I was very young when my mom started Prozac but do remember how angry and sad she was before compared to after.
Years later there was a time when me and my sister noticed our mom was acting a bit strange -- more snappish and irritable than usual, and she even started dressing differently. Then at dinner she announced proudly that she had been off Prozac for a month. My sister and I looked at each other and at the same time went, "Ohhhh!" Mom was shocked that we'd noticed such a difference in her behavior and started taking the medication again.
I've been on the exact same dose as her for 15 years, and my 7-year-old son just started half that dose.
If I have a good day it's impossible to day whether that's due to Prozac. But since starting Prozac I have been much more likely to have good days than bad. So, since Prozac is cheap and I don't seem to suffer any side effects, I plan to keep taking it in perpetuity.
What I tell my kids is that getting depressed, feeling sad, feeling hopeless -- those are all normal feelings that everyone has from time to time. Pills can't or shouldn't keep you from feeling depressed if you have something to be depressed about. Pills are for people who feel depressed but don't have something to be depressed about -- they have food, shelter, friends, opportunities to contribute and be productive, nothing traumatic has happened, but they feel hopeless anyway -- and that's called Depression, which is different from "being depressed."
A later comment notes that it works well for some patients and not others. The argument is that drugs probably don't fix things very well unless the cause is mostly just bad brain chemistry. Some people have bad brain chemistry, others have "real" (usually more external - financial, relationships, actual life issues) problems they need to fix, and hiding from them by just taking a pill to help ignore them might not work so well.
(OK bad brain chemistry is also a real problem, but one that's fixable with a pill).
Also yes that's all a bit simplified.
There's a stigma against pills for a number of reasons, some good and some bad, the fact that often they don't work being one reason.
The study found the average effect was no different from placebo. It’s plausible, based on anecdotes like the one you’re responding to, that Prozac is harmful for some people, helpful for others, with the expected benefit close to zero. If so, it might be necessary to just try it and see if it’s obviously helping, keep taking if so, stop if not.
I wish I could have taken something as a kid. I knew when I was 5 that something was wrong. I felt different from other kids (as least as they said they felt) and that continued through my late 20s when I started taking SSRIs. It was the best decision I've made. Ever.
But back to being a kid and thinking and feeling differently: It negatively impacted me. And the abuse only made it worse. If only I was put on drugs and/or sent to talk therapy.
Under-nourishment/malnutrition, traumatic incidents/events, genetics, societal conditions, bullying and abuse, and so many things are also all brain altering. Why do we not consider them so and turn a blind eye to all that?
I'm very sorry to hear your story, and I'm really glad the medication has worked well for you and your family. It's early days, but it seems to be working well for ours too.
I also really admire the way you're dealing patiently with everyone in this thread arguing in bad faith, you have a lot more tolerance than I do! Hopefully it's not getting to you. Best wishes.
We had/have a lot of reservations about it too, and discussed it at length with our pediatrician over months of observation. We decided what was more horrifying was hearing a 7-year-old — who has supportive family and friends, good health, no traumatic events, no major life changes going on, never worries where food/shelter is coming from — say he feels like "he shouldn't be on Earth anymore" and suddenly react with extreme physical anxiety to almost everything. It was bad enough that he couldn't really implement any of the coping skills he learned in therapy. His therapist hoped that medication would bring him to a baseline where he was able to benefit more from therapy. My family's historical success with Prozac also made the decision more palatable since depression appears to be hereditary.
There has been a phenomenal positive shift in his behavior since he started medication. All that said, another commenter pointed out that the study specifically says that Prozac is no better than placebo for depression, which is similar to but distinct from anxiety, which is what my son is being treated for. My mom and I were both diagnosed with depression, but anxiety may be more accurate -- I'm not sure.
It's also horrifying to hear your 7-year old child talk about committing suicide when you have a deep family history of depression, anxiety, and suicide.
Why? If a kid has diabetes, would it be horrifying to treat it? Why would it be different for a neurochemistry issue that makes the same kid tired and sad all the time?
I've learned a lot through life, one thing I've learned is about detrimental long term physical and even social effects of antidepressants, and other medications like adderal. Both I used to take.
At this point in my life, if I realized my parents gave me an antidepressant prescription when I was SEVEN years old because I said something stupid WHEN I WAS SEVEN I'd be very disturbed and disappointed in them, I'd definitely give both of them a solid scolding.
Before you respond to this remember I'm talking about me. Not your kid or your friends kid or your cousins kid.
EDIT: Quick edit to add when I was a kid I was a total outcast, I was weird, anxious, and definitely often depressed. A lot of kids in my religious schooling systems were.
Medicine is advancing. We're increasingly able to understand and adjust dysfunctions that cause major, negative quality of life impacts. These dysfunctions have always existed, we're just getting better at finding ways to help people work through it.
You don't understand what having extreme anxiety at that age feels like.
As someone who lived through that, I refuse to let him. All of memories of school are just feeling anxious about everything, just tight and suffocated, always in a panic. I started living when I started taking anxiety pills at 39 years old, and I can see my 2 year old having the exact same anxiety ticks and fits I have.
I don't know at what age I'll medicate him, but I'll do it as soon as I notice he isn't coping and happy anymore.
Horrifying is forcing him to experience that because you can't comprehend us.
I had terrible anxiety as a child and what I experienced dramatically affected the core of who I am. It is engrained in me and I struggle with it daily, though after decades I have surpassed a good portion of it. If a small dose can help someone have a somewhat "normal" childhood, then its worth a try.
