Oral Antidepressants...No Thanks.
Honestly, I don't think they're a good idea as a first line treatment
I'm just gonna say this out loud. But it's into my phone. And I'm using Siri, so it's an article. It’s an opinion piece.
Oral antidepressants are not good treatments for depression compared to what anyone would objectively consider a good treatment for depression.
If money was not a factor, and inconvenience was not a factor (because of money)…I would never prescribe an oral antidepressant ever again. Brain stimulation and plausibly psychedelic compounds are vastly better treatments. I actually have a hard time believing that Oral anti-depressants, in 5 to 10 years, will be considered ethical to prescribe.
This is not because they are terrible. The why?
It is not because they don't work for some people. It is because the likelihood of them working for any individual person is Vastly lower than I consider acceptable. This is probably going to annoy people. It's likely to annoy people I like. People whose opinion I value. And I'm willing to say it, because at this point, I'm pretty sure history will bear me out.
If you had the option between a treatment that is going to get your depression to be over, completely, and the only logistical problem is getting the treatment again so that it works well enough again so that your depression is over—would you ever want to take something that didn't do that, if the side effect were also vastly better? Yes.
Now, the world has realities. Pills are convenient. They're endlessly profitable. But getting depression 50% better is not good enough. And that's what they're measured to do. For some people they get permission to happen. For some people they treat other problems. But depression should be over, not a little bit better.
We don't need better access to treatments that aren't good enough. We need to scale treatments that a remarkably effective. Then we never ever ever should bother with things that barely have a chance of working. I don't want to have to defend pills. I don't have the data yet to say that we should stab them in the heart forever. But I do think that that's what the data is going to show.
In the meanwhile…I dropped a mic…help?
—Owen