numbing, loss of libido, and sexual dysfunction. It seems to me that anyone taking SSRIs when their brain is still developing would be more likely to have these side effects, and to have them persist after ceasing use.
It's anecdotal, but I know some people who were prescribed SSRIs during puberty. It's not possible to know how they would have turned out if they hadn't taken these drugs, but as adults I pity them. Their lack of sex drive causes relationship problems, which is especially sad since they do want children. They're starting to get older, so I doubt it'll ever happen.
1. https://en.wikipedia.org/wiki/Selective_serotonin_reuptake_i...
I thought we were talking about long-term effects, i.e. ones that persist to and through adulthood? The sources in that Wiki article appear not to address that.
The clinicians I've interacted with have always warned me of the possible side-effects of psychotropic medications, and said they should be notify immediately if the side-effects appear. I believe this is at least standard procedure, if not legally required?
I do have a low libido. Can't say whether or not that's due to Prozac, but regardless it hasn't negatively affected my life, probably because it was low before I met my wife. If someone enters a relationship while their libido is at one level and then during the relationship it changes considerably then I can certainly see how that could be a major challenge. That's an important thing to weigh when evaluating medication.
In addition to the increased rates of suicidal behavior and aggression in children (which we know lasts for at least 9 months, but don't know if it's longer because the study only ran for that long), the Wikipedia article talks about long term effects in adults, at least one of which you have. Why should it be less likely for children to end up with these same issues?
You are asking for evidence that does not exist because nobody has done good studies on it. That's too high of a bar. There are many drugs and life interventions that we don't have studies on regarding children, but that doesn't mean those things are safe for children. To use an example so ridiculous that we can both agree on it: There are no studies showing long term effects of fentanyl on children. Yet if some parent managed to get a fentanyl prescription for their kid, I think we would both be concerned.
Obviously I'm not implying that giving a child Prozac is as harmful as fentanyl. I'm saying that your line of reasoning proves too much. If someone did get their kid on a dangerous drug, and defended their decision by pointing out that there are no studies on children showing its long term harm, there is nothing you can say to that parent that others in this thread haven't already said to you. That should give you pause.
This is one of the most shocking things I have ever read. There is a black box warning for Prozac:
‘Warning: Suicidality and Antidepressant Drugs
Increased risk of suicidal thinking and behavior in children, adolescents, and young adults taking antidepressants for Major Depressive Disorder (MDD) and other psychiatric disorders’
Read the package insert: https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/01...
The fact that you were not informed about this should serve as proof that you cannot blindly trust what doctors tell you. They will absolutely kill you out of ignorance or incompetence, and never even realize their responsibility.
Note that the black box warning has nothing to do with long-term effects of the medication. It was added specifically because kids were killing themselves within weeks of starting the medication.
> This is one of the most shocking things I have ever read.
Good grief. I hope you're exaggerating for effect.
> Note that the black box warning has nothing to do with long-term effects of the medication
What are the long-term effects of suicide?
A 7-year-old kid doesn't understand what suicide really means. Putting them on something that encourages a behavior that they don't understand and has completely catastrophic results isn't a risk I would take with my children.
I respectfully submit you might feel differently about it if your child were suicidal. When someone has to be watching them 24/7 already for fear they'll hurt themselves, the black box warning is a lot less worrisome. SSRIs prevent more suicides by far than they cause. It's that first few weeks where they can have a paradoxical effect.
Death is a long term effect. And I am not exaggerating. I did not feel the need to list any of the myriad other potential long term effects because death seemed sufficiently serious.
Edit: in case the OP is reading, I should say also that the package insert won’t mention many other potential long term effects addressed in the literature, like extra pyramidal symptoms (akathisia, Parkinsonism, dystonia, tardive dyskinesia).
Another edit: ask GPT-5 ‘What are the long term side effects of Prozac use which aren’t addressed in the package insert?’ for a list.
It sounds to me like you're saying suicidality in children either doesn't exist, or shouldn't be treated, or should only be treated with talk therapy. If what you're saying instead is "this SSRI is especially dangerous" then ok, you and I just disagree about what information sources are reliable, and that's probably not a difference we can resolve. But if you're saying suicidality in children shouldn't be treated with medication, I'm curious whether you've ever met a six- or seven-year-old who wants to die. It is terrifying. It needs treatment. And talk therapy in children that age is honestly a joke. In the OP's place I would give my child an SSRI without any hesitation.
right which is why they are treating the depression (which leads to suicidal tendencies) which is a symptom of depression, with prozac. that's what the prozac is for. to prevent death
Prozac and other SSRIs are proven to cause MORE suicidal tendencies in children.
I'll raise my hand in agreement. This thread is definitely one of the most disturbing sub-threads I've ever read on HN.
The specific thing they were shocked by was the claim of no long-term effects.
Are you disturbed by that claim? That's what you're raising your hand to.
It’s disturbing that a seven-year-old was treated for suicidality? Or it’s disturbing that people are opposed to such treatment?
We were certainly informed of this. I didn't count it among the long-term health effects. I'm an educated and skeptical person but have never found any reason to distrust my physicians.
I have many reasons for distrusting physicians, but here's a particularly good one: the large drug companies have been fined repeatedly billions of dollars for illegal schemes to convince doctors to prescribe drugs off-label. From a justice department press release (https://www.justice.gov/archives/opa/pr/pharmaceutical-giant...):
'AstraZeneca LP and AstraZeneca Pharmaceuticals LP will pay $520 million to resolve allegations that AstraZeneca illegally marketed the anti-psychotic drug Seroquel for uses not approved as safe and effective by the Food and Drug Administration (FDA), the Departments of Justice and Health and Human Services’ Health Care Fraud Enforcement Action Team (HEAT) announced today. Such unapproved uses are also known as "off-label" uses because they are not included in the drug’s FDA approved product label.
[..]
The United States alleges that AstraZeneca illegally marketed Seroquel for uses never approved by the FDA. Specifically, between January 2001 through December 2006, AstraZeneca promoted Seroquel to psychiatrists and other physicians for certain uses that were not approved by the FDA as safe and effective (including aggression, Alzheimer’s disease, anger management, anxiety, attention deficit hyperactivity disorder, bipolar maintenance, dementia, depression, mood disorder, post-traumatic stress disorder, and sleeplessness). These unapproved uses were not medically accepted indications for which the United States and the state Medicaid programs provided coverage for Seroquel.
According to the settlement agreement, AstraZeneca targeted its illegal marketing of the anti-psychotic Seroquel towards doctors who do not typically treat schizophrenia or bipolar disorder, such as physicians who treat the elderly, primary care physicians, pediatric and adolescent physicians, and in long-term care facilities and prisons.
[..]
The United States contends that AstraZeneca promoted the unapproved uses by improperly and unduly influencing the content of, and speakers, in company-sponsored continuing medical education programs. The company also engaged doctors to give promotional speaker programs on unapproved uses for Seroquel and to conduct studies on unapproved uses of Seroquel. In addition, the company recruited doctors to serve as authors of articles that were ghostwritten by medical literature companies and about studies the doctors in question did not conduct. AstraZeneca then used those studies and articles as the basis for promotional messages about unapproved uses of Seroquel.
"Illegal acts by pharmaceutical companies and false claims against Medicare and Medicaid can put the public health at risk, corrupt medical decisions by health care providers, and take billions of dollars directly out of taxpayers’ pockets," said Attorney General Eric Holder. "This Administration is committed to recovering taxpayer money lost to health care fraud, whether it’s by bringing cases against common criminals operating out of vacant storefronts or executives at some of the nation’s biggest companies."
The United States also contends that AstraZeneca violated the federal Anti-Kickback Statute by offering and paying illegal remuneration to doctors it recruited to serve as authors of articles written by AstraZeneca and its agents about the unapproved uses of Seroquel. AstraZeneca also offered and paid illegal remuneration to doctors to travel to resort locations to "advise" AstraZeneca about marketing messages for unapproved uses of Seroquel, and paid doctors to give promotional lectures to other health care professionals about unapproved and unaccepted uses of Seroquel. The United States contends that these payments were intended to induce the doctors to prescribe Seroquel for unapproved uses in violation of the federal Anti-Kickback Statute. '
The takeaway is that anytime a physician prescribes you a drug, at the very least you have to check that there hasn't been a gigantic fine levied against the drug maker for illegally tricking your doctor into prescribing it to you.
It remains legal to provide drugs off-label because physicians sometimes know better than federal regulators
It's horrible that A-Z would illegally market drugs for off-label uses -- I would not disagree for a minute with your reasoning! -- but we retain this "escape hatch" because it is important to patient health
without the off-label "escape hatch," we would not have, for example, the glp-1 class of anti-obesity drugs, or, buproprion for smoking cessation, the most effective drug ever found in its area.
We needed doctors working firsthand with patients, and building "anecdotal" (i.e. case-based) evidence to learn things that really matter on a population level
This is such a blatant misrepresentation of the parent post that it feels almost bad faith.
The subject was specifically about long term brain chemistry changes.
People committing suicide after taking it, while incredibly sad, is completely unrelated.
There is no effect which is more long term than death. It is incredible to me that this is not obvious. But if you want other potential long term effects:
Lower bone mineral density, increased risk of fractures, osteoporosis
Sexual dysfunction / PSSD (Post-SSRI Sexual Dysfunction)
extra pyramidal symptoms (akathisia, Parkinsonism, dystonia, tardive dyskinesia)
emotional blunting / apathy
slowed thinking, brain fog
increased risk of gastrointestinal bleeding
QT prolongation
I, like every other person who hasn't been living under a rock, am abundantly aware of corruption in Big Pharma and medicine. If my mother and I have both taken a given well-known medication for decades and found it effectively treated a condition that may be hereditary with no negative side effects, and my son is demonstrating symptoms similar to mine and my mother's, is it unreasonable to tolerate my son trying the same medication? That's a far cry from committing to forcing him to take the medication his whole life, or trying some mystery drug with which I have no familiarity.
My deepest views on this subject are personal, subjective, and more controversial. I have watched several family members take antidepressants for upwards of four decades, and I myself suffered terrible depression throughout my childhood and teenage years. Despite my depression, I always avoided antidepressants for some ineffable reason-- a hunch, a nebulous suspicion, I'm not sure what to call it. Somewhere in my mid twenties my depression lifted and never returned. I look back on my life, which has been filled with hardship, and I feel positively disposed to the suffering. The suffering made me who I am. I feel strongly that my character would be diminished had I not experienced it.
On the other hand, I watched family members take these drugs, and their lives seem somehow dulled-- filled with banal tragedy, like staying in a bad marriage, or not being particularly interested in their grandchildren. I have a theory that the drugs make palatable that which otherwise wouldn't be, hence they stay in the bad marriage, the bad job, and they watch their bad TV and eat their bad food and everything is fine. I've also seen one of them go off the drugs, and for a couple months they were a much more vibrant person. I saw them express joy. I feel a low grade rage toward the industry that I've been deprived of this version of them. I do entertain the possibility that I'm imagining it all. Maybe things really would have been worse without the drugs. But I am glad no one ever insisted, or even strongly advocated I take them myself.
To be clear, nobody ever insisted or strongly advocated that I take medication — suggested maybe, but it was entirely my decision. And I completely agree about the importance of hitting "rock bottom." That's something I struggle with as a parent: wanting to make sure my kids have plenty of opportunities to fail, yet fail in a way that isn't irreversibly damaging. If at rock bottom I had simply killed myself rather than starting Prozac I wouldn't be around to have benefited from it.
A large part of me dislikes being on any sort of medication long-term, and think most people have the same dislike. I have gone off of Prozac a few times and always found that I gradually became frustrated and depressed again, and as you said the reason for the dislike is ineffable, so I chose to go back on. I'm fortunate to have a life with no bad marriage, no bad job, and very little trauma at all, which is also unfortunate since it means despite years of therapy and introspection and travel and hobbies and other varied experiences I've never been able to find any cause for the depression and therefore no way to fix it, other than medication. It makes me think of Captain Picard: "It is possible to commit no mistakes and still lose. That is not a weakness; that is life."
> palatable that which otherwise wouldn't be
Medication does not remove the need for therapy. If they are stuck in a bad situation and do not have the tools to come out of it, then in therapy they can learn about the tools and techniques.
Medication avoids having that particular day where everything hits rock bottom and the only solution seems to be suicide.
For some people just therapy is not sufficient but need also medication.
Psychiatric illness is something where many people have misunderstandings. Since many people go through depressive episodes, they feel that their experience is the same as others who are facing chronic depression. And since it is not physically visible, it is also hard to empathize with.
No one says you can come out of heart disease or diabetes by just bearing it bravely. Somehow for psychiatric illness people assume that it is something that can be braved out.
> . Despite my depression, I always avoided antidepressants for some ineffable reason-- a hunch, a nebulous suspicion, I'm not sure what to call it.
Yeah, I did that too, then I took some and I was less goddamn depressed aftwards.
[dead]
How can you believe it's both "no better than placebo" but also that it's "going to have his brain chemistry altered and essentially be addicted to a drug". SSRIs are not considered addictive, though people can develop a dependence if it provides them significant improvement.
The whole point of the linked article is that the drug is no better at placebo at treating depression but also carries a host of known side effects, besides unknowns when it comes to long term use. They're not saying it's inert.
That's fair, though I never implied that there were no side effects. The part I was trying to point out in the quote was the mention of it being addictive which is not really supported, nor is that mentioned in the article.
A drug can have real effects while being no better than a placebo for doing something specific (what they're supposed to do).
Okay, so what makes you believe that about prozac (or SSRIs) then?
