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Antidepressants - Fact or Fiction
Antidepressants - Fact or Fiction
I have an interest in CBT Psychology and know Dr. David Burns on a superficial semi-personal level.
David is one of the pioneers in CBT following on from earlier work by Aaron T Beck (academically) and Albert Ellis (popularly)
You may have heard of his book (it's the classic book used these days on CBT)  "Feeling Good: The New Mood Therapy"

[Commercial Link Removed]  Search using,  "Feeling Good: The New Mood Therapy"

But that's not the point of this thread.

I notice that some people on this forum are using various "sleeping pills" that are actually classified as "Antidepressants" and very often are SSRIS.

Dr. Irving Kirsch has done some highly scientific meta-analyses of all the data submitted to the FDA for the approval of "so called" antidepressants.
His results are quite shocking.

I may be doing him a disservice by summarizing his work... however.. when we look at all data studies (not just the ones that the drug companies choose to publish) the conclusions are that "antidepressant drugs" are not significantly more effective (in terms of clinical outcomes) than placebos and yet they have serious side-effects and withdrawal-effects.

Ironically, the withdrawal effects mimic the symptoms of depression which makes people even more convinced that they actually were working in the first place.

Furthermore.. if we take into consideration the effects of "breaking blind" in those double-blind studies, he argues that the clinical outcomes of "placebo" versus "drug" are virtually inseparable.
(Any misquotes or misrepresentations are totally my fault not his)

He used the Freedom of Information Act to gain access to the studies that the drug manufacturers conveniently choose to withhold from publication.

He explains that the entire theory of Seratonin in the brain and its presumed effect on depression is totally debunked.
This is easy to see at a glance.

SSRIs try to boost serotonin by reducing the re-uptake of seratonin in the brain
SSREs try to reduce serotonin by enhancing the re-uptake of seratonin in the brain
.. and yet they are BOTH classified as "anti-depressants"
If one of them increases seratonin and the other reduces seratonin...  there's something immediately fishy there.

SSRE here:  http://effectivediagnosis.org/selective-...-enhancer/

Irving's easy to read book on the subject is here:
[Commercial Link Removed]  Search using, "Emperors New Drugs Exploding Antidepressant"

Many of his papers appear at first sight (to me) to be re-hashes of the same paper with minor additions.  One such paper is here:

My worry is that people don't know this and they are using these drugs out of desperation to find any possible remedy for their sleep issues.
I also worry about all the people who use these drugs for depression... but that's a whole separate issue.

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RE: Antidepressants - Fact or Fiction

One of the reported side effects of using either SSRIs or SSREs is.... Insomnia !
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RE: Antidepressants - Fact or Fiction
Grin  HI AQ.  Plmnb here.

Interesting conundrum in my case I do believe.

I don't know how much you know about Bipolar Disorder, so I'll just write some thoughts, etc. and you can fill me in on what you know.

When I got my diagnosis of Bipolar Disorder, ADHD, Severe Anxiety Disorder, it was a complete shock to me.  (Oddly, my best girlfriend from high school, when I told her about the diagnosis, told me she always knew I had the condition of Bipolar).

I had checked myself in to a psychiatric hospital due to major depression, exacerbated by my home life at the time.  Initially, they expected me to be there for a week.  Turns out they kept me for a month.

They had me on at least 7 medications, sometimes at once, trying to find the right "cocktail".  When I was released, I could barely walk.

I immediately signed up for AA because I was told I'd die if I drank while taking the medications.  I did not drink often, at least up to around the time I went to the hospital.  But I didn't want to take any chances. (I haven't had even a sip of alcohol in over 10 years now and I stopped going to AA after about a year).

Around this time I developed Trigeminial (?) Neuralgia.  I haven't mentioned it because I forgot to add it to "list".  Also, I haven't had an attack in over 8 or 9 years.  I had been told once I had it, I would always have it.  So far I have proven them wrong.  I believe this is because, although the doctors disagreed with me, I believed it to be trauma induced.  (Long story having to do with a tattoo).  Anyway, I stopped having attacks about the time they were thinking they might have to do brain surgery.

