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Matthew Whalley writes "Researchers got hold of published and unpublished data from drug companies regarding the effectiveness of the most common antidepressant drugs.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 However, when the unpublished data is taken into account the difference between the effects of drug and placebo becomes clinically meaningless — just a 1 or 2 point difference on a 30-point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."
This just in! (Score:3, Insightful)
Well that's depressing.... (Score:2, Insightful)
Re:This just in! (Score:5, Insightful)
Intresting choice of words (Score:1, Insightful)
Depression not natural? (Score:2, Insightful)
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.
Re:Sooo... (Score:3, Insightful)
Re:Depression not natural? (Score:5, Insightful)
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.
Re:Depression not natural? (Score:3, Insightful)
The wrong med from the wrong dr. (Score:5, Insightful)
Missing the point (Score:5, Insightful)
Re:This just in! (Score:3, Insightful)
Re:This just in! (Score:3, Insightful)
Depression is Cyclical (Score:2, Insightful)
The real test is how effective the meds are at preventing future episodes of depression, or at least limiting how bad they are. TFA doesn't go into enough detail on the length of time over which the data was collected, so I don't know what it has to say about this.
Re:Depression not natural? (Score:2, Insightful)
Re:Depression not natural? (Score:3, Insightful)
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.
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.
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.
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:Prozac changed my life (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 business is HUGE, I wouldn't be surprised if it's measured in the billions, from depression "herbs" to homeotherapy to stones to every other bit of nonsense you can think of - every one of these snake oils salesmen are salivating right now ready to jump on this study as "proof" that you should buy their products rather. Then there are also many churches who don't believe in depression as an illness to be cured with pills (it's a "spiritual problem", you see), plus all those who simply believe that there is no such thing as an illness of the mind (it's all pyschological, you see), or even the common view that people are just feeling sorry for themselves. Depression must be one of the most contested diseases in existence.
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:Depression not natural? (Score:2, Insightful)
Re:Eli Lilly CEO (Score:2, Insightful)
Ha! Watch more late-night TV, see more ads for penis pills [msn.com], and reconsider that.
Re:This just in! (Score:5, Insightful)
Re:I have friends on anti-depressants (Score:3, Insightful)
Re:Anafranil (Score:2, Insightful)
By definition, placebo effect is indistinguishable from a drug's chemical reaction.
I'm not saying whether your result was placebo or not; just that you couldn't tell the difference.
Re:This just in! (Score:4, Insightful)
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.
Re:This just in! (Score:3, Insightful)
If someone has real severe clinical depression, drugs are the only scientifically proven way to get back to leading a normal life.
Re:This just in! (Score:2, Insightful)
Re:This just in! (Score:3, Insightful)
Re:This just in! (Score:3, Insightful)
Re:This just in! (Score:5, Insightful)
This Thread Cheerfully Bought to You by (Score:5, Insightful)
Now, stop jumping on my couch!
Re:This just in! (Score:1, Insightful)
There's a big difference between being sad and being depressed. If you're bummed because your dog died, your wife left you, your job sucks, you were abused as a child, whatever... That's emotional. That can probably be corrected through some kind of therapy or counseling or self-help book. That's not depression
Depression is a medical condition. It is a biological problem. It's no different than having a broken leg or diabetes. You can't just talk it better. You can't repair depression with a positive outlook any more than you can fix severe head trauma that way.
I have to wonder how many people in this study were actually, genuinely, medically depressed... I'm constantly seeing people prescribed anti-depressants because they're just sad, and I wouldn't expect it to do much for them - there's nothing medically wrong with them. And the pharmaceutical companies certainly don't help things with their constant commercials.
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.
Re:well prozac works (Score:3, Insightful)
Most likely you're self-medicating, and if the doctors don't immediately see that it may be time to get different doctors.
At the same time, try laying off the recreational drugs while you're on the prescription ones. Interactions between recreational drugs and prescription drugs have not been studied as well as prescription vs. prescription. Recreational drugs also tend to be more complex. In general, mixing the two can be pretty dangerous.
Re:This just in! (Score:3, Insightful)
Stop with strawmen already. They are nothing alike; one scenario you have control over, the other someone else is controlling you. How dare you equate the violence of rape with depression; you trivialize those that have been raped.
