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Matthew Whalley writes "Researchers got hold of published and unpublished data from drug companies regarding the effectiveness of the most common antidepressant drugs.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 However, when the unpublished data is taken into account the difference between the effects of drug and placebo becomes clinically meaningless — just a 1 or 2 point difference on a 30-point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."
Prozac changed my life (Score:2, Interesting)
Sooo... (Score:2, Interesting)
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.
Depression is not all serotonin (Score:5, Interesting)
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: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.
Re:Anafranil (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 that empties out your supply seems like a recipe for a suicidal Sunday morning, not to mention the long-term effects (like your brain getting so used to the high serotonin levels that it needs the drug just to be mildly cheerful).
This study has been published in 2002 (Score:3, Interesting)
Can someone explain?
Re:This just in! (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):
I'm not sure whether I agree with him entirely or not. I do think that "mental illness" is at least in part a social construct - but the same is true of a lot of physical illness.
Required supplemental reading (Score:5, Interesting)
Re:Depression is not all serotonin (Score:3, Interesting)
I think you identified part of the problem right there. Zoloft and adolescents are a volatile combination. IANAPsychiatrist, but I would guess that anyone under the age of about 22 who takes Zoloft has an even chance of thinking about suicide just as often when their moods are elevated as when they were severely depressed and the drug was first administered.
The rest of the problem is as you noted: people often try to treat symptoms rather than illnesses. Sometimes the meds do the trick. Sometimes they're just the first step. I'm glad you survived.
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]
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.
Re:Eli Lilly CEO (Score:1, Interesting)
I am ADHD, i currently am on adderall xr 15mg. Strattera did not work for me, i was on it for about 3 months. It was terrible, i would suffer from blackouts, almost narcoleptic in nature. I would sleep over 16 hours a day, 10 in one period. I would forget things, forget where i was, fall asleep doing everyday tasks. To make matters worse it also made me feel constantly feel strange. its a hard feeling to describe but its almost like anxiety with a little loss of will thrown in. I found it hard to make decisions, to solve problems, or just preform what is asked of me. Its not like i felt like i was on auto pilot, it was more like i would randomly wake up at the wheel and i just haddent crashed yet. In the end it was the people around me that convinced me to not take it and talk to my doctor, because when i was on it, it was like i didnt notice anything was wrong.
i dont know, this is just my story, like ive said ive seen Strattera work like magic for some people, but me it was a curse.
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.
Re:Anafranil (Score:1, Interesting)
Keep in mind, all depends on your set and setting. There's some interesting reading out there on MDMA used in clinical settings. I have a family member on some antidepressants, but the changes in her seem minimal. I bet if a doctor could administer her a nice dose of MDMA it would be a good shocker to throw her into a different world.
Being a diagnosed manic depressive... (Score:2, Interesting)
This is not to say that they have no effect, though.
The way that an antidepressant works (from the point of view of someone that isn't a chemist/biologist/pharmacist) is that it's much like a compression filter: it chops off the bottom end and the top end of emotional response. The purpose of them is not to 'make you happy' - that would cause a mass addiction problem, I reckon. They take you out of the horrific depths of depression, be it suicidal or not, and give you enough breathing space to gain some perspective.
There are people who cannot cope without antidepressants. Most of us (depressives, that is) can survive without them, though, once we've managed to level ourselves out a bit. I personally found them to be pretty hard work: anything that messes with your brain chemistry tends to have other results, too: I became prone to very short bursts of high activity, with long, long periods of lethargy and listlessness. Think stoned but jittery, with moments of sharp and fast clarity.
The important thing to remember is that there is a vast difference between mild depression, and very serious depression. Serious depression will stay with you for your entire life, while mild depression is more transitory. It hits you hard, regardless of whether it's 'mild' or not, but it's less likely to come back in any significant capacity if it's milder depression.
Don't forget that by muting the depths of depression, you can actually benefit a lot with the alleviation of many of the other associated problems. I found that my horrific insomnia (as in 1-2 hours of real sleep a night, tops) started to ease, purely because my mind wasn't working overtime on considering and worrying about my problems. That proved to be enough to help me start to fix myself, which is, I believe, the real purpose of antidepressants. Despite my doctor's belief that they're some kind of magic bullet...
Re:This just in! (Score:3, Interesting)
Re:Meta-analysis? (Score:2, Interesting)
I'm just thankful that the efficiency of most drugs aren't measured that way. "On a scale of one to ten, ten being about to die of cancer and one being cancer free, how do you feel?"
Re:If you can DECIDE not to be depressed (Score:3, Interesting)
1) Healthy Diet
2) Healthy amount of sleep
3) Healthy amount of exercise/activity
Depression is a chemical imbalance in the brain by definition - the chemical imbalance isn't the cause (well, not directly). Everything your brain does is a chemical reaction, so it doesn't really give you any information. Anything differing from the "norm" is a chemical imbalance.
I've suffered from depression, but I didn't go to a doctor because I knew it would pass eventually - IF I took care of myself.
I'm sure there are extreme cases in which a person's genetics plays a major role. Those are most likely the extreme cases in which medication really will help.
Re:This just in! (Score:3, Interesting)
On another level, there are meditations that will allow the brain to ignore "pain" signals. The most well-known of these meditation methods is the high level chi gung that top falun gung members practice, but it actually comes from a much older Chen Buddhist tradition.
Re:If you can DECIDE not to be depressed (Score:3, Interesting)
What is usually most difficult and nearly impossible for some people is accepting their true mental state. Denial is the mind's worst enemy.
Some tips:
Have a crew. Depression can be overwhelming enough even in the company of friends, it's far worse alone.
Have a consistent schedule with said crew. It makes the time in between worthwhile.
Smile more. People who smile more tend to make the people around them happier. That elevates the happiness of the whole group of people.
Think the glass is half full. Or at least recognize the idea. Being able to see the other side, or the silver lining, is a big step to getting out of the depressed mentality.
Forgive and forget. Try not to get too hung up on anything, especially the negative things. Let go.
At the end of the day, resignation to being unable to do something is as good as not being able to do it. Never resign, never give up, always believe it is possible. It's not just about believing though. There needs to be substance behind the belief in oneself. So where there is failure, it just means there is a lacking, and that which is merely lacking can always be remedied.
Re:mod parent up (Score:2, Interesting)
Re:If you can DECIDE not to be depressed (Score:3, Interesting)
I'm a mild case for genetics. My grandfather committed suicide, my dad & mom are in prison, and I've been on anti-depressants off/on since the I was in middle school.
Back in middle school I couldn't sleep. I'd toss and turn and never sleep well*. They put me on antidepressants and I finally slept. (something that has not changed since even when I stopped taking them - I think it trained my brain to sleep) I went from being a B/C student to straight As. I was put into honor classes. My life turned around.
And then I grew a bit and my brain chemistry changed and the drugs no longer worked. I dropped out of high school.
Then as an adult the drugs had advanced and I started taking again. I've accomplished more while under drugs, but I haven't achieved the highs points as when I was off them. My creativity is constrained.
I think about suicide often, but I dismiss it just like my dad does. We don't want to end like my grand father. It doesn't stop the feelings or desire, but dying is the last thing I want to do
I'm not sure I'd want to stop these feelings. Control them yes, but they do give me a kind of strength, a kind of understanding. I wouldn't want to lose them. I just don't want to suffer because of them.
*side note about my dad and