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Antidepressants Work No Better Than a Placebo
Posted by
kdawson
on Tue Feb 26, 2008 07:02 AM
from the sugar-pills-are-cheaper dept.
from the sugar-pills-are-cheaper dept.
Matthew Whalley writes "Researchers got hold of published and unpublished data from drug companies regarding the effectiveness of the most common antidepressant drugs.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 However, when the unpublished data is taken into account the difference between the effects of drug and placebo becomes clinically meaningless — just a 1 or 2 point difference on a 30-point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."
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Submission: Antidepressants don't work better than a placebo by Anonymous Coward
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Placebos Are Getting More Effective 349 comments
Wired is reporting that the well-known "placebo effect" seems to be increasing as time goes on. Fewer and fewer medications are actually making it past drug trials since they are unable to show benefits above and beyond a placebo. "It's not only trials of new drugs that are crossing the futility boundary. Some products that have been on the market for decades, like Prozac, are faltering in more recent follow-up tests. In many cases, these are the compounds that, in the late '90s, made Big Pharma more profitable than Big Oil. But if these same drugs were vetted now, the FDA might not approve some of them. Two comprehensive analyses of antidepressant trials have uncovered a dramatic increase in placebo response since the 1980s. One estimated that the so-called effect size (a measure of statistical significance) in placebo groups had nearly doubled over that time."
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This just in! (Score:3, Insightful)
Re:This just in! (Score:5, Insightful)
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Re: (Score:3, Insightful)
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Re:This just in! (Score:5, Funny)
*plugs fingers in ears*
la la la la la
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Re: (Score:3, Interesting)
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 [yorku.ca] (available also in an expanded book form [wikipedia.org], but the original paper gives the gist of it):
Re:This just in! (Score:5, Insightful)
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If you can DECIDE not to be depressed (Score:4, Informative)
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.
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Re:If you can DECIDE not to be depressed (Score:5, Insightful)
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.
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Pills only kick-start the process (Score:5, Insightful)
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.
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Re:This just in! (Score:5, Insightful)
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.
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Re:This just in! (Score:5, Interesting)
That was of course until I started taking steroids [webmd.com], 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.
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Re:This just in! (Score:5, Informative)
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. ]
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Re:This just in! (Score:4, Interesting)
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.
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Re:This just in! (Score:5, Insightful)
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This Thread Cheerfully Bought to You by (Score:5, Insightful)
Now, stop jumping on my couch!
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Re:This just in! (Score:4, Insightful)
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Re:This just in! (Score:5, Insightful)
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.
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Re:This just in! (Score:5, Insightful)
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.
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Re: (Score:3, Informative)
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.
Re:This just in! (Score:5, Interesting)
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.
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Re:This just in! (Score:4, Insightful)
Another thought, perhaps controversial, is that women seem inclined to worry more than guys. I try to minimize potential worry-items -- opening up bills just before I plan to actually pay them, for example. My wife will open a bill the minute she sees it, even if we are just off for a walk with the dogs. Then while we are walking the dogs in the fresh air, she has to be thinking about that ridiculous Comcast bill.
Finally I would add that carrying too much stuff around in our head does us no favors. No one in our family has a cell phone, nor do we wish we did. That way when I'm driving from A to B, I am not so rudely interrupted that I almost drive off the road. Instead I can enjoy the beautiful bumper-to-bumper traffic in peace. But seriously, if I am fuming in traffic I would just as soon not share my headspace with someone else at that exact moment. I have also used a reminder program [xreminder.com] for eight or nine years now, and currently have 225 reminders in it. When my wife hits me with an event -- take the dog to the vet on Wed -- I create a reminder and then forget about it until the reminder goes off. I miss fewer events and carry a dozen times less event-related detail in my mind -- has to be a good thing.
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Re:This just in! (Score:5, Insightful)
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.
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Re:This just in! (Score:4, Informative)
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."
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Further evidence... (Score:5, Interesting)
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.
Re:Further evidence... (Score:4, Funny)
Pah. Does every Slashdot comment need an Apple angle?
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Depression is not all serotonin (Score:5, Interesting)
Quitting "Cold Turkey" (Score:5, Informative)
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.
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Eli Lilly CEO (Score:5, Informative)
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) that figures (Score:5, Funny)
I have friends on anti-depressants (Score:3, Informative)
Must all be the placebo effect though.
Anafranil (Score:5, Interesting)
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: (Score:3, Interesting)
The major difference is that while clomipramine just inhibits the re-uptake of these neurotransmitters in the synapse, MDMA also induces heavy release of serotonin, enough that your serotonin reserves are rapidly emptied on a "normal" dose.
I wouldn't touch MDMA with a mile long barge pole ; serotonin is the "happy" hormone, taking a drug th
The wrong med from the wrong dr. (Score:5, Insightful)
Re:The wrong med from the wrong dr. (Score:4, Interesting)
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 [medscape.com]
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Missing the point (Score:5, Insightful)
Don't forget (Score:4, Informative)
This study has been published in 2002 (Score:3, Interesting)
Can someone explain?
Grossly misleading headline (Score:5, Insightful)
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.
Re:Grossly misleading headline (Score:5, Insightful)
Clinical depression is a world apart from "a bad month." It can cause hallucinations, anorexia, insomnia, profound fatigue, sensory disturbances, and inability to think. It's a physical disorder, and generally the physical symptoms precede the subjective ones (sadness, apathy, suicidal ideation).
I agree that it's normal for most people to get in a funk from time to time, but usually that's situational - your dad dies, you move somewhere new, you lose a job. I also agree that it's possible to use therapy to help instead of drugs, if your problem is due to negative/erroneous beliefs and self-narrative.
What I don't agree with is the herd mentality to throw out antidepressants due to an erroneous conception of the disease and the proper use of medications. The first antidepressants were discovered accidentally, by doctors treating tuberculosis patients with Iproniazid [wikipedia.org]. The patients' moods changed enough that it was obvious something was going on. This wasn't anticipated, and thus certainly wasn't a placebo effect.
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There is a reason why studies go unpublished (Score:5, Informative)
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
Required supplemental reading (Score:5, Interesting)
The Black Dog (Score:5, Insightful)
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 [google.com.au] was written about depression as it aptly describes what is truly the modern plague of our time.
Re: (Score:3, Insightful)
Re:Depression not natural? (Score:5, Insightful)
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Re:Prozac changed my life (Score:4, Insightful)
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.
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Re:Prozac changed my life (Score:5, Informative)
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Re: (Score:3, Insightful)
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 b