by robertakarobin
12 subcomments
- 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 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 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.
- 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.
by blastersyndrome
3 subcomments
- 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.
- Our 11 year old daughter was seriously depressed recently. N=1, but fluoxetine was life changing (and potentially life saving) for her, at least.
by marcus_holmes
1 subcomments
- > "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?
- 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 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.
by monero-xmr
10 subcomments
- 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!
by hcknwscommenter
0 subcomment
- 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.
by slantedview
2 subcomments
- 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.
- 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.
- 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.
by burnt-resistor
2 subcomments
- 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.
- 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.
- 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.
by RickJWagner
2 subcomments
- 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/
- 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.
by timtim51251
0 subcomment
- 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.
- 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"
- 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.
- 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.
- For some reason, the title mangler chopped off the word "say": "Prozac ‘no better than placebo’ for treating children with depression, experts say."
by Braxton1980
0 subcomment
- 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?
by SubiculumCode
0 subcomment
- small effects in overall trial does not mean that for some individuals the effects were very large. The Heterogeneity is Real.
by darthvaden
0 subcomment
- So people who used it till now. What are they now? Stupid
- 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.
by Forgeties79
2 subcomments
- 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.
by collingreen
1 subcomments
- This should get locked. People are horrible.
by FatherOfCurses
1 subcomments
- Folks who are ideologically opposed to psychiatric drugs are almost as irritating as folks who are ideologically opposed to vaccines.
- I thought Prozac was for anxiety.
- 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.
by burner420042
0 subcomment
- 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.
- RFK Jr dancing
- [flagged]
by djohnston
2 subcomments
- [flagged]
- [flagged]
- > 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 :')
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