#68369 Depression and Drugs

[Fredjikrang]

http://theboard.byu.edu/questions/68369/

So, due to some recent happenings in my life I found this Q&A very interesting, and I was wondering what the other members of the BB thought about it?

I can totally understand the disbelief that people have about depression and drug therapies, but I've done a lot of reading in the last couple days, and pretty much all peer reviewed studies that I have looked at show that modern antidepressants are significantly more effective at helping people feel better than a placebo or some kind of therapy alone (though most seem to say that a combination of therapy and medication is more effective than either alone.)

I also have a family member that has always had anxiety issues. She was eventually prescribed Zoloft, and it had a marked and rapid positive affect on her life, so I have to say that while I don't know much about depression and its causes (and let's be honest, no one does) it does seem like at least some drugs help some people to deal with it.

What do you all think? Ideas? Experiences?

[Zedability]

I'm really conflicted on the depression/drugs thing. I've heard some studies saying the drugs work, and other studies saying it's a placebo. I heard one statistic that said that a drug that was 70% effective dropped to 3% effective for patients who had heard that it was just a placebo, but that could be kind of a "reverse placebo" effect - if they think it's NOT going to work, it's less likely to, just like thinking it IS going to work makes it more likely.

I think what it comes down to is mental health is centuries behind physical health, in terms of doing good, empirical research on how it works. But like Watts says, science isn't really turning up any good answers right now.

I know some people don't like using drugs for mental health (for a variety of reasons, such as side effects), but I think that if I developed a mental health disorder and a professional recommended drugs as part of my treatment, I'd try them. I'm still undecided on whether I think they're any good, but I've seen people improve after finding the right drug for them, and I think our understanding of the neurobiology of mental health disorders is poor enough that it's possible that some of them work without understanding why they work. My view is basically, why not try them, if they work, great, if not, oh well.

(yeah, I know I already answered that question, but I'm sooooo bored right now.)

[Marduk]

I'm just wondering what "doesn't believe in depression" means. Does that mean he thinks depression is like fairies, leprechauns and eskimos? I'm wondering what discipline would say that depression doesn't exist.

[Emiliana]

Anecdotally, I don't know or care whether my antidepressants work because of the placebo effect or some other reason, but I'm sure a hell of a lot better off than I was before I started taking them.

[bobtheenchantedone]

I understand what they mean by not believing in depression how it's currently defined, but I am glad I don't have the struggle of trying to fix something you don't believe has a good way of being fixed. One of the main emotions associated with depression is hopelessness or helplessness, and to have at those times an idea that anything you can do is not the right way to "get better" has got to be hard.

Personally, I don't take medication, even though my therapist recommended it. My reason is that several members of my family take medication and seem to think that that alone will solve all of their problems. Also, I feel that I am far too easily overwhelmed and so try to run from my problems instead of solve them, so I wanted to learn how to handle things on my own. And finally I know that if I start exercising regularly and eating better that will help a lot, so I'd rather have motivation to do so then try to develop these habits when medication is already making me feel better.

Loved therapy though. It was a perfect choice for me and I'm so glad I jumped at the chance when it was offered. It really put me in a better mindset, not only that we were solving problems I was coming up against but also that I was being given tools to solve problems like them in the future. I made progress in huge leaps and bounds for the two months or so that I went and I'd recommend it to anyone who was struggling.

[NerdGirl]

1. Personal anecdote: I have OCD. I have had it since I was about 7. My compulsions have included turning off stoves/lights/appliances, locking doors, things needing to be in even numbers, needing to count EVERYTHING, praying about specific things at specific times, and lots of other stuff. It has seriously interfered with my functioning in the past. Pharmacological treatment for OCD is certainly not as good as it is for some other psychiatric conditions, but one treatment is a high-dose SSRI. When I finally started to get help for my OCD 10+ years ago, I saw a psychiatrist who treated me with high-dose prozac and I also started seeing a psychologist who treated me with cognitive behavioral therapy. I was on prozac for about 7 months, I think, and I ultimately had to stop taking it because the side effects (nausea/diarrhea/insomnia) had really become pretty unbearable. After a few years of CBT I got to the point where I could manage my OCD. It's still there, but I now have the tools to deal with it and it doesn't interfere with my life too much anymore. But I have to say that while I was on the meds for it, it was a LOT easier to control it. The drugs made the compulsions nearly disappear. The CBT didn't take them away, it only gave me tools for living my life around them. Mental health issues are real, and medications really do help. Using medication to treat mental health problems is obviously more complicated than something simple like using thyroid hormones to treat my hypothyroidism. But mental health problems are no less real than my thyroid problem, and if someone finds a medication that works for their depression and that doesn't cause intolerable side effects, then I think that is wonderful and legitimate and in no way indicates that they have some kind of personal or spiritual deficits. I'm not saying that there aren't spiritual aspects to it, but I think it can be dangerous to focus on the spiritual aspects of it to the exclusion of things that have the potential to help.

