Talk:Antidepressant/Archive 1

Archive 1

Archive 2

Controversy

There's a large body of recent research suggesting anti-depressants either have a very small or non-existent effect, and that anywhere from 75-90% of their efficacy is accounted for by variations on the placebo effect (50-75% from the classic placebo effect itself, and another 15-25% from the unblinding effects that take place in studies that use sugar pills instead of active placebos—which is many of them). Some research even indicates that some of the physiological changes in brain function are mimicked by placebos as well. This is obviously controversial, but I think needs to be at least mentioned. Is anyone familiar with this able to write something up? If not, I'll try to put something in eventually. For reference, some papers on the subject include:

• Enserlink, M. (1999). Psychopharmacology: can the placebo be the cure? Science 284: 238-240
• Even, C. Siobud-Dorocant, E., and Dardennes, R.M. (2000). Critical approach to antidepressant trials: Blindness protection is necessary, feasible and measurable. British Journal of Psychiatry 177(1): 47-51.
• Kirsch, I. & Sapirstein, G. (1998). Listening to Prozac but hearing placebo: a meta-analysis of antidepressant medication. Prevention and Treatment 1, article 2a, posted July 28, 1998. http://journals.apa.org/prevention/volume1/pre0010002a.html
• Mayberg, H.S., Silva, J.A., Brannan, S.K., Tekell, J.L., Mahurin, R.K., McGinnis, S., and Jerabek, P.A. (2002). The functional neuroanatomy of the placebo effect. American Journal of Psychiatry 159(5): 728-737.
• Moncrieff, J., Wessely, S., and Hardy, R. (1998). Meta-analysis of trials comparing antidepressants with active placebos. British Journal of Psychiatry 172: 227-231.
• Parker, G., Anderson, I.M., and Haddad, P. (2003). Clinical trials of antidepressant medications are producing meaningless results. British Journal of Psychiatry 183(2): 102-104.

--Delirium 03:14, Dec 10, 2003 (UTC)

Well, that is all well and good but I think all the antidepressant articles here on wikipedia seem to focus on the negative with little to know discussion of the benefits. And there are many, many, many studies showing the effectiveness of these medications. Most pschiatrists, many of them intelligent competant people have found these meds very effective in treating depression. There needs to be more coverage of this.

protohiro 17:35, 22 July 2005 (UTC)

I do worry that the controversy surrounding antidepressants is in danger of overshadowing what is surely its raison d'etre, which is the wellbeing of depression sufferers. Just a thought. Chris 10:59, 27 June 2006 (UTC)

As I understand it, that's precisely the controversy---whether antidepressants contribute to the wellbeing of depression sufferers, or fail to do so. --Delirium 21:55, 21 December 2006 (UTC)

Precisely. The "controversy" originated with case histories of depressed patients whose condition either did not improve or seriously worsened when they were treated with ADs, and with patients who discontinued ADs and found themselves substantially worse than before they began treatment. Even people like Glenmullen and Healy aren't denying that drug therapy has its uses, they're questioning the absolute faith in drug therapy on the part of psychiatry, precisely BECAUSE of their concern for the well-being of people with depression. The reason most WP articles on this subject contain large amounts of information about the controversy is because the controversy is very real and taken very seriously by anyone who has studied the possible negative effects of antidepressants (or indeed, experienced them). It would be POV to play this down, not to mention it 82.37.58.152 22:44, 26 December 2006 (UTC)

The placebo effect is important in another way. I once came across an article on the difficulty of conducting genuinely blind clinical trials. Many candidate antidepressants have clear side-effects. Test subjects will feel these and guess (correctly) that they are on the drug and not the control (e.g. a sugar pill). This could increase the placebo effect for these patients and invalidate the trials. Pigkeeper 21:06, 14 May 2007 (UTC)

Ding! Ding! Ding! We have a winner everybody. If there wasn't so much monetary interest in their success, anti-depressants would face the scrutiny they deserve. 121.209.147.52 (talk) 14:43, 2 October 2008 (UTC)

It's still important to understand that these drugs are made for something scientists don't understand fully. They're doing an incredibly good job for something with such wide diversity in symptoms and causes. These blanket drugs aren't perfect but they are a stop-gap until something better is developed. 122.58.105.95 (talk) 08:46, 6 June 2009 (UTC)

The problem is that they are not actually doing an incredibly good job. They only perform nominally better than even an inactive placebo. Even some of the drug companies admit this publically -- A spokesperson for Pfizer cited the 'wealth of scientific evidence documenting [antidepressants'] effects,' but went on to say that the fact that antidepressants 'commonly fail to separate from placebo' is 'a fact well known by the FDA, academia, and industry.' according to News Week's article "The Depressing News About Antidepressants". 69.141.179.81 (talk) 18:06, 2 February 2010 (UTC)

isoniazid not mao inhibitor should be iproniazid

This discussion topic was apparently created by 130.126.49.10 way back in 2003, but it doesn't look like it has been discussed or implemented yet. As far as I know, isoniazid has no MAOI or antidepressant efficacy, and iproniazid was the first synthetic MAOI and antidepressant. This is one source which could be cited.

Also, perhaps the article should mention that harmala alkaloids and other naturally occuring MAOIs existed and were used medicinally and spiritually long before the synthesis of iproniazid, although these MAOIs were generally completely impractical for the treatment of depression. Perhaps that belongs on the MAOI page, instead.Fluoborate 04:45, 3 January 2007 (UTC)

---

First of all, I reordered the classes list to put the drugs in rough chronological order. The MAOIs came first, then the TCAs, etc. Second, I removed the class of "norepinephrine reuptake inhibitor". I did this because, unlike serotonin, norepinephrine does not have a class of drugs that selectively targets its reuptake (at least as far as I know. If I am wrong, please correct me). Instead, there are a number of drugs, such as Venlafexine, Wellbutrin, Mirtazapine, the TCAs, etc, that target norepinephrine as well as either serotonin, dopomaine, or both. So a seperate class doesn't really fit. Thirdly, I removed the drugs given as examples after some of the classes. Having only examples for one or two classes seemed strange, and some of the examples were wrong. Mostly it just seemed like clutter. Defenestration 19:26, 18 Mar 2004 (UTC)

Okay, I was wrong. Norepinephrine reuptake inhibitors DO exist, only they are called Noradrenaline Reuptake Inhibitors (NARIs), to avoid the confusion of mixing acronyms with SNRIs, I presume. Two exist, reboxetine and atomoxetine, though neither are approved for treating depression in the US. I added a link for the NARIs, and may getting around to writing up a page for them eventually. Defenestration 21:59, 15 Apr 2004 (UTC)

---

where are the related links???

Dysphoric?

To quote from the article: "Certain antidepressants can initially make depression worse, can induce anxiety, or can make a patient aggressive, dysphoric or acutely suicidal." Is what's being alluded to here by use of dysphoric the blanket concept of dysphoria or the concept of gender dysphoria? Antidepressants are often prescribed to transsexuals, especially transwomen, so the latter wouldn't surprise me. Arivia 11:46, 24 July 2005 (UTC)

Dysphoric almost certainly refers to dysphoric mood in this context and definetly does not refer to gender dysphoria. Also while antidepressants would be prescribed to a transexual suffering from Major Depressive Disorder or an anxiety disorder, the suggestion that it is 'often' used to treat transsexualism is categorically wrong. djheart 19:46, 26 September 2005 (UTC)

How do they work?

Cut from intro:

... antidepressants function generally by interacting with the neurotransmitters (signalling chemicals) in the brain believed to influence mood"

This is unclear. What sort of "interaction" do occurs in the brain, when people take these drugs.

How does this affect mood? And who says so, and why do they only "believe" it? Don't they know for sure?

What sorts of studies have been done on the effectiveness of these medications? How much better are they than placebos? How much better than various kinds of therapy?

Dr. David D. Burns, a practioner of rational-emotive therapy, claims a high success rate. Yet we have no article on his approach. I'm not even sure if its his own approach, or is a common practice. Uncle Ed 15:38, 19 October 2005 (UTC)

It is generally known that antidepressants interfere with neurotransmitters, such as serotonin, dopamine and noradrenaline. It has little to do with belief - this has been confirmed experimentally.

All registered antidepressants have a measurable effect on mood. Some are only marginally better than placebos, while others can cause a significant improvement. Natural counterparts (St John's wort) do appear to have some effectivity but with more side-effects.

Rational-emotive therapy is one of the modalities used in clinical depression, and moderately succesful. It is not just Dr Burns who propagates this approach. Psychotherapy and cognitive therapy should ideally be offered to all patients with depression. JFW | T@lk 03:46, 20 October 2005 (UTC)

Most of the first-line drugs interact with neurotransmitter receptors, not the transmitters themselves (I say most because the MAOIs aren't like that), as described here. Another reason that so much research went into catecholamine presence-increasers was reserpine, the catecholamine-depleting herbal antipsychotic/antihypertensive that was reported to cause depression in long term users and is used in animal models of depression even today. And then there the finding that depressives had lower levels of certain neurotransmitter metabolites in their cerebrospinal fluid compared to the general population (that's not the earliest reference by any means; they've been seeing this since at least 1966.) But there is now evidence that monoamines are not the entire story. That, and the very existence of a drug like tianeptine, the selective serotonin reuptake enhancer. Funny story: tianeptine is classified as a TRICYCLIC antidepressant.--Rmky87 21:02, 6 November 2005 (UTC)

"Antidepressant is a medication"!? Necessarily?

What about electroshock and deep brain stimulation? -fnielsen 16:36, 22 October 2005 (UTC)

These are not antidepressants. These are treatment methods. Varnav 18:15, 23 October 2005 (UTC)

They are antidepressants in the literal meaning. They aren't antidepressant drugs though, obviously, which is to what this article alludes. 148.177.129.213 13:53, 26 October 2005 (UTC)

There is no proof, that antidepressante curing depressions. It is more so, that they remove symptoms of depression or shorten the time of this disease. --Fackel 21:15, 3 June 2006 (UTC)

Antidepressants ause deppresion.Darth Anzeruthi (talk) 22:03, 10 December 2007 (UTC)

Structured

I have restructured the article to have a more natural flow. The references apparatus is still a mess; I think select studies should be cited using Wikipedia:Footnote3 according to academic format. JFW | T@lk 23:31, 28 November 2005 (UTC)

Changes in controversy & efficacy

I moved the controversy efficacy section back up under mechanism of action. I know this may seem out of order. I did this because I think these drugs are too often considered to be amazing and mostly a positive treatment. So I wanted some questioning about that assumption to be right there near the top of the article. If that is unacceptable, and it MUST be moved then so be it.

