A question about SSRIs: Anyone who has been prescribed an

[hedgehog]

SSRI or one of its cousins knows that finding the right drug(s) can be a trial and error process. The drugs get changed and the doses changed to come up with a winning combination. We know that these drugs work for a lot of us (most of us?) but there are a couple of studies kicking around claiming they don't work very well. Here's my question:

Say SSRI "A" is tested and works for about 30% of the people in the test group. In practice, doctors prescribe it for 100 people. It doesn't work for 70 of the people who try it, but they go on to use something else. For 30 of the people, SSRI "A" is a new lease on life. It works for 100% of the people who have that particular form of depression.

So, is SSRI "A" only 30% effective, or is it 100% effective?


Say that SSRI "A", SSRI "B" and SSRI"C" all test out at 30% effectiveness.

But say you have a group of people, some using A, some using B, some using A+B etc and all having good results.

Is this the explanation for reports saying individual SSRIs are not very effective even though thousands swear by them?

[EFerrari]

1. The one about a train leaving Chicago is looking good right now.

:)

[hedgehog]

6. It took me a while to figure out your reference.

:rofl:

Let me try an analogy: Pneumonia is a symptom that can be caused by bacteria, viruses, chemical exposure, inhaling stomach contents or water in the lungs. Someone tests an antibiotic by giving it to a group of people all of whom have pneumonia from different causes. The antibiotic cures the people with bacterial pneumonia but does squat for the other people. Is the antibiotic effective or not?

Clearly, the antibiotic is effective if it is given to people with the right kind of pneumonia and useless for others. I think any given SSRI is useful for some depressives, partly effective for others, and useless for the rest. If you test a SSRI with a random group of depressives, you may decide that the SSRI is no better than a placebo. Give the SSRI to the people with the right kind of depression, and the SSRI is a miracle drug. Some people swear by Prozac, others find it does nothing. Some people depend on Celexa, others can't stand the side effects, etc., etc. In fact, I've read articles suggesting that the variable responses to different SSRIs and related drugs indicates different causes for depression. Depressives may all look alike from the outside, but these people have a malfunctioning hypothalamus while those people have a seratonin deficit while this other group needs more dopamine, etc.

This would explain the recurring articles claiming that SSRIs as a class are no better than a placebo while we know that once we find the right SSRI, it's the difference between life and death.

[EFerrari]

7. Gotcha. I haven't read anything on theories of depression

for many years. But if it is in fact a baggy term that herds several different situations together, that would explain a lot. As I said down thread, I could never figure out why anyone would take the "old" or original anti-depressants. They all made me feel ill or maybe that should be "they both" because there were two different kinds, MAO inhibitors and that other one I can never remember. They did nada for my depression except possibly make it a little worse! And I'd go on teevee for Prozac.

[zippy890]

2. good questions, don't know answer

I fall into category that SSRIs do NOT work on very well.

I expect your conclusion is correct - that for those that they do help,
there is big support for them.

[EFerrari]

4. I was one of those people that couldn't take any of the old anti-depressants.

They all made me feel ill. I don't even remember their names any more but my doctor tried me on all of them and it was sort of a disaster. When SSRIs came out, I felt like I'd been let out of a cage.

Ditto for Zanax then Klonopin + all the work done on panic disorder in the early 80s. (Actually, the Zanax came first, iirc.) I'm one of the ones whose panic attacks went away entirely and the low level anxiety became easily manageable with meds and therapy and a little b-mod. I take about 1/8 of the anxiety meds they started me out on and would gladly kiss the ring of whoever put Klonopin on the market.

I haven't had either of these meds for the last two years because of under or unemployment. Although I've managed, it's been difficult and all the symptoms of depression are exhausting and I can't manage the unexpected or crisis or even a good night's sleep as well as I expect to after all those years on my meds. 1 week until my doc's appointment. It will be great to have my brain back. :woohoo:

ETA: Imipramine? Isn't that one of the old(est) ones? I felt like I was on acid AND depressed. :)

[uriel1972]

3. In many ways psychiatry

is still in it's infancy. We don't have an effective way of differentiating between types of depression so it's hard to say A is effective in B type depression at the moment. We don't even know how anti-depressants (or anti-psychotics for theat matter) work. What is true that over all medications/conditions physical and mental the initial prescription often doesn't work. It may be the wrong anti-biotic for that organism or it might be that the dose of thyroxine is too low to treat your hypothyroidism.

In the end we have to feel our way blindly towards the right drug dose combination. I tend to believe that your explanation will end up being the correct one over time, but it will be a long while and plenty of new tests/methods of testing before the answer will be known.

[EFerrari]

5. It says something about our culture that most or many expect psychiatrists

to be immutable authorities who dispense calm and comfort.

I certainly did at one point.