[kafkaesq]

I look at it the other way: companies "pushing"[1] antidepressants not just on pregnant women, but on all of us, for years on end, should be putting out a very clear message that you should not take these medicines unless absolutely recommended by your doctor, and other, generally more efficacious methods -- such as talk therapy and lifestyle changes -- have been at least explored, and found to be ineffective (or depending on the severity of your case, not immediately effective).

Unfortunately, this is not what these companies are doing, as a rule. And given what we've found out SSRIs -- and the behavior of some of the major players in this industry, in recent years -- no one should be terribly surprised at the findings in the JAMA study (assuming they hold up to scrutiny).

Also:

Restarting the SSRI of course did the trick, but they don't work fast and I lost nearly a year of my life. I currently regard this as the worst decision I have ever made.

With all due respect to your situation -- and not intended in the least to belittle either your suffering, or the thought you put into the decisions you made -- perhaps the bigger mistake was not going off SSRIs (at which point the die may have been more or less cast for you, in the short- to medium-term) -- but agreeing to go on them in the first place.

[1] Yes, this is a loaded term. But I use it quite intentionally. Having not only studied the tradeoffs associated with one major class of antidepressants, but also having worked for one of the market's leading distributors -- and having made a careful study of their marketing materials -- I'd say "pushing" is not a bad description for the aggressive marketing tactics these companies have used over the years.

[tptacek]

When someone on HN relates their personal experiences with a serious illness, there is no list of mitigating phrases you can apply that makes second-guessing or criticism of their handling of that illness civil. Please don't do that.

HN provides plenty of other venues for airing your feelings about medications; some of them are subthreads of this very story. Here, though, was just about the worst place you could have done that.

[dennisgorelik]

Why do you think that "personal experiences with a serious illness" are so special that any second-guessing or criticism is not appropriate?

[hluska]

Simply, that is not how compassionate, caring people respond to such stories in a polite, civilized society.

In this particular instance, a doctor chose to prescribe a drug based upon a person's complete set of symptoms and medical history. And, the person, knowing his or her own set of symptoms and history, chose to follow through and begin taking an anti-depressant. This was the result of a consultation between a victim and a medical professional. Another doctor would not criticize the prescription without doing a full work up. Who are you to criticize without doing the same?

Moreover, this is a mental illness and people who suffer from a mental illness deserve nothing but support. One of the 'joys' of depression is that while you are under the cloud, you are a master at criticizing yourself.

When you add in the stigma still attached to mental illness, simply telling a personal story requires huge amounts of bravery. If you criticize or second guess the story, you provide a strong reason to stay bottled up. This is the exact opposite of what our world needs right now.

In essence, carefully criticize the system not the victim.

[jmhain]

> I look at it the other way: companies "pushing"[1] antidepressants not just on pregnant women, but on all of us, for years on end, should be putting out a very clear message that you should not take these medicines unless absolutely recommended by your doctor, and other, generally more efficacious methods -- such as talk therapy and lifestyle changes -- have been at least explored, and found to be ineffective (or depending on the severity of your case, not immediately effective).

I'm in complete agreement with you here - the majority of people prescribed SSRIs probably should not have been. I don't even recommend them to other people, despite the fact that they worked incredibly well for me.

> With all due respect to your situation -- and not intended in the least to belittle either your suffering, or the thought you put into the decisions you made -- perhaps the bigger mistake was not going off SSRIs (at which point the die may have been more or less cast for you, in the short- to medium-term) -- but agreeing to go on them in the first place.

It wasn't a mistake. The mental illnesses I suffered started early in childhood, and nearly all my relatives on one side of my family experience some form of it. I resisted medication for a while because I was brought up by parents who considered psych meds to be against the natural order of things, and prohibited me from so much as asking my doctor about them.

In college, the panic attacks had become so severe I was beginning to lose touch with reality. My psychiatrist convinced me to give SSRIs a shot, so I reluctantly agreed, and they turned my life around. Within 6 months, friends and family (both those who knew I was taking a med and those who didn't) remarked that I seemed to be a completely different (and better) person.

Obviously, they don't work this well for most people. But likely the psychiatrist, in the absence of a mature scientific understanding of these disorders, had learned to recognize patterns that predicted a successful response to SSRIs.

My only point was that the discontinuation of an antidepressant should not be taken lightly when you have already had a successful response to it.

[kafkaesq]

It wasn't a mistake.

Great, I'll take your word for it, then. And I sincerely apologize if my remarks were in any belittling of, or sympathetic towards your experience.

[ryan-allen]

It's different in different countries. I'm in Australia and we have laws that limit the influence drug companies have over our doctors here, and we don't have pharma ads on television.