I also added back the references because people should be able to access some of the studies question this treatment. The drug companies spend billions hyping themselves and never admitting to any wrong doing or problems - ever. So I think in this public forum, there should be some voice that allows for a different message - especially a message punctuated by researchers doing risky research. Tshann (talk • contribs)

Perhaps you could have discussed this first over here? JFW | T@lk 08:15, 20 December 2005 (UTC)

I removed the pile of references:

• Hollon SD, DeRubeis RJ, Shelton RC, Weiss B (2002), The emperor's new drugs: effect size and moderation effects. Prevention & Treatment 5:Article 28. Available at: journals.apa.org/ prevention/volume5/toc-jul15-02.html.
• Jacobson NS, Roberts LJ, Berns SB, McGlinchey JB (1999), Methods for defining and determining the clinical significance of treatment effects: description, application, and alternatives. J Consult Clin Psychol 67(3):300-307.
• Kirsch I, Sapirstein G (1998), Listening to Prozac but hearing placebo: a meta analysis of antidepressant medication. Prevention & Treatment 1: Article 0002a. Available at: journals.apa.org/prevention/volume-1/toc-jun26-98.html. Accessed Aug. 2, 2002.
• Kirsch I, Scoboria A, Moore TJ (2002b), Antidepressants and placebos: secrets, revelations, and unanswered questions. Prevention & Treat-ment 5:Article 33. Available at: www.journals. apa.org/prevention/volume5/toc-jul15-02.html. Accessed Aug. 2.
• Klein DF (1998), Listening to meta-analysis but hearing bias. Prevention & Treatment 1:Article 0006c. Available at: www.journals.apa.org/prevention/volume 1/toc-jun26-98.html. Accessed Aug. 2, 2002.
• Thase ME (2002), Antidepressant effects: the suit may be small, but the fabric is real. Prevention & Treatment 5:Article 32. Available at: journals.apa.org/prevention/volume5/toc-jul15-02.html. Accessed Aug. 2.
• Walach H, Maidhof C (1999), Is the placebo effect dependent on time? A meta-analysis. In: How Expectancies Shape Experience, Kirsch I, ed. Washington, D.C.: American Psychological Association, pp321-332.
• Moncrieff, J., Wessely, S., and Hardy, R. (1998). Meta-analysis of trials comparing antidepressants with active placebos. British Journal of Psychiatry 172: 227-231.
• Parker, G., Anderson, I.M., and Haddad, P. (2003). Clinical trials of antidepressant medications are producing meaningless results. British Journal of Psychiatry 183(2): 102-104. * Enserlink, M. (1999). Psychopharmacology: can the placebo be the cure? Science 284: 238-240

Tshann, I agree there should be a section on this subject, but citing a long list of references is completely off-balance. Please select one or two solid studies or commentaries from this list, but do not flood the article just because these articles are mildly "critical of antidepressants". There's a lot of Kirsch work - are you sure the initial list was not an attempt at Vanity? JFW | T@lk 08:23, 20 December 2005 (UTC)

Jfdwolff, I'm confused. Why is citing a long list of references off-balance? I think when you look at the overall size of this article on antidepressants - the bulk of it suggests that antidepressants are an application of scientific medicine. I think it is WAY to unbalanced in favor of that assumption. When reading through the articles on those links I've pasted in, it is quite clear that much of the reality of antidepressants is not much more than industry hype. The bulk of this article is about theory and opinion, but what about prove of efficacy. Medicine is suppossed to be able to show efficacy, otherwise theories are simply theories. Sure that is my opinion, but I think citing those studies is critical in balancing out the overhype that antidepressants get. In addition, the bottom of the article has little or no reference to the contoversy about antidepressants. As for Vanity in citing the articles, again I'm confused. I looked at the concept of vanity from the standpoint of Wikipedia. It suggests that authors are using an article to promote themselves in some way. I fail to see how citing some controversial antidepressant links/studies has anything to do with me, my image, or my gain. I'm sure you had more than a passing reason to use that term, so please explain yourself. ThanksTshann 16:42, 6 January 2006 (UTC)

Novel antidepressants?

I'm asking on here because I think this article has more visibility... What precisely is a novel antidepressant? Specifically, would the ones in List of antidepressants#Others all be considered novel antidepressants? --Galaxiaad 15:06, 26 July 2006 (UTC)

I think so. Historically, it seemed to be a catch-all for anything that wasn't categorised as an MAOI, a TCA or an SSRI. I think I remember at one point the tetracyclics might've been included in that category. Chris 15:55, 26 July 2006 (UTC)

Copyright violation

Either this article is copied from [1] or vice versa. 163.1.162.20 13:06, 16 November 2006 (UTC)

2

Spam Cleanup

As part of spam cleanup effort, tested all external links, deleted several broken ones, removed spam tag. Cmichael 03:50, 15 March 2007 (UTC)

Nonsensical Sentence in "Antidepressant" article

In the "Antidepressant" article, the following sentence is illogical: "It is also reported that, despite unequivocal evidence of a significant difference in efficacy between older and newer antidepressants, clinicians perceive the newer drugs, including SSRIs and SNRIs, to be more effective than the older drugs (tricyclics and MAOIs).[26"

IT IS PRETTY CLEAR THAT THE INTENTION HERE WAS TO SAY THAT THERE IS NO DEFINITE EVIDENCE OF A SIGNIFICANT DIFFERENCE IN EFFICACY BETWEEN OLDER AND NEWER ANTIDEPRESSANTS, BUT THAT IS NOT WHAT THE SENTENCE, AS IT STANDS, SAYS.

(ELAINE BLUME; [email protected])

70.18.243.200 15:23, 11 July 2007 (UTC)

Clean up tag

How can I help with clean up? --9urges 15:57, 27 August 2007 (UTC)

Link to Violent Tendencies

Although you can find links to this blog from other wiki pages like the Columbine Massacre page, there's nothing here actually discussing possible links between antidepressant use and homocidal tendencies. Suicidal tendencies are mentioned, but not murder sprees, as occured in Columbine, the more recent VA tech school massacre and quite a number of news stories (I actually went looking for this information after a news story today mentioning yet another inter-family murder/rape/attemtped-murder episode where the teen involved was on anti-depression medication of some sort).

It would be interesting to see what percentage of random, "brutal" attacks are coming from people who are on anti-depressant medication, if such a statistic can be found.

I seperated this query from "Controvery", since Controversy is discussing whether anti-depressants work. I'm more interested in the psychological costs, regardless of if they work or not. --TheCynic 17:53, 5 September 2007 (UTC)

I reckon there's a strong positive correlation between antidepressant use and these killing sprees. Or more like these killers take them and then end their medication, wait a couple of months.. and killing spree it's. 2 recent cases: Kauhajoki in Finland and the one yesterday in Germany. 84.248.33.104 (talk) 14:42, 12 March 2009 (UTC)

They cause deppresion

Anitdepresants cause deppresion and lead to viiolent behavior. The shooter in ther mall in nebraska use them.Darth Anzeruthi (talk) 22:05, 10 December 2007 (UTC)

Please provide citations, and read WP:NOT#SOAP Parsival74 (talk) 22:09, 10 December 2007 (UTC)

More antidepressants and augmentors

I can think of a number of other antidepressants and augmenters, but these are generally either uncommon or far-off-label uses for common medications or procedures. Deep brain stimulation and other psychosurgeries are interesting, but are very rarely used for depression in practice, unless the patient needs DBS for their Parkinson's anyway. Perhaps the page should mention past antidepressant measures, like frontal lobotomy, metrazol shock therapy, and insulin shock therapy. Another procedure is transcranial magnetic stimulation. Dopamine agonists like pramipexole have shown a little bit of promise in depression studies. Pindolol is thought to speed the response to SSRIs when used as an adjunct. Levodopa is often good for associated depressive symptoms in Parkinson's patients, but not necessarily in normal depression. Do people think any of these should be included? Can people think of even more treatments?

Also, I don't think electroconvulsive therapy is mentioned enough in this article. The procedure is quite en vogue now, and I think that due to its prevalence and efficacy it deserves a section in the article.Fluoborate (talk) 01:45, 19 December 2007 (UTC)

Disupted section - Most commonly prescribed antidepressants

It appears that the list of most commonly prescribed antidepressants in the article conflicts substantially with the list in the citation[2] given. Am I missing something here? Should the list simply be removed? I did an initial search for a reliable and more easily interpreted alternate source but didn't find anything useful. From what I can tell, it looks like the list in the article is not accurate. Zahnrad (talk) 06:19, 15 February 2008 (UTC)

Please explain for which antidepressants on the list you observe the conflicts. Before answering please read the footnote fully and do the addition. Paul gene (talk) 11:12, 15 February 2008 (UTC)

The combination of the two PDFs in the single citation was initially misleading and thus made it appear that the lists did not match, since they were in different orders. But, that's why I asked on the talk page rather than simply deleting the list -- I figured I could be missing something, which is now apparent. I see that you added the list, Paul gene, and it's certainly an improvement over the previous one. Have you considered presenting it in the form of a table? It seems like it might suit the type of data well. Zahnrad (talk) 12:36, 15 February 2008 (UTC)

Zahnrad, I agree it is confusing, but I am not sure what the best way to refer to these two PDF's would be. Please go ahead and improve it. The same goes about presenting the info in the table . What I did was just a fast fix. Paul Gene (talk) 03:39, 16 February 2008 (UTC)

