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Antidepressants Work No Better Than a Placebo
Matthew Whalley writes "Researchers got hold of published and unpublished data from drug companies regarding the effectiveness of the most common antidepressant drugs. Previously, when meta-analyses have been conducted on only the published data, the drugs were shown to have a clinically significant effect. However, when the unpublished data is taken into account the difference between the effects of drug and placebo becomes clinically meaningless — just a 1 or 2 point difference on a 30-point depression rating scale — except for the most severely depressed patients. Doctors do not recommend that patients come off antidepressant drugs without support, but this study is likely to lead to a rethink regarding how the drugs are licensed and prescribed."
I just listened to the CEO of Eli Lilly speak for an hour last night, and he said most prescription drugs work at best in 80% of patients who are diagnosed with the disease it's supposed to treat. Their least effective drugs only treat 20% of patients. Until effective genomics, proteinomics, and metabonomics testing systems come out, which will show exactly how people react differently to drugs, they have to train doctors in choosing criteria where the drug will work, and ensure that they don't prescibe drugs that don't work in that circumstance. Selling drugs that don't work is an unsustainable business policy.
He talked about Strattera, a nonstimulant ADHD drug, that works works best in people with ADHD combined with clinical anxiety. Otherwise, the patient should be prescribed a stimulant based ADHD drug, which works more often in other cases.
Anyways, a lot of drug trial data is needed to find the population where the drug works. In a lot of cases the drug might not work at all. Prescribing methicillin against methicillin-resistant Staphtacaccous aureus will probably an efficacy similar to placebo.
When they're on them they are normal and healthy. They feel so normal and healthy that they often decide they don't need them anymore - so they go off them. Then they are not normal and healthy.. they are depressed. After one too many 2am phone calls one of their friends will recommend that they go back on the anti-depressants. Soon after they will be normal and healthy again.. until the cycle repeats itself.
Must all be the placebo effect though.
How we know is more important than what we know.
And it depends on WHY you're depressed.
If you're depressed because of a neurological glitch - yeah, meds might help. But if like me you're depressed because of environmental issues (cabin fever compounded by social phobias) - they might just not work at all - Prozac didn't do shit for me, didn't even cause a reaction when I OD'd on it.
-uso.
What you hear in the ear, preach from the rooftop Matthew 10.27b
At least in Sweden, if you've had a deep depression and are on the way to getting good, they will stop helping you and force you to go back to work 100% immediately. If you've ever had a (real) depression you know that that is not an option. You need to start slowly before you can get up to speed or you will be back to where you started (when you got depressed/burned out). So what to do? You lie to the doctors for a while and pretend that it's still as bad as it used to be so you get a chance to recover. The doctors would understand and agree with you but they aren't allowed to sick-list you if you aren't so down that you rather starve than go outside to buy some food. So, I think this survey isn't telling the whole truth.
My other account has a 3-digit UID.
Prozac == fluoxetine, which is mentioned in the article.
Tiller's Rule: Never use a word in written form that you've only heard and never read. You will end up looking foolish.
Disclamer first, I work for an R&D company that develops interactive voice response systems (ie: phone surveys) that are used to apply traditional depression and mental health tests in a consistent manner. My company is in part funded by grants and projects paid for by large pharma comps. Although I personally have no contact with them.
When pharma's want to do a study, they set up sites, each site will have one or more doctor and each doctor will have one or more patient who is participating. Quite often, these studies pay a bonus for each patient up to the quota, or the docs will want to try to help and fill their quota. When they do this, it introduces people into the programs who really should not be there. It's not that they are being purposely decietful or anything, they just aren't being as consistent and strict as they should be. I know this to be a fact, we have done numerous studies in which our system's performance is compared to real world docs across the US. And each and every time, our system would exclude over 20% of the patients that the doctors would enroll.
Since these studies are being poluted with people who do not reach the level of condition the drug was ment to treat, the drug will be ineffective on them. You can't "undepress" people who aren't depressed to start with. So they will reduce the effective correlation of the drug. There is also another natural bias that clinicians apply that causes a deflation of scores at the end of the study due to the double blind factor being eliminated by side effects.
