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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Matthew Whalley writes "Researchers got hold of published and unpublished data from drug companies regarding the effectiveness of the most common antidepressant drugs.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 However, when the unpublished data is taken into account the difference between the effects of drug and placebo becomes clinically meaningless — just a 1 or 2 point difference on a 30-point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."
Thinking that you're going to not be depressed anymore makes you less depressed!
I'm not really surprised that the drugs are overperscribed. However, I do find that the subject heading is misleading.
People seem to miss something that seems very obvious to me... They think "Oh! You're depressed.. there's something wrong with you, maybe these drugs can help it" ... but depression is a _natural_ state in most living beings. Just look at dogs, they can get severely depressed, just like their owners. Sometimes, yes, a chemical imbalance is to blame and drugs can help. But more often than not a human being is depressed for a reason... bad relationship, money problems, reading about too much pain in the world from the newspaper. You name it, there are plenty of very valid reason all around us to get depressed. Our society has changed very quicktly in the past few centuries, and the past few decades, and it seems that this new way of living does not agree with a lot of people. Rush, do this, do that, look like this, behave like this, own this, spend your money more, more, etc, etc. This is all extremely stressful, and none of it to the betterment of ourselves as people. "Okay, so, I bought myself a fancy new $600 sofa. It's pretty and soft and my guests will be impressed...... Hmmm.... So, where's my scotch?"
It is no measure of health to be well adjusted to a profoundly sick society. - Krishnamurti
I think Mr. Cruise was ranting about post partum depression specifically. As I understand it, he actually had some details right (no one is certain why mothers get it), but you can't go busting on a new mom on national TV and come out as anything but an ass. And really, he was one.
I will shred my adversaries. Pull their eyes out just enough to turn them towards their mewing, mutilated faces. Illyria
This summary doesn't mention it, but I saw another summary of this recently, and as I recall Prozac was not one of the drugs covered under this study (assuming it's the same one I read about).
While the results are interesting and worth keeping an eye on as a basis for further research, we should retain heavy skepticism here. It would be absurd and incredibly stupid to draw major conclusions already from this one small study (like the slashdot headline does). In ANY given field you'll find studies that disagree with most other studies. And for all we know this study could've been funded by a company whose main competition is anti-depressants, for example (e.g. many of the quack "cures") or some other group that ideologically disagrees with anti-depressants, and/or there could've been problems with the methodology --- I mean, we may know the drug companies have a financial reason to be biased, but that doesn't mean no drugs have value and doesn't mean that nobody other than drug companies have reasons to be biased.
Sorry, I have a considerable amount of experience with family members who went the counseling route for years without seeing improvements. After finally deciding to try anti-depressants, anti-anxiety, etc., the problems they had most of their lives went away or were reduced to levels that made it easier for them to have a better life. The biggest problem I've seen is not whether they work or not, it's that GPs are the ones issuing the Rx. GPs are just that - GENERAL practitioners. The good ones admit that their knowledge of the nuances involved with the "low-level" chemical behavior of the brain is limited. A psychiatrist, someone with a medical understanding of the topic (not knocking psychologists, but their understanding is in a different area: the non-biochemical causes of issues) should be the person making the determination of just what a person should be on. They're aware of more of the potential "cocktails" of drugs (one particular drug is not enough) - both in terms of what works and what needs an additional medication to target secondary causes/effects of depression....
Bark less. Wag more.
The point is not that antidepressants don't work - the point is that diagnosis criteria for depression has been to lax for too long. "Everybody gets depressed, not everyone needs antidepressants" It makes sense that the only people who respond to antidepressants designed to fix chemical imbalance are the ones with severe depression.... who are likely to have a real chemical imbalance. These are not "happy pills" they are formulated to fix an insufficiency. Normal, mild depression from events (death, divorce, etc) has always been treated best by cognitive behavioral therapy (aka psych visits), unless you just want to zonk someone out. But, in our society, if you have a problem you get a pill. No one wants to hear "go talk to someone and get over it," so doctors write the scripts and the generally malcontent get them filled.
This fits with what some other studies have shown in the past... in the short run. Depression is often cyclical; people get more or less depressed over time and will often be fine for long periods of time. So simply by taking nothing and waiting, they'll often start to feel better soon. This is why taking anti-depression meds is almost indistinguishable from a placebo in the short run, except in the most severe cases.
The real test is how effective the meds are at preventing future episodes of depression, or at least limiting how bad they are. TFA doesn't go into enough detail on the length of time over which the data was collected, so I don't know what it has to say about this.
