[sillyquiet]

Wow.

"We conclude that it is impossible to say that taking SSRI antidepressants is worthwhile, or even completely safe. People need all this information to make informed decisions about whether or not to take antidepressants."

[mateus1]

To say the golden standard is useless without providing a better alternative.

I find this kind of messaging completely irresponsible and it just contributes to the stigma around mental health and medications.

[PheonixPharts]

> mental health and medications.

The individualization of mental health problem misses that there are very likely systemic causes of depression.

I've gone through several severe periods of depression, and at the time it all seemed like something was wrong with me and this is the prevailing narrative. In retrospect all of these were caused by a very real external problem in my life that I didn't see (depressing job, emotionally abusive parents, unhealthy marriage etc).

I have no doubt that had I sought medication in any of these cases I would have been given it. But that would have prevented me from being forced to realize the very real problems in my life.

In a broader perspective there are plenty of wide spread social issues that are very likely legitimately causes depression. The idea of simply medicating this away is akin to simply giving Tylenol to someone who has a abscessed tooth. I'm horrified at the wide adoption of medications (often with adverse side effects) to mask what are very real and legitimate sources of depression.

A better alternative is to openly discuss and challenge the prevailing social issues leading to a mental health crisis.

[squidbeak]

And yet if it's the conclusion of their study and their study is sound, wouldn't it be irresponsible to fudge and mince it?

[mateus1]

I take no issue with the study, I'm taking issue with the messaging around it.

[drno123]

Lobotomies and electroshocks were golden standard just a few decades ago.

[runarberg]

No they weren’t. They were a fringe treatment that was popularized by stigma and prejudice. The fake science and the torturous nature behind them were called out many times by real scientists at the time, and simply ignored by health authorities.

Heck. Just watch how the treatment was portrait in a Hollywood blockbuster in the 1970s. There is no way One Flew Over the Cuckoo’s Nest would frame lobotomy so badly if it was consider a “golden standard”.

Comparing SSRI to lobotomy is a historic revisionism at best.

[linuxftw]

Canada is still shocking unconsenting asylum inmates against their family's wishes. A truly barbaric state.

[dotgov]

The golden standard is talk therapy and working through internalized trauma and beliefs instilled by external forces that lead to bad outcomes for the individual. But that needs a well trained professional and costs around 200 bucks an hour and is not available to a big swath of the population. I have never taken anti-depressants, but the people I know that do are still not quite functional in their lives and it looks to me like they find it hard to cope with the nature of life. This is not to say that anti-depressants do not have temporary uses in specific situations. Personally, I find it hard to believe that a person with a chemically shut down libido can live a fulfilled life, then again a fulfilled life is defined differently across cultures (the pursuit of happiness is a US invention as far as I understand).

[mateus1]

If we're going into anecdotal evidences then I can tell you I have many friends that were suicidal who are successful and thriving that took SSRI for depression.

If you're cherry-picking negative examples that's the very definition of stigma.

[dotgov]

I think I was referring to that as "temporary uses in specific situations". Like getting clients into a state of therapy addressing underlying issues being viable. I might be misunderstanding, but the way I read your response is that they are not taking them anymore?

I do disagree with your cherry-picking assessment, I am relaying my lived experience. The people I know of that take SSRIs are either in an unhealthy environment or are masking trauma. Or a bit of both.

And speaking from personal experience: I was never suicidal, more like burnt out and depressed. What helped me was an exceptional therapist that assisted me in making sense of what I am feeling and gently worked with me to build a framework to cope. That involved a spiritual component and helped me regain my creativity.

My point being: I can not imagine that SSRIs would have enabled me to do that. I am glad they helped your friends. Out of curiosity I would be interested in what they had going on at that time. I also do understand that this is deeply personal and none of my business.

[300bps]

To say the golden standard is useless without providing a better alternative.

If the golden standard were to hit yourself in the head with a hammer, it is very useful to point out that it doesn't seem to help and is not safe. Even if you don't have a better alternative.

[jerf]

"To say the golden standard is useless without providing a better alternative."

This is a popular idea, and I have no idea where this corruption of the scientific process came from.

It's not true.

It is completely viable, legal, moral, and all the things to simply scientifically point at something and say "That doesn't work." No obligation to produce something that does work is incurred.

[fellow_human]

The golden standard of depression treatment is long term talk therapy to actually work with the qualitative nature of ones depressive thoughts and sufferring and resolve those feelings, not magic chemical imbalance pills that don't actually work much better than a placebo and cause disassociation from ones real life problems.

