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Antidepressant prescribing for youths surged during COVID

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#1 Daniel Cooper

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Posted 28 February 2024 - 07:24 PM


From Axios (with links to underlying research)
 
Antidepressant prescribing for youths surged during COVID

 

 

What they found: The monthly antidepressant dispensing rate for females ages 12-17 surged 129.6% from March 2020 onward compared with beforehand, the University of Michigan-led study concluded.

  • The rate rose 56.5% for women between the ages of 18 and 25.
  • But dispensing among male adolescents declined abruptly during March 2020 and did not bounce back.
  • Researchers said it's likely that young males received care less often, not that their mental health improved during the pandemic.

 

126.9% increase for females aged 12-17. Astounding.

 

I find this troubling given that as time moves on we find that these antidepressants don't seem to work all that well and they often times come with very significant side effects of their own.


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#2 Galaxyshock

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Posted 29 February 2024 - 03:13 AM

That's indeed worrisome prescribing antidepressants as a solution to social isolation stress, especially to young people. I assume it's mostly SSRIs which like you said don't really work that well - but I guess it's lesser evil than getting them hooked on benzodiazepines or something? But perhaps doing no pharmaceutical intervention would have been the best course of action knowing most psych drugs just don't offer a solution to these things. There's some evidence Ashwagandha mitigating effects of social isolation stress though, but of course it's not in any doctor's prescription book hehe.



#3 Dorian Grey

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Posted 29 February 2024 - 03:24 PM

I was dumbstruck when I heard the primary side effects of SSRI meds included weight gain & sexual dysfunction (including inability to climax).  

 

And they are giving these to teenagers???  How depressing!!!

 

It's like they are trying to morph humanity into a horde of lonely robots.  Work-eat-sleep, work-eat-sleep, work-eat-sleep...  

 

Isn't life grand?  


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#4 Daniel Cooper

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Posted 29 February 2024 - 07:59 PM

One of the side effects of SSRIs that is now widely recognized is PSSD - "Post SSRI Sexual Dysfunction". People can be completely sexually non-functional for an extended period after discontinuation of these drugs - up to and including permanently as far as anyone can tell.

 

Maybe instead of giving teenagers psychotropic drugs with potentially dramatic life long side effects maybe we shouldn't have locked them away in their homes for a risk that was to them almost non-existent. 

 

 


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#5 Galaxyshock

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Posted 01 March 2024 - 02:57 AM

Maybe instead of giving teenagers psychotropic drugs with potentially dramatic life long side effects maybe we shouldn't have locked them away in their homes for a risk that was to them almost non-existent. 

 

Indeed,

 

"To do nothing is sometimes a good remedy."

Hippocrates

 

But I guess it isn't just the social isolation that lead to antidepressant prescribing but also health anxiety and concerns about the future from all the fearmongering. Still, psych drugs as a first-line treatment to a situation that was never a real threat seems like a mistake looking backwards. Of course doctors at the time couldn't know and there were probably a lot of desperate young people looking for relief so it's sort of understandable to do something. But it's also the bigger problem in psychiatry that they rely on these medications whereas something like therapy alone shows better outcomes.


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#6 Daniel Cooper

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Posted 01 March 2024 - 04:40 PM

Indeed,

 

"To do nothing is sometimes a good remedy."

Hippocrates

 

But I guess it isn't just the social isolation that lead to antidepressant prescribing but also health anxiety and concerns about the future from all the fearmongering. Still, psych drugs as a first-line treatment to a situation that was never a real threat seems like a mistake looking backwards. Of course doctors at the time couldn't know and there were probably a lot of desperate young people looking for relief so it's sort of understandable to do something. But it's also the bigger problem in psychiatry that they rely on these medications whereas something like therapy alone shows better outcomes.

 

Yeah, there was/is a whole milieu of things that seemed almost designed to scare the hell of out people. Young people in particular.

 

The lock downs, the fear mongering, etc. Studies show that many teenagers believe that the earth will be unhabitual in their lifetime due to climate change. With the pressures of all this on top of the corrosive effects of social media on teens and young adults, it's a wonder they all aren't getting dosed to the gills with psychotropic drugs.

 

At times I'm really glad that I wasn't born during this epoch. Which is the opposite of how I felt as a young person. Back then I always wished I'd been born decades later so I'd be around to see more of the astounding technological development that I was sure would happen.

 

It is not easy growing up in this brave new world we've created.


