The Case Against Antidepressants

[HarryCat2]

Over a similar twenty year period, I've taken fluoxetine, sertraline, escitalopram, bupropion, mirtazapine, selegiline, moclobemide, alprazolam, lorazepam, buspirone, methylphenidate, amphetamine, modafinil, agomelatine, and many more drugs that I'm forgetting.

Wow, that's quite the list. How many doctors did you have to see to get that many meds prescribed? I took a boatload of AD's before finding out I had low T, hypothyroidism and other health issues, but I only got to try about half the drugs on your list. I also found that none of the ones I tried had any lasting beneficial effects.

 

[Fortunate]

I think it would be better to present a balanced argument with studies that both support and run against the use of antidepressants. Your title makes it clear that you’re only looking to present one side of the story and have already come to a conclusion, and some of these “studies” seem to do the same. There are also double-blind studies that show antidepressants can be very effective, particularly when they are part of a treatment protocol (therapy, lifestyle changes, etc.). They certainly can have negative side effects in some that can overcome the benefit, but reading how you’ve gone about presenting this would lead one to believe that they are completely worthless and only harmful. There are many who would contend that antidepressants have saved their lives and have been taking them for years. Not ideal, and I think the hope is that you could wean your way off of them eventually, but I think they do have a place in treatment and should at least be considered as part of a protocol.

I completely agree with this. The information presented is impressive, but is one-sided. I have seen close family members climb out of psychologic ruts with the assistance of antidepressants. I can tell you first hand that, despite perfect conditions, with no reason to be down, I personally have had times when it's hard to feel content. It's like your brain is telling you: "everything is great", but you just don't feel that way. This has to be in some way mediated by neurotransmitters.

On the other hand, I do not believe the pharmacology alone can do the job. It's my sense that the medications open windows of opportunity for an individual, but it's still up to the individual to exploit the opportunity.

I believe depression needs to be attacked from multiple angles, probably including some from of CBT. I also appreciate @FunkOdyssey's other references to stoicism. I haven't read the recommended book, but I have a tendency to lean into this line of thinking. For a variety of reasons (capitalism, etc), I think our society has conditioned us to expect awesomeness all the time, when that is not reality. Our set point for contentment gets out of whack, making it sometimes hard to feel joy at just being alive.

Wow, I am waxing really philosophical. I will stop pontificating.... In summary, my opinion is that antidepressants are likely useful for some people under the right circumstances.

 

[FunkOdyssey]

I think it would be better to present a balanced argument with studies that both support and run against the use of antidepressants. Your title makes it clear that you’re only looking to present one side of the story and have already come to a conclusion, and some of these “studies” seem to do the same. There are also double-blind studies that show antidepressants can be very effective, particularly when they are part of a treatment protocol (therapy, lifestyle changes, etc.).

First, let me say that you seem like a reasonable person and I appreciate your comments. The idea that antidepressants are safe and effective is our societal default -- that position gets plenty of airtime already and my assumption is that readers will already be familiar with it. I don't see value in cluttering the thread with positive studies whose results are already undermined by information presented here. When you see a short-term industry-funded drug trial, you are now equipped to notice the small effect sizes and the reporting bias that leads to selective publication of positive results. When you see a longer-term study, you understand the antidepressant is most likely staving off its own withdrawal symptoms.

They certainly can have negative side effects in some that can overcome the benefit, but reading how you’ve gone about presenting this would lead one to believe that they are completely worthless and only harmful. There are many who would contend that antidepressants have saved their lives and have been taking them for years.

Anyone that recovers from depression is living differently than they were before. They get out of their heads and become externally-oriented, pursuing goals, socializing, exercising, eating better, maintaining healthier circadian rhythms, grooming and improving their appearance, nurturing their relationships, and generally participating in life in ways that the world responds positively to and rewards them for.

Skipping directly to the antidepressant behaviors above is an effective treatment for depression -- it's called Behavioral Activation Therapy. For many, the energy boost of cranked up monoamines and strong active placebo effect provides the permission and the nudge people need to behaviorally activate their way out of depression. This is what I believe is happening when the drugs appear to work. On the flip side, you can take whatever psychiatric drug cocktail you want and you will not recover if you remain a homebound, ruminating, nocturnal, isolated, couch potato hermit.