Seriously, Slashdot editors: be a bit more responsible when you are dealing with potentially serious and life-threatening medical conditions. The study did not find that "Antidepressants work no better than a placebo". What it seems to have found is that there is an indication that antidepressants do work for people who do have a serious depression, while there is little indication it works better than a placebo for lighter (possibly misdiagnosed) cases.
Here's the thing: a clinical depression is a serious, crippling condition. Recent research has tied its physical underpinning to a slowdown in neurogenesis in certain areas of the brain. Most likely, this slowdown is caused by the bad quality of sleep caused by continuous and prolonged stress. But whatever the cause, the end result is a brain that is physically different. Yes, this is a physical condition, one whose recovery is progressive and takes a fair amount of time. And it's precisely in this condition that antidepressants have been shown to be of help. Moreover, you cannot magically cure someone with a clinical depression by having them "snap out of it". (Would you say "snap out of it" to someone with a broken leg?)
Part of the reason why depression is so wildly misunderstood is because everyone gets the blues every now and then. That is not the same as a clinical depression. And if a misinformed doctor prescribes antidepressants to someone who just has this "pseudo-depression", then it's no surprise that antidepressants won't really make much of a difference. However, this does not invalidate that antidepressants are valuable tools in fighting real clinical depressions.
My main concern, which you've not addressed
What? Nonsense, I stated clearly that I believe drug companies have motive to be biased (OBVIOUSLY they do). I don't doubt for a minute that they would do exactly as you state. But that doesn't mean every study is tainted or that the drugs have no effect; just because drug companies might be "evil" doesn't mean everything that casts them in poor light is automatically to be taken as gospel, we keep the same scientific mindset regardless. The depression quackery business is HUGE, I wouldn't be surprised if it's measured in the billions, from depression "herbs" to homeotherapy to stones to every other bit of nonsense you can think of - every one of these snake oils salesmen are salivating right now ready to jump on this study as "proof" that you should buy their products rather. Then there are also many churches who don't believe in depression as an illness to be cured with pills (it's a "spiritual problem", you see), plus all those who simply believe that there is no such thing as an illness of the mind (it's all pyschological, you see), or even the common view that people are just feeling sorry for themselves. Depression must be one of the most contested diseases in existence.
Amongst the side affects of the many drugs that are prescribed, he has become overweight and now suffers from sleep apnea further complicating the depression. If anything I have learned from observation is that people suffering from depression need the support of people close to them, for the condition is like a downward spiral of physical, mental and spiritual decay. Contact, phone calls conversations, anything you can do to help unravel the root cause of the depression, like challenging the paranoid feelings all help to take power away from the disease.
For the fist time in a long time, I think I see him finally come out of it because he is starting to excercise. I don't know if the drugs helped, perhaps leveled things out and maintained the status quo. They were probably required as on several occasions I was physically attacked by him (and he is a big guy), fortunately for me (and him) I also am a big guy and have trained physical combat for most of my life. I say that because there was a strong responsibility on my part to not hurt him any more than it was required to control and disarm him. You have to realise it's not the person attacking you, it's the disease and for this reason I think that it is also can become contagious (so to speak) who do not have this capability.
I can't say whether the drugs are good or bad (just that there is a lot of them and he takes them e-v-e-r-y--d-a-y) but I do know the drugs have changed his brain chemistry forever, I often wonder if the person I grew up with is still in there, occasionally I see a glimpse. I have studied all I can about depression to learn everything I could to help him and I look forward to reading about other peoples experiences in this discussion. What I learned is that the medications are a commitment for all the people around to be aware that the critical time is when they are coming off the medication and they finally lose their apathy towards self harm, i.e they finally have enough energy to do it, signs that must be watched for if you want someone you care about to actually survive depression.
I also learned that regardless of the drugs there are two core issues that every person who suffers depression will have to face;
1) Rigorous physical excercise is that path back to mental well-being, the sooner the better and something fun and positive that helps self esteem and confidence.
2) The issues that triggered the depression will eventually have to be faced.
I hope one day it will be gone, because I don't want my family member to die from it or with it. I call it the black dog because it chases and hunts you down and occasionally I sense it coming after me, but I fight it and you have to fight it. Perhaps if people who were susceptible to depression were made to excercise it would disappear, but then the drug companies wouldn't get to sell all that expensive medication and I definitely think it is a factor in the diagnosis of this modern curse. I also think that good spinal care is a factor as I also noticed an improvement in his demeanor when this was done. Additionally I think that depression is a natural consequence to some overload of emotional stress, alas IANAP, that triggers a change to the brain chemistry.