2. I have some issues with this quote from Watts' professor: "Body chemistry changes so rapidly and restores itself completely over a period of 24-48 hours. If depression was purely a chemical imbalance then it would take a matter of hours or days for the drug to take affect. Yet the average depression patient usually takes 6-9 weeks to start feeling the benefits of the drug in question." I think that is an oversimplification at best. Without getting into the complicated nuances of pharmacology, there are a lot of drugs that take more than hours or days to start working. A lot of drugs that treat problems that are unequivocally physical (Methotrexate for rheumatoid arthritis or lupus, for example) can take months to start working. Body chemistry and the way that drugs interact with it are complicated, and the fact that a drug takes weeks or months to take effect does not mean that it is not treating something physiological.

3. I too am wondering what discipline says that depression doesn't exist. It does exist, and I really hope the question asker gets some help, because depression is not someone's fault and it is not something that anyone deserves to just suffer through. There are ways to get help, both with drugs and without, but it is a very real thing and people who are suffering from it need to know that there are ways to get help. There's no magic cure for it, and the same things don't work for everyone, but there are things to try that can help.

[Dead Cat]

Does that mean he thinks depression is like fairies, leprechauns and eskimos?

Side note: Technically, Eskimos do and don't exist. The preferred term is "Alaska Native" or one of the more specific group names like "Aleut," "Athabaskan," or "Tlingit"--many of which in fact are decidedly not Eskimo (because, as I have previously explained, half of Alaska can eat Texas for breakfast, and so there is a lot of ecological diversity that has to be dealt with differently). Yupik and Inuit are often classified as Eskimo; some of these natives eschew "Eskimo" as an identifier while others don't care.

You may continue your actual discussion now.

[Zedability]

In Canada, "Eskimo" is considered derogatory. The northern First Nations call themselves "Inuit".

Sorry, thread derailment.

[Katya]

In Canada, "Eskimo" is considered derogatory. The northern First Nations call themselves "Inuit".

Sorry, thread derailment.

The Inuit are not technically First Nations (see the first sentence of this), but the Inuit, Métis, and First Nations collectively constitute the Aboriginal peoples of Canada. (By the way, "Aboriginal" sounds terribly derogatory to me, but apparently it's the proper international term. Is it "Aborigine" that's derogatory, maybe?)

[Emiliana]

1. Personal anecdote: I have OCD. I have had it since I was about 7. My compulsions have included turning off stoves/lights/appliances, locking doors, things needing to be in even numbers, needing to count EVERYTHING, praying about specific things at specific times, and lots of other stuff. It has seriously interfered with my functioning in the past. Pharmacological treatment for OCD is certainly not as good as it is for some other psychiatric conditions, but one treatment is a high-dose SSRI. When I finally started to get help for my OCD 10+ years ago, I saw a psychiatrist who treated me with high-dose prozac and I also started seeing a psychologist who treated me with cognitive behavioral therapy. I was on prozac for about 7 months, I think, and I ultimately had to stop taking it because the side effects (nausea/diarrhea/insomnia) had really become pretty unbearable. After a few years of CBT I got to the point where I could manage my OCD. It's still there, but I now have the tools to deal with it and it doesn't interfere with my life too much anymore. But I have to say that while I was on the meds for it, it was a LOT easier to control it. The drugs made the compulsions nearly disappear. The CBT didn't take them away, it only gave me tools for living my life around them. Mental health issues are real, and medications really do help. Using medication to treat mental health problems is obviously more complicated than something simple like using thyroid hormones to treat my hypothyroidism. But mental health problems are no less real than my thyroid problem, and if someone finds a medication that works for their depression and that doesn't cause intolerable side effects, then I think that is wonderful and legitimate and in no way indicates that they have some kind of personal or spiritual deficits. I'm not saying that there aren't spiritual aspects to it, but I think it can be dangerous to focus on the spiritual aspects of it to the exclusion of things that have the potential to help.