 

[FunkOdyssey]

Wow, that's quite the list. How many doctors did you have to see to get that many meds prescribed? I took a boatload of AD's before finding out I had low T, hypothyroidism and other health issues, but I only got to try about half the drugs on your list. I also found that none of the ones I tried had any lasting beneficial effects.

I remembered a few more since my last post: tianeptine, reboxetine, and atomoxetine. I saw several different doctors and ordered some of the more exotic medications from overseas. Unfortunately, I don't think our results are unusual.

 

[FunkOdyssey]

I completely agree with this. The information presented is impressive, but is one-sided. I have seen close family members climb out of psychologic ruts with the assistance of antidepressants. I can tell you first hand that, despite perfect conditions, with no reason to be down, I personally have had times when it's hard to feel content. It's like your brain is telling you: "everything is great", but you just don't feel that way. This has to be in some way mediated by neurotransmitters.

I have experienced this often, and I have identified some of my personal causes for what certainly feels like a biochemically-mediated shit mood. They include eating dairy, gastritis, side effects of various supplements, and the rebound effects of drugs that cause euphoria, including alcohol, THC, MDMA, and opiates (what goes up must come down). I have no doubt that our biochemistry is equally as important as antidepressant behaviors to maintaining a positive mood. I just don't think antidepressants are the correct way to modify the biochemistry.

 

[FunkOdyssey]

I believe depression needs to be attacked from multiple angles, probably including some from of CBT. I also appreciate @FunkOdyssey's other references to stoicism. I haven't read the recommended book, but I have a tendency to lean into this line of thinking. For a variety of reasons (capitalism, etc), I think our society has conditioned us to expect awesomeness all the time, when that is not reality. Our set point for contentment gets out of whack, making it sometimes hard to feel joy at just being alive.

The philosophical side of this is really important. If you define happiness as pleasure and believe our purpose in life is to maximize the pleasure we experience, your hedonic capacity becomes critical to your success. As someone like myself that experiences some degree of anhedonia more or less permanently, you're screwed.

On the other hand, if you listen to Aristotle and the Stoics, you might define happiness as eudaimonia (translated as "good soul", "good spirit", living well, flourishing) and you might believe the way to achieve that is via arete (excellence, virtue, full realization of potential). If achieving eudaimonia becomes the goal, a life well-lived remains a possibility for the hedonically impaired.

 

[Fortunate]

The philosophical side of this is really important. If you define happiness as pleasure and believe our purpose in life is to maximize the pleasure we experience, your hedonic capacity becomes critical to your success. As someone like myself that experiences some degree of anhedonia more or less permanently, you're screwed.

On the other hand, if you listen to Aristotle and the Stoics, you might define happiness as eudaimonia (translated as "good soul", "good spirit", living well, flourishing) and you might believe the way to achieve that is via arete (excellence, virtue, full realization of potential). If achieving eudaimonia becomes the goal, a life well-lived remains a possibility for the hedonically impaired.

These are great thoughts. I have done some reading that touches upon these ideas. I would recommend taking a look at Joy on Demand, a book written by a Buddhist who used to work at Google. He suggests that our happiness operates sort of like a thermostat. We have an internal “setpoint“. External circumstances may put you above or below your personal set point, but it’s only temporary. He contends that the key to being content is being able to change your own personal setpoint. Otherwise, we are all running on a hamster wheel, chasing ways to find ourselves above our setpoint, but it’s not sustainable. Not understanding this leads to suffering. His advice is to find a way to get off the hamster wheel.

I am paraphrasing and may not be doing his message justice. I encourage you to take a look for yourself.

 

[Hyrulewarrior1978]

I remembered a few more since my last post: tianeptine, reboxetine, and atomoxetine. I saw several different doctors and ordered some of the more exotic medications from overseas. Unfortunately, I don't think our results are unusual.

Lol

 

[Hyrulewarrior1978]

How is trt working for your depression? It doesn’t get rid of mine but it does help somewhat.

 

[FunkOdyssey]

How is trt working for your depression? It doesn’t get rid of mine but it does help somewhat.

Pretty well I think. I put my money where my mouth is and ditched the last psychoactive drug two months ago (caffeine). If my mood on a 1-10 scale is usually a 5 on caffeine, last time I was two months into caffeine withdrawal I was at a 3. Right now on TRT I'm at a 5 or maybe 6 -- as good or slightly better than I felt on caffeine. I think TRT is making the difference there.