In short, traditional ways of performing these studies are heavily flawed and will often result in a lower apparent effectiveness than the drug actually has.
-Rick
"Most people in the U.S. wouldn't know they live in a tyrannical state if it walked up and grabbed their junk." - MyFirs
Then it isn't a chemical imbalance. There is a difference between being unhappy and being depressed. I know that many times when I am in the grips of it, I wish I could actually feel unhappy. It's more like a fog, a lead blanket, a loss of engagement with life. A positive attitude could help, but how do you do that? "Just decide to" isn't the answer. Exercising can help, lots of things can help, but how do you decide to do those things, and then actually do them? If you have an answer, I'd love to hear it.
But I've heard people like you all my life. The "Buck up little camper," the "Just snap out of it," the "Oh stop whining," you know you aren't doing it for me. The fact that I am depressed makes you uncomfortable, maybe even challenges your ideas about the self and free will, and you just want me to shut up and go away. You don't really care if I get over it or not. At least that's what most people who talk your talk are actually like, who knows, maybe you are different. But I doubt it.
- None can love freedom heartily, but good men; the rest love not freedom, but license. -- John Milton
Look, I'm troubled by these results too -- people very, very important to me have benefited greatly, I dare say in life-saving ways, from antidepressants, and having seen some of the very physical side effects I'm disinclined to think it's something as simple as a placebo effect. If you're going to go after something, consider that the study authors didn't do moderator analyses to test whether results differed for men and women, or based on the mean age of the samples, or (as one poster noted above) whether talk therapies were administered in addition to drugs. But the methodology in this study is sound, and impugning the authors for imagined conflicts of interest is just cheap.
"A few days after I'd quit the pills cold turkey"
Just a note - whether or not you think your pills are helping you, don't try this. It's extremely dangerous with most medications. I'm not posting to berate the Parent, just letting others know that it's a really bad practice that can lead to serious consequences with a lot of these drugs.
Yes, this is not under dispute
The research does in fact say that for the most serious cases of clinical depression, the drugs do have a benefit. They don't work any better in such cases you understand; it's just that the placebo effect drops away sharply at the extreme end of the severity curve, so that drugs become more effective by comparison.
The point here is that for the vast majority of cases where the four anti-depressants in question are usually prescribed, they have roughly the same effect as a couple of grams of chalk wrapped up in a sugar coating. Which rather brings into question their value in all but the most extreme cases.
[ Info based on an interview on Radio 4's Today Program, this morning. They had an interview with one of the researchers, and another with a rep from the drugs industry. ]
Don't let THEM immanentize the Eschaton!
I know a few depressed people and a couple bipolar people, and I also know the clinical definition of "depression", and boy, having "lots of hobbies" and doing "many different things" does not fucking compute.
Depressed people have trouble enjoying things that they used to find enjoyable -- that includes hobby --, that's the god damned definition. They also have trouble getting things done, that's the god damned definition too.
Ergo, if you enjoy lots of hobbies and do lots of stuff -- you're probably not depressed! Very depressed people can't get out of the bed, for fuck's sake.
> Stop feeling sorry for yourselves!
There are some who don't necessarily feel sorry for themselves, but instead are mad at themselves for not being able to overcome their depression. The same psychology still comes into play, but it's not like all depressed people sit around thinking "I'm so sad and everyone should pity me."
As one of the comments to TFA notes, one problem with the studies reviewed is that the trials may not have been long enough to detect differences. They were mostly 6 week trials, with a few shorter and a few longer. That may not be long enough to pick up a significant difference. The effects for some can peak between 6-8 weeks. Disclaimer: I am a psychologist.
As a martial arts expert I can say that no amount of training will ever allow you to ignore pain. Anyone who says otherwise is a liar.
Tricyclic anti-depressants, a previous generation of medication before SSRIs, were largely abandoned because they had more side effects and were considered less effective. Sort of throws water on that theory.