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The Depressing News About Antidepressants


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Why placebo works:

Placebo effect gives people hope. Hope can spark up the brain (thinking changes brain chemicals) which might, hypothetically, help pull people out of depression. If you give someone hope, and they sit there swallowing a sugar pill thinking positive thoughts ("this pill might help!"), the positive thinking causes changes in brain chemistry which resolves depression. Placebo can only work if the patient thinks the placebo might/will work. Positive thinking.

Depression causes negative thinking which worsens depression.

Placebo forces positive thinking which can help terminate depression slowly.

Why are ADs not particularly more effective than placebo? I don't know. I find that really hard to believe. It doesn't make sense. Neurotransmitters control feelings/thoughts, right? So hypothetically affecting neurotransmitters via pills ought to also affect feelings and thoughts. People take drugs of abuse that cause a rush of serotonin or dopamine or endorphin to induce euphoria/highs. Given this is true, why shouldn't antidepressants work? They ought to work, they do similar things as drugs of abuse (although obviously not as extremely).

Speaking personally, when I sat in front of the light box for a half hour on december 2nd, by that evening I had a jolt of energy. I had more energy than I had the entire month before. There is no way thinking patterns caused this change. I didn't even expect it to do much good, I was surprised how fast/quickly things changed.

After I began the light box, my depression took a turn from "getting worse every day", to "getting better every day". By the end of december, I wasn't depressed anymore.

(Oh and that's another secret: Light boxes are shown to be very effective for non-seasonal depression, about as effective as ADs. There is a myth that you can't do anything non-prescription for depression, but the reality is that light is very antidepressant (particularly those with atypical symptoms, e.g. lethargy/low energy). ) Seeing as research states ADs aren't more effective than placebo, I'm not sure that it matters much then, lol.

I don't know about the rest of the world, but my depression is absolutely chemical. It comes and goes, many times it comes and goes suddenly (e.g. back last year, I was quite depressed all june, and then by the third day of july, I was fine/normal/happy again). It's not my thought patterns (although that can help worsen/sustain my mood state). ...

I'm really tired of this myth that depression is mostly an issue of thoughts/thinking patterns.

I wish this affliction on all those who believe that, especially the doctors/psychiatrists.

The myth would die dead in its tracks if these people actually lived as I do, with pain and sadness and no hope for no reason, only to have it vanish suddenly and irrationally as it came days, weeks, months later.

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That's a really interesting article. The bit near the end in particular really got me thinking - if the researcher has discovered that the mechanism of AD efficacy is largely down to placebo effect, then perhaps he should keep that fact quiet in order to prevent loss of said placebo effect. But it is acceptable to sell people a myth? Now there's an interesting moral dilemma...

Personally, I take ADs (well, I'm on and off them in a cyclic fashion) and I'm quite open to the idea that they might work largely because I believe that they're going to. I suppose that I believe in the medical model. But I sort of compartmentalise that knowledge, don't think about it too deeply in case I accidentally erase the magic-pill effect. A nice handy bit of self-deception.

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Look, when I first took Prozac I didn't really believe anything could help me...so I really disbelieve the idea that my medication works because of the placebo effect. My antidepressants work because they work. And without them I'm both suicidal and nonfunctional.

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Brick T - thanks for the update re:How this study was conducted.

All I know is - 2 weeks without my Lexapro, and I am crying a lot, not sleeping, and mostly a _itch to live with.

So, "placebo-effect" or not, I will continue to take it.

Like dianthus said: Geez - there are so many cases I can think of - where some ADs don't work for some people and those same ADs works seemingly miraculously for others - did the researchers stop to consider that? It sounds like a very, very narrow study.

It took me years to find an AD that actually worked well for me - I am sure if they had put me on, say, Noritryptiline (which didn't work particularly well for me, among many others that also did not work very well) - and then compared its effect to what I felt and acted like without it - that it could be said that whatever effect that AD did have on me was merely a "placebo effect." Simply because that particular AD did not work very well for me, so that its effect was negligible.

Thank God I finally found one that did work. Sure as hell does not feel like any "placebo-effect" to me.

I could be wrong, but I don't think so.

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I think the real issue here is that there is no single one thing called "depression" there are a bunch of different neurological states all of which produce the same symptoms as the thing we call "depression" but what's going on at the chemical soup level is very different.

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Look, when I first took Prozac I didn't really believe anything could help me...so I really disbelieve the idea that my medication works because of the placebo effect. My antidepressants work because they work. And without them I'm both suicidal and nonfunctional.

ditto

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I think the real issue here is that there is no single one thing called "depression" there are a bunch of different neurological states all of which produce the same symptoms as the thing we call "depression" but what's going on at the chemical soup level is very different.

BINGO!

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Part of it, too, is we suddenly are being paid attention to. We're special in someone's eyes. Whether it's seeing a pdoc and getting a script or starting talk therapy, we're singled out for treatment other people aren't getting. Like when you start dating someone new. Same kind of lift in mood and outlook.

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Part of it, too, is we suddenly are being paid attention to. We're special in someone's eyes. Whether it's seeing a pdoc and getting a script or starting talk therapy, we're singled out for treatment other people aren't getting. Like when you start dating someone new. Same kind of lift in mood and outlook.

I disagree with this. I went to my doctor in desperation and tried 4 antidepressants before I found one that worked. It's not a placebo, because when I had to switch to the generic, I slipped back down the slope into ugly depression-land.

I don't want to take my AD. It's expensive. It's yet another med to tax my liver. I don't feel the least bit special and I would go off it in a second if I could.

olga

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Part of it, too, is we suddenly are being paid attention to. We're special in someone's eyes. Whether it's seeing a pdoc and getting a script or starting talk therapy, we're singled out for treatment other people aren't getting. Like when you start dating someone new. Same kind of lift in mood and outlook.

I disagree with this. I went to my doctor in desperation and tried 4 antidepressants before I found one that worked. It's not a placebo, because when I had to switch to the generic, I slipped back down the slope into ugly depression-land.

Agreed, and the same thing happened to me. I started slipping down into a depression and the only changing variable in that time period was a specific anti-depressant. I didn't realize it until I really thought about it. Other generics I have switched to beautifully, in fact, I usually welcome the cheaper drugs. This *one* time, though, I wasn't so lucky.

I think that the placebo effect does work for some people. Those people, though, are the ones who probably should never have been put on medication to begin with. I think that a lot of doctors are very liberal with doling out antidepressants to people who say they are depressed. Humans are supposed to get depressed... it is part of the spectrum of human emotion. It is when that depression goes too far, that treatment should be sought in the form of medication. Doctors are better off telling their patients who are unhappy to seek therapy rather than just write them a prescription. Therapy is for anyone and everyone. Medication, though, I would really only expect to work if someone were depressed in a clinical sense of the term.

I'm tired and just came home from work. I have no idea if that made any sense.

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No, not at all.

Depressed people are a pretty self-centered and self-indulgent lot. Anything that gets us out of ourselves is a step towards getting better.

Ask your psychiatrist or therapist about what I'm saying. It's certainly known well enough in the medical community.

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No, not at all.

Depressed people are a pretty self-centered and self-indulgent lot. Anything that gets us out of ourselves is a step towards getting better.

Ask your psychiatrist or therapist about what I'm saying. It's certainly known well enough in the medical community.

Speak for yourself. I am not and never have been self-centered or self-indulgent. I'd like to know the therapists who consider this a "well-known" fact.

olga

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