[recs] Depression's root cause is puppy deficiency

[kaberett]

Content notes: reference to depression, weight loss, survivalism, discussion of SSRI efficacy.

Here is an actually excellent article about SSRI efficacy [content note: uses "diet pills" and "weight loss" with numbers as an accessible example of drug efficacy, without critiquing the underlying concept; ditto IQ; also, discusses, like, severe depression and shit], via pseudomonas. I spent most of it cackling with glee and quoting entire paragraphs at anyone who'd listen.

(I've said it before and I'll say it [over and over] again: citalopram has an obvious marked enormous effect on my general levels of cope, and the only way you will get me to stop taking it - short of it stopping working, as meds sometimes to for me, or total economic collapse destroying the supply chain - is by prying it out of my cold, dead hands. I do not for a moment wish to suggest it works for everyone - it absolutely doesn't, and SSRIs as a class don't work for everyone, and indeed no drug works for everyone - but I am so very bored of the blanket assertion that SSRIs "don't work".)

Comments

[cosmolinguist]

I try really hard to make sure that I say "they don't work for me" (or at lest the several I've tried haven't worked at the times I've tried them). Because they definitely have been a lifesaver for many friends of mine (no hyperbole at all there) and tangibly beneficial to other friends. All of whom I'm really happy for and don't want to piss off when discussing how they did nothing but make me fat.

[kaberett]

It is quite likely that I'd be dead if it weren't for the citalopram, yeah. I'm sorry things are rough atm and that the things don't do the thing for you. <3 I'm very willing to geek psychopharmacology at you if you think it might be useful but don't want to infodump unrequested!

[liv]

You will probably not be surprised to hear that I find Scott Alexander very annoying a lot of the time, but he's really on form with this article. It's a really good summary of complex and emotionally fraught research, so I'm pleased it's getting attention.

[kaberett]

Huh, I'm previously oblivious to the individual in question - thanks for the heads-up!

[joshuaorrizonte]

I am in the "they don't work for me" camp, but I've also done a proverbial slap-upside-the-head at a friend who saw what they do to me and refused to even try them for himself. He is now taking an SSRI and he's doing much better.

They absolutely do work, when they're the right drug for the situation. Much like ALL drugs, like you say.

[kaberett]

<3

[highlyeccentric]

I am willing to accept the premise that I am suffering from puppy deficiency. That sounds like a good premise. Especially if I can have prescription access to puppies.

[kaberett]

QUITE.

[redbird]

It might also be a kitten deficiency, you know.

[azurelunatic]

The doctor of a relative of a friend once wrote a prescription for a puppy. It was promptly filled, and made all the difference in the world.

[cxcvi]

Timing-appropriate, given that I've just started on fluoxetine. Dr C (GP who actually seems like she has a clue) warned me that the first couple of weeks might be rough.

[kaberett]

Yeah. Side-effects are always worst for me in the first few weeks. I think there's a symptoms log under my med:citalopram tag, if you wanna check it out, or feel free to grab me.

[thefairymelusine]

This is good and interesting, and I will try and engage later, but could you possibly put a trigger warning or cut tag on this?

[kaberett]

Sure. Done.

[redbird]

Based on this, I have amended the sticky post at the top of my journal to say what I generally cut-tag and say that people should let me know if there are other things they would like to be warned of. I may do an actual post about this at some point.

[untonuggan]

They don't work for me because I have bipolar, and it's pretty well documented that SSRI's tend to aggravate manic tendencies in people with bipolar disorder (or other fun!side effects, etc.). For me, SNRI's do the same as well, so basically if a medication affects serotonin I tend to be like "no don't let it near meeeeee!"

I do have a long list of people in my head that SSRI's DO work for, yay. And I'll just be over here with my mood stabilizers, which are the appropriate medications for my condition despite annoying blood level checks and scary lists of side effects (fatal rash, what even).

This is where I am also going to go on a slight side-rant about people who say things to me like, "I hate taking medication" or "Have you tried [random alternative medicine]?" which YES I WOULD LOVE IT if those things alone would work or if I didn't *have* to take these medications of which I am not overly fond nor do I like constantly having to go to the pharmacy because they are *never* on the same refill schedule if you get them from different doctors especially. So please just check your privilege at the door, be thankful you don't have to take these things (right now), and don't comment on the size of my pill box.

/rant

[kaberett]

I REALLY FUCKING HATE TAKING MEDICATION. SO MUCH. SO. MUCH.

[highlyeccentric]

Wait, do SNRIs not have the same profile re: manic tendencies? Ooooh that's interesting. I've never come up as 'actually bipolar' when a complex diagnostic is used, but I've been showing far fewer of the warning signs that lead proffessionals to *seek* complex diagnostic info since I switched over to SNRIs.

[quirkytizzy]

Same. Same everything you said, diagnosis included. Also ARGH to people being douchebags about alternative treatments, or how they hate medicine (good for you??? Did you want a cookie, cuz I've got to take some meds here in about two hours) or whatever.