Here’s a paper from last year: The nature and impact of antidepressant withdrawal symptoms and proposal of the Discriminatory Antidepressant Withdrawal Symptoms Scale (DAWSS) https://doi.org/10.1016/j.jadr.2024.100765
‘Highlights
• Antidepressant withdrawal can be severe and protracted.
• It produces characteristic physical and emotional symptoms.
• All symptoms were more severe after stopping than before starting antidepressants.
• We identified the 15 most discriminatory withdrawal symptoms in our sample.
• Withdrawal did not differ between people with physical or mental health diagnoses.’
O cool. Do you have any appointments I can book for my kid?
Mine too! Only 2 years old but I can already see the massive anxiety bursts in him.
If this guy has a non chemical cure, I'm all for it. In fact I'm actively researching children psychologists to stave off the meds as much as we can, the problem is that 99% of psychologists are quacks, so choosing them is tough.
There's only so many times a kid can get sent home from school for biting/kicking/punching before you realize you need some professional help and will do anything to help the poor kid. I wish you luck.
I'm very sorry to hear your story, and I'm really glad the medication has worked well for you and your family. It's early days, but it seems to be working well for ours too.
I also really admire the way you're dealing patiently with everyone in this thread arguing in bad faith, you have a lot more tolerance than I do! Hopefully it's not getting to you. Best wishes.
That's what freaks me out about these drugs. You-on-the-pill becomes you, and you can't ever stop.
Sorry, I don't mean to second-guess your choices. There's clearly some very interesting issues here, and my experience is as someone who never felt they had any serious issues with mental health. But I do think that we have this culture where everyone is expected to be OK all the time. Do you worry at all that your son cues in to his parents relationship with the drug? I mean, say it was me, and I knew my parents took a pill so that they could "have a good day" but they didn't give me the have-a-good-day pill. I would think (perhaps subconsciously) that if I was having a bad day the drug could have made it into a good one. Having a bad day would be medical now, a reason to feel like you're sick or broken.
Prozac doesn't define me. It's just something I take to address a health condition, like an iron supplement for low iron levels or amoxicillin for strep throat. My kids learned about it because they saw me taking a pill every day and asked what it was. No biggie.
To be clear, Prozac is not a "feel-good" pill, it's a "gradually feel more stable" pill. It makes my lows less debilitatingly low and more manageable -- my lows are now largely logical responses to difficult events, as opposed to randomly happening for no reason at all. The effect is very gradual and subtle: you can't really evaluate it until after several weeks, and then the "evaluation" is a conversation about whether your affect has seemed generally more stable recently. An average person taking Prozac would probably notice no effect at all, good or bad. By contrast, a stimulant like Adderrall will have a noticeable effect on anyone within minutes.
My son never asked for Prozac or for a "feel-good" pill. My kids have heard of addiction before so we've talked about pills that do make you feel good and why they're dangerous, and also "dopamine drips" like brainrot on YouTube.
That's fair. Thank you for your thoughtful reply.
well when the you-off-the-pill wants to kill yourself, becoming you-on-the-pill is a pretty rad thing
Such a simple concept, and for some reason so difficult to grasp for certain people. Usually the ones not coming across as particularly empathetic or open-minded.
I suppose the "good" news is that is just how life goes. Conceptually similar comparison to someone who is hungry and someone who isn't - the tendency towards snapishness is definitely there. Who someone is becomes unstable of long stretches of time (unless they are very boring), it results more from the present conditions that involve them than anything else.
The main issue with drugs is they are more likely to have unexpected or socially harmful side effects than most things.
> My sister and I looked at each other and at the same time went, "Ohhhh!"
I suppose the next step would be to upgrade from single-blind to double-blind, so that your mom won't know which month is the placebo month...
Interestingly my son has an identical twin! I like to joke that one is the control and sleeps in the house and the other has to sleep in the storage shed out back, and when they're 18 we'll publish a paper comparing their emotional development. :)
I always thought DNA determined pretty much everything, and we raised them exactly the same, but they have distinct personalities and some different physical features, although of course they're much more similar than they are different. My other son shows some symptoms of anxiety but not as much, yet.
> like to joke that one is the control and sleeps in the house and the other has to sleep in the storage shed out back
Glad to see you have your priorities straight! :p
https://www.girlgeniusonline.com/comic.php?date=20090706
I am surprised by how many people seemingly independently come up with a completely indescriptive "bad day" label - for the lack of a better one.
Good that things are working out for you.
Recently found that, on top of meds (that started wearing off - after taking them for a couple years now following a challenging life situation), going to social latin dance classes for a couple hours almost every day after work helps quite a bit.
I’m thoroughly impressed with how you handled the comments in this subthread. As someone who was on and off antidepressants for years, I can say confidently that for every one person spewing vitriol and judgement at you for your parenting decision, there was someone else solemnly nodding and sending love to you and your family. People just don’t fucking get it unless they get it. Best of luck to you.
I recently started giving my 11 year old SAM-e, available over the counter and much faster acting than SSRIs for serotonin support. He's been much happier and more regulated since taking it. I'd encourage folk to read up on the literature around SAM-e and consider it as a lower risk alternative to try first, that may in fact work better.
Out of curiosity - do you know whether SAM-e can be taken safely with SSRIs? I went looking for this a bit back and didn’t find anything conclusive. I know there’s a handful of seratonergics to steer clear of, but I didn’t get a good answer about SAM-e.
> Pills are for people who feel depressed but don't have something to be depressed about -- they have food, shelter, friends, opportunities to contribute and be productive, nothing traumatic has happened, but they feel hopeless anyway
This warrants a whole different discussion, and I'll be down voted for it, but one that's never addressed: quality over quantity.
Pills are the individuals response to a society that feeds empty food, bland sterile shelter, fake friends, and meaningless jobs.
The natural human response to a lack of meaning is hopelessness, and this comes from our society. Pills helps individuals cope with continuing the meat grinder just a little while longer.
I had depression, and I cured it by finding meaning and beauty in the world. I get told "if you can cure it without pills, you never really had it" yeah cool, self fullfilling prophecy in that case innit. Can't cure it, because it doesn't exist without meds. It just comes out of "nowhere" and is here to stay.
I agree with your perspective but these things are on a spectrum. For very severe cases medication can be highly helpful and supportive, as they move to find their meaning and purpose. Each person’s situation is unique and I think blanket judgements are unhelpful.
> I cured it by finding meaning and beauty in the world.
That's incredibly fortunate and I'm very jealous of you. How would you recommend one goes about finding meaning and beauty? I'm fortunate to have had lots of unique experiences and traveled to lots of unique places and still haven't found the fulfillment that you seem to. That's basically what depression is: a debilitating feeling of lack of fulfillment, without any idea of what's missing.
I'm happiest when busy building and fixing things. It could be that if I was born 200 years ago into an agrarian society where day-to-day life was focused on building and fixing things to survive, then I would have felt very fulfilled and done quite well. What were gainful full-time jobs back then have been reduced to hobbies now, though: blacksmithing, cobbling, weaving, hunting, making furniture, etc. Hobbies don't fill the hole for me. Sure, a few artisans are still able to turn those into a living, but a large part of the job is marketing and the clients are largely the wealthy elite. I've enjoyed working in food service and construction but it's hard to support a family of 4 doing those. So my career has been in software engineering since that involves building and fixing and pays well, but it still doesn't fill the hole.
If this sounds whiny I'm painfully aware. What right do I have to complain about feeling unfulfilled when there are real problems in the world? And that's the very essence of major depression.
For what it's worth, I have dealt with pretty severe depression for most of my adult life. I am only starting to have periods of coming out when I realized that most of depressed feelings come from a place of ego. I have an identity of who I am and what I like, and I seek things in the external world which might provide meaning for me. For me, it's because I always sought value from the things around me, rather than believing that I am already enough. Every single day, I have to beat down my instincts that tell me that I am worthless and remind myself that there is more beauty in the world and it's actually absurd that I am letting society tear away from me my natural instincts to want to live and enjoy life. You have to really sit with these feelings though... like really really get to know your voice vs the internalized societal voice. I have developed "tests" that help me discern which voice is which, but it has helped a bit. Also working out and taking care of your body is a bonus, and just taking pride in like... doing things to lead a peaceful life is underrated. Hope you feel better.
I hope you can understand that this and other comments about needing to find meaning and needing to sit with inner feelings... It feels patronizing. I have spent tremendous amounts of time and energy analyzing my feelings and looking for meaningful experiences. I've sought relief in meditation, religion, therapy, yoga, travel, art, etc. Most people probably have in one way or another. It's not rocket science to know those activities may be beneficial. They undoubtedly do help some people overcome feeling depressed. But feeling depressed is different from having depression.
I'm sorry it came off that way, I really didn't intend it to be, it was actually a self call out because I actually never learned as a child to sit with my inner feelings. I attribute that to being more sensitive and probably more intelligent than my siblings and acting as a buffer for my parents and basically only ever wanting to make other people happy, I never developed an inner world like other kids do.
Also I noticed... yoga, travel, art, those are still external. Even meditation can be if you approach it from a standpoint of like... one that is about forming your ego around it rather than being present... not sure if this makes sense. Like you can approach anything from a negative or place of wanting to 'fix' yourself, which ruins the experience imo. For me I would ruin things that were supposed to be fun because I would tell myself I should do this because it's good for me.
That being said, there are really low days still when I will feel absolutely nothing, I will think to myself... if this psychological pain is so intense, why should I keep going? I don't have answers for that. I genuinely just have to make it through the day. I understand that with the pressures of a family and kids, it's not one of those things where you can easily tap out, medication makes sense for that. I was just trying to share how I feel because honestly for me there isn't anyone in my life who I can relate with on this deep of a level... of these feelings, and it's really alienating in itself.
> So my career has been in software engineering since that involves building and fixing and pays well, but it still doesn't fill the hole.
A brief thought on this - I’ve found working in large software companies to be fairly unfulfilling, but working at smaller shops focused on delivering something other than software, or for which there’s some tangible connection to the real world, to be much more fulfilling. At its best, software engineering is indeed a craft and something you can take pride in and something where you can have a real impact on people’s lives by building things. A lot of that gets lost somewhere between the third roadmap meeting and the weekly scrum session to figure out how to prioritize product’s requests alongside paying down tech debt so we can improve ad unit performance, but the craft of software itself is still a creative act.
That's exactly the problem, "meaning in life" has no static definition and there is no possible way to explain it in general terms, even for people who proclaim to have "found" it.
Pills, on the other hand, are easy to understand. This is not to say that they are a viable substitute in any way, but it does explain why so many prefer substance treatments.
That's a good consideration.
Meaning in life is hard and personal. Some might have no idea where to start.
But I'd argue (somewhat pointlessly as I'm not going to change anything) -- This is the role that society, traditions, family, etc. has: "to bring people up" swimming in the same stream, given a purpose and meaning, etc.
> I'm fortunate to have had lots of unique experiences and traveled to lots of unique places
For comparison I've barely traveled more than 1000kms. Never had a passport. Travel is not related.
> where day-to-day life was focused on building and fixing things to survive, then I would have felt very fulfilled and done quite well.
Incorrect assumption; It's not the building and busy-ness. And the experience doing hobbies supports that. Nothing fills that "hole".
The feeling, the "hole" you're missing, is a combi-mix of purpose/meaning/larger-picture. I know it because I also had it. Many people try politics to fill their hole too, which also doesn't work: political parties are not big enough.
I'm not going to try to persuade you to change your life, I'm going to talk about what did it for me, and you (and others) can spectate and speculate, take and leave whatever you want. I'm sure I'll get flagged anyway.
My great realization is that nothing is set in stone, everything changes at all times, and humans have survived it.
> a debilitating feeling of lack of fulfillment, without any idea of what's missing.
A good way to start out is to start thinking about: what is your mission? What is your tribe in the world stage? are there messages or lessons from the ancestors of your tribe?
Shy away from getting over-scientific. Simple broad points. The universe is in constant change and chaos. But humans have survived for a long time. We have "lizard" brains that give us reactions, then we have learned / ingrained behavior on top of that, through all this time we've encoded "how to survive" in our brains and throughout our history; we are a storytelling species, so what stories do we have from history (note: not about history, but from history).
Realising stories, like fairytales,(ie: Rumpelstiltskin) etc - ARE old stories that ENCODE information as a way to pass knowledge from culture to culture. WHAT information is in there? what are they trying to tell us? This is the tribe of "humans" telling us something from the past, which is actually absurdly interesting and fulfilling to try and learn from.
Yes this is all "woo-woo" stuff, none of this is going to be a revelation to you. I'll probably look like a quack, but You can have a ponder about it, and realise that there's a big group that you're a part of, and there is a bit of a cosmic mission, and history plays out every day.
this won't give you purpose or fill the hole, but I think you might start to chip away at some different things in your life, (or you won't and I've just wasted 5 mins of your time, ¯\_(ツ)_/¯ who cares)
Sorry but giving a 7 year old prozac is psycho behaviour.
do you genuinely think depression is preferable? suicidality?
What do they do when they turn 15, realize they, say, have no sex drive, but have been on anti depressants for years and cannot take a break from life in order to now learn the emotional regulation skills they should have developed from 7-15? Antidepressants often mask issues which later manifest in unexpected ways, even if you don’t notice any immediate side effects.
A post on HN a couple years ago discussed research showing antidepressants only work for about 15% of patients: https://news.ycombinator.com/item?id=37671529
The thing is, they work very well for that 15%. I suspect the eventual conclusion will be that depression is a syndrome with multiple causes rather than a single condition, and SSRIs treat one of the causes.
Edit: Mark Horowitz is one of the authors of both studies.
The NNT[1] of Prozac, and SSRIs in general, has been previously estimated around 6. Meaning that treatment is more helpful than a sugar pill in only 1 out of 6 cases (a dirty secret).
