Anti-depressants

[Rickson1]

I am a 45 year old male.  I have suffered depression all of my life, feeling sad as far back into childhood as I can remember.  I spent many, many years self-medicating (alcohol+drugs).  I know for me, I have tried 16 different anti-depressants and other than the ones that gave me severe nausea and the ones that made me feel like a walking Zombie (Effexor, Seroquel and Olanzapine), the others did nothing.  From what I have read as well as independent, double-blind studies done by universities (not drug company trials), they showed that for mild to moderate depression, a sugar pill was sometimes more effective than any of the SSRI, SARI, anti-psychotics,Tri-cyclics, etc. meds.  So that would indicate that because you think you are feeling better due to the drug while in fact it is only a placebo effect.  These drugs have, however shown to be quite helpful in people with SEVERE depression.  People with Mild to Moderate depression have found relief in Suboxone (Buprenorphine/Naloxone) or Subutex.  However, beware that Buprenorphine, although only being a partial opiate-agonist has a VERY high affinity for the same receptors in your brain as painkillers/heroin.  So you will become addicted to it and will become very, very sick for quite a long time if you stop it.  Dosages as low as 2mg (4mg max) should be all you need.  This drug is used as an adjunct therapy for opiate addicted people normally but has been used off label for regular treatment resistant depression so it is regulated much the same as Methadone and has the same type of rules.  However, if your doctor prescribes it for depression (if he/she is able to) you may not have to jump through the same hoops as an addict does (pee samples once/week, doctor visits once/month)

[Paxiled]

Another point -- university trials are usually funded by drug companies.  Very few truly independent research is done anymore and is hard to find, but it does exist.  There's just not much money for it.  And sometimes you just have to use common sense -- mild to moderate illness is always easier to treat than severe illness, and therefore placebo would be more likely to help as it often goes away on its own anyway, whereas severe illness would be much less likely to do so.  But again, since most drug trials no matter who is doing them (it's almost impossible to find people in the medical community who aren't in some way paid by drug and medical device companies, to the extent that when FDA tried to eliminate them from its review panels it couldn't find enough experts to staff them) don't treat illnesses that show little promise in being treated unless getting special funding to treat rare diseases since that would be unlikely to result in a drug getting to market and recouping the research costs, it's hard to know how we could know the answer you heard.  It may be they saw a study, but the majority of studies wouldn't be about that.  It's a hard world out there when profit determines treatment.

[Rickson1]

Thank you for your insight.  The part about anti-depressants working better on severely depressed people was actually something I saw on the show "60 Minutes" where they were comparing drugs to placebo's in mild, moderate and extreme depression.  I was pretty sure that they said the results for placebos on mild/moderate depression were very close to 50/50 but that severe depression showed much better results.  I may be incorrect though as it was awhile ago.   And to your point, you are exactly right when you say that everyone is different when it comes to medication.  I guess you could group people into sub-groups and say "this med did exactly the same for all of this group of people" but other groups, or even individuals for that matter can and do certainly respond differently.

[Paxiled]

Just to comment, antidepressant trials almost always involve moderate to mild depression, almost never severe.  The reason is that the drug companies want to get the drug approved and make money on it, and it is much easier to treat easier than harder problems.  Getting into a trial for a standard antidepressant is very hard if you have complicated problems.  So your theory that they work better for severe depression isn't actually backed up by the trials.  The trials also show, and drug trials always show, that many are helped more by placebo than by the drug.  That's why they do the trials.  However, the drugs generally outperform placebo by enough of a percentage to get approval, and placebo effects generally wear off while drugs keep working.  Some people also get worse side effects from placebo than from the real drug, just showing how complex the human brain is.  Opiates would be a bad choice for depression, as they cause depression in many people because they're a downer drug.  Benzos can do the same thing if you take them too often.  So while it's true you feel great while you're on them, when they wear off you come down and are more depressed, so the addictive nature sets in and you're tempted to keep taking more.  Drugs are approved by statistics, and when you use statistics, you ignore individuals -- meaning, different people react differently.  It's also true that not all drugs can be metabolized by a particular individual, which is why often drugs don't work at all -- the body simply can't metabolize them.  It's complicated.  The only thing we know for sure is drugs don't cure depression or anxiety because we don't know yet what causes it, but for some they help a lot and for others they just don't.  The same is true for therapy and natural medicine.  Peace.