Psychotherapy

Psychotherapy or just therapy is what I'm going to use as an umbrella term for everything psychologists, licensed counselors, social workers, and psychiatrists. All that mental health stuff.

I'll be using the United States as my reference since it's a huge population with very easy to get English source data, but it's not at all limited to the USA.

Types of Antidepressants

Both SSRIs and Benzodiazepines (Benzos for short) are weapons of choice for so called doctors when treating mental health issues like depression, anxiety, PTSD, and pretty much the range of negative human behaviors.

SSRIs (Selective Serotonin Re uptake Inhibitors) like prozac, zoloft, lexapro and others, mainly function to depress the central nervous system. They are not that fast acting and need to be taken for a few days to weeks for the effects to fully engage. Their function is more or less to regulate emotions by a broad calming effect but in a way that is less relaxation and more dissociation. These are usually first-line and prescribed long term. SNRIs are similar to SSRIs but are preferred for cases where low energy and fatigue are more prevalent.

Benzos like Xanax, Valium, and Ativan are potent drugs that produce rapid calming, sedative, anticonvulsant, and muscle-relaxant effects. These are usually prescribed short term on an as needed basis.

There are also a couple others that are similar, not as common, but still used like Gabapentin, beta blockers (propranolol), Trazodone, Bupropion, Hydroxyzine and more.

When I refer to antidepressants I'm referring to basically all of the above since they all have a similar impact on the body which is to regulate the central nervous system. Also if for some reason you don't agree with the summary of the effects, just go and try some, you'll see what I mean.

Analysis

Across the totality of evidence, SSRIs appear to provide small average short-term symptom benefits versus placebo in adult depression, with effect sizes that are statistically robust but often debated for clinical meaningfulness on symptom totals [Source]. In pragmatic primary-care populations, a high-quality sertraline placebo trial found no clinically meaningful depression-score reduction at 6 weeks, though it did find improvements in anxiety, mental health quality of life, and self-rated improvement, and only weak evidence of depression-score reduction by 12 weeks [source].

By severity, credible influential analyses conclude that benefits are minimal or near-zero on average in mild-to-moderate ranges and become meaningfully larger only at very high baseline severity; other individual-participant analyses find no clear severity moderation within selected trial contexts. A conservative synthesis is that SSRIs likely help more reliably in higher-severity presentations, but the precise shape of that relationship remains contested and sensitive to trial selection and modeling choices [source].

For remission and relapse prevention, continuation generally reduces relapse risk versus discontinuation in trial settings (including a strong UK primary-care trial), but confidence is moderated by discontinuation/withdrawal confounding concerns and by the challenge of separating relapse from withdrawal in symptom-based outcomes [source].

Scope and Scale of Drug Use

Around 11-15% of americans are on some type of antidepressant, that's roughly 40 to 50 million people [PubMed]. Hard to pin down but roughly the 100,000 to 300,000 pregnant women use antidepressants, mainly SSRIs but some benzos. For children it's a few million, around 2.5 million, mainly in the female teen age range [ASPE]. The scope of use is massive and prevalent throughout society, especially post covid. I'm sure you know someone on some type of antidepressant.

Biological Markers

My favorite, and in my opinion the strongest, argument against the use of antidepressants is that there is no set of biological markers for depression, even with very comprehensive and detailed testing. No way to diagnose it objectively. Or even for most mental conditions. They are diagnosed purely on subjective analysis and most of the time via a very crude set of criteria, the doctor asks you some questions and ticks off a yes or no on a list, if you tick enough boxes then he diagnoses you as depressed or anxious or something else and then prescribes the medication. We have all the tools to detect the biological markers if they exist, MRIs, scans, blood tests, even spinal fluid tests, but there is literally nothing objective outside of what would be considered normal human variation (as in would even be found in an otherwise perfectly fine person) to diagnose depression. From the mainstream perspective this is strange because depression and other issues like anxiety are treated as medical conditions, chemical imbalances, not something as subjective as a regular emotion. These chemical imbalances are then “treated” with antidepressants. How can this be? what balance is being fixed if there was no detectable disturbance to start with? This is a logical contradiction that somehow evades even well meaning doctors, although I will elaborate on this a bit more later. The real answer is that it is not fixing but instead numbing, it is doing what anyone who has tried these drugs will tell you which is blunt emotions across the board. Regulate the nervous system instead of letting emotions take over.