Meanwhile the NNH[2] is as low as 21, that is 1 in 21 cases will stop due to negative side effects.
Source: https://www.aafp.org/pubs/afp/issues/2008/0315/p785.html
[1]Number Need to Treat, that is, number of patients you need to treat to prevent one additional bad outcome
[2]Number Needed to Harm, that is, number of patients you need to treat to generate side effects so bad that someone halts treatment
I suspect the biggest, but not the only, problem with these supposedly weak SSRI/SNRI numbers we routinely see in clinical trials has to do with the definition of depression, with the diagnosis itself. For example it has some of the worst inter-rater reliability across the entire DSM (meaning that two doctors are least likely to both reach the same diagnosis in the same patient independently). So if you start from a poorly defined set, which likely encompasses some genuine affective disorders, people going through difficult times, undiagnosed personality disorders, dysthymic ADHDers, burned out ASDs, and God knows who else - yeah, you'll get poor performance data. Every psychiatrist knows intuitively that SSRIs/SNRIs do work, even if you have to trial a few. Also, without arguing about the number, that 15% is not exactly the same 15% for each drug.
Also, since we're here: the secret knowledge about depression (and affective disorders in general) is that it is an episodic illness, where episodes are measured in weeks or in months. Most people experience just one episode which will end whether or not any medical intervention is undertaken, although the intervention can greatly shorten the course and avoid a potential suicide. But some will not stop at one episode, and can go on to have multiple episodes, perhaps develop melancholic features or even suffer from a lifelong recurrence. It is in the latter groups where medication is the most effective.
The disclosure section in the cited research article may indicate a financial interest in the authors being able to say that Prozac is not effective:
“ MAH and JM are co-applicants on the RELEASE and RELEASE + trials in Australia, funded by the Medical Research Future Fund (MRFF) and the National Health and Medical Research Council (NHMRC), evaluating hyperbolic tapering of antidepressants against care as usual. MAH reports being a co-founder of and consultant to Outro Health, a digital clinic which provides support for patients in the US to help stop no longer needed antidepressant treatment using gradual, hyperbolic tapering; and receives royalties for the Maudsley Deprescribing Guidelines. JM receives royalties for books about psychiatric drugs, and was a co-applicant on the REDUCE trial, funded by the National Institute of Health Research, evaluating digital support for patients stopping long-term antidepressant treatment. MP and RL have no conflicts of interest to declare.”
I would caution those in this thread who have never seen or treated patients in any psychiatric clinic or hospital let alone a pediatric one to be careful assuming that they have adequate experience to make sweeping judgements on the utility of antidepressants in children.
From the article:
> They can also increase suicidal ideation.
A very close family member committed suicide, after Prozac dosage adjustments made his brain chemistry go haywire.
This happened 30 years ago, and it has been known to us that Prozac can cause this, since then.
The Guardians headline is way, way understating the real situation here.
The problem with suicidal depression is that if someone has created the thought pattern that death is best, then removing the symptoms of depression (lethargy, lack of energy, no willpower) now gives the person the ability to actually follow through with the act.
Medications almost always target symptoms and never address root causes.
This is a good thing to know, but should also be noted that the same thing can happen with simply naturally recovering from a depressive episode.
The phenomenon should not be considered a reason to not medicate (which I don’t think you are implying, but some may take that as the conclusion). Instead it’s definitely something important to explicitly make people aware of.
Depression or the feeling so much mental agony that the idea of escaping with death becomes comforting, is a signal that something is wrong.
Realizing this has been important with weathering my own occasional dealings with severe[0]depression, once I realize “something is wrong”, I can start the annoyingly slow process of trial and error making changes to correct things. This turns depression from “how reality is” into “this is just feedback on my body’s state”. It turns things getting worse into either a “this is either a transient state or the wrong solution”.
[0] Which I define as the point where any passive ideation (fantasies of dying) starts to enter the gradient of becoming involuntary. As opposed to regular negative thoughts which can (and should) be brushed away as easily as a fly landing on me. Curiously, once I noticed it also affected my ability to experience color. While I could technically see colors, it was like have a mental partial greyscale filter because there was no beauty in it, color was just a meaningless detail.
A sudden improvement in mood is one of the key warning signs for suicide. Often it's genuinely just a sudden improvement, but sometimes it is a byproduct of the relief people experience when they commit to ending their life. If you know someone who is severely depressed, you should watch them very carefully if they suddenly seem carefree.
>once I noticed it also affected my ability to experience color
A small amount of evidence does support the notion that depressed people literally see the world as being less vibrant.
https://pubmed.ncbi.nlm.nih.gov/34689697/
https://cdnsciencepub.com/doi/10.1503/jpn.200091
This is what my psychiatrist more or less warned me about when I went on medication; that a lot of people who are suicidal lack the energy and ability to plan their suicide, and medications can sometimes undo those particular symptoms and people manage to end themselves.
I'm not sure what kinds of studies have been done about it, but I've had a few therapists same similar ideas. If it's not a studied phenomenon, then it has folks that believe it exists.
I'd like to make the point that even if this does occur, it doesn't mean, "therefore this medication shouldn't be used/is worse than doing nothing," just that awareness and caution is needed.
I went through a frankly terrible few months on my current meds because they removed the emotional numbness before removing the bad feelings. However, once that was over they effectively gave me my life back after 10+ years of continual exhaustion and brain fog.
This theory is a science-free zone. It seems far more likely that the drug induced sudden, overwhelming suicidal thoughts than someone said "I feel the best I've ever felt and life is looking up. I think I'll kill myself and make all the good feelings go away".
Furthermore, if the latter were true, it would be an indication that depression was a symptom rather than a cause and the psychiatrist misdiagnosed and improperly treated the patient.
Sometimes willpower improves before mood.
[flagged]
Depression is likely to have many possible underlying causes.
It’s a description of a persistent set of symptoms not necessarily any specific biological process.
>Depression is likely to have many possible underlying causes
including adaptive evolutionary procreative success
Correct.
and one of the leading causes is what I described.
You really have to unpack "detox inefficiency" because even a google search comes back with nothing.
When your normal lymphatic processes (and glymphatic processes) are slowed, or near-halted.
Can you link any evidence supporting this claim?
Beyond the links in other comments?
No, ones that would support your claim.
And at least mention terms you used.
Do you not count depression as a mood disorder…?
Is there a known correlation between lymphedema and depression?
Calling it lymphatic impairment would be more straightforward.
Lymphatic inefficiency, maybe.
Impairment sounds too permanent, when this is often an intermittent, “on average” sort of issue - not a complete freeze.
It might be worth using those words rather than detox inefficiency because the latter conjures thoughts of woo peddlers.
Yes,
it turns out toxins (environmental, die-off and waste of cells from infection, dietary, lifestyle) are important to everyone,
not just vegans in Sandler movies.
What is "detox inefficiency"?
EDIT - I ask because the only results I get when searching are a Harvard article debunking it. I'd rather hear the opinion of someone that actually believes in it before I read about why it's all malarky. I believe in arguing against the best version of someones argument.
https://www.health.harvard.edu/staying-healthy/the-dubious-p...
https://my.clevelandclinic.org/health/body/glymphatic-system
PS Thanks for keeping this a good place to be!
https://news.ycombinator.com/newsguidelines.html
More for the avid reader:
1.) https://pmc.ncbi.nlm.nih.gov/articles/PMC7698404/
2.) https://pubmed.ncbi.nlm.nih.gov/40012567/
3.) https://pubmed.ncbi.nlm.nih.gov/36498538/
Your first linked page has no word "depression" on it
It wasn’t intended to.
It was just the best “every man” link I could provide for understanding how efficacy of toxin-clearing (toxicity) could be related to depression, other struggles with homeostasis.
Did you grasp the connection?
I am still waiting for something that would support your claim rather than mention something sort - of - related.
Do you not count depression as a mood disorder…?
This gets even more interesting when you realize many SSRIs are antibacterials.
It gets less interesting when one notices that social animals are much more prone to depression.
Inflammation and depression are linked. Infection causes inflammation. It doesn’t follow that depression is caused by infection.
I’m not quite following the previous conversation here, but your comment brings to mind that one theory of a possible “function” of depression, is as a “sickness behavior” to help isolate a sick animal from others to protect the group. A sheep or cow getting sick and going off on its own is a common thing.
I’m not sure if it has a technical name or if it’s been rigorously studied, but it’s a common observation which even I’ve seen (and reported to growers I work for).
A casual mention here: http://www.sheep101.info/201/behavior.html
> but your comment brings to mind that one theory of a possible “function” of depression, is as a “sickness behavior” to help isolate a sick animal from others to protect the group. A sheep or cow getting sick and going off on its own is a common thing
It's one explanation of the phenomenon. I'm not remotely convinced by it, but that doesn't mean I think it's untrue.
What I do think we can conclude is that we have no evidence depression is caused by infection. (Singularly and universally, as OP implies.) With higher confidence I believe I can conclude that interrogating chatbots designed to keep your attention is a poor way to resolve this.
> we have no evidence depression is caused by infection
Besides talking to patients and reading case files.
You can wait another decade or three for someone to spend the money on a specific study that meets your individual criteria (I'm sure very high), for doing obvious things like:
1.) Treating known infections, testing for others,
and
2.) Addressing nutritional gaps, as well as tracking circadian/endocrine, and nervous symptoms (which often intertwine with depression symptoms!)
but I will not wait.
I'd prefer to no longer be depressed, and/or unwell.
So I'll do the obvious things – even if they're not obvious to you, yet.
Correct.
It’s caused by inflammation,
one of the causes being: detox inefficiency.
> It’s caused by inflammation
No, it’s not. Depression can be influenced by inflammation.
This thread is a good example of the GIGO pitfalls that researching with chatbots entails.
Yeah, “linked to” is better than “caused by” here, for sure.
Not often this kind of thing comes up on HN, so I was replying in haste at a stoplight!
I’ll ignore the slight, which you should know better than.
It seems pretty common for people to read "linked to" and interpret that as "caused by". It feels like media had kind of pushed that for a long time.
Stopping back in, because I unironically came across someone's almost-surely AI assisted summary that does a better job than I have summarizing the processes being discussed:
== === Why the Sick Get Sicker Most people think illness progresses because of pathogens, toxins, or genetics — but the deeper truth is that tension, stress, and breathing patterns control the trajectory of health more than anything else.
When the body is stressed, the breath changes.
When the breath changes, the lymph stagnates.
When the lymph stagnates, toxins accumulate.
When toxins accumulate, inflammation accelerates.
And that is how sick becomes sicker.
Here’s the breakdown:
1. Stress Immediately Changes Your Breathing Pattern
When the nervous system senses stress — emotional, physical, mental, or energetic — breathing becomes:
• shallow
• rapid
• high in the chest
• tight in the ribs
• limited in diaphragm expansion
This cuts oxygen supply, raises cortisol, and signals the body to brace.
Bracing = stagnation.
2. Your Breath Controls Your Lymphatic System
The lymphatic system is the body’s drainage system, and it has no pump of its own.
It relies entirely on: • diaphragmatic breathing
• muscle movement
• fascia softness
• a calm nervous system
Shallow breathing = no diaphragm movement.
No diaphragm movement = lymph stagnation.
When lymph stagnates:
• waste can’t drain
• toxins recirculate
• inflammation builds
• swelling increases
• the immune system gets overwhelmed
This is why people in long-term stress decline rapidly.
3. Chronic Tension Physically Constricts Detox Pathways
Tension in the shoulders, neck, jaw, abdomen, and ribs acts like a clamp on the lymphatic system.
Chronic tightness:
• blocks lymph nodes
• stiffens fascia
• shuts down circulation
• compresses nerves
• restricts oxygen
• slows detox
The body becomes a closed loop where waste can’t leave — so it begins leaking into tissues, joints, and organs.
This accelerates aging, pain, brain fog, and inflammation.
4. This Is the Progression From Sick → Sicker
When breath + lymph + fascia are blocked:
Phase 1 — Shallow breathing
Fatigue, anxiety, tight chest, poor digestion.
Phase 2 — Lymph stagnation
Swelling, puffiness, inflammatory symptoms, chronic infections.
Phase 3 — Detox recirculation
Migrating symptoms, rashes, headaches, histamine issues, chemical sensitivity.
Phase 4 — Systemic overload
Autoimmune symptoms, mold sensitivity, debilitating fatigue, hormone disruption.
It appears “mysterious,” but physiologically it is predictable.
Please don't do this.
Please don't do this.
You've contributed nothing curious to this thread whatsoever, just threw some doubt in, then buggered off during the replies – more or less communicating "stuff I can't directly or completely refute is AI slop".
That's....disappointing.
I saw this textpost made by someone else, and literally thought of you, JumpCrisscross.
Can you link any evidence supporting this claim? This term sounds like a standard-issue woo.
Replied to your other request too: see other comments, ask for what’s missing for you.
Links to materials that would support your claim.
And at least mention terms you used.
Do you not count depression as a mood disorder…?
Do you often require people you’re chatting with to have three copies of the same conversation?
Finding everyone’s cow is expensive and time consuming: https://antidepressantcow.org/2020/02/the-story-of-the-antid...
But is the only true cure to the suffering. We’d have to undergo a massive reorganization of society (and upset a few hefty profit margins) to prioritize that, so we settle for the messy symptom management we have.
That story doesn’t work for people with depression who otherwise have very good lives.
I grew up in a stable household with a loving family and both parents present and supportive. I’ve never had financial hardship, either as a kid depending on my parents to provide or as an adult providing for myself and family. I did very well in school, had plenty of friends, never had enemies, never got bullied or even talked bad about in social circles (so far as I know…). I have no traumatic memories.
