I suffer from severe crippling OCD and anxiety. Years of therapy and psychoanalysis have failed to find any cause, and, if anything, made it worse. The best explanation has been it's probably because I'm autistic, and these things tend to happen to autistics.

Luckily, sertraline was an almost instant cure.

I can come off it for periods, but it tends to reoccur after a while. So, it does mean I have to take a drug indefinitely, but is that really a problem? It turns my life into one worth living.

The reason we can't take sleeping pills daily is because they stop working in fairly short order. But if, like antidepressants (typically), they didn't lose their effectiveness over time, would there even be a problem with using sleeping pills if you had trouble sleeping?

Agree. But sometimes there is no "root cause", the brain is still a mystery. If you had been depressed even when you knew there was nothing to worry about, you would see it differently, because then you deduce that the black cloud is produced within.

Chemistry trumps psychology. Good enough chemistry enables cognitive treatments. But to fix the wrong chemistry you need chemistry.

Also they are often prescribed as a life-long solution, instead of a temporary stop-gap to get through some bad state of mind while, as you said, "tackling the root cause". At some point they will potentially stop working which requires switching meds and often the next one won't work as well, plus, leaving the user stuck with withdrawal symptoms for unspecified amount of time (potentially years) and anti-depressant pushers don't usually warn about this, or even acknowledge it when confronted with "since stopping I have symptom x, y, z".

Source: multiple friends, family and forums (while researching how to help friends & family get off of various SSRIs).

> but rather that they're abused by psychiatrists

Doctors of all countries have been under a lot of pressure by patients and health administrators to "fix the issue and quick". The last thing that your doctor wants is giving you pills so you go away, but that's what the context very strongly incentivize. You want doctors to stop abusing pills, stop asking them for immediate fix. Give them less patients, more time and more resources to deal with the health of the population. Also, prevention.

Most forms of depressions have no "root cause" you can fix. Sometimes they have amplifiers or triggers, you might be able to work around, but that also demands first to reach a point where the patient is able to work on something.

It's a symptom of the "health care" insurance industry. Many people end up paying a specialist doctor's co-pay when they see a psychiatrist. Some plans limit you to a maximum number of sessions you can have (6, in my case) per year. Talk therapy eats up sessions and co-pays like Pac-Man eats dots. One doctor expected me to come in twice a week. Americans don't get all the PTO and/or excused sick time they want to accommodate such a schedule.

"It's like if we took sleeping pills every time we had trouble sleeping. Having said that, I just realised I have the impression that's exactly what people do in the USA?"

Not that my personal experience is actually a statistically significant sample, but I don't know anybody who takes sleeping pills. Or maybe I do, but they haven't told me. I've also never heard heavy sleeping pill use is one of the stereotypes about Americans. There are an estimated 342 million people in the United States, so impressions aren't always meaningful.

> like if we took sleeping pills every time we had trouble sleeping

Yes, that's normal in the US. I have multiple family members who take Ambien (zolpidem) before bed every night.

The US is heavily over-medicated, for sure. The pharma reps are very intimate with our doctors and it expresses as one might expect. If you go to the doc with nearly any significant complaint, you will very likely come away with some drugs. But it is not all doctors; people want easy fixes that do not require any change in habits. Not an easy problem to solve, systemically.

Wellbutrin can/should(?) be taken indefinitely and there's nothing wrong with that, it doesn't pose big long term health risks. As I understand it the issue is with SSRIs (they do pose health risks, obviously there's nothing wrong with taking them if it is a net positive for you).

> I have the impression that's exactly what people do in the USA?

It's not a great idea to make general assumptions about such a large and diverse country. Some drugs may be over prescribed, I have no idea if Ambien is one of them, but trying to fit 340 million people across 50 states into the same box isn't going to be very accurate.

you're not wrong that pharmaceutical crutches are overused. but as an outsider to these problems my 'ambient impression' was always one of haha antidepressants are for suckers. well, in my specific case, so what if i'm a sucker... they're super effective in fixing what appears to be a defective winter brain.

> The hate on antidepressants is not because they're not effective,

But that’s exactly what many claim. Even this article is trying to claim that Vitamin D has 4.5X higher effect size than antidepressants (e.g. that they don’t work)

> It's like if we took sleeping pills every time we had trouble sleeping. Having said that, I just realised I have the impression that's exactly what people do in the USA?

USA is actually not the world leader in over medication in this domain, even though it’s popular and safe to hate on Americans. The rates of benzodiazepine and Z-drug prescription in some countries like France are substantially higher than the USA.

> It's like if we took sleeping pills every time we had trouble sleeping. Having said that, I just realised I have the impression that's exactly what people do in the USA?

I can't speak for USA but in parts of Europe a lot of people have PTSD that prevents normal sleep, so they end up on these pills, and then they end up with PTSD and worse insomnia caused by long term use of sleep meds.

I think it's just incentives. Easier to take a pill than to deal with horrible trauma. And that probably stays true forever.

> Ideally, a professional will prescribe them as a necessary helper to becoming (more) mentally healthy whilst tackling the root cause.

I wish people would stop saying this.

Our understanding of the brain is not sufficiently sophisticated to allow us to identify the "root cause" (whatever that means) of depression in most people. Indeed we have no reason to believe that there even is a root cause to most people's depression.

If you take antidepressants, go to therapy (or meditate or exercise or whatever), then go off them and still feel good, that's great.

