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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Matthew Whalley writes "Researchers got hold of published and unpublished data from drug companies regarding the effectiveness of the most common antidepressant drugs.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 However, when the unpublished data is taken into account the difference between the effects of drug and placebo becomes clinically meaningless — just a 1 or 2 point difference on a 30-point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."
Spoken by someone who's obviously never suffered from depression.
As its been widely noted this study does not take into consideration as a variable those patients that talked about their depression with a psych or councilor and those that didn't.
Anti-dep medication allows you to handle your current situation enough so that you can go and talk to someone about your wider issues.
Its a band aid. The real fix is to find the thing making you depressed and fix that. And you need to talk to someone for that.
I think you're confusing depression as in "Man, I'm pissed off today" and depression as in the medical condition. "Real" depression is a horrible thing and needs treatment. It's as if you're saying cancer neends no treatment, since the cells grow very naturally.
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.
No, seriously, he's right. It's not so simply like you can just say, "I'm not going to be depressed" but just being depressed is itself a real downer than sucks you in deeper. Antidepressants, even if they only work through placebo affect, provide a patient with hope, which could help the roller coaster move gradually upward.
The best days are usually the days you've made a plan of action and convinced yourself it will change everything and you'll be better--you're thinking positively and not fixated on your depression. The worst days are when you realize you plan of action didn't do shit and everything still the same.
I actually think this is a wonderful advice. Doing these things makes you forget how shitty your life is and when you actually get at them, your life isn't shitty anymore. The worst thing to do is to just lie around and sulk. You become focused on your own depression and that just makes it spiral out of control. Well, sometimes that actually IS the only thing I want to do when feeling down - and in that way it is maybe not so hard to understand how depression happens to people.
Sometimes just cleaning my room, or doing the laundry helps me get up again. And having a fairly regular life, eating good food, and getting outside, if not only to walk around a bit. Heck, even writing comments on slashdots can help.
The basic tenet of this philosophy is to "keep yourself busy". Don't ever just sit down and let the feelings overwhelm you. By and by, they diminish and life won't suck anymore. I know this isn't enough for many people and I suspect a lot of "you have no idea what _I_ have been through". But I think people should TRY. We are often too quick to judge something as clinical depression and sometimes forget that depression is also a normal state of things that CAN be overcome by effort. Even when it gets so bad that you don't leave your bed for a week - it CAN be normal - or at least inside some manageable neighboorhood of normal.
As for the last thing: Stop feeling sorry for yourselves! This might sound harsh, but feeling sorry for yourself is the worst thing you can do to yourself.
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.
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.
Just like you can decide not to feel pain when someone hits you, right? I mean all the beating did was send a bunch of electrical signals into your brain. Pain itself is all in your head.
He said "real severe clinical depression". That's the 1/3 you're talking about where the drugs work. Many people are diagnosed with depression based on just the most general definition (feeling "down" for longer than 2 weeks). And most people should only be treated with therapy. Today the drugs are handed out like candy. If they were only handed to the people that genuinely need them you'd find anti-depressants work quite well, which seems to be what TFA is saying.
Developers: We can use your help.
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".
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
Most people aren't comfortable with the idea that bad things happen to people through no fault of their own. If bad things can happen to you through no fault of your own, then I have to consider that terrible things might happen to me!
It's like people believing in a meritocracy. People who believe they owe all their success and material wealth to their own strength of character and nothing else, as if, had they been switched at birth and raised in the 3rd world or an inner-city slum, instead of a middle-class family in an industrialized country, that they'd still be programmers or stockbrokers or something.
Are you suggesting that the fact that SSRIs do nothing supports the assertion that people can just 'think themselves out of depression'? 'Cause I don't think you can draw that conclusion at all. The only conclusion I think you can draw from the fact that SSRIs are no better than placebo is that we don't understand the brain nearly as well as we thought.
The plural form of "anecdote" is "anecdotes", not "evidence".