# Are SSRI antidepressants worthless in the long term? **URL:** \ **Category:** Great Debates\ **Created:** [November 30, 2015, 7:36pm UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052 "2015-11-30T19:36:25Z")\ **Posts on this page:** 20\ **Page:** 9
**Author:** ![Crazy\_Canuck](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/crazy_canuck/32/5282_2.png) [@Crazy\_Canuck](https://boards.straightdope.com/u/Crazy_Canuck)\ **Post date:** [December 7, 2015, 11:53pm UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/161 "2015-12-07T23:53:29Z")
All those last two posts tell me is that it appears that drad dog does not understand fair use and copyright law any better than psychiatry. ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [December 8, 2015, 12:37am UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/162 "2015-12-08T00:37:54Z")
> [@storyteller0910](#): > > OK, let me turn this around on you, if I may: in what way, specifically, do you think it is _not_ true? I’ve just outlined the clinical trial process; at which stage do you think there are differences? What do you think those differences are?.. drad dog, your post is way too long and tedious. But did you ever get to answering the question? What I read is why all drug trials are corrupt. I don’t believe that to be true in general, but I suppose you did provide an answer to the question that wasn’t asked, “why are drug trials corrupt”. What you haven’t answered (as far as I read) is what storyteller asked, which is, “how are drug trials different for psych drugs than from any other drugs?” > [@drad\_dog](#): > > [Psychiatric Drugs: Cure or Quackery?](http://www.wayneramsay.com/drugs.htm) > > The Worthlessness of FDA Approval > You are probably wondering how psychiatric drugs get approval from government agencies such as the U.S.A.'s Food & Drug Administration (FDA) if they are as harmful as indicated here. There are several reasons. > One reason is former drug company executives who seem to have more loyalty to their former employers than to the public hold high positions within the FDA… If your wall of text included an answer to that, could you please summarize it? ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [December 8, 2015, 12:45am UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/163 "2015-12-08T00:45:11Z")
> [@drad\_dog](#): > > … > Happy pills have many side effects. They remove both the top and the bottom of the emotions,… Okay, but this caught my eye, and I feel the need to respond to it. I had several unpleasant side effects from Prozac, such as difficulty sleeping and a dry mouth. That’s really why I stopped taking it. (And discovered that I didn’t need it any more.) But it ABSOLUTELY DIDN’T remove the "top and bottom of my emotions. Quite the contrary. Depression felt like my mind was covered with a damp rag, and while the collapsing in tears and having little initiative were unpleasant, the worst part was that I was nearly unable to feel joy. Prozac relieved that problem. It was a vast relief to be able to feel joy again. It didn’t really dampen my negative emotions, either, I just didn’t feel down all the time, I only felt down for a short period after some reason to feel down. I am just one person, reporting my subjective reaction to a drug. But I have never read a description of a drug effect that was more counter to my own reaction. ---
**Author:** ![pulykamell](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/pulykamell/32/3166_2.png) [@pulykamell](https://boards.straightdope.com/u/pulykamell)\ **Post date:** [December 8, 2015, 2:22am UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/164 "2015-12-08T02:22:15Z")
> [@puzzlegal](#): > > Okay, but this caught my eye, and I feel the need to respond to it. I had several unpleasant side effects from Prozac, such as difficulty sleeping and a dry mouth. That’s really why I stopped taking it. (And discovered that I didn’t need it any more.) But it ABSOLUTELY DIDN’T remove the "top and bottom of my emotions. Quite the contrary. Depression felt like my mind was covered with a damp rag, and while the collapsing in tears and having little initiative were unpleasant, the worst part was that I was nearly unable to feel joy. Prozac relieved that problem. It was a vast relief to be able to feel joy again. It didn’t really dampen my negative emotions, either, I just didn’t feel down all the time, I only felt down for a short period after some reason to feel down. > > I am just one person, reporting my subjective reaction to