The reason I mention this is because when I was at Mayo Clinic for testing on my TN, they had me have a meeting with medical personal to review all the drugs I was on.  I sat there and watched them throw bottle after bottle away.  Ultimately I was handed the two bottles that were left.  I don't remember exactly the names, I'm pretty sure one was Depakote - "Depakote is a medication known as an anticonvulsant that is used to treat the manic symptoms of bipolar disorder. It is also used to treat seizures and prevent migraine headaches."

The other medication was a mood stabilizer.  I was told I had to take this with the bipolar medication or there would be issues with the drugs working correctly.

Mood stabilizers are different from ANTIDEPRESSANTS, which can be dangerous for a person with bipolar disorder. As a matter of fact IF a person with bipolar is prescribed an antidepressant it is recommended that it be taken WITH a mood stabilizer. 

An NIMH study found that antidepressants work no better than placebo. Antidepressants can trigger mania in people with bipolar disorder. If antidepressants are used at all, they should be combined with a mood stabilizer such as lithium or valproic acid.

I believe this may be why I was prescribed an antihistamine instead of an antidepressant for the anxiety I was having a few weeks ago.   I was given 10 and not allowed a refill. which was fine by me.

HOWEVER, My entire life I have been surrounded by people, family and friends that have benefited greatly from antidepressants.  I believe it is because the majority of these people REALLY needed them.  It sure wouldn't hurt to try other form of therapies before medicating, but some times it just has to be.

Let me know if you would like any more comments or thoughts about this thread of yours.  It is very interesting and MIGHT just get my mind off apnea posts  Dielaughing

Most Sincerely,
Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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RE: Antidepressants - Fact or Fiction
Question for you.... Did you read the paper I referenced in the initial post?
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RE: Antidepressants - Fact or Fiction
I don't see the paradox.  In either case, the net result is a surfeit of serotonin, which is what the literature claims will enhance mood. Is the literature mistaken about that?

Serial Tapist
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RE: Antidepressants - Fact or Fiction
I don't see how both modalities create a surfeit. What am I missing?

Here's how Irving described it in the paper I referenced under the section "The Serotonin Myth"

The most commonly prescribed antidepressants are SSRIs, drugs that are supposed to selectively target the neurotransmitter serotonin. But there is another antidepressant that has a very different mode of action. It is called tianeptine, and it has been approved for prescription as an antidepressant by the French drug regulatory agency. Tianeptine is an SSRE, a selective serotonin reuptake enhancer. Instead of increasing the amount of serotonin in the brain, it is supposed to decrease it. If the theory that depression is caused by a deficiency of serotonin were correct, we would expect to make depression worse. But it doesn’t. In clinical trials comparing the effects of tianeptine to those of SSRIs and tricyclic antidepressants, 63% of patients show significant improvement (defined as a 50% reduction in symptoms), the same response rate that is found for SSRIs, NDRIs, and tricyclics, in this type of trial (Wagstaff, Ormrod, & Spencer, 2001). It simply does not matter what is in the medication – it might increase serotonin, decrease it, or have no effect on serotonin at all. The effect on depression is the same.

What do you call pills, the effects of which are independent of their chemical composition? I call them “placebos.”

Irving here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/
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RE: Antidepressants - Fact or Fiction
Also, if we follow the SSRE link I mentioned we read this...

There is another type of antidepressant called a selective serotonin reuptake enhancer (“SSRE”).  SSREs do the opposite of the selective serotonin reuptake inhibitors (SSRIs).  Both drugs seek to affect the amount of serotonin in the brain.

The SSRIs seek to increase the amount of serotonin in the brain by reducing the rate that the serotonin is absorbed back into the cells releasing it.  SSREs do the opposite by reducing the amount of the serotonin in the brain by increasing the rate that serotonin is absorbed.

Like SSRIs, the exact way that SSREs work is not known or understood.

SSRE here: http://effectivediagnosis.org/selective-...-enhancer/
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RE: Antidepressants - Fact or Fiction
For anyone interested in Dr. David Burns explaining his thoughts on this issue, here is a 32 minute podcast.
He talks about the work of Irving Kirsch and much more.

The "interview" is not done by a professional interviewer and Fabrice was just doing his best and tends to interrupt David a little more than I'd prefer.
In later podcasts, the interaction flows better. Nevertheless, the information comes across very clearly.