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#7 Hip

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Posted 01 March 2024 - 05:51 PM

It is true that SSSI and SNRI antidepressant and tricyclic antidepressant (TCA) drugs are associated with a high incidence of permanent physical sexual dysfunction, and also emotional blunting.

 

But there are safer alternatives such as moclobemide, an effective antidepressant that boosts dopamine levels via an MAOI mechanism.

 

 

 

This paper looks at the rates of sexual dysfunction reported in different antidepressants:

 

Table 1 shows SSRIs and SNRIs are often associated with sexual dysfunction, with rates of sexual dysfunction up to 70%.

 

By comparison, TCAs have 30% rate of sexual dysfunction.

 

And MAOIs 40%.

 

But moclobemide which is an MAOI had a low rate of sexual dysfunction of just 3.9%.  

 

 

But few doctors will prescribe moclobemide (and it is not even licensed in the US).



#8 Hip

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Posted 01 March 2024 - 06:03 PM

That's indeed worrisome prescribing antidepressants as a solution to social isolation stress, especially to young people.  

 

I would not jump to the conclusion that lockdowns caused depression in young people, especially these days when kids and adolescents mainly interact through social media anyway, and lockdown did not stop that interaction.

 

When people see a new phenomenon, such as this sharp increase in depression in the young, they usually assume the simplest or easiest-to-understand explanation, in this case lockdowns. But we live in a complex network of cause and effect, and the easiest-to-understand possibility is not always right.

 

 

We should consider the adverse neurological effects that the SARS-CoV-2 virus may have on the brain and central nervous system. We know SARS-CoV-2 can frequently cause the neurological illness of myalgic encephalomyelitis / chronic fatigue syndrome; and studies have shown SARS-CoV-2 can also cause psychiatric illnesses such as depression and anxiety in children and adolescents:

 

Prevalence of mental health problems among children with long COVID: A systematic review and meta-analysis 2023. 

Anxiety, depression and appetite problems were significantly increased among post-COVID-19 infected children, compared to those without a previous infection

Edited by Hip, 01 March 2024 - 06:04 PM.


#9 Galaxyshock

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Posted 01 March 2024 - 07:16 PM

It is true that SSSI and SNRI antidepressant and tricyclic antidepressant (TCA) drugs are associated with a high incidence of permanent physical sexual dysfunction, and also emotional blunting.

 

But there are safer alternatives such as moclobemide, an effective antidepressant that boosts dopamine levels via an MAOI mechanism.

 

 

 

This paper looks at the rates of sexual dysfunction reported in different antidepressants:

 

Table 1 shows SSRIs and SNRIs are often associated with sexual dysfunction, with rates of sexual dysfunction up to 70%.

 

By comparison, TCAs have 30% rate of sexual dysfunction.

 

And MAOIs 40%.

 

But moclobemide which is an MAOI had a low rate of sexual dysfunction of just 3.9%.  

 

 

But few doctors will prescribe moclobemide (and it is not even licensed in the US).

 

The paper in the original post doesn't state which antidepressants were prescribed, but I assume it was mostly SSRIs/SNRIs since they are to my knowledge still the first-line antidepressants. You are right there are alternative ADs such as MAOIs and Bupropion that don't cause sexual dysfunction but then again have problems of their own. In Germany, St. John's Wort is used widely as first-line treatment for mild to moderate depression and the side effect profile is perhaps better than most man-made chemicals.

 

Personally even a combination of maximum-dose Escitalopram, Olanzapine and Accutane (not a psych drug but pretty harsh med regardless), which I was on for several months (years ago), wasn't able to kill my libido. Then again I'm a bit odd case in regard to response to different drugs. Had I taken the same drugs during adolescence with a still developing brain, perhaps the situation would have been different though.

 

 

I would not jump to the conclusion that lockdowns caused depression in young people, especially these days when kids and adolescents mainly interact through social media anyway, and lockdown did not stop that interaction.

 

When people see a new phenomenon, such as this sharp increase in depression in the young, they usually assume the simplest or easiest-to-understand explanation, in this case lockdowns. But we live in a complex network of cause and effect, and the easiest-to-understand possibility is not always right.

 

 

We should consider the adverse neurological effects that the SARS-CoV-2 virus may have on the brain and central nervous system. We know SARS-CoV-2 can frequently cause the neurological illness of myalgic encephalomyelitis / chronic fatigue syndrome; and studies have shown SARS-CoV-2 can also cause psychiatric illnesses such as depression and anxiety in children and adolescents:

 

Prevalence of mental health problems among children with long COVID: A systematic review and meta-analysis 2023. 

