Effectiveness of Anti Depressants

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Before I start, let's ignore any impact that this may have on a medical. Assume that I don't care if I can get a medical anymore for the rest of my life, even though I've held one for over a decade. This is strictly a question of effectiveness for those who've been on antidepressants.

Background (I'm leaving out some details here intentionally since I don't want to be easily identified): I've been living with depression basically my entire life. Never diagnosed, never treated. I did see a therapist for a while. I've just dealt with it myself never abusing any substances. I've always been strongly against the use of anti depressants and have never considered it, until now.

The reality of my current situation is I've been miserable virtually every single day of my life for close to a decade. Standard family stuff. It's not going to get better for a long time, if ever (although the Covid situation hasn't helped). I don't see therapy as something that will work because that involves trying to solve internal conflicts and get past struggles. This isn't an internal conflict or struggles, it's just the reality of what is my life. Talking to someone won't solve it, and frankly I don't want to go through the probably wasted effort of trying to find a therapist who's a good fit and pay for/commit to regular sessions, which would still impact my medical anyway.

Since my issue is situational, the obvious answer would be to change the situation. It's not going to happen, because to change my situation would require other changes that I'm not willing to do and would create their own (much greater) problems, both for me and more importantly for others I care about.

That leaves me with two options: continue to be miserable, or accept that maybe some kind of anti-depressant could help me. I've always been against this as I've considered it akin to illegal drug use (something else that I'm strongly against). And, even though I don't care about holding a medical, it's effectively a one-way ticket.

One friend of mine who struggles with depression too has advised against use of anti depressants as they've not worked well for her. However her situation is very different and more of her depression has to do with internal conflicts rather than general situation. Given how many people we have coming on here asking for various anti-depressant advice and getting a medical, my questions are:

1) What did anti-depressants do for/to you? (positive negative)
2) Do you think it was overall helpful or did what you expected? (ignoring aspects relating to getting or keeping a medical certificate)
3) Do you think they helped you improve your life situation?

I've held a medical for a long time, still have a valid one. But I'm willing to give up flying if that helps to put me in a better spot.

Thanks for (helpful) insight.
 
Looking for a magic pill so you don't have to face up to your issues?

My understanding of these pills is that they are not magic and require you to talk stuff out to be effective. Find a good therapist and start talking. Don't go in begging for pills. You don't know what you don't know (neither do I for that matter.) Find someone who knows. I hope things get better for you.
 
First of all, I am NOT a medical professional. :)
My experience with depression is all through friends and family (first wife and child).

Based on your post you have picked up some knowledge about depression. Talk therapy can provide two major benefits, first is one you focus one. That is resolving an issue that is causing your depression. Second major benefit is learning skills, tools and other things to address symptoms of depression which can nake you feel better.

In terms of antidepressants, they can help. But it is a lot of trial and error to find the right one or combination that works for you. For the drugs to work, you need to work with the prescriber and usually a therapist to both address the chemical aspects of depression and the root cause.

Tim

Sent from my HD1907 using Tapatalk
 
I'm not a doctor and I don't take antidepressants. But as the others have said, they aren't intended to solve your problems, they correct certain chemical imbalances. If your life really sucks, they're not going to unsuck it. You have to do that. If changing your situation isn't an option, then changing how you deal with it is the other option. So therapy is where I'd start for sure, and no, it doesn't have to impact your medical at all if you go to the right provider and don't get stuck with a whacky diagnosis. The drugs definitely will affect your medical, even if they don't make you immediately ineligible, and you will get a diagnosis to go with the prescription.
 
Antidepressants work very, very well for those who are clinically depressed. I won't bore you with the chemistry, but it is solid. The problem is there are lots of people who take them because they're unhappy. You are either depressed or not. If you are, you're depressed most of the time. Unhappiness is situational, something bad happens and you're unhappy. Antidepressants don't work on this at all, the only things that do are dogs and alcohol.

From what you've written I can't really tell which category you fall into. Good luck.
 