Anybody who's ever seen anyone suffering from genuine depression (as opposed to feeling down after you lost your job or something) knows that nobody would wish that on themselves any more than they'd wish cancer on themselves.
Speaking as someone that WAS, I agree, but that doesn't mean its not any less in your mind (and actually under your control). The fact that these pills DO NOTHING seem to re-enforce my point, wouldn't you think?
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.
Re:Don't forget (Score:3, Insightful)
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.
Re:This just in! (Score:1, Insightful)
i'll agree as long as you include food and fish oil as drugs.
Battling The Blues - Ongoing research shows that omega-3 fatty acids help treat depression.
http://www.saturdayeveningpost.com/issues/2005/0506/7370750.shtml [saturdayeveningpost.com]
Mood-Boosting Fat: Good for Head and Heart?
http://www.nutrisana.com/html/EFA_Bipolar.html [nutrisana.com]
Dr. Sears' comments: This trial with high-dose EPA/DHA concentrates demonstrated that significant improvement could be observed in patients with bipolar depression when compared to a placebo consisting of olive oil.
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=10232294&ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum [nih.gov]
drsears.com and zonediet.com are the homes of the only hormonally balanced on the planet. this is why it works to help athletes win god medals and helped the world's heaviest man to lose almost 500 lbs in two years (he also lost his hunger and depression, too).
if you care about your health. try the zone diet and ultra refined fish oil for 2 weeks.
Re:If you can DECIDE not to be depressed (Score:3, Insightful)
I don't think our society is devolving like you say. I think it is coming out of some major post traumatic stress, and there are going to be all kinds of juvenile, self involved responses to that, but that is just part of the healing process. Sometimes things appear worse before they get better. You know, you're in therapy and you have a breakthrough, and maybe your a complete mess while you work through all the shit you've been repressing, but then you feel much better and more in control? I think that's what our society is going through on a large scale.
I mean really, do you want to go back to the days of beating kids, wives as chattel, no vote for women or blacks, almost no middle class home ownership, 12 hour, 7 day work weeks, child labor, no worker safety laws, union organizers gunned down by hired thugs, and all the other fun crap we dealt with in the last century? Because I don't.
Sure it's fun to feel all cynical and superior and grouse about how the world is turning to crap, but where does that get you, hmmm?
Re:This just in! (Score:3, Insightful)
Re:This just in! (Score:3, Insightful)
The truth is more like "Becoming less depressed makes you think that something you thought made you less depressed."
I can't tell you how many people I've known who have suffered from clinical depression have come to the conclusion (after the fact) that they willed themselves out of it.
Until they suffer their next bout and can't repeat the trick of "snapping out of it" without assistance.
Re:Eli Lilly CEO (Score:1, Insightful)
No, a lot of drug trial data is generated to convince the FDA that a pre-selected demographic for target marketing is real. When extra convincing is needed, invent pretend awareness groups to stimulate consumer demand, and add new illnesses to the DSM that match the drug, not the other way around.
Re:This just in! (Score:3, Insightful)
Consider not having the energy to get back up from your microwaved macaroni when you realize you forgot to take a fork, and just leaving it there uneaten because it's too hot to eat with your fingers, and just "not worth it", after all. Then try to imagine how someone in that state can draw the strength to "start focusing on what needs to be done".
It's an incredibly nasty circle to get drawn in, and not as simple as just changing a mindset.
I don't think there's a simple way to generally describe depression, as it is a consequence of so many different causes. Mine was because of work burn out.
For me, sadness and depression are two completely different feelings. Sadness is an easy feeling to describe : losing something dear, an opportunity, someone, or just generally being disappointed with life. It can go far, and can lead to depression, but it's "just" a feeling. I was sad I let down my team mates, for instance, but that wasn't the issue.
Depression is being so overwhelmed by a situation that feelings are a constant jumble. Sadness, hopelessness, rage, apathy, frustration, but mostly a serious lack of energy and motivation to do *anything*. Getting up in the morning takes you 15 minutes of anxious anticipation, as if all of the day's weight was concentrated in that silly little step off the bed. You sit somewhere, getting up to DO something takes forever, and the longer it takes, the more you hate yourself for being so lazy for not doing anything.
Re:Further evidence... (Score:1, Insightful)
Re:This just in! (Score:1, Insightful)
Just because men don't REPORT their depressed feelings and worry as often as women doesn't mean they don't experience them.