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Comment by Aurornis | Hacker News Reader

> what about effect size and remission rate? This feels a bit like cherrypicking

Trying to pull out NNT feels like cherry picking because it sounds really bad to people who don’t know how other drugs look on this measure.

If your point is that it would be better if we had better drugs then I agree.

I think trying to imply that SSRIs are barely a step above useless is not helpful, though. Statistics like NNT and remission rates do not capture incremental improvements that these medications can make for people who need all the help they can get. Even if it doesn’t cause complete remission by itself it can be very helpful.

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> If your point is that it would be better if we had better drugs then I agree.

My point is that there are other interventions which do have an effect size over the perceptual threshold. Exercise is a big one, but there are lots - sleep deprivation, intensive therapy, the esketamine class, TMS, ECT in extremis, (nature exposure and other seeming woo like that need study but are promising) are all significantly better than handing someone an SSRI. And many of those don't have the withdrawal symptom and side effects under treatment that SSRIs do. People are, in aggregate, being harmed by SSRIs displacing things that work right now, and also displacing the urgency of new drug development in the space.

The gap is that, in an acute treatment setting, people are being handed a drug that cannot be effective for at least a week or two, up to 6-8 weeks, instead of drugs that work in hours or days.

It's the first time I've seen sleep deprivation mentioned as an antidepression tool. Anecdotally, I have an acquitance that has mentioned a couple of times how he feels wonderful when he doesn't get any sleep (he sometimes partakes on weekdays all night hangouts), but I always thought that was just a little psychosis and not much more. Or were you meaning to fix sleep deprivation as the treatment?

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