Posted by zeugma on March 3, 2004, at 18:59:46
In reply to Some thoughts, posted by Questionmark on March 3, 2004, at 10:01:22
>Knowing that infuriates me to think of how the SSRIs have become the freaking gold standard of antidepressant (and even antianxiety [?]) medication, and how everyone including doctors think they're so dam* safe and bad-side-effect free, and such an improvement to the drugs of old, and so on. Ridiculous. i wonder how many people have to try other SSRIs after having a definitely inadequate first trial of SSRI, before being able to try something else-- let alone a TCA or , God forbid, an MAOI. Ah it makes me sick.>
Makes me sick too. I remember how doctors would confidently tell me how "you wouldn't believe how good the medications we have now are," etcetera etcetera. After a couple of disatrous trials, what I couldn't believe was how far treatment standards seemed to have regressed. The roots of the illusion, I think, are twofold:
1) the illusion of specificity, 'rational design,' whatever. That somehow SSRI's targeted only the system that was causing the depression and left the other systems alone (I'm paraphrasing loosely but you know what I mean). This illusion is hubristic because we know barely anything about the normal brain, much less the depressed one (and I am almost sure that depressions are heterogeneous and not a natural kind).
2) the illusion that because a treatment has a wide 'therapeutic index,' then you can afford to be cavalier with what you do with it. Since you can't OD on an SSRI a doctor could diagnose 'depression' in less time than it takes to write a script. And since the treatment was so 'safe', then ANY effects the drug had on people could be taken less seriously. I mean, prescribing someone a TCA or MAOI is serious business. A narrow 'therapeutic index' means that the treatment had better be therapeutic, since the consequences of ineffective treatment are greater, in prescribers' minds. And there is a subliminal transition from 'safe' to effective' in doctors' minds, a transition encouraged by the illusion of specificity in 1).
poster:zeugma
thread:318034
URL: http://www.dr-bob.org/babble/20040228/msgs/319873.html