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Are we spiraling towards a future where antidepressants are the next opioid crisis?
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I think it's a fair question
Antidepressent usage has rise dramatically, up 65% in the past 15 years, and also not evenly (some groups like older white women are far more likely to use than other groups).
Is a quarter of the population really clinically depressed? Or is it the new money maker for doctors and pharmas?
Antidepressent usage has rise dramatically, up 65% in the past 15 years, and also not evenly (some groups like older white women are far more likely to use than other groups).
Is a quarter of the population really clinically depressed? Or is it the new money maker for doctors and pharmas?
There's kind of a point to be made about some doctors being too trigger happy with antidepressants, but I think a lot of times it creates more of an unnecessary stigma that your doctor may be a pill pusher and you shouldn't listen to them when they tell you to take them (it's the reason I didn't take them for years).
But outside of that, no, this makes no sense. They aren't addictive, there's no recreational application of them, they aren't going to just flat out kill you on their own, and even with withdrawal it's easy to wean off them; plus it's not like you're living pill to pill, if you miss a dose or two you'll be fine, worst I've ever gotten is a small headache.
But outside of that, no, this makes no sense. They aren't addictive, there's no recreational application of them, they aren't going to just flat out kill you on their own, and even with withdrawal it's easy to wean off them; plus it's not like you're living pill to pill, if you miss a dose or two you'll be fine, worst I've ever gotten is a small headache.
Both can be true at the same time, is the thing that makes anti-depressants more complicated than opioids.
The main features of opioids that fuel the crisis is: addictive, recreational use, death by overdose
Those 3 features are very bad to have in a single drug class.
Nah.
Benzos are currently fucking a lot of people up though. I almost died from Xanax withdrawal.
Benzos are currently fucking a lot of people up though. I almost died from Xanax withdrawal.
While the discussion on whether or not doctors should or should not be RX-happy is valid, Anti-Depressants are nowhere near as dangerous as opiods.
Opiods have a direct, addictive, strong high that is dangerous outside of standard prescribed use-case because they can be abused recreationally. Outside of heavy anxiety medications or antipsychotics it's pretty rare for antidepressants to have the same kind of recreationally abusive applications. Like, I don't think I could really get high if I took a bunch of my Escitalopram.
The thing with Opiods that makes them a high threat isn't just that Big Pharma is pushing them and they are easily accessible, it's that Pharmaceutical companies and politicians enabled their saturation while knowing that they would be easily sold and traded on black markets to create demand. I don't think the same strategy makes sense for most Anti-depressants for the aforementioned reasons, so they are much less of a danger to public health.
Opiods have a direct, addictive, strong high that is dangerous outside of standard prescribed use-case because they can be abused recreationally. Outside of heavy anxiety medications or antipsychotics it's pretty rare for antidepressants to have the same kind of recreationally abusive applications. Like, I don't think I could really get high if I took a bunch of my Escitalopram.
The thing with Opiods that makes them a high threat isn't just that Big Pharma is pushing them and they are easily accessible, it's that Pharmaceutical companies and politicians enabled their saturation while knowing that they would be easily sold and traded on black markets to create demand. I don't think the same strategy makes sense for most Anti-depressants for the aforementioned reasons, so they are much less of a danger to public health.
While not nearly as serious a problem as opioids...it would still be desirable to have antidepressants that did not have to be taken daily indefinitely, and did not cause withdrawal symptoms on discontinuation. SSRIs/SNRIs work, and have helped many people escape depression, but they're certainly not ideal. There is some recent progress being made on alternatives; esketamine was recently approved (although as an adjunct to a traditional antidepressant, and it has to be administered under supervision), and psilocybin is currently in phase III trials for depression; the appeal of psychedelic-assisted therapy is that the benefits seem to persist long after the last drug therapy session.
There are non-drug treatments that deserve more attention as well; electroconvulsive therapy (ECT) works for depression, but has an undeserved stigma as "shock therapy." That's not to say it's side-effect free (transient memory problems are a known drawback) but it's an often overlooked option.
There are non-drug treatments that deserve more attention as well; electroconvulsive therapy (ECT) works for depression, but has an undeserved stigma as "shock therapy." That's not to say it's side-effect free (transient memory problems are a known drawback) but it's an often overlooked option.