I would like to update the numbers for 2007. (I may also convert this section to a table.) I also checked the numbers from 2006. All my numbers agree exactly with the given numbers, except bupropion. The article lists 21.141 million, but I only got 17.824. I added three specific entries to get this: bupropion SR, bupropion ER, and Wellbutrin XL. I could not find any other entries for bupropion, Wellbutrin, Zyban, or amfebutamone in 2006. Does anyone know if there is something I'm missing? (It seems especially important as this drug seems to have dropped dramatically in popularity to only 11.882 million in 2007, but I can't be sure if that's true or if there is another name that became more popular.) Silroquen (talk) 20:24, 23 October 2008 (UTC)

Nevermind, it finally occurred to me to subtract, and so I found the missing name, Budeprion. This did make a big difference in 2007. Silroquen (talk) 20:54, 23 October 2008 (UTC)

article cleanup tag

Doing a quick survey of the article I see several significant problems. Some sections are written in the style of a high school essay. They are lopsided, poorly written, and provide no citations. What do others think?--scuro (talk) 12:04, 22 June 2008 (UTC)

No, this is much worse than a high school essay. Some comments and suggestions:

• "Types of antidepressants - SSRIs" includes information on mechanisms of action and efficacy which belong in other sections
• Much of the "Types" section is unreferenced
• The "Augmenter drugs" subsection is chaotic, overinclusive and can be largely deleted or have parts placed in other sections.
• "Prescription trends" reads like a series of unrelated sentences.
• The "most commonly prescribed" list should be changed to a table, perhaps comparing different countries.
• "Mechanism of action" section is difficult to read and over-technical in parts, and the "anti-inflammatory" subsection has undue prominence
• "Therapeutic efficacy" should expand the "clinical guidelines" subsection and cut out much of the rest (most important research is already included in the clinical guidleines publications); there can be a subsection in the placebeo effect in antidpressants, which is topical and important; possibly needs a subsection comparing efficacy of antidepressants and psychotherapy, and a subsection on children and adolescents
• Tolerance and dependance" needs citatons and re-writing
• The "Side effects" section ... where to start? needs re-structuring and referencing
• "Controversy" - all of this can be included under Efficacy or Side Effects
• "Lawsuits" section full of weasel words
• "Non-mainstream" needs to be re-structured. Opiates have undue prominence.
• Uses of antidepressants for problems other than depression is mentioned in the intro but not in the main body of the arrticle

Anonymaus (talk) 20:39, 16 July 2008 (UTC)

Cannabis

There's a part on cannabis use that sounds awfully pro legalisation or at least doesn't read like wikipedia should. Specifically, "If someone is caught by law enforcement with this substance that helps them enjoy life, they are looked at as criminals, rather than someone that is fighting for their life on a daily basis." This should be re-written. Max white (talk) 00:15, 30 August 2008 (UTC)

Contested statements removed to talk

• Although recent drugs may have fewer side effects, patients sometimes report severe side effects associated with their discontinuation, particularly with paroxetine and venlafaxine{{Fact|date=January 2007}}.
• The paper in question has been severely criticized by independent researchers, however.{{Fact|date=April 2008}}
• More than half of the 47 studies found that patients on antidepressants improved no more than those on placebos, Kirch says. "They should have told the American public about this. The drugs have been touted as much more effective than they are." He says studies finding no benefit have been mentioned only on labeling for Celexa, the most recently approved drug. The others included in his evaluation: Prozac, Paxil, Zoloft, Effexor and Serzone.{{Fact|date=April 2007}}
• The documentary claims Seroxat could not be proven to work for teenagers, and that one clinical trial indicated they were six times more likely to become suicidal after taking it.{{Fact|date=February 2007}}

Please do not restore this information to the article without a citation.--BirgitteSB 02:21, 16 February 2009 (UTC)

While I didn't add that, I can attest to it being true for me. I've been on several AD's since 4 years ago and developed suicidal tendencies. 1 drug for 1 year about, and every time it got worse. But it doesn't really matter about my personal experience. I don't know who added that, but I'll try to find a citation to help along with the article. 68.51.41.46 (talk) 20:35, 25 February 2009 (UTC)

Hypercytorism?

Per a Medline/NIH search, this term does appear in medical literature, and a general web search results in the same verbatim line that appears in the article here:

"Also, antidepressants have been used for hypercytorism, with mixed reviews..."

Does anyone have any idea what condition is being referenced and where that might be cited? Since this is not my specific field, I wanted to check in before I deleted this. dio (talk) 13:45, 17 December 2009 (UTC)

I think this should go - can't find use of this term elsewhere. StripeyBadger (talk) 00:23, 16 January 2010 (UTC)

I concur with your observation(s); as a matter of fact not only online search but also my medical literature and/or encyclopedias do not reveal any information on such "term". I believe it needs to go and will go ahead and remove that item.Aceofhearts1968 (talk) 19:47, 6 March 2010 (UTC)

Error in dopamine column of comparison chart

There is an error in the comparison chart if one tries to arrange it according to dopamine reuptake. —Preceding unsigned comment added by 83.70.79.146 (talk) 18:46, 3 March 2010 (UTC)

this article is overdue for clean up

we all discuss the issues but the sad truth is that the article is disorganized and hard on the general public reader; it rambles on and on where it needs be succinct and i simply do not have the time to sit an rewrite it, although that is exactly what needs to happen... Aceofhearts1968 (talk) 19:55, 6 March 2010 (UTC)

More recent chart of antidepressant use (number of prescriptions in US)

The chart on the number of antidepressants prescribed in US is for 2007. Can't we get a newer version? I assume the data is published periodically and that of 2009 should be available by now. —Preceding unsigned comment added by 24.80.227.81 (talk) 12:34, 17 July 2010 (UTC)

Lead

This long-winded section on the antidepressant effects of opioids and other drugs not (or no longer) used as antidepressents per se doesn't belong in the lead by any stretch of the imagination. It should be cleaned up and moved elsewhere.

Opioids, specifically buprenorphine and tramadol, have demonstrated clinical superiority, both in terms of anti-depressant efficacy and tolerability, to all conventional anti-depressants. Nearly 90% of patients with unipolar non-psychotic refractory depression (defined as failure to respond to two first-line and one second-line treatments) treated with low-dose buprenorphine experienced a mild to marked improvement on self-reported depression scales and 20% of patients experienced a complete remission of all depressive symptomology . Similar results were recorded of tramadol as well, although tramadol had a tendency to exaggerate anxious symptomology in anxious and agitated depression, whereas buprenorphine reduced anxiety. The anxiolytic effect of buprenorphine is likely linked to its competitive antagonist action at the kappa opioid receptor, whereas the anxiogenic effect of tramadol is due to its serotonin-releasing action and inhibition of norepinephine reuptake. Opioids have the benefit of nearly immediate onset, with most patients experiencing relief from the first dose. Depending on the opioid, it can take from one to four days to reach optimal therapeutic concentration. This is a great advantage for patients in an acute-care setting, as the response - or lack thereof - to treatment can be monitored and the dose likewise adjusted to optimal levels in an average one to two-week hospital stay. At the end of such a hospital stay, it would be known if a specific opioid anti-depressant would be efficacious or not, unlike the SSRIs, which take a minimum of two - and often four to six - weeks to show any appreciable effect beyond placebo, even if they will have a positive effect. Most of the objective and subjective effects of thymoleptic drugs in the first week are adverse reactions. Due to this "therapeutic lag" of a minimum of several weeks for the thymoleptic antidepressants, depressed patients are often released without knowledge of whether their treatment will be effective, and without knowledge of how effective it will be if it is effective - only knowledge that the side effects of their medication are tolerable. Opioids were used as anti-depressants from the late 19th century until the introduction of the monoamine oxidase inhibitors. Amphetamines were also used as anti-depressants from the early 20th century until several years after the introduction of monamine oxidase inhbitors - of which the prototypical member of the class, phenelzine, is an analogue of amphetamine - which supplanted all previous anti-depressants, although their efficacy was never established to be greater, and the incidence of adverse effects was much greater, than with either the opioids or amphetamines. The later anti-depressants, the SSRIs, of which fluoxetine is prototypical, were developed from first-generation anti-histamines, such as tripelennamine, that showed an anti-depressant effect. Amphetamines also have the advantage of immediate onset, within twenty-four hours: if a response is not noted in that time, it is likely the medication will be ineffective.

—Fvasconcellos (t·c) 15:30, 18 July 2010 (UTC)

Difference between antideppressant and deppressant drugs

Because of their names, one may think one has the opposite effect of the other. —Preceding unsigned comment added by 4ll4n (talk • contribs) 07:00, 30 July 2010 (UTC)

Herbal antidepressants

I just added a section on herbal antidepressants. There's a wealth of information out there about these, St. John's wort is already mentioned extensively in the article but there are a number of others that have been less well-studied. I'm not 100% sure where to put these. It seemed better to make a separate section, rather than including it under "types of antidepressants" because the types are classified by mechanism, and the mechanism of most herbal antidepressants is poorly understood, with the possible exception of St. John's wort. In some ways it's like comparing apples to oranges because the herbs have hundreds of years of documented use, in contrast to modern antidepressants, and yet have sparse scientific studies about them. This is why I think it would be best to keep them in separate sections for now.

But I'm not convinced that I've found the best place to add this material on the page, so I'm open to having it be moved around and to discussion about where it should be placed on the page. Cazort (talk) 20:23, 1 October 2010 (UTC)

"People do well on Marijuana"?

On this page, right at the bottom under "Other Treatments"

"Marijuana - The use of marijuana, in moderation, has shown to be of benefit in severely depressed patients. Many people that do not respond well to the use of traditional antidepressants, or who do not like the many unpleasant side effects, prove to do rather well using this plant in moderation"

Where is the substantiation for this statement?

Applet (talk) 22:26, 19 October 2008 (UTC)

I found this topic interesting and searched for it and was unable to find anything. This doesn't mean there aren't any studies out there, but I personally was not able to find any. The only work I found studying marijuana use and depression points towards a negative effect of heavy marijuana use (contributing to depression). Although a causal link has not been firmly established, it has been suggested that heavy marijuana use causes depression; it's unknown whether the association is truly causal or is just due to other factors: [3] Cazort (talk) 21:04, 2 October 2010 (UTC)

St. John's Wort is not a drug

St. John's Wort is a common naturopathic remedy and should not be classified as a drug. Only substances controlled by the FDA or other governing agencies should be labelled this way.