If you're horrified that we are in a world and society where a 7yo has been put in a position where antidepressants help them, yeah, that's understandable. If you're horrified that a kid is taking them, that the parents sought medical intervention for "just a kid", then, I'd say you're reacting to the concept of a kid on antidepressants than actually listening to the OP and their family's history and story.
Often, people react to the concept of a thing rather than the ground reality of life and its complexities of lived experience. Most people also extrapolate (in either direction) others' lived experiences based on their learnings, understandings, pasts and future ambitions. In this case especially, there's also added stigma around mental health, antidepressants and the locus of personal responsibility when it comes to mental health issues.
The _concept_ of a child on antidepressants suspends trust in parents, that's often assumed and unquestioned depending, depending on the child's age. Maybe close to 18yo? Supportive parents. 7yo? Horrible parents. I'd argue it also tends to suspend critical thinking and introduces an unshakeable bias, that a child of 7yo _never [ever]_ needs antidepressants. Why? What makes you say that? What's your evidence and reasoning?
If you feel so horrified by that, can you consider for a moment that the parents recognize the weight and gravity of this decision too? That they had to really think this through, pursue more thorough medical advice than usual, make a judgement call, and have to live through this decision throughout all their lives?
OP's response to multiple comments indicates that they did not make this decision lightly and without making sure that this was the better thing to do overall. I commend OP's openness and honesty in talking about it. It's certainly inspiring to see a parent care for their child's mental health, and not dismissing that to be "oh, the kid's just young and moody, they'll feel better tomorrow."
PS. We (as a society) are always learning more and newer things about mental health and treatments. It might look like we know a lot. Perhaps. But we also don't know so much!
I’m thoroughly impressed with how you handled the comments in this subthread. As someone who was on and off antidepressants for years, I can say confidently that for every one person spewing vitriol and judgement at you for your parenting decision, there was someone else solemnly nodding and sending love to you and your family. People just don’t fucking get it unless they get it. Best of luck to you.
Interestingly my son has an identical twin! I like to joke that one is the control and sleeps in the house and the other has to sleep in the storage shed out back, and when they're 18 we'll publish a paper comparing their emotional development. :)
I always thought DNA determined pretty much everything, and we raised them exactly the same, but they have distinct personalities and some different physical features, although of course they're much more similar than they are different. My other son shows some symptoms of anxiety but not as much, yet.
Sorry, I don't mean to second-guess your choices. There's clearly some very interesting issues here, and my experience is as someone who never felt they had any serious issues with mental health. But I do think that we have this culture where everyone is expected to be OK all the time. Do you worry at all that your son cues in to his parents relationship with the drug? I mean, say it was me, and I knew my parents took a pill so that they could "have a good day" but they didn't give me the have-a-good-day pill. I would think (perhaps subconsciously) that if I was having a bad day the drug could have made it into a good one. Having a bad day would be medical now, a reason to feel like you're sick or broken.
IMO, that's a common misconception. The fact that it seems this way can be attributed misunderstanding, bias in data, and perhaps a poor treatment choice. Sometimes, it's also the best healthcare can do for now.
Medical interventions for mental health issues aren't a forever-crutch. Plenty of people do taper off/change something about their prescriptions after a certain point, but we rarely ever hear those stories. What we do hear is plenty of people getting on meds/being on meds for a long time, which can bias us and make us think that most people who get on meds are on it for life.
I suppose the "good" news is that is just how life goes. Conceptually similar comparison to someone who is hungry and someone who isn't - the tendency towards snapishness is definitely there. Who someone is becomes unstable of long stretches of time (unless they are very boring), it results more from the present conditions that involve them than anything else.
The main issue with drugs is they are more likely to have unexpected or socially harmful side effects than most things.
I am surprised by how many people seemingly independently come up with a completely indescriptive "bad day" label - for the lack of a better one.
Good that things are working out for you.
Recently found that, on top of meds (that started wearing off - after taking them for a couple years now following a challenging life situation), going to social latin dance classes for a couple hours almost every day after work helps quite a bit.
> Pills are for people who feel depressed but don't have something to be depressed about -- they have food, shelter, friends, opportunities to contribute and be productive, nothing traumatic has happened, but they feel hopeless anyway
This warrants a whole different discussion, and I'll be down voted for it, but one that's never addressed: quality over quantity.
Pills are the individuals response to a society that feeds empty food, bland sterile shelter, fake friends, and meaningless jobs.
The natural human response to a lack of meaning is hopelessness, and this comes from our society. Pills helps individuals cope with continuing the meat grinder just a little while longer.
I had depression, and I cured it by finding meaning and beauty in the world. I get told "if you can cure it without pills, you never really had it" yeah cool, self fullfilling prophecy in that case innit. Can't cure it, because it doesn't exist without meds. It just comes out of "nowhere" and is here to stay.
I agree with your perspective but these things are on a spectrum. For very severe cases medication can be highly helpful and supportive, as they move to find their meaning and purpose. Each person’s situation is unique and I think blanket judgements are unhelpful.
> I cured it by finding meaning and beauty in the world.
That's incredibly fortunate and I'm very jealous of you. How would you recommend one goes about finding meaning and beauty? I'm fortunate to have had lots of unique experiences and traveled to lots of unique places and still haven't found the fulfillment that you seem to. That's basically what depression is: a debilitating feeling of lack of fulfillment, without any idea of what's missing.
I'm happiest when busy building and fixing things. It could be that if I was born 200 years ago into an agrarian society where day-to-day life was focused on building and fixing things to survive, then I would have felt very fulfilled and done quite well. What were gainful full-time jobs back then have been reduced to hobbies now, though: blacksmithing, cobbling, weaving, hunting, making furniture, etc. Hobbies don't fill the hole for me. Sure, a few artisans are still able to turn those into a living, but a large part of the job is marketing and the clients are largely the wealthy elite. I've enjoyed working in food service and construction but it's hard to support a family of 4 doing those. So my career has been in software engineering since that involves building and fixing and pays well, but it still doesn't fill the hole.