I suspect the Metalica song Until it sleeps was written about depression as it aptly describes what is truly the modern plague of our time.
My ism, it's full of beliefs.
Ha! Watch more late-night TV, see more ads for penis pills, and reconsider that.
Tom Swiss | the infamous tms | my blog
You cannot wash away blood with blood
No, it's unlikely to be the placebo effect. It's more likely to be something called 'withdrawal.' Try the same thing with alcohol, caffeine, or tobacco. You won't be any happier because you've started taking it, but your friends will notice one hell of a decline once you stop.
...mild or insignificant or anything...By definition, placebo effect is indistinguishable from a drug's chemical reaction.
I'm not saying whether your result was placebo or not; just that you couldn't tell the difference.
The Church of Scientology.
Now, stop jumping on my couch!
"Flyin' in just a sweet place,
Never been known to fail..."
It's the fair world bias.
/.ers are true believers in fair world and meritocracy.
Many
So the idea that bad things happen to people for no reason at all, through no fault of their own, makes people who believe that they're 100% responsible for the state of their life profoundly uncomfortable. So you get this 'blame the victim' mentality.
Comfortable, well educated, middle class white guys don't like being told that they didn't get where they are solely on their own strength of character.
I submit that anybody who says you can 'decide' to not be depressed has absolutely no idea what they're talking about.
The plural form of "anecdote" is "anecdotes", not "evidence".
Most likely you're self-medicating, and if the doctors don't immediately see that it may be time to get different doctors.
At the same time, try laying off the recreational drugs while you're on the prescription ones. Interactions between recreational drugs and prescription drugs have not been studied as well as prescription vs. prescription. Recreational drugs also tend to be more complex. In general, mixing the two can be pretty dangerous.
I got my Linux laptop at System76.
It's interesting. Basically, people with the short form of the seratonin synthesis gene are prone to depression, if they have a traumatic triggering event or events at the right stage of their development. The researcher who did the experiment tested herself and found she had the short form, but had not experienced any major trauma growing up, and so wasn't herself prone to depression.
By chemical imbalance I mean, "Unable to properly synthesize enough seratonin for normal functioning." The thing that medication does, for those suffering from real, clinical depression, is it lets us get over the hurdle of, "How do we motivate ourselves to do thing things we know will help get us out of it?" I mean, that's the real killer. You know what to do to get yourself out, you just don't have the motivation to do it, even knowing it will help. The medication lets us engage that motivation enough to get out of it.
That's the thing this study doesn't take into account. You need to do more than just take the pills, they only kick-start the process.
- None can love freedom heartily, but good men; the rest love not freedom, but license. -- John Milton
Interesting side-effect of nationalized health-care.
When information is power, privacy is freedom.
Hey, nuance! I like nuance. You are starting to sound a little smarter to me. Certainly, many people who should "just get over it" are prescribed drugs they don't need and that won't help. But just as certainly, there are people who need some kind of kick start before they can engage their own positive coping mechanisms. And there are also people who are just going to be miserable no matter what, the poor sods.
I don't think our society is devolving like you say. I think it is coming out of some major post traumatic stress, and there are going to be all kinds of juvenile, self involved responses to that, but that is just part of the healing process. Sometimes things appear worse before they get better. You know, you're in therapy and you have a breakthrough, and maybe your a complete mess while you work through all the shit you've been repressing, but then you feel much better and more in control? I think that's what our society is going through on a large scale.
I mean really, do you want to go back to the days of beating kids, wives as chattel, no vote for women or blacks, almost no middle class home ownership, 12 hour, 7 day work weeks, child labor, no worker safety laws, union organizers gunned down by hired thugs, and all the other fun crap we dealt with in the last century? Because I don't.
Sure it's fun to feel all cynical and superior and grouse about how the world is turning to crap, but where does that get you, hmmm?
- None can love freedom heartily, but good men; the rest love not freedom, but license. -- John Milton
"Anyways, a lot of drug trial data is needed to find the population where the drug works."
No, a lot of drug trial data is generated to convince the FDA that a pre-selected demographic for target marketing is real. When extra convincing is needed, invent pretend awareness groups to stimulate consumer demand, and add new illnesses to the DSM that match the drug, not the other way around.
How about beer?