The Skinny on Anti-Depression Medications

LabRat529

I'm a neuroscientist.

I'm a pharmacologist.

I suffer from depression.

I am not an expert on treating depression. I am not a medical doctor. But I have some information that I'd like to share. I'm sharing this information after reading on another thread that anti-depression medications 'statistically' don't help. I've seen that news-report too and here's what I have to say:

The human population is pretty diverse. Of course we share many biological similarities, but we also have many biological differences. One of those differences is how we respond to anti-depression medication. On a molecular level, the anti-depression medication does the same thing to each of us. Selective Serotonin Re-uptake Inhibitors (SSRIs) increase the amount of serotonin available in our brains for cell signaling. Examples of SSRIs include prozac, zoloft, paxil, etc., Other anti-depressants might increase dopamine availability, norepinephrine availability, or a combination of serotonin, dopamine, and norepinephrine (Welbutrin is a good example of a combination drug, though welbutrin is heavy on the dopamine if I remember correctly). Our brains all experience this when we add these drugs. We can measure these changes in the lab.

BUT our reactions to the increased levels of hormone in our brain will vary from person to person, as will the side effects we experience.

The deal about anti-depression meds being 'statistically' useless is... a half truth. When you consider the entire population of humans, only about 30% to 50% of them respond positively to SSRIs, and in that 30% to 50%, some of those people respond very well, and some only respond a little. So yes, if you look at the whole population and just SSRIs... the statistical effect is small.

However, if you're one of those people that is sensitive to SSRIs... the benefits for you could be amazing.

Now... that's just the SSRIs. There are other anti-depression meds, the new generation of meds, and those meds also effect 30 to 50% of the population or so... but it might be a somewhat different group, depending on the drug.

The point I am trying to make is, if you suffer from depression, medication might help you. You don't know if you're one of those that responds well or if you aren't, and you won't know until you try it. There are some people who won't respond at all, but saying that there's no strong statistical effect of anti-depression medication hides the fact that for some people, these drugs can make a difference between life and death, sometimes literally.

Now with all that said, the BEST treatment for depression (according to scientific studies) is counseling + meds.

I'm also not saying meds are necessary for everyone. If you can manage your depression without medication, that's great! You can avoid some of the side-effects, which can include weight gain.

And last comment... St. John's Wort is often touted as an alternative to meds, however, in my opinion, it IS medication, just in a natural, unpurified form. The biological effects of St. John's Wort can be measured. They're real. And those effects can cause problems with other medication, so St. John's Wort should always be treated as a medication and your doctor should be informed that you are taking it.

buckeye86

If everyone could afford to get genetic testing to get an idea of how meds will metabolize in them, it'd make prescribing things a lot easier for doctors. Until then, if you need something, there's nothing wrong with trying it out.

LabRat529

If everyone could afford to get genetic testing to get an idea of how meds will metabolize in them, it'd make prescribing things a lot easier for doctors. Until then, if you need something, there's nothing wrong with trying it out.

Agreed. One day, maybe. Genetic testing would be incredibly useful for treating cancer too. It's used in some cases, I believe, but its too expensive as you say to be commonly.

fmbomzo

Thanks for posting. I agree. I see too many people suffering from depression without any type of treatment (medication, counseling or otherwise). They are basically just walking through life but not really living. It's sad. Medication has value and can help some people. No one knows until they try. And medication is not a long-term solution in my opinion. It's a means to an end. When I suffered from PTSD, I tried the no meds route and I progressed, but very slowly and inconsistently. Adding meds in with the counseling accelerated my progress and I was able to stop the meds after a short period of time.

Lolli1986

I'm one of the people for whom meds work well, even for anxiety.

so... when you say the whole population, do you mean even those without depression?

I thought the stats for positive response was higher for those who do have depression. *edit. i cannot find where i read this, so treat it as a question.

LabRat529

I'm one of the people for whom meds work well, even for anxiety.

so... when you say the whole population, do you mean even those without depression?

I thought the stats for positive response was higher for those who do have depression. *edit. i cannot find where i read this, so treat it as a question.

