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Matthew Whalley writes "Researchers got hold of published and unpublished data from drug companies regarding the effectiveness of the most common antidepressant drugs.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 However, when the unpublished data is taken into account the difference between the effects of drug and placebo becomes clinically meaningless — just a 1 or 2 point difference on a 30-point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."

Comments

Further evidence...

[inviolet]

A while ago somebody noticed that anti-depressant drugs don't work at all unless they have some side-effects. The side-effects remind the user that he or she is taking a wow-must-be-powerful drug, which increases its placebo effect. The upshot is that it is completely counterproductive to search for an anti-depressant drug that has no side-effects. In fact, the more side-effects the better.

I don't remember more details than this, though.

In any case, it reminds me of a similar effect in microeconomics, in which consumers would tend to evaluate a widget more favorably if they had paid more money for it.

Depression is not all serotonin

[zombie_striptease]

I was on Zoloft for a couple of years way back when I was a teenager. It did fuckall to help my depression, I still hated life and still contemplated suicide, but I noticed something funny after I stopped taking it (due to severe gastrointestinal side effects). A few days after I'd quit the pills cold turkey, I was thinking of something I was stressed about, and along with the common wave of emotional despair, felt a physical sinking in my chest that I realized I hadn't felt for... about two years. I laughed when I realized that that was probably the chemical reaction that the SSRI had been halting, and laughed harder the longer I contemplated what a drop in the bucket it was in the scope of the depression I was struggling with. It made me understand the extent to which the Zoloft was just targeting a symptom of a larger problem, like any number of other medications do. There may be some people whose depression truly does stem from such a one-note imbalance, and I truly hope that the medication can help them, but it doesn't surprise me that antidepressants could be so insignificant to so many others.

Anafranil

[SharpFang]

I don't know about deep depression, but with rather mild depression I took a 25mg pill of Anafranil and had some 2 days of pretty much silly euphoric high.

The effect wasn't mild or insignificant or anything you could consider effects of placebo. I was feeling like in very good mood, work that felt like dread before, could be finished at my standard efficiency and the effects were NOT negligible.

Of course there -were- side effects and they were quite strong (feeling of heat, including sweating and problems with sleep, lower max physical strength, getting physically tired faster, problems with urination), but first they felt like a total non-issue due to the great mood I was in, and second, the lower efficiency of my body at physical work was ballanced by increased enthusiasm and will to work more and mental efficiency was not affected (not just in subjective opinion) and no other factors of perception than general very good mood were affected (although feeling far too warm to fall asleep resulted in natural effects of insomnia).

No idea what drugs they talk about but Anafranil is THE shit :)

Re:This just in!

[Aladrin]

I have to agree. My sister and mother are both are anti-depression meds... And I used to feel I was depressed, but wouldn't do anything about it.

I no longer feel depressed and I know why: I have hobbies now.

My mother and sister don't have hobbies at all... They just sit around and play games or watch tv... They have nothing to look forward to each day, or even each week.

Me, I can't -wait- to get home and mess with one or more of my hobbies at any given time... I've got so many that it's actually a burden at times to decide what I want to mess with... And I want to add more.

It really was the difference between wondering what life's about and loving my life.

I'm not a doctor, and this isn't the solution for everyone... But I'd bet a -lot- of people would be better off if they had things to look forward to, instead of living life minute-by-minute and never looking forward. Having friends is not 'having a life'. Having a future is, and that -should- include friends to do those things with.

This study has been published in 2002

[dandv]

I don't get this - the same news has been published by USA Today in 2002. Still, the PLoS article appears published on 2008-02-26.

Can someone explain?

Re:This just in!

[Mr. Slippery]

Depression is not illusionary, it's a real disease.

Depression is certainly not illusionary, and is certainly a real problem.

Whether it is helpful to call depression, and other "problems in living" that are not directly diagnosed as neurological lesions or malfunctions, "diseases" or "illnesses", is questionable. I suggest reading Thomas Szasz's The Myth of Mental Illness (available also in an expanded book form, but the original paper gives the gist of it):

...In actual contemporary social usage, the finding of a mental illness is made by establishing a deviance in behavior from certain psychosocial, ethical, or legal norms. The judgment may be made, as in medicine, by the patient, the physician (psychiatrist), or others. Remedial action, finally, tends to be sought in a therapeutic -- or covertly medical -- framework, thus creating a situation in which psychosocial, ethical, and/or legal deviations are claimed to be correctible by (so-called) medical action. Since medical action is designed to correct only medical deviations, it seems logically absurd to expect that it will help solve problems whose very existence had been defined and established on nonmedical grounds. I think that these considerations may be fruitfully applied to the present use of tranquilizers and, more generally, to what might be expected of drugs of whatever type in regard to the amelioration or solution of problems in human living.

I'm not sure whether I agree with him entirely or not. I do think that "mental illness" is at least in part a social construct - but the same is true of a lot of physical illness.

Required supplemental reading

[Phanatic1a]

Everyone needs to read the Last Psychiatrist's article on this study. He's a forensic psychiatrist, and a great blogger, and he makes some very interesting points:

It's the exact same data they had 10 years ago, the exact same data. This isn't a discovery, this isn't Woodward and Bernstein, this is a bunch of academics who are no longer on Pharma payrolls who have now decided that they have nothing further to gain from pushing antidepressants.