Continually referring to herbs and vitamins as drugs only further pushes the idea that these (as of now) relativity inexpensive prescription alternatives should be controlled by governments.

207.199.249.153 06:11, 9 June 2007 (UTC)

St. John's Wort may not be a drug, but hyperforin and hypericin, the active ingredients in St. John's Wort, most certainly are. Acting like taking SJW is different from taking a drug is just ignorant. Plants that work as medicines work BECAUSE they have drugs in them. On Thermonuclear War (talk) 03:29, 9 March 2008 (UTC)

This is an incredibly ignorant statement. Drugs are drugs and plants are plants. The above assertion that, "plants that work as medicines work because they have drugs in them" is idiotic. Plants are natural and any effects from them are natural as well. —Preceding unsigned comment added by 71.107.63.56 (talk) 21:31, 16 April 2009 (UTC)

However! St John's Wort in herbal pill form is incredibly unregulated and the effectivity is not guarenteed. There is a huge difference of active ingredient even from pill to pill and I personally believe that they should be controlled in some way at least to make sure you are going to get steady results. The active ingredient contained is a drug. Asprin is derived from willow bark. It's orginally natural. Is it a drug? Yes. Many of the drugs we have and use are derived from plants. But they are still drugs. 122.58.105.95 (talk) 08:44, 6 June 2009 (UTC)

I think it is hard to argue that the components of St. John's wort or any herbal medicine are not drugs. Whether they are classified as a drug by the FDA is irrelevant; keep in mind that this classification is highly arbitrary and varies from country to country. In order to maintain a global WP:NPOV, we need to recognize the underlying universal truths and not write our articles from the perspective of the U.S. I would agree with someone who said that there are important differences between herbal remedies and synthetic drugs though...herbal treatments include many different chemical components, and it is often unclear which ingredients are "active" or "inactive", or if it is even possible to make this sort of distinction. As such, herbal treatments are often studied in two different ways--as a complete treatment (inclusive of whatever part of the plant is used, with all its chemical components) and study of individual components, like hyperforin and hypericin mentioned above. Yes, it gets more complex than with drugs that consist of a single chemical component. But I still think they're drugs. Should they be treated the same way on the page? I don't know. I think they probably should not be, which is why I created a separate section for herbal treatments. I think this is particularly true because synthetic western medicines tend to be classified by their mechanism of action or chemical family, both of which are well-understood. Herbal medicines, on the other hand, are often directly studied but their mechanisms are less well understood, and often they cannot be chemically classified because they have multiple active components, and in many cases, it's not even known which components explain which degree of their effectiveness. Cazort (talk) 19:03, 3 October 2010 (UTC)

Coverage and Structure

I feel the need to describe a few possible changes to this article, partly drawing together comments made by various people above which don't seem to have been acted on:

1) 'Antidepressant' doesn't necessarily mean a medication, or even treatment. This usage occurs in the titles of scientific articles:

• Antidepressant effects of light therapy combined with sleep deprivation are influenced by a functional polymorphism within the promoter of the serotonin transporter gene (2003)

• The Efficacy of Exercise as a Long-term Antidepressant in Elderly Subjects (2003)

• Does Semen Have Antidepressant Properties? (2002)

• and manuals e.g. "Seasonal affective disorder and the use of light as an antidepressant." from NIMH, 1988.

• or phrases like e.g. "Negative ions are a natural anti-depressant."

Perhaps this page could include a section on non-medication usage, or are separate pages needed..

2) The layout seems quite unclear to me. I think the intro could be reworded and extended to cover the basics and range of issues more. I think there could be a subsection on efficacy/effectiveness, describing the assertions and counter-assertions and main related studies & reviews (perhaps divided according to type med or disorder) rather than just a controversy section. What rationale is there for listing things like St John's Wort towards the end as 'Alternative' and not in the main section listing types of antidepressants. I think adverse effects would be a better subheading than side-effects and more consistent with the wikipedia page on that topic. Various random-seeming subheadings towards the end..

I think it's problematic to represent a specific treatment, like St. John's Wort, as "alternative" without source; this is a form of WP:Weasel Words. The article has been restructured though and I am satisfied with its current state as of writing this comment. Cazort (talk) 19:45, 3 October 2010 (UTC)

3) Does seem to need a footnote-type reference section, there being a lot of unsourced strong or informal claims, like "The main classes of antidepressants have similar efficacy", "Although these drugs are clearly effective in treating depression", "a successful antidepressant trial involves at least 50% of the test subjects on the drug responding to the medication", "It is generally not a good idea to take antidepressants without a prescription", "Use of antidepressants should be monitored by a psychiatrist, but..."

Good insights; go at these comments...find sources for them or remove them. Any statement like this needs to be backed up with sources...and things like "clearly" are weasel words and need to be removed to maintain WP:NPOV. Cazort (talk) 19:45, 3 October 2010 (UTC)

Don't mean to seem critical but didn't want to start over-editing without mention here.

EverSince 22:17, 21 December 2006 (UTC)

I've rewritten the intro to try and frame the above points (+ avoid the copyright issue if there is one). I forgot to sign in first. EverSince 23:34, 22 December 2006 (UTC)

I've rewritten and expanded the history section. I'm planning to reorganise the various sections below it some time soon, if there's no reply I'll take it as no objection (in advance at least) to the idea. I'll also make all the references inline. EverSince 18:56, 26 December 2006 (UTC)

List of classes & members

There's a box listing all the classes & members (ATC N06A box) and below that a near-duplicate list of classes. The ATC box is authoratative but dense and yet doesn't list notable trade names etc. I'm thinking this could go at the end of the article as a reference, to be used as the source for a more simple list of classes up-front (i.e. the one that's there).

The list of prominent antidepressants doesn't seem to be derived from an objective measure. I'm thinking it could be based on a recent list of the best-selling antidepressants, and matched up with most common trade names and the list of categories. I'll try something like this unless any objections or other suggestions EverSince 00:01, 3 January 2007 (UTC)

I've had a go at this, but keeping the ATC box (with an intro) and basing the notable list on 2005 US prescription sales from RxList[4]. Probably missed some in the list - just looked over it and only up to no. 100. Hopefully over time, other drugs that might be rated as notable by other methods, or by sales in other countries or globally, could be added to the list if they have a source. Don't konw whether it should be kept to a top 10 or top 15 or something... EverSince 21:52, 5 January 2007 (UTC)

Tolerance and Dependence.

"Most antidepressants, including the SSRIs and tricyclics, are known to produce tolerance (i.e. a patient receiving antidepressant therapy for some years will often have to increase the dose over time, or add other drugs, to receive the same therapeutic effect), and withdrawal (particularly if abrupt) may produce adverse effects, which can range from mild to extremely severe.

Antidepressants do not seem to have all of the same addictive qualities as other substances such as nicotine, caffeine, cocaine, or other stimulants - in other words, while antidepressants may cause dependence and withdrawal they do not seem to cause uncontrollable urges to increase the dose due to euphoria or pleasure, and thus do not meet the strict definition of an addictive substance. However, antidepressants do meet the World Health Organisation definition of "dependency-inducing", and indeed the SSRIs are listed by the organisation as among the most strongly dependency-inducing substances in existence."

I would tend to tell, that these are non-senses; the only antidepressant (by the ATC classification), known to posses a primary addictive potential is amineptine, due to its psychostimulant and euphorigenic effects. While the "antidepressant dependence" is a common urban myth, supported by Scientology and antipsychiatric movements, there is in fact as good as none expert support for these claims. Simple fact, that an abrupt discontinuation of a long-term medication does induce problems, is not a "proof of addictive potential" of a substance; this occurs also with most hearth medications, such as β-blockers, ACE-inhibitors or cardiac glycosides, yet not one expert would mark these medications as "addictive", because of this. Also, the assumption of tolerance towards therapeutic effects seems to be condensed of nothing, some backing would be great if this claim should stay in the article. If an antidepressant works well "on the first hit", it is usually continuing to be effective in same dose range for the time of pharmacotherapy needed. So, I would please someone, preferably the autor of these (as I suppose, utterly unsourced) claims to provide a citation of, preferably multiple, valid, relevant and peer-reviewed studies backing these claims; also I suggest to mark the whole section "Tolerance and Dependence" as unsourced, at last. Thank you in advance.--84.163.87.66 15:15, 28 April 2007 (UTC)

The whole section: Tolerance and dependance:

"Most antidepressants, including the SSRIs and tricyclics, are known to produce tolerance (i.e. a patient receiving antidepressant therapy for some years will often have to increase the dose over time, or add other drugs, to receive the same therapeutic effect), and withdrawal (particularly if abrupt) may produce adverse effects, which can range from mild to extremely severe.

Antidepressants do not seem to have all of the same addictive qualities as other substances such as nicotine, caffeine, cocaine, or other stimulants - in other words, while antidepressants may cause dependence and withdrawal they do not seem to cause uncontrollable urges to increase the dose due to euphoria or pleasure, and thus do not meet the strict definition of an addictive substance. However, antidepressants do meet the World Health Organisation definition of "dependency-inducing", and indeed the SSRIs are listed by the organisation as among the most strongly dependency-inducing substances in existence.

If an SSRI medication is suddenly discontinued, it may produce both somatic and psychological withdrawal symptoms, a phenomenon known as "SSRI discontinuation syndrome" (Tamam & Ozpoyraz, 2002). When the decision is made to stop taking antidepressants it is common practice to "wean" off of them by slowly decreasing the dose over a period of several weeks or months, although often this will reduce the severity of the discontinuation reaction, rather than prevent it. Most cases of discontinuation syndrome last between one and four weeks, though there are examples of patients (especially those who have used the drugs for longer periods of time, or at a higher dose) experiencing adverse effects such as impaired concentration, poor short-term memory, elevated anxiety and sexual dysfunction, for months or even years after discontinuation.[citation needed]

It is generally not a good idea to take antidepressants without a prescription. The selection of an antidepressant and dosage suitable for a certain case and a certain person is a lengthy and complicated process, requiring the knowledge of a professional. Certain antidepressants can initially make depression worse, can induce anxiety, or can make a patient aggressive, dysphoric or acutely suicidal. In certain cases, an antidepressant can induce a switch from depression to mania or hypomania, can accelerate and shorten a manic cycle (i.e. promote a rapid-cycling pattern), or can induce the development of psychosis (or just the re-activation of latent psychosis) in a patient with depression who wasn't psychotic before the antidepressant."

