| ▲ | Zak 6 hours ago | |
A post on HN a couple years ago discussed research showing antidepressants only work for about 15% of patients: https://news.ycombinator.com/item?id=37671529 The thing is, they work very well for that 15%. I suspect the eventual conclusion will be that depression is a syndrome with multiple causes rather than a single condition, and SSRIs treat one of the causes. Edit: Mark Horowitz is one of the authors of both studies. | ||
| ▲ | H8crilA 2 minutes ago | parent | next [-] | |
I suspect the biggest, but not the only problem with these supposedly weak SSRI/SNRI numbers in clinical trials has to do with the definition of depression, with the diagnosis itself. For example it has some of the worst inter-rater reliability across the entire DSM (meaning that two doctors are least likely to both reach the same diagnosis in the same patient independently). So if you start from a poorly defined set, which likely encompasses some genuine affective disorders, people going through difficult times, undiagnosed personality disorders, burned out ASD, and God knows what else - yeah, you'll get poor performance data. Every psychiatrist knows intuitively that SSRIs/SNRIs do work, even if you have to trial a few. Also, without arguing about the number, that 15% is not the same 15% for each drug. Also, since we're here: the secret knowledge about depression (and affective disorders in general) is that it is an episodic illness. Most people experience just one episode which will end whether or not any medical intervention is undertaken, although the intervention can greatly shorten the course and avoid a potential suicide. But some will not stop at one episode, and can go on to have multiple episodes, or even a lifelong recurrence. It is in the latter group where medication is the most effective. | ||
| ▲ | CGMthrowaway 5 hours ago | parent | prev [-] | |
The NNT[1] of Prozac, and SSRIs in general, has been previously estimated around 6. Meaning that treatment is more helpful than a sugar pill in only 1 out of 6 cases (a dirty secret). Meanwhile the NNH[2] is as low as 21, that is 1 in 21 cases will stop due to negative side effects. Source: https://www.aafp.org/pubs/afp/issues/2008/0315/p785.html [1]Number Need to Treat, that is, number of patients you need to treat to prevent one additional bad outcome [2]Number Needed to Harm, that is, number of patients you need to treat to generate side effects so bad that someone halts treatment | ||