Dude, are you serious?
First off, if you were under the care of a GOOD physician, you would be receiving a:
-Thyroid panel
-Metabolic panel
-Complete HPTA analysis (this includes ALOT of ****... a complete panel for hormone levels which is a whole 'nother ballgame on its own)
-Diet analysis
-Sleep pattern analysis
-Analysis of daily habits (caffeine usage, stress levels)
And, Id be almost certain that a 'GOOD' doctor who does this would find 99% of the time the problem isnt serotonin. For the record, I am low testosterone and require TRT. For just one bullet on the above list (complete HPTA analysis), I am driving 7 hours to an adjacent state to see a 'GOOD' doctor (one who will do all the tests I mentioned). And thats for just one aspect of the list above. You think the PCP that I almost guarantee the OP or any Joe Schmoe average American is going to walk into will be a 'GOOD' doctor? Dont fool yourself, buddy.
You are horribly misinformed. Between 17 and 60% of people experience sexual dysfunction alone. The numbers vary widely but the point is: SSRIs clearly **** your sexual system up.
..
Perhaps our definitions of depression are different. I have not suggested that SSRIs (or other antidepressants) be routinely prescribed for minor mood issues that should could otherwise be dealt with using therapy/counseling/exercise/etc. I am advocating the use of these meds in severe cases (major depressive disorder) where there are little, if any, alternatives. In fact, your dangerous statement ("Depression treatment should NEVER come down to SSRIs") prompted me to make my post. There are serious cases that necessitate the use of medication in order to get the person to a place where they can take advantage of other treatment alternatives. Since we know little about the OPs wife, I thought it was irresponsible for you to make a blanket statement about SSRIs having no place in treatment. In your last post you did state that you felt antidepressants could play a role in "major, severe depression", so perhaps your first comment was made in haste.
I should clarify one of my comments. In the vast majority of cases where antidepressant therapy is absolutely necessary, there are little to no side effects THAT OUTWEIGH THE POTENTIAL LIFE-SAVING BENEFITS OF THE MEDICATIONS. I am well aware of how common sexual side effects are, but it often is not a deal breaker in appropriately prescribed cases. Many patients are more than happy to deal with them in order to get their lives back. I'm not sure why you take exception to my comment that a good physician is required to appropriately prescribe these meds ("Dude, are you serious?") which I also agree can be overprescribed. I stand by my statement that good physicians, in any medical specialty, are essential in appropriately using medications. In fact, you admitted that you are willing to drive a far distance to get the care you need and deserve. The existence of bad doctors should not mean that good medications should not exist for those who need them. And, you assume too much when you commented about the OP's PCP ("You think the PCP that I almost guarantee the OP or any Joe Schmoe average American is going to walk into will be a 'GOOD' doctor? Dont fool yourself, buddy.") We have no idea what kind of care they have access to.
I agree that every patient with a "mental illness" should first have a complete workup to rule out so-called "organic" causes. I also agree that brain/behaviour issues are influenced by a "vastly huge network of bodily systems very closely wired together". Thyroid problems, tumors, endocrine issues, strokes, drug use, medication reactions, viral infections, and electrolyte/glucose abnormalities can ALL mimic depression. These causes must/will be considered by a "good" physican. As a medical resident in psychiatry, not a single patient was admitted to our unit without a CBC, EKG, thryoid check, renal panel, and tox screen (among other tests at our discretion depending on the case). MRIs were routinely ordered as well.
I think you are overemphasizing the role of serotonin in depression. While obviously important, few psychiatrists believe in the simple/old model that depression is simply a shortage of any one neurotransmitter. SSRIs increase serotonin in the brain WITHIN HOURS of the first dose. However, it is usually weeks before a patient sees a significant improvement in mood. If it were just a matter of a shortage of serotonin, a person's depression would be alleviated within hours of the first dose. Clearly there is some other pathway that is RESPONDING to the serotonin that ultimately results in feeling better, rather than the presence of serotonin itself. This also explains why other antidepressants that don't primarily effect serotonin (Effexor, Wellbutrin, Cymbalta) are just as effective as SSRIs. There is currently no lab test in existance that can check your brain for a shortage of any neurotransmitter, so most psychiatrists have to treat based on symptoms.
You stated that " those same triggers that got you into that given hormonal mess (or any other mess of health) can do the same in reverse... no SSRI required". I agree. Sometimes. However, sometimes the damage is so substantial that simply removing the offending factor doesn't fix the problem. It's like quitting smoking AFTER you get lung cancer. You still require treatment for the cancer. After treatment, however, not smoking will improve your chances of remaining cancer free.
I have PERSONALLY seen hundreds of lives saved because of antidepressant therapy. In these severe cases, the part of the brain responsible for providing pleasure/comfort/satisfaction is no longer working, and the patient experiences constant fear and sadness. Talking, sleeping, eating well, and exercising will do nothing for these people, at least in this acute state of crisis. Their brains are betraying them and, at least initially, the cause is not important. Whether it was trauma, stress, abuse, or genetic factors, a severely depressed person needs medication before they can work on changing life factors. I'm sure you and I would agree that problems in treatment decisions lie in the "grey" areas: those patients that aren't miserable/suicidally depressed, and simply are sad or stressed. Do you treat these people with medications? Are potential side effects worth it?
I would encourage you to do some more research on the positive side of antidepressant therapy. Sleep, weight, and eating habits (and even sexual issues) often IMPROVE on these meds (again, when they are prescribed correctly). When sexual side effects occur, they go away when the medication dose is stopped/changed. THEY ARE NOT PERMANENT (Where did you get this?). I'm not sure what you think these meds do. They don't induce euphoria or "drug" you up. In fact, if you are a happy person, they won't make you happier. They will probably do nothing, or give you a few side effects. They fix a very specific biological problem, and if that problem isn't there, the meds will do nothing. It is a misconception that you become dependent on these meds or "use them as a crutch" instead of dealing with real issues. Please show me the source that supports your idea that these meds "reduce your ability to ever naturally (without drugs) experience happiness again". This simply is not true. True, many people must remain on these drugs for the rest of their lives in order prevent depression, but it is not because the meds have "ruined" their ability to fuction drug free. It is the DEPRESSION and the resulting damage that has taken away their ability to function without meds. Again, this is only in extreme cases.
Believe it or not, I am a strong advocate for keeping people off meds at all costs if it is in their best interests. However, it is simply ridiculous for you to say "tell your sister in law she is a ****ing nut" for wanting to help. You state this with way too much conviction for someone who knows nothing about these people, and this is potentially dangerous. I respect your opinion, but not when you impose it on other people.
I thought it was a sleep aid -- nevermind then!