a drug. But I have never read a description of a drug effect that was more counter to my own reaction. That was my same reaction to it (Prozac) and the same description I would have of my “depression” (minus collapsing in tears–the problem for me was more that I just couldn’t cry, even though I felt like it), although I took it for a short time (under 6 months, although my doc didn’t think I would need it for more than that amount of time and I paid exactly $0 for it as it seemed the university just had Prozac samples to give away) and was the only time I’ve been on any type of psychiatric drug. This was without any therapy, which I elected out of. I don’t know if I can credit the drug completely from helping it from spinning out of control, but it helped steady the boat and regain the course, and I feel that it did help contribute to me being able to finish my best semester at college. My experience with it is positive but, once again, like you, I’m just one person. ---
**Author:** ![coremelt](https://avatars.discourse-cdn.com/v4/letter/c/4491bb/32.png) [@coremelt](https://boards.straightdope.com/u/coremelt)\ **Post date:** [December 8, 2015, 2:40am UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/165 "2015-12-08T02:40:05Z")
I want to turn this question around, I want Drad Dog to tell us all what he/she suggests those with severe and long term depression should do instead? Ok, we can’t trust doctors, you’ve convinced me. “happy pills” are either worthless or have worse side effects than they cure. Now what do I do? I’m still depressed. ---
**Author:** ![Leaper](https://avatars.discourse-cdn.com/v4/letter/l/4bbf92/32.png) [@Leaper](https://boards.straightdope.com/u/Leaper)\ **Post date:** [December 8, 2015, 3:28am UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/166 "2015-12-08T03:28:49Z")
Especially since Wayne Ramsay, the source of that first link above, believes that psychiatry itself needs to be abolished. ETA: And doesn’t the characterization of antidepressants as “happy pills” fundamentally misrepresent both depression and the medications used to treat it? ---
**Author:** ![coremelt](https://avatars.discourse-cdn.com/v4/letter/c/4491bb/32.png) [@coremelt](https://boards.straightdope.com/u/coremelt)\ **Post date:** [December 8, 2015, 3:55am UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/167 "2015-12-08T03:55:31Z")
I took a quick look at Wayne Ramsay. He denies the existence of all mental illness. Seeing as I have a severely schizophrenic person as a member of my family this is pretty obviously false to me. As as for this whole, no blood test or MRI can detect depression thing. Patently false: [http://www.dbsalliance.org/site/PageServer?pagename=education\_anxiety\_stress\_brain\_structure](http://www.dbsalliance.org/site/PageServer?pagename=education_anxiety_stress_brain_structure) The reason that doctors usually diagnose depression from symptoms and not from MRI is simply cost. A Brain MRI scan costs USD $2500+ , so you saying we should do one of those on every patient before we prescribe any drugs? And that will help people? ---
**Author:** ![raventhief](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/raventhief/32/4_2.png) [@raventhief](https://boards.straightdope.com/u/raventhief)\ **Post date:** [December 8, 2015, 5:38am UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/168 "2015-12-08T05:38:53Z")
> [@Leaper](#): > > Especially since Wayne Ramsay, the source of that first link above, believes that psychiatry itself needs to be abolished. > > ETA: And doesn’t the characterization of antidepressants as “happy pills” fundamentally misrepresent both depression and the medications used to treat it? Personally, I find the characterization extremely dismissive. I have taken Zoloft for…well, quite a while, really. They don’t make me “happy.” Nor do they cut off top and bottom of the ranges of emotion. They allow me to get out of bed in the morning, and deal with those top/bottom emotions instead of retreating into a gray, shapeless blanket of depression. Happy pills? I’ve taken those, in my dissolute youth. Pretty illegal, and the doctor wasn’t the one providing them. SSRIs ain’t happy pills. ---