Now they can pretend to be on the side of science. We reviewed the data, and found some of it was not published.

You knew that already. You were the ones who didn't publish it -- it's your journal. Turner worked for 3 years as an NIH reviewer. He just notices this now?

Is no one wondering how it is that this study comes out now, when all antidepressants but two are generic?

As suspicious of Pharma as everyone is, no one seems to see that they are no longer getting Pharma money, they are now getting government money-- NIH-- so they're going to push the government line. No one finds it at all suspicious that the two biggest NIH studies in the past two years both found the generic to be the best?

You think that in 2000 those studies would have been published? But now-- 2007, 2008, if they'd found Cymbalta to be the best on the NIH's dime, you think that they'd get re-funded? What's the difference? Same authors, same studies, same data. All that's changed is the climate.

People want a direct financial link to show bias, not realizing that bias is much more prevalent and more powerful elsewhere.

Re:The wrong med from the wrong dr.

[xanthines-R-yummy]

Mod this guy up! By FAR, the majority of psychiatric drugs are prescribed by GP's and NOT psychiatrists!

This isn't the best reference but it's the best I could come up with in a few seconds:

http://www.medscape.com/viewarticle/406083

Re:This just in!

[TheLostSamurai]

It's funny, I used to be among the camp of people that would say "just make yourself be happy". For me it was really that simple. Anytime I was in a bad mood I could just will myself out of it and simply could not understand other people that couldn't.

That was of course until I started taking steroids, no not the shoot 'em in your ass and get big kind, the prescription kind. Now a normal dose for this drug is 5-10mg usually given for skin problems and sometimes for asthma. The bottle specifically states that you should not suddenly stop taking this medication and there needs to be a weening period to help you get off of this drug. The dose I was given was 120mg that I was instructed to start on the first day of the month, take for 5 days and then stop altogether. The goal was to try to make my immune system recover from months of intensive chemotherapy. After the second day of taking this medication, my mood could only be described as extremely optimistic about everything and a view that I was, for the most part, wholly invincible. This feeling lasted until the sixth day at which point I had stopped taking the drug and started to feel like the world was literally crumbling around me. I would see a commercial on TV and start to cry when I realized that I do sometimes get that 'Not so fresh feeling'. It was ridiculous. At one point I got into an argument with an old friend who did not know what I had been going through, and for a moment considered jumping 3 stories to my death so she could see how much she hurt me.

It was at that moment that I realized what true depression was. I looked back on the moment a week later after the side effects had dithered and thought about how irrational those thoughts were. At the time when I was having them however, they seemed a perfectly logical solution. Now I realize this is an extreme case brought on by side effects of a powerful drug, but it does represent to me how an unbalancing of chemicals in the brain can greatly affect a persons mood and I will never again jump to the conclusion that a persons depression is not affected by a real problem with their physiology.

With regards to the placebo effects of anti-depressant drugs, I will say that at one point I was prescribed Lexipro by my doctor for what at the time was really situational depression. This drug was certainly no placebo. While it did not make me happier, it had the affect of making me extremely anxious and angry. I developed very violent tendencies over the 2 weeks I was on it. This drug was obviously mis-prescribed by a bad doctor, but it most certainly altered my brain chemistry. My cousin, who is more similar to me that our parents are to each other (sisters), was prescribed the same drug with very similar effects. So there may be some drugs out there prescribed for depression that don't work for a lot of people, and others that have unintended effects, but this may be due more to doctors not understanding the illness of their patients and not understanding the drugs intended uses.

Re:This just in!

[hedwards]

If someone has real severe clinical depression, drugs are the only scientifically proven way to get back to leading a normal life. I think you mis-phrased that. Medications can be useful in getting somebody out of the mire enough to start utilizing approaches like Cognitive Behavioral Therapy and taking better care of themselves.

It bothered me when I first read the BBC article on this, that people were being prescribed antidepressants for mild depression. There isn't generally any reason why a mild case should be worth the side effects, expense and possible suicide risk of prescribing the pills. I've been a fervent believer for quite a while that unless a person is suicidal or debilitated to the point where they aren't functioning, that they should really think about whether the pills are the right solution or not.

The most effective treatments always include both pills and therapy in the beginning, and usually over time become just therapy as a patient improves. I wouldn't personally be surprised that the placebo effect factors into this somewhere, outlook on medication has been known for a long time to be an influencer of efficacy. And even in cases where a person knows that a treatment or method is bunk, but chooses to delude themselves anyways, there's a bump in efficacy.

Medications should be in wane in terms of development at this point, it's pretty well established that exercise, light box therapies, certain fatty acids, CBT and things of that nature make a much larger impact than was believed in the past. Not to mention the fact that much of what gets diagnosed as depression is more accurately describes as insomnia.

Unfortunately, this isn't a one size fits all solution to things, people will frequently need combinations of the above, with possible other treatments as well. The big problem with medication is that it was never proven that the pills addressed the cause of the problem in the first place. Because of that, there was always the risk that the pills were kind of like treating drowsiness with meth, it appears to work in the short term, but doesn't actually address the underlying problem.