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RE: Antidepressants - Fact or Fiction
[Image: apology-2.gif]I didn't read the paper until just now. I was at work when I replied and took the quick route.  I have just read it now.

I too have always wondered about the placebo effect of certain medications.  Obviously not to the degree of a researcher or medical professional, but just your average person.

Such an interesting issue.

Some information I have looked up and copied and pasted for your review.  At the moment I am trying to formulate my thoughts about your post and the study you cite and the information I have just found.  Mostly about the chicken and egg situation, "researchers don't know whether the dip in serotonin causes the depression, or the depression causes serotonin levels to drop", also, the importance of psychotherapy in conjunction with antidepressants, (I'm pretty sure that millions of people are not receiving psychotherapy along with taking antidepressants, I know this from my own experience with antidepressants), and the idea that there are other ways to address depression besides taking an actual antidepressant pill.  These are just a few of the points I am wondering about and want to address.  

"Serotonin: 9 Questions and Answers

1. What is serotonin?

Serotonin acts as a neurotransmitter, a type of chemical that helps relay signals from one area of the brain to another. Although serotonin is manufactured in the brain, where it performs its primary functions, some 90% of our serotonin supply is found in the digestive tract and in blood platelets.

2. How is serotonin made?

Serotonin is made via a unique biochemical conversion process. It begins with tryptophan, a building block to proteins. Cells that make serotonin use tryptophan hydroxylase, a chemical reactor which, when combined with tryptophan, forms 5-hydroxytryptamine, otherwise known as serotonin.

3. What role does serotonin play in our health?

As a neurotransmitter, serotonin helps to relay messages from one area of the brain to another. Because of the widespread distribution of its cells, it is believed to influence a variety of psychological and other body functions. Of the approximately 40 million brain cells, most are influenced either directly or indirectly by serotonin. This includes brain cells related to mood, sexual desire and function, appetitesleep, memory and learning, temperature regulation, and some social behavior.

In terms of our body function, serotonin can also affect the functioning of our cardiovascular system, muscles,and various elements in the endocrine system. Researchers have also found evidence that serotonin may play a role in regulating milk production in the breast, and that a defect within the serotonin network may be one underlying cause of SIDS (sudden infant death syndrome).

4. What is the link between serotonin and depression?

There are many researchers who believe that an imbalance in serotonin levels may influence mood in a way that leads to depression. Possible problems include low brain cell production of serotonin, a lack of receptor sites able to receive the serotonin that is made, inability of serotonin to reach the receptor sites, or a shortage in tryptophan, the chemical from which serotonin is made. If any of these biochemical glitches occur, researchers believe it can lead to depression, as well as obsessive-compulsive disorder, anxietypanic, and even excess anger.

One theory about how depression develops centers on the regeneration of brain cells -- a process that some believe is mediated by serotonin, and ongoing throughout our lives. According to Princeton neuroscientist Barry Jacobs, PhD, depression may occur when there is a suppression of new brain cells and that stress is the most important precipitator of depression. He believes that common antidepressant medications known as SSRIs, which are designed to boost serotonin levels, help kick off the production of new brain cells, which in turn allows the depression to lift.

Although it is widely believed that a serotonin deficiency plays a role in depression, there is no way to measure its levels in the living brain. Therefore, there have not been any studies proving that brain levels of this or any neurotransmitter are in short supply when depression or any mental illness develops. Blood levels of serotonin are measurable -- and have been shown to be lower in people who suffer from depression - but researchers don't know if blood levels reflect the brain's level of serotonin.

Also, researchers don't know whether the dip in serotonin causes the depression, or the depression causes serotonin levels to drop.
Antidepressant medications that work on serotonin levels -- SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin and norepinephrine reuptake inhibitors) -- are believed to reduce symptoms of depression, but exactly how they work is not fully understood.

5. Can diet influence our supply of serotonin?

It can, but in a roundabout way. Unlike calcium-rich foods, which can directly increase your blood levels of this mineral, there are no foods that can directly increase your body's supply of serotonin. That said, there are foods and some nutrients that can increase levels of tryptophan, the amino acid from which serotonin is made.

