On the Royal College of Psychiatrists website re. anti-depressants

[deliakate]

they admit they "don't know for certain" how anti-depressants work. This scares me, and imo puts paid to the idea that they are just like replacing, for eg., missing insulin for a diabetic person.

I think they have so many scary side effects, I have googled one or two (bad move), but its really put me off going near them. Does it worry anyone else?

Eeeek. Well I'd just about come to terms with taking them but I'm a bit worried again now! I hadn't realised they 'don't know for certain' how they work. I had read a brief explanation re. seratonin but I do not have a head for Science at all so I tend not to question these things too much as I know I wouldn't understand the answer!

From anecdotal experience, ADs have helped me to function over the last couple of years and possibly also prevented me from killing someone I live with

Actually it doesn't. Have taken ADs for years, yes to some side effects but bye bye horrible crippling depression. Worthy trade off.

Doesn't worry me at all.

Not only have I taken ADs myself, but I also work in mental health and have seen them used safely and effectively time and time again.

Every medication has side effects, and medication affect people differently. That doens't mean they don't do a good job, or are unsafe.

Ditto Topaz. All drugs have the risk of side effects for a small minority, but depression is horrible. We don"t know exactly how SSRIs work - but we do know they work! I have my life back.

i would only take them as a last resort

more and more medical professionals are now questioning their use especially over long periods of time and if they are addictive or not. they are given out so freely purely because there is not the money to support people in other ways. they are a quick fix and should you feel down again the dose can be upped, ask most people that are on them or have been this is what happened to them and before they know many are taking 60mg of prozac a day

i was on and off them for about 12 years and hope to never take them again, not that i do not want to at times as they made life easier i do not want to feel down at times but that is life it is full of ups and downs

For me they were great, I was on Fluoxetine for around 9 months during a very stressful time when DS2 was tiny, he was very poorly, in and out of hospital etc and I found they helped me cope better and not get stuck in a downward spiral. I came off them very gradually over 6 months ago and didn't have any problems.

However I had a great GP who I saw monthly just for a chat and he helped me rationalise a lot of my worries, he also did loads of research into DS2s condition so I was reassured by that - maybe that did more help than the drugs who knows??

Either way I'm glad I took them and would consider them again if I was in a similar mindset.

As I understand it we don't know exactly how general anaesthetics work either, but we know how to do them and that they are safe.

I remember my chemistry lecurer telling us that we don't really know how certain anaesthetics work, just that they do the job.

I'd still take my chances rather than have surgery without them!

I think it's the case for quite a few drugs that the mechanism of their action is not fully understood, but often the advantages outweigh any doubt about their use.

The mechanisms of a lot of drugs aren't quite understood. The effects of lot of drugs (Viagra for instance) were discovered when they were being used for something else. Because the chemistry of the body is so complex it's very hard to predict how it will respond to any drug, and sometimes the response is completely unexpected. So I wouldn't worry about the mechanism of ADs not being understood fully.

That said, I agree with the viewpoint that ADs are sometimes handed out as replacement for support and counselling. IMO people need to be monitored very very closely when they're on ADs and I think GPs should not be allowed to prescribe anything above 20mgs of any AD. If 20mg doesn't work then the person should be referred to a psychiatrist, not just pumped full of more and more drugs. This is what happened to my friend, who after a year was on well above the recommended maximum dose of a very powerful AD that was still having no effect. She was still depressed and engaged in some very risky behaviour. Luckily she was eventually given the help she needed, but not before she'd almost killed herself through doing something very silly.

I found ADs an absolute godsend when I was depressed - the definitely lifted the horrible fog for long enough so that other interventions such as exercise and counselling could work. Without them I'm not sure I would have made it.

When people originally started chewing willow bark for aspirin, or for the first antibiotics, people didn't 'know how they worked' either. They used empirical observation of cause and effect, and realised that these things had an effect- it's only maybe in the last 50 years that we know how they really work on a cellular or physiological level. Really, really support much higher level basic science education in the UK so people are more informed about this kind of thing. The brain is an incredibly complex organ and it's hardly surprising that the exact mechanisms of action of drugs are not fully understood yet- but the evidence is that they (and exercise, and some forms of therapy) do have an effect on people suffering some degrees of clinical depression, so there is a clear case for their use and continued prescription regardless of the exact mechanism of action.