Is unsourced. Some parts of this section (the first two paragraphs?) are been suggested to be possibly violating WP:NPOV and WP:NOR; I think it would be good to review this section by users expert in fields of medicine, psychiatry or pharmacology and to reassess its current form and contents, possibly backed up by relevant verifiable sources.--Spiperon 08:03, 2 May 2007 (UTC)

That section is pretty badly written, but SSRI discontinuation syndrome is well-documented. Tolerance (often called "Prozac poop-out") is less so, but there are a lot of anecdotal reports by patients and psychiatrists.[5] [6] I found only a couple papers on PubMed [7] [8] but I'm not all that experienced at searching for journal articles. And in response to the first poster, "discontinuation of a long-term medication [causing] problems" is the definition of dependence. "Addiction" is a flimsier concept, but if people coming off of SSRIs feel worse (the physical symptoms especially are harder to deny) than they did before they took them, then they induce dependence. I think most of the anti-SSRI stuff (especially by non-professionals) is sensationalistic and not very useful (and has made a mess of related Wikipedia articles), but I have experienced the brain zaps firsthand even after tapering off sertraline. So I also don't think it's helpful to insinuate that anyone who talks about SSRIs having tolerance and dependence effects is influenced by Scientology propaganda. I'll try and work on this more later, and you could ask for more comments at Wikipedia:WikiProject Pharmacology or Wikipedia:WikiProject Clinical medicine. --Galaxiaad 16:23, 2 May 2007 (UTC)

I agree that there are / were problems with that section--most importantly that it was completely unsourced. But I think this is material that should be improved / sourced rather than deleted. There is a lot of material on this sort of thing, more than enough to solidly source a whole section on it. Cazort (talk) 19:53, 3 October 2010 (UTC)

Move to thymoleptic

I propose that this article be split/moved. The drugs described here, including the monoamine oxidase inhibitors, serotonin-specific reuptake inhibitors, serotonin/noradrenaline reuptake inhibitors, and dopamine/noradrenaline reuptake inhibitors, belong to a superclass of drugs termed the thymoleptics; these act in accordance with the monoamine theory of depressive disorders.

This distinction is important, as other classes of drugs are used to counteract the symptoms of unipolar depressive disorder, more commonly known as depression; this is the very definition of an antidepressant. These other classes of drugs include the sympathomimetics, such as dopamine-specific reuptake inhibitors (chiefly amphetamines, such as dextroamphetamine, lisdexamphetamine, and methylamphetamine) as well as dopamine-specific releasing agents (chiefly methylphenidate and cocaine). The drugs collectively known as opioids (those most well-known include oxycodone, hydromorphone, pethidine, and methadone) form another useful class of antidepressants (they are also known as endorphin analogues, mu-selective opioid agonists, or narcotics).

Although opioids have been less frequently used for this purpose since the 1950s, and the sympathomimetics since the 1960s, the use of these drugs for the symptomatic treatment of depression is still accepted in clinical practice.

I can draw an analogy here to the analgesics; the salient property of analgesics is that they combat pain. It would be imprecise to say that only coxibs, such as celecoxib and rofecoxib, be called analgesics. Similarly, it would be imprecise to limit the definition to anilides, or to salicylates, or to opioids. All drugs that combat pain, regardless of class or mechanism of action, are analgesics.

Therefore, I suggest that this page be abbreviated to discuss the fact that the term antidepressant refers to a drug used for the palliative treatment of unipolar depressive disorder, and a brief overview of each superclass of antidepressants and their mechanisms of action: the thymoleptics, the sympathomimetics, and the opioids.

--Nmatavka (talk) 01:48, 16 September 2011 (UTC)

placebo effect

From the lede: Inert placebos can have significant antidepressant effects, and so to establish a substance as an "antidepressant" in a clinical trial it is necessary to show superior efficacy to placebo

There is no evidence provided that placebos have antidepressant effect. This would require studies comparing patients given placebo with patients who don't receive medication. Otherwise we might as well conclude that placebos cure the common cold. There's no evidence that an untreated depression will persist indefinitely, the fact that some people get better on placebo doesn't prove they work. 84.197.180.127 (talk) 02:40, 16 January 2012 (UTC)

reader comment

The comparison chart is not very useful without an explanation of the numbers shown. What does a high value mean compared to a low value? What are the units for the numbers? — Preceding unsigned comment added by 75.47.67.228 (talk) 23:01, 23 February 2012 (UTC)

'Love' section

This section seems very dubious. Given that "...the study has not been reproduced and no clinical evidence exists to lend support to this theory," should it be removed outright? 129.22.169.226 (talk) 23:53, 10 August 2012 (UTC)

You are quite right. This is original research. I'll remove it. Lova Falk talk 09:52, 26 September 2012 (UTC)

unrelaited statements

these statements seem to be painting a picture that antidepressant are ineffective though publication bias and the palcebo effect are prolbem for all drugs and most science in general relay. "Inert placebos can have significant antidepressant effects, and so to establish a substance as an "antidepressant" in a clinical trial it is necessary to show superior efficacy to placebo.[4][5] A review of both published and unpublished trials submitted to the U.S. Food and Drug Administration (FDA) found that the published trials had a 94% success in treating depression while the unpublished literature had below 50% success.[5][6] Combined, 51% of all studies showed efficac" — Preceding unsigned comment added by 130.102.158.16 (talk) 09:40, 26 September 2012 (UTC)

I agree, sort of. That is, these problems are problems of all drugs, but it seems the writer intend to convey the idea that such is the case especially with SSRI's. Also, the article seems to attempt to argue that the effect size compared to placebo is quite small. Still, the section needs a lot of work and better sources.Tpylkkö (talk) 11:17, 11 December 2012 (UTC)

The use of benzodiazepines will cause a physical dependence within days

There is no reference for this statement, and given that many people can use benzodiazepines long term without dependence, and that benzodiazepines arnt approved as treatments for depression, I cant see any reason to leave it here.

210.8.47.16 (talk) 04:51, 26 February 2013 (UTC)Jonathan

I just made an edit to clarify its use and risk as well as adding a reference. - Maximusveritas (talk) 23:04, 26 February 2013 (UTC)

Out-of-date Suicide section

I flagged the Suicide section as out-of-date as a 2012 study challenged the black box warning:

• Gibbons, Robert D.; Brown, C. Hendricks; Hur, Kwan; Davis, John M.; Mann, J. John (2012). "Suicidal Thoughts and Behavior with Antidepressant Treatment: Reanalysis of the Randomized Placebo-Controlled Studies of Fluoxetine and Venlafaxine". Archives of General Psychiatry. 69 (6): 580–7. doi:10.1001/archgenpsychiatry.2011.2048. PMC 3367101. PMID 22309973. {{cite journal}}: Unknown parameter |laydate= ignored (help); Unknown parameter |laysource= ignored (help); Unknown parameter |laysummary= ignored (help)

  —Chris Capoccia ^T⁄_C 15:35, 21 March 2013 (UTC

I hardly think one study run by a well-known drug company shill makes the suicide section "out of date." There has still never been an independent study of antidepressants (i.e. a study not run by a drug company or a drug company associate) that confirms their efficacy as better than that of a placebo (or, particularly, an active placebo) at a clinically-significant level, and the increased suicide risk in members of experimental groups compared to those in the placebo groups is more than well-established. I'd take Dr. Gibbon's conclusions with a grain of salt.BugRib (talk) 05:35, 28 August 2013 (UTC)

Which types of medicines make me dream a lot of things?--Mustafa Bakacak (talk) 20:33, 20 April 2013 (UTC)

Which medicines make me dream a lot of things neurologically? The most important cause I ask this question is to feel neurologically and emotionally missing...--Mustafa Bakacak (talk) 20:41, 20 April 2013 (UTC)

Wellbutrin (bupropion)

Wellbutrin (buproprion hydrochloride) is an antideppresant that's not related to any of the 3 listed classes of AD's

--MarXidad, 2002-01-17 6:30 AM EST

---

I thought that Welbutrin was a dopamine reuptake inhibitor, and that Serzone inhibited reuptake of both seratonin and norepinephrine.

-arteitle, 2003-05-20

---

Anti Depressants linked to heart risk in middle aged men, as well as brain disorders and diabetes

http://www.reuters.com/article/2011/04/02/us-heart-antidepressants-idUSTRE7312FR20110402

http://www.nybooks.com/articles/archives/2011/jun/23/epidemic-mental-illness-why/?pagination=false

http://www.nybooks.com/articles/archives/2011/jun/23/epidemic-mental-illness-why/

Article split

Where can I find the binding profile chart that used to be on this page? I think it is very necessary to keep that included here. — Preceding unsigned comment added by 76.28.76.147 (talk) 22:53, 2 December 2013 (UTC)

Due to the size of the page, this article needs a content split, per WP:SIZESPLIT. (Page is at 150k - policy indicates a split at 100k)

Given the extremely diverse neuropharmacology of drugs listed on the page, including cholinergics (nicotine), TAAR agonists (amphetamine), sigma receptor agonists (opipramol), SSRE/glutamatergics (tianeptine), the SSRI and monoaminergic tricyclic classes, MAOIs, and PDE inhibitor/adenosine antagonist (caffeine), just to name a few, it makes absolutely no sense to have an adverse effects section on this page, as it might as well just be the kitchen sink of adverse effects from all related pages. I would just outright delete that section.