[hirako2000]

I'm all fine with stigmatising the current use of prescription drugs to treat mental issues. And that's not stigamtising mental health, it's promoting it with the push for more better treatments of the root causes. At this point only scientists struggle to come up with undeniable prove mental issues are mostly environmental, maybe if the sociology branch could step into cross disciplinary research but they would introduce a whole lot of noise. Of course there are genetic factors or plain genetics as the causes but even then, the popular treatments are questionable at least.

[ScoobleDoodle]

If something doesn’t work, I want to know it is not effective #1. That way I don’t have false hope and waste my energy and time, but instead turn my attention to find something actually effective. And also skip the negative side effects of something that won’t have any benefit.

It’s not the responsibility of one study to resolve depression. That would be nice and convenient, but it’s a scientific community driven solution space exploration. And determining a path is ineffective leads to more time and money spent on alternate paths to find something which is effective.

[lr4444lr]

Almost no one who is given these pills has a lab confirmed neurotransmitter "imbalance". They are not even tested for it. So it should severely trouble you IMHO that it bears the "gold standard" designation for anyone who can be subtly influenced to fill out a depression screening form correctly.

[carapace]

That's not how science works.

If the "golden standard" is in fact the placebo effect, that's good to know.

Mental health is too important to leave to superstition.

You don't have to be a tailor with a ready new suit to point out that the Emperor is naked.

[jonnycomputer]

You know, they really aren't looking at the efficacy of SSRIs in reducing symptoms of depression, right?

[tinyhouse]

This is indeed a wow statement. Not from the field and completely anecdotal. I know 5 people in my family taking Lexapro for anxiety and all with significantly improved results after a month or two of use. I know it's not depression but still.

[starkd]

There's no doubt there's a short term efficacy. The real issue is the waning efficacy over long term with risk of dependence.

[tartoran]

Short term to get you out of the dark hole or unstuck the rut, antidepressants are no panacea but are helpful especially combined with some other form of psychotherapy to figure out the underlying problem.

[starkd]

Right. Just don't stay on them for too long and make a plan to discontinue before becoming dependent. They are hard to get off of.

[tinyhouse]

Again, just anecdotal evidence, but I know people who have been taking it for more than 10 years with good results. One had to increase the dose over time but that's it. We don't know the long term impact of Lexapro and similar drugs to know how big issues the risk of dependence is. It's a tradeoff like everything in life. I agree it's better to find "safer" long term solutions if possible and stopping the meds gradually, but for many people it's not an option, so in the end it's their quality of life vs the long term risk of taking meds.

I feel many people who comment on meds like SSRI never really needed them so much so for them the long term safety is a big issue, but when these pills have a huge positive impact on your life then you are more willing to accept it.

[kingkawn]

As far as I know they were not developed or tested for anything beyond acute <6 month use

[tinyhouse]

Like most meds. The incentive of drug companies is to do enough testing to get an FDA approval (or equivalent in other places).

[runarberg]

Don’t discount the successes of a short term efficacy. Depression is a deadly disease. Sometimes a short term efficacy can be the different between life and death.

Usually depression is treated with a mix of drugs—such as SSRIs—and psychotherapy. I think health officials are completely aware of the long term effects, and that is why the treatment is most often multi-faceted.

[starkd]

No doubt they can be useful. Unfortunately, I don't have as much confidence as you in our health officials. It seems to resort to the lowest common denominator in recommending treatments. Psychotherapy is complex and it's hard to find a "good" counselor without multiple appointments to find one. It is highly personal treatment that is under the control of a highly unpersonal bureaucracy.

[zionic]

I worry about long-term users skipping a day and going deep down a blackhole. Some correlate mass shootings and heavy antidepressant use (then rapid cessation).

[ttpphd]

That is a moral panic whipped up by pro-gun crusaders who want to blame everything but the easy availability of guns for America's domestic terrorist problem

[bigbillheck]

> Some correlate mass shootings and heavy antidepressant use (then rapid cessation).

Seems like an attempt to deflect from much more likely issues.

[pjerem]

French people are notoriously heavily using antidepressants and still we have no mass shootings of any kind.

[nibbleshifter]

Legal access to firearms is pretty heavily limited in France compared to the US.

[starkd]

That's a very real risk. Do not suddenly stop these meds.

[LatteLazy]

The natural remission rate for depression is about 70%, so plenty of people taking antidepressants think they helped...