I could go on and on, but despite having a virtually perfect life on paper, I have always struggled with depression and suicidal ideation. It wasn’t until my wife sat down and forced me to talk to a psychiatrist and start medication that those problems actually largely went away.
In other words, I don’t think there’s a metaphorical “cow” that could have helped me. It’s annoying we don’t understand what causes depression or how antidepressants help, and their side effects suck. But for some of us, it’s literally life saving in a way nothing else has ever been.
First of all, I want to write that I am glad you found something that worked so that you are able to remain here with us.
Though, I am curious about the, "otherwise have very good lives" part.
Whose definition are you using? It seems the criteria you laid out fits a "very good life" in a sociological sense -- very important, sure. You could very well have the same definition, and perhaps that is what I am trying to ask. Would you say you were satisfied in life? Despite having a good upbringing, were you (prior to medication) content or happy?
I am by no means trying to change your opinion nor invalidate your experiences. I just struggle to understand how that can be true.
As someone that has suffered with deep depressive bouts many times over, I just cannot subscribe to the idea that depression is inherently some sort of disorder of the brain. In fact, I am in the midst of another bout now. One that's lasted about 3 or so years.
To me, I have always considered emotions/states like depression and anxiety to be signals. A warning that something in one's current environment is wrong -- even if consciously not known or difficult to observe. And if anyone is curious, I have analyzed this for myself, and I believe the etiology of my issues are directly linked to my circumstances/environment.
> I don’t think there’s a metaphorical “cow” that could have helped me.
The smart-ass in me can't help but suggest that maybe medication was your cow?
> Whose definition are you using?
To be honest, I've never really thought about it... I suppose I mean in both a sociological and self fulfillment way.
> Would you say you were satisfied in life? Despite having a good upbringing, were you (prior to medication) content or happy?
I would say "yes" overall. Aside from the depression (typically manifesting as a week or two of me emotionally spiraling down to deep dark places every month or so), I was very happy and satisfied. That's what makes the depression so annoying for me. It makes no sense compared to my other aspects of life.
> In fact, I am in the midst of another bout now. One that's lasted about 3 or so years.
*fist bump*
> To me, I have always considered emotions/states like depression and anxiety to be signals. A warning that something in one's current environment is wrong -- even if consciously not known or difficult to observe. And if anyone is curious, I have analyzed this for myself, and I believe the etiology of my issues are directly linked to my circumstances/environment.
I think that's a great hypothesis so long as it's not a blanket applied to everyone (which I don't think you're doing, to be clear; I mention this only because it is what motivated my original response to the other commenter).
I don't want to go into private details of family members without their permission, but I will say that given the pervasive depression in my family and mental health issues like schizophrenia and bipolar disorders (neither of which I have, thank goodness), I feel like there's something biologically... wrong (for lack of a better word?)... with us, particularly since you can easily trace this through my mother's side.
> The smart-ass in me can't help but suggest that maybe medication was your cow?
Ha fair. I interpreted the story to be about depression being a symptom of your situation (job, health, etc.) and if you just fixed that then there's no need for medication. That definitely makes sense in some (many? most?) situations. But not all, unfortunately.
Take my baseless speculation for what it's worth, but could it be that you were depressed because your life was too easy? We humans are meant to struggle through adversity. Can you really appreciate your financial security if you've never faced financial insecurity, or appreciate companionship if you've never experienced loneliness?
It’s a reasonable question but I doubt it. We weren’t affluent at all and I worked my butt off for everything. And that’s good, because I agree that if things are too easy it turns into a curse.
> I don’t think there’s a metaphorical “cow” that could have helped me.
The medication is the cow for you. In this story your support system figured out what would work best for you, which was medication, and facilitated that.
It’s a story about a doctor that serves patients in rural Cambodia. Help from the local community would look different in Borey Peng Huoth, for example.
I think that's a huge stretch.
"Your community" isn't your doctor. This annecdote, to me, is cleariy an attempt to blame modernity for depression.
The story in the article that is being discussed here does not say that the doctor was explicitly not a member of the community that he served. You would have to just sort of make that part up and then come up with an explanation for how the doctor even knows that story if he wasn’t part of that community.
The doctor in the story exists in pretty recent history, which you would call modernity. If for some reason you’re using “modernity” as a way to say “systemic alienation of the individual” rather than “modernity” meaning “happening in the modern world” then yes, by your definition of that word, it is indeed a story about “modernity” being to blame for poor treatment for depression.
very interesting. would you be comfortable sharing what therapy uncovered as the cause for you?
Part of the diagnosis procedure for major depressive disorder is ruling out physical conditions that can cause similar symptoms. No one is going to miss that the guy had his leg blown off.
I mean sometimes. For me it was multivariate for sure. Biggest problem - wife and kid. Helped a ton. My specific wife, really. I doubt someone else would have helped me. I had a lot of self defeating thought patterns she helped me fix.
Second - light. Lots of light, specifically in winter time. Like this https://www.benkuhn.net/lux/
I had a horrible time with school because as finals rolled around in the fall semester I’d get extremely depressed and anxious.
People would very likely still develop depression in whatever utopia you could imagine.
For starters, everybody has a different utopia, so no matter how you change society it "won't work" for someone.
And depression isn't sadness.
My understanding is that the optimal scenario is taking an SSRI in combination with therapy. The SSRI adds flexibility for the brain to respond to therapy and envisage new possibilities. If you don't include therapy, you've just established a new baseline to habituate to.
This is true overall, but it only works for a limited set of patients. It's pretty likely that what we're calling depression is a different set of diseases that manifest with common symptoms, and SSRIs + therapy work wonders for some variants, but not others.
In fact, we actually do know this to be the case already: bipolar disorder also manifests with the same symptoms as depression for some time, and SSRIs + therapy are definitely not enough to treat bipolar disorder. Most likely there are other similar diseases that present with depressive symptoms that we have yet to identify distinctly and don't know how to treat effectively.
Yes, this is what happens.
No it's not.
[flagged]
Yup. Depression medication can significantly help the emotional symptoms, but that takes longer to be effective.
I’m bipolar and a lot of the medication I take does not become fully effective for months. For me, my medication slowly became more effective over years as my brain no longer had to compensate for hardware problems.
I also had a close family member who committed suicide shortly after going on Prozac -- this also happened nearly 30 years ago. His young son later went on Prozac himself (several months after his fathers suicide) and immediately started demonstrating bizarre disinhibited anti-social behavior (e.g., damaging property, stealing from friends, etc). He was immediately yanked off Prozac when he started articulating his own thoughts of suicide. The bizarre anti-social behavior improved after discontinuing Prozac.
For some people, Prozac is a very dangerous drug. It is fully deserving of its FDA black label warning (which it didn't have 30 years ago).
That sounds like mania which is even more likely considering that early depression is often actually bipolar.
Suicidal ideation is a risk for many CNS drugs, and not unique to Prozac as far as I know. But yes this is a major risk factor that needs to be taken in account before such kind of treatments.
Isn't that a possibility with a lot of drugs though? I think it depends on the rate and not a "does or does not" type of questions. Now if the drug doesn't help more than a placebo that's clearly a huge negative, but if it has a high rate of success vs placebo then they will make adjustments and watch out for the side-effect (of course) letting patients know it's a possibility and to report if it starts happening.
The efficacy of anti-depressants has been consistently over-inflated, so generations were poisoned with side-effects: suicidal ideation, homicidal tendencies, etc.
https://pubmed.ncbi.nlm.nih.gov/20616621/
Results: Meta-analyses of FDA trials suggest that antidepressants are only marginally efficacious compared to placebos and document profound publication bias that inflates their apparent efficacy. These meta-analyses also document a second form of bias in which researchers fail to report the negative results for the pre-specified primary outcome measure submitted to the FDA, while highlighting in published studies positive results from a secondary or even a new measure as though it was their primary measure of interest. The STARD analysis found that the effectiveness of antidepressant therapies was probably even lower than the modest one reported by the study authors with an apparent progressively increasing dropout rate across each study phase.*
I can't bring myself to try an SSRI. I just cannot do it. I've got a prescription for an NDRI on my desk, and I still won't take it. I am not anti-psychiatry either. I take psychiatric medication for a different condition already. But something about anti-depressants just doesn't sit well with me.
As crazy as it may sound, I think a lot of my depression stems from living a life that is not true to myself and due to countless failed attempts to be someone I cannot never be. As far as I am concerned, depression is just a symptom of my situation and not some true disorder. For the sake of analogy, I would say it's like food poisoning. Yes, the GI issues are awful, but the body is responding appropriately.
> I've got a prescription for an NDRI on my desk, and I still won't take it. ... something about anti-depressants just doesn't sit well with me.
At first it sounded like your antipathy was with SSRIs specifically (which I largely share), but it seems like it's anti-depressants in general.
FWIW, I used to think similar to you, and roughly agree with the gist of your second paragraph, but I've come to think of antidepressants as useful in a specific way: people say "it's a crutch" as a negative thing (about a lot of things including antidepressants), but a crutch was very useful to me when recovering from a fracture, and helped me enormously with my progress; similarly, even if "depression is just a symptom of my situation", it can and does often lead to a cycle where the depression itself feeds into the situation and in turn sustains itself. An antidepressant that works for you is a good way to be able to see things more clearly, feel the motivation and insight that depression clouds out, and thus be able to break out of the cycle.
It doesn't have to be a "cure" that counters a disorder, it can be a tool that you use for its purpose and then throw away (and it does sound like you're well-motivated to do that).
> not some true disorder
there's a tool on your desk that might help you solve your problem; what does it matter if the problem is an "appropriate response of your body"? so is pain/anxiety/diarrhea
> stems from living a life that is not true to myself and due to countless failed attempts to be someone I cannot never be.
If this is their mindset, they might benefit from CBT more than medication.
I'm not against SSRI at all. But after taking them for a few months in my 20's, and experiencing how terrible the withdrawal symptoms are when stopping, I'd be very hesitant to ever start up on them again. I remember having to open up the lowest dose pill capsule and splitting the dose into very tiny increments to be able to wean off completely.
I'm the GP of this comment chain. I actually did a 16 week long trial of CBT with a professional where my symptoms were tracked during each week. I actually ended the 16 weeks worse than before I started.
I later learned that CBT can have that effect on people with ADHD, so I attribute that to being a possible explanation.
I still do therapy, but honestly, I think it's a waste of time and money. I predominantly do it for cathartic purposes and so other people/professionals will stop recommending it.
> terrible the withdrawal symptoms are when stopping
I tried one when I was in my early 20s too. I swore I would never take one again. Withdrawals weren't my issue really. It was the clarity I gained after getting off. I realized how awful I was to people around me. I had such blunted emotions, that I basically became devoid of empathy. I also learned that I needed high levels of anxiety to function, which the medication took away from me.
One needs to not work and be able to remain at home for about a week or so to see if the side-effects are manageable. One shouldn't simply continue on with operating machinery or working a job while titrating up a new psychiatric medication. Honestly, employers should offer medical time off for this.
SSRI can have annoyances (to stay polite) if you ever need a fix so much that you go that route, be sure to ask about them. Didn't help me really but I believe that sometimes, a bit of chemical (placebo or not) relief can help staying afloat enough to work your way back up quicker.
I understand your comment, my issues were due to life circumstances and not a low level neurological imbalance, and I too dismissed these treatments almost entirely, mostly because they felt like blanket solutions from medical professionals who didn't really listen to symptoms.
> medical professionals who didn't really listen to symptoms
Even if they did listen to me, what else can they do? They aren't going to apply to new jobs for me, find friends and hobbies for me, etc.. To the men with pills, every issue looks like a disorder.
Maybe that's just me, but flooding my brain with chemicals is a big step and I need doctors to really pay attention and not just use trial and error on me. That's what i meant/
> As crazy as it may sound, I think a lot of my depression stems from living a life that is not true to myself and due to countless failed attempts to be someone I cannot never be. As far as I am concerned, depression is just a symptom of my situation and not some true disorder.
It's true for some, but be wary of such a generalization.
It took many years of people telling me the same thing before I understood what they were saying: "Having an objectively crappy life is normal. Being depressed about it isn't."
(Almost) everyone will have problems - temporary or permanent. And while they may feel down about it for a while, or occasionally, most of them more or less recover their mental health and are not chronically depressed.
Because the majority of people have problems, it becomes easy for a depressed person to think "Ah, this is just due to problem X" or even "This is just because I want a life different from mine". Most people with problems also want a different life than what they have. But they're not depressed.
> be wary of such a generalization.
My mistake. I should have worded what I wrote differently. I meant to say "not some true disorder for me."
> Having an objectively crappy life is normal. Being depressed about it isn't.
Not sure I can agree on this though. Rates of depression are quite high in institutions like prisons, for example. Especially in solitary confinement. Of course, I am not in prison, but I do believe the environment plays a larger role in depression than many are willing to admit.
This is not my first rodeo with depression. I'm in my early 30s, and this is probably my 5th or 6th time. I won't go into the details of those periods, but I almost didn't make it through a few of them.
> Ah, this is just due to problem X
Why is this outside the realm of possibility though? I believe depression is just a catch-all term for negative states that are too abstract to treat. If one is in a bad environment or unsatisfied in life, then a doctor cannot really do much to treat that. However, pills can be given to make people numb enough to their circumstances that they no longer care. Though, perhaps that lack of care is enough that people can actually benefit?
I mean, with SSRIs, the lows of life are diminished as are the highs of life, one might gain significant weight, and have a host of other issues like low libido, erectile dysfunction, anorgimasa, etc., but at least they aren't depressed...
If anything, I think of antidepressants like opioids. Opioids do not treat pain -- the pain is still there -- one just can't feel it.