If this sounds whiny I'm painfully aware. What right do I have to complain about feeling unfulfilled when there are real problems in the world? And that's the very essence of major depression.
I recently started giving my 11 year old SAM-e, available over the counter and much faster acting than SSRIs for serotonin support. He's been much happier and more regulated since taking it. I'd encourage folk to read up on the literature around SAM-e and consider it as a lower risk alternative to try first, that may in fact work better.
Out of curiosity - do you know whether SAM-e can be taken safely with SSRIs? I went looking for this a bit back and didn’t find anything conclusive. I know there’s a handful of seratonergics to steer clear of, but I didn’t get a good answer about SAM-e.
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.
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.
I suspect the biggest, but not the only, problem with these supposedly weak SSRI/SNRI numbers we routinely see 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, dysthymic ADHDers, burned out ASDs, and God knows who 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 exactly 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, where episodes are measured in weeks or in months. 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, perhaps develop melancholic features or even suffer from a lifelong recurrence. It is in the latter groups where medication is the most effective.
The problem with suicidal depression is that if someone has created the thought pattern that death is best, then removing the symptoms of depression (lethargy, lack of energy, no willpower) now gives the person the ability to actually follow through with the act.
Medications almost always target symptoms and never address root causes.
This is a good thing to know, but should also be noted that the same thing can happen with simply naturally recovering from a depressive episode.
The phenomenon should not be considered a reason to not medicate (which I don’t think you are implying, but some may take that as the conclusion). Instead it’s definitely something important to explicitly make people aware of.
Depression or the feeling so much mental agony that the idea of escaping with death becomes comforting, is a signal that something is wrong.
Realizing this has been important with weathering my own occasional dealings with severe[0]depression, once I realize “something is wrong”, I can start the annoyingly slow process of trial and error making changes to correct things. This turns depression from “how reality is” into “this is just feedback on my body’s state”. It turns things getting worse into either a “this is either a transient state or the wrong solution”.
[0] Which I define as the point where any passive ideation (fantasies of dying) starts to enter the gradient of becoming involuntary. As opposed to regular negative thoughts which can (and should) be brushed away as easily as a fly landing on me. Curiously, once I noticed it also affected my ability to experience color. While I could technically see colors, it was like have a mental partial greyscale filter because there was no beauty in it, color was just a meaningless detail.
This is what my psychiatrist more or less warned me about when I went on medication; that a lot of people who are suicidal lack the energy and ability to plan their suicide, and medications can sometimes undo those particular symptoms and people manage to end themselves.
I'm not sure what kinds of studies have been done about it, but I've had a few therapists same similar ideas. If it's not a studied phenomenon, then it has folks that believe it exists.
But is the only true cure to the suffering. We’d have to undergo a massive reorganization of society (and upset a few hefty profit margins) to prioritize that, so we settle for the messy symptom management we have.
My understanding is that the optimal scenario is taking an SSRI in combination with therapy. The SSRI adds flexibility for the brain to respond to therapy and envisage new possibilities. If you don't include therapy, you've just established a new baseline to habituate to.
Yup. Depression medication can significantly help the emotional symptoms, but that takes longer to be effective.
I’m bipolar and a lot of the medication I take does not become fully effective for months. For me, my medication slowly became more effective over years as my brain no longer had to compensate for hardware problems.
I also had a close family member who committed suicide shortly after going on Prozac -- this also happened nearly 30 years ago. His young son later went on Prozac himself (several months after his fathers suicide) and immediately started demonstrating bizarre disinhibited anti-social behavior (e.g., damaging property, stealing from friends, etc). He was immediately yanked off Prozac when he started articulating his own thoughts of suicide. The bizarre anti-social behavior improved after discontinuing Prozac.
For some people, Prozac is a very dangerous drug. It is fully deserving of its FDA black label warning (which it didn't have 30 years ago).
Suicidal ideation is a risk for many CNS drugs, and not unique to Prozac as far as I know. But yes this is a major risk factor that needs to be taken in account before such kind of treatments.
Isn't that a possibility with a lot of drugs though? I think it depends on the rate and not a "does or does not" type of questions. Now if the drug doesn't help more than a placebo that's clearly a huge negative, but if it has a high rate of success vs placebo then they will make adjustments and watch out for the side-effect (of course) letting patients know it's a possibility and to report if it starts happening.
The efficacy of anti-depressants has been consistently over-inflated, so generations were poisoned with side-effects: suicidal ideation, homicidal tendencies, etc.
Results: Meta-analyses of FDA trials suggest that antidepressants are only marginally efficacious compared to placebos and document profound publication bias that inflates their apparent efficacy. These meta-analyses also document a second form of bias in which researchers fail to report the negative results for the pre-specified primary outcome measure submitted to the FDA, while highlighting in published studies positive results from a secondary or even a new measure as though it was their primary measure of interest. The STARD analysis found that the effectiveness of antidepressant therapies was probably even lower than the modest one reported by the study authors with an apparent progressively increasing dropout rate across each study phase.*
The disclosure section in the cited research article may indicate a financial interest in the authors being able to say that Prozac is not effective:
“ MAH and JM are co-applicants on the RELEASE and RELEASE + trials in Australia, funded by the Medical Research Future Fund (MRFF) and the National Health and Medical Research Council (NHMRC), evaluating hyperbolic tapering of antidepressants against care as usual. MAH reports being a co-founder of and consultant to Outro Health, a digital clinic which provides support for patients in the US to help stop no longer needed antidepressant treatment using gradual, hyperbolic tapering; and receives royalties for the Maudsley Deprescribing Guidelines. JM receives royalties for books about psychiatric drugs, and was a co-applicant on the REDUCE trial, funded by the National Institute of Health Research, evaluating digital support for patients stopping long-term antidepressant treatment. MP and RL have no conflicts of interest to declare.”
