<story><title>Comparative efficacy and acceptability of 21 antidepressant drugs</title><url>http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/fulltext</url></story><parent_chain><item><author>jdietrich</author><text>&amp;gt;If I hadn&amp;#x27;t gotten a prescription for Prozac I probably would have killed myself by now.&lt;p&gt;The majority of people with depression just get better of their own accord, for no obvious reason. The NNT for most antidepressants is ~7, meaning you need to give them to about seven patients for one patient to see a clinically-significant improvement.&lt;p&gt;The evidence suggests that there&amp;#x27;s no significant relationship between SSRI use and suicide risk except for young people, for whom SSRIs may actually &lt;i&gt;increase&lt;/i&gt; the risk of suicidal behaviours and self-harm.&lt;p&gt;&lt;a href=&quot;https:&amp;#x2F;&amp;#x2F;www.ncbi.nlm.nih.gov&amp;#x2F;pmc&amp;#x2F;articles&amp;#x2F;PMC3353604&amp;#x2F;&quot; rel=&quot;nofollow&quot;&gt;https:&amp;#x2F;&amp;#x2F;www.ncbi.nlm.nih.gov&amp;#x2F;pmc&amp;#x2F;articles&amp;#x2F;PMC3353604&amp;#x2F;&lt;/a&gt;&lt;p&gt;&amp;gt;If you can&amp;#x27;t make your own neurotransmitters, store bought are fine.&lt;p&gt;There is no evidence whatsoever that people with depression are &amp;quot;deficient&amp;quot; in neurotransmitters. We don&amp;#x27;t really understand the mechanism of action of any antidepressant. Plenty of drugs that have no effect whatsoever on serotonin are equally effective as SSRIs.&lt;p&gt;&lt;a href=&quot;https:&amp;#x2F;&amp;#x2F;www.ncbi.nlm.nih.gov&amp;#x2F;pmc&amp;#x2F;articles&amp;#x2F;PMC4471964&amp;#x2F;&quot; rel=&quot;nofollow&quot;&gt;https:&amp;#x2F;&amp;#x2F;www.ncbi.nlm.nih.gov&amp;#x2F;pmc&amp;#x2F;articles&amp;#x2F;PMC4471964&amp;#x2F;&lt;/a&gt;&lt;p&gt;Antidepressants can be useful for some patients, but they aren&amp;#x27;t miracle drugs - they aren&amp;#x27;t even particularly good drugs. If you&amp;#x27;re depressed then you should certainly consider pharmacological treatment, but you should regard it as only one tool among many. Talking therapy is equally effective and the combination of drugs and talk therapy is more effective than either alone. You might need to try several different drugs before you find one that works for you and has tolerable side-effects, especially if you have been depressed for some time or have comorbid conditions. If your depressive symptoms are relatively mild, you should probably look at lifestyle interventions like diet, exercise, sleep hygiene and self-help before considering drug treatment.&lt;p&gt;&lt;a href=&quot;https:&amp;#x2F;&amp;#x2F;www.nice.org.uk&amp;#x2F;guidance&amp;#x2F;cg90&quot; rel=&quot;nofollow&quot;&gt;https:&amp;#x2F;&amp;#x2F;www.nice.org.uk&amp;#x2F;guidance&amp;#x2F;cg90&lt;/a&gt;</text></item><item><author>amputect</author><text>I think that the United States is getting better about dealing with mental health, but we still have a long way to go. This is a little soap-boxy and anecdotal, and I apologize if it&amp;#x27;s inappropriate here.&lt;p&gt;If I hadn&amp;#x27;t gotten a prescription for Prozac I probably would have killed myself by now. And I definitely would have destroyed my marriage and most of my important friendships. That&amp;#x27;s not an over-dramatization, it&amp;#x27;s the honest truth just based on the direction my life was heading without them.&lt;p&gt;If you can&amp;#x27;t make your own neurotransmitters, store bought are fine. I&amp;#x27;m not writing this to say &amp;quot;RARGH YOU MUST USE THESE DRUGS&amp;quot;, but I absolutely am writing it to say &amp;quot;hey, this worked for me and got me out of a really dark and bad place&amp;quot;. If you are reading this from a dark and bad place, please know that you&amp;#x27;re not alone. You have a lot of options, and I promise that if you take that first step, things can get better.</text></item></parent_chain><comment><author>tachyoff</author><text>I agree with all of this, and I can’t help but ask: when did we start ignoring people’s environment and their circumstances? I have tens of thousands of dollars of student loan debt (my monthly payment is basically a mortgage payment) and I’m not particularly satisfied at work. Is it any wonder I find it impossible to get out of bed? Now, I try to be careful because, sure, perhaps the depression was already there and is just making my life complicated, but that seems less likely. I KNOW I’m not happy at work; I KNOW my debt burden makes me feel trapped and helpless. Look at Harlow’s monkeys. Turns out putting creatures in helpless, depressing environments makes them feel helpless and depressed. If seeing your friend get blown up by a roadside bomb can give you PTSD, couldn’t falling wages, no social safety net, stressful news media, crushing debt, and poor job mobility make you depressed?</text></comment>
