SSRI's - The Evidence For And Against

[kers]

I think SSRIs are worth a try if someone is severely symptomatic enough with depression and anxiety. It's impossible to know if they will work for you without trying them.

I never would have been able to do the work of therapy without mine. Then, when I tried to go taper off it, my hyperarousal and depression skyrocketed. To me this does not indicate that the drug has been bad for me, just that I depend on its effects to feel more even-keeled. My psychiatrist has said that long-term trauma may change the brain chemistry such that I will take this drug long-term. I'm okay with that, because combined with the work I've done in therapy, I might eventually get a normal life.

 

[anthony]

I have always had the following view on medication, which is said time and time again here. Medication has its time and place. It is over prescribed due to the kickbacks endorsed to physicians... that is a fact. The more they prescribe the more money they get, and as doctors, it is a business which exists to make money, nothing more, nothing less. The doctor you find that is often poor, is the one often you will find the most level headed and honest. Just look in the driveway if they have a big expensive car, house and lifestyle, maybe not the best choice for your best interest. They are more concerned at making money than making patients better.

Medication during uncontrolled PTSD I could only say is a must. You should be medicated during that time, until the time in which you learn what you must do in order to heal trauma and manage PTSD to get back into life.

Once you finish trauma therapy you should begin tapering medications to lower levels. If on many, you should reduce to just one, etc. If on anti-depressants, you should be reducing them to nothing and replacing them with activity instead.

As you learn and expose yourself to life again, you taper medication out of your life. Once all gone you will find it hard for a couple of months, have no doubt what so ever, life will feel like shit and as though all your work has just been undone. Suddenly though you will find you begin getting control of yourself again, by applying all you have learnt without the use of medication.

You will only get better the more you learn. Now.... there are a small amount of people who will require medication the rest of their life.... and I doubt many of that small amount are here. You will find a lot of people with PTSD will go onto medication off and on during their life, dependant upon how their life is at any time. Family, friends and love one's still die, still get ill, etc.... no doubt medication may be needed for six months during such times, if not a year until you get control of yourself again. You may go for years without it, then something sends you spiralling out of control.

You may want to work, which will by itself require medication just to cope with daily life. Those who work will have symptoms regardless.... whilst you expose yourself to work with PTSD you will have symptoms. Live with it.... fact.

If you opt for a stay at home life, or a job that is nil stress, work by yourself, no deadlines, etc.... you may be able to do it without meds. Maybe!!! Staying at home, you should be able to do it easily.... as you can manage your exposure to daily stressors quite well, much better than someone who is working.

Medication has a purpose and use.... problem is that society and money has put it up for abuse.

 

[Cowgirl]

My DH had a disastrous experience on these things. He was "treated" with drugs only, and spiraled into the abyss. It got very, very bad - I won't go into detail. I'm not a fan of them.

I won't go so far as to say they don't help anyone, as a friend is on them for major depression, and she swears they help. Maybe it is the placebo effect, but I doubt her doctor could legally sell her sugar pills and tell her they were the latest wonder drug.

Cowgirl

 

[dlross]

I must admit I get a bit churned up over all this discussion of medications. Rather than repeat things I have posted elsewhere I am just going to point anyone interested towards the best book on depression I have ever read.

Against Depression by Peter Kramer

 

[Auburngirl]

I just want to add into the fray that not in all systems do doctors derive any financial benefit from prescribing. It's unfair to tar them all with the same brush. Not all health care systems work on a for profit basis.

Where I am the doctor gets a flat fee from the government per service (ie psychotherapy). And the drug I was prescribed (which is just for occasional use and is not an SSRI) is a generic that cost 5 dollars for 15 pills.

Right now I'm mainly be treated with psychotherapy. But I can see the usefulness of drugs in getting some people to the point where psychotherapy could help (ie if you are too anxious to handle psychotherapy you might need some medication to be able to get there and then start dealing with things).

 

[kers]

You will find a lot of people with PTSD will go onto medication off and on during their life, dependant upon how their life is at any time.

Many people find that after they have gone off a particular SSRI, when they go on it again, its effectiveness is different. However, some people also find that long-term SSRI treatment becomes less effective over time. It varies between people.

I think that unless one is a psychiatric doctor, it is impossible to say whether drug treatment is appropriate. Frankly Anthony, I know that you mean well, but you are advocating against medication from a layman's perspective. Only a PTSD sufferer's doctors can help them make medical decisions.

 

[anthony]

Frankly Anthony, I know that you mean well, but you are advocating against medication from a layman's perspective. Only a PTSD sufferer's doctors can help them make medical decisions.

Actually Kers, far from it actually. I am not pro-medication or pro-alternative medication. I state here over and over, I sit on the fence and look at all the facts to make a more diverse observation. I DO NOT give medication specific advice because it cannot be done online, it could only ever be done face to face, and it can never be done by theory, knowledge or experience. It can only be gauged by the sufferer themselves on a trial and error basis.

