A paradox in anti-depressants?

cj.23

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cj.23
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I'm sure most readers of this forum are familiar with SSRI's which reduce depression symptoms by inhibiting the re-uptake of serotonin so more remains in the system. I have long been puzzled by what constitutes low serotonin levels, given the rather large spread of serotonin levels in human populations anyway.

Now I see SSRA's, which work by accelerating Serotonin re-uptake, have also been demonstrated in trials to be clinically effective. This leads to the obvious question -- why?

It sounds like a paradox - and i'm just curious as to how it works. Don't worry I am not going to make any medical decisions based on this thread, I just don't understand what is being reported? Anyone with medical knowledge willing to explain?

cj x
 
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I've not been following the literature that closely for a while now, but the hypothesis that SSRI's have their effect just from raising serotonin levels went out a long time ago (if it was ever "in"). I know there has been some work suggesting that anti-depressants work because they promote neurogenesis, but I'm not sure how far that has been confirmed.

ETA: Try this link for further info on this:

http://www.functionalneurogenesis.c...iew-1-the-neurogenesis-depression-hypothesis/
 
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C_Felix said:
No idea.
But I've always gotten a perverse kick out of the fact that anti-depressants make some people more suicidal.
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I don't believe there is any compelling evidence that they do. When people are severely depressed, they are often incapable of doing anything, and many depressed people have suicidal thoughts. When they get some relief from their symptoms, they may complete something that they have already thought about (suicide).

Here's one study:

Relationship Between Antidepressants and Suicide Attempts: An Analysis of the Veterans Health Administration Data Sets

CONCLUSIONS: These findings suggest that SSRI treatment has a protective effect in all adult age groups. They do not support the hypothesis that SSRI treatment places patients at greater risk of suicide.
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http://ajp.psychiatryonline.org/cgi/content/abstract/ajp;164/7/1044
 
Emet said:
I don't believe there is any compelling evidence that they do. When people are severely depressed, they are often incapable of doing anything, and many depressed people have suicidal thoughts. When they get some relief from their symptoms, they may complete something that they have already thought about (suicide).

Here's one study:



http://ajp.psychiatryonline.org/cgi/content/abstract/ajp;164/7/1044
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Do you know if they have the same findings with children/adolescents? It's been a while since I looked at this issue.
 
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If you pay attention to the commercials, it is stated that "no one knows how anti-depressants work, however" followed by various guesses depending on what company is selling the drug.

This is a good clue as to why there seems to be a paradox.
 
Professor Yaffle said:
Do you know if they have the same findings with children/adolescents? It's been a while since I looked at this issue.
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I don't have time to research it now, but I am aware of the issue in young'uns.

This will have to do for now:

Why do antidepressants have warnings about suicidal behavior in children?
The Food and Drug Administration (FDA) says that an extensive analysis of clinical trials showed that antidepressants may cause or worsen suicidal thinking or behavior in children and adolescents. The analysis showed that children taking antidepressants had about a 4 percent chance of developing suicidal thoughts or behavior, compared with only a 2 percent chance in children taking a sugar pill (placebo). None of the children in any of the studies actually took his or her own life. Still, the FDA considered the findings so disturbing that in October 2004 it issued a public health advisory and began requiring manufacturers to label antidepressants with strong warnings about the link to suicide in children.

However, not all mental health researchers believe these warnings are necessary. Some studies have reported opposite results — that suicide rates in children decrease when they take antidepressants.
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http://www.mayoclinic.com/health/antidepressants/MH00059

ETA: Here's a quick link to a newspaper article about the FDA and black box warnings (FWIW):

http://articles.latimes.com/2008/aug/18/health/he-closer18
 
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Professor Yaffle said:
I've not been following the literature that closely for a while now, but the hypothesis that SSRI's have their effect just from raising serotonin levels went out a long time ago (if it was ever "in"). I know there has been some work suggesting that anti-depressants work because they promote neurogenesis, but I'm not sure how far that has been confirmed.
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That explains why the benefit from SSRI's often take a couple of weeks to develop, but the side effects kick in immediately.
 
Careyp74 said:
If you pay attention to the commercials, it is stated that "no one knows how anti-depressants work, however" followed by various guesses depending on what company is selling the drug.

This is a good clue as to why there seems to be a paradox.
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Thanks Carey! I have never seen an advertisement for anti-depressants - not being a GP no drug rep would target me, as i live in the UK and medicines don't get advertised here: our doctors make choices as to what to prescribe. SO I had no idea of that!

cj x
 
C_Felix said:
No idea.
But I've always gotten a perverse kick out of the fact that anti-depressants make some people more suicidal.
Click to expand...

lets see a person is depressed but lacks energy or motivation to commit the act, you begin treatment and they start to have energy and motivations to commit the act.

I bet you shove old ladies in front of buses as well.
 
cj.23 said:
Thanks Carey! I have never seen an advertisement for anti-depressants - not being a GP no drug rep would target me, as i live in the UK and medicines don't get advertised here: our doctors make choices as to what to prescribe. SO I had no idea of that!

cj x
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I'll be honest--I don't watch TV ads all that carefully, if at all. I don't recall one that specifically stated what Carey has claimed, but I can't say for sure.

You can find a lot of the US TV ads for anti-depressants on YouTube.
 
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