[biophysboy]

I wish he had gone into more detail about the specific issues with anti-depressants.

Most anti-depressants target serotonin or norepinephrine because the medical industry is still more or less following the "monoamine hypothesis". The hypothesis goes like this: monoamine neurotransmitters are crucial in the human brain, depressed people have depleted levels of them, therefore we should give them a drug that prevents their reuptake.

But there are issues. SSRIs take roughly 5 hours to become bioavailable, but the positive effects of antidepressants take weeks. Why? If the core issue was depleted serotonin levels, shouldn't the person be happier same-day?

Perhaps I'm building a strawman (I doubt med professionals believe the mono-amine hypothesis either), but antidepressants are being prescribed at record rates, and they are being increasingly trusted by the public. Why? The science is trial and questionnaire, the drug efficacy is low, and the side effects are many.

[johnchristopher]

> But there are issues. SSRIs take roughly 5 hours to become bioavailable, but the positive effects of antidepressants take weeks. Why? If the core issue was depleted serotonin levels, shouldn't the person be happier same-day?

Also we don't see negative effects on non-depressed people that take drugs to reduce serotonin levels (or so I was told).

[outlace]

Most SSRI’s are prescribed by general practitioners and often with fairly low thresholds. I’ve seen interactions like this: Patient comes in to follow up high blood pressure. Doctor: Have you been feeling depressed lately? Patient: Well, yeah I have actually. Doctor: Do you want to start a medication for that? Patient: Uh, ok.

Most psychiatrists would not do that. And I think psychiatrists at academic centers would not pretend to know exactly how SSRIs work at this point.

Nonetheless, SSRIs have a modest effect on average but for some patients they’re life changing. Recently met someone who was so depressed she could barely get out of bed in the morning. Started on the right Med (after a first failed trial) and she’s been happy ever since (more than a decade).

Soon enough we’ll be able to specifically identify which patients are likely to be good responders and who won’t.