This is true...we don't want the pendulum to swing too far. That said, maintaining a prescribed dose of opiates over a long period of time is nigh guaranteeing addiction.
when they start feeling as good as a painkiller and people start dropping like flies due to the overdose potential, sure. until then what are you talking about?
I'm actually graduating medical school in a few weeks and starting my psychiatry training soon after so this is something I've been interested in.
While antidepressants aren't as inherently addictive as opioids, a "prescription cascade" forms a lot of times where physicians prescribe additional medications to cover up the side-effects of other drugs, and this happens a lot with mental health medications. There also needs to be more info on how to taper off and completely stop anti-depressant medications when patients no longer need them. Many physicians do not do this in the same way, which causes more stress for patients who want to lessen their pharmaceutical burden.
The New Yorker published a good article on this earlier talking about a women who took years to eventually cut down her psychiatric medications. It's long but definitely worth a read.: https://www.newyorker.com/magazine/2019/04/08/the-challenge-of-going-off-psychiatric-drugs
But no, at this point it is not like opioid addiction. it's worrying but for different reasons.
While antidepressants aren't as inherently addictive as opioids, a "prescription cascade" forms a lot of times where physicians prescribe additional medications to cover up the side-effects of other drugs, and this happens a lot with mental health medications. There also needs to be more info on how to taper off and completely stop anti-depressant medications when patients no longer need them. Many physicians do not do this in the same way, which causes more stress for patients who want to lessen their pharmaceutical burden.
The New Yorker published a good article on this earlier talking about a women who took years to eventually cut down her psychiatric medications. It's long but definitely worth a read.: https://www.newyorker.com/magazine/2019/04/08/the-challenge-of-going-off-psychiatric-drugs
But no, at this point it is not like opioid addiction. it's worrying but for different reasons.
No, this is not right.
Medications have more than their place in numerous cases that social and non-pharmacological interventions are not good for, and for a large amount of people. They need to be prescribed correctly but they should be prescribed.
Polypharmacy is one of the scariest things happening to everyday Americans and we don't know it. Pharmacists are important healthcare auditors but they have no central backbone to help them make their voices heard.
People saying this have no idea what antidepressants actually do.
They make lives tolerable for millions out there.
They make lives tolerable for millions out there.
Overprescribed opioids are a problem because opioids are dangerous, addictive, and available on the black market. Overprescribed antibiotics are a problem because they lead to increased resistance in dangerous diseases. Overprescribed antidepressants do neither.
You need a grave consequence to the hypothetical problem or it's not a big deal.
You need a grave consequence to the hypothetical problem or it's not a big deal.
No.
Next thing is "why are there a billion different statins when they all help with hyperlipidemia"
Crushing up zoloft and cranking my bloody valentine is the new taking mdma and blasting some acid house, haven't you heard?
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That's why I said "so easily". I know many folks need those meds, but I also know many of them don't. At some point I thought I needed them, went to therapy and my therapist told me to start doing exercise everyday before getting into meds. So far so good and I'm glad she didn't prescribe antidepressants right away.
Absolutely agree.
Drugs that alter brain chemistry have side effects that are permanent and might end up being worse than the illness itself. ADHD medications and antidepressants can leave people feeling emotionally dead or unable to feel happy... I've seen it happen.
The issue is "so easily" is implying that there is some sort of metric or standard that should be met that you are saying we are going past.
I don't feel like doctors are too readily prescribing anti-depressants, but if I were shown or proven otherwise I would believe it. I also would like to say it's wildly presumptive of you to say you can tell that people you know on these meds do not need them, unless you have medical expertise in this field.
I was on Lexapro a few months and I kinda felt like I was a slave to it. I ended up hating it by the time I ran out. I do feel like there is a valid concern for the addiction of antidepressants and how they are prescribed.
Anti-depressants, like opioids, are prescribed easily because of the influence the industry that produces them wields. That said, I could flip your statement and suggest that people should stop pushing sports and active life style on people that need actual help. Speaking from experience.
I'm not stating that you're "wrong" here, but what you've suggested there feeds the stigma.
^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
People struggling with mental health issues already deal with enough stigma.
Can we not make them feel like crack fiends? Thanks.
Um, no.