 

The interaction through social media doesn't really equal to true human interaction though, and like Daniel Cooper mentioned can sometimes be counterproductive. I saw a video of woman paralyzed after taking covid vaccine on social media once - imagine adolescents sharing these type of videos (whether they're factually true or not) with each other, well the fearmongering (towards to both the COVID and the vaccines) has easy tendency to get through doesn't it.

 

Good point, I don't know anything about virology, you seem better educated in that regard. So perhaps the COVID has direct effect on this depression/anxiety symptomatology too, but I wouldn't say it's all-explanatory either.


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#10 Hip

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Posted 01 March 2024 - 11:24 PM

Good point, I don't know anything about virology, you seem better educated in that regard. So perhaps the COVID has direct effect on this depression/anxiety symptomatology too, but I wouldn't say it's all-explanatory either.

 

With advancing medical brain scan technology, we have discovered in the last 5 or 10 years that many psychiatric illnesses involve chronic low-level brain inflammation. This inflammation in the brain  (which is an ongoing state of war in the brain driven by the immune system) can disturb normal brain functioning, and so may be responsible for creating mental symptoms. The brain after all creates the mind. So it increasingly looks like mental health conditions could be caused by ongoing low-level neuroinflammation.

 

But we can ask: what causes this ongoing brain inflammation in the first place? Well one obvious answer is a low-level brain infection, as this would cause a constant immune attack in the brain, to try to keep the infection under control.

 

 

The idea that adverse life events can trigger mental illness is a very popular one amongst psychiatrists and psychologists (especially the ones that want to offer you talk therapies so that you might overcome these adverse experiences). And there is no doubt that some mental conditions, eg depression, can be triggered by adverse life events. 

 

But this idea of adverse life events being the cause of mental illness comes from an earlier era where we did not have the ability to peer into the brain as we do now, with advanced brain scans. As we start to see more and more things physically amiss in the brain in people with mental health symptoms, it's looking like physical dysfunction in the brain, from factors such as infection, may play a major role in psychiatric illness.


Edited by Hip, 01 March 2024 - 11:27 PM.

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#11 Galaxyshock

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Posted 02 March 2024 - 07:20 AM

With advancing medical brain scan technology, we have discovered in the last 5 or 10 years that many psychiatric illnesses involve chronic low-level brain inflammation. This inflammation in the brain  (which is an ongoing state of war in the brain driven by the immune system) can disturb normal brain functioning, and so may be responsible for creating mental symptoms. The brain after all creates the mind. So it increasingly looks like mental health conditions could be caused by ongoing low-level neuroinflammation.

 

But we can ask: what causes this ongoing brain inflammation in the first place? Well one obvious answer is a low-level brain infection, as this would cause a constant immune attack in the brain, to try to keep the infection under control.

 

 

The idea that adverse life events can trigger mental illness is a very popular one amongst psychiatrists and psychologists (especially the ones that want to offer you talk therapies so that you might overcome these adverse experiences). And there is no doubt that some mental conditions, eg depression, can be triggered by adverse life events. 

 

But this idea of adverse life events being the cause of mental illness comes from an earlier era where we did not have the ability to peer into the brain as we do now, with advanced brain scans. As we start to see more and more things physically amiss in the brain in people with mental health symptoms, it's looking like physical dysfunction in the brain, from factors such as infection, may play a major role in psychiatric illness.

 

Interesting, I'll need to look into these things. I do have heard of neuroinflammation linked to psychiatric illnesses.

 

Looks like viral infections are linked to schizophrenia too:

https://www.ncbi.nlm...es/PMC10302918/

 

But perhaps the illness still needs an environmental or life event trigger as seen in a lot of cases of first psychosis or depressive episode? So the infection makes the person susceptible and works as a catalyst. Some cases of course might be so that the infection and brain inflammation alone can lead to psychiatrically treated illnesses. Just speculating here.  ;)

 

Yeah advanced brain scans and improvements in technology will reveal us more about these things. Interesting times.