<story><title>Comparative efficacy and acceptability of 21 antidepressant drugs</title><url>http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/fulltext</url></story><parent_chain><item><author>jdietrich</author><text>&amp;gt;If I hadn&amp;#x27;t gotten a prescription for Prozac I probably would have killed myself by now.&lt;p&gt;The majority of people with depression just get better of their own accord, for no obvious reason. The NNT for most antidepressants is ~7, meaning you need to give them to about seven patients for one patient to see a clinically-significant improvement.&lt;p&gt;The evidence suggests that there&amp;#x27;s no significant relationship between SSRI use and suicide risk except for young people, for whom SSRIs may actually &lt;i&gt;increase&lt;/i&gt; the risk of suicidal behaviours and self-harm.&lt;p&gt;&lt;a href=&quot;https:&amp;#x2F;&amp;#x2F;www.ncbi.nlm.nih.gov&amp;#x2F;pmc&amp;#x2F;articles&amp;#x2F;PMC3353604&amp;#x2F;&quot; rel=&quot;nofollow&quot;&gt;https:&amp;#x2F;&amp;#x2F;www.ncbi.nlm.nih.gov&amp;#x2F;pmc&amp;#x2F;articles&amp;#x2F;PMC3353604&amp;#x2F;&lt;/a&gt;&lt;p&gt;&amp;gt;If you can&amp;#x27;t make your own neurotransmitters, store bought are fine.&lt;p&gt;There is no evidence whatsoever that people with depression are &amp;quot;deficient&amp;quot; in neurotransmitters. We don&amp;#x27;t really understand the mechanism of action of any antidepressant. Plenty of drugs that have no effect whatsoever on serotonin are equally effective as SSRIs.&lt;p&gt;&lt;a href=&quot;https:&amp;#x2F;&amp;#x2F;www.ncbi.nlm.nih.gov&amp;#x2F;pmc&amp;#x2F;articles&amp;#x2F;PMC4471964&amp;#x2F;&quot; rel=&quot;nofollow&quot;&gt;https:&amp;#x2F;&amp;#x2F;www.ncbi.nlm.nih.gov&amp;#x2F;pmc&amp;#x2F;articles&amp;#x2F;PMC4471964&amp;#x2F;&lt;/a&gt;&lt;p&gt;Antidepressants can be useful for some patients, but they aren&amp;#x27;t miracle drugs - they aren&amp;#x27;t even particularly good drugs. If you&amp;#x27;re depressed then you should certainly consider pharmacological treatment, but you should regard it as only one tool among many. Talking therapy is equally effective and the combination of drugs and talk therapy is more effective than either alone. You might need to try several different drugs before you find one that works for you and has tolerable side-effects, especially if you have been depressed for some time or have comorbid conditions. If your depressive symptoms are relatively mild, you should probably look at lifestyle interventions like diet, exercise, sleep hygiene and self-help before considering drug treatment.&lt;p&gt;&lt;a href=&quot;https:&amp;#x2F;&amp;#x2F;www.nice.org.uk&amp;#x2F;guidance&amp;#x2F;cg90&quot; rel=&quot;nofollow&quot;&gt;https:&amp;#x2F;&amp;#x2F;www.nice.org.uk&amp;#x2F;guidance&amp;#x2F;cg90&lt;/a&gt;</text></item><item><author>amputect</author><text>I think that the United States is getting better about dealing with mental health, but we still have a long way to go. This is a little soap-boxy and anecdotal, and I apologize if it&amp;#x27;s inappropriate here.&lt;p&gt;If I hadn&amp;#x27;t gotten a prescription for Prozac I probably would have killed myself by now. And I definitely would have destroyed my marriage and most of my important friendships. That&amp;#x27;s not an over-dramatization, it&amp;#x27;s the honest truth just based on the direction my life was heading without them.&lt;p&gt;If you can&amp;#x27;t make your own neurotransmitters, store bought are fine. I&amp;#x27;m not writing this to say &amp;quot;RARGH YOU MUST USE THESE DRUGS&amp;quot;, but I absolutely am writing it to say &amp;quot;hey, this worked for me and got me out of a really dark and bad place&amp;quot;. If you are reading this from a dark and bad place, please know that you&amp;#x27;re not alone. You have a lot of options, and I promise that if you take that first step, things can get better.</text></item></parent_chain><comment><author>tyrex2017</author><text>NNT might be 7 for one drug and one try, but the therapist will try several drugs and doses.&lt;p&gt;I could imagine that NNT might significantly improve if you consider “use antidepressants” instead of “use 1 antidepressant 1 time”</text></comment>