SSRI medication doesn't lead to dangerous dependencies.
The opioid crisis has fucked us over because it's turned people into drug addcits [heroin, fentanyl, etc].
That won't happen with SSRI meds, they just help right your happiness.
Speaking as someone who just weaned off SSRI meds after 3 years on them, and who SHOULD be on ADD meds but chooses to go the "natural route" instead [exercise, creative & active hobbies, meditation, etc].
ADD numbers are legitimately going up, and as far as I know nobody knows why [yet], but it's curious to be certain.
Does it really surprise you more & more people are depressed and requiring SSRI meds when the world is going to shit? It just makes sense [imho].
Wage disparity / income inequality, cost of living vs. average pay, the rise of fascism in the safe-haven of the west, climate change not being tackled, fucking ancient previously-defeated diseases coming back due to the rise of pseudoscience and scientism?
IT JUST MAKES SENSE YO.
SSRI medication doesn't lead to dangerous dependencies.
The opioid crisis has fucked us over because it's turned people into drug addcits [heroin, fentanyl, etc].
That won't happen with SSRI meds, they just help right your happiness.
Speaking as someone who just weaned off SSRI meds after 3 years on them, and who SHOULD be on ADD meds but chooses to go the "natural route" instead [exercise, creative & active hobbies, meditation, etc].
ADD numbers are legitimately going up, and as far as I know nobody knows why [yet], but it's curious to be certain.
Does it really surprise you more & more people are depressed and requiring SSRI meds when the world is going to shit? It just makes sense [imho].
Wage disparity / income inequality, cost of living vs. average pay, the rise of fascism in the safe-haven of the west, climate change not being tackled, fucking ancient previously-defeated diseases coming back due to the rise of pseudoscience and scientism?
IT JUST MAKES SENSE YO.
Are you seriously just coming in here and labeling all anti-depressants as poison?
I don't know too much about antidepressant chemistry but opiods are the most addictive prescribed drug and there's a direct path to heroin and fentanyl abuse and you can overdose and die with a single prescription. Don't antidepressants also require a halfway serious evaluation of the patient? Opiods were prescribed for broken toes and post -op recovery for decades with no warnings.
This has been known since forever and there are ways to combat that side-effect so I don't know how that makes it poison.
Yes, benzos are probably analogous to opioids if you want to compare some of the dangers. Quitting benzos cold turkey can literally kill you. The thing is, when I was prescribed Klonopin, I wasn't told about any of the dangers, and I was fairly young (around 20). Knowing what I know now, I wouldn't have started them at all. Plus, now I'm at a higher risk for developing Alzheimer's in the future. Yay!
The problem is, benzos fucking *work*. At least they did for me, with my extreme anxiety. It was like a godsend. I could go out and do things again without constantly freaking out. Long term, though, you reach a tolerance with them, so you have to keep upping the dosage. I am working with my psychiatrist now to finally get off of Klonopin, but it's a very slow, 3-year withdrawal schedule.
The thing is, I'm aware of the dangers of getting off benzos, but I think about all the other people who have been prescribed them who really have no clue. It's scary.
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Antidepressants are not the next opioid crisis for so many reasons. To think this is the case indicates a fundamental misunderstanding of both these drugs (how they work and what they treat) and what caused the opioid crisis in the first place. To really get into the details would take more time than I have right now, but I'll give you a very brief overview.
First, "opioid" refers to a specific type of drug (one that acts on opioid receptors), whereas "antidepressant" is a general term that can be used to describe many different kinds of drugs. For the sake of discussion though, I'm going to assume you're referring to the most common type of antidepressant which is some form of SSRI (selective serotonin reuptake inhibitor) such as Prozac, Lexapro, Paxil, Zoloft, etc.
Second, SSRIs don't affect you the way opioids do. They don't get you high like an opioid. People are not going to steal money from their relatives to get a quick Prozac fix. You're not going to find someone living on the streets because they lost everything from a Zoloft habit. The truth of the matter is that SSRI can take weeks or even up to a month or more of continued usage to have any significant effect. And for some people, a particular type of SSRI may have little to no effect on them. This is why for many, it takes a lot of trial and error to find the right SSRI at the right dose to have any therapeutic effect at all. Even then, some have to use an SSRI in combination with other drugs to get much out of them. Contrast that with opioids, which don't have anywhere the same variability in terms of psychoactive effectiveness (drug tolerance and pain level aside).
