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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Matthew Whalley writes "Researchers got hold of published and unpublished data from drug companies regarding the effectiveness of the most common antidepressant drugs.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 However, when the unpublished data is taken into account the difference between the effects of drug and placebo becomes clinically meaningless — just a 1 or 2 point difference on a 30-point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!
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.
FATMOUSE + YOU = FATMOUSE
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.
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.
(SIGH) nothing ever works, its hopeless!
stuff |
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.
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.
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.
I agree with you, clinical depression is a very serious thing. I should know, I've been diagnosed as bipolar, manic-depressive, and, I quote "SEVERELY clinically depressed". To the point where I don't mention feelings to my doctors, cause they start asking me about razor blades and the like. I've tried the drugs -- believe me, I know what I'm talking about. I'm not talking about "Man, this is a crappy day" I'm talking about a never-ending, life long dysphoria with LIFE. You get occasional pick-me-ups in the form of the people you life, a funny cartoon, etc... but in general, life seems to kind of... suck. And even when those thoughts AREN'T going through your head (or mine), you still feel bogged down just by how you have to live in this society.
It is no measure of health to be well adjusted to a profoundly sick society. - Krishnamurti
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
45 5F E1 04 22 CA 29 C4 93 3F 95 05 2B 79 2A B2
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.
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.
Can someone explain?
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.
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
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.
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.
The Church of Scientology.
Now, stop jumping on my couch!
"Flyin' in just a sweet place,
Never been known to fail..."
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