Not understanding the exact mechanism of a drug's action and being concerned about potential side effects are two different issues. No drug is risk free, and neither is anything else you put in your body, or even walking out through the front door. Life is about making choices and risk assessments. Taking ADs doesn't preclude you doing other things, such as counselling or CBT, but generally your GP will prescribe them because they can help. You will only "go near" them if they are prescribed by your doctor after a consultation and asessment of your health both physical and mental - you aren't going to pick them up at a corner shop and you certainly won't be forced to take them. Just Googling a list of potential side effects for any drug is going to throw up lots of scarey things - the key is that they are usually rare, and generally are outweighed by the benefits of the drug.

I took them for depression following cancer and they helped me enormously - helped to stabilise things,(even kept me in full time work for a while) and though I also found having counselling very helpful too, taking the tablets in moderate doses for just under a year helped me through a very bad and dark place. With my GP's support, as things improved, my dose gradually reduced and then I was able to stop taking them. In the event of having depression again (which I hope I don't) I would definitely take them again, or another suitable medication prescribed by my GP.

We still don't know for sure what sleep is and what it's for.

There are a lot of known unknowns in science. Why is that scary?

We know roughly how they work, but not exactly with all of them. But then there is an awful lot we don't know about lots of things like that. Thats not a bad thing, we still have massive amounts of data about risks, side effects etc.

Science and medicine aren't really about being exact all the time.

YABU

If something has been found (in proper repeated double-blind trials) to work, then you would really not use it just because we're not sure of the exact mechanism?

I don't know how the phone works but I still use it.

Seriously, I have no clue as to how my actual voice can be heard so far away, it seems bizarre when I think about it. And I'm a highly educated person!

The difference there Marvin is that experts know how the phone works. In this case even the people who know the most about SSRIs aren't 100% sure how they work, they just know that they do.

(brain the size of a planet indeed!)

they say they do

I know, brain the size of a planet and I can't grasp phones. I can tell you how SSRI anti depressants affect the monamine transporters in the synaptic cleft, and I could draw the chemical symbol for serotonin ....

I could draw the chemical symbol for serotonin if you let me look at wikipedia

I wouldn't worry too much, I was reading about fevers on the nhs website the other day, apparently they font know exactly how paracetamol works either, there are theories but no certainty.

Bet Sherlock knows how they work.

Anyway, I don't think we need to know exact mechanism, just that it works is good enough for me. I'm on a crossover from one to the other at the moment because of side effects and neither the side effects nor this would put me off antidepressants, because the side effects of the illnesses they treat are far far worse for me.

I'm on them and I don't care how they work, I'm just glad that I feel well again

I know how they work for some, I take them, saved my life, I don't give a fuck how they work, for me they do.

For me, they are preferable to feeling suicidal and desperate. They have brought me back to an even keel, albeit at a low level, and enabled me to survive and get through the days.

When SSRI's came out first they were feted as wonder drugs. Their effectiveness were exaggerrated, the side-effects minimised (to be fair the side-effects seemed at first to be much milder than previous generation anti-depressants) and they were, for a time, massively over-prescribed.
It is only now that we are seeing that SSRI's are not a wonder drug. For a small amount of people they work. For those who feel the benefits, are happy to tolerate any side-effects and who are aware of any risks, then of course SSRIs are a good idea. So what if doctors aren't sure how they work?

But I totally agree with your second point. I was prescribed anti-depressants and never felt they suited me. The diabetes analogy was pulled out. I was just like a diabetic. I needed my tablets like a diabetes patient needs insulin. To stop taking them was to risk my life. Well, I stopped taking them and yes, I did not go into a hyposerotonine coma!

It's a rubbish analogy. Doctors- please stop lying to patients that "depression is just like any other illness".

They work for me. Without them I would have no life.