> "Having an objectively crappy life is normal. Being depressed about it isn't."
Sounds like a philosophy more than a science. What does "normal" even mean in this context? Are we talking about something measurable? For instance, if the number of people who were depressed about those circumstances doubled (or quadrupled) would it then be normal, and there would be no reason to treat it (because it's normal)?
If you have an objectively crappy life, but not just ignore it and instead are incapable of even noticing, that sounds a little like dysfunction to me. It's not some superpower, it's a micro-lobotomy.
> If you have an objectively crappy life, but not just ignore it and instead are incapable of even noticing
Noticing it is very different from being depressed about it.
> What does "normal" even mean in this context? Are we talking about something measurable?
Let's take a trivial example. Person A is depressed because he is unhappy that he doesn't make enough money to travel and buy nice cars. Now take all the people who are unhappy that they cannot afford to travel and buy nice cars. Most will not be depressed - they will merely be unhappy about it.
Person A isn't depressed because he can't travel and buy nice cars. He's depressed and he can't travel and buy nice cars. He's mistakenly coupling the two.
Another tell for these kinds of things: Ever know someone chronically depressed who blames it on X? Then somehow, X is resolved. There may be a temporary improvement, and they go back to being depressed again, only they now blame it on Y? Somehow Y gets resolved and some months later they're blaming it on Z.
Everyone has problems. Including those who are not depressed. Fixing X, Y, Z, AA, AB, and whatever else is not going to take care of the depression.
On the flip side, people who do not suffer from depression make the same mistake: They claim they are not depressed because they "choose" not to let the problems get to them. Self serving beliefs!
>Let's take a trivial example. Person A is depressed because he is unhappy that he doesn't make enough money to travel and buy nice cars. Now take all the people who are unhappy that they cannot afford to travel and buy nice cars. Most will not be depressed - they will merely be unhappy about it.
These two words are semantically the same in your context. Unhappy = depressed. Unless you can define something measurable, and if you did in the comment above I can't find it.
I suspect there is something measurable, but I don't see very much attempt at discerning what that is. And without it, this conversation is pointless.
> *depression is just a symptom of my situation and not some true disorder+
There is a great Bojack Horseman episode in which Diane struggles with the idea of taking antidepressants for similar reasons.
If it’s depression, that’s closer to allergies, chronic inflammation or a broken bone healed wrong than vomiting after food poisoning.
I'm with you on this. People who pathologize themselves or others - assuming they're malfunctioning rather than acknowledging they might simply be living a life that doesn't fit - have a very limited way of looking at things.
Depression is almost never caused by actual life circumstance - just by your response and usually a delayed response.
Also you should try your SSRI prescription. They really aren't very strong drugs. You might get mild relief or if you're like me and the majority of people you will see no effect whatsoever. It's worth a try anyway. You won't get "high" or "dull" or any of that nonsense. At best it will lift your mood a bit. But more often than not, just won't do anything.
> Also you should try your SSRI prescription. They really aren't very strong drugs. You might get mild relief or if you're like me and the majority of people you will see no effect whatsoever. It's worth a try anyway.
Someone else in the thread's testifying with personal experience that there were significant withdrawl symptoms after only a few months: https://news.ycombinator.com/item?id=45999622#46008522
Are they lying, or are you misrepresenting something?
It is true. Withdrawals from SSRIs are no joke and can take a long time.
Well, all the n number of times I have been depressed in the past have been resolved by a change in life circumstances, so perhaps I am just an outlier?
> SSRI prescription
I'm supposed to take an NDRI (Bupropion) and not an SSRI, which is kind of like Ritalin or cocaine. The problem is that I already take amphetamines every single day, so I am not sure why this is really the one my doctors settled on.
In fact, they told me that if my blood pressure increases anymore that I am to stop the medication immediately and then contact them. So, that's not really inspiring a lot of motivation in me.
When I was a teen I was put on Prozac because I threatened to commit suicide.
The drug absolutely destroyed me. Within a few days of taking it, I was in a bizarre state of delirium where I would sleep something like 18 hours a day. When I wasn't asleep I would gnash my teeth at my parents. At school I would lash out at my classmates and randomly punch the walls of my classroom. I was taken off the drug after about five days but I didn't fully recover.
To this day, my emotions are severely blunted. I still have complete anhedonia and avolition. I can go on a roller coaster and feel not a shred of an adrenaline rush. Nothing. I struggle maintaining relationships with people because I have no innate "desire" to do so.
The drug is absolutely evil and should never be given to minors.
I don’t want to discount your experience, but attributing a lifetime of symptoms to 5 doses of SSRIs (when you were already exhibiting an unstable mental state) seems extreme.
I've seen a post like this before on reddit.
We know SSRI's really do cause permanent sexual dysfunctional in a small minority of people, small enough that this side effect doesn't come up in traditional FDA tests.
If a side effect is extremely rare it would be impossible or at least impractical to prove in a population.
Grandparent could be right or wrong about how the drug affected them, maybe their brain suffered from other issues and the timing of the medications was purelycoincidental, but if they are correct, your dismissive response is exactly what we'd expect given when they are saying sounds unusual/ improbable.
> If a side effect is extremely rare it would be impossible or at least impractical to prove in a population.
This is also true for a non-existent side effect. I’m not trying to tell GP he is wrong, just that from a reader’s perspective, extraordinary claims require extraordinary evidence.
This isn't a good fit for the phrase "extraordinary claims require extraordinary evidence."
Grandparent's report is hard to verify, not extraordinary.
These drugs are approved based on statistical safety profiles in limited trial populations, not on a scientific consensus that absolutely nobody on Earth will ever experience a unique adverse reaction.
Also, I never said that you, the reader, had an obligation to change your worldview based on Grandparent's report.
Millions of people take SSRIs on a daily basis without these dramatic symptoms. Millions more tried them (for much longer periods than 5 days) and then desisted from treatment without major lifelong mental alterations. So yes, I would say GP’s experience is ‘extraordinary’, i.e., outside of the ordinary expectation
I really hope you do or you will talk to someone about yourself again. You deserve it. For example to a counselor/therapist who doesn't even prescribe medication, if you are not interested in that. Off the top of my head these symptoms could match at least a few diagnoses, most of which are treatable, but it's by far not enough information in this post.
How long were you on Prozac? The way you describe your experience it makes it sound like you were affected long term. Are you still on it or any other SSRI? Hope you eventually rediscover/redevelop your emotional functionality.
I took it for one week.
I haven't taken any antidepressants since.
Our 11 year old daughter was seriously depressed recently. N=1, but fluoxetine was life changing (and potentially life saving) for her, at least.
Genuine question (which I accept may be too personal to answer): what does depression in someone that young look like?
How is it different from the expected hormonal changes that an adolescent is expected to go through?
As someone who has been seriously depressed from an early age, I can tell you that it looks exactly like the DSM/ICD criteria - a lack of energy, loss of appetite, loss of interest in all activities, insomnia, feelings of worthlessness, suicidal thoughts and pervasive sadness and hopelessness.
Some people would rather believe that pediatric depression isn't real, rather than confront the reality of a loved and cared-for child who is constantly tearful, severely underweight, sleeps for three or four hours a night, spends most of their time staring into space and frequently talks about wanting to die.
Depression is an utterly dreadful illness and should not be confused with normal sadness or unhappiness.
Probably something like Boy Interrupted[0]. Sad story and something I can sympathize with having some of the same feelings very early on despite having a rather normal upbringing and siblings not showing signs of it.
0: https://en.wikipedia.org/wiki/Boy_Interrupted
It's incredible that my last four comments are down voted to -1, for engaging in genuine dialog across topics.
@dang it's hard to believe that I'm not being brigaded.
And several of your comments before that were upvoted. Are we to regard those as suspicious?
Of the recent downvoted comments, one was a complaint about moderation that anyone who has paid attention to dang's track record here over more than a decade knows is baseless. (And if you think the top comment on any thread is a bad one, you can always choose to be a helpful contributor to the community and email us to let us know).
Of the other two of your downvoted comments, none were downvoted by the same users.
The choice is yours to make an effort to observe the guidelines and be a positive contributor to HN, or alternatively to keep using HN for political/ideological battle and complain to the moderators when things don't go your way, but it's clear what others in the community want to see.
> when things don't go your way,
You're a ridiculous person.
> or alternatively to keep using HN for political/ideological battle
Which ones? The one about ML and programming languages? Or the one about asking a genuine question about an experience with childhood depression? Or the one observing that you and dang unevenly apply moderation rules? Or the one commenting about how you can't say the word for the literal definition of fascism on this site without getting downvoted? Or the one about dishwashers?
Where's my ideological battle?
You have no credibility. You unlike dang, don't do a good job. Go ahead and ban me or put me on a cool down to prove my point.
I've scanned your full list of comments and can find plenty that have an ideological flavor to them, and others that are in the flamewar style, but are not so clearly related to politics/ideology. I'm not interested in getting into an argument about which of your comments are ideological or not. That's not the issue. What is the issue is the hostile and inflammatory style of commenting towards other community members and HN as a whole.
It's notable in this instance:
- You posted a series of comments about controversial topics, having established a history of participating on HN with this persona of being a brave combatant for, I don't know, some worldview or philosophy that you seem to be fighting for;
- When a handful of your comments receive even a solitary downvote, you call in "the cops" (dang) to come to your aid, with a claim of "brigading";
- When we investigated and found that, no, there's no "brigading", some of those comments are not even net-downvoted anymore, and that any downvotes you're getting are to be expected given your combative style of commenting, you've responded with these incoherent attacks on moderation/moderators.
Whether we all agree that many of your flamewar-style comments really are, in fact, political/ideological, is not the point and seems to be a way for you to deflect from being held to account for your conduct.
What I'm saying to you is that people who care about making HN better have all kinds of ways of showing it, and it begins with making an effort to observe the guidelines, and it also involves engaging respectfully with other community members and the moderation system. We are always, always working to make HN better and our moderation approaches better, and we always welcome and engage with feedback, as dang has been doing with you in another subthread today. But we've both been doing this job long enough to sense when someone isn't really wanting to help make HN better at all.
> What is the issue is the hostile and inflammatory style of commenting towards other community members and HN as a whole.
Please.
> having established a history of participating on HN with this persona of being a brave combatant for, I don't know, some worldview or philosophy that you seem to be fighting for;
What? Just because I have a different worldview than you, doesn't mean I am fighting for or am a brave combatant of anything. But it's extremely telling that you think that, and revealing about your own views. And furthermore troubling that you are a moderator here.
Maybe you should read up on the clustering phenomena wiki and understand your own personal biases a little more.
My advice as a long time participant here: pay no attention to upvotes or downvotes. Sometimes they seem to be completely unrelated to whatever you said. Stay curious.
Placebo can be life changing
Absolutely. These random namedrops of drugs are irritating. People respond to different psychiatric medications in wilddly different ways. And actually, the majority do not respond at all. Throwing a random name of some random medication helps absolutely nobody. It will just make some desperate people seek "this one drug" that they heard about on the internet.
That was an anecdote about the medication in question, not a random namedrop. Prozac is fluoxetine.
Nocebo can too. Apropos the featured article, I wonder if we should worry about that when we report in the popular media that antidepressants trigger suicides.
[flagged]
Do you have a plan to get her off, or is she on the maintenance drug for life?
It's too early to say. Obviously the idea is to get her off it if possible.
SSRIs never help because of boosting serotonin.
That's a hell of a claim, which could use some evidence.
https://www.nature.com/articles/s41380-022-01661-0
> It's too early to say. Obviously the idea is to get her off it if possible.
You understand that the people who sold you that drug have a vested interest in making sure it's not possible and/or that you & she think it's not possible, right?
You think the pediatrician is getting a kickback for prescribing it?
I'm big on medications for brain stuff but uh yes, in the US, doctors get lots of kickbacks for prescribing drugs.
Usually this takes the form of "I'm prescribing you with <Brand> instead of generic" or "I'm prescribing you this specific drug from this class of drug"
https://openpaymentsdata.cms.gov/
> doctors get lots of kickbacks for prescribing drugs.
From your own source: "In 2024: $172 or more in general payments have been received by half of physicians."
Even if all of those payments count as kickbacks, a median of $172 in a year (significantly less than 0.1% of the median physician's annual pay) is not "a lot of kickbacks".
Okay, but nobody is paying doctors to prescribe medications like sertraline and fluoxetine that have been generic for years and are cheap as dirt.
> > SSRIs never help because of boosting serotonin.
> That's a hell of a claim, which could use some evidence.
My experience with the chatbots is that they start with the conventional marketing tropes, but if you ask pointed questions they'll dig into the actual research.
This thread started with a generic question about why ECT seemed to help some patients. It had a really good reasoning about why SSRIs are still the first-line treatment for depression, even though the MAOIs were much better drugs.
https://chatgpt.com/share/69207aa3-26a0-8005-8dda-8199da153f...
The whole 'conversation' is pretty good, and would provide plenty of search terms for helping you figure out what science has actually figured out about depression.A simple pregnenolone supplement can sometimes be magical, because of the steroidogenesis cascade: https://en.wikipedia.org/wiki/Steroid#/media/File:Steroidoge...
There's a supplement seller that said his pregnenolone powder was made with a newer, cleaner process than is used by most of the pregnenolone supplement vendors, but I don't know if he's still using that supplier. The powders are a much better value than the capsules.
hth.
The chatbot is great as a first-line of research for many things, but something like this needs to be backed up by actual research to make a concrete claim. It will absolutely fabricate falsehoods or misrepresent truths based on an unknown number of stochastic factors behind any response. Shame on your for propagating a bunch of mumbo-jumbo that every reader must go verify for themselves if they want to substantiate or refute your claim - in response to a request for substantiation!
