What we’ve said about Antidepressants

“I think they're probably equal in efficacy. Now, medications work a little bit faster. So we know that our standard antidepressants take about four to six weeks to work, but it takes about two weeks to kind of see an effect”

“So by treating the biological there, you can have a knock-on effect on the psychological or the social”

“Psychotherapy is the treatment for unipolar depression, and people ought to get trials of three different Psychotherapies before they get a first trial of an antidepressant”

“none of these respond to an SSRI. None of these respond to an antidepressant, primarily. So do not just think someone is suicidal or depressed, give an SSRI. You need to have a formulation, diagnosis, and treatment plan before you prescribe things”

“Neuroticism was the only trait that responded better to antidepressants than to CBT. It is a personality style that you would expect the antidepressants to”

“I'll never pick medications that will cause weight gain or appetite increase if I can help it. and I try to minimize side effects. That's kind of rule one. And then rule two is most efficacious”

“Purity is very overrated, both in real life and in medications. And I would I would say that I love a dirty drug. I love medications that can do multiple things at once”

“the tier list that you use for medication should really be tailored to your patient population. Patient populations are different, and your diagnostic pool is going to be different, and so your treatment response is going to be different, too”

“treat to remission and then at least a year before you make some changes. That's not really data supported. It's just kind of prudence because what we do know is usually even if you treat to remission, an early stop or decrease can seems to can it can result in a return of depression”

“probably half of depressions are one episode depressions and half of people who have depression are going to have chronic depression that they're going to have recurrence if you come off the medications. Um, Um, typically what I do is I say, listen, as you said, we, we get you in remission”

“pulling it off quickly is also an acute stressor. So you need to be mindful of that”

“the best advice is to avoid weight gain inducing medications. Avoid weight gain inducing medications. Prevention is the best strategy there. Now, don't get me wrong. Some people also begin to gain weight, even on the medication that treats depression that does not itself cause weight gain”

“Why do some people get worse than antidepressants? In my opinion, it's mostly because they have some kind of a more bipolar disorder type condition and experience antidepressant-related agitation and sleep problems. That's probably, in my opinion, why we see the increased risk for suicidal ideation in people under the age of 25 on antidepressants”

“rem deprivation can treat depression which is very bizarre to me yeah if you just wake people up before they hit rem which if you do that to an average person they'll hate you and be miserable um it can help treat depression”

“The biggest one for sure is how likely is it that we're going to make you worse with an antidepressant? And conversely, to the extent that we worry about that, then we think that maybe a mood stabilizer based approach is a better idea”

“The big problem is inducing mood instability and mixed states. You make cycling more likely to happen because antidepressants are Antidepressant, all antidepressants with almost no exceptions are pro cycling”

“I'm going to avoid them like the plague unless I can't get away without using them. So the first thing I'm going to say is that if someone is on a antidepressant and they're rock solid stable, then fine”

“it's not a never use them. It's a use them after you've tried multiple other things. And there's a specific subset of patients for whom I think there is a potential role. And when I finally come around to that, it would be bupropion”

“whenever you're talking to a bipolar specialist, they emphasize the importance of mood stabilizers. And you'll see as you treat more and more patients, you start to use antidepressants less and you focus the mainstay of treatment on mood stabilizers, mood stabilizers, mood stabilizers”

“get rid of something first so that Lamotrigine gets a fairer trial. In particular, antidepressants. Patients who are already on an antidepressant makes it less likely that lamotrigine will demonstrate its remarkable capacities”

“So what we're really looking for in this response to treatment finger is an adverse reaction to an antidepressant. Something weird happened. What a primary care colleague called antidepressant misadventures. Oh, you know, something really strange happened. That's all I'm listening for”

“Simply taking Prozac, lexaprozol off for some people can result in agitation, sleep disruption, or even emergent hypomania. And while those people can have those substance and medication-induced episodes, you take away those substances and you watch them, they may not have another one without those substances”

“You can't forget the prescription medications that are being taken by patients that don't consider drugs, even if they are prescribed or are not prescribed to them. Obviously, the biggest ones are stimulants, but we also have to consider the possibility of antidepressant induced mania”

“The answer is it depends on what your index of suspicion of bipolarity was before you started the whole thing. If your suspicion was very, very low, then you can, you and your client patient can kind of tolerate some of this and explore and carry it on a little farther and see what direction this is going”

“I show my thinking and I say, what do you want to do? Obviously within certain parameters”

“the medication is not the treatment. It's part of the treatment. And how do these work? You're not just going to start feeling happier. This is not a happy pill. What this medication probably does is that it makes it easier for you to change”

“a lot of people are already trained to expect that you're there to throw a medication at them. That's why they're seeing you. Right. And if therefore, if you don't take active steps to show that the treatment process is more than the medication, then that's the natural assumption”

“If you're prescribing these things from a stance of, I am a gatekeeper, I give you the meds and this treats your thing, you're going to have so much worse outcomes”

“how often do we see patients on higher and higher doses of stimulants? Patients who, you know, they're running through the gambit of different antidepressants because the persons were not thinking through the hierarchy appropriately”