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Hello Anon, bbnurse, Daisy, et al:

I have two main thoughts here, and I hope sharing them will be helpful.

One, depression that includes "hyper" episodes, which sometimes get described as anxiety, could potentially indicate bipolar disease. Bipolar is a very different condition neurologically than unipolar depression, and conventional depression meds will either make bipolar worse, or simply have no effect. What seems to work in bipolar are mood stabilizers, which are very different from antidepressants.

The second issue is much more delicate: what is emerging from years of research into antidepressants, including newer (since the 1990s) SSRIs, but also tricyclics and other meds, is that they are not any more effective than placebo in the majority of cases. This means SSRI antidepressants are ONLY effective for Major Depression, which amounts to only a fraction of the prescriptions made (though perhaps people reading this post do in fact have Major Depression and not the mild to moderate variety.) That, and that no lab or researcher or scientist has ever been able to demonstrate that the theory behind these medications (the neurotransmitter theory of depression) is accurate, verifiable, valid, or worthwhile.

This comes as a shock to patients with depression as well as other conditions that have been treated with antidepressants, like PMDD and PMS, as well as to doctors, psychologists, and concerned individuals who know people with these conditions.

I realize how difficult it is to accept such a shocking conclusion. Here is some recent coverage of this emerging scientific paradigm shift:

http://j.mp/JYTX5C (New York Times)

http://j.mp/K39BuK (New York Review of Books, articles by former editor in chief of the New England Journal of Medicine)

http://j.mp/IBiJId (from the PMS Comfort Blog, my brief commentary on this subject as it may relate to PMDD and PMS)

One very important point made by Professor Irving Kirsch of Harvard in his book "The Emperor's New Drugs" - while antidepressants may have no advantages over placebo for treating depression, they do have one notable disadvantage: coming off them exacerbates depression, which can lead doctor and patient to conclude that the medicine was working or is necessary.

As you might expect, there is some pushback against this new understanding, but it comes mostly from drug companies; doctors and practitioners who believe the evidence they've seen but don't have the perspective available from the studies that examine tens of thousands of patients, rather than one at a time - and that include placebo and other treatments; and from patients who are shocked and dismayed to hear that the information their doctor has given them may not be correct.

The main takeaway here, in my opinion, is that if being on medication isn't working, or feels like a rollercoaster or merry-go-round, it's not your imagination or your fault. The brightest scientists in the world would say your experience is more normal than you might think. Another takeaway is that if you DO want to to get off psychotropic medication, you are justified in this desire, and your doctor should work with you. Also, if you want to get off medication, you absolutely MUST work WITH your doctor to get off it, since it's not easy, and getting off the medication can make things worse.

Finally, if your medication is working, and you're happy with it, you certainly can stay on it. Getting off of it might be more complicated, even though the long term effects of these medications don't appear rosy, and are underpublicized (of course!) by drug companies. On the other hand, there are things that appear to work as well as medication: placebo, which is a belief in and hope for getting better; exercise, which is excellent for your mood and brain; and counselling, which is more work and harder than taking one pill per day, but works better than medication, especially in the long run.

Whew! Long post. I'm interested in your thoughts and concerns, and would be happy to continue this discussion.

Dr. Daniel Heller
PMS Comfort

June 1, 2012 - 12:49pm


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