**Author:** ![coremelt](https://avatars.discourse-cdn.com/v4/letter/c/4491bb/32.png) [@coremelt](https://boards.straightdope.com/u/coremelt)\ **Post date:** [December 8, 2015, 7:04am UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/169 "2015-12-08T07:04:51Z")
Lets just completely kill this blatant lie that DSM disorders do not have any underlying biological changes that can be detected or studied: Two links on physiological changes in brains of patients with Schizophrenia: > **[How Schizophrenia affects the brain](https://www.sciencedaily.com/releases/2013/09/130911103325.htm)** > > A study has been published using brain scans to document the effects of schizophrenia on brain tissue. The findings may help doctors better understand the origin of the illness and the best ways to treat it. > **[Understanding structural brain changes in schizophrenia - PubMed](https://pubmed.ncbi.nlm.nih.gov/16640116/)** > > Schizophrenia is a chronic progressive disorder that has at its origin structural brain changes in both white and gray matter. It is likely that these changes begin prior to the onset of clinical symptoms in cortical regions, particularly those... Study on MRIs of people with Bipolar Disorder: > **[Understanding structural brain changes in schizophrenia - PubMed](https://pubmed.ncbi.nlm.nih.gov/16640116/)** > > Schizophrenia is a chronic progressive disorder that has at its origin structural brain changes in both white and gray matter. It is likely that these changes begin prior to the onset of clinical symptoms in cortical regions, particularly those... Bipolar Disorder Diagnosis May Soon Include MRI Brain Scan Test > **[Bipolar Disorder Diagnosis May Soon Include MRI Brain Scan Test](https://www.medicaldaily.com/bipolar-disorder-diagnosis-may-soon-include-mri-brain-scan-test-246553)** > > MRI brain scans work as reliable bipolar disorder tests, according to a new study. ---
**Author:** ![Beelzebubba](https://avatars.discourse-cdn.com/v4/letter/b/ed8c4c/32.png) [@Beelzebubba](https://boards.straightdope.com/u/Beelzebubba)\ **Post date:** [December 9, 2015, 7:00am UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/170 "2015-12-09T07:00:51Z")
I have taken various SSRI and SNRI anti-depressants consistently for 22 years (started at age 18). What I have found is that the only truly effective long-term treatment for depression or anxiety is a combination of medication, therapy and (most importantly) dedication of the patient to make a change. The meds fizzle out after a while, which is why I’ve taken nine different ones in 22 years. ---
**Author:** ![coremelt](https://avatars.discourse-cdn.com/v4/letter/c/4491bb/32.png) [@coremelt](https://boards.straightdope.com/u/coremelt)\ **Post date:** [December 10, 2015, 4:52am UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/171 "2015-12-10T04:52:01Z")
> [@Beelzebubba](#): > > What I have found is that the only truly effective long-term treatment for depression or anxiety is a combination of medication, therapy and (most importantly) dedication of the patient to make a change. Absolutely, meds can help you escape a particular mindset which is a self perpetuating trap. Diet, exercise, lifestyle changes and stress reduction techniques are always the best solution but it can be impossible for someone with clinical depression to even get started down that road. ---
**Author:** ![tomndebb](https://avatars.discourse-cdn.com/v4/letter/t/b9e5f3/32.png) [@tomndebb](https://boards.straightdope.com/u/tomndebb)\ **Post date:** [December 10, 2015, 5:34am UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/172 "2015-12-10T05:34:12Z")
> [@coremelt](#): > > Lets just completely kill this blatant lie. . . As this sort of expression could too easily be construed as an attack on the poster rather than the poster’s sources, let’s refrain from calling such claims “lies.” [/Moderating] ---
**Author:** ![coremelt](https://avatars.discourse-cdn.com/v4/letter/c/4491bb/32.png) [@coremelt](https://boards.straightdope.com/u/coremelt)\ **Post date:** [December 10, 2015, 12:02pm UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/173 "2015-12-10T12:02:48Z")
Ok point taken. Its a blatant falsehood that there is no biological underpinnings that can be studied of DSM disorders. See my cites in post above. ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [December 10, 2015, 1:57pm UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/174 "2015-12-10T13:57:39Z")
> [@coremelt](#): > > Absolutely, meds can help you escape a particular mindset which is a self perpetuating trap. Diet, exercise, lifestyle changes and stress reduction techniques are always the best solution but it can be impossible for someone with clinical depression to even get started down that road. Yup. Meds gave me the initiative and emotional stability to move to a better job and to improve my relationship with my husband. I’m pretty sure those two life-improvements are why I stopped needing them. ---