I'll have to double check. I think even in the depressed population, the response rate to any given class of drugs is only about 30 to 50%. Of course that varies from drug to drug even within a class. Prozac is pretty effective and might be more effective than Zoloft for example, even though they are in the same class, but as a whole, SSRIs might only work in 30% of patients with depression. When you start combining the drugs or trying out different things, most people who are depressed will respond positively to medication. There is a population that is medication resistant. They don't respond to anything, but that's a small percentage of patients with depression.

By the way, if anyone knows anything more about all this, feel free to chime in. My expertise is actually brain cell death... so I might be a little off on some of these numbers (though I think I'm mostly right).

Anomalia

Oh...I see...

Krazy_Kat

I tried at least 10 different medications. None of them were effective or didn't have horrible side-effects. I'd become suicidal, zombie-like, gained weight had cessation syndrome.

What helped me the absolute mostie most was Amino Acids. I am not a quack or a shrink, but a very frustrated mental illness sufferer. If you are interested...try "The Mood Cure" as a place to start. It saved my life.

suthrnladey

Thanks for posting this! I cannot take SSRIs because of the side effects that I experienced in the past. I had some success with Lithium, but had to discontinue use because I have no health insurance and couldn't afford the blood tests required by my doctor. I am currently taking Welbutrin SR and Doxepin HCL.

I know everyone is different. I HATE taking meds for any reason. I especially hate daily meds for my mental health issues, but I do not have the power to treat myself in the best way possible without them. I wish some of the non-pharmaceutical methods would work for me. But they don't. Several times I have stopped taking meds because I thought I would be fine without them. I was wrong.

Many years of experience with depression, etc. have taught me that taking meds isn't a sign of weakness. It is a sign of strength and courage.

I am grateful for the men and women who have dedicated their careers to finding meds to treat my conditions (and the conditions of others.) I'm also thankful for the doctors, therapists, etc. who have gone through the extensive training to help me--to be honest, I have seen some who weren't a proper fit for me, so I would move on to another to find the right one.

I am curious to know your thoughts on ECT, if that is in your field. I have known a few people who think it's a great option for certain patients.

wackyfunster

The statistical issue is not that they are "30-50% effective" it is that they are not more effective than placebo to a statistically significant level (i.e. placebo is 30-50% effective as well). Tricyclics and MAOIs ARE, but are not commonly prescribed due to side-effect profile. As a pharmacologist you should already know this though.

Arthurpod

I gained a lot of weight on Paxil AND St. John's Wort and I'm assuming it's because of the increase in serotonin which seems to be involved in appetite. I'm currently on Wellbutrin (Buproprion) because of its association with weight loss. The same mechanism that works for the ability to control nicotine cravings seems to help with food cravings, or at least, that's what I've heard. We'll see if it makes a difference for my depression and my waist line!

beccag28

Good on you for posting this! I hate seeing incorrect information thrown around - especially about mental illness.

autumnk921

Very interesting read....Thank you for posting this!!

Lolli1986

The statistical issue is not that they are "30-50% effective" it is that they are not more effective than placebo to a statistically significant level (i.e. placebo is 30-50% effective as well). Tricyclics and MAOIs ARE, but are not commonly prescribed due to side-effect profile. As a pharmacologist you should already know this though.

...that's almost half true. This wiki-ripped summary of two meta-analyses states that effect of SSRI in mild or moderate depression is statistically significantly higher than placebo, but doesn't reach 'clinical significance'. However effect of SSRI is both statistically and clinically significantly higher than placebo in cases of severe depression.

"A widely reported 2008 meta-analysis combined 35 clinical trials [...] found that although the effect of antidepressants vs placebos was statistically significant, it did not exceed the NICE criteria for a clinically significant effect. In particular they found that the effect size was very small for moderate depression but increased with severity reaching 'clinical significance' for very severe depression. The relationship between severity and efficacy was attributed to a reduction of the placebo effect in severely depressed patients, rather than an increase in the effect of the medication. Some researchers have questioned the statistical basis of this study suggesting that it underestimates the effect size of antidepressants but even when they re-analyse the data they find that this is still below the NICE threshold for 'clinical significance' when all results are combined (although individually paroxetine and venflafaxine exceed this threshold).
A 2010 review reached similar conclusions: in mild and moderate depression, specifically that the effect of SSRI is very small or none compared to placebo, while it is clinically significant in very severe depression."