The SSRI's have always been terrible drugs. Apparently the trials before their approval found increased suicidality. Another response to this thread shared how his/her mother was given a "murderous impulse" with Prozac in 1989 [0].
Because this class of drugs was so heavily promoted for such a long time, the side effects have always been swept under the rug.
My comment above proposed that the 11yo girl's depression could actually be caused by precocious puberty. Another possibility is that she's a poor methylator (#MTHFR) who's poisoned by fortified flour and other sources of shelf-stable provitamins.
I haven't yet found a comprehensive SSRI-truth resource that makes SSRI advocates pause their advocacy, so I just shared the chatbot link. This was supposed to provide the father enough of the background terms and anti-SSRI thinking for him to search for his own resources.
Someone else posted a link to "The serotonin theory of depression: a systematic umbrella review of the evidence" [2022] at Nature [1]. This is okay, but it still dances around the core issue: whether ECT and Serotonin-enhancers sometimes benefit people because of how the brain responds to brain damage.
[0] https://news.ycombinator.com/item?id=46002561
[1] https://news.ycombinator.com/item?id=46008211
Puberty in general can be rough. I (a dude) had all kinds of bad thoughts and moods going through puberty and then one year it was just gone, grades improved dramatically, started making friends again, etc
I thought this was already known? I can’t recall exactly but there was some research pointing to SSRIs in general as not being particularly effective at all. They were just hyped a lot and became mainstream.
I wouldn't go that far, but there was a now-famous study (Princeton?) that showed that doing aerobic exercise for maybe 30 mins every day, about five days per week, was equally effective at alleviating depression symptoms.
There's one big problem with that - getting seriously depressed people to do 30 minutes of exercise (or anything else) five days a week. "Get more exercise" is excellent advice for someone who feels a bit down, but it's absolutely useless for someone who can barely summon up the strength to eat or brush their teeth.
It gets even harder if you offer them the alternative of just taking a pill. For widespread health policy, we should want the proportion of depressives who will never learn to manage it themselves because a pill is offered to be smaller than the proportion for whom the pill is effective. I had always assumed these pills were effective enough but studies like these make me wonder.
They are by no means mutually exclusive. If you want depressed people to get more exercise, then a really useful starting point is to give them a pill that could rapidly increase their energy and motivation. The idea that people will be stuck on those pills forever is just lazy psychiatry; ongoing maintenance treatment is often the best option for patients with a history of severe depression and a high risk of relapse, but antidepressants are equally useful as a stepping-stone towards self-management.
Bluntly, if someone is capable of actually starting and sticking with an exercise routine, then they aren't very depressed and should not be offered medication as a first-line treatment. Antidepressants are markedly less effective in patients with milder illnesses, so psychotherapy and lifestyle interventions are a far better initial treatment option. It's only when these treatments fail - or when engaging with them is severely impaired by the severity of the illness - that medication becomes the favoured option.
It's also very hard to get severely depressed people to make a Dr's appt and get out of bed and show up to it. It's hard to get them to do anything.
It’s always frustrating to see the implication that people just need to exercise to solve their mental health struggles. It might not be your intention, but it's a take I see a lot online from influencers.
I say this as someone who is extremely fit. I've worked out religiously since high school. While exercise is integral to me feeling somewhat normal and provides a short-term boost, that is just not how it works for everyone. Some of us have 'broken brains' that cardio can't fix.
Exercise manages my baseline, but sertraline is what helped me finally bridge the gap. It allowed me to regulate my emotions and anxiety in a way that no amount of exercise ever did. And the introspection from being on it helped me make lifelong changes.
To be honest, fearmongering from folks online is what stopped me from taking it sooner, but I wish I had. It was fairly life-changing.
Here the context is for children, not in general.
> "But a new review of trial data by academics in Austria and the UK concluded that..."
> "Mark Horowitz, an associate professor of psychiatry at Adelaide University and a co-author of the study,"
Austria - cold, has mountains, but not Adelaide University
Australia - hot, has kangaroos, and Adelaide University
Is the Grauniad returning to form?
Nature is healing. https://en.wikipedia.org/wiki/The_Guardian#References_in_pop...
My understanding with SSRIs and other depression meds is that they are hit and miss for anyone. I have a family member who, as a teen, suffered from severe depression and didn't want to live. Therapy wasn't able to help - it was actually the therapist who recommended more drastic measures such as medication. And so they tried Prozac and that worked. Having seen the reversal myself, it's hard to understand how this is placebo.
It is extremely hit and miss. My understanding is that for those with "shit life syndrome", prozac is generally ineffective, but for those with genetic predispositions it can be extremely helpful. the catch is that the two are not exclusive, and those with genetic predispositions to depression may never have it, and people with bad life circumstances may feel more stable mentally with prozac and better equipped to tackle life's challenges.
The placebo effect ( https://www.health.harvard.edu/newsletter_article/the-power-... )? (In the context we are discussing it, Prozac could be considered as an active placebo - https://en.wikipedia.org/wiki/Active_placebo ).
I think this is the paper in question?
https://osf.io/preprints/psyarxiv/wk4et_v3
Clinical trials of antidepressants are weird because they're usually short-term (6-12 weeks), whereas practical use of antidepressants usually lasts years. I personally suspect that short-term trials show an exaggerated placebo effect, because the novelty doesn't have time to wear off.
SSRIs literally saved my life, no question about it. Night and day difference, from daily panic attacks destroying my life, happiness, and career, to being almost completely better in 2 weeks after starting. I tried exercise and diet and meditation and you name it, for years!, before I gave medication a go.
Do not care what the science says. It 100% worked for me. Please get help if you need it, tens of millions of people use this medicine successfully
Articles like this are part of the narrative that SSRIs in general are no better than placebo. Absolutely not true for me!
Same here, after struggling for 39 years, glp-1 + SSRI + ADHD meds have made me a normal productive human, and 2 years ago I had pretty much given up on the possibility.
Having a child forced me to fix my life, and I'm incredibly happy because of it.
Pharmacology and chemistry can really make the world a better place.
Evidently not for children with depression. But yes chemistry is great.
Yoir choice between the red pill, the blue pill or no pill is pretty obvious but this choice is highly subjective.
What’s normal anyway?
I think that's a shorthand for "not dysfunctional and neurotically impaired".
For me? Not being hyper anxious all day (to the point that I just freeze and procrastinate all day), being able to sort of focus on the most important task (I'm still ADHD with 1000 unfinished projects, but at least I finish the things that have to be finished), eating healthy and enjoying exercising (100 lbs down and got quite good at tennis), not entering into a rage state due to anxiety overflow everytime I fight with my wife, being able to regulate my emotions, I could go on and on honestly.
[flagged]
This seems a little snarky. For someone with ADHD it’s not as much about “increased” productivity but rather non-zero productivity.
As someone with ADHD, if your productivity was decreased or did not increase in the slightest, then I doubt a doctor would keep prescribing the medication. Such increases do not have to be astronomically large, but I do believe increasing the productivity of people with ADHD is absolutely part of the benefit.
I agree, but I think you’re misunderstanding my comment. I was replying to a snarky comment that seemed to imply that the effect of taking amphetamines is obvious and mundane.
The point I was trying to make is that the effect on someone with ADHD can be profound and transformative, not like going from 80 to 100 but rather from 0 to 100. You suddenly feel like a functional person (I say this as someone with ADHD).
See: The dot com boom and its recovery into Web 2.0
It was so pervasive at the time that the references to it spilled over into SF Bay Area hip hop culture...
Massive amounts of cocaine did the same for the housing bubble in the 2000s.
Doctors. That is why they prescribe it.
I have tried prozac in my teens and zoloft in my 30s. Prozac made me dissociate pretty hard, I found myself between classes not knowing where I was coming from or going. Zoloft did nothing but give me the zaps when I came off it.
There have been some serious efforts made to reproduce the original groundbreaking results that showed how effective SSRIs were, without much success. Anecdotally, I know plenty of people who have benefited from them, so I would not say they are ineffective as a blanket statement. I do think it’s important to understand that nobody really knows how these drugs will impact any one individual, and it’s trial and error to find something that may help.
I think it’s important to note the headline that it’s specifically about children. Maybe Prozac is effective for adults but not kids in that range?
Had you tried a placebo without knowing that it was a placebo? No? Then your story's irrelevant to whether the medication's working (yes, even on you) any better than a placebo would.
current evidence suggests that prozac is effective well over placebo for adults
Placebo works very well for many people too! That's precisely the thing. That's what makes these studies tricky.
If you're a doctor, and if Prozac helps your patients, then it's obviously excellent. You should keep writing prescriptions.
If you're a scientist, you obviously want to distinguish between "real" drugs and drugs that help because people believe they should. So, you do these kinds of tests.
And then, from the perspective of ethics, once you know it's just placebo, you kinda shouldn't keep giving it to people, even if it helps? Maybe? I don't know. That's the weird part.
> And then, from the perspective of ethics, once you know it's just placebo, you kinda shouldn't keep giving it to people, even if it helps?
That's a very big ethical question in the medical field. Placebos _do_ help, but only if people believe they will. So is it ethical to lie to a patient and give them a placebo knowing it's likely to help?
Hopefully people don’t see articles like this (for depression) and think the results are the same for anxiety disorders.
THIS!
SSRIs have been proven to be very effective against anxiety disorders, which in many ways mimic depression, but have different pathologies and causes.
Also, they saved me.
This seems like bias against the placebo effect.
Spitballing here. I always understood stuff like this as "the system doesn't care about you, it cares about the masses." If the result is overwhelmingly looking no better than a placebo, then the small number of people it actually helps is sort of irrelevant. The exception might be cases where people are willing to drop a bomb of cash for lifesaving drugs for rare diseases (Pharma Bro got a lot of flack for massively jacking up the price of one of these drugs.) I don't know what implications such a study may have in a complex space. I imagine the drug will still be available for those who want to try, but far less prescribed as a sort of safe default. I doubt drug companies will care much for this, since the patent has long expired.
You should have tried placebo first
> Articles like this are part of the narrative that SSRIs in general are no better than placebo. Absolutely not true for me!
Does "placebo" mean "no effect" to some people? Placebo absolutely has an effect. Testimonies like this are on the level of "vaccines caused autism" pseudoscience and the serotonin theory of depression isn't even taught any more. It belongs in the bin of crackpot treatments like chiropractic. There is zero chance Prozac would receive FDA approval today.
I don't know if I'd call it "placebo" for me; prozac gave me the worst, most horrible pit of sadness I've ever had in my entire life. I couldn't stop feeling guilty over every single bad thing I have ever done, and it completely killed my appetite and that probably didn't do great for my mood either. I was only on it for about two months until I begged my doc to get me off of it. She told me that it's one of those things that doesn't affect everyone, but since I was already taking Wellbutrin it can have negative effects.
Never again. I'm taking Pristiq now and that has been considerably better.
I have overseen over 20 phase III clinical trials. Many of those clinical trials have failed to show statistical efficacy. In every single one of those trials there are patients who see dramatic and undeniable benefits. In the oncology field, we continue to treat such patients even when the statistics say, no benefit. And, sometimes those patients just stay better. My point is, when the trial shows "no better than placebo", it doesn't mean the treatment doesn't work. It might be that. But more likely it means we don't know how to define the population of folks for whom the treatment does work. Maybe it's a particular genetic background, maybe it's age, gender, serum CPR or Tau level. Maybe it's something else. This stuff is complicated and interesting. And we are still figuring it out.
As an adult, Prozac for me has been life changing and for the better. After suffering from anxiety and depression since childhood I have been able to get a new lease on life in my 40s. It is a drug that needs to be respected though, start on the lowest dose and give it months to settle. Find a doctor you trust and that will take time to discuss your situation. I feel that often this class of drugs is often prescribed without careful consideration and people are ramped up to higher dosages faster than they should be by doctors who are rushing to see the next patient.
Pikachuface.jpg
The mass prescribing of SSRIs is going to be seen like leaches (well worse since leaches actually do help in some cases). The rock bottom levels of replication of results in physchiatry and these SSRIs, the whole area should be treated much more like snake oil than it is.
Maybe SSRIs work for some, but Paxil gave me serotonin syndrome and Prozac made my mom psychotically homicidal. I've tried every SSRI titrating on and off (except Paxil), but they all caused deal-breaking side-effects.
Sorry to hear it. I believe it's best practice to try different types of drugs (SNRI, atypical/Bupropion, etc).
Homicidal?
Yep. My dad recounted that in 1989, he had to restrain her because she (then age 40) had a psychotic episode described as a "murderous impulse" just after starting a brand new "wonder pill", Prozac. This was quite uncharacteristic for a tiny, docile woman who is often described as "sweet" and "nice" who never had any psychiatric symptoms before or since except a couple of brief times of situational depression. There's a lot of FUD and social ills washing in mass media rather than less biased peer-reviewed research that blames individuals, conflates preexisting conditions with medication side-effects, and clouds the issue of whether SSRIs increase suicide and/or violent psychosis or not.
Check out one of the modern black box warnings of fluoxetine (Prozac) that only addresses a subset of side-effects, suicide in children and young adults: https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?set...
Somehow, I doubt there is much motivation to look for economically inconvenient and unnerving side-effects in some demographics, especially if they're adults who can easily be blamed entirely for all of their own actions because it's "definitely not" due to a (formerly) profitable pill or a pseudoscientific profession that doesn't exactly know how the medications it prescribes work, who would benefit from or be harmed by them, or have any ability to measure the organ or system they're supposed treating.