**Author:** ![Thing\_Fish](https://avatars.discourse-cdn.com/v4/letter/t/ecb155/32.png) [@Thing\_Fish](https://boards.straightdope.com/u/Thing_Fish)\ **Post date:** [December 11, 2015, 12:00am UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/175 "2015-12-11T00:00:08Z")
Here is my perspective as a psychiatrist (and antidepressant user) on some of the issues raised in this thread. TLDR: These drugs are awesome. There are certainly folks who they don’t work for, or who find that the side effects outweigh the benefits, but the vast majority of the patients I treat for depression or anxiety experience significant improvement on one of the first few meds I try them on, and serious side effects, though not unheard of (as is true of any effective medication) are quite rare. Having said that, most antidepressant prescriptions are not written by psychiatrists, but by generalists or other specialists who may not have sufficient time or training to adequately determine if such a prescription is really appropriate, or to judge its efficacy on followup. Also, almost all of my patients are referred by psychotherapists, so they are also receiving the benefit of that treatment. With that in mind, I don’t doubt that the overall success rate of these meds is much lower than what I see in my practice. These drugs have been widely prescribed for decades, so we can say with absolute certainty that there are no long-term side effects that we need to be worried about. Not only do they not increase the chances of becoming depressed again later in life, but the opposite is true: the longer a patient stays on them, the greater the chance that the improvement can be sustained after stopping. It is true that we don’t know exactly how they work. It clearly isn’t simply a matter of increasing serotonin availability in synapses, as that effect happens basically immediately when you start taking them, but it usually takes several weeks to see improvement in symptoms. And as the OP points out, the brain responds to that serotonin increase by downregulating receptors in order to restore the previous balance, anyway. Presumably it is some aspect of that attempt to restore equilibrium which produces the positive mood effects, but the truth is that we really aren’t sure exactly what mechanism is at work. A minority of patients do experience severe physical discomfort upon stopping antidepressants; in almost all cases, this can be dealt with by slowly tapering the dose. Even in the small group of patients who need to keep taking the meds longer than they would like due to these problems, that certainly isn’t an “addiction” in any generally accepted sense of the word; they aren’t taking them due to a psychological compulsion or to achieve immediate mood alteration. Although many people remain stable on the same drugs for years (or are able to come off them without recurrence of symptoms), it isn’t uncommon for drugs to “poop out” and stop working after having been effective for a while. Usually they will respond will to a change of medication. Likewise, it isn’t unusual for patients to complain of being overly “flattened” and unable to experience positive emotions; a change of medications will usually resolve this problem. The meds certainly don’t “change your personality”, unless you consider yourself to be a different person when you are feeling sad than when you are feeling happy. I would certainly encourage a healthy skepticism about the motives of the pharmaceutical industry, who do market their products aggressively. I’m sure storyteller and the other guys in the lab are generally highly ethical people, but that’s not necessarily the case with the front-line sales force. In general, I think this opinion of the industry is almost universally held among doctors. I think things have gotten much better in the couple decades since I entered med school, though. I missed the glory years of the 90s when pharm reps would offer doctors and even lowly medical students all-expenses paid junkets to Hawaii for “educational presentations”, but I certainly got my share of meals at expensive restaurants during residency (I still get invitations, but they are much less frequent and I am much less interested now that I can afford to buy my own meals). On one occasion a drug rep did actually say that he had looked at my prescribing records (yes, they can do that! Or at least could ten years ago) and strongly implied that the flow of free meals would be shut off if I didn’t start prescribing more of their products. These days, they can’t even take you to lunch unless there is an MD present to discuss their products (they can bring food to your office, though, which somewhat undercuts that regulation). However, aside from these sorts of perks, they don’t really have any leverage over doctors; we get paid by the hour or by the patient, regardless of how many or few drugs we prescribe or the cost of said drugs. ---