Medtech2004

WARNING! For anyone taking St Johns Wort -- there is increased risk of cataracts in people who take St Johns wort so you should protect you eyes from the sun. Look it up. I just know I worked in a pharmacy when it was a big herbal product that people took and years later they made the connection between cataracts and St Johns wort.

wackyfunster

It is true that there is generally a 1-3% difference in efficacy found between SSRI and placebo. IMO this is very marginal compared to the pronounced increase in suicide risk when there are more effective treatments available (e.g. 15 mins per day of high intensity cardio has around an 80% efficacy rate, and the other two drug classes of antidepressants are in the 60's). The various cognitive-behavioral therapies are also quite effective.

IMO SSRIs are commonly prescribed because they are easy and low risk (assuming the patient doesn't off themselves in the first month or so).

I do actually have both a psych degree and grad-level training in psychopharmacology, although I chose note to pursue either as a career field.

LabRat529

The statistical issue is not that they are "30-50% effective" it is that they are not more effective than placebo to a statistically significant level (i.e. placebo is 30-50% effective as well). Tricyclics and MAOIs ARE, but are not commonly prescribed due to side-effect profile. As a pharmacologist you should already know this though.

That's not entirely correct. That's where the half-truth comes in. Let's play pretend. Let's say that you are running a clinical trial on an anti-depressant medication. You have 7500 people in your trial, all of whom are depressed to one extent or another. Only 2500 actually get your trial drug, 2500 get a placebo, and 2500 get nothing at all- maybe they just do cognitive therapy. It's double-blind, so the patient and the doctors don't know who's getting what. Now let's factor in genetic variability. Of your 2500 that are getting the drug, only 30-50% of those people are going to respond to the medication. Some of those are going to be big responders. Some are not.

When you add all the results together, you get a 10% improvement in depression based on placebo alone. That's statistically significant compared to those without medication at all. The people who get the anti-depressant medication might show a 13% improvement over those who get nothing at all. That's only 7% higher than the placebo.

BUT within those who get the anti-depression medication, you've got people who not only improved a little, they improved a lot.

Is your drug worthless because it only had a 3% higher effect than the placebo? Is it worthless to the person who experienced a night-and-day difference after taking the meds?

There IS a small statistical difference between placebo and anti-depressant drug in each study, or else the drug would be tabled and wouldn't go anywhere. However, I agree that the difference is small. I also think the difference would be much much bigger if there was a way to test only those likely to respond. And no, that's not cheating. There are some anti-cancer drugs out there that are amazingly effective IF you've got the right genetic profile. There's noting wrong with exploiting that knowledge, and I do think one day we will know enough to do the same with depression. Depression can be life-threatening, after all, and it deserves our attention.

The point of my original post was not to say "Rah Rah Anti-depressant meds!" Instead, I was putting the facts out there as I perceive them. Some people respond very very well to medication and its not an avenue of treatment that should be ignored. There are people who down-play anti-depressant medications and make the patient feel weak or stupid for relying on them, and this is wrong.

If you are depressed, medication might help you. There's a pretty good chance that it will, provide you are patient and honest with your counselor and doctor- you might have to try 10 different meds/combos before you find one that works for you, but it can help.

Then again, there are some people who will not respond at all. This is unfortunate. But the non-responders are better off having gone to a counselor and doctor than they would be if they didn't try. They at least know what doesn't work and they can focus on other things.

LabRat529

Just an FYI, I really appreciate all the responses. I won't be able to respond to all of them. I have to work :P I'm glad this started some discussion. As with everything, I hope people will do their own research (you can... check out mayo clinic, webmd, and even wiki for the basics, pubmed for the actual science that supports the basics). Talk to your doctor about your concerns too. Make an educated decision and do what is best for you. This may mean no medication. I DO understand the desire to stay medication free. There are side effects to every medication. And honestly, I'm medication free right now. I take the meds when I need them the most, and then I get off them when/if I can. I do this not because I don't believe they work, but because medication has costs and benefits both. I always way these out before deciding what to do.

