To wonder what people did before antidepressants?

[dottypotter]

Don't know how long anti depressants have been around for depression and anxiety etc, but what happened before they were invented does anyone wonder?
Did people go mad?
Put up with it, but never get better.
Did their depression etc just go away. Intrigued.

They were miserable and some of them died I expect.

It doesn't necessarily follow that increased suicide rates are due to ineffectiveness of SSRI's.

It could be because SSRI's are being overprescribed in lieu of more appropriate remedies due to cost or availability, it could be it's nothing to do with SSRI prescription rates whatsoever. It could be entirely down to socio-economic and environmental factors.

The vast majority of people being treated with SSRI are people who have are experiencing a mild depressive episode, or suffer recurring episodes. For those SSRI's are reasonably effective at relieving symptoms. People who have more profound depressions and psychiatric illnesses are usually referred on, treated by psychiatry, and SSRI's either supplemented by other drugs, other types of treatment, or the SSRI treatment is discontinued because it's no longer relevant.

[…]

the vast majority of instances of poor mental health are one-off mild depressive episodes, which SSRI's are reasonably effective in tackling, especially if they are combined with other forms of therapy and lifestyle/environmental changes. They're not intended to treat more profound conditions, and nobody is pretending they are a guaranteed cure.

That's not what I've read. While there's lots of fairly confusing evidence around the whole topic, what I've read generally seems to converge on a consensus that SSRIs are, if anything, more effective for moderate to severe depression than for mild depression.

It's not straightforward, some suffered a lot, using alcohol or other drugs, being locked up etc but others had better resilience. Even in my adult lifetime, consumption of ssri's has increased rapidly and we certainly were not more mentally ill back then, if anything we were less.

Social media, 2 parent full time working households as the norm, not living near extended family, not knowing your neighbours and the general expectation that we should be radiantly happy all the time otherwise something is wrong (spoiler warning, life isn't always good) all contribute to people seeking pills from their doctor who quite frankly give them on demand.

Plenty of people's lives have been revolutionised by medication, some have been saved but plenty or others simply didn't need them, you can't miss what you don't have.

@borntobequiet

IMO the modern iteration of 'care in the community' is one of the most abject failures in the history of our NHS. It was a well intentioned idea that has not been implemented in anything like the way it was envisioned to be, largely because of cost, but also because provision for mental health care and psychiatric treatment is still viewed as the absolute bottom of the list of priorities. I don't blame your father for retiring when he did as his fears were well founded.

@FurryDandelionSeekingMissile

Perhaps so, however, the point I was making is that they are more effective in treating mild depressive episodes, which still make up the overwhelming bulk of visits to doctors due to poor mental health, compared to any of their predecessor drugs, especially once you consider that they tend not to come with as many detrimental or side-effects, and those that do present tend to be less severe and debilitating.

When I referred to 'more profound conditions', I wasn't referencing more profound depression specifically, only that it's quite common for a patient to present with what appears to be a common depressive episode, receive treatment for it, the treatment to be ineffective, then only after further investigation it's discovered the depression is actually a comorbid symptom of something more serious that turns out to be a lifelong condition. That's where SSRI's are usually only part of the prescribed concoction, or withdrawn altogether.

I'm not sure why people are being such dicks to you OP. I think it's an interesting question and something I've thought about too. I take sertraline and have often wondered about how my life would be different without it - including if I lived in the past. From what I can tell from reading, lots of self-medication and addiction.

I often ponder lots of random things about the past, especially when I had babies and had lots of medical intervention that saved our lives. Even putting the heating on I sometimes think about how this is different. My house is from the 1850s and so are the houses around us, so I like to think about the past and the lives of people who lived there before.

I've just read The Way of All Flesh which is a fiction novel about someone who apprenticed to Dr Simpson - a famous obstetrician in Edinburgh. Set in the 18th century it discusses quite a lot about the discovery of early modern medicine and childbirth. And is a creepy murder mystery to boot 🙂

the point I was making is that they are more effective in treating mild depressive episodes, which still make up the overwhelming bulk of visits to doctors due to poor mental health, compared to any of their predecessor drugs, especially once you consider that they tend not to come with as many detrimental or side-effects, and those that do present tend to be less severe and debilitating.

