Friday, August 17, 2007

Anti-depressants

Zach has a recent post in which the comments have veered towards the validity of homeopathy and alternative medicine in general, and just now into the effectiveness of anti-depressents.

I've never been on them, but I've thought about them a lot.

I can tend to be a "down" sort of person. The last woman I dated was more of an optimist than I have ever known, and really brought this home to me. It was nice for me to have her perspective on things (she really saw the good in almost everything, it wasn't like she was saying something sweet and insipid about really bad situations, just that she really saw what there was to be excited about. It baffled me sometimes, but was really nice too) - I'm sure it was often less nice for her to have mine :)

And I know a lot of people who have taken them, at least for a while. Not least my mom, who I never really "processed" it about. But I remember my dog ate the bottle of valium from her purse when I was nine, and worrying about the dog - but why was my mom on valium? that didn't come til later. I think she was one whatever everyone ws on before that (something with an L?) and she was on paxil a few years ago (might still be, I'm not monitoring her nursing home meds as maybe I should be, but they took her off a lot of them when I moved her there, which I appreciated) - In any case, I can't imagine it helped. She's always been very negative and terribly anxious the whole time I've known her. Would it have actually been worse without drugs? yikes!

Two people I know who went on and off different drugs described it as like being under water, or seeing your emotions on the other side of a glass, but not being able to feel them.

But a friend of mine has tons of friends who are on them, and she says they feel their emotions just fine.

I have lost two people to suicide. Both were on drugs at some point, one was when it happened (she was actually IN a psych hospital when it happened, which pissed me off, can't they at least do THAT?) but they never got the mix "quite right" I guess.

My cousin had been on prozac (I think) and gone off it a while before. Various folks in my family pointed to that as THE PROBLEM. - Not that he was 33 and unemployed in a family where acheivement is important, or that he'd broken up with the love of his life a few years before (dumbass), or that it was a few months after 9/11 and he was volunteering every day at "ground zero" (well, actually, that was a popular notion too, I guess), or that he lived in a family where the best they can offer you for despair is prozac (I am convinced that if I or his ex had still been actively involved in his life it wouldn't have happened, a fact that doesn't eat at me as much as it used to.) Not to mention that he'd told me he'd decided that the way he eventually did it was the best way to kill yourself when we were teenagers.

I've had therapists suggest drugs, mostly when I was in a real downswing in my life breakup, lost job, right after Jon's suicide) - and I said "no" - but the one time I considered it I had to do SOMETHING, so I took St. John's Wort and vit. B (which I think is more important, now, for me) and stopped eating sugar, and the effects were pretty amazing. I was also getting a ton of exercise about then as I lived about 10 miles from where I mostly wanted to be, and didn't have a car, so I got a lot of biking in.

It also seems like for some people it is this amazing turn-around - from functioning to not functioning. And often I envy them. Someone told me once that a friend on Wellbutrin got super duper efficient and drove everyone nuts around him, but I thought, hey, maybe I could use that. Even if I wasn't less depressed, my house would be clean for once, right?

3 comments:

James Riemermann said...

I'm glad you've re-started this conversation. Very interesting stuff.

I'm depressed by nature, especially when I'm feelingstressed and ineffectual at work, which is fairly often. I've tried maybe 8 or 9 antidepressants and never gotten any serious relief. I'm what they call a "non-responder," which really bums me out because I'd rather not be depressed.

I am delighted that some people report tremendous relief from antidepressants, but a close look at the research strongly suggests the drugs themselves--especially the highly popular "SSRI" drugs--aren't doing much.

Basically, the positive response rate for *any* sort of treatment for depression--any sort of talk therapy, any sort of drug, including placebos--is strikingly similar. I don't remember the specifics in terms of numbers, but I think it's something like, if you test a large group and get a positive response rate of 53% for the tested drug, and 50% for a placebo, that's statistically signficant. In other words, 50 out of 100 people find their depression lifts from eating sugar pills; whereas 53 out of 100 find their depression lifts eating Prozac. That's easily enough to get a drug approved for treating depression.

So does that mean that the actual chemicals in Prozac effectively treat depression in 53 percent of people? Not unless you can also say the same about sugar in 50 percent of people.

Like I said, I don't remember the actual numbers I've read but I think they're in this neighborhood. Surprisingly large numbers respond to placebo; slightly larger numbers respond to the actual drug. The difference between statistically significant and statistically insignificant is paper-thin. If a drug company tests enough new compounds, chemically almost identical, a certain number of them will come out as "statistically significant" just by chance. That is how the anti-depressant industry works, for the most part.

The obvious logical conclusion is, the placebo effect is what is really doing the trick for the vast majority of anti-depressant users.

It's almost criminal to say this out loud, because the placebo effect works best if you don't understand the placebo effect. I'm very skeptical by nature, and that may be a fair part of the reason I'm a non-responder.

The following strikes me as a pretty educated and well-researched skeptic's take on the problem:

http://www.psychotropical.com/ad_rev.shtml

James Riemermann said...

By the way, Pam, Valium's a very different deal. Anyone who takes it can tell very quickly the positive effect it has on mood and well-being. Pleasant enough to lead to serious addiction for some people.

earthfreak (Pam) said...

Thanks James!

I didn't actually know valium was any different, though I took valerian (the natural "version") for something at some point, and it certainly had a noticeable affect! I wonder why she eventually went off it? It didn't seem to make her happy...

I also enjoyed the article you linked to. I had no idea the effectiveness was quite that "iffy"

I tend to assume I'm too much of a skeptic too, and if it's gonna be a placebo effect, why not just decide to believe I have a guardian angel protecting me from my demons or something?

I also wonder, though, why so many of us need something. It seems like we can't be all just predisposed to being bummed all the time.

I guess I believe in "anti-depressents" like community, exercise (which I don't get enough of), time in nature, and maybe chocolate :)