One counter to this is that people start at the result and work back. They say we know the drug for sure works, so then there must be something that it's fixing. That's fine as a starting theory but not as a backbone to an entire medical practice. And that's without even getting into the actual studies and their massive logical and ethical flaws that we will get into in a later section.

The chemical imbalance I mentioned above is a bit of a strawman. It's true that on the patient side the nuance is almost always lost and it is framed as an imbalance, even to many doctors. But among the people who know, the more post 90s view is that depression is heterogeneous, involves multiple systems, and antidepressants modulate neuroplasticity, stress response, etc. in ways we don't fully understand. But even that is very weak and still relies on the chemical imbalance combined with working back from the results (no concrete explanation).

Studies

There are several big reasons why antidepressant studies can often be wrong.

Exclusion and Manipulation: FDA literally just selectively publishes the studies that confirm the result they want and exclude the rest. Erick H Turner and colleagues showed that in the FDA antidepressant review data among 74 FDA registered studies of 12 antidepressants, 31% were not published or published deceptively. [source]
Short Term: Virtually every SSRI study only lasts 6-12 weeks, despite the drugs being prescribed for years [source].
Clinical Significance is hard to measure: Experts are not in full agreement on how to exactly quantify the results of a depression treatment study. this allows manipulation of the results in both directions.
Double Blinds are not really possible: Double blind placebo controlled studies are not really possible since antidepressants are still strong enough that a doctor can usually detect if someone is on the drugs or not just from basic interactions.
Biological markers: As explained above, it is impossible to quantitatively diagnose depression. Let along the spectrum from mild to severe.

Side effects

Follow the Money

The best way to figure things out is usually to follow the money. In this case who stands to gain from treating depression (and other conditions like anxiety) with drugs? Pharmaceutical companies obviously, as well as doctors making the prescriptions.

Facebook has kind of dampened the “Big Pharma” scare with outlandish theories but there is still a lot to be said there. Prozac is what made Eli Lilly into a billion dollar company. Lobbying is real. Doctor ego and money chasing is real.

My stance is one of don't take drugs. No money to be gained but there are potentially some ideological conflicts of interest. Maybe I just want people to suffer and not get treated for depression, maybe it's against my religion. Even if those were true, the real world works with money and power, not ideologies.

Addiction Tolerance and Withdrawal

Pretty much all of the antidepressants listed above are highly addictive, proportional to their strength. SSRIs are addictive after a couple weeks, you will go into withdrawal and feel worse if you stop them. Bezos are stronger and more addictive with a stronger withdrawal. This happens to everyone, it's not a niche side effect.

Tolerance is the other side of the coin with addiction. Tolerance develops to all these drugs as well, again proportional to their strength. Anyone on antidepressants will tell you that they need increasing doses to maintain the same effect over time.

Addiction and Tolerance create a synergy of effects where there is a honeymoon period when starting them because your tolerance is low so the impact is noticeable. Tolerance then builds and you will need more for the same effect, your doctor can and will prescribe it. The addiction and tolerance both build as the dose increases. Stopping SSRIs and others becomes increasingly difficult the longer you take them, the same as any drug.

Doctors usually get around this by diagnosing a new condition and/or switching (or adding) medications. Not necessarily to something stronger but just something that gets around the tolerance. As you'd expect, this cycle repeats and is why many people who have been on antidepressants for a long time aren't even usually on just 1 the whole time, it changes and they add others to their daily list of pills.

Not so side note, somehow SSRIs are not considered Addictive (benzos are and I won't even engage in anything to the contrary). At least not in a solid clinical sense. Or they say it's not addictive but there is withdrawal. Here are some links to papers: [NICE updates antidepressant…][Stopping antidepressants][Antidepressants, withdrawal, and addiction; where are we now?]

Depression - SSRIs

SSRIs are not clinically significant compared to exercise

addictive, they don't account for that. Reproductive issues

Never actually solve anything.