 

[Hyrulewarrior1978]

Pretty well I think. I put my money where my mouth is and ditched the last psychoactive drug two months ago (caffeine). If my mood on a 1-10 scale is usually a 5 on caffeine, last time I was two months into caffeine withdrawal I was at a 3. Right now on TRT I'm at a 5 or maybe 6 -- as good or slightly better than I felt on caffeine. I think TRT is making the difference there.

Are you planning on exploring other options for your depression? All those drugs you mentioned cause chemical imbalances they are marketed to correct. It’s all bullshit really, but I think they are good for a temporary fix for the right person. Im not really big on taking pharmaceuticals these days though so I agree with you.

 

[tareload]

There are so many different angles that you can attack these disorders from and I guarantee there are several you haven't considered or tried yet. I firmly believe non-drug approaches to be most fruitful at this point

• 3 month outpatient CBT/DBT
• Trauma therapy / prolonged exposure
• EFT / tapping silliness
• Meditation
• TRT
• Naltrexone
• Nandrolone
• Propanolol
• Metoprolol
• Dietary interventions
• Crapload of different supplements methodically tested

For most of my life I have had the same issue with anhedonia, which was a breeze compared to the anxiety/panic currently. I thought to myself in the CBT class, wow, I wonder what all these people coming here for anxiety must feel.

Now I get it. So it may make sense to differentiate the use of ADs to help with acute event vs organic brain issue. As analytical as I try to be, I have no idea whether my issue is brain/heart or both. Came on after AFIB episode but thought I had it beat. Then creeped back in and now metastasized. Very difficult to decouple in post-COVID world.

I will say the anhedonia stuff is nothing compared to not knowing when you will be out and all of a sudden your HR is 150-180 bpm and you really don't know what's going on. The gym used to be my refuge; not it is like an asylum.

Got any other magic treatments, I am all ears. Given the heart/autonomic whatever I am very hesitant to start ADs. Perhaps benzos the way to go to put me out of my misery humanely .

Once your heart gets involved and you are prone to panic, it makes it interesting to say the least. Never had an issue with panic since early teens when hormones must have been in flux.

 

[FunkOdyssey]

• 3 month outpatient CBT/DBT
• Trauma therapy / prolonged exposure
• EFT / tapping silliness
• Meditation
• TRT
• Naltrexone
• Nandrolone
• Propanolol
• Metoprolol
• Dietary interventions
• Crapload of different supplements methodically tested

For most of my life I have had the same issue with anhedonia, which was a breeze compared to the anxiety/panic currently. I thought to myself in the CBT class, wow, I wonder what all these people coming here for anxiety must feel.

Now I get it. So it may make sense to differentiate the use of ADs to help with acute event vs organic brain issue. As analytical as I try to be, I have no idea whether my issue is brain/heart or both. Came on after AFIB episode but thought I had it beat. Then creeped back in and now metastasized. Very difficult to decouple in post-COVID world.

I will say the anhedonia stuff is nothing compared to not knowing when you will be out and all of a sudden your HR is 150-180 bpm and you really don't know what's going on. The gym used to be my refuge; not it is like an asylum.

Got any other magic treatments, I am all ears. Given the heart/autonomic whatever I am very hesitant to start ADs. Perhaps benzos the way to go to put me out of my misery humanely .

Once your heart gets involved and you are prone to panic, it makes it interesting to say the least. Never had an issue with panic since early teens when hormones must have been in flux.

I am more familiar with approaches to dealing with depression than anxiety/panic but I do have some thoughts.

You have a very tricky situation there with the a-fib, which can be indistinguishable from a panic attack by its symptoms, and which can also be triggered by anxiety/panic. I can tell you I had panic attacks for awhile that were caused by physical heart-related sensations. I was having pain in my chest, palpitations, rapid heart rate, and trouble breathing, and these symptoms would provoke a panic attack. This went on for some years and I was treating it off and on with psych drugs. Eventually, I figured out the physical symptoms were just reflux: a combination of GERD and LPR. Once I understood that as the cause, and knew at a deep level that these symptoms were not life-threatening, they lost their capacity to provoke panic attacks.

