For some. If it works for you, you’re lucky. Especially if it’s the first drug you tried.
For others, depression treatment means bouncing around between different drugs and drug classes until landing on something that works, and doesn’t make things worse. For some people that’s a holy grail that doesn’t actually exist, and they won’t be helped by any of the “traditional” first-line treatments. (The SSRI, SNRI, tricyclic, etc. drugs).
Some of these take weeks before you even know if it’s working or not. If it doesn’t work, and you have to stop taking it, you either go cold turkey, risking bizarre withdrawal symptoms and/or worse mental issues, or its a slow taper of weeks to months. Best case scenario you feel dull and blah for a few weeks during that taper. Or you may experience worse symptoms. Either way, it’s a huge waste of time and resources, with a high degree of chance you’ll just say “fuck it” and make a choice that will make things even worse.
Now imagine repeating that cycle several times over, until you cross whatever arbitrary threshold your local health system deigns is enough suffering to allow them to give you the “treatment resistant” label and open the gates to newer, “non-traditional” treatments with a higher chance of actually working. This magic number of different drugs you have to try can vary based on local laws and your insurance. In my situation, it’s at least 7 different drugs, and you have to try one from each major category. (So 1 SSRI, 1 SNRI, etc…) You also must comply with all your provider’s instructions. If they want you to taper off, you can’t just say “fuck it”, you must take all the scheduled doses until that’s complete. You must be a good obedient patient until whatever authority applies to you decides you’ve had enough.
Patients in my area have to survive the drugs gauntlet I’ve described above, plus talk therapy, before they’re allowed to take advantage of the things which medicine already knows are just as safe and vastly more effective - it’s really fucked. Many don’t come out better on the other side of that process, which can take YEARS, and some don’t survive. The only exceptions to this are of course wealthy people who can just end-run around most of the rules because they have the ability to pay directly for the good stuff out of pocket.
Speaking of money, these treatments which are known to work more often for a greater percentage of people are often a lot more expensive in the short term - if they’re even available where you live. It doesn’t have to be that way but, thanks to regulatory capture, there is a boatload of overhead. These therapies all require licensing, certifications, a higher level of expertise and skill, etc., way way above and beyond just writing a script for, e.g., wellbutrin.
Because they all work for quite a while after a session, though, you don’t need them as often, and they cost far less in the long run. Sounds good, right? But insurance companies hate things like that. They would much rather you take one or more pills every day for your entire life. They especially like the ones that are difficult to get off of. So they force providers to tinker around with your brain chemistry for a while, with drugs that are just barely effective enough that they continue to be manufactured. They would love for you to give up or die during that phase of treatment, because then they don’t ever have to subsidize those expensive therapies which are more of an occasional appointment or even “one and done” treatment model.
Some turn to black market sources of ketamine, MDMA or psychs in a desperate attempt to treat themselves, but, naturally, not everyone coloring outside the lines has the knowledge or werewithal to test their drugs or use the correct dose/dosing schedule or provide themselves the proper mindset and environment like a professional would.
Mental health treatment can be a real wilderness for many.
This is congruent with my own experiences, from which I could draw at least one of two conclusions: 1, the science isn’t done on these medicines. How often outside of psychiatry do you hear “We have to find the cocktail that works for you”? 2, the industry isn’t worthy of caring for patients because money comes before patient care. “This treatment will probably work but so that we can buy a ninth yacht we’ll make you buy all these others first.”
For some. If it works for you, you’re lucky. Especially if it’s the first drug you tried.
For others, depression treatment means bouncing around between different drugs and drug classes until landing on something that works, and doesn’t make things worse. For some people that’s a holy grail that doesn’t actually exist, and they won’t be helped by any of the “traditional” first-line treatments. (The SSRI, SNRI, tricyclic, etc. drugs).
Some of these take weeks before you even know if it’s working or not. If it doesn’t work, and you have to stop taking it, you either go cold turkey, risking bizarre withdrawal symptoms and/or worse mental issues, or its a slow taper of weeks to months. Best case scenario you feel dull and blah for a few weeks during that taper. Or you may experience worse symptoms. Either way, it’s a huge waste of time and resources, with a high degree of chance you’ll just say “fuck it” and make a choice that will make things even worse.
Now imagine repeating that cycle several times over, until you cross whatever arbitrary threshold your local health system deigns is enough suffering to allow them to give you the “treatment resistant” label and open the gates to newer, “non-traditional” treatments with a higher chance of actually working. This magic number of different drugs you have to try can vary based on local laws and your insurance. In my situation, it’s at least 7 different drugs, and you have to try one from each major category. (So 1 SSRI, 1 SNRI, etc…) You also must comply with all your provider’s instructions. If they want you to taper off, you can’t just say “fuck it”, you must take all the scheduled doses until that’s complete. You must be a good obedient patient until whatever authority applies to you decides you’ve had enough.
There are a few things out there with much higher success rates, like ketamine therapy, MDMA therapy, psylocybin and electroconvulsive therapy (which sounds really scary, but it’s been and continues to be refined and modernized, and currently has a success rate of about 60%, which is considered very good).
Patients in my area have to survive the drugs gauntlet I’ve described above, plus talk therapy, before they’re allowed to take advantage of the things which medicine already knows are just as safe and vastly more effective - it’s really fucked. Many don’t come out better on the other side of that process, which can take YEARS, and some don’t survive. The only exceptions to this are of course wealthy people who can just end-run around most of the rules because they have the ability to pay directly for the good stuff out of pocket.
Speaking of money, these treatments which are known to work more often for a greater percentage of people are often a lot more expensive in the short term - if they’re even available where you live. It doesn’t have to be that way but, thanks to regulatory capture, there is a boatload of overhead. These therapies all require licensing, certifications, a higher level of expertise and skill, etc., way way above and beyond just writing a script for, e.g., wellbutrin.
Because they all work for quite a while after a session, though, you don’t need them as often, and they cost far less in the long run. Sounds good, right? But insurance companies hate things like that. They would much rather you take one or more pills every day for your entire life. They especially like the ones that are difficult to get off of. So they force providers to tinker around with your brain chemistry for a while, with drugs that are just barely effective enough that they continue to be manufactured. They would love for you to give up or die during that phase of treatment, because then they don’t ever have to subsidize those expensive therapies which are more of an occasional appointment or even “one and done” treatment model.
Some turn to black market sources of ketamine, MDMA or psychs in a desperate attempt to treat themselves, but, naturally, not everyone coloring outside the lines has the knowledge or werewithal to test their drugs or use the correct dose/dosing schedule or provide themselves the proper mindset and environment like a professional would.
Mental health treatment can be a real wilderness for many.
tldr
This is congruent with my own experiences, from which I could draw at least one of two conclusions: 1, the science isn’t done on these medicines. How often outside of psychiatry do you hear “We have to find the cocktail that works for you”? 2, the industry isn’t worthy of caring for patients because money comes before patient care. “This treatment will probably work but so that we can buy a ninth yacht we’ll make you buy all these others first.”