Large study shows SSRIs work for only 15% of patients, huge placebo effect
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Anonymous
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I have worked with three different doctors/psychiatrists at different points in my life to address severe depression and/or anxiety. Each one made it clear that brain chemistry is complex and finding the right medical solution can be a frustrating and lengthy process of trial and error with lots of side effects along the way. Specific medications and dosages work for some people and not others.
I’m on a life changing SNRI currently, and it took almost a year to get to just the right point. I started with an SSRI, spent weeks at one dosage, weeks at a higher dosage, weeks tapering off to try an SNRI. Weeks at one dosage, weeks at a higher dosage, weeks at the current dosage until deciding that it was working well. Weeks more to get past all of the side effects. Only then was I at the point where I knew I was on the right medication for me. A 15% success rate for just one category of psychiatric medication doesn’t sound alarming to me, especially given that many people are not going to tolerate the process necessary to find the right one at the right dosage. Placebo effect doesn’t work for those of us with significant chemical imbalances. Good for those for whom it does. |
Anonymous
Why does it have to be one or the other? The fact is we don't know everything about how depression operates. It's genetic, but it's also environmental. Both my parents have struggled with depression and anxiety. They gave me their genes and they raised me. How much of it is nature vs nurture doesn't matter to me and I certainly don't take it personally. |
Anonymous
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I’ve been on 3 different meds. First helped a little but really messed with my libido, so I stopped. Second works great—life changing (no more pmdd or crying at the dinner table or feeling like I’d rather die than live another day). Third seemed like a sugar pill—no side effects but also no benefit. I guess I only had placebo effects for the second.
(Isn’t it kind of weird for people to say the negative emotional side effects are real—but not the positive effects?) I guess I need to not feel so defensive—maybe I’m in the 15%. But these studies do make me feel invalidated, like my anxiety/depression is made up. I’d also like to add that I became severely depressed each time I was on birth control pill. But very horny. Same with when I have bad PMS: horny—but also a depressed psycho. It’s not great to be horny when nobody wants to have sex with you. My point is that the SSRIs do diminish my sex drive but they also even out my moods. There just has to be a some sort of connection there. At least for some us us. |
Anonymous
Yeah, I feel you - how could a drug that has such OBVIOUS effects on so many systems be ineffective? For me, it was zero libido, nonstop dreams all night, weight gain, gross stomach issues. And the withdrawal was brutal, three weeks of vertigo, sensitivity to noise, crying and irritability. They do something to the brain, that's for sure! My subjective belief is that for me, Lexapro makes me more positive and less reactive. But who knows, maybe the same thing would happen on placebo. And, as consumers and patients, we do deserve to know that nobody really knows how the meds work. "It's just brain chemistry" is an advertising logo, not an explanation. |
Anonymous
It's also very very hard to convince a depressed person to take proactive steps like daily exercise. For mild or moderate depression I think meds are often seen as a way to try to even things out until other lifestyle changes can take effect. Doctors know they have side effects. But those side effects can often be tolerated for a short while until things improve and the person is able to take other steps such as exercise or therapy. |
Anonymous
| It has worked wonders for me with very little side effects. |
Anonymous
It doesn't. But you're making a nuanced argument and most people who aren't heavily invested in the issue won't take the time to understand that nuance--unfortunately. |
Anonymous
| Tom Cruise has been mocked ruthlessly for his tense and cringey Today Show interview with Matt Lauer, and yet everything he said was 100 percent undeniably true. |
Anonymous
OP here and I don’t see it like that at all. The thing I’ve struggled with is that the “chemical imbalance” theory makes people think that if you just take a drug to fix the imbalance, then presto chango, no more depression. When that didn’t work for me, I had people in my life who absolutely then concluded “oh then this is just your fault.” So then I was dealing with three things at once: my depression, the side effects from drugs that did not fix my depression, and a sense of defeat at not having solved my depression easily through drugs like all the ads convince people is possible. I agree with the PPs that sometimes SSRIs are useful for kick starting a process that can be next to impossible without some kind of ignition. I am definitely not saying drugs don’t have a place— they absolutely do. But it’s problematic that most people view SSRIs as the first line of defense against depression when they work for such a small percent of people. When I’ve struggled with the medication in the past, I’ve been told that I’m part of a small subset of people with depression who don’t respond well to drugs. But it turns out that’s probably not the case. Factoring placebo effect and the fact that the drugs often don’t work well long term, I’m probably in good company and instead we should view those whose depression responds well to medication as a lucky minority. But we need more solutions for the other 85% of people. Drugs, sure, but also a real acknowledgment that long term relief probably lies elsewhere. We have to figure out how to get people access to alternative therapies, and how to pay for it. Another note: one thing I often think as someone who responds well to CBT/DBT is that part of the solution lies in educating EVERYONE in better thought patterns, even people who aren’t depressed. It should be part of standard education, like sex Ed. Because one thing I’ve realized is that part if the problem is about relationships and communication. We need a common vocabulary for talking about emotions, especially negative and scary emotions. Teaching depressed people this vocabulary gets us halfway there. But if everyone knew it, I think a lot of these issues would be easier to bear. |
Anonymous
| If a woman takes these medications to relieve depression, and because of the reduced libido the husband has an affair/visits prostitutes/divorces her & marries a younger woman, is that a desired effect of the medication? I am not writing this hypothetically. |
Anonymous
Hahaha! Hell no. You sound just like him- “what I believe is 100 percent undeniably true, and I personally know for a fact that no one else has done the research.” |
Anonymous
Right, so there isn't a medication that works so they back ones that don't to make $$$. |
Anonymous
| Guess I’m one of the lucky ones. Zoloft is a miracle drug for me and I don’t have any bad side effects. My libido is great! |
Anonymous
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My OCD onset when I was in my early 20s. It was earth shattering and extremely painful. Zoloft was like a miracle drug… I have tried therapy and mindfulness and exercise alone and it’s just not even close to the glory of Zoloft.
That said, after a few months I read a study that said the effects of SSRIs wear off after a 4-6months. Terrified, I asked my psychiatrist if that was going to happen, and he basically said, most people don’t actually need this drug. It doesn’t help them beyond a placebo effect. I am happy to report that years later it still works! I’ve only gotten off for pregnancy, but the ocd in all it’s nastiness came back (and then was immediately relieved by going back on the drugs). |
Anonymous
+1 I am the ocd sufferer above, and yeah, it also doesn’t kill my libido and I had no weight gain on it. But I do wonder if side effects are lesser for those who need the medication OR if life is just so much more improved when you’ve been so mentally sick that even your physical body just works better. |