I would caution those in this thread who have never seen or treated patients in any psychiatric clinic or hospital let alone a pediatric one to be careful assuming that they have adequate experience to make sweeping judgements on the utility of antidepressants in children.
I can't bring myself to try an SSRI. I just cannot do it. I've got a prescription for an NDRI on my desk, and I still won't take it. I am not anti-psychiatry either. I take psychiatric medication for a different condition already. But something about anti-depressants just doesn't sit well with me.
As crazy as it may sound, I think a lot of my depression stems from living a life that is not true to myself and due to countless failed attempts to be someone I cannot never be. As far as I am concerned, depression is just a symptom of my situation and not some true disorder. For the sake of analogy, I would say it's like food poisoning. Yes, the GI issues are awful, but the body is responding appropriately.
> I've got a prescription for an NDRI on my desk, and I still won't take it. ... something about anti-depressants just doesn't sit well with me.
At first it sounded like your antipathy was with SSRIs specifically (which I largely share), but it seems like it's anti-depressants in general.
FWIW, I used to think similar to you, and roughly agree with the gist of your second paragraph, but I've come to think of antidepressants as useful in a specific way: people say "it's a crutch" as a negative thing (about a lot of things including antidepressants), but a crutch was very useful to me when recovering from a fracture, and helped me enormously with my progress; similarly, even if "depression is just a symptom of my situation", it can and does often lead to a cycle where the depression itself feeds into the situation and in turn sustains itself. An antidepressant that works for you is a good way to be able to see things more clearly, feel the motivation and insight that depression clouds out, and thus be able to break out of the cycle.
It doesn't have to be a "cure" that counters a disorder, it can be a tool that you use for its purpose and then throw away (and it does sound like you're well-motivated to do that).
there's a tool on your desk that might help you solve your problem; what does it matter if the problem is an "appropriate response of your body"? so is pain/anxiety/diarrhea
> stems from living a life that is not true to myself and due to countless failed attempts to be someone I cannot never be.
If this is their mindset, they might benefit from CBT more than medication.
I'm not against SSRI at all. But after taking them for a few months in my 20's, and experiencing how terrible the withdrawal symptoms are when stopping, I'd be very hesitant to ever start up on them again. I remember having to open up the lowest dose pill capsule and splitting the dose into very tiny increments to be able to wean off completely.
One needs to not work and be able to remain at home for about a week or so to see if the side-effects are manageable. One shouldn't simply continue on with operating machinery or working a job while titrating up a new psychiatric medication. Honestly, employers should offer medical time off for this.
SSRI can have annoyances (to stay polite) if you ever need a fix so much that you go that route, be sure to ask about them. Didn't help me really but I believe that sometimes, a bit of chemical (placebo or not) relief can help staying afloat enough to work your way back up quicker.
I understand your comment, my issues were due to life circumstances and not a low level neurological imbalance, and I too dismissed these treatments almost entirely, mostly because they felt like blanket solutions from medical professionals who didn't really listen to symptoms.
> medical professionals who didn't really listen to symptoms
Even if they did listen to me, what else can they do? They aren't going to apply to new jobs for me, find friends and hobbies for me, etc.. To the men with pills, every issue looks like a disorder.
> As crazy as it may sound, I think a lot of my depression stems from living a life that is not true to myself and due to countless failed attempts to be someone I cannot never be. As far as I am concerned, depression is just a symptom of my situation and not some true disorder.
It's true for some, but be wary of such a generalization.
It took many years of people telling me the same thing before I understood what they were saying: "Having an objectively crappy life is normal. Being depressed about it isn't."
(Almost) everyone will have problems - temporary or permanent. And while they may feel down about it for a while, or occasionally, most of them more or less recover their mental health and are not chronically depressed.
Because the majority of people have problems, it becomes easy for a depressed person to think "Ah, this is just due to problem X" or even "This is just because I want a life different from mine". Most people with problems also want a different life than what they have. But they're not depressed.
My mistake. I should have worded what I wrote differently. I meant to say "not some true disorder for me."
> Having an objectively crappy life is normal. Being depressed about it isn't.
Not sure I can agree on this though. Rates of depression are quite high in institutions like prisons, for example. Especially in solitary confinement. Of course, I am not in prison, but I do believe the environment plays a larger role in depression than many are willing to admit.
This is not my first rodeo with depression. I'm in my early 30s, and this is probably my 5th or 6th time. I won't go into the details of those periods, but I almost didn't make it through a few of them.
> Ah, this is just due to problem X
Why is this outside the realm of possibility though? I believe depression is just a catch-all term for negative states that are too abstract to treat. If one is in a bad environment or unsatisfied in life, then a doctor cannot really do much to treat that. However, pills can be given to make people numb enough to their circumstances that they no longer care. Though, perhaps that lack of care is enough that people can actually benefit?
I mean, with SSRIs, the lows of life are diminished as are the highs of life, one might gain significant weight, and have a host of other issues like low libido, erectile dysfunction, anorgimasa, etc., but at least they aren't depressed...
If anything, I think of antidepressants like opioids. Opioids do not treat pain -- the pain is still there -- one just can't feel it.