And if you take antidepressants indefinitely because doing so improves your life, that's also great! Your life is improved! This isn't an "abuse" of the drugs.

No psychiatrist is making you do anything. They're advising you based on their clinical judgement and experience, but ultimately it's your decision to take the pills or not. If your goal is to go on antidepressants temporarily, any decent psychiatrist will support you in that (because, again, they understand that they can't make you take the pills one day longer than you want to).

I've been on Lexapro and done evidence-based therapy for years. They both have been helpful, but if I had to pick one, I'd immediately pick Lexapro. For me it is a miracle drug. And the miracle is, I can choose how I feel.

(I also added a small dose of Buspar to help with the sexual side-effects.)

If you're on the fence about trying an antidepressant, I really encourage you to talk to a psychiatrist. If you try it and hate it, then you can stop. But a lot of people try it and love it. And I think a lot more people would be willing to try it if the notion that this is somehow "wrong" were gone.

For further reading I recommend https://lorienpsych.com/2021/06/05/depression/. I don't agree with everything Scott Alexander says, but his writing about mental health specifically has been useful to me.

Every time I have a yearly physical, my GP will ask if I have feelings of depression.

I know this road leads to SSRIs at the very least, so I always reply in the negative.

The parent comment hints to me that this might be a mistake. I do not want to become accustomed to an antidepressant, so perhaps my course of action was correct.

I was measured low on Vitamin D, which I've hopefully corrected, and I haven't always eaten fish regularly. Perhaps I should pay more attention to that.

Sometimes the root problem is that your neurochemistry is FUBAR and no amount of counseling with overcome a biological cause.

Frankly, I see this as similar to telling diabetics that they should use just enough insulin to get them to learn to stop being diabetic. That’s possible for a few type 2 diabetics who could make lifestyle changes that got them back into good ranges. It’s completely useless for type 1 diabetics, or type 2 who can no longer go back.

I’m neither diabetic nor depressed. I don’t have a dog in this hunt. I’m just always astonished at “have you tried not being depressed?” Some people can “snap out of it”. Many times that number of people cannot.

Yeah some people pop a melatonin every night before bed

> I just realised I have the impression that's exactly what people do in the USA?

How would you have formed that impression? Whatever media and culture you’re consuming, or how you are interpreting it, is leading you to incorrect conclusions. You should examine that.

We all live in a cultural bubble but any time you find yourself thinking that millions of people somewhere else do something crazy, you should probably talk to someone from there.

Sleeping meds might be prescribed at a higher rate in the US, that wouldn’t surprise me due to the specific incentives in our health care system. But that’s a far cry from your impression.

> The hate on antidepressants is not because they're not effective, but rather that they're abused by psychiatrists.

I don’t know how rampant that problem actually is, but I don’t think you should discount the impact of social stigma when it comes to mental health. It is only in the past 10 to 15 years, at least in the US, that mental health has entered the public dialogue in any meaningful sense. Historically it has been a source of massive shame with people expressing embarrassment at their loved ones suffering from mental health crises. And now we have a whole generation of influencers and politicians who are trying to tell people to pour out all their medications, reject doctors wholesale, take their specific brand of colloidal silver, and be free.

I just think this is a lot more complicated than “psychiatrists abuse the diagnosis.”

"Imagine if we took insulin every time our pancreas failed to properly process sugar."

> it's more of a "here, take these indefinitely"

And when you question this approach, the famous lecture comes: "but diabetes patients take insulin for life. You realize depression is a real condition and need to be treated right?"

It's not like sleeping pills at all actually. Sleeping pills have a huge dependence and tolerance factor. Antidepressants, generally, do not. Once you find one that works, they keep working effectively forever.

It's actually like statins. Ideally, a doctor will recommend diet changes in addition to the pills. However, relying on lifestyle interventions almost never is effective, And the more we learn about it, the more we realize that cholesterol is mostly genetic based rather than diet based anyway. So the most effective thing they can do is say "here, take these indefinitely". And thank God they do because it saves thousands of lives annually.

For many people with depression, a neurochemical imbalance is the root cause. Just like with statins, addressing it means taking some pills.

> but rather that they're abused by psychiatrists

Well that but also they have poorly understood long term effects even after being discontinued (in some people, not others) and they don't work for everyone. The latter is probably most of the reason they get hated on. I don't recall the source but a given antidepressant only works for something like 1/3 or less of the population. So take a person not in a great place emotionally, who is also statistically not in a great place in life overall, subject them to an insufferable bureaucratic process, give them a drug that doesn't end up working for them, add in some pretty wild side effects, sprinkle on a few long term effects that persist after they discontinue the thing that didn't work to begin with, and of course you end up with a bad reputation.

The tl;dr is that our understanding of the brain and mood disorders kind of sucks.

> It's like if we took sleeping pills every time we had trouble sleeping. Having said that, I just realised I have the impression that's exactly what people do in the USA?

I'm not sure if it is common but I've definitely taken my fair share of my dog's trazodone.

The truth about antidepressants is that the majority of people with depression that respond to an antidepressant would also have responded to a placebo. This doesn't mean that their depression isn't real or that antidepressants "don't work". It just means that placebo has a relatively high response rate in trials for depression. The hate is (among other points) because they are only arguably, marginally, better than placebo, and antidepressants also have real side effects (activation syndrome, increased suicidality, sexual side effects, withdrawals, etc.) over placebo.