Protein-rich foods, such as meat or chicken, contain high levels of tryptophans. Tryptophan appears in dairy foods, nuts, and fowl. Ironically, however, levels of both tryptophan and serotonin drop after eating a meal packed with protein. Why? According to nutritionist Elizabeth Somer, when you eat a high-protein meal, you "flood the blood with both tryptophan and its competing amino acids," all fighting for entry into the brain. That means only a small amount of tryptophan gets through -- and serotonin levels don't rise.

But eat a carbohydrate-rich meal, and your body triggers a release of insulin. This, Somer says, causes any amino acids in the blood to be absorbed into the body -- but not the brain. Except for, you guessed it -- tryptophan! It remains in the bloodstream at high levels following a carbohydrate meal, which means it can freely enter the brain and cause serotonin levels to rise, she says.

What can also help: Getting an adequate supply of vitamin B-6, which can influence the rate at which tryptophan is converted to serotonin.

6. Can exercise boost serotonin levels?

Exercise can do a lot to improve your mood -- and across the board, studies have shown that regular exercise can be as effective a treatment for depression as antidepressant medication or psychotherapy. In the past, it was believed that several weeks of working out was necessary to see the effects on depression, but new research conducted at the University of Texas at Austin found that just a single 40-minute period of exercise can have an immediate effect on mood.
That said, it remains unclear of the exact mechanism by which exercise accomplishes this. While some believe it affects serotonin levels, to date there are no definitive studies showing that this is the case.

7. Do men and women have the same amount of serotonin -- and does it act the same way in their brain and body?

Studies show that men do have slightly more serotonin than women, but the difference is thought to be negligible. Interestingly, however, a study published in September 2007 in the journal Biological Psychiatry showed there might be a huge difference in how men and women react to a reduction in serotonin -- and that may be one reason why women suffer from depression far more than men.

Using a technique called "tryptophan depletion," which reduces serotonin levels in the brain, researchers found that men became impulsive but not necessarily depressed. Women, on the other hand, experienced a marked drop in mood and became more cautious, an emotional response commonly associated with depression. While the serotonin processing system seems the same in both sexes, researchers now believe men and women may use serotonin differently.
Although studies are still in their infancy, researchers say defining these differences may be the beginning of learning why more women than men experience anxiety and mood disorders, while more men experience alcoholismADHD, and impulse control disorders.

There is also some evidence that female hormones may also interact with serotonin to cause some symptoms to occur or worsen during the premenstrual time, during the postpartum period, or around the time of menopause. Not coincidentally, these are all periods when sex hormones are in flux. Men, on the other hand, generally experience a steady level of sex hormones until middle age, when the decline is gradual.

8. Since both dementia and Alzheimer's disease are brain-related conditions, does serotonin play a role in either problem?

In much the same way that we lose bone mass as we age, some researchers believe that the activity of neurotransmitters also slows down as part of the aging process. In one international study published in 2006, doctors from several research centers around the world noted a serotonin deficiency in brains of deceased Alzheimer's patients. They hypothesized that the deficiency was because of a reduction in receptor sites -- cells capable of receiving transmissions of serotonin -- and that this in turn may be responsible for at least some of the memory-related symptoms of Alzheimer's disease. There is no evidence to show that increasing levels of serotonin will prevent Alzheimer's disease or delay the onset or progression of dementia. However, as research into this area continues, this could also change.

9. What is serotonin syndrome -- and is it common or dangerous?

SSRI antidepressants are generally considered safe. However, a rare side effect of SSRIs called serotonin syndrome can occur when levels of this neurochemical in the brain rise too high. It happens most often when two or more drugs that affect serotonin levels are used simultaneously. For example, if you are taking a category of migraine medicines called triptans, at the same time you are taking an SSRI drug for depression, the end result can be a serotonin overload. The same can occur when you take SSRI supplements, such as St. John's wort.
Problems are most likely to occur when you first start a medication or increase the dosage. Problems can also occur if you combine the older depression medications (known as MAOIs) with SSRIs.