SSRIs were recommended to me by a proper doctor and it was a good decision to start them. I was fortunate that the first type I took worked well and I didn't have to change types.

> perhaps the bigger mistake was not going off SSRIs but agreeing to go on them in the first place.

This kind of 'common sense' stigma is what kept me away from professional help for years. It's not helpful, it's FUD.

[kafkaesq]

SSRIs were recommended to me by a proper doctor and it was a good decision to start them. I was fortunate that the first type I took worked well and I didn't have to change types.

That's great and I'm glad your decision worked out well for you.

This kind of 'common sense' stigma is what kept me away from professional help for years. It's not helpful, it's FUD.

Funny thing is, there's about an equal amount of FUD floating around as to the potential benefits of talk therapy. Which is what kept me off it for decades and decades.

Anyway, what I'm saying about SSRIs isn't FUD. There's a near-consensus view out there that though they may sometimes help, their technical workings are still poorly understood[1]; that they have complex side effects; are hard to get off of, for many people; have been over-proscribed for certain vey broad classes of folks (such as adolescents and children); and have often been disingenuously promoted by their makers -- in at least one very famous case, criminally so.

I'm not giving citations for these points. There's plenty of stuff out there to read about these topics -- most of it not only non-sensationalistic, but quite well-reasoned (to the point of sounding dry and impassioned), and really now, pretty easy to find.

[1] Not in "serotonin re-uptake inhibition" part; but in the, you know, "how do these drugs actually treat chemical depression?" part. (Assuming your depression actually is chemical, which is also quite debatable).

[ars]

> It's different in different countries. I'm in Australia and we have laws that limit the influence drug companies have over our doctors here, and we don't have pharma ads on television.

Is there a difference in prescription rates between Australia and countries with less strict rules? i.e. does it actually change anything?

[sjy]

According to this article, the only countries to allow direct marketing to consumers are New Zealand and the United States, and doctors in NZ noticed a dramatic change when direct marketing became prevalent from 2002.

Toop L and Mangin D. The impact of advertising prescription medicines directly to consumers in New Zealand: lessons for Australia (2006) http://www.australianprescriber.com/magazine/29/2/article/78...

[rosser]

You are neither 'jmhain nor their doctor — nor, as far as I can tell from a quick perusal of your comment history, a medical professional of any kind — and as such it is egregiously irresponsible of you to be offering medical advice, however well-intentioned or well-researched you may think it is.

I have some pretty strongly negative feelings about the way (most) mental illness is treated in modern Western society — not least the radical over-use of SSRIs — but the way to address that does not begin with, or even involve, telling someone who reports unambiguous benefit from the use of antidepressants how wrong they were, how they were a pawn of the Pharma-Industrial Complex, or anything else other than, "I'm glad that's helping."

[kafkaesq]

telling someone who reports unambiguous benefit from the use of antidepressants...

Given that he also said he was unable to go off them without "losing a year of his life", it sounds like the benefit was hardly unambiguous.

... how they were a pawn of the Pharma-Industrial Complex,

I'd address some of the other points you're trying to make, but you know very well that I said no such thing, so why should I bother?

[hluska]

With all due respect to your situation -- and not intended in the least to belittle either your suffering, or the thought you put into the decisions you made -- perhaps the bigger mistake was not going off SSRIs (at which point the die may have been more or less cast for you, in the short- to medium-term) -- but agreeing to go on them in the first place.

With all due respect to your situation, this is the shittiest comment I have read on this site in a very long time.

If you somehow think that belittling another's medical history is okay, you seriously need to grow a bit of compassion.

[drumdance]

Seconded. The commenter knows next to nothing about the medical history but feels no compunction about telling him what to do. I wish there were a drug to arrest that malady.

[KirinDave]

> such as talk therapy and lifestyle changes

The places where anti-depressants are applied vs talk therapy are applied are fairly different. The idea that there is a cohort of mustache-twirling doctors and pill pushers trying to shove pills down the throat of every person who'd be better suited to talk therapy is about as ridiculous as I made it sound.

For many people, talk therapy is simply not effective or possible. And in many situations there are social forces which MUST be taken into consideration because they can cause lead to more anxiety and depression.

> perhaps the bigger mistake was not going off SSRIs (at which point the die may have been more or less cast for you, in the short- to medium-term) -- but agreeing to go on them in the first place.

I get so angry reading this. Hot under the collar even. If you think that SSRIs don't help people then you simply don't understand what a true and chemical despair feels like. The difference they can make, both short term and long, is counted in human lives. Many people like me who used them to bridge a short term gap could barely comprehend days without despair, fear and pain.

To have some smug anti-medicine comment oh-so-politely walk up to someone who says, "Hey I treated my mental illness like a real illness and it worked" and respond with scorn an derision? You simply do not understand what real, clinical, and life-threatening depression is.