It is highly likely that your mother was misdiagnosed as suffering from unipolar depression when she was in fact suffering from bipolar disorder. A sudden switch to mania is a common outcome, even in cases where the patient has no previous history of mania. It is crucially important to take a comprehensive history to rule out bipolar disorder, but many general practitioners (and some psychiatrists) reflexively prescribe SSRIs whenever they see a depressive episode, even where there is clear evidence of a personal history of hypomania or a family history of mania.
Please don't do unsolicited diagnosis over the internet. You're completely wrong. There is absolutely no history and she isn't bipolar at all.
Thanks for sharing your mom's experience with big pharma's then-new wonder-drug.
> Somehow, I doubt there is much motivation to look for economically inconvenient and unnerving side-effects in some demographics,
Robert Whitaker examined the pharmaceutical industry's ideological capture of conventional psychiatry in his third book, Psychiatry Under the Influence.
https://robertwhitakerbooks.com/psychiatry-under-the-influen...
I've written for the Mad in America Foundation's webzine. My latest piece was titled Theodoric of Arizona: State-Sanctioned Pharma-Based Pseudo-Doctor: https://www.madinamerica.com/2024/07/theodoric-arizona/
This was inspired by the old SNL skit, Theodoric of York, Medieval Barber. The article is structured around my proposal of a Theodoric’s Principle of Medical Advancement, to explain why medical progress is so glacial.
Yup. There's too much institutional inertia to adopt evidence-based approaches.
I've tried 19 antidepressants over about 15 years. Stuck with mirtazapene-induced obesity that doesn't qualify for GLP-1 coverage, so I can either be fat, broke, or crushingly catatonic.
"Institutional inertia" is a great term, thanks.
> I've tried 19 antidepressants over about 15 years. Stuck with mirtazapene [...]
Have you tried any anti-serotonin interventions? (chatbot in comment link below)
Mirtazapene is a "tetracyclic antidepressant". I think the development of antidepressants went MAOI -> Tricyclic -> tetracyclic -> SSRI. My chatbot transcript said the SSRI's are marginal drugs, but "SSRIs are much safer in overdose" than the earlier drugs.
My understanding is that the MAOIs were reasonably-effective at bringing people out of an acute depression, but they interacted with high-tyramine foods (fine cheese, etc) to cause high blood pressure. Reversible MAOIs are less problematic than the non-reversible ones. Methylene Blue [MB] is the most ubiquitous of the reversible MAOIs. I felt a definite warming effect with my first MB microdose (a fraction of a milligram), but I've never noticed anything from larger doses.
My comments on this thread might be helpful: https://news.ycombinator.com/item?id=46000812
My own experience with SSRIs was very unpleasant. Sure, it worked to reduce my anxiety problems while I was on them for years. The first year I was off of them was the worst though. I didn't have that bad anxiety ever, as in constant panic and feeking of impeding doom. This made me realize that they aren't really an option of me. So began my long therapy journey. After 7 years of weekly therapy, a healthy work-life balance, and regular exercise I'm just feeling better than ever.
So, I'd buy that they don't fix your brain. They definitely reduced anxiety for me and I can see the value for stabilizing people so they can do the heaking work in therapy.
My experience as well. SSRI and other similar drugs for anxiety remove a strong signal to your brain and bring other issues or signal.
But the issue is that nobody wants to really look at the cause. We are all trying to treat the symptoms with those quick-fix pills.
The cause is deep in our society. We are too stressed, lost touch with each others, work on meaningless jobs (or downright negative jobs for society.. if you work at Meta or TikTok, yes your job is in fact a negative for society).
I have also been on a journey for the last 5 years on working on myself and bringing those things back in my life and I have been feeling better than ever: - A lot of outdoor time and exercise. - Take the time to build a community of friends that genuinely care for each other - Work on some projects that you feel help humanity and each other (or volunteer). - Build things you are proud of. Build a legacy
All of those removed almost all anxiety and depression. It is not an easy journey but I'm shocked how few people even consider making those changes
I hear this story over and over again and it makes me sad. Medication for depression, anxiety, or adhd should be used to enable the work with a therapist, not to make life bearable without working on the underlying problems. Been there, done that. Wasted a couple of otherwise good years on not doing the work.
Its not just children, its adults too. Because of the FOIA we have seen the studies these drug companies made disappear and this applies to probably every single antidepressants. Keep in mind the placebo effect happens in about 30% of people which are the people that think it works and then eventually stops working.
Fortunately, there are well documented lifestyle adaptions that can sharply reduce depression.
Religion is a good example. https://pmc.ncbi.nlm.nih.gov/articles/PMC3426191/
Swapping one problem for another. Religion sounds like the worst place for someone who is mentally vulnerable. It's like pulling out your credit card in a shopping mall full of salesmen who are under tremendous pressure to make big sales asap
I have seen no studies that suggest such a thing. Hoards of studies suggest religion is good for mental health.
I can be persuaded, though. Can you show research?
For whose mental health? My point is that religion brings its own shared of issues. And by religion here I mean organised religion. Religions that don't involve rituals or gatherings with other people in hierarchical settings are different (but I assume most people are after rituals and gatherings with other people in well defined settings imo rather than the actual metaphysical beliefs).
- If you look at highly religious areas like the bible belt, they are often linked to worse mental health outcomes for those who don't the religious worldview such as queer people https://www.thetrevorproject.org/research-briefs/lgbtq-youth... https://pmc.ncbi.nlm.nih.gov/articles/PMC8724198 https://pmc.ncbi.nlm.nih.gov/articles/PMC10752621
- That wave of christianism, ironically called christian science, was the cause of mental distress and deaths of tons of children due to the parents religious views. Religious based neglect is a common form of religious based abuse too.
https://childrenshealthcare.org/victims https://pmc.ncbi.nlm.nih.gov/articles/PMC7545013 https://pubmed.ncbi.nlm.nih.gov/9521945/
- Having religious parents is often associated with conditions like anxiety or depression
https://pmc.ncbi.nlm.nih.gov/articles/PMC10719686
- Struggles of a religious nature causing mental health issues all the way up to suicidal ideation
https://www.sciencedirect.com/science/article/pii/S266691532... https://pmc.ncbi.nlm.nih.gov/articles/PMC4776639 https://www.researchgate.net/publication/371293385_SUICIDE_A...
Thank you for the conversation.
The first 3 links you’ve provided discuss mental health as it relates to geography, not religion. To be sure, religion is associated with those geographic areas, but so are numerous other factors like race, income, etc etc.
The next links are closer to target, they talk about religious objections to medical treatments and the adverse affects upon kids. Nobody should deny this is a real problem, but fortunately it is a very small problem. ( One of the studies found only 172 fatalities over 20 years, and even estimated 10% of the kids may have died anyway.). So I’ll grant that is a real problem, but not one that affects many people. With luck, perhaps it will get better over time.
The next study is interesting, but again very limited. It has 6k subjects, but these are only with religious mothers and only in the UK. This study cites prior study that concluded “ an individual's religiosity is consistently, positively related to their own mental health in US samples”.
The next study associated suicidal tendencies with a very narrow aspect of religion, and even then self reported: “We recruited a relatively small sample that was geographically, racially, and socioeconomically homogenous. We also relied solely on self-report data.”
The next study does not seem to help your argument. It deals with religious beliefs in cancer patients and says “Higher levels of religiosity and spirituality are associated with reduced risk of suicidality and suicidal behaviors [29–31], including in advanced cancer patients “
The final link is just a case study about a single suicidal pastor. It concludes with a paragraph that says “Although there are studies showing that religious people are less prone to suicide…”
So I can’t say all that changes the findings of the many studies that conclude religion is good for mental health.
Here the context is prozac FOR CHILDREN, not in general. Yet some people make a point in commenting that SSRIs are ineffective in general because they believe in some big pharma conspiracy. This is spreading misinformation. The truth is that SSRIs are modestly more effective than a placebo for approximately >> one third of the individuals << who try them. In other words, SSRIs are effective for more than 60-66% of adults. Moreover, there are a few different types of SSRIs. It takes time to find the one that fits you.
> they believe in some big pharma conspiracy
See: the Sackler family
Also pfizergate featuring von der leyen.
Chemicals like this imho act like "global variables" for the neural network. Perhaps a bit like temperature in an LLM. They have an effect, but the effect is sort of holographic -- there's no way to predict/compute exactly what the effect will be, because it's a function of parameters that include all the training data, specifics of neuron function that depend on DNA and other environmental factors and so on. The effect might be beneficial, by some definition of beneficial, but it might not. Even a simple chemical like ethanol has a wide variety of effects on different people.
Harvard: "Exercise is an all-natural treatment to fight depression"
https://www.health.harvard.edu/mind-and-mood/exercise-is-an-...
"Seasonal Affective Order, or SAD ... has been linked to vitamin D, otherwise known as the sunshine vitamin, because the skin absorbs it through exposure to sunlight."
https://www.va.gov/washington-dc-health-care/stories/combati...
"Consider adding some of these steps into your daily routine to improve your mood:"
"Spend time outside to get ample vitamin D ... Eat foods rich in vitamin D (salmon, eggs, tuna, etc.) Take vitamin D supplements"
So people who used it till now. What are they now? Stupid
As someone with MDD, reading these comments is depressing. It's full of people who don't even know what MDD is exists and that people should stop being sad.
Hacker News really does attract a specific type of person...
They must have been pretty damn confident of the results to give depressed children a placebo.
small effects in overall trial does not mean that for some individuals the effects were very large. The Heterogeneity is Real.
I'd really be curious about distribution of the result they see. The folklore is definitely that that there's vary high variance in how people respond to SSRIs, and not recommending them because the average value is low is pretty irresponsible.
This reads to me like over-prescription rather than lack of efficacy but I’m also not a doctor and won’t presume my kneejerk reaction is accurate.
We saw a similar whiplash with Ritalin after over-prescribing in the 90’s/2000’s. ADHD medication absolutely works, but for a lot of people it didn’t for this reason.
Effect size is strongly affected by severity - people who aren't very ill just don't have as much to gain compared to people who are gravely ill. Widening diagnostic criteria and more liberal prescribing will inevitably lead to a reduction in the observed effect size.
Antidepressants were bona-fide miracle drugs when we first started using them on desperately ill inpatients who experienced every moment as exquisite torture. We saw the most miserable lives completely transformed in a matter of weeks. They have become merely "sorta-kinda useful sometimes" now that we're mainly prescribing them to broadly functional people who are feeling a bit sub-par.
SSRIs are a pretty poor fit for the latter cohort, because SSRIs cause significant emotional blunting in the majority of patients, to the extent that some people hypothesise that emotional blunting is the fundamental beneficial effect. Feeling quite numb is an incredible improvement if you are constantly unbearably miserable. If you have a more normal range of emotional experience than relentless misery, it is likely a sideways move at best; if your core complaint is that you feel numb and apathetic, they're probably actively harmful.
SSRIs are very widely used because of their extraordinary safety, but they're often thoughtlessly prescribed by overworked primary care doctors. There are a wide range of antidepressants (and drugs that have antidepressant effects despite not being marketed as such) that are likely a better option for a large proportion of patients.
Even for people with legit ADHD, like myself, medication isn't always a home run. I think something like 10%-20% of people do not respond well to any medications. I personally am only a 'partial responder' in that I only really get an improvement in focus/concentration -- not really anything else. But hell, that is still better than life without medication.
Definitely didn’t mean to imply it’s a home run. I’m just saying it clearly and legitimately helps a ton of people.
My point is if you include more and more people who don’t need it because of over-prescription it’s going to appear as lower overall efficacy while still helping a lot of people in the pool.
Making up numbers: If only 20 out of 100 people actually have ADHD then out the gate you’ve ruled out helping 80% of the people. So if 15 of the remaining 20 see improvement in their daily lives that means 75% suddenly looks like 15%.
Diagnosing and treatment is never that clean, there will always be some people who don’t necessarily need a certain medication yet get it prescribed (or don’t when they need it! Especially women with ADHD) because doctors are fallible like anybody else, systemic issues, etc. But with a commonly prescribed medication like Adderall the problem is definitely more pronounced.
Anyway I’m curious enough to look more closely at the study, this is a very interesting topic. If Xanax is really not helping people that’s pretty serious.
This should get locked. People are horrible.
Depression is literally a lack of meaning and beauty. This gets imposed on us by society through social norms, and increasingly not working for people
But rather than fixing society, we will impose experimental drugs on kids. In some cases altering their lives irreversibily
It absolutely should be discussed and openly talked about
> Depression is literally a lack of meaning and beauty.
actually, "depression" or major depressive disorder is literally a mental illness, which has a genetic link. it is not a "lack of meaning or beauty" -- to suggest every depressed person who killed themselves had no "meaning" for life is deeply disrespectful to every parent, child, sibling, partner that killed themselves.
Maybe because "Fixing society" (putting aside questions of what that even means...) is going to take a long, long time and a lot of effort. Which isn't to say we shouldn't continue to fix it (hint: we do!) but it doesn't mean we should just ignore other ways of helping our kids.
> we will impose experimental drugs on kids
What a terribly disengeuous way of putting it! "Imposing" implies there's not a choice. And all drugs are experimental in that we are constantly learning about the effects they have on us and adjusting our knowledge accordingly.
> implies there's not a choice
There isn't a choice if * Questing it is "morally wrong" as it's made out to be * It's the only solution.
Nobody's saying it's "morally wrong" not to give your kids antidepressants - but nor is it morally wrong to give them to them.
What tends to be "morally wrong" is when parents are like "I'm not giving my kids those pills! There's no such thing as depression! Just go play outside some more!" - in other words, dismissing your children's feelings
I can agree, but I often think those commentors would probably be dismissing the parents diagnosis of the child expressing themselves, rather than dismissing the child.
Children are experiencing everything growing at once. They have preferences, they have new experience, everything is very close to "the first time this has ever happened" and so, can be a very big deal for them, at the time.