Controversy and Therapeutic efficacy could be split to the relevant articles, and then summarized here, as it makes more sense to keep it. Based upon a quick read of that section, most of it seems to be on SSRIs anyway. I don't have time to manage a split of this size, so if anyone has the time and interest, that's my tentative proposal.
Seppi333 (talk) 07:55, 12 October 2013 (UTC)

• Thanks user:Seppi333. I did part of this just now by splitting the suicide section into Antidepressants and suicide risk. I think that the content here is great but the level of detail here was too much, and this content is worth highlighting in the template:Suicide2 navbox. Because this article need to be trimmed and because I felt like that content should be on its own, I forked this content. Blue Rasberry (talk) 22:27, 18 November 2013 (UTC)

The various classes are so different to each other in terms of side effects that all side effects on this page should be dispensed with and a brief brief overview provided only. Cas Liber (talk · contribs) 05:02, 28 November 2013 (UTC)

It looks like the article was restructured yesterday in a way that does not make sense to me. Almost every other article on drug classes starts with a history section (if it has one) and a description of the types of medications in the class. Then comes their general mechanism/pharmacology and then Efficacy/Adverse Effects comes after that. The article as is reverses that and doesn't seem logical to me. As is, nothing in the lead (which is a summary of the most important parts of the article) is discussed in the body of the article anymore and that signifies a big problem. While the full list of all antidepressants can be linked to, I think there still should be a summary of the subclasses within the Types section. - Maximusveritas (talk) 13:52, 28 November 2013 (UTC)

The lead needs to be rewritten after the article is restructured anyway, so that's not really an important issue at the moment. The point I was making originally was that antidepressant drugs are so diverse in pharmacology, and consequently adverse effects, that it doesn't make sense to have full sections for all of them. Full sections for some of them would just make an WP:UNDUE weight problem. The only feasible alternative is splitting and summarizing the split content. The best way to give a cursory summary of that many thing, in my opinion, is through a wikitable like this one (this is an outstanding wikitable IMO - credit to Fuse809 for making it) to list pharmacodynamics, adverse effects, and efficacy (and possibly approved use status like the table does). Explaining all that through prose, like the article did when I first wrote this split proposal, would just make the article excessively long. Seppi333 (talk) 17:15, 28 November 2013 (UTC)

Anybody understand "mechanism of action" as used in the article?

"Like all anti-depressants their mechanism of action remains unknown."

Does anybody else understand what mechanism of action is (maybe I don't)? I mean, I thought it was simply the pharmacological interpretation of how a drug works; without which we wouldn't have the knowledge to create the drugs we have today. SSRIs for example. They block the reuptake of serotonin on receptors we have labeled and identified. I checked the basic definition, and still can't find any mention of "we can't ascertain the mechanism of action".

What really gets me is it's placed in the section lead just before 3 theories of depression, suggesting—and contradicting—its meaning.

I was BOLD about this once, but twice finding this content and going to remove it made me wonder.

meteor_sandwich_yum (talk) 14:16, 19 November 2013 (UTC)

I think you're right in your understanding of the mechanism of action but you're to a degree wrong in saying 'without which we wouldn't have the knowledge to create the drugs we have today', a significant number of therapeutic drug effects are discovered by accident perhaps more historically than today but it still occurs, a classic example are the monoamine oxidase inhibitors where the antidepressant effect was discovered by chance while using the drug (Iproniazid) to treat tuberculosis. I think it was used therapeutically for depression long before there was any understanding of it's mechanism of action. Similarly lithium for bipolar, where the mechanism of action is still debated. How antidepressants work is more a series of hypotheses rather than proven fact from my understanding. Have a read of the abstract of this 2004 paper at http://www.ncbi.nlm.nih.gov/pubmed/15180481 , 'An obstacle in the development of better antidepressants is that the mechanism of the therapeutic action of these compounds is unknown. The prevailing view is that antidepressants exert their therapeutic effect by inhibiting the pre-synaptic re-uptake of the neurotransmitter amines, noradrenaline and serotonin. However, there are objections to this hypothesis.' Woodywoodpeckerthe3rd (talk) 20:10, 19 November 2013 (UTC)

I see your point on SSRI's though, that's one class of drugs where the (hypothesized?) mechanism of action was used directly to create the drug. Woodywoodpeckerthe3rd (talk) 21:11, 19 November 2013 (UTC)

Brilliant explanation; thank you. I think in my confusion I took the wording too literally - the presence of a model doesn't mean we understand it, just that we've made predictions. I suppose many areas of science are a work-in-progress, after all. meteor_sandwich_yum (talk) 16:42, 20 November 2013 (UTC)

This review discusses the various hypotheses on antidepressant mechanisms of action. The drug the review is about is a very interesting thing in its own right, since it either works entirely opposite to SSRIs (SSRE) with comparable efficacy or works through the glutamate system as opposed to via monoamine neuromodulation. In any event, I figured I'd just mention the paper in case you're interested in reading about the various hypotheses. Seppi333 (talk) 16:56, 28 November 2013 (UTC)

References

British- or American- style English?

I know there are many more pressing issues (such as trimming content, finding more reliable sources, etc.) but had wondered which style to use while copyediting.

Right now, it's about 50/50, with US/U.S.; behavior/behaviour; randomize/randomise; stigmatize/stigmatise; characterized/characterise; popularize/popularise; etc.

I don't think "neutral-English" can be achieved here. Right now the article is leaning a bit in favor of American English, because many of the studies seem to use American English, and many of the suffixes are pretty uniformly -ize, but the exceptions made me unsure.

Also, anybody mind if I tag the article with {{dmy}} (day-month-year) dating style? meteor_sandwich_yum (talk) 10:43, 28 November 2013 (UTC)

The DMY template is fine with me. I always use American since I don't know the words that are different in British English (except obvious ones like colour). Seppi333 (talk) 17:43, 28 November 2013 (UTC)

Anti depressants are very unpredictable. The doctor uses a trial and error and hopes

One doctor told me when use these medication the is absolutes its a like pulling one out and wait and that does not work lets pull another one out of our"BUCKET" when dealing the psycho tropic medicines we have "gone nowhere" we have no idea how they "really do work in the brain. The side effects profile is better . We have "fancy" release systems As far as positive results :in the antidepressants we compare it to the one . Impramine is the "gold' standard" still: to compare to' — Preceding unsigned comment added by 71.204.184.191 (talk) 18:16, 25 January 2014 (UTC)

CNN bit removed from placebo section

This had nothing to do with placebo comparisons unless a great leap of SYNTH is employed. It isn't immediately clear where in the article, or whether, this bit should go; I've moved it here for now. petrarchan47tc 23:36, 31 May 2014 (UTC)

• In 2005, antidepressants became the most prescribed drug in the United States, causing more debate over the issue. Some doctors believe this is a positive sign that people are finally seeking help for their issues. Others disagree, saying that this shows that people are becoming too dependent on antidepressants.

References

Suicidal ideation

The summary in this article includes some cherry-picking and leads to a conclusion not found in RS or in the main article. For this reason, I have removed those references and added from the summary of the "Antidepressants and suicide" article in this edit. Although it's been changed quite a bit, I'll add this template to be safe: Template:Copied petrarchan47tc 22:43, 8 June 2014 (UTC)

I disagree with your edit, your edit summary states:

'Rmvd cherry-picking, summarized from main article (where there is no mention that only in the beginning of treatment is the risk greater, as was previously stated here)'

But the main article states 'Fourteen years later, warning labels were put on antidepressants suggesting particular difficulties during the early phase of treatment' So there is reference to problems at the beginning of treatment which is synonymous to early phase.

You've removed an FDA reference, that's a strong reference. You've also removed a meta-analysis (Risk of suicidality in clinical trials of antidepressants in adults: analysis of proprietary data submitted to US Food and Drug) which is a high level of evidence. The meta-analysis agrees with the main article that the increased risk for suicide from antidepressant use is age dependent and decreases with increasing age. There is also a Cochrane Review reference that's been removed.

I don't think you should assume the main article is superior. I think the meta-analysis study should be in the main article. I don't see any evidence of cherry picking. Woodywoodpeckerthe3rd (talk) 23:09, 8 June 2014 (UTC)

I've reverted it. The older version was better referenced, more detailed, and more precise. Petrarchan47, why would you remove a meta-analysis supported statement that the risk of suicide is lowered by anti-depressants in those over 25 unless you have better references saying that this is incorrect? I did not see any mention of such references. Formerly 98 (talk) 23:24, 8 June 2014 (UTC)

Please don't undo this work, it contains much more information. There was a cherry-picked mention from one review stating that only in the beginning of treatment is suicidal ideation increased. First you wrote that in the first few weeks this is the case - which is not found in the source. Then it was changed to "at the beginning of treatment". I would rather see more references stating this relationship, as I can't find support for it. I will revert but leave the reference in place (sans claim that effect is only found in early days of usage). I did not mean to remove any claim that risk is lowered once over 25. I thought my version was pretty clear that this is a risk for younger people. petrarchan47tc 23:30, 8 June 2014 (UTC)

You removed it because it was less detailed, but added an unsupported detail about "in the early stages". You removed:

It remains controversial whether increased risk of suicide is due to the medication (a paradoxical effect) or part of the depression itself. The antidepressant may enable those who are severely depressed, and who ordinarily would be paralyzed by their depression, to become more alert and act out suicidal urges before fully recovered from their depressive episode. The increased risk for suicidality and suicidal behaviour among young adults approaches that seen in children and adolescents.