Further, while you do have the possibility to build tolerance and create dependence using an SSRI, this generally only happens over a long period of use. This is why accidental overdoses aren't nearly as common with SSRI. Since SSRIs don't get you high like opioids, you're not constantly upping your dosage to chase the magic dragon. And while you can have problems with discontinuation, it's easily mitigated by stepping down your dosage. Which again, because it doesn't give you a typical high, you don't have rebounding like you do with highly addictive drugs such as opioids. Nobody's falling off the wagon and hitting up a dealer for a quick hit of Paxil.
The final point I'll leave with you is that the opioid crisis is made more severe due to prescription opioids being a gateway drug to other, more dangerous opioids. People that might start out on pills, even if prescribed to them by a doctor for legitimate pain, can sometimes graduate to heroin after getting addicted. I very seriously doubt you're going to find someone say, "Yeah, all it took was a couple of hits of Lexapro and before I knew it, I got hooked on crack".
The reality of the situation is that SSRIs and most other antidepressants have an extremely low risk of abuse. The danger of it turning into the next big drug is so absurd and unlikely that it's almost hilarious. The humor leaves pretty quickly when you realize how bringing this up and popularizing the idea risks further stigmatization of the mentally ill that use antidepressants, and potentially scares away people that should use them, but don't. As someone said earlier in this thread, SSRIs can actually save lives. I realize this isn't your intention, OP, but I would implore you to please do a little more research next time.
First, "opioid" refers to a specific type of drug (one that acts on opioid receptors), whereas "antidepressant" is a general term that can be used to describe many different kinds of drugs. For the sake of discussion though, I'm going to assume you're referring to the most common type of antidepressant which is some form of SSRI (selective serotonin reuptake inhibitor) such as Prozac, Lexapro, Paxil, Zoloft, etc.
Second, SSRIs don't affect you the way opioids do. They don't get you high like an opioid. People are not going to steal money from their relatives to get a quick Prozac fix. You're not going to find someone living on the streets because they lost everything from a Zoloft habit. The truth of the matter is that SSRI can take weeks or even up to a month or more of continued usage to have any significant effect. And for some people, a particular type of SSRI may have little to no effect on them. This is why for many, it takes a lot of trial and error to find the right SSRI at the right dose to have any therapeutic effect at all. Even then, some have to use an SSRI in combination with other drugs to get much out of them. Contrast that with opioids, which don't have anywhere the same variability in terms of psychoactive effectiveness (drug tolerance and pain level aside).
Further, while you do have the possibility to build tolerance and create dependence using an SSRI, this generally only happens over a long period of use. This is why accidental overdoses aren't nearly as common with SSRI. Since SSRIs don't get you high like opioids, you're not constantly upping your dosage to chase the magic dragon. And while you can have problems with discontinuation, it's easily mitigated by stepping down your dosage. Which again, because it doesn't give you a typical high, you don't have rebounding like you do with highly addictive drugs such as opioids. Nobody's falling off the wagon and hitting up a dealer for a quick hit of Paxil.
The final point I'll leave with you is that the opioid crisis is made more severe due to prescription opioids being a gateway drug to other, more dangerous opioids. People that might start out on pills, even if prescribed to them by a doctor for legitimate pain, can sometimes graduate to heroin after getting addicted. I very seriously doubt you're going to find someone say, "Yeah, all it took was a couple of hits of Lexapro and before I knew it, I got hooked on crack".
The reality of the situation is that SSRIs and most other antidepressants have an extremely low risk of abuse. The danger of it turning into the next big drug is so absurd and unlikely that it's almost hilarious. The humor leaves pretty quickly when you realize how bringing this up and popularizing the idea risks further stigmatization of the mentally ill that use antidepressants, and potentially scares away people that should use them, but don't. As someone said earlier in this thread, SSRIs can actually save lives. I realize this isn't your intention, OP, but I would implore you to please do a little more research next time.
Is it really that medications are being handed out like candy or that more people with mental illness are now getting appropriate treatment?
And all the millions of people currently on medication to cope with their clinical depression, you seent that?
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