> "Having an objectively crappy life is normal. Being depressed about it isn't."
Sounds like a philosophy more than a science. What does "normal" even mean in this context? Are we talking about something measurable? For instance, if the number of people who were depressed about those circumstances doubled (or quadrupled) would it then be normal, and there would be no reason to treat it (because it's normal)?
If you have an objectively crappy life, but not just ignore it and instead are incapable of even noticing, that sounds a little like dysfunction to me. It's not some superpower, it's a micro-lobotomy.
I'm with you on this. People who pathologize themselves or others - assuming they're malfunctioning rather than acknowledging they might simply be living a life that doesn't fit - have a very limited way of looking at things.
Depression is almost never caused by actual life circumstance - just by your response and usually a delayed response.
Also you should try your SSRI prescription. They really aren't very strong drugs. You might get mild relief or if you're like me and the majority of people you will see no effect whatsoever. It's worth a try anyway. You won't get "high" or "dull" or any of that nonsense. At best it will lift your mood a bit. But more often than not, just won't do anything.
Well, all the n number of times I have been depressed in the past have been resolved by a change in life circumstances, so perhaps I am just an outlier?
> SSRI prescription
I'm supposed to take an NDRI (Bupropion) and not an SSRI, which is kind of like Ritalin or cocaine. The problem is that I already take amphetamines every single day, so I am not sure why this is really the one my doctors settled on.
In fact, they told me that if my blood pressure increases anymore that I am to stop the medication immediately and then contact them. So, that's not really inspiring a lot of motivation in me.
> Also you should try your SSRI prescription. They really aren't very strong drugs. You might get mild relief or if you're like me and the majority of people you will see no effect whatsoever. It's worth a try anyway.
As someone who has been seriously depressed from an early age, I can tell you that it looks exactly like the DSM/ICD criteria - a lack of energy, loss of appetite, loss of interest in all activities, insomnia, feelings of worthlessness, suicidal thoughts and pervasive sadness and hopelessness.
Some people would rather believe that pediatric depression isn't real, rather than confront the reality of a loved and cared-for child who is constantly tearful, severely underweight, sleeps for three or four hours a night, spends most of their time staring into space and frequently talks about wanting to die.
Depression is an utterly dreadful illness and should not be confused with normal sadness or unhappiness.
Probably something like Boy Interrupted[0]. Sad story and something I can sympathize with having some of the same feelings very early on despite having a rather normal upbringing and siblings not showing signs of it.
Absolutely. These random namedrops of drugs are irritating. People respond to different psychiatric medications in wilddly different ways. And actually, the majority do not respond at all. Throwing a random name of some random medication helps absolutely nobody. It will just make some desperate people seek "this one drug" that they heard about on the internet.
Nocebo can too. Apropos the featured article, I wonder if we should worry about that when we report in the popular media that antidepressants trigger suicides.
When I was a teen I was put on Prozac because I threatened to commit suicide.
The drug absolutely destroyed me. Within a few days of taking it, I was in a bizarre state of delirium where I would sleep something like 18 hours a day. When I wasn't asleep I would gnash my teeth at my parents. At school I would lash out at my classmates and randomly punch the walls of my classroom. I was taken off the drug after about five days but I didn't fully recover.
To this day, my emotions are severely blunted. I still have complete anhedonia and avolition. I can go on a roller coaster and feel not a shred of an adrenaline rush. Nothing. I struggle maintaining relationships with people because I have no innate "desire" to do so.
The drug is absolutely evil and should never be given to minors.
I don’t want to discount your experience, but attributing a lifetime of symptoms to 5 doses of SSRIs (when you were already exhibiting an unstable mental state) seems extreme.
We know SSRI's really do cause permanent sexual dysfunctional in a small minority of people, small enough that this side effect doesn't come up in traditional FDA tests.
If a side effect is extremely rare it would be impossible or at least impractical to prove in a population.
Grandparent could be right or wrong about how the drug affected them, maybe their brain suffered from other issues and the timing of the medications was purelycoincidental, but if they are correct, your dismissive response is exactly what we'd expect given when they are saying sounds unusual/ improbable.
I really hope you do or you will talk to someone about yourself again. You deserve it. For example to a counselor/therapist who doesn't even prescribe medication, if you are not interested in that. Off the top of my head these symptoms could match at least a few diagnoses, most of which are treatable, but it's by far not enough information in this post.
How long were you on Prozac? The way you describe your experience it makes it sound like you were affected long term. Are you still on it or any other SSRI? Hope you eventually rediscover/redevelop your emotional functionality.
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Years later there was a time when me and my sister noticed our mom was acting a bit strange -- more snappish and irritable than usual, and she even started dressing differently. Then at dinner she announced proudly that she had been off Prozac for a month. My sister and I looked at each other and at the same time went, "Ohhhh!" Mom was shocked that we'd noticed such a difference in her behavior and started taking the medication again.
I've been on the exact same dose as her for 15 years, and my 7-year-old son just started half that dose.
If I have a good day it's impossible to day whether that's due to Prozac. But since starting Prozac I have been much more likely to have good days than bad. So, since Prozac is cheap and I don't seem to suffer any side effects, I plan to keep taking it in perpetuity.
What I tell my kids is that getting depressed, feeling sad, feeling hopeless -- those are all normal feelings that everyone has from time to time. Pills can't or shouldn't keep you from feeling depressed if you have something to be depressed about. Pills are for people who feel depressed but don't have something to be depressed about -- they have food, shelter, friends, opportunities to contribute and be productive, nothing traumatic has happened, but they feel hopeless anyway -- and that's called Depression, which is different from "being depressed."