In my mind, to sever the anxiety/panic response to physical symptoms, what you would need is to be fully and deeply convinced that these episodes of rapid heart beat are not posing a serious threat to you. That is easier said than done, especially if there actually is an element of danger, if these episodes are sometimes a-fib or you are in danger of triggering a-fib by having them. I guess I would be exhausting all possible diagnostics, hopefully performing some during the episodes, to prove to myself that the episodes are not dangerous. I would also be reminding myself that I had not died yet despite this occurring so many times previously, so this next episode I'm experiencing is not going to kill me either and will pass just like the others.

In terms of what else you could try, I'm sure you've done obvious things like magnesium. Some research has shown increased risk of a-fib with omega-3 supplementation: Omega-3 Fatty Acids and Atrial Fibrillation

As I recall your diet is very heavy on the fatty fish. I've personally experienced anxiety symptoms from higher doses of EPA. I would try replacing the fish with some different meat for awhile if you haven't tried that yet. I would also experiment with carbs along the spectrum between moderate carb and full keto. That may have some impact on your symptoms for good or ill.

I would also be suspicious of the thyroid supplementation. I mistakenly thought I was hypothyroid some years ago when I was following a poorly executed low carb diet without enough fat, that left me cold and fatigued all the time. I began supplementing with armour thyroid and saw a clear relationship between taking too much thyroid hormone and anxiety symptoms. I felt best when I was not taking any. That may not be an option for you, but a dose reduction might be.

 

[FunkOdyssey]

Got any other magic treatments, I am all ears. Given the heart/autonomic whatever I am very hesitant to start ADs. Perhaps benzos the way to go to put me out of my misery humanely .

Benzos would probably work great for awhile, until tolerance developed. I would not take them regularly though, because you will become dependent and withdrawal can be hellish / impossible.

A short-acting benzo like alprazolam might be a good option to use on an as-needed basis when these episodes come on. When I was suffering panic attacks, I used to carry them with me everywhere, and they would give me a sense of security. I knew if I was having an unbearable experience I could pop the pill and it would bring rapid relief. Fortunately, I discovered that I could bear it in most cases and rarely resorted to using them. There was probably an entire year at the end where I carried the same alprazolam pill around in my pocket without taking it.

Just be careful if you try this though, because its a very slippery slope where you may be tempted to increase frequency. Each time you take one, you will be increasingly vulnerable to anxiety and panic in the days that follow due to the rebound effects.

 

[tareload]

I am more familiar with approaches to dealing with depression than anxiety/panic but I do have some thoughts.

You have a very tricky situation there with the a-fib, which can be indistinguishable from a panic attack by its symptoms, and which can also be triggered by anxiety/panic. I can tell you I had panic attacks for awhile that were caused by physical heart-related sensations. I was having pain in my chest, palpitations, rapid heart rate, and trouble breathing, and these symptoms would provoke a panic attack. This went on for some years and I was treating it off and on with psych drugs. Eventually, I figured out the physical symptoms were just reflux: a combination of GERD and LPR. Once I understood that as the cause, and knew at a deep level that these symptoms were not life-threatening, they lost their capacity to provoke panic attacks.

In my mind, to sever the anxiety/panic response to physical symptoms, what you would need is to be fully and deeply convinced that these episodes of rapid heart beat are not posing a serious threat to you. That is easier said than done, especially if there actually is an element of danger, if these episodes are sometimes a-fib or you are in danger of triggering a-fib by having them. I guess I would be exhausting all possible diagnostics, hopefully performing some during the episodes, to prove to myself that the episodes are not dangerous. I would also be reminding myself that I had not died yet despite this occurring so many times previously, so this next episode I'm experiencing is not going to kill me either and will pass just like the others.

In terms of what else you could try, I'm sure you've done obvious things like magnesium. Some research has shown increased risk of a-fib with omega-3 supplementation: Omega-3 Fatty Acids and Atrial Fibrillation

As I recall your diet is very heavy on the fatty fish. I've personally experienced anxiety symptoms from higher doses of EPA. I would try replacing the fish with some different meat for awhile if you haven't tried that yet. I would also experiment with carbs along the spectrum between moderate carb and full keto. That may have some impact on your symptoms for good or ill.

