Saturday, June 9, 2012

Why psychiatry gets no respect

One of my options has been to switch antidepressants. But, as my psychiatrist says, there is no way of knowing if anything I switch to will be better or worse than the Effexor that I am on now.

There is no study, there are no guidelines, to tell me what to switch to. Should it be another SNRI like Cymbalta? Or maybe an SSRI like Lexapro- as I did well on Prozac in the past. Should I revisit some of the drugs I've been on in the past, but then stopped working? Or should I stick to things never tried? Should I try the TCA's again? Or maybe the MAOI's, which worked well in the past, the best antidepressants, if you can forget the washout period, the orthostatic hypertension, and the fact that they each stopped working rather dramatically eventually, and there aren't a lot of things you can augment them with to keep them going.

Almost everything I read tells me that differences in efficacy of antidepressants for depression are minimal. The main differences are in side effects. And it is all trial and error.

So now that things are bearable again, I think I'll stay on the Effexor as my main antidepressant. I want better odds than this.

It seems to me that psychiatry should have progressed to the point where, based upon the severity of your depression, the specific symptoms you are having, and the number of depressions you have had in the past, they could tell you that you are more likely to respond to an SSRI, SNRI, MAOI, TCA, etc.

But in psychiatry, depression is depression. If you can check off all of the boxes, you meet the diagnostic criteria, and that is it. So they are incapable of doing any kind of research to determine who would respond best to what drug.

If the drugs work at all, which is the other possibility. You have to admit. If an MAOI has the same efficacy as Prozac as Wellbutrin, maybe it is because they are not doing anything. Maybe if you threw in aspirin, it would work as well. Either your effect sizes are so small that you cannot make comparisons given the size of the studies, or the studies are poorly designed when it comes to finding differences. Or these drugs are working in ways we know nothing about, and not the ways we think.

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