Do Antidepressants Really Work?

[Cotcha Yankinov]

A meta study on MDD/dysthymia studies (almost 200 studies in total) showing anti depressants have efficacy over placebo http://www.ncbi.nlm.nih.gov/m/pubmed/21527126/

I think it's important to understand that what your diagnosis is matters in how you respond to a class of medications. MDD and dysthymia are two examples that SSRIs have efficacy for. If you have bipolar then you might have depression during some periods of time but antidepressants don't really work very well for bipolar: you use a different class of medications for bipolar that are supported by their own studies to be effective. People kinda self diagnose and then say "this medication didn't work for my depression", WELL, if you didn't really have MDD but just had a shitty life then these drugs aren't going to just make your shitty life magical Many of these different disorders have genuine pathology (just as Alzheimer's has genuine pathology) so if someone is more having "psychological problems" and not biological problems (pathology) I would suggest that they have decreased efficacy for that person and that cognitive behavioral therapy would be more successful.

I guarantee you if you have insomnia that you don't want SSRIs though. There are many different anti-depressants out there, and depending on who you are and what you've got going on some will have a better chance at being effective than others, or they will have reduced side effects.

I think everybody is a unique snowflake and depending on the problems you are having some anti-depressants will work better than others. For example, if you have trouble sleeping, I think you'll find Mirtazapine would have a high success rate, and I typically recommend Mirtazapine. It might not address the depression physiology at its root level (though improving sleep can address pathology), but I guarantee that treating insomnia will have its benefits. If your main complaint is fatigue then typically SSRIs will work okay. Better than placebo anyways.

Everything must be compared to placebo IMO.

 

[MrRoot]

I have been taking a lot of different anti-depressants for depression episodes of bipolar disorder. Currently I won't take a single AD anymore.

Makes my anxiety and depression hell of a worse when starting the treatment and in a worse case I might even be back to remissive state before the AD finally kicks in.

Also my depressive episodes have been longer when I have been on AD than without AD and they have been even shorter when I have had benzo treatment especially when combined with simple yada yada yada therapy with psyconurse once or twice a week.

Public healthcare in my area (Finland) has switched from using ADs to benzos at the start of bipolar depressive episodes combined with semi frequent visits to a psyconurse and also with normal depression they now use benzos along CBT unless it is very severe and then they use benzos and ADs with CBT.

This was due the fact that current meta studies have found out that ADs are pretty much as effective as placebo for depression unless it is very severe.

 

[Dresden]

This may sound strange, but I would say for bipolar people with depression and insomnia, Seroquel actually probably far outperforms the SSRIs for both the insomnia and anti-depression. Of course, the weight gain can be a bitch, but there's no need to be so vain if you're clinically insane already like me. In that case, you've probably scared off most of your potential relationship partners long ago and thus there is no need to watch your figure so closely as there is no one there left to impress. That's how I feel about myself and my own situation anyway.

 

[Cotcha Yankinov]

Seroquel is honestly amazing for insomnia (I think because of 5-HT2A antagonism), and I'm of the school of thought that improving sleep improves everything no matter what you have. And I think there is very little risk of Seroquel causing a manic switch in bipolar. I swear SSRIs are like a guaranteed manic switch for people with a tendency towards mania.

Also Dresden my (manly) heart goes out to you, I understand the relationship situation.

To the OP, I think you should see a mental health practitioner and try to figure out what you have. Or try to figure out what you have on your own if seeing someone isn't a good option for you. Things aren't always cut and dry like depression, I think mild bipolar is under diagnosed.

 

[Johndoedoe.junk]

I can attest to the efficacy of Seroquel for insomnia. Works wonders even at low doses for me (25-50mg) although with me the tiredness seems to carry into the next day. Great med. I used to take Zyprexa/olanzapine and that shit would always carry into the next day. Even if I wasn't sleeping I felt extremely heavy the next day like I was made of cement or something and it gave me crazy bad rls/restless body. Seroquel doesn't see to have that effect thankfully.

Not much recreational value for me with Seroquel although when dealing with insomnia sleep is plenty recreational!

 

[paranoid android]

This may sound strange, but I would say for bipolar people with depression and insomnia, Seroquel actually probably far outperforms the SSRIs for both the insomnia and anti-depression. Of course, the weight gain can be a bitch, but there's no need to be so vain if you're clinically insane already like me. In that case, you've probably scared off most of your potential relationship partners long ago and thus there is no need to watch your figure so closely as there is no one there left to impress. That's how I feel about myself and my own situation anyway.

Quetiapine does have anti-depressant properties even as a monotherapy. I actually found the drug to work great at treating the depression side of my Bipolar disorder and it's definitely on par with just about any anti-depressant in treating Major Depression. Olanzapine is another atypical anti-psychotic that i personally found good for Depression and unlike anti-depressants that can take 2 weeks to start to work the effects of Olanzapine start working as soon as it kicks in which with Zyprexa Zydis could be as little as 20 minutes.

Another medication worth mentioning i think is Lamictal. Lamotrigine is a anti-convulsant used in treating some forms of epilepsy and is also used as a mood stabilizer in treating Bipolar disorder. In fact as it treats both the Mania and also the Depression side of Bipolar disorder it's 1 of only 2 true mood stabilizers out there with Lithium being the other one. The anti-depressant effects from Lamotrigine tend to kick in at a much lower dose then the mood stabilizing properties with some users reporting that it starts to help their depression at only 25mg's a day.