I know you're, like, in med school and stuff and are probably more up on this than I am, but my boyfriend has had ENORMOUS success with Luvox CR for his OCD. It's an older drug, but the CR version is new and specifically labeled for OCD. His OCD is mostly obsessive without a whole lot of external compulsions, though, so it's a bit different from what you probably experience, but it's reduced the amount of time he spends each day ruminating from 5+ hours to maybe 30 minutes. He's also doing some CBT to help with what's left of the obsessions.

[Zedability]

In Canada, "Eskimo" is considered derogatory. The northern First Nations call themselves "Inuit".

Sorry, thread derailment.

The Inuit are not technically First Nations (see the first sentence of this), but the Inuit, Métis, and First Nations collectively constitute the Aboriginal peoples of Canada. (By the way, "Aboriginal" sounds terribly derogatory to me, but apparently it's the proper international term. Is it "Aborigine" that's derogatory, maybe?)

Right. I was looking for "Aboriginals," but I couldn't remember what the technical term was there. I used to know that, but I purged it from my brain after high school Social Studies.

As always, I'm in awe of Katya's breadth of knowledge on everything. PC terms for Canadian Aboriginals? Check.

[Katya]

In Canada, "Eskimo" is considered derogatory. The northern First Nations call themselves "Inuit".

Sorry, thread derailment.

The Inuit are not technically First Nations (see the first sentence of this), but the Inuit, Métis, and First Nations collectively constitute the Aboriginal peoples of Canada. (By the way, "Aboriginal" sounds terribly derogatory to me, but apparently it's the proper international term. Is it "Aborigine" that's derogatory, maybe?)

Right. I was looking for "Aboriginals," but I couldn't remember what the technical term was there. I used to know that, but I purged it from my brain after high school Social Studies.

As always, I'm in awe of Katya's breadth of knowledge on everything. PC terms for Canadian Aboriginals? Check.

Ha! Well, we have a Canadian Studies department, so I end up cataloging a lot of Canadiana. (Fun fact: The National Library of Canada uses a modified version of Library of Congress call numbers, so part of my job is to switch the call number back for our library.)

I also spent the earlier part of this year trying to learn more about Canadian history, but I had to give up that personal project when another outside project fell in my lap and pretty much ate up all of my free time.

[Zedability]

I also spent the earlier part of this year trying to learn more about Canadian history, but I had to give up that personal project when another outside project fell in my lap and pretty much ate up all of my free time.

Canadian history: keeping the Americans out, keeping the French in, and wishing the Natives would somehow disappear. That's about it.

[Katya]

I also spent the earlier part of this year trying to learn more about Canadian history, but I had to give up that personal project when another outside project fell in my lap and pretty much ate up all of my free time.

Canadian history: keeping the Americans out, keeping the French in, and wishing the Natives would somehow disappear. That's about it.

Well, I've got that covered, then. On to learn about something else!

[mic0]

I sort of wanted to answer this question originally, but had a hard time articulating my feelings since I generally try not to think about this subject. I will just say that drugs for depression are tricky business. My mom had severe depression and anxiety for most of my life (and over half of hers), but in the last few years she finally found something that worked. She started trying to treat her problems over 25 years ago, so... even though drugs do work, I can understand why someone might be hesitant, since sometimes you have to be patient and try many, many, many things before you find a solution. Seeing my own mom struggle with this for such a long time has made me wary of trying anything to treat my own (albeit mild in comparison) mental health issues. The reader's concerns resonated with me; I certainly "believe in" depression, and think medicines can work, but it is nevertheless hard to try it for yourself.

[NerdGirl]

I know you're, like, in med school and stuff and are probably more up on this than I am, but my boyfriend has had ENORMOUS success with Luvox CR for his OCD. It's an older drug, but the CR version is new and specifically labeled for OCD. His OCD is mostly obsessive without a whole lot of external compulsions, though, so it's a bit different from what you probably experience, but it's reduced the amount of time he spends each day ruminating from 5+ hours to maybe 30 minutes. He's also doing some CBT to help with what's left of the obsessions.

Thanks, that's actually really good to know. I certainly haven't ruled out the possibility of trying medication again in the future if things get worse, so it's always good to hear about stuff that is working well for people! I think when I tried medication there wasn't actually anything that was specifically labelled for OCD yet.