References

It makes no sense to argue that you want more detail while removing an entire paragraph. I don't want to edit war, but this makes no sense. petrarchan47tc 23:34, 8 June 2014 (UTC)

Hey Petrarchan47,

Let me look and find some more references. This seems to be "common knowledge" among the psychiatrists I know, but the source is not a great one I acknowledge. Formerly 98 (talk) 23:35, 8 June 2014 (UTC)

Here is what the UK National Institute for Clinical and Health Excellence says:

"A person with depression started on antidepressants who is considered to present an increased suicide risk or is younger than 30 years (because of the potential increased prevalence of suicidal thoughts in the early stages of antidepressant treatment for this group) should normally be seen after 1 week and frequently thereafter as appropriate until the risk is no longer considered clinically important."

is that good enough? Formerly 98 (talk) 23:39, 8 June 2014 (UTC)

It's good enough to maybe add if given attribution, ie, "According to...". However in my knowledge this is WP:FRINGE, and that is evidenced by the fact that you could find only one reference to it. So the previous two versions of this had undue weight. I don't think the statement warrants inclusion with only one reference. This is a claim I have never heard (and I have a good number of Psychiatrists in my family, fwiw). petrarchan47tc 23:53, 8 June 2014 (UTC)

On further consideration, no, this one reference is not good enough. It's 5 years old. A recent MEDRS or two would be great. petrarchan47tc 23:59, 8 June 2014 (UTC)

Ive heard a lot of arguments on Wikipedia before, but this is the first time I've heard NICE called fringe. Do you know who NICE is???? Formerly 98 (talk) 03:59, 9 June 2014 (UTC)

sexual side effects

just gathering most recent reviews here for use in the future

• Schweitzer I, Maguire K, Ng C. Sexual side-effects of contemporary antidepressants: review. Aust N Z J Psychiatry. 2009 Sep;43(9):795-808. PMID 19670052
• Serretti A1, Chiesa A. Treatment-emergent sexual dysfunction related to antidepressants: a meta-analysis. J Clin Psychopharmacol. 2009 Jun;29(3):259-66. PMID 19440080 (already cited)
• Kennedy SH, Rizvi S. Sexual dysfunction, depression, and the impact of antidepressants. J Clin Psychopharmacol. 2009 Apr;29(2):157-64. PMID 19512977
• Gartlehner G et al. Comparative benefits and harms of second-generation antidepressants: background paper for the American College of Physicians. Ann Intern Med. 2008 Nov 18;149(10):734-50. PMID 19017592

still hunting. Jytdog (talk) 12:02, 5 August 2014 (UTC)

problem with an extract

• hello,

i decided to write on the "talk" of this article because i have a problem with an extract of this article. the extract: "In the late 1990s, some investigators thought that the fact that symptoms emerged when antidepressants were discontinued might mean that antidepressants were causing addiction, and some used the term "withdrawal syndrome" to describe the symptoms. Addictive substances cause physiological dependence, so that drug withdrawal causes suffering. These theories were abandoned, since addiction leads to drug-seeking behavior, and people taking antidepressants do not exhibit drug-seeking behavior. The term "withdrawal syndrome" is no longer used with respect to antidepressants, to avoid confusion with problems that arise from addiction.[1]"

the history of the problem: i wanted to traduct this extract for the french version. i have see your source, this: http://www.ncbi.nlm.nih.gov/pubmed/16913164 and i would like to read the complete article so i search the complete article and i find it here: http://www.aafp.org/afp/2006/0801/p449.html

and i decided to read the article to understand the argument to says that symptoms of discontinuation antidepressant are not caused by dependency or addiction or that the term "withdrawal syndrome" is no longer use. and after reading this article, there are no mention of that anywhere. the source don't justify this extract. and the extract need to be reformulated or deleted.

i think the debate "dependency or not and "syndrome or not" is not close; and putting this extract without justification close the debat.

for exemple in french wiki you read this: here http://fr.wikipedia.org/wiki/Antid%C3%A9presseur in this section: "Syndrome de sevrage et dépendance" : "Les antidépresseurs IRS peuvent entraîner à l'arrêt un syndrome de sevrage. Une méta-analyse danoise a conclu qu'il s'agit de dépendance32. Comme l'akathisie, le syndrome de sevrage peut entraîner des pulsions meurtrières et des suicides33, les suicides étant cette fois entraînés. Le nombre de personnes sujettes a un syndrome de sevrage varie selon les molécules de 50 % à 78 % environ. Certains laboratoires ont été condamnés pour avoir caché cette possibilité (Deroxat / Seroxat / Paxil par exemple)[réf. souhaitée]. Le syndrome prolongé de sevrage aux antidépresseurs (pouvant durer des mois ou des années) n'est pas reconnu en France. Plusieurs forums Internet sont consacrés à ces problématiques.

La revue Prescrire a en 2008 rouvert le débat sur la dépendance en publiant un extrait du livre Medicines out of Control? Antidepressants and the Conspiracy of Goodwill de Charles Medawar et Anita Hardon. L'extrait choisi évoque la dépendance aux antidépresseurs et l'absence de reconnaissance de cette dépendance par le milieu médical. Ce livre a également reçu un des prix Prescrire34."

i hope you will understund what is written in this extract of french wiki.

thanks for reading

(consider that i am not often on the english wiki and perhaps i will not read your response. but you can contact me in the french wiki, the adresse of the account is in my user's page) Vatadoshu (talk) 11:42, 29 January 2015 (UTC)

• yes, the french wikipedia has different standards than English WP. The controversy over addiction is old and ended about 10 years ago in the scientific community. I rechecked pubmed and found a recent review on this, and have added content to the article based on it. It notes that some drugs sold only in France are more prone to abuse (but even that abuse is rare and mostly limited to people who already had substance abuse issues). Jytdog (talk) 12:11, 29 January 2015 (UTC)

• perhaps the controversy is ended about 10 years" but it is staying that the "reference" n°112 has no link with the sentence, you may delete the reference.

i didn't talk about substance abuse or misuse, you seem to have no look at the french extract i posted.

i talked about this study http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2011.03686.x/abstract;jsessionid=B0150DB6760E20579DCD1939A7F804B6.f04t01 dated of 2012 so recent. that conclude: "Withdrawal reactions to selective serotonin re-uptake inhibitors appear to be similar to those for benzodiazepines; referring to these reactions as part of a dependence syndrome in the case of benzodiazepines, but not selective serotonin re-uptake inhibitors, does not seem rational". but do what you want. Vatadoshu (talk) 12:55, 29 January 2015 (UTC)

hi - thanks for pointing out again PMID 21992148. I added content based on that, as well as the 2 responses, which re-iterated the scientific consensus. The section of the French article you pointed me to has unsourced content in it and a dead link. Seems written by someone with an ax to grind. Thanks again for raising these issues. The article has been improved with more sources now! Jytdog (talk) 13:14, 29 January 2015 (UTC)

• ok @Jytdog:
  
• there is nothing to read in your links of reference, you post with the sentences added to the article:[121][122]. the links work but on the web site, there is no information, only the title.
  

you could insert the link of the complete article? why don't you? readers of wikipedia could read the complete article instead of "a title".

(perhaps you do this, in order to have, a link modèle like pubmed or ncbi?)

i post the links of the complete article, corresponding of the "ncbi link" with no information.

121 : http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.03862.x/full

122 : http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2011.03736.x/full

• How did you manage to find studies, that follow (in pages) the article, I gived to you? (i have seen ,concerning the studies you posted, that the study you posted , where on the next page of the same book)
  
  

• you could add (carry on) on this sentence of the article:
  

"Responses to that review noted that there is no evidence that people who stop taking SSRIs exhibit drug-seeking behavior while people who stop taking benzodiazepines do, and that the drug classes should be considered differently..."

->keeping the same references:

"... (ref121-122), even if ,Symptoms that appear on the cessation of treatment, are similar for ssri and benzodiazepines." (perhaps reformulating in a better english)

• because the two studies say that:
  

the first study:

"The fact that these symptoms are similar to those that occur with abrupt discontinuation of the use of benzodiazepines is also true" in this:
http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.03862.x/full

the second study:

" Thus, BZD and SSRI withdrawal reactions are very similar in their clinical impact despite the differences in the underlying pharmacology, but there is one major difference...drug seeking"

http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2011.03736.x/full

• One of the two studies (you posted the link) speaks of "withdrawal reactions." as that term seems to be ok even if there is no dependency.
  

• the dead link is normal i have juste copy and paste the text without the code.
  

i tried to modify but even with copy paste the code it does not work. the second reference of the french wiki is in french here: http://www.prescrire.org/docus/po2008_lpvantidepresseurs.pdf

• in studies they say that symptomes ar the same as dependency wherehas what is different is only drug-seeking. it is just that the name of that don't exist. dependency is a term too rigid that seem to ban the possibility of a form of isrs dependency. just nobody knows how to name that.
  
• Doors should not be closed, whether it is named : dependency or "not dependency" or "another thing".

Vatadoshu (talk) 19:05, 29 January 2015 (UTC)

I don't understand most of what you write above. Thanks again for posting! Jytdog (talk) 19:19, 29 January 2015 (UTC)

@Jytdog: yes i try but it is complicated. please could you read the last post another time.
if you see the term "dependance " it mean dependency, it is an error of traduction. Vatadoshu (talk) 19:55, 29 January 2015 (UTC)

• What you are trying to say about content in this article... maybe I do not understand. I understood your first post, to say that you think the English Wikipedia are should use the language of "addiction" and "withdrawal" and "dependence" and not "discontinuation syndrome." I responded, saying that the English-language medical literature does not use the language of "addiction" and "withdrawal" and "dependence" - those terms are used for addiction - things like heroin and alcohol. In English, SSRIs do not cause addiction/dependence/withdrawal. If you were making some other point, I am sorry that I do not understand. Jytdog (talk) 19:57, 29 January 2015 (UTC)

@Jytdog:here I use google translation. I am not saying that we should talk about addiction, withdrawal or withdrawal syndrome. i dunno. I'm just saying that we should not close the doors. and if the term addiction is too rigid and does not stick, because of drug-seeking behavior that is not present in the ssri. Perhaps there will one day be a specific name for the ssri or may be it is a form of addiction. so you better understand this message, maybe translate my previous message.Vatadoshu (talk) 20:08, 29 January 2015 (UTC)

Thank you, I understand you! Jytdog (talk) 20:35, 29 January 2015 (UTC)

---

with the help of google

@Jytdog:ok i understand English, but I can not write in English it's frustrating.
the previous message:

• There is nothing to read in the links of your references (references 121 and 122 that you posted with your sentence). The links work, but on the website, there is no information. On the website "ncbi" only the title appears: you can insert a link to the full article?
  

why do not? readers of "wikipedia" might be interested to read the article complet.
Is it because of the link model: "PMID" you do not want to put the full articles?
(same for the link 120 you did not put the full article as I gave you the link to full article)
links to full items corresponding to the links you put those there are:
http://www.ncbi.nlm.nih.gov/pubmed/22471576?dopt=Abstract
http://www.ncbi.nlm.nih.gov/pubmed/22471575?dopt=Abstract

• My curiosity: How did you manage to find these items? Knowing that I have noticed that they are on the next page of the same book (with the reference 120 you put in the article and that I have communicated) .
  
