Posted by Racer on August 6, 2005, at 12:28:36
In reply to Re: Do SSRIs work? » saltate, posted by ed_uk on August 6, 2005, at 10:38:16
OK, I have way too much to say about this, but I'll try to keep it short. Forgive me. I will, however, try to keep this in outline form, so you can skip anything that doesn't interest you...
1. Studies have shown that pretty much ALL the different sorts of antidepressants are equally effective. That doesn't mean that they'll all work as well for every person who takes them, it only means that they all work -- to some degree -- for about the same percentage of people studied. Usually, that works out to about 70%.
Now, those studies are usually short term, and what happens clinically is different from what happens in a study lasting 9 weeks.
2. Most all of the antidepressants will poop out. Those that target serotonin most preferentially tend to poop out more consistently, because of serotonin's role in various body systems. Most of it is used in the gut, for digestion, so the body will "normalize" the sensitivity of the various receptor types, and badabing -- poop out. Changing drugs within a class can help.
3. These days, most anyone who gets overstressed will end up with a prescription for an SSRI. They're the Magic Pill that allows you to go back to living a full, happy life -- didn't you see the commercial for it? That will skew the stats a lot, especially since those mild-to-moderate depressive episodes are likely to resolve with or without treatment in about nine months. Think of it from the point of view of Big Pharma: make a drug, any drug, and most people who take it will be "cured" WITHIN NINE MONTHS! Big Winner, huh? The rest of us may not have the same experience.
4. Most of us on this board have a somewhat different set of problems from the basic lifestyle blues. I know that I've tried virtually EVERY antidepressant on the market, and probably half the people on this board have, too. And my depressive episodes may resolve in nine months -- but if they do, they start up again a week later... We're gonna give the world a very different view of the effectiveness of any psychotropic med, you know?
5. Because most of us here have tried so many meds, we are a hell of a lot more sophisticated in our perspectives on them. The first time I was on an antidepressant, nortriptyline, I was so relieved that I was willing to put up with lousy sleep, gaining 70 pounds in a couple of months, being constipated beyond belief, lethargy a sloth would have been proud of, etc. Twenty years later, I'm not. I know that there are drugs that would relieve the depression itself -- but if I can't function when I take them, I do not consider them effective treatment. They're not worth it.
6. "Major Depressive Disorder" and "Bipolar Disorder" are diagnoses made based on a constellation of symptoms -- they are not discrete diseases. While the symptomology may be the same, the biochemical processes involved may be very different for everyone. I have never had much response to the medications that target serotonin alone, for example, but have generally responded well to those meds that preferentially target norepinephrine, with a side shot of serotonin. Other people might need a drug that is more balanced between those two neurotransmitters, or something else entirely. That's because, while the disorders may look the same, the underlying processes may be very different.
7. There's another point I was going to make here, but then my husband came in to talk to me, and I forgot it... That's because my mind is like a steel -- sieve!
Sorry for being long and all, I just gots so much to say, and no where else to say it all... Thanks for putting up with me. This really is a great place.
poster:Racer
thread:537656
URL: http://www.dr-bob.org/babble/20050803/msgs/538285.html