I would also be suspicious of the thyroid supplementation. I mistakenly thought I was hypothyroid some years ago when I was following a poorly executed low carb diet without enough fat, that left me cold and fatigued all the time. I began supplementing with armour thyroid and saw a clear relationship between taking too much thyroid hormone and anxiety symptoms. I felt best when I was not taking any. That may not be an option for you, but a dose reduction might be.

Great points. Thank you for taking the time to write that. Every time I get these symptoms in the gym I stop and haven't died yet. What I should try is push through with my prior intensity and if it doesn't kill me that may be a breakthrough. I will report back (or not) and thanks again. Sometimes you just have to push through. Wish me luck .

 

[tareload]

Great points. Thank you for taking the time to write that. Every time I get these symptoms in the gym I stop and haven't died yet. What I should try is push through with my prior intensity and if it doesn't kill me that may be a breakthrough. I will report back (or not) and thanks again. Sometimes you just have to push through. Wish me luck .

Although exercise induced ectopic beats are associated with mortality. So don't try this at home folks. Get big or die trying only in theory. I will give it a roll for you crazy ExcelMale bunch.

 

[FunkOdyssey]

Although exercise induced ectopic beats are associated with mortality. So don't try this at home folks. Get big or die trying only in theory. I will give it a roll for you crazy ExcelMale bunch.

Please leave this thread open on your phone so whoever finds you can post an update.

J/K I'm sure you'll be fine. Good luck!

 

[tareload]

Please leave this thread open on your phone so whoever finds you can post an update.

J/K I'm sure you'll be fine. Good luck!

Open.

 

[Fortunate]

• 3 month outpatient CBT/DBT
• Trauma therapy / prolonged exposure
• EFT / tapping silliness
• Meditation
• TRT
• Naltrexone
• Nandrolone
• Propanolol
• Metoprolol
• Dietary interventions
• Crapload of different supplements methodically tested

For most of my life I have had the same issue with anhedonia, which was a breeze compared to the anxiety/panic currently. I thought to myself in the CBT class, wow, I wonder what all these people coming here for anxiety must feel.

Now I get it. So it may make sense to differentiate the use of ADs to help with acute event vs organic brain issue. As analytical as I try to be, I have no idea whether my issue is brain/heart or both. Came on after AFIB episode but thought I had it beat. Then creeped back in and now metastasized. Very difficult to decouple in post-COVID world.

I will say the anhedonia stuff is nothing compared to not knowing when you will be out and all of a sudden your HR is 150-180 bpm and you really don't know what's going on. The gym used to be my refuge; not it is like an asylum.

Got any other magic treatments, I am all ears. Given the heart/autonomic whatever I am very hesitant to start ADs. Perhaps benzos the way to go to put me out of my misery humanely .

Once your heart gets involved and you are prone to panic, it makes it interesting to say the least. Never had an issue with panic since early teens when hormones must have been in flux.

Brothers, I am so sorry to hear how many have and are struggling. I, too have dealt with anxiety and depression for much of my life. When I look at my family, though, and see how many members are afflicted in a similar way, I can't help but conclude that a lot of this crap is mediated by brain chemistry. Some of this we inherit, and it helps to know that, so you can avoid the secondary and sometimes shameful line of self doubt questioning (ie, what the hell did I do wrong? Why can't I just enjoy life?).

Anyway, maybe we should all head over to the psilocybin thread and reconvene our thoughts there!

 

[Fortunate]

Benzos would probably work great for awhile, until tolerance developed. I would not take them regularly though, because you will become dependent and withdrawal can be hellish / impossible.

A short-acting benzo like alprazolam might be a good option to use on an as-needed basis when these episodes come on. When I was suffering panic attacks, I used to carry them with me everywhere, and they would give me a sense of security. I knew if I was having an unbearable experience I could pop the pill and it would bring rapid relief. Fortunately, I discovered that I could bear it in most cases and rarely resorted to using them. There was probably an entire year at the end where I carried the same alprazolam pill around in my pocket without taking it.

Just be careful if you try this though, because its a very slippery slope where you may be tempted to increase frequency. Each time you take one, you will be increasingly vulnerable to anxiety and panic in the days that follow due to the rebound effects.

Totally agree. I'd be very, very hesitant to use benzo's.

I have documented some of struggles with beta blockers (they turned me into a sad zombie), but I do think PRN propranolol can be really helpful to deal with sudden increases in anxiety or a panic attack.