I prescribe antidepressants. All different kinds. All the time. Some ppl here might feel I’m part of the problem but in the right person they can be quite effective, lifesavers. Admittedly, not by myself, they often get over prescribed for the wrong reasons.
The most basic want to think about whether or not someone needs a true antidepressant is to ask these questions:
Are you in an abnormal situation and having a normal reaction to it??? ie someone just died in your family, you have financial trouble, work trouble, and you feel down about it- guess what-That’s the normal reaction to your “abnormal” situation. Antidepressants don’t change this screwed up things around you- your supposed to feel like crap. In fact the ppl that have the world imploding on them that say “I’m great” have problems that need meds (jk)

if you are having an abnormal reaction to a pretty normal situation. ie life on paper pretty ok despite good things happening around and to you you continue to feel down, can’t enjoy, can’t relax, can’t find simple pleasures- your brain chemistry is off and you likely need a med.
Now as a pilot I do often ask if they have any aspirations on being a pilot and make them aware that there can be ramifications down the road of decisions we make today.
There are often therapy solutions that can help but when the chemicals are off it usually will fail.
so ask yourself - does your situation if you put 100 ppl in your shoes- is the normal reaction how you are feeling???

Ppl often get put on antidepressants because someone died- or they are going through a “tough time”. That crap sieves me nuts al- that is often the theme to a lot of -SSRI posts here. Those ppl likely didn’t need one in the first place. When life sucks your supposed to feel bad about it. IMO.
Take my advise for what it costs to you which is nothing, but ppl Do come to pay for that advise 5 days a week.
 
The best results with anti-depressants are obtained combining them with therapy of some type. So maybe start the therapy now and see how it goes. Then discuss with the therapist adding the meds.

Of course, if you are presently feeling suicidal or that you might hurt yourself, seek medical help immediately. But it didn’t sound like that was the situation from the post.
 
Since my issue is situational, the obvious answer would be to change the situation. It's not going to happen, because to change my situation would require other changes that I'm not willing to do and would create their own (much greater) problems, both for me and more importantly for others I care about.

Medicine, drugs, or whatever you call them are not the answer. You have admitted to knowing the answer but you don't have the courage to do what needs to be done. As much as you say you can't go this route it is the way that gives you back your life.

Years ago working in a high dollar, high pressure management position, my doc offered me a certain brand of serotonin reuptake inhibitor which I declined. I knew that if I had to take a pill to have the sanity and ability to work in such a high pressure environment that the job needed to go ... and it did.

There are many times in life when the right answer is the hardest thing you'll ever do but the real way forward is to "adult" and do what you know and admitted needs to be done. It's your life and you should take charge of it.

I know this isn't the answer you seek and not popular one in today's culture. I do pray you get this figured out ...
 
If one can 'pull yourself up by your bootstraps', then by all means do so. SSRI's are effective in about 35% of depressed patients. Some I see in the aviation arena are ready to come off of the medications, and we do so. But I do also run into aviators who have that look of 'no way doc, I can't live without'. For those, the HIMS-SSRI route is the one to take.
 
They can absolutely be "night and day" effective and change your life. But whether they will in your case is not something that can be answered on POA.
 
Before I start, let's ignore any impact that this may have on a medical. Assume that I don't care if I can get a medical anymore for the rest of my life, even though I've held one for over a decade. This is strictly a question of effectiveness for those who've been on antidepressants.

Background (I'm leaving out some details here intentionally since I don't want to be easily identified): I've been living with depression basically my entire life. Never diagnosed, never treated. I did see a therapist for a while. I've just dealt with it myself never abusing any substances. I've always been strongly against the use of anti depressants and have never considered it, until now.

The reality of my current situation is I've been miserable virtually every single day of my life for close to a decade. Standard family stuff. It's not going to get better for a long time, if ever (although the Covid situation hasn't helped). I don't see therapy as something that will work because that involves trying to solve internal conflicts and get past struggles. This isn't an internal conflict or struggles, it's just the reality of what is my life. Talking to someone won't solve it, and frankly I don't want to go through the probably wasted effort of trying to find a therapist who's a good fit and pay for/commit to regular sessions, which would still impact my medical anyway.

Since my issue is situational, the obvious answer would be to change the situation. It's not going to happen, because to change my situation would require other changes that I'm not willing to do and would create their own (much greater) problems, both for me and more importantly for others I care about.

That leaves me with two options: continue to be miserable, or accept that maybe some kind of anti-depressant could help me. I've always been against this as I've considered it akin to illegal drug use (something else that I'm strongly against). And, even though I don't care about holding a medical, it's effectively a one-way ticket.