If you think you do, if you had a mild case that you talked through? Congratulations! I wish the disease on no one. But that doesn't give you license to skulk about making everyone else with a less treatable form of the illness question everything they've done to secure their right to experience happiness.

[ufo]

In any case, the current research consensus is that generally antidepressants and talk therapy are complimentary. So talk therapy is better than nothing and antidepressants are better than nothing and combining both treatments is better than sticking to only one.

[KirinDave]

For me, it is difficult to disentangle my feelings for talk therapy from my fear and antipathy towards the church councillors of my young life who put me on such a destructive path of self-denial.

[hluska]

I am very sorry that that happened to you and I completely understand how sometimes church counsellors can cause more problems. I was raised Catholic so believe me when I say that I understand your words about being on a destructive path of self denial.

For what it's worth, as an adult, I had to make a conscious decision not to let the assholes of my youth ruin my life.

It's bullshit that people treated you like that. I'm very sorry that that happened.

[KirinDave]

Thanks. I wish I had been born even 10 years later sometimes, I didn't even know the word for my gender until I was in my 30s. People trying to "correct" my course when I was young left me a lot of scars.

So, I'm not saying my case should shape the world. But I think it's worth considering. People here tend to mix "SSRIs are over-prescribed" with "SSRIs don't work." The data suggests the more focused the study, the stronger the effect, which is usually indicative of practicioners failing to properly use an intervention.

Or so my doctor tells me. He was happy to explain carefully why he uses SSRIs, how long he'll agree to prescribe them for, and what his current reading of the research is. I was surprised, but he says GPs often have to be the first line of defense for people who don't outright end up in the emergency room. I guess that stands to reason.

[KirinDave]

Sure, but the general pattern is: Get the patient stable. Then, follow with talk therapy since that generally is a more permanent solution.

[Alex3917]

> If you think that SSRIs don't help people then you simply don't understand what a true and chemical despair feels like.

Or you read? If SSRIs are so helpful, then why does the majority of the research suggest that this isn't the case?[1] If you think they are helpful, then the burden of proof is on you to show that the science is incorrect.

[1] http://www.amazon.com/Emperors-New-Drugs-Exploding-Antidepre...

http://www.amazon.com/Anatomy-Epidemic-Bullets-Psychiatric-A...

[evoloution]

Please for whatever you hold dear do not say please read and then point to books. Books? seriously, most people know that the peer-review is many times laughable but anyone can publish whatever book they want even if they are respected professionals/scientists/philosophers... You are just downgrading the conversation by orders of magnitude...

[kafkaesq]

Issues such as those books address don't generally fall within the scope guidelines of journals. Anyway, his basic point is that there's plenty of information about SSRIs out there, if one is willing do a bit of focused reading.

[kafkaesq]

For many people, talk therapy is simply not effective or possible.

I don't dispute this; not only that, I was basically acknowledging this fact in what I originally said. The crux of the issue would seem to lie with how you quantify "many."

If you think that SSRIs don't help people ...

That is quite definitely not what I said.

...then you simply don't understand what a true and chemical despair feels like.

Inasmuch as others have criticized me for "second-guessing" the original commenter's decision about how to treat his illness, without knowing medical history: you also have no knowledge, whatsoever, of mine. So I'm not sure what value there is in the assertion you're making.

[KirinDave]

Sorry, but I'm not buying it. You started this by asserting your experience and knowledge gove you a platform to talk down to someone else. Someone who very likely has a difficult story backing them.

You made this a topic of discussion. Now you're upset that people are judging you via what looks like an ableist agenda.

Charitably, lets assume this is all a big misunderstanding. Either you actively are avoiding expressing any empathy or you're not good at empathy.

Whichever it may be, it doesn't matter. You're implicitly picking a fight with this writer and every reader over the efficacy of chemical interventions, and doing it in a crude, inappropriate, backhanded fashion.

[kafkaesq]

Whichever it may be, it doesn't matter.

Agreed. I'd appreciate it, though, if in the future you'd kindly not attribute specific statements to me that I quite simply didn't make.

[KirinDave]

Your intent is not magic. If your communications are "misinterpreted" then it's your fault for not being specific enough.

Taking me to task for my interpretation (which attributed no SPECIFIC statement but rather an interpretation of your words) is a classic example of trying to use an asymmetric appeal to "civility" as a blind for your mistakes.

So no. If I see you spout stuff I consider to be ableist, and I feel like it, I'm going to hit reply and call your statements ableist and explain why.

That is the nature of this forum, and I'm one of the very few people who actually tries to do these things; so you're not exactly being overwhelmed with recriminations of that sort.