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huuhee3

Then it's still no worse than widely used SSRI's, which also mostly don't differ from placebo

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I don't think SSRIs "mostly don't differ from placebo".

SSRIs only seem to work while you take them.

Some report side-effects that make them not worth it.

Others report that they're life-changing.

The case for Ketamine is that some periodic (but not permanent) use would bring you out of depression, rather than put it in check by indefinite drug use. As far as I understand, this is what's being challenged.

The effect of SSRIs on depression is moderate but statistically significant:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5667359/

I suspect the response varies greatly by individuals: some respond a lot and some don't respond at all.

My experience with SSRIs was very positive. I took a low dose for depression for a few years and it helped significantly. I went off it a few years ago and my depression hasn't returned.

That study found a small effect size compared to placebo, and a large placebo response.

That seems consistent with OP's comment of "SSRIs...mostly don't differ from placebo" (emph added).

Also not addressed in the paper is the fact that SSRIs and SNRIs have well-known and pronounced side effects, with make it questionable whether double-blind studies are really fully blinded.

I’ve used both, ketamine and SSRI (fluoxetine to be exact). Ketamine didn’t do anything for me, other than being a funny experience, but it certainly did nothing for my depression.

Fluoxetine also didn’t magically cure my depression, but it made me more risk taking. And I certainly got the anti-depressant effect from the rewards of taking such risks (asking someone out, applying for a new job, asking for extra ketchup on your fries).

It’s still the patients job to fight the disorder, and SSRI can certainly help.

Don't post lies and FUD here please.

If you're gonna accuse someone of posting lies and FUD, at least have some sort of reference [0] to point to, please. Otherwise you're just participating in a "uh-huh!", "nuh-uh!" pissing contest.

[0] https://www.nature.com/articles/s41380-022-01661-0

You know SSRIs can work while the serotonin hypothesis is wrong right? And no - I'm just going to asking people posting FUD, like SSRIs dont work, to stuff it. If huuhee had posted some of the review articles problematising the performance of SSRIs we could have exchanged different studies and had a discussion. But they didn't, as you didn't even if you think you did. And don't accuse me of having a pissing contest when you are the one hufffing and puffing.

Telling people to shut up needs to come with a reference. Giving your opinion doesn't. The only people who care about the fact that you disagree with them are your friends and family. Strangers only care why you disagree with them. They don't know you personally.

> The only people who care about the fact that you disagree with them are your friends and family. Strangers only care why you disagree with them. They don't know you personally.

This is exactly my point. You've hit the nail on the head.

There's a simple reference that doesn't even need to be quoted: SSRIs are approved for treating depression in all major countries on Earth. And this approval required they pass phase 3 clinical trials, demonstrating effectiveness over placebo.

Also, given that they are typically preferred over other classes of anti-depressants (try-cyclics etc), we also know they have demonstrated better effectiveness than other drugs.

Given all this, it is obviously up to the person flippantly contradicting well-established medical practice to provide citations, or rightfully be accused of spreading FUD.

SSRIs are preferred because better tolerability and safety compensate for worse efficacy.[1]

[1] https://www.ncbi.nlm.nih.gov/books/NBK67142/

If it's so obvious and well-established, it shouldn't be hard to find some reference to support it, no?

How else would I know that the emperor is, indeed, wearing clothes?

Do you disagree that SSRIs are an FDA-approved treatment for depression, should I find references for that? Or do you not know what is the standard for FDA approval?

Does drug being approved by FDA prove its effectiveness? If you can demonstrate without reasonable doubt that it does, i.e. that it's virtually impossible for a drug to be both approved by the FDA and as effective as placebo, then that would make a good argument.

In any case, any argument is better than just a "Stop spreading FUD and misinformation, you antivaxxer"-style comment.

The standard for drug approval by the FDA is that the drug has proven to be more efficient than the controls in a phase 3 clinical trial, to the satisfaction of the FDA's experts. The ESA has similar requirements, as do the NHS and other national bodies.

Given this, I consider that the right prior is to believe that a drug that has been FDA, ESA, NHS and many other national bodies is actually more effective than placebo. Which means, the onus is on you to bring evidence if you want to claim they are not - otherwise, "Stop spreading FUD and misinformation" is the exact right response.

Edit: I should have written EMA(European Medicines Agency) not ESA (the European Space Agency).

> "Stop spreading FUD and misinformation" is the exact right response.

I strongly disagree. Everyone should have the right to "spread FUD and misinformation" as much as they like, and those who care should learn how to argue for the truth. Otherwise our society is pretty much guaranteed to devolve into a bunch of gullible morons.

The fact that nobody is willing to dig up any proof of effectiveness of SSRIs beyond "well, they're in use, so they must be good", but are perfectly okay with silencing people who disagree with them is both funny and scary to me. And annoying. Who the fuck are they to silence others?

It's exhausting to argue every obvious point over and over. If you want to claim that well established practices are wrong, it's up to you to bring the evidence. I'm not going to cite studies to prove the earth is round either.

As of a while ago, this was a very good discussion of the situation with research on this topic:

https://slatestarcodex.com/2014/07/07/ssris-much-more-than-y...

No one needs to reference decades mature globally established best practice.

True, bloodletting and leeches have been used for centuries. No need to reference them, or question them. Just trust the status quo.

The burden of proof is on the person making the initial claim, ie that SSRIs are no better than placebo.

If I say there's no teacup flying in orbit of Saturn, is the burden of proof on me? Or on the person telling me to stop spreading FUD and misinformation, because everyone knows there's a teacup orbiting Saturn?

Yes the burden of proof is on you. And in this analogy, the tea cups of saturn have been regularly observed for decades, so you have your work cut out for you.

The teacup is too small to be seen by any Earth's telescope.

Is the burden of proof still on me? Why?

Yes the burden is still on you. You're not just claiming you have not yet seen sufficient evidence of something existing, you are claiming it explicitly doesn't exist, ie that there has been some search conducted that should have found it if it had been there, but got a null result.

Of course in this case, not only can the tea cup be seen by Earth's telescopes, pictures of it are widely published in every book on saturn.

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