Finally, recreational drugs such as ecstasy or LSD have also been linked to serotonin syndrome.
Symptoms can occur within minutes to hours and generally include restlessness, hallucinations, rapid heartbeat, increased body temperature and sweating, loss of coordination, muscle spasmsnauseavomitingdiarrhea, and rapid changes in blood pressure.
Although not a common occurrence, it can be dangerous and is considered a medical emergency. Treatment consists of drug withdrawal, IV fluids, muscle relaxers, and drugs to block serotonin production."


"Almost 25 million adults have been taking antidepressants for at least 2 years, a 60% increase since 2010. Moreover, approximately 15.5 million individuals have been taking the drugs for at least 5 years, nearly doubling the rate since 2010."


"Many people taking antidepressants discover they cannot quit...While the drugs have helped millions of people with depression and anxiety, and many people can stop taking them without significant issues, some individuals who try to wean themselves off cannot due to harsh withdrawal symptoms they say they were not warned of. Initially, the drugs were cleared for short-term use; but even today, with millions of long-term users, there is little data about their effects on individuals who take them for years."


(I deleted some points here that were not relevant and added color to points of interest to me), "Fears and Facts About Antidepressants

Along with psychotherapy, antidepressants are a common treatment for depression. Four out of 10 people treated with antidepressants improve with the first one they try. If the first antidepressant medication doesn’t help, the second or third often will. Most people eventually find one that works for them. Yet many people who could benefit from an antidepressant never try one, often because of fears about them, experts say.
Here are eight common fears about antidepressants, as well as facts that can help you and your doctor decide if an antidepressant is right for you.

Fear:Antidepressants make you forget your problems rather than deal with them.
Fact: Antidepressants can’t make you forget your problems, but they may make it easier for you to deal with them. Being depressed can distort your perception of your problems and sap you of the energy to address difficult issues. Many therapists report that when their patients take antidepressants, it helps them make more progress in psychotherapy.

Fear: Antidepressants change your personality or turn you into a zombie.
Fact: When taken correctly, antidepressants will not change your personality. They will help you feel like yourself again and return to your previous level of functioning. (If a person who isn’t depressed takes antidepressants, they do not improve that person’s mood or functioning - it's not a "happy pill.") Rarely, people experience apathy or loss of emotions while on certain antidepressants. When this happens, lowering the dose or switching to a different antidepressant may help.

Fear: If I start taking antidepressants, I’ll have to take them for the rest of my life.
Fact: Most people who take antidepressants for a first-time episode of depression need to take them continuously for six to nine months, not necessarily a lifetime. Once an antidepressant gets depression under control, you should work with your doctor to decide when to stop your medication and then decrease your dose gradually. Discontinuing them suddenly may cause problems such as headaches, dizziness, and nausea.

Fear: Taking an antidepressant is a sign of weakness.
Fact: Like medical conditions such as diabetes or high cholesterol, major depression is a condition that often responds to medication. When depression interferes with your ability to function normally, seeking treatment is not a sign of weakness. It’s a sign of good self-care.

Fear: Antidepressants increase the risk of suicide.
Fact: Studies in recent years have raised concerns that antidepressants may raise the risk of suicidal thoughts or behaviors (but not deaths) among children, adolescents, and young adults. For example, a 2009 review in the British Medical Journal (BMJ) looked at 372 studies involving nearly 100,000 people who were taking antidepressants. It found that compared to placebo, antidepressants were associated with a slightly higher risk for suicidal thoughts in some children and young adults, have no effect on suicide risk among those 25 to 64, and reduce the risk in those 65 and older.

In 2004, the FDA required manufacturers of antidepressants to revise their labels to include a boxed warning statement about these risks.

Other studies paint a different picture. A 2006 study published in PLoS Medicine suggests that antidepressants have saved thousands of lives. Data show that the U.S. suicide rate held fairly steady for 15 years before the popular antidepressant Fluxetine (Prozac) was sold, and then dropped steadily over 14 years while sales of Prozac rose. The strongest effect was among women.

The bottom line: Regardless of your age or sex, it’s important to see a doctor immediately if you have suicidal thoughts or other significant symptoms of clinical depression."


What is your input about all this?

Huhsign  WARNING: It may take a while to sink in...I tend to get befuddled at times.
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RE: Antidepressants - Fact or Fiction
Wow! That's a long post.
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