Prozac effects, numb emotionally restricted. Made eli lilly a billion dollar company
14% on antidepressants, 500% increase since 90s. More disability and suicides.
1. The classic “depression isn't just sadness” it's a medical issue.
The idea is that “mean society” is belitteling people's issues and you need to protect them with drugs and it's not their fault, they're just getting bullied by red necks.
They say the drugs are stemming the tide, slowing down what's happening more and more for reasons they don't know.
Why is depression rising? For sure the treatment is bad, also society is getting crapier.
Psychiatry is very limited, no time to actually understand the patient, the effort is just to use the checklist for symptoms and then if it chck 5/9 boxes then the doctor can then perscribe the drugs. The idea is that you have to treat the person directly with FDA approved drugs.
Tolerance develops as well. There's a honeymoon period where it works and you get instant relief , or SSRIs where it's a couple weeks. They do work for that period but you need higher and higher levels over time. Clearly the effectiveness wears off over time.
Half of the people use them for 5 years.
clinical trials are for 12 weeks only, never for 12 months.
No randomized controlled trials.
Researchers are not motivated to find issues with the drugs. Finding issues is a massive amount of work for no financial reward.
Media is not motivated because criticizing it means you're making it harder for people to get life saving drugs, supposedly.
A manic side effect is possible, they categorize it as bipolar disorder, no evidence for that. The entire diagnostic system is subjective. They look at worsesning as the original condition or a new one. they never diagnose it as a worsenenign of what they did, cuz then they'd be wrong.
healthcare system incentives turnover.
Drugs make psychiatry an elevated profession, they have the drugs they are the doctors. If it mental and can be fixed then a personal trainer could be on the same level, they don't like that.
Thinking about or talking about your issues all the time just make it worse.
Similar to vodka, works but isn't a treatment.
Drugs on drugs, drugs to treat the drugs that they're one
PSSD also promotes homosexual or asexual since they lose that drive.
Pregnant Woman: Drugs freely cross the placenta. Mice exposed in utereo, they develop autistic like behavior. In humans there are 12 MRI kids that showed their central processing has been altered permanently. 10% of pregnant women take antidepressants.
School shootings - Get the numbers exactly, trans SSRIs
1. Any long term studies done? no, check
Doctors don't try the SSRIs and drugs they administer. like doctors running away from the X ray
Side effects:
1. hide the underlying issue. like energy issues from diabetes or bad lifestyles. These drugs just hide the underlying issue which make it worse.
2. PSSD: Post SSRI sexual dysfunction, 70% of people. ED and others. They say that it's temporary but an increasing number of people are developing permanent issues like genital anaesthesia. Some people recover in a few years, others it lasts decades or forever. Europe already has it on the drug labels for SSRIs
3. Brain Damage, cognitive issues. No focusing and all that
4. Emotional distance, no feeling good either, like a lobotomy. That makes suicide easier. In clinical trials they are more likely to be suicidal while on SSRIs
5. The same way that if 10 people smoke, 9 have a good time but 1 gets a panic attack.
ADHD medication has no impact on academic performance, only behavior.
Putting someone on a stimulate makes something boring fun, try cocaine.
Poor diet and insulin resistant also increases brain fog
Weed is a big precursor for mania and schitzophrenia, psychosis. They download the role of weed and give them anti psychotics. Cannabis has increased massively in potency. Psychosis can endure for a year or two.

Anxiety

Bullshit

alex honnold's example of how people's references reset, they think everything is an emergency because their lives are so riskless.

Always Drugs, Never changes

It's always a drug to fix it, never a lifestyle change.

ADHD - Chilren

addreall, amphetamine

why is it even bad if a kid is hyperactive in a concrete prison.

Lead impacting ADHD

Drugging a child

Isolation - the real danger

Being socially isolated is the worst, most of the time it's just about pople not having anyone to talk to

When it's Real

There are legitimate cases of when therapy is needed, mainly during real external crises. Real crises like actual rape in an alley, not raped by a husband. PTSD from war. Torture in prison. Abuse as a child. Those also by the way can be solved by just having someone to talk to.