Posted by Racer on April 13, 2004, at 18:15:45
In reply to scarey anti-SSRI web site, posted by Joslynn on April 12, 2004, at 21:16:07
Those sites make me angry. It's hard enough to suffer from depression, but then these idiots come along and start shouting about how the drugs used to treat the disease are killing the poor victims...
Here's what I've learned in the last 15 years:
All the antidepressants, from MAOIs to TCAs to SSRIs and beyond have about the same level of efficacy. All of them have their own side effects. All of them work for about 40% of the people who take them.
The drawbacks to the MAOIs are pretty major. The dietary changes alone are so significant that it's a drug of last resort for most people. They also have a pretty high drug interaction rate, which is a concern if there's a chance you'll ever need to take another drug for anything at all. While they are life saving for a lot of people, for most depressed patients they're not worth the difficulties.
The TCAs are also about 40% effective, but they have a much more benign profile than the MAOIs. The problem is, they're pretty non-specific in what they do -- which neurotransmitters they effect, etc -- and so they cause a fairly high incidence of adverse effects. They are also a risk in overdose, so for profoundly depressed patients who are unsupervised during initial treatment, they may not be the best idea.
SSRIs have about the same level of effectiveness as the older ADs, but they have -- reletively speaking -- far fewer and more benign side effects.
The hype about suicide risk has been there since Prozac first came on the market. These people are shouting it so loud -- and they're shouting PART of the story, but not all of the story. The consensus in the psychiatric field seems to be that the risk of suicide is not from the drug per se. The risk is that SSRIs increase energy and motivation before complete remission from the depression happens. That means that there are a lot of people who feel well enough to ACT on their suicidal impulses, but don't feel well enough to function in their lives. When you first start taking an AD, of any sort, there's often an initial period when the placebo effect makes you think that you're feeling better. Then, that wears off, often before the ADs have really kicked in. Can't you imagine how devastating that is? Here you think you're going to get better, and one morning you wake up feeling just about as bad as you did before? Doctors, in general, don't discuss this with their patients. Patients who wake up with this sudden reversion to their depressed state -- but with more energy -- may think that they've failed, it was as hopeless as they'd thought, etc. Yes. Many of them do attempt or commit suicide. The psychiatric community has known this for decades. The highest risk for suicide isn't while a patient is lying on the sofa crying. It's when that patient gets up off the sofa and starts cleaning the house. The risk with SSRIs is part of the same phenomenon.
As for the rest of it, yeah, we're guinea pigs. Those drugs are studied for six to eight weeks for approval, and then doctors figure out over many years what else happens. Unfortunately, what's available is what's available. Which is worse? Depression, or the drugs? That's something only you can decide. Remember, the TCAs and MAOIs are understood a little better, but they have their own problems.
Personally, a good relationship with your doctor is about all I can offer as a suggestion to coming to terms with this.
Good luck.
poster:Racer
thread:335735
URL: http://www.dr-bob.org/babble/20040412/msgs/336090.html