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The British Medical Journal provides an editorial from Professor David Healy, Head of Psychiatry at the Hergest psychiatry unit in Bangor in which it is stated:
When concerns emerged about tranquilliser dependence in the early 1980s, an attempt was made to supplant benzodiazepines with a serotonergic drug, buspirone, marketed as a non-dependence producing anxiolytic. This flopped. The lessons seemed to be that patients expected tranquillisers to have an immediate effect and doctors expected them to produce dependence. It was not possible to detoxify the tranquilliser brand.
Instead, drug companies marketed SSRIs for depression, even though they were weaker than older tricyclic antidepressants, and sold the idea that depression was the deeper illness behind the superficial manifestations of anxiety. The approach was an astonishing success, central to which was the notion that SSRIs restored serotonin levels to normal, a notion that later transmuted into the idea that they remedied a chemical imbalance. The tricyclics did not have a comparable narrative.
Serotonin myth
In the 1990s, no academic could sell a message about lowered serotonin. There was no correlation between serotonin reuptake inhibiting potency and antidepressant efficacy. No one knew if SSRIs raised or lowered serotonin levels; they still don’t know. There was no evidence that treatment corrected anything.
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This lack of evidence-based practice was apparent to Thomas Insel, Director of the US National Institute Of Mental Health who announced in 2013 that the institute would abandon funding towards the DSM:
While DSM has been described as a "Bible" for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been "reliability" - each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.
In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.
Does this mean that psychiatry is finally moving away from a practice akin to leeches for everything?
(Score: 3, Informative) by Anonymous Coward on Friday April 24 2015, @03:40AM
Having tried multiple medications for my issues, it often seems like the doctors are just making educated guesses.
My own experiences with SSRIs was moderately successful in lowering anxiety, but at the same time causing sexual dysfunction.
Wellbutrin made my depression worse, to the point of suicide planning, and made me a nasty angry drunk when I drank.
Benzos have their own problems, especially if you drink alcohol on them you'll end up regretting it.
(Score: 3, Insightful) by Anonymous Coward on Friday April 24 2015, @04:03AM
I took SSRIs for a few years (don't remember which ones since it was several years ago) and they didn't seem to do anything. I did have several months of withdrawal when I stopped taking them. Random twitching and electric shock sensations. It was more annoying than anything else.
Benzos are super-duper effective at treating short term anxiety, the trouble is when they are used long term. I've read that if you get addicted to them the withdrawals are worse than heroin. You can even have seizures.
I'm pretty skeptical about any medication my doctor want's to prescribe me now. I do research on any pill I take. I think more people should take the "trust, but verify" approach when it comes to medical advice/care. I'm not saying that doctors don't have your best interests at heart (generally), but only you can really tell how a medication is making you feel, or if the side effects might be intolerable to you.
(Score: 5, Interesting) by gallondr00nk on Friday April 24 2015, @11:15AM
The problem is that (as another commenter below noted) is that they can be helpful. People are different, and clinical psychiatry is well behind the curve on that realisation.
My experiences are roughly parallel to yours. I've been on and off Citalopram of varying doses, and stopped a year back when I realised that there really was no sweet spot where my symptoms diminished but without unpleasant side effects.
Even on small doses I found myself robotised - not giving a shit about anything, staring out the window, waiting to (and wanting to) die. There were times when that was actually preferable to what I was suffering from, and that's when I'd take them.
I'd go and say that the majority of people suffer from depression and anxiety because their lives are genuinely depressing and insecure. Yet our socio-economic system always pins blame for suffering on the individual - it's your fault you're unhappy and anxious. That we prescribe tablets that "cure" our unhappiness underpins that assumption.
We could probably dispense with billions upon billions of expenditure if we just sat people down and worked out what made them happy, before assisting them in realising that vision. But that wouldn't fit into our industrial age labor force models.
Isn't it something like 1/4 adults are on some sort of anti-depressant? There's no bigger indictment of the system than that.
(Score: 3, Informative) by Reziac on Saturday April 25 2015, @03:17AM
With depression, ALWAYS check thyroid function first. Marginal or low thyroid is probably the single most significant cause of depression, yet the least considered. It causes poor glucose transport which means your brain doesn't get enough energy and consequently just doesn't work right. Incidentally, lithium is known to eventually damage thyroid function.
And don't just test TSH, which by itself can only tell you someone is sick; it *cannot* tell you if they are well. There is some factor we're not yet considering, since there is a long history of subclinical and "sublaboratory" (untestable) symptomatic hypothyroidism not generally recognised and seldom treated (at least, not since the TSH test put a halt to symptom-driven treatment), yet most of these cases resolve when treated AS hypothyroid, usually but not always requiring natural desiccated thyroid rather than synthetic.
http://www.altmedrev.com/publications/9/2/157.pdf [altmedrev.com]
http://hormonerestoration.com/files/TSHWrongtree.pdf [hormonerestoration.com]
And there is no Alkibiades to come back and save us from ourselves.
(Score: 0) by Anonymous Coward on Saturday April 25 2015, @04:43AM
> Having tried multiple medications for my issues, it often seems like the doctors are just making educated guesses.
> My own experiences with SSRIs was moderately successful in lowering anxiety, but at the same time causing sexual dysfunction.
> Wellbutrin made my depression worse, to the point of suicide planning, and made me a nasty angry drunk when I drank.
> Benzos have their own problems, especially if you drink alcohol on them you'll end up regretting it.
I have had close to 50 years of experience with anxiety and panic disorder, beginning with the onset of puberty. Over the years, I have tried every medication available to treat an "anxiety/depression" disorder. I was not always depressed, but I was (am still am) anxious with accompanying spontaneous panic attacks. I have tried tricyclyics, MAOIs (dangerous stuff, almost died twice), SSRIs, a handful of others, all under the care of a couple of psychopharmacologists. Over the years the only thing that has provided any real relief for the anxiety are the benzos. Diazopam (Valium), to be specific. Alprazolam (Zanax) is a shorter acting benzo, and, while great for a quick response to a panic attack, does not provide the longer term effectiveness of diazopam for relief of anxiety symptoms. There have been times in my life when I have been able to go for a few years without taking anything, and times when the problem was so severe that I was unable to work. In all cases, none of the "antidepressents" or other anti-anxiety drugs (Wellbutrin, Buspar, etc.) provided nothing but the side effects, no relief for the anxiety.
The benzos get a bad rap due to misuse by the general public; they are a "recreational" drug for a lot of folks (especially a handful of Xanax chased by liquor) and, because of that, the are not prescribed very frequently any more. Fortunately, I have an enlightened physician who trusts me not to abuse the drug, and I have never had an addiction problem with benzos. That generally only happens with abusers. For the last year I have been doing some "old school" treatment to address the anxiety/panic issues without assuming there was an underlying depression (I did say that my physician was enlightened) - I am taking 500mg of Depakote and 5-10mg of diazopam daily and, while I was skeptical at first, I'm not the zombie I thought I would be and I have not had any spontaneous panic attacks since starting this combination.
BTW, even taking this cocktail, I find a couple of glasses of wine to be no more troublesome than a year ago, when I was taking nothing at all (a "good patch" - very few spontaneous attacks). Now, if you're taking 10-20mg of diazopam for yuks and drinking a bottle of wine, you're gonna have problems. And, if you are taking the prescribed dosage and have a bad alcohol reaction, you have to figure out which is more important to you in your life. I've had friends who chose to go with alcohol as a way of "self-medicating" - not really a god choice, but I understand it. It's a frustrating issue, and not well understood or treated by the medical community.