Best wishes, everyone.

LabRat529

I gained a lot of weight on Paxil AND St. John's Wort and I'm assuming it's because of the increase in serotonin which seems to be involved in appetite. I'm currently on Wellbutrin (Buproprion) because of its association with weight loss. The same mechanism that works for the ability to control nicotine cravings seems to help with food cravings, or at least, that's what I've heard. We'll see if it makes a difference for my depression and my waist line!

Yes, your assumptions are most likely right

St. John's Wort is a monoamine oxidase (MOAs) inhibitor. I'm not sure what it does to serotonin. I'd have to check, but serotonin DOES play a role in appetite.

Good luck with Wellbutrin. I've been on it. I liked it... except it made me a bit anxious.

LabRat529

I tried at least 10 different medications. None of them were effective or didn't have horrible side-effects. I'd become suicidal, zombie-like, gained weight had cessation syndrome.

What helped me the absolute mostie most was Amino Acids. I am not a quack or a shrink, but a very frustrated mental illness sufferer. If you are interested...try "The Mood Cure" as a place to start. It saved my life.

I am sorry medications have not worked for you, and I'm glad that you've found a way to regulate your condition through diet.

LabRat529

As a pharmacologist you should already know this though.

P.S. Pharmacologist does not mean "all knowing". Even in my field of expertise (brain cell death in stroke, traumatic brain injury, and neurodegenerative diseases like Alzheimer's Disease), I do not know everything and learn something new almost daily. I admit I am NOT an expert on anti-depression meds, but I'm more of an expert than the average person and the information I have shared is true to the best of my knowledge. If you can show me the science that says otherwise, I'll gladly read it and change my opinion.

Although, you'll be hard pressed to get me to believe anti-depressants are ever worthless. You're working against my own personal anecdotal evidence. They work for me. I respond very well to medication. Maybe it's the placebo effect that I'm enjoying. Maybe not. But I respond.

Anecdotal evidence is hard to combat. It's almost as hard to combat as faith. Neither represent 'science', but they're strong strong strong.

MaraDiaz

Because the difference between placebo and the medication is not statistically significant in milder cases of depression and because of the many side effects of these medications, they should be the treatment of last resort, not first resort.

The truth is, they make a lot of people a lot of money when prescribed as they are, and they 'save' a lot of money on counseling (which is what the patient often really needs).

Otherwise, it would be fine to hand them out even if they were %100 placebo, because oddly, placebos have been known to help people. But a placebo should first be harmless to the person taking it. These drugs are not harmless and should not be prescribed nearly as often as they are.

Lolli1986

Because the difference between placebo and the medication is not statistically significant in milder cases of depression and because of the many side effects of these medications, they should be the treatment of last resort, not first resort.

They do have an effect that is statistically significantly higher that placebo in mild/moderate cases of depression. It's just not 'clinically significant', whatever that means. This means that in clinical trials, SSRIs do perform better than placebo.

These drugs are not harmless...

They have some side effects, and believe me, they can really, really suck for up to a month... but I wouldn't consider really sucky to be harmful. Not harmless, but in the vast majority of cases, not harmful either.

It would have been -annoying- to go through those side effects without any positive effect from the medication, but that's about it.

Frankly, the side-effects of bad anxiety are far more crippling and last much longer than any negative l effects I experienced from the drugs (and I was further toward the 'bad side-effects' end of the scale than most people). I would also absolutely classify bad anxiety or depression as harmful.

LabRat529

Because the difference between placebo and the medication is not statistically significant in milder cases of depression and because of the many side effects of these medications, they should be the treatment of last resort, not first resort.

The truth is, they make a lot of people a lot of money when prescribed as they are, and they 'save' a lot of money on counseling (which is what the patient often really needs).

Otherwise, it would be fine to hand them out even if they were %100 placebo, because oddly, placebos have been known to help people. But a placebo should first be harmless to the person taking it. These drugs are not harmless and should not be prescribed nearly as often as they are.