One friend of mine who struggles with depression too has advised against use of anti depressants as they've not worked well for her. However her situation is very different and more of her depression has to do with internal conflicts rather than general situation. Given how many people we have coming on here asking for various anti-depressant advice and getting a medical, my questions are:

1) What did anti-depressants do for/to you? (positive negative)
2) Do you think it was overall helpful or did what you expected? (ignoring aspects relating to getting or keeping a medical certificate)
3) Do you think they helped you improve your life situation?

I've held a medical for a long time, still have a valid one. But I'm willing to give up flying if that helps to put me in a better spot.

Thanks for (helpful) insight.

It's great you're reaching out for some guidance, but most off all you need to get out of your dire way of thinking.

Antidepressants do work, but not for everyone. Just because you know one person who says they didn't work for them does not mean they will not work for you! The main thing that antidepressants do is break the cycle of depressing thoughts and the resulting effect on the brain chemistry. Depressing thoughts bring us down, and as our mood sinks, the brain chemistry follows, and with a lowering of the brain chemistry comes more depressing thoughts. With more depressing thoughts comes...well...you get the idea.

Take care of yourself, and do what you need to do to get better. You deserve to be good to yourself! By all means, see a therapist, and/or see a doctor. They are the true experts in this, and can help. Take control of your life, and don't let life control you.

You are already reaching out by asking questions, so it appears you're on the right path. I wish you the best of luck, but I bet you'll work things out! Hang in there!
 
I appreciate the (few) helpful responses I got on here which helped solidify that I was likely on the right path by considering anti-depressants. While I'd talked to some friends and coworkers who'd gone down the SSRI path and gotten their opinions, I'd hoped that some other Unregistereds would share their personal experiences. So, I'll share what I've learned in hopes it helps someone else along the way.

Two weeks ago today I was officially diagnosed with moderate/severe depression (I forget the official medical jargon) and started on Prozac. I was told to expect it to take 7-10 days to start noticing effects with my family noticing before me, and around 6 weeks for the effects to totally work out. Obviously I have a ways to go before the 6 week portion.

The difference has been very positive already. I've been taking daily notes (in part to help me catch any negative side effects should they occur). The improvement in my mood and feeling of well being started almost immediately. I'm sleeping much better, and no longer spending 10 hours in bed only to wake up exhausted and miserable. I'm much happier around my kids, and they're responding well and being better behaved around me as a result. They don't know that I've stared any medication (that's a conversation for when they're older), but they certainly notice the improvement. My wife especially notices an improvement.

An interesting side effect is that immediately after starting, I lost all interest in alcohol and have stopped drinking entirely. Not that I was drinking excessively (at least compared to some people I know), but it was more than it should've been and I was using it as a "feel good" crutch. I haven't had a drink since starting and plan to keep that up. Feeling better has also made it easier for me to make some of the better life decisions (like exercising more and taking some more me time) which will hopefully help keep things moving in a circular upward motion. So far, the only negative side effect is a decreased sex drive.

I was terrified about starting on anti-depressants for a number of reasons. The potential negative side effects being one, but the biggest being concerns about whether I would still be myself at my core or somehow different. For a long time this was my greatest concern and I would say to myself "I'd rather be me than medicated." What I'm finding is that I don't feel (or seem to be acting) any less me, have regained interest in activities I enjoy, if anything maybe more interested and positively so now that I'm feeling better. So I'm definitely not any less me, at least not yet.

There are the obvious impacts this will have if I decide I want a medical in the future, but that's not something I'm concerning myself with as I had no plans to fly anytime soon anyway, and for the flying I might want to do LSA/Basic Med are options.

It's only the start of the journey, I'm keeping a close eye on behaviors/side effects (as is my wife and some close friends who I've told), and I realize that negative side effects may pop up at some point. I definitely don't want to be on this for the rest of my life. But it's nice that the world isn't so dark anymore.
 
They can completely change your life.

Ignore the comments from those who say their some kind of crutch. They're not. People who know nothing about it seem to think that you take one pill and there is an instant reaction, like cocaine or something.

They are not like that at all. It's more like you start taking one tiny pill a day - and then some days later you suddenly realize you feel a little more positive for some reason. And then the next day you find you have the same positive feeling. Things don't seem so hard. And this stays with you. Since the change is so subtle you'll wonder if it's the pill or something else that caused the change.