I think your reading something that doesn't exist though kers, as I am not either. What physicians tell you is not necessarily true. Just because a doctor has a degree, does that make them right? No. It is proven more and more now that physicians have moved from what we knew as conventional treatment to now a business model. Factors from society have pushed that. You often don't see a rich naturopath to the extent as a doctor. Why? Because one is more interested in the patients health, the other is more interested in the bottom line figure. Pick which one?

Neither by themselves are right. You get people who are all medication or all naturopath, not even willing to entertain a combination of both to provide a better result. Not wise IMO. Each person must try a myriad of treatments and combinations in order to find what best suits them. My point has always been this, nothing more, nothing less.

The majority of doctors are money based, not all, majority. You can find the right one. Just read the experience of so many here who listened and went looking.... they soon found for themselves they are not created equal when it comes to dealing with PTSD. You need trauma specialists, not just a physician or therapist who wants to shove pills down your throat. You want one who evaluates all factors and gives a wide range of treatment variations in order to best help the patient.

How many people here report how they go to their doctor and are kicked out the door in 10 minutes? The majority.... why? Because the majority are money based business models now, not physicians who are actively interested in helping their patients get better, but instead keep repeat customers coming back to continue spending money. Very few treat properly now. These are facts, not fiction.

 

[upstream]

There is concrete and continually mounting evidence that physical bonding, holding, mirroring, gazing, etc. (or lack thereof) will have a major impact on the infant's developing brain and immune/endocrine systems. I've recently studied two excellent books that you might want to look into: A General Theory of Love, by Lewis Thomas MD et. al, and The Trauma Spectrum: Hidden Wounds and Human Resiliency, by Robert Scaer.

The depression, PTSD, and other "mental" symptoms in my case have, in part, a definite physiological root. Later abuse that I experienced just seemed to cement the earlier patterns.

I can't see the body and the mind as entirely separate -- everything in us is connected with everything else. Our culture is still struggling to arise from centuries of mistaken beliefs about illness that is primarily of the mind. Demonic possession ... fallen moral character ... witchcraft ... laziness ... you name it, the label's been slapped on. Unfortunately, many people still choose to remain ignorant, and that's where the nasty judgments come in. I've been called every name in the book, from lazy to crazy, stupid, filthy, etc. ... by people who didn't know any better, and didn't want to know any better.

It's been pointed out in many ways that every thought and emotion has a biochemical equivalent (Candace Pert writes about this in her book, Molecules of Emotion). Likewise, every physical experience or symptom is marked on the brain and interpreted by the mind. Illness that people think of as only "mental" has its physical corelations.

Roo, I agree with almost all of this, but I believe where you and I differ is in ideas of permanence and plasticity. I have seen recent research showing that people are much more plastic and malleable that previously thought. Also, psychoanalyst and therapist Marie-France Hirigoyen has observed that many survivors of abuse, while having been altered from the experience, have the ability to evolve and grow. Her book is called "Stalking the Soul."

Another way to put it, we have the ability to work through many emotional issues through therapy, reflection, new experiences, and change of environment. We do not have similar abilities to work through cancer, that requires medical technology.

Thanks for the recommendations, I'll look into them.

 

[upstream]

I have to add here though; Upstream your outline of SSRI's only included anti-depressants, where as an SSRI covers several functional categories, not just depression. SSRI's are classified for anxiety only also.... which some of these do work.

Anthony, I have heard of Paxil being prescribed for social anxiety, but do not have much information other than that. Thanks for raising this point, I'll have to look into it.

 

[upstream]

I'm at the point where I truly believe that the SSRI's are causing my current major depressive episode. I have not had a depressive episode like this in 2 and a half years which just so happened to be the last time I was on an SSRI. :mad:

Rachel, again I'm biased here, but with medication I believe it is better to listen to your gut than your doctor.

I hope everything works out.

 

[Roo]

Roo, I agree with almost all of this, but I believe where you and I differ is in ideas of permanence and plasticity. I have seen recent research showing that people are much more plastic and malleable that previously thought. Also, psychoanalyst and therapist Marie-France Hirigoyen has observed that many survivors of abuse, while having been altered from the experience, have the ability to evolve and grow. Her book is called "Stalking the Soul."

Upstream...funny you should mention this, 'cause I've been starting to read about brain plasticity recently (if that's what you are referring to here). I will definitely look into Stalking the Soul.

I'm at a point now, after 27 years of more or less consciously working with my history, of trying to discern what can (still) be changed, and what I need to accept and live with as gently and mindfully as possible. I know I've come a long way...and I've come to understand that some wounds never heal completely. (I hope I'm mistaken about this...)

Another thought about SSRIs ... I'm in perimenopause and I can't help but wonder what strangeness might occur after being on Paxil for 11.5 years.:eek: If anyone has insight into this, please share and thanks...

 

[anthony]

Wow Roo.... that is a long time to be on a medication. Unless a medication specialist exists here, I would maybe seek one out in your community and see what they have to say. You can always find an expert in every area of medicine and mental health, you just have to look a little usually. I think someone who specialises in medication could give you a pretty good scope and idea of your question though. Would love to hear your feedback though if you do seek such specialist out about your specific request.