(OK bad brain chemistry is also a real problem, but one that's fixable with a pill).
Also yes that's all a bit simplified.
There's a stigma against pills for a number of reasons, some good and some bad, the fact that often they don't work being one reason.
But back to being a kid and thinking and feeling differently: It negatively impacted me. And the abuse only made it worse. If only I was put on drugs and/or sent to talk therapy.
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I also really admire the way you're dealing patiently with everyone in this thread arguing in bad faith, you have a lot more tolerance than I do! Hopefully it's not getting to you. Best wishes.
This is horrifying.
There has been a phenomenal positive shift in his behavior since he started medication. All that said, another commenter pointed out that the study specifically says that Prozac is no better than placebo for depression, which is similar to but distinct from anxiety, which is what my son is being treated for. My mom and I were both diagnosed with depression, but anxiety may be more accurate -- I'm not sure.
Have some empathy.
I agree with this.
I've learned a lot through life, one thing I've learned is about detrimental long term physical and even social effects of antidepressants, and other medications like adderal. Both I used to take.
At this point in my life, if I realized my parents gave me an antidepressant prescription when I was SEVEN years old because I said something stupid WHEN I WAS SEVEN I'd be very disturbed and disappointed in them, I'd definitely give both of them a solid scolding.
Before you respond to this remember I'm talking about me. Not your kid or your friends kid or your cousins kid.
EDIT: Quick edit to add when I was a kid I was a total outcast, I was weird, anxious, and definitely often depressed. A lot of kids in my religious schooling systems were.
Medicine is advancing. We're increasingly able to understand and adjust dysfunctions that cause major, negative quality of life impacts. These dysfunctions have always existed, we're just getting better at finding ways to help people work through it.
As someone who lived through that, I refuse to let him. All of memories of school are just feeling anxious about everything, just tight and suffocated, always in a panic. I started living when I started taking anxiety pills at 39 years old, and I can see my 2 year old having the exact same anxiety ticks and fits I have.
I don't know at what age I'll medicate him, but I'll do it as soon as I notice he isn't coping and happy anymore.
Horrifying is forcing him to experience that because you can't comprehend us.
Often, people react to the concept of a thing rather than the ground reality of life and its complexities of lived experience. Most people also extrapolate (in either direction) others' lived experiences based on their learnings, understandings, pasts and future ambitions. In this case especially, there's also added stigma around mental health, antidepressants and the locus of personal responsibility when it comes to mental health issues.
The _concept_ of a child on antidepressants suspends trust in parents, that's often assumed and unquestioned depending, depending on the child's age. Maybe close to 18yo? Supportive parents. 7yo? Horrible parents. I'd argue it also tends to suspend critical thinking and introduces an unshakeable bias, that a child of 7yo _never [ever]_ needs antidepressants. Why? What makes you say that? What's your evidence and reasoning?
If you feel so horrified by that, can you consider for a moment that the parents recognize the weight and gravity of this decision too? That they had to really think this through, pursue more thorough medical advice than usual, make a judgement call, and have to live through this decision throughout all their lives?
OP's response to multiple comments indicates that they did not make this decision lightly and without making sure that this was the better thing to do overall. I commend OP's openness and honesty in talking about it. It's certainly inspiring to see a parent care for their child's mental health, and not dismissing that to be "oh, the kid's just young and moody, they'll feel better tomorrow."
PS. We (as a society) are always learning more and newer things about mental health and treatments. It might look like we know a lot. Perhaps. But we also don't know so much!
I suppose the next step would be to upgrade from single-blind to double-blind, so that your mom won't know which month is the placebo month...
I always thought DNA determined pretty much everything, and we raised them exactly the same, but they have distinct personalities and some different physical features, although of course they're much more similar than they are different. My other son shows some symptoms of anxiety but not as much, yet.
Medical interventions for mental health issues aren't a forever-crutch. Plenty of people do taper off/change something about their prescriptions after a certain point, but we rarely ever hear those stories. What we do hear is plenty of people getting on meds/being on meds for a long time, which can bias us and make us think that most people who get on meds are on it for life.
The main issue with drugs is they are more likely to have unexpected or socially harmful side effects than most things.
Good that things are working out for you.
Recently found that, on top of meds (that started wearing off - after taking them for a couple years now following a challenging life situation), going to social latin dance classes for a couple hours almost every day after work helps quite a bit.
This warrants a whole different discussion, and I'll be down voted for it, but one that's never addressed: quality over quantity.
Pills are the individuals response to a society that feeds empty food, bland sterile shelter, fake friends, and meaningless jobs.
The natural human response to a lack of meaning is hopelessness, and this comes from our society. Pills helps individuals cope with continuing the meat grinder just a little while longer.
I had depression, and I cured it by finding meaning and beauty in the world. I get told "if you can cure it without pills, you never really had it" yeah cool, self fullfilling prophecy in that case innit. Can't cure it, because it doesn't exist without meds. It just comes out of "nowhere" and is here to stay.
That's incredibly fortunate and I'm very jealous of you. How would you recommend one goes about finding meaning and beauty? I'm fortunate to have had lots of unique experiences and traveled to lots of unique places and still haven't found the fulfillment that you seem to. That's basically what depression is: a debilitating feeling of lack of fulfillment, without any idea of what's missing.