It can completely change your life. Yes, you will read all the negative crap on the internet. But the vast majority of people who have been helped don't post on the internet because they have moved on to enjoying their lives.
 
I worked for an insurance company where I investigated how to get our subscribers (senior citizens) to use our services to keep healthy. Not because the owners were saints - well people have less claims. We knew from the data that mental health is key to physical health, so we did a lot with that.

What the docs do know is that a diabetic is someone who doesn't make enough of their own insulin, and if they take it they can get "back to normal". Talking about it isn't going to fix it. Some people have poor eye site. With glasses, it adjusts the focus so they are "back to normal". Talking about it isn't going to give someone 20 20. People with a depression don't make enough serotonin. The anti depressants correct that so the person "gets back to normal". All the same.

It is medical / physiological.

With a clearer mind, you can make better decisions on your life - change that job, etc.
 
BTW - you already have a medical (3rd class ?). I think if it expired, you can do basic med, and the decision on using anti depressants and basic med is between you and your doctor.
 
I'll stick with my initial answer and suggest that if you had done the things you say you are doing now that things would have been different without the medications:

but it was more than it should've been and I was using it as a "feel good" crutch. I haven't had a drink since starting and plan to keep that up. Feeling better has also made it easier for me to make some of the better life decisions (like exercising more and taking some more me time)

You might be amazed at what "clean living" does for the body, mind, and soul. Get the alcohol out, get proper rest, stay on a good diet, and get some daily exercise. Maybe it's just me but I would have exhausted every possible avenue before using a SRI ...
 
I think a clear head helps one get cleaner living and better choices. It feeds on itself. Depressed don’t exercise - more depressed. Don’t socialize - more depressed. Don’t sleep well - more depressed.

It’d not a crutch. It’s a weapon that helps you to do the other things you need to do.

it’s not one or the other. Take the pill AND make other changes.
 
Been there.
Quick back ground, i eat well, work out daily, fit as fiddle.

Life occassionally sneaks up. Ive a spouse with chronic illness, and two kids that have both been more than anything in parenting manuals. Basically all three have varying medical needs.

99% of the time life goes along and i troop on without a care.

When life decides to toss on an extra shovel of "tests" it has gotten me in a flat spin of which on two occassions, (a death, and a failed suicide attempt by a loved one) celexa or zoloft were used as a rudder to get it to stop.

So that i could level off and return to normal flight. That was two points 7 years apart for short durations.

I think there are times even short term is a benefit. It leveled me off to get back to the workouts, eating, etc.

As a student pilot, the last script being inside of 3 years has me in deferral land though.
 
I'll stick with my initial answer and suggest that if you had done the things you say you are doing now that things would have been different without the medications:


You might be amazed at what "clean living" does for the body, mind, and soul. Get the alcohol out, get proper rest, stay on a good diet, and get some daily exercise. Maybe it's just me but I would have exhausted every possible avenue before using a SRI ...

I don’t want to rain on OP’s parade but keep in mind there is such a thing as placebo effect, but that’s not a bad thing. Even if you only imagine the pill is making you feel better, and that makes you want to exercise or eat better, that will benefit you. Sometimes you need a kick start to make lifestyle changes and the pill could be that, either because it’s actually helping or because of your mere belief it’s helping.

For me they did absolutely nothing other than make me go through “discontinuation syndrome” (aka withdrawal) when I tried to quit. NEVER again. But then I don’t think I have primary depression. They gave me antidepressants to treat pain, which it didn’t.

Keep in mind there are a lot of physical conditions that can mimic features of depression. All your hormones need to be up to speed. Thyroid, not just TSH but free T3 needs to be mid range or better, testosterone in both males and females (yes we need some too), even if you are young these should be checked.

Can’t sit inside all day every day never seeing the sun and expect to feel happy.

Some of us are carb sensitive, pre-diabetic, with fluctuating blood sugar and insulin. From personal experience this plays havoc with your moods and is truly under-recognized as a strong contributor to “psychological” problems.

Then of course as everyone else pointed out, if you live under miserable circumstances it might not be possible not to be depressed. That’s what they call situational but if it goes on long enough it can become your default state and require a long healing period, if you ever escape the situation.