**Author:** ![pool](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/pool/32/4152_2.png) [@pool](https://boards.straightdope.com/u/pool)\ **Post date:** [December 11, 2015, 12:14am UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/176 "2015-12-11T00:14:10Z")
That’s very interesting **Thing Fish** about how the mood elevation from the medication is possibly related to the brain adapting to the drug. It makes a certain amount of sense to my uneducated self that maybe if you have too many active receptors and also a small amount of serotonin then downgrading some receptors and having enough a greater amount of serotonin in the synaptic cleft would improve mood. What is the most likely reason for a medication to work for a while and then suddenly or gradually stop working, is it the brain’s response to the drug or is it a completely different mechanism? ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [December 11, 2015, 1:17pm UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/177 "2015-12-11T13:17:26Z")
Thing fish, that’s very interesting. I actually responded within half an hour or so to taking Prozac, (although the effect increased time) which led me to wonder if I was just experiencing a placebo effect, since told me it wouldn’t that way. I was okay with that, hey, whatever works. But maybe it actually was the direct action of increasing serotonin availability. ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [December 11, 2015, 2:19pm UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/178 "2015-12-11T14:19:26Z")
> [@Thing\_Fish](#): > > However, aside from these sorts of perks, they don’t really have any leverage over doctors; we get paid by the hour or by the patient, regardless of how many or few drugs we prescribe or the cost of said drugs. Well, unless you dispense prescriptions in-house. Great post, by the way. ---
**Author:** ![Thing\_Fish](https://avatars.discourse-cdn.com/v4/letter/t/ecb155/32.png) [@Thing\_Fish](https://boards.straightdope.com/u/Thing_Fish)\ **Post date:** [December 11, 2015, 8:51pm UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/179 "2015-12-11T20:51:00Z")
> [@pool](#): > > That’s very interesting **Thing Fish** about how the mood elevation from the medication is possibly related to the brain adapting to the drug. It makes a certain amount of sense to my uneducated self that maybe if you have too many active receptors and also a small amount of serotonin then downgrading some receptors and having enough a greater amount of serotonin in the synaptic cleft would improve mood. > > What is the most likely reason for a medication to work for a while and then suddenly or gradually stop working, is it the brain’s response to the drug or is it a completely different mechanism? AFAIK there is no currently compelling explanation for this. It is very curious, especially in light of the fact that these patients often then do quite well when switched to very similar drugs. ---
**Author:** ![Thing\_Fish](https://avatars.discourse-cdn.com/v4/letter/t/ecb155/32.png) [@Thing\_Fish](https://boards.straightdope.com/u/Thing_Fish)\ **Post date:** [December 11, 2015, 8:52pm UTC](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052/180 "2015-12-11T20:52:55Z")
> [@puzzlegal](#): > > Thing fish, that’s very interesting. I actually responded within half an hour or so to taking Prozac, (although the effect increased time) which led me to wonder if I was just experiencing a placebo effect, since told me it wouldn’t that way. I was okay with that, hey, whatever works. But maybe it actually was the direct action of increasing serotonin availability. Yeah, this definitely happens from time to time. Could be placebo, or maybe there is some relatively rare kind of depression which really is, at least partially, just due to inadequate serotonin in the synapses. [Previous page](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052.md?page=8) [Next page](https://boards.straightdope.com/t/are-ssri-antidepressants-worthless-in-the-long-term/739052.md?page=10)