I'm happiest when busy building and fixing things. It could be that if I was born 200 years ago into an agrarian society where day-to-day life was focused on building and fixing things to survive, then I would have felt very fulfilled and done quite well. What were gainful full-time jobs back then have been reduced to hobbies now, though: blacksmithing, cobbling, weaving, hunting, making furniture, etc. Hobbies don't fill the hole for me. Sure, a few artisans are still able to turn those into a living, but a large part of the job is marketing and the clients are largely the wealthy elite. I've enjoyed working in food service and construction but it's hard to support a family of 4 doing those. So my career has been in software engineering since that involves building and fixing and pays well, but it still doesn't fill the hole.
If this sounds whiny I'm painfully aware. What right do I have to complain about feeling unfulfilled when there are real problems in the world? And that's the very essence of major depression.
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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.
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
Also, since we're here: the secret knowledge about depression (and affective disorders in general) is that it is an episodic illness, where episodes are measured in weeks or in months. 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, perhaps develop melancholic features or even suffer from a lifelong recurrence. It is in the latter groups where medication is the most effective.
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> They can also increase suicidal ideation.
A very close family member committed suicide, after Prozac dosage adjustments made his brain chemistry go haywire.
This happened 30 years ago, and it has been known to us that Prozac can cause this, since then.
The Guardians headline is way, way understating the real situation here.
Medications almost always target symptoms and never address root causes.
The phenomenon should not be considered a reason to not medicate (which I don’t think you are implying, but some may take that as the conclusion). Instead it’s definitely something important to explicitly make people aware of.
Depression or the feeling so much mental agony that the idea of escaping with death becomes comforting, is a signal that something is wrong.
Realizing this has been important with weathering my own occasional dealings with severe[0]depression, once I realize “something is wrong”, I can start the annoyingly slow process of trial and error making changes to correct things. This turns depression from “how reality is” into “this is just feedback on my body’s state”. It turns things getting worse into either a “this is either a transient state or the wrong solution”.
[0] Which I define as the point where any passive ideation (fantasies of dying) starts to enter the gradient of becoming involuntary. As opposed to regular negative thoughts which can (and should) be brushed away as easily as a fly landing on me. Curiously, once I noticed it also affected my ability to experience color. While I could technically see colors, it was like have a mental partial greyscale filter because there was no beauty in it, color was just a meaningless detail.
I'm not sure what kinds of studies have been done about it, but I've had a few therapists same similar ideas. If it's not a studied phenomenon, then it has folks that believe it exists.
But is the only true cure to the suffering. We’d have to undergo a massive reorganization of society (and upset a few hefty profit margins) to prioritize that, so we settle for the messy symptom management we have.
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I’m bipolar and a lot of the medication I take does not become fully effective for months. For me, my medication slowly became more effective over years as my brain no longer had to compensate for hardware problems.
For some people, Prozac is a very dangerous drug. It is fully deserving of its FDA black label warning (which it didn't have 30 years ago).
https://pubmed.ncbi.nlm.nih.gov/20616621/
Results: Meta-analyses of FDA trials suggest that antidepressants are only marginally efficacious compared to placebos and document profound publication bias that inflates their apparent efficacy. These meta-analyses also document a second form of bias in which researchers fail to report the negative results for the pre-specified primary outcome measure submitted to the FDA, while highlighting in published studies positive results from a secondary or even a new measure as though it was their primary measure of interest. The STARD analysis found that the effectiveness of antidepressant therapies was probably even lower than the modest one reported by the study authors with an apparent progressively increasing dropout rate across each study phase.*
“ MAH and JM are co-applicants on the RELEASE and RELEASE + trials in Australia, funded by the Medical Research Future Fund (MRFF) and the National Health and Medical Research Council (NHMRC), evaluating hyperbolic tapering of antidepressants against care as usual. MAH reports being a co-founder of and consultant to Outro Health, a digital clinic which provides support for patients in the US to help stop no longer needed antidepressant treatment using gradual, hyperbolic tapering; and receives royalties for the Maudsley Deprescribing Guidelines. JM receives royalties for books about psychiatric drugs, and was a co-applicant on the REDUCE trial, funded by the National Institute of Health Research, evaluating digital support for patients stopping long-term antidepressant treatment. MP and RL have no conflicts of interest to declare.”
I would caution those in this thread who have never seen or treated patients in any psychiatric clinic or hospital let alone a pediatric one to be careful assuming that they have adequate experience to make sweeping judgements on the utility of antidepressants in children.
As crazy as it may sound, I think a lot of my depression stems from living a life that is not true to myself and due to countless failed attempts to be someone I cannot never be. As far as I am concerned, depression is just a symptom of my situation and not some true disorder. For the sake of analogy, I would say it's like food poisoning. Yes, the GI issues are awful, but the body is responding appropriately.
At first it sounded like your antipathy was with SSRIs specifically (which I largely share), but it seems like it's anti-depressants in general.
FWIW, I used to think similar to you, and roughly agree with the gist of your second paragraph, but I've come to think of antidepressants as useful in a specific way: people say "it's a crutch" as a negative thing (about a lot of things including antidepressants), but a crutch was very useful to me when recovering from a fracture, and helped me enormously with my progress; similarly, even if "depression is just a symptom of my situation", it can and does often lead to a cycle where the depression itself feeds into the situation and in turn sustains itself. An antidepressant that works for you is a good way to be able to see things more clearly, feel the motivation and insight that depression clouds out, and thus be able to break out of the cycle.
It doesn't have to be a "cure" that counters a disorder, it can be a tool that you use for its purpose and then throw away (and it does sound like you're well-motivated to do that).
there's a tool on your desk that might help you solve your problem; what does it matter if the problem is an "appropriate response of your body"? so is pain/anxiety/diarrhea
If this is their mindset, they might benefit from CBT more than medication.