It took me a lifetime to figure out all this and more, and now I’m finally happy (just in time to age out and die) but then I never had a “serotonin deficiency”. For the subset of people SSRIs actually help they may be a godsend. There is such a thing as genetic tendencies toward depression regardless of all the above. Personally I believe they are over prescribed but are absolutely appropriate for some. That was the whole reason Dr. Bruce et al got the SSRI certification pathway in place.
 
About five years ago, I felt the headwinds start to increase. It was getting harder to focus. Good days were fewer and further between. My creativity and ability to solve problems withered. My supervisor asked me about my productivity, and I didn't know what to say; I could only give hand wavy excuses about being exhausted from having two small kids at home, which I was. I transferred internally, hoping that a new challenge would help, but it didn't.

I took a job closer to home in 2019, thinking that less time commuting would improve my work/life balance. It was a new role for me, and I felt like I didn't know what I was doing.

2020 was 2020. I still didn't know what I was doing, but now I was at home with kids 24/7.

About six months ago, a series of family events made matters substantially worse. My blood pressure crept up. I started seeing a therapist, began exercising regularly, and cut out alcohol completely. My body thanked me, but my mind was still blank.

Colleagues again began asking questions about my productivity. I felt unable to work, which left me feeling frustrated and ashamed. I felt washed up and I considered resigning. Having exhausted all other options, I threw a Hail Mary pass and got on Lexapro three weeks ago.

Improvements began almost immediately and continue to accumulate. Mood, energy, interest, engagement, direction, motivation, productivity, everything. Instead of there being too many hours in the day, it's starting to feel like there are too few.

I feel like I'm back in gear. It might be first gear, but that's better than neutral.

https://www.faa.gov/licenses_certificates/medical_certification/hop/media/depression.pdf
 
Ask 10 people, you'll get 10 different answers. The only correct answer is, "it depends."

My wife suffered a rare neurological disease some years ago that left her visually impaired and with lots of other things going on neurologically. Doctor first tried Prozac; meh. Then, Zoloft. Meh. A little better, not much. Then Effexor; a little better. Finally, he switched her to the "des" version of venlafaxine -- Pristiq -- and it was night and day. BIG difference, in spite of the fact that so-called "studies" insist that there's "no evidence" that DESvenlafaxine is more effective than venlafaxine. Whatever.

The point there is ... it depends. They may help you, they may not. Just because one SSRI doesn't help, doesn't mean that there isn't one out there that could help a great deal.

I will add this:

Those who say that you don't need drugs ... again, it depends. If you have a chemical imbalance in your brain, all the counseling in the world won't help. Before the invention of SSRIs and SNRI drugs, these poor folks commonly became alcoholics, or were addicted to something else. (Edit: or even worse, their doctor would prescribe a "benzo" -- Valium, Klonopin, et. al. -- and they'd REALLY get addicted.) Their friends would just shake their heads and say, "pity about poor Joe, but whatever."

You do what's right for you. Sounds like you're getting there.
 
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You probably won’t get much useful conversation here because while you’re anonymous? Replies aren’t. Have a talk with your doc. Try a med for a few weeks. See how you feel.

Best wishes for getting better!
 
I’ve never taken them myself but have been very close (as in we have kids together) to two people that have.

first let me say I think it’s wonderful we live in a world working to solve these issues… and I am not against them entirely…

however if you decide to try them do so knowing they are a bandaid and that that is ok- doesn’t diminish the fact we sometimes need a bandaid!

but what I mean by this is it was shared with me twice that they don’t just make you not “feel sad” they make you “not feel”….

if you need them to clear your head and get an on an even keel, may modern science be with you… but use them as a tool not a solution. One must grasp mental health in such a way to not be dependent on them life long to make them “ok” to truly be ok…

I sincerely wish you the best
 
You probably won’t get much useful conversation here because while you’re anonymous? Replies aren’t

Not true. You can post an anonymous reply, like I’m doing now. You can even quote in an anonymous reply, like I’m also doing now.

but what I mean by this is it was shared with me twice that they don’t just make you not “feel sad” they make you “not feel”….

I’m now 7 weeks in to my Prozac prescription and what you list here is one of the things I was concerned about, the “not feel” as opposed to “not feeling sad.” I was worried about not being able to have bad days anymore, or good experiences not feeling as good. I can tell you that for me personally, with Prozac, that has not happened at all. I can still have good days and bad days, as is part of life, but without the constant black cloud following me around and the never ending pit-of-the-stomach despair, waking up miserable every morning I’d been having.