I will agree that other treatments should be tried before prescribing an antidepressant in cases of mild to moderate depression, but I don't agree that it should be a last resort. In many, the side effects are very mild and even unnoticeable, and the benefits are substantial. Why suffer the pain of depression for months if medication can provide relief? Counseling + medication is far more effective than counseling alone. For that matter, counseling + medication is far more effective than medication alone, so why not use the tools available to you to bring relief?

And for cases of severe depression? When suicidal thoughts enter the picture? And/or when anxiety is combined with depression and puts someone at risk of losing their job, their family, their friends, their ability to function? In my opinion, you lose the luxury of dallying with other treatments.

But that is my opinion and not science.

LabRat529

Frankly, the side effects of bad anxiety are far more crippling and last much longer than any negative l effects I experienced from the drugs (and I was further toward the 'bad side-effects' end of the scale than most people). I would also absolutely classify bad anxiety or depression as harmful.

I agree completely. The effects of bad depression are also crippling and even life threatening and are worse than the negative effects of almost any antidepressant drugs.

Umeboshi

I thought this was going to be a "medication is evil" post. Everything went better than expected.

LabRat529

Here is my question. I have a friend from this site who was going through depression. She was also in a plateau for a long time 8 months or so with her weight loss. They put her on medication, she's feeling better. She also stopped her binging and she says she doesn't need as much sleep. What comes to mind this is more of a stimulant based anti depressant, she also says she's not hungry anymore.

I foresee possible dependency, weight gain when she gets off it and goes back to her old calorie limit. Her metabolism might be slower due to the lower calorie limit., so she might gain more weight in the end if she gets off it.

Of course this is a 'possibility" but what is the likely hood this will happen?

It's impossible to say what the likelihood is without knowing your friend, her medical history, her personality, whether she's in counseling, and so forth.

The thing to remember about depression is it's a complicated and multi-factorial disease. If she eats for emotional reasons (a lot of us do), she might very well not be 'hungry' any more because those emotional needs are being met in another way. If she's in counseling, then she'll be learning coping skills that could prevent her from relapsing both with depression and with overeating if she chooses to come off her medication. But then again, she might gain the weight back.

"Dependency" is not a word used lightly in pharmacology. It usually means the brain and/or body changes up it's cell signaling processes so that you MUST have the drug to function optimally. Any drug that triggers dopamine release has the potential for abuse. One can become addicted, but to my knowledge, that's pretty rare with anti-depressant meds. In fact, I've never heard of it happening.

Now if you just mean 'reliant' in a non-pharmacological/biochemical/cell-signaling way... well... a lot of people take anti-depressant meds for life, and in my opinion, that's okay. One theory of depression is that there's a chemical imbalance in the brain. You can train yourself to cope with that imbalance. You can compensate for that imbalance with medication. Or both. There's nothing wrong with being on anti-depression meds for life just like there's nothing wrong with being in counseling long term either.

Coping strategies can include diet and exercise, by the way.

onedayillbeamilf

I agree that it shouldn't be assumed they just won't work for someone. If someone doesn't want to try them, for whatever reason, fine. But the argument shouldn't be that they just don't work. Some people do have great success with them. Unfortunately, I'm one of the people that has tried every drug class of antidepressants there is, including a new one that's been out less than a year that's in It's own drug class, and they don't affect me well. But, that doesn't mean they won't work for others.

Umeboshi

Here is my question. I have a friend from this site who was going through depression. She was also in a plateau for a long time 8 months or so with her weight loss. They put her on medication, she's feeling better. She also stopped her binging and she says she doesn't need as much sleep. What comes to mind this is more of a stimulant based anti depressant, she also says she's not hungry anymore.

I foresee possible dependency, weight gain when she gets off it and goes back to her old calorie limit. Her metabolism might be slower due to the lower calorie limit., so she might gain more weight in the end if she gets off it.

Of course this is a 'possibility" but what is the likely hood this will happen?

None of the many antidepressants I've been on have been stimulants. Depression probably caused the binge eating, oversleeping, and excessive hunger. I'm guessing now that she's getting better, those symptoms are going away.

Like LabRat said, she may never get off her antidepressants. I'm probably going to be on mine for life. I'm thinking she probably won't gain weight unless she's eating below 1200 now and then decides to eat more than her maintenance later on.