It's so stupid that people try to get other people off or on meds that won't work for them. Good to try meds (within diagnosis parameters, i.e - us bipolars don't always do so well with SSRI's) but also good to trust the people ON those meds to gauge what those meds do FOR THEMSELVES.

[annalytica]

I <3 citalopram. And if it were a placebo effect, how come when I really believed other things would work and tried them before I tried drugs, none of the other things worked?

[kaberett]

yeeeeeeeep

Mostly! I just thought this article was interesting and really funny.

[recessional]

Interestingly, what the article seems to frame as a new/exciting idea (that psychs take patients on and off drugs based on the drug's effects; that optimal treatment includes both therapy and meds) is, like....standard operating procedure where I live. And he is SO right about it usually being the patient who has to push for drugs, especially with GPs (psychiatrists my experience is more OKAY LET'S STABILIZE YOU, then we'll talk about therapy).

The thing he doesn't note that I'm hearing increasingly from field-involved med pros is the idea that "depression" as a term is like "cancer": a lump-together that puts things with very different pathophysiology, causes, outcomes and optimal treatments in the same bucket, which causes misapprehensions. The "depression" in the isolated overworked single mother is likely a different disease than the "depression" of someone on the down side of a bipolar cycle and that again is not the "depression" that I experience, which is pretty clearly my brain being fucked somehow in basic operations. (This is also increasingly being said about "obesity" - that the outcome of "more fat on the body" may well be coming from a myriad different causes and effectively be different conditions, and we just act like they're the same thing because we're too ignorant as yet to see the causes. Sort of like back when we called everything that caused a rash "a pox" and had little sense if the difference between diseases we wouldn't dream of synonymising now.)

[quirkytizzy]

Why don't we reclassify the different kinds of depression then? It seems stupid of science to just lump it all together and go "DEPRESSION! IT'S A GRAB BAG!" when we can quite definably categorize the different things that would cause different types of depression.

[pretty_panther]

Yes. I don't mind people saying that they don't work for their personal mental health but I hate when people claim they don't work. Yes, I have also engaged with a lot of therapy to get to where I am today but my medication allowed me to be in a mindset capable of doing that. Plus, I know damn sure that I'd tumble backwards if someone stopped my tablets tomorrow because they are making up for something my brain stopped doing. I see my medication like my insulin. I'm replacing a hormone balance a failure in my body knocked out of joint. The hardest thing is when people who have never tried to use the medication but have a diagnosis that may benefit from them say they won't work.

[kaberett]

yeeeeep.

I'm one of the lucky ones, in that my depression is really obviously progesterone-mediated: I've done the experiments, I can shut down anyone who tries the "it's all in your miiiiiiiind tho" conversation with actual solid data. And this means I can then go "WE JUST DON'T KNOW HOW IT WORKS FOR OTHER PEOPLE YET" and occasionally make some headway, but basically I want the entire physical/mental health dichotomy to die in an fire.

[jesse_the_k]

Thanks! That was equal parts interesting (relative to my daily pill consumption) and mystifying (nope, never learned statistics).

[kaberett]

Heh. I keep meaning to actually learn stats properly...

[hairyears]

People who say '"SSRI's don't work"... I do wonder, what's their agenda?

It's not a rational, evidence-based position; it presumes better judgement on the matter than the professionals who are actually the experts, not 'the experts'; and it isn't a very kind opinion - indeed, it's an opinion that stands in opposition to all notions of empathy.

So I wonder if '"SSRI's don't work" is clustered with other opinions and behaviours - not necessarily a consistent agenda, nor even a rational one - that mark out a deeply unpleasant person, and a genuinely dangerous one if they gain positions of influence and authority.

The kind of people who, for example, see evidence that food banks encourage people to claim poverty and hunger; or say that the fox enjoys the hunt.

And yes, the SSRI's worked for me: not miraculously, but enough to gain the space and time for other things to work - and those things would not have worked without pharmaceutical assistance.

[naath]

I suppose at one level it's a simple lack of "other people are not me" empathy - if *I* take SSRIs and get all the side effects and none of the "being less depressed" then I can rationally conclude that they don't work *for me* and might irrationally conclude that they don't work for anyone because of the mistaken assumption that everyone is just like me.

I think the more nasty position is "depression is part of the normal human emotional range, not an illness, and you should just put on your best stiff upper lip and push on through it". Which sometimes comes with a side-order of "and besides none of this psycho-bollocks works anyway". And this is clearly very wrong and very toxic.

[vass]

"(fun fact: there’s actually no such thing as “Placebo Studies”, but Professor Kirsch’s belief that he directs a Harvard department inspires him to create much higher-quality research.)"

I'm glad I didn't have a mouthful of liquid when I read that.

Having read the rest, I'm now wondering whether studying stats would help me find a way to quantify which is more pernicious bullshit, IQ or the BMI.

[kaberett]

haaaaaaa yeah