As @Rushie suggested, it’s possible that there’s some placebo effect, but at 7 weeks in I don’t think that’s the case. I went into this assuming the first medication wouldn’t work and I’d have to try a different one to see if that did the trick for me, and maybe another. In other words I went in expecting it to fail the first try, and surprised when it did. The common theme I hear from people who try an antidepressant briefly and stop is that they tried one, it didn’t work, and the withdrawal symptoms were bad enough that they didn’t want to try a different one. It’s possible that for those people, the meds just wouldn’t work. I am fortunate enough to be a person for whom medication usually does exactly what it’s supposed to with few (if any) side effects, so I have that going for me.

Now that I’m doing better and thinking more clearly, I’m fairly certain that I’ve never had correct seratonin levels, and looking at family members, I think that there are several in my bloodline who never did either. We’d just written it off as “she had a rough childhood” “he’s just grumpy” “nobody knows what’s wrong with her but she’s off.” But these people are/were a lot older, in a time when these medications didn’t exist and/or you just didn’t talk about mental health.
 
Not true. You can post an anonymous reply, like I’m doing now. You can even quote in an anonymous reply, like I’m also doing now.



I’m now 7 weeks in to my Prozac prescription and what you list here is one of the things I was concerned about, the “not feel” as opposed to “not feeling sad.” I was worried about not being able to have bad days anymore, or good experiences not feeling as good. I can tell you that for me personally, with Prozac, that has not happened at all. I can still have good days and bad days, as is part of life, but without the constant black cloud following me around and the never ending pit-of-the-stomach despair, waking up miserable every morning I’d been having.

As @Rushie suggested, it’s possible that there’s some placebo effect, but at 7 weeks in I don’t think that’s the case. I went into this assuming the first medication wouldn’t work and I’d have to try a different one to see if that did the trick for me, and maybe another. In other words I went in expecting it to fail the first try, and surprised when it did. The common theme I hear from people who try an antidepressant briefly and stop is that they tried one, it didn’t work, and the withdrawal symptoms were bad enough that they didn’t want to try a different one. It’s possible that for those people, the meds just wouldn’t work. I am fortunate enough to be a person for whom medication usually does exactly what it’s supposed to with few (if any) side effects, so I have that going for me.

Now that I’m doing better and thinking more clearly, I’m fairly certain that I’ve never had correct seratonin levels, and looking at family members, I think that there are several in my bloodline who never did either. We’d just written it off as “she had a rough childhood” “he’s just grumpy” “nobody knows what’s wrong with her but she’s off.” But these people are/were a lot older, in a time when these medications didn’t exist and/or you just didn’t talk about mental health.

hey I’m glad to hear that you are having a positive experience. I think it’s great our modern sceientific community is working these issues as well as a trend for it to be “more okay” to discuss mental health. I think we still have a ways to go on it- but we are further ahead than we have been in that reguardless.

best of luck to ya, you got this!
 
People that believe proper meds are a band aid? They’re wrong. Talk to your doc.
I would never discount proper meds. But depression can be a tricky thing to diagnose. There is no blood test to find a chemical that isn't supposed to be there. It doesn't show up on an Xray. It is an enormously subjective thing. And there are a LOT of people taking antidepressants. Physicians prescribe them, why not? There are few side effects in adults. If you look across the board at effectiveness, what you find is that antidepressants are no more effective than placebos. This shouldn't be.

The science behind monoamine uptake inhibitors (which if the modus operandi of all these things) is rock solid. The problem is simple. They treat depression very very well. They don't treat unhappiness. Depression is an abnormal chemical imbalance in the human brain. It can be treated chemically. Unhappiness isn't a chemical imbalance, it isn't even abnormal. Unhappiness occurs when bad things happen to us or good things fail to do so. The only treatments I know are dogs and/or alcohol. Antidepressants won't do a damn thing against unhappiness, but they're prescribed anyway.
 
People that believe proper meds are a band aid? They’re wrong. Talk to your doc.

you are correct- my wording was wrong.

I think a better way to phrase my intent would be-

“realize they are a tool in the toolbox, not necessarily a quick/perfect fix.”

Much like if I want to lower my cholesterol I should take my Crestor, but also eat better and exercise.

thank you for the check in my poor comparison there, as I am by no means an anti-med guy.
 
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