Yeah, SSRIs are more tolerable and safer than some older antidepressants, and therefore more likely to be used for mild conditions than those older drugs were. The impression I got from your other post was that you were saying they're okay for mild depression but not great for severe depression, which isn't what the evidence suggests, so I posted what I did in case someone else got that impression too.

@FurryDandelionSeekingMissile

Fair enough. I can see why what I said might have been taken that way, and I'm glad that's been cleared up.

Interesting new research indicates that depression is not caused by a chemical imbalance in the brain, and antidepressants are often no more effective than placebo. www.psychologytoday.com/us/blog/insight-therapy/202207/depression-is-not-caused-chemical-imbalance-in-the-brain

😀

Put into asylums, along with unmarried mothers, Deaf people, Menopausal women.
My aunt had to sift through the records of a huge mental hospital in the 80s. These records went back over 100 years, she was horrified and heartbroken, unmarried mothers going in as teens and forgotten about , then they died in there, quite often the babies spent their lives in there.
My family has a history of mental illness, severe depression etc... and many had ect, long stays in psychiatric units, my great Nan was said to have died in her 50s, we later found out she lived til her 80s in an asylum, possibly post natal depression? She had 13 living children. Bloody awful.

My father's family battled depression and alcohol was probably their medicine of choice. My father's approach was to excessively work thus leaving no time to think about what saddened him. It worked until he could not work due to physical restraints at which point religion took over.

I remember reading something about western psychiatry doctors traveling to non western countries to see how depression is treated. One country that had recently experienced war (and the horrors associated with it) had an approach of 'prescribing' an acre of land to the individual suffering from what we would describe as PTSD. Don't know if that was a new or traditional treatment.

They were drugged differently!

Killed themselves, or were put into a "lunatic asylum" where quite often they remained for the rest of their lives.

They are crazy. Or they died quickly. They were the thousands of begger outcasts that roamed the cities.

Also lots of opiates and alcohol and early death.

Amphetamine can be effective for some kinds of depression. It helps with tiredness and fatigue, and helps you concentrate, and for some depressed people that can be really helpful in helping them find the energy, motivation and cognitive ability to do the things they need to do to help them get better.

Unfortunately it doesn't really lift your mood, so what you can end up doing is taking a horribly depressed person who wants to die but can't organise their thoughts to plan suicide or gather the energy to carry it through, and turning them into a horribly depressed person who wants to die and has the ability to plan it and carry it out.

We also need to remember that some people are still in psychiatric hospitals long term and conditions might not be positive:

www.bbc.com/news/uk-63045298

Yes there’s evidence that depression can resolve, many people don’t take medication for it now. There’s also a placebo effect which would have been the same in times gone by with the various remedies they had for it. Some like St. John’s wort are also clinically effective. There’s an awful lot of older people on antidepressants, life expectancy was shorter so less people
dealing with the problems that old age brings.
Asylums were more for people with psychosis rather than affective disorders which would be a minority of those with depression
im not sure life was so much less stressful, if you were poor you’d be working very long days at least 6 days a week, starting from being a child! Not to mention that women had very little rights

stimulants seem to be pretty effective for mood in those with ADHD. Presumably the affective disorder is triggered by the difficulties but not sure there’s any definitive answer

16.9 from 16.2 and 5.3 to 5.0 over 14 or 20yrs is not a statistically significant difference. In other words, the suicide rates are substantially the same. The historic chart posted upthread shows better how suicide rates have dropped dramatically over the past century and a half despite the “encouragement” of decriminalising suicide.

I guess with ADHD people sometimes feel bad mostly because of the things they struggle with due to their ADHD, so if you treat the ADHD they naturally begin to feel brighter in mood.

I say "they", I have an an ADHD diagnosis and take stimulant medication for it on the rare occasions I remember so I should probably say "we" 🤣

To be fair, a big chunk of that decrease was down to removing the piped-in supply of poison gas to everyone's houses.

Doctors used to be a lot freer with the valium and opiates. My uncle died addicted, though not of addiction. Before that a lot of poor people were addicted to alcohol, notably cheap gin. Look up "mothers ruin".