#12 Galaxyshock

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Posted 02 March 2024 - 07:53 AM

Perhaps St. John's Wort would have offered us a two in one treatment against both the direct virological effects of COVID and the depressive symptoms caused by the pandemic situation?  :cool: 
 
Hypericum perforatum and Its Ingredients Hypericin and Pseudohypericin Demonstrate an Antiviral Activity against SARS-CoV-2
https://www.mdpi.com...4-8247/15/5/530


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#13 Galaxyshock

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Posted 03 March 2024 - 02:06 PM

A bit off-topic but it seems antipsychotic prescribing to old people with dementia also increased during the COVID pandemic:

 

https://pubmed.ncbi....h.gov/36696128/

 

https://www.ncbi.nlm...les/PMC9514966/

 

So it supports the trend of increased usage of psychotropic medications during the pandemic. We know antipsychotics are prescribed off-label for insomnia and anxiety too (to pretty much people of all ages), I wouldn't be surprised if those prescriptions also rised during COVID but couldn't find direct evidence of this with a quick search. We also know that antipsychotics can worsen outcomes of COVID infection - besides their broad range of side effects. 

 

Worried about COVID and depressed because of the situation? Alright, let's make you an impotent zombie more vulnerable to the disease.


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#14 Hip

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Posted 04 March 2024 - 01:39 AM

Perhaps St. John's Wort would have offered us a two in one treatment against both the direct virological effects of COVID and the depressive symptoms caused by the pandemic situation?  :cool: 
 
Hypericum perforatum and Its Ingredients Hypericin and Pseudohypericin Demonstrate an Antiviral Activity against SARS-CoV-2
https://www.mdpi.com...4-8247/15/5/530

 

I have not looked at the paper, but pretty much all of these studies searching for COVID antiviral compounds are performed in vitro, where they used excessively high concentration of the compound, concentrations which are unobtainable in the body in vivo. Loads of compounds were found to have potent antiviral effects for SARS-CoV-2 in vitro, but are useless in the body, as the high concentrations are unobtainable.


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#15 Galaxyshock

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Posted 04 March 2024 - 02:01 PM

I have not looked at the paper, but pretty much all of these studies searching for COVID antiviral compounds are performed in vitro, where they used excessively high concentration of the compound, concentrations which are unobtainable in the body in vivo. Loads of compounds were found to have potent antiviral effects for SARS-CoV-2 in vitro, but are useless in the body, as the high concentrations are unobtainable.

 

Right, it was perhaps an overenthusiastic idea I decided to bring to discussion.  :-D

 

Echinacea I guess is in the same boat of lacking evidence besides in vitro studies? I took Echinacea during the pandemic and never got sick until I stopped taking it, but oh well that doesn't really prove much hehe.


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#16 Hip

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Posted 04 March 2024 - 04:04 PM

Echinacea I guess is in the same boat of lacking evidence besides in vitro studies? I took Echinacea during the pandemic and never got sick until I stopped taking it, but oh well that doesn't really prove much hehe.

 

Echinacea is not a direct antiviral as such, but boosts the immune system, and in that way can fight viruses.

 

Studies show Echinacea can reduce the chances of getting a common cold by half. And remember that coronaviruses are cold viruses. So I would imagine that Echinacea would also reduce the chances of catching COVID.

 

I used Echinacea at lot years ago: I found that if you took good dose of Echinacea on the very signs that you have a cold coming on, that cold would be destroyed before it had a chance to take a grip. I always used to carry Echinacea with me, so that even when at work during the day, I could take some immediately if the tell tale signs of a cold appeared. If you wait too long to take Echinacea, then it does not work, I found. Once the cold has started, it does not have any benefits, in my experience. But as a protection against colds, it works very well. 

 

Allicin from garlic is another which can reduce the chances of catching a cold by around a half. 

 

So if you take Echinacea and allicin together, in theory you should reduce your chances of catching a cold (and probably SARS-CoV-2 too) by a factor of 4.

 

 

Echinacea and allicin are my own personal methods of avoiding SARS-CoV-2 (along with more standard approaches such as masks and vaccines).


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#17 Galaxyshock

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Posted 05 March 2024 - 05:50 AM

Echinacea is not a direct antiviral as such, but boosts the immune system, and in that way can fight viruses.

 

Studies show Echinacea can reduce the chances of getting a common cold by half. And remember that coronaviruses are cold viruses. So I would imagine that Echinacea would also reduce the chances of catching COVID.

 

Nice, perhaps Echinacea is in fact an effective prophylactic. These natural substances are often underrated compared to pharmaceutical inventions.

 

Anyways, returning to the topic, some more evidence of increased psych med usage, not just antidepressants but also anxiolytics, during the pandemic:

 

Effect of the COVID-19 pandemic on the psychotropic drug consumption

https://www.ncbi.nlm...les/PMC9797694/

 

Good thing antipsychotics consumption didn't change much though.







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