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Medicine Science

Antidepressants Work No Better Than a Placebo 674

Posted by kdawson
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Matthew Whalley writes "Researchers got hold of published and unpublished data from drug companies regarding the effectiveness of the most common antidepressant drugs.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 However, when the unpublished data is taken into account the difference between the effects of drug and placebo becomes clinically meaningless — just a 1 or 2 point difference on a 30-point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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Antidepressants Work No Better Than a Placebo

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  • Eli Lilly CEO (Score:5, Informative)

    by ruinevil (852677) on Tuesday February 26, 2008 @08:47AM (#22557108)
    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.
  • by Anonymous Coward on Tuesday February 26, 2008 @08:48AM (#22557114)

    The side-effects remind the user that he or she is taking a wow-must-be-powerful drug, which increases its placebo effect.
    I have been taking Wellbutrin for almost a year and a half and I have yet to have any side effects, even with no side effects the drug worked perfectly and helped me get through my senior year of high school. While taking it someone told me about someone they knew whose pharmacist switched her over to the generic form of the drug with out her knowing it(thus no placebo effect) and the drug stopped working. So either she did know and was lying to get attention or she had no idea which shows that in some cases it can work or the third option that it was a bad batch of the drug that wasn't as powerful as the normal ones.
  • by QuantumG (50515) <qg@biodome.org> on Tuesday February 26, 2008 @08:51AM (#22557132) Homepage Journal
    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.

  • Re:This just in! (Score:3, Informative)

    by dosius (230542) <bridget@buric.co> on Tuesday February 26, 2008 @09:17AM (#22557282) Journal
    And it depends on WHY you're depressed.

    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.
  • Don't forget (Score:4, Informative)

    by Per Wigren (5315) on Tuesday February 26, 2008 @09:20AM (#22557308) Homepage
    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.
  • by Muad'Dave (255648) on Tuesday February 26, 2008 @09:35AM (#22557416) Homepage
    Prozac == fluoxetine, which is mentioned in the article.
  • by RingDev (879105) on Tuesday February 26, 2008 @10:40AM (#22557972) Homepage Journal
    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
  • by spun (1352) <loverevolutionary@@@yahoo...com> on Tuesday February 26, 2008 @11:18AM (#22558370) Journal
    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.
  • by Miang (1040408) on Tuesday February 26, 2008 @11:54AM (#22558826) Journal

    In ANY given field you'll find studies that disagree with most other studies.
    Of course. The solution to those is meta-analysis (using statistical techniques to combine results from many disparate studies), which...is exactly what these authors did. It's not "one small study."

    And for all we know this study could've been funded by a company whose main competition is anti-depressants
    Oh come on. It says right there in the paper, "Funding: The authors received no specific funding for this study." I don't know about the fifth author, but everyone else on the paper is university-affiliated -- probably just your typical professors and grad students out to up their publication count, preferably with a nice sexy (controversial) paper that will get cited a lot.

    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.
  • by Ieshan (409693) <ieshan@gmai[ ]om ['l.c' in gap]> on Tuesday February 26, 2008 @11:57AM (#22558882) Homepage Journal
    "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.
  • Re:This just in! (Score:5, Informative)

    by NickFortune (613926) on Tuesday February 26, 2008 @12:17PM (#22559292) Homepage Journal

    If someone has real severe clinical depression, drugs are the only scientifically proven way to get back to leading a normal life.

    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. ]

  • by Anonymous Coward on Tuesday February 26, 2008 @12:44PM (#22559790)
    I know a few depressed people and a couple bipolar people, and I also know the clinical definition of "depression", and boy, having "lots of hobbies" and doing "many different things" does not fucking compute.
    Depressed people have trouble enjoying things that they used to find enjoyable -- that includes hobby --, that's the god damned definition. They also have trouble getting things done, that's the god damned definition too.
    Ergo, if you enjoy lots of hobbies and do lots of stuff -- you're probably not depressed! Very depressed people can't get out of the bed, for fuck's sake.
  • Re:This just in! (Score:4, Informative)

    by hesiod (111176) <.moc.liamg. .ta. .reierhcskoon.> on Tuesday February 26, 2008 @12:57PM (#22559998)
    > Stop feeling sorry for yourselves!

    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."
  • by Diziet (102023) on Tuesday February 26, 2008 @01:00PM (#22560046)
    As one of the comments to TFA notes, one problem with the studies reviewed is that the trials may not have been long enough to detect differences. They were mostly 6 week trials, with a few shorter and a few longer. That may not be long enough to pick up a significant difference. The effects for some can peak between 6-8 weeks. Disclaimer: I am a psychologist.
  • Re:This just in! (Score:2, Informative)

    by Anonymous Coward on Tuesday February 26, 2008 @01:38PM (#22560670)
    As a martial arts expert I can say that no amount of training will ever allow you to ignore pain. Anyone who says otherwise is a liar.
  • by dbcad7 (771464) on Tuesday February 26, 2008 @02:40PM (#22561572)
    I submit that anybody who says you can 'decide' to not be depressed has absolutely no idea what they're talking about.

    As others have pointed out.. if you are talking about a chemical imbalance, then no amount of "positive thinking" is going to change that... However there are situational depressions.. ie a person who's brain chemistry is such that if the situation were different (say.. girlfriend didn't dump him) then they would not be depressed... these people can be helped by choosing their own mood.

    I lived with a manic depressive for a long time.. We both had many of the same "bad times".. no amount of positive attitude would help her. My depressions were short lived, but I still had to deal with hers which were at a higher intensity and lasted a long time. When our pet died for example.. very sad time for me.. sad time for us both,, but I got over it in a few days.. it took her months before she had a day where she didn't spend an hour crying.. and even after a year an a half there were times she would break out in tears... there is absolutely no control of emotions with the brain chemistry she had.. and she was medicated to the extreme.

    There was a time however, when I was an extremely unhappy person..(this is different from clinical depression).. and finally one day I read that happiness was a choice.. that you choose to be happy.. well it does work for me, and even when everything goes to hell, I can still be happy.. but then I don't have a chemical imbalance. When I first started living with the manic depressive, I tried like heck to help her with this attitude.. It was a waste of time.. it can't be done any more than telling a drunk to "think sober"

    BTW.. the depression bad to deal with, but mania could be even worse... but whole other ball of wax.

  • Re:Don't forget (Score:3, Informative)

    by Jizzbug (101250) on Tuesday February 26, 2008 @03:18PM (#22562238)
    In America, people don't have the benefit of living is a socialist/communist monarchy. Unless you're committed to a mental institution or you're on welfare/medicare, good luck getting time off from work for your "depression". You can't pay for drugs if ya don't work.
  • by PCM2 (4486) on Tuesday February 26, 2008 @09:03PM (#22567158) Homepage

    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.

    Really true. This is something that I struggle to explain to people who have never experienced it.

    I've had episodes of pretty severe (I'm not qualified to say "clinical") depression, lasting a few months at a time. When I tell people this, they give me that "aw, that's too bad" look -- not understanding that, throughout these periods of depression, I was rarely actually "sad." People picture you moping around the house, looking through old pictures, crying at TV commercials ... for me it was nothing like this.

    The only way I can describe it is this: Picture your emotions as a sine wave. The top of the wave is "happy." The bottom of it is "unhappy." The zero line is "feeling nothing much." Throughout your life you oscillate between various points on the curve. As you slip into depression, though, your baseline drifts below the zero line, into "unhappy." It does this in such an insidious way that you don't really notice it slipping. Eventually, though, the tops of your own personal sine curves -- the points that used to reach into the "happy" zone -- stop hitting "happy." Instead, they only make it about as far as "not feeling much of anything."

    I'm a pretty logical person, most of the time. But when your brain is misbehaving on you like this, your normal logical processes start to get clouded and messed up, and this can compound the problem. Here's how it worked for me:

    Let's say you're feeling sort of down, so you want to cheer up. You go and take down your favorite book off the shelf, the one you've loved since childhood, and you start flipping through it for a little pick-me-up. But you're depressed, so you still feel ... nothing much. Not much of anything at all. So you put the book back. LOGICAL CONCLUSION? I must not really like that book after all. I guess I grew out of it.

    A few such "conclusions" and the evidence starts to mount up: All this stuff that I say I'm "about," that I've been saying I like and enjoy, is really sort of a sham. Because clearly I don't really like any of it. I don't like going to movies, I don't like music...I don't get much joy out of any of it, at all. So the fact that I own these rock band T-shirts...what a joke! I'm putting people on. I'm just making small-talk, covering up for the "fact" (again, pseudo-logical deductions taking place here) that I don't have any real interests at all.

    At my absolute lowest points, I would find myself downtown, out in front of Macy's somewhere, and I would have a "revelation": Look at all these people, all these crowds. Everyone coming and going. Everyone with their own way of looking, their own way of speaking, their own interests, their own goals and plans. Everyone, that is ... except me. Because I have no discernible hopes or joys or interests. I have no discernible personality at all.

    And I know it's pretty hard for people to believe this if you're not in the same space -- I have a hard time comprehending those feelings right now -- but when I was in the grip of it, let me assure you that I was not speaking metaphorically. I really, seriously meant that I was a non-person, some kind of entity, desperately afraid that all the people around me were going to catch on to the fact that I had been lying to them all the years that I'd known them, because all the ways that I had pretended to be a unique individual had just been an elaborate ruse to cover up my shame at being a complete and utter non-person.

    If you knew me, you'd see immediately how absurd that notion is. But that's the thing about delusions. When you're having them, there still might be a little voice in the back of your head saying, "Whoah, buddy, ease up, maybe you oughtta go lie down for a while or something" -- but it doesn't matter. You're not going to be

  • by shark swooner (1077115) on Tuesday February 26, 2008 @11:57PM (#22568900)
    Tricyclic anti-depressants, a previous generation of medication before SSRIs, were largely abandoned because they had more side effects and were considered less effective. Sort of throws water on that theory.

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