¯\_(ツ)_/¯ internet arguments about parenting, experiences, assholes, having one, putting it in others faces, etc. The internet is just talking to a bunch of people who have different ideas. I wouldn't take it too seriously, over half of it is bots or socially inept people anyway
I thought Prozac was for anxiety.
Fluoxetine has received FDA approval to treat major depressive disorder (8 and older), obsessive-compulsive disorder (7 and older), panic disorder (with or without agoraphobia), [and] bulimia nervosa...
https://www.ncbi.nlm.nih.gov/books/NBK459223/
Antidepressants benefit specific populations, those that have a predominant "internal" stress/depression and not due to a profound external trauma. They will not help a child that is continuously bullied, but one that has inherited a depressive trend. This holds for children and adults, barring some differences due to age maturity. Saying "no difference from placebo" for a treatment that is used by hundreds of millions is poor science, if not misinformation and malice.
Not to get into the historic details but growing up there was lot of tension in my parent's house. When you're a kid you feel these things and are aware of the issues that cause them, but you haven't yet learned how to talk about them or the right words to describe the truth of them. Instead you internalize them.
The lack of learning constructive perspectives and ways for discussing emotions while young, may very much be a source of depression, the same way people say "he can't help it, he has ADHD".
I was about 16 and the doctor recommended this new SSRI called ... I think it was Paxil, The side effects, especially if you missed a dose are hard to describe. If you missed a dose you couldn't function at school, and everyone thought you were really stoned. Also, you could look at a pretty girl and just nothing. A 16 year old boy doesn't know why THAT's happening, neither does the girl, and it just makes things worse. Try having that conversation with your Dad, while doped out on the drugs he told you to take. Imagine the anxiety. It's really depressing. Better to be alone, and safe in one's bedroom and on the Internet... ( and that was 20 years ago ).
Around the same time there was Ritalin and maybe a few others came out.
The issues kids are facing, the feelings they are then given pills to erase are still there, even when numbed to them. The answer lies somewhere in familial stability and relearning respect?, and how to constructively frame life's difficulties and teach that to our kids.
I would never give my kids anything that altered their brain chemistry. Even as adults, the only way is through.
Couldn't this be explained by children being misdiagnosed as having depression?
If those children just had a temporary sadness then the placebo would appear to work?
For some reason, the title mangler chopped off the word "say": "Prozac ‘no better than placebo’ for treating children with depression, experts say."
None of those drugs helped me personally in the 90s (Prozac, Zoloft, etc). What helped me personally was talking about my problems with other humans only to the learn we all are "crazy,(aka totally normal)" and the majority all deal with something similar. Anxiety, OCD, insecurity .. all are parts of the human condition we all deal with throughout our lives.
RFK Jr dancing
[flagged]
Use more words.
[flagged]
Um, that's fewer words.
FDA = Joke
[flagged]
I used to share your opinion, and in a way I still do, but after having 3 children and seeing how horrible some of these behaviors and habits can get, I completely understand why people cave in to get some relief. The stress of dealing with severe behavioral issues day after day can easily destroy a marriage and family.
It's even more fascinating when you have first hand experience with how much unmitigated guesswork goes into selecting psychiatric meds and their dosage.
it's somehow even more fascinating when you talk to dozens of people who were medicated as kids and get an idea of the real implications
...or literally watched friends get over-medicated into committing suicide.
[flagged]
Fluoxetine is one of two medicines listed in WHO Model List of Essential Medicines for the treatment of depression since 2007 (use of other SSRIs are also allowed)[1]. The listing means it has proven to be safe and effective enough that WHO believes it should be readily available in every healthcare system. You will need much more than a Wikipedia article listing side effects for the entire drug class, without incidence rate, to convince people these drugs aren't what they seem.
Also relevant to this article, WHO since 2023 does not recommend Fluoxetine (or any antidepressants) for children younger than 12 years[2].
[1]: https://iris.who.int/server/api/core/bitstreams/17642505-ecd...
[2]: https://list.essentialmeds.org/recommendations/313
The WHO hardly is a reliable, neutral source. It's a political organization that's subject to all sorts of outside influences.
During my first manic episode I was handed sertraline. This pushed the mania full send and I lost a lot of time that I can't account for, things I did I can't remember but friends have recalled. Climbing the house to get in through the upstairs window whilst having the house key on me. Locking myself in my room for a week or two convinced I was the real world John Connor and Arnie was looking for me. Blowing all my savings on cocaine for me and anybody in my vicinity in a month. Going through a gram of mdma more than once in a night. Feeling like I was on a therapeutic dose of MDMA for a few months and thinking this was what SSRIs were meant to feel like. The list goes on.
I will admit I was semi cognizant of the distorted thinking/reality so played it down when talking to the psychiatrist I was urgently (+2 months into it) referred to for early psychosis intervention. I was eventually handed a dozen valium (which the doctor was incredibly hesitant to prescribe, for good reasons) which let me sleep and the mania lifted.
I'm terrified of SSRIs now. I have been diagnosed bipolar for a few years now (went private because in the UK unless you're a danger you're ignored). This week was the first session with a clinical psychologist in a bipolar group. Unsurprisingly almost everyone had a similar experience with SSRIs.
I'm speculating here but I'm pretty sure if you did an MRI on my brain you'd see lesions from the mixing of mdma and sertraline (I get myoclonic jerks to this day).
> I'm terrified of SSRIs now.
Surely the massive amounts of cocaine and MDMA bear some responsibility.
SSRIs are definitely not commonly recommended or normally used for treating bipolar disorder - especially not for people who are showing signs of a manic episode.
Unfortunately, this is one of the major limitations of our diagnosing abilities with mental illness: when someone presents with severe depressive symptoms and no other known history of mental illness, we have no real way of telling whether it should be classed as Major Depression, or whether it may be Bipolar disorder.
So, sadly, yours is a common story where people with bipolar disorder that initially manifests with a depressive episode get treated with SSRIs that then push them into their first manic episode. I've had a good friend go through something very similar (though, thankfully, less severe in terms of intensity of the manic episode).
If you were given SSRIs to handle the start of your manic episode, that to me seems like a gross mistake by your physician.
ssris are known to unmask or precipitate manic episodes in people with family history of bipolar or schizophrenia.
> I'm speculating here but I'm pretty sure if you did an MRI on my brain you'd see lesions from the mixing of mdma and sertraline
ssris actually block the serotonergic effects of mdma and similar.
> I'm speculating here but I'm pretty sure if you did an MRI on my brain you'd see lesions from the mixing of mdma and sertraline (I get myoclonic jerks to this day).
Could you speak more to this? A family member was recently diagnosed with myoclonic jerks without a clear root cause, so treatment has been hit or miss so far. I’m trying to learn what I can to help inform them.
Every medication can have severe and permanent side effects, the question is how often that occurs for a particular drug, and how that stacks up against the quality-of-life improvement from taking that drug.
And whether patients are properly informed of the risks (I was not)
> Every medication can have severe and permanent side effects
SSRIs are by an order of a magnitude worse than any other common medication in that respect.
Moreover, like I said there's little evidence these drugs actually achieve any quality-of-life improvement beyond a placebo effect.
SSRIs are very bad, but antipsychotics are worse. There are many other reasons, but a demonstrative one is that there is a cumulative annual risk as high as 7% of developing a permanent movement disorder when on them.
TD is no joke!
It was really hard for my ex to have to choose between anti-psychs and the potential side effects, or exceedingly strong paranoia with incredibly lucid hallucinations - I did not envy her position
I think the reality is likely more nuanced than 'all good' or 'all bad.' While the side effects you linked are real risks that should be taken seriously, claiming these drugs are 'by no means safe,' cause 'mostly permanent' damage, or lack evidence is a pretty extreme generalization that doesn't align with the experience of millions of patients.
Speaking for myself, I took sertraline for years and it did wonders for my mental health. It didn't ruin my life or numb me, it gave me the ability to regulate my emotions when I previously struggled immensely with anger and crippling anxiety.
It’s possible for these drugs to be handed out too easily in some contexts and simultaneously be life-saving, effective treatments for those who genuinely need them. Suggesting they violate 'do no harm' ignores the massive harm caused by leaving severe mental health struggles untreated.
> treating depression
Most of the "treatment" is apparently just telling people to stop feeling sad [0], or giving them drugs
[0] https://old.reddit.com/r/thanksimcured
but no one bothers to take the time out to sit down and figure out WHY they feel sad and FIX THAT FOR THEM. That takes too much work.
Sometimes depression is this vague feeling that this world is just wrong. That Damocles' sword of mortality. The nagging sense of ultimate pointlessness. You can't really "fix" that. But having stuff to ignore it helps, like video games :')
>but no one bothers to take the time out to sit down and figure out WHY they feel sad and FIX THAT FOR THEM. That takes too much work
Out of curiosity, have you ever been depressed or do you know people with diagnosed depression?
I ask, because when I first visited a psychiatrist my life was going great - very good job, great financial situation (i think i could FIRE today), happy marriage, perfect health. It didn't save me from recurring self harm and suicidal ideation, and it doesn't explain why I had weeks when I couldn't even open my work email.
Sometimes your brain is just causing your trouble for no reason. Drugs work, or may work, and may save lives. I write this because I had a similar opinion before being personally affected, so I see where you're coming from.
Depression isn't just feeling sad. It's not necessarily caused by anything external. You cannot necessarily just "figure out why" you feel bad; that's really not how it usually works.
>It's not necessarily caused by anything external. Y
Then how could a drug fix it? We're positing that there is not only a mechanism causing it, but that this mechanism can be manipulated external to their own self/agency/whatever.
I think that it is at least as absurd to posit that you can come up with one chemical substance or another that will alleviate their depression when you dismiss the idea of coming up with a sequence of words spoken to them that might alleviate their depression. It's the conceit that we have a better idea of how their brains work chemically than we do of how their brains work cognitively.
>Then how could a drug fix it?
Many things that are not necessarily caused by anything external can be fixed by drugs. I don't understand your point.
If the problem is brain not working correctly (because some organ is not doing it's job properly) then no sequence of words will make the brain physically fix itself, just like no sequence of words will cure a heart attack.
Of course it depends, and many people just need a correct therapy. I'm not dismissing talking and figuring out the root cause.
> You cannot necessarily just "figure out why" you feel bad
Well, of course, if you anesthetize someone they can't feel anything. If you cut off the physical pathways of ""feeling sad"" then they can't feel sad, but is that really the same as "fixing" the reason for why they were feeling sad in the first place?
Unless the reason was that the physical causes are running haywire and making someone feel sad when they otherwise wouldn't, but how often is that just uhh a lazy scapegoat? "Oh this person has no reason to feel sad, something must be wrong in their brain"
> Well, of course, if you anesthetize someone they can't feel anything.
Not what the post you replied to was talking about.
> Unless the reason was that the physical causes are running haywire and making someone feel sad when they otherwise wouldn't, but how often is that just uhh a lazy scapegoat? "Oh this person has no reason to feel sad, something must be wrong in their brain"
That's basically the definition of clinical depression. Doctors try quite hard to make sure it's not a scapegoat.
If someone is sad for a specific, identifiable and tractable reason, then they are experiencing a categorically different phenomenon to someone who just feels sad all of the time regardless of their life circumstances.
One of the key diagnostic criteria for melancholic depression - what we might lazily and inaccurately call biological or "real" depression - is mood unreactivity. Someone with severe melancholic depression could win the lottery one week, lose all of their family in a plane crash the next, and feel literally nothing about either event.
Some people with atypical depression (or normal sadness that has been mis-diagnosed as depression) can respond rapidly and dramatically to a change in their circumstances. For many others with depression, there is no external why - something has gone fundamentally wrong in the functioning of their brain. Trying to help those people with talk therapy or exercise or companionship would be as futile as using those things to treat hepatitis or gangrene.
> Trying to help those people with talk therapy or exercise or companionship would be as futile as using those things to treat hepatitis or gangrene.
I get what you want to say, but to nitpick the analogy: If the "treatment" for gangrene is amputation, then that's not really "fixing" anything. That's just the scorched earth strategy of destroying the afflicted along with the affliction. Like lobotomies. What do people think of them now?
> Someone with severe melancholic depression could win the lottery one week, lose all of their family in a plane crash the next, and feel literally nothing about either event.
Why SHOULD someone feel a specific feeling about any event? If you're subconsciously aware of the ultimate pointlessness of any event, if you're aware that feelings won't change what happened, you won't. You'd move on and handle the new reality in the means available to you.
I'm not saying that medicine should never be used and there's never a "chemical" cause to sadness (or any "wrong" feeling), just that it may be used too often as a lazy escape for the "helpers".
>Like lobotomies. What do people think of them now?
Lobotomy was in fact an effective treatment (albeit with extremely severe side-effects), but we now have much better and safer treatments available. The abandonment of lobotomy was fundamentally driven by the invention of effective antidepressants, antipsychotics and mood stabilisers. Neurosurgery is still offered to an extremely small proportion of patients suffering from very severe and treatment-resistant depression and OCD.
https://www.cambridge.org/core/journals/bjpsych-advances/art...
The discredited procedure that was banned in the Soviet Union before the United States? That was used disproportionately against women?
https://en.wikipedia.org/wiki/Lobotomy
well, yes, it did work. the side effects are horrible, and often the disease was better than the cure, but it worked, similar to how being dead also is extremely effective for managing depression.
Murder is a very successful cure to a lot of ailments.
I feel like you're not getting the very obvious implied point in that no one thinks lobotomy was good practice in retrospect
The guy I replied to seemed to, after I mentioned lobotomies as an example of physical treatments for "feeling sad" that are now seen as barbaric.