I'm not against SSRI at all. But after taking them for a few months in my 20's, and experiencing how terrible the withdrawal symptoms are when stopping, I'd be very hesitant to ever start up on them again. I remember having to open up the lowest dose pill capsule and splitting the dose into very tiny increments to be able to wean off completely.
I understand your comment, my issues were due to life circumstances and not a low level neurological imbalance, and I too dismissed these treatments almost entirely, mostly because they felt like blanket solutions from medical professionals who didn't really listen to symptoms.
Even if they did listen to me, what else can they do? They aren't going to apply to new jobs for me, find friends and hobbies for me, etc.. To the men with pills, every issue looks like a disorder.
It's true for some, but be wary of such a generalization.
It took many years of people telling me the same thing before I understood what they were saying: "Having an objectively crappy life is normal. Being depressed about it isn't."
(Almost) everyone will have problems - temporary or permanent. And while they may feel down about it for a while, or occasionally, most of them more or less recover their mental health and are not chronically depressed.
Because the majority of people have problems, it becomes easy for a depressed person to think "Ah, this is just due to problem X" or even "This is just because I want a life different from mine". Most people with problems also want a different life than what they have. But they're not depressed.
My mistake. I should have worded what I wrote differently. I meant to say "not some true disorder for me."
> Having an objectively crappy life is normal. Being depressed about it isn't.
Not sure I can agree on this though. Rates of depression are quite high in institutions like prisons, for example. Especially in solitary confinement. Of course, I am not in prison, but I do believe the environment plays a larger role in depression than many are willing to admit.
This is not my first rodeo with depression. I'm in my early 30s, and this is probably my 5th or 6th time. I won't go into the details of those periods, but I almost didn't make it through a few of them.
> Ah, this is just due to problem X
Why is this outside the realm of possibility though? I believe depression is just a catch-all term for negative states that are too abstract to treat. If one is in a bad environment or unsatisfied in life, then a doctor cannot really do much to treat that. However, pills can be given to make people numb enough to their circumstances that they no longer care. Though, perhaps that lack of care is enough that people can actually benefit?
I mean, with SSRIs, the lows of life are diminished as are the highs of life, one might gain significant weight, and have a host of other issues like low libido, erectile dysfunction, anorgimasa, etc., but at least they aren't depressed...
If anything, I think of antidepressants like opioids. Opioids do not treat pain -- the pain is still there -- one just can't feel it.
Sounds like a philosophy more than a science. What does "normal" even mean in this context? Are we talking about something measurable? For instance, if the number of people who were depressed about those circumstances doubled (or quadrupled) would it then be normal, and there would be no reason to treat it (because it's normal)?
If you have an objectively crappy life, but not just ignore it and instead are incapable of even noticing, that sounds a little like dysfunction to me. It's not some superpower, it's a micro-lobotomy.
There is a great Bojack Horseman episode in which Diane struggles with the idea of taking antidepressants for similar reasons.
If it’s depression, that’s closer to allergies, chronic inflammation or a broken bone healed wrong than vomiting after food poisoning.
Also you should try your SSRI prescription. They really aren't very strong drugs. You might get mild relief or if you're like me and the majority of people you will see no effect whatsoever. It's worth a try anyway. You won't get "high" or "dull" or any of that nonsense. At best it will lift your mood a bit. But more often than not, just won't do anything.
> SSRI prescription
I'm supposed to take an NDRI (Bupropion) and not an SSRI, which is kind of like Ritalin or cocaine. The problem is that I already take amphetamines every single day, so I am not sure why this is really the one my doctors settled on.
In fact, they told me that if my blood pressure increases anymore that I am to stop the medication immediately and then contact them. So, that's not really inspiring a lot of motivation in me.
Someone else in the thread's testifying with personal experience that there were significant withdrawl symptoms after only a few months: https://news.ycombinator.com/item?id=45999622#46008522
Are they lying, or are you misrepresenting something?
How is it different from the expected hormonal changes that an adolescent is expected to go through?
Some people would rather believe that pediatric depression isn't real, rather than confront the reality of a loved and cared-for child who is constantly tearful, severely underweight, sleeps for three or four hours a night, spends most of their time staring into space and frequently talks about wanting to die.
Depression is an utterly dreadful illness and should not be confused with normal sadness or unhappiness.
0: https://en.wikipedia.org/wiki/Boy_Interrupted
@dang it's hard to believe that I'm not being brigaded.
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> "Mark Horowitz, an associate professor of psychiatry at Adelaide University and a co-author of the study,"
Austria - cold, has mountains, but not Adelaide University
Australia - hot, has kangaroos, and Adelaide University
Is the Grauniad returning to form?
The drug absolutely destroyed me. Within a few days of taking it, I was in a bizarre state of delirium where I would sleep something like 18 hours a day. When I wasn't asleep I would gnash my teeth at my parents. At school I would lash out at my classmates and randomly punch the walls of my classroom. I was taken off the drug after about five days but I didn't fully recover.
To this day, my emotions are severely blunted. I still have complete anhedonia and avolition. I can go on a roller coaster and feel not a shred of an adrenaline rush. Nothing. I struggle maintaining relationships with people because I have no innate "desire" to do so.
The drug is absolutely evil and should never be given to minors.
We know SSRI's really do cause permanent sexual dysfunctional in a small minority of people, small enough that this side effect doesn't come up in traditional FDA tests.
If a side effect is extremely rare it would be impossible or at least impractical to prove in a population.
Grandparent could be right or wrong about how the drug affected them, maybe their brain suffered from other issues and the timing of the medications was purelycoincidental, but if they are correct, your dismissive response is exactly what we'd expect given when they are saying sounds unusual/ improbable.
I haven't taken any antidepressants since.