• You have added this sentence to article:"Responses to that review noted that there is no evidence that people who stop taking SSRIs exhibit drug-seeking behavior while people who stop taking benzodiazepines do, and that the drug classes should be considered differently..."
  

You could continue your sentence -in keeping the same references- and say,
"... even if the symptoms that appear to discontinuation were similar for ssri and benzodiazepines." (reformulated in a better English)
I propose to continue this way your sentence because the 2 studies (121 and 122) say this:
The first study:
The fact that these symptoms are similar to those that occur with abrupt discontinuation of the use of benzodiazepines is also true" in this:http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.03862.x/full
The second study
"Thus, BZD and SSRI withdrawal reactions are very similar in their clinical impact despite the differences in the underlying pharmacology, but there is one major difference...drug seeking"
http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2011.03736.x/full

• One of the two studies :
  

http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.03862.x/full
refers "withdrawal reactions." This term seems to be ok to name.
" there is a good rationale to support the use of the term ‘Withdrawal Reaction’ in discussions about the discontinuation syndrome associated with cessation of SSRI use."

• les dead links I posted in the article french are normal, I did not copy and paste tags références. I'tried to copy the text with tags but the links still worked not.The second link is present in the french excerpt I've put this one was:
  

http://www.prescrire.org/docus/po2008_lpvantidepresseurs.pdf
La "revue prescrire" is a known and respected magazine in France. she revealed in France related problems "mediator".
https://fr.wikipedia.org/wiki/La_revue_Prescrire

• In studies (ref 121 and 122), the 2 studies say that the symptoms are the same for ssri and benzodiazepines but what is different is only the drug-seeking behavior that leads to an increase doses.It is maybe just the name for the SSRI withdrawal phenomenon is not.The term is too rigid "dependency" and appears to prohibit the possibility of another form of addiction. it's just that nobody knows how the call. it's a battle of words.
  

the debate should not be closed, it states that it is of dependance/addiction, or that this is not dependance/addiction, or is something else.

• thank our patience both if you can understand me. google translation too .
  

(note: I had made a mistake in the previous posts, I thought the term was "dependance" , then "dependency" , while "dependence")
I know that the terms "addiction" and "dependence" are different.
Google seems to substitute one for the other.

• curiously on the next page
  

https://en.wikipedia.org/wiki/Physical_dependence
If you do a search on the page with ssri in several places it is written that ssri cause physical dependence.Article on physical dependence contradicts the sentence
" Addictive substances cause physiological dependence, so that drug withdrawal causes suffering. These theories were abandoned, since addiction leads to drug-seeking behavior, and people taking antidepressants do not exhibit drug-seeking behavior. "
of this article on antidepressants.

• the fact remains that the reference:
  

"Warner CH, Bobo W, Warner C, Reid S, Rachal J (August 2006). Antidepressant discontinuation syndrome. Am Fam Physician 74 (3): 449–56. PMID 16913164.".
Which is supposed to justify this sentence: " The term withdrawal syndrome is no longer used with respect to antidepressants, to avoid confusion with problems that arise from addiction.".
The full article here: http://www.aafp.org/afp/2006/0801/p449.html.
it is nowhere stated that sort of thing. it is written in this article:
the phrase:
"in early reports it was referred to as a “withdrawal reaction.”
and the phrase:
"Early reports of antidepressant discontinuation syndrome made heavy use of the term “withdrawal” to describe discontinuation symptoms; however, antidepressant medications are not believed to be habit forming and are not associated with drug-seeking behavior."
The phrase "wikipedia":
"The term "withdrawal syndrome" is no longer used with respect to antidepressants, to avoid confusion with problems that arise from addiction";
the term, " is no longer used, is an interpretation of originales.
Moreover again you should put the full article link; and not the link you put that overlooks a summary
http://www.ncbi.nlm.nih.gov/pubmed/16913164.
Vatadoshu (talk) 09:07, 30 January 2015 (UTC)

I've added an additional source that is explicit about abandoning "withdrawal" due to its association with addiction, which is the incorrect paradigm. With regard to citations, the citation identifies the source; pubmed generally provides a link in the upper right corner to the article and if there is a free version on pubmed central, it provides a link to that version. Jytdog (talk) 11:39, 30 January 2015 (UTC)

---

@Jytdog: Hi,

• I came to ""pubmed generally provides a link in the upper right corner to the article", I did not know it existed. thank you.
• I read your new source for the phrase that was a problem, that's ok.
• I saw that you added this phrase.
  

"Responses to that review noted that there is no evidence that people who stop taking SSRIs exhibit drug-seeking behavior while people who stop taking benzodiazepines do, and that the drug classes should be considered differently"

• in fact: one of the two said this review:
  

"SSRI users rarely escalate their doses, nor do they seek illicit supplies. Similarly, the bulk of BZD users are maintained on therapeutic doses by their prescribers. However, some do escalate their doses, becoming high-dose users with severe dependence" http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2011.03736.x/full#b10

• not this, "Responses to that review noted that there is no evidence that people who stop taking SSRIs exhibit drug-seeking behavior while people who stop taking benzodiazepines do"
• but I agree with the end of the sentence, " and that the drug classes should be considered differently."
• This n 'not black or white. It would be easier, but it is not so.

The other study says this:
"The most appropriate term is a matter of context, not of the characteristics or severity of symptoms." If discontinuation symptoms occur in the context of a behavioral syndrome in which the procurement and use of a drug dominate an individual's motivation ......, this is DSM Dependence" ;and "if an individual takes benzodiazepines as prescribed by a physician for a long period of time and experiences physical and cognitive symptoms following abrupt continuation, this would most appropriately be called a withdrawal reaction" http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.03862.x/full

• but another study says that:
  

"Withdrawal reactions, ....., are common in a proportion of both BZD and SSRI users, despite their being maintained on normal therapeutic dosages" http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2011.03736.x/full#b10

• Thank you for the changes you have made.Vatadoshu (talk) 18:52, 30 January 2015 (UTC)

There appears to be some issue that is personally very important to you, but you are getting into nuances of language that google translate cannot support. I believe the current content is well supported. If you want to propose replacing some content and sourcing with some other content and sourcing I might be able to understand what you want. (i did some googling myself, and "having an axe to grind" in English is supposed to be close to "agir dans un but intéressé" in French) Jytdog (talk) 19:06, 30 January 2015 (UTC)

@Jytdog: :) "An ax to grind"~ may be for you. I just mean that studies contradict even if all agree to use another term to avoid confusion. but the new term implies that the symptoms are the same, it is the context and behavior that determines the term.
I would change anything, it is difficult to make myself understood here.Vatadoshu (talk) 19:25, 30 January 2015 (UTC)

@Jytdog: ok the term "antidepressant Discontinuation syndrome" is in the DSM-5. page 412 you can add this too. https://books.google.fr/books?id=lKeTAwAAQBAJ&pg=PA531&lpg=PA531&dq=Antidepressant+discontinuation+syndrome+dsm+5&source=bl&ots=t-XND9gA8G&sig=Lr2V1hpmhbk9LVYMC96rKtXnqdU&hl=fr&sa=X&ei=RufLVJnOG8vmavqPgpAC&ved=0CDMQ6AEwAg#v=onepage&q=Antidepressant%20discontinuation%20syndrome%20dsm%205&f=false Vatadoshu (talk) 20:26, 30 January 2015 (UTC)

I'm having a little trouble following this conversation, but think it is important to communicate that 1) some people experience unpleasant symptoms when they stop an antidepressant, but 2) it is very different from drugs like alcohol, opiates, nicotine and benzodiazpines that induce psychological dependence and drug seeking behavior. For this reason I like "discontinuation syndrome" better than "withdrawal", which carries strong implications of psychological dependence. I'm aware that many in the literature have used these terms interchangably, even though the syndromes are widely agreed to have very different characteristics. I would very strongly urge that we not do so. Formerly 98 (talk) 21:05, 30 January 2015 (UTC)

@Jytdog: ok.

I say, I discovered that the term "antidepressant Discontinuation syndrome" is registered in the DSM-5.
and you can add a sentence that says that the term included in the DSM-5.
I've put the book link in the previous message, the term appears on page 142.
if you do not know what the DSM-5, look here: https://en.wikipedia.org/wiki/DSM-5 Vatadoshu (talk) 22:52, 30 January 2015 (UTC)

My 2¢. Seeing as how this is referring to benzo (GABA) antagonists, I suspect this is indicating physical dependence, since dependence from benzos (and probably GABA antagonists) is primarily physical. In any event, there are many terms for various types of withdrawal-related syndromes that do not constitute true dependence; e.g., rebound effect describes an effect where a user experiences symptoms similar but not identical to a withdrawal syndrome. A meth abuser that uses the drug to stay awake continuously for 100 hours, for example, will experience progressively more physical strain from doing this and will have a massive crash (a rebound effect) upon cessation of methamphetamine use; however, this isn't physical dependence because it typically doesn't involve negative reinforcement (i.e., staving off the ensuing crash isn't the reason for continued meth use: the rewarding effect of the high is). Meth actually doesn't produce physical dependence. In light of this, it's probably best not talk talk about SSRI dependence and withdrawal if most sources use the term "discontinuation syndrome" instead.

Also, dependence is a completely distinct phenomenon from addiction. Addiction involves only positive reinforcement, whereas dependence arises through negative reinforcement; in light of that, it's not surprising that the mechanisms in the brain associated with addiction and dependence are distinct. In any event, there is literally no way a generic SSRI can induce an addictive state unless it also has strong DAergic effects (I don't know of any that fit this description). Blocking the serotonin transporter throughout the brain will have only a trivial effect on signaling in the nucleus accumbens (and therefore have no effect on nucleus accumbens ΔFosB). Seppi333 (Insert 2¢ | Maintained) 03:45, 31 January 2015 (UTC)

References

Seppi333 (Insert 2¢ | Maintained) 03:50, 31 January 2015 (UTC)