Thanks for writing this, great to hear that you’re feeling better.
I’m usually a fan of self-experimentation, and the upside of finding an antidepressant with few side-effects (and that you can take a lower dose of) is definitely valuable. This seems especially true if you can stop taking it during better mental health periods, then have it in your arsenal for future use. But I still have a few doubts about this process, and I’m a little concerned that some of the premises behind your experiment need a bit more scrutiny. I hope someone with a bit more domain-specific knowledge can correct me if I’m wrong, or improve my arguments if I have a point. I’m also aware that there’s no such thing as a ‘perfect self-experiment’, and I don’t think there are obvious ways that you could have improved the experiment. But here are a few things that I’d like to hear your thoughts on:
Firstly, the depression episode was triggered by an disruptive external factor- the pandemic. This would probably invalidate any observational study held in the same period. As this external factor improved, and people could start travelling/ socialising normally, you might expect symptoms to lift naturally from mid-2021 onwards. From what you’ve mentioned here, you don’t seem to have disproved this hypothesis. I gather that depressive episodes seem to last a median of about 6 months ( see pic below), with treatment not making a huge difference for duration within the first year (some obvious caveats about selection effects here). How do you consider the possibility that you would have recovered without antidepressants?
Secondly, the process of switching between 5⁄6 antidepressants seems to be a significant confounding factor here. I don’t know how good the evidence base for the guidelines link you sent was, but it seems likely that the multiple (start, side-effects, ending, potential relapse) effects of antidepressants are significant enough to really mess up any attempts to have a ‘clean slate’ between treatments, and to therefore make it a unfair comparison. It seems possible that what you thought was a negative reaction to x medicine was actually contingent on having just tapered off y medicine and/ or experiencing a relapse. Does that seem plausible, or do you think that there was a stable enough baseline for comparisons to be valid?
Third, just a bit of concern about the downsides of the experiment. There are some long-term side-effects to antidepressants, and they seem understudied for fairly obvious reasons (most clinical studies only last for 6 months, no long-term RCTs). There seems to be a few studies that point to longer-term risks and ‘oppositional effects’ being underestimated. Unknown confounding factors and additional health risks from going on and off antidepressants would make me very concerned. Obviously, untreated depression also has a range of health risks, so I don’t want to discount the other side of the ledger, but I would definitely not be confident that I was doing something safe. How confident do you feel in your comparison of these risks? And did you feel that you had to convince yourself against (potentially irrational) fear of over-medication?
Finally, a bit unrelated, there’s a meta question that often comes to mind when I read posts about more rational/ self-experimenting approaches to health issues, which is: “How strong should our naturalistic bias/heuristic be when approaching mental health/ general health issues?” Particularly for my own health, I have a moderate bias against less ‘natural’ (obviously a very messy term, but I think it’s useful) health solutions. I often feel EAs have the opposite bias, preferring pharmacological solutions, perhaps because they can be tested with a nice clean RCT. I’m interested what level of bias you, (and forum readers), think is optimal.
Thanks for writing this, great to hear that you’re feeling better.
I’m usually a fan of self-experimentation, and the upside of finding an antidepressant with few side-effects (and that you can take a lower dose of) is definitely valuable. This seems especially true if you can stop taking it during better mental health periods, then have it in your arsenal for future use. But I still have a few doubts about this process, and I’m a little concerned that some of the premises behind your experiment need a bit more scrutiny. I hope someone with a bit more domain-specific knowledge can correct me if I’m wrong, or improve my arguments if I have a point. I’m also aware that there’s no such thing as a ‘perfect self-experiment’, and I don’t think there are obvious ways that you could have improved the experiment. But here are a few things that I’d like to hear your thoughts on:
Firstly, the depression episode was triggered by an disruptive external factor- the pandemic. This would probably invalidate any observational study held in the same period. As this external factor improved, and people could start travelling/ socialising normally, you might expect symptoms to lift naturally from mid-2021 onwards. From what you’ve mentioned here, you don’t seem to have disproved this hypothesis. I gather that depressive episodes seem to last a median of about 6 months ( see pic below), with treatment not making a huge difference for duration within the first year (some obvious caveats about selection effects here). How do you consider the possibility that you would have recovered without antidepressants?
Secondly, the process of switching between 5⁄6 antidepressants seems to be a significant confounding factor here. I don’t know how good the evidence base for the guidelines link you sent was, but it seems likely that the multiple (start, side-effects, ending, potential relapse) effects of antidepressants are significant enough to really mess up any attempts to have a ‘clean slate’ between treatments, and to therefore make it a unfair comparison. It seems possible that what you thought was a negative reaction to x medicine was actually contingent on having just tapered off y medicine and/ or experiencing a relapse. Does that seem plausible, or do you think that there was a stable enough baseline for comparisons to be valid?
Third, just a bit of concern about the downsides of the experiment. There are some long-term side-effects to antidepressants, and they seem understudied for fairly obvious reasons (most clinical studies only last for 6 months, no long-term RCTs). There seems to be a few studies that point to longer-term risks and ‘oppositional effects’ being underestimated. Unknown confounding factors and additional health risks from going on and off antidepressants would make me very concerned. Obviously, untreated depression also has a range of health risks, so I don’t want to discount the other side of the ledger, but I would definitely not be confident that I was doing something safe. How confident do you feel in your comparison of these risks? And did you feel that you had to convince yourself against (potentially irrational) fear of over-medication?
Finally, a bit unrelated, there’s a meta question that often comes to mind when I read posts about more rational/ self-experimenting approaches to health issues, which is: “How strong should our naturalistic bias/heuristic be when approaching mental health/ general health issues?” Particularly for my own health, I have a moderate bias against less ‘natural’ (obviously a very messy term, but I think it’s useful) health solutions. I often feel EAs have the opposite bias, preferring pharmacological solutions, perhaps because they can be tested with a nice clean RCT. I’m interested what level of bias you, (and forum readers), think is optimal.