Antidepressants Work No Better Than a Placebo 674
Matthew Whalley writes "Researchers got hold of published and unpublished data from drug companies regarding the effectiveness of the most common antidepressant drugs.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 However, when the unpublished data is taken into account the difference between the effects of drug and placebo becomes clinically meaningless — just a 1 or 2 point difference on a 30-point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."
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.
Re:Further evidence... (Score:1, Informative)
I have friends on anti-depressants (Score:3, Informative)
Must all be the placebo effect though.
Re:This just in! (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.
Don't forget (Score:4, Informative)
Re:Prozac changed my life (Score:5, Informative)
There is a reason why studies go unpublished (Score:5, Informative)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
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.
Re:Prozac changed my life (Score:3, Informative)
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.
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.
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. ]
You must be fucking kidding (Score:2, Informative)
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)
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."
Some important details (Score:2, Informative)
Re:This just in! (Score:2, Informative)
Re:If you can DECIDE not to be depressed (Score:3, Informative)
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)
Re:If you can DECIDE not to be depressed (Score:3, Informative)
Really true. This is something that I struggle to explain to people who have never experienced it.
... for me it was nothing like this.
... 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.
... except me. Because I have no discernible hopes or joys or interests. I have no discernible personality at all.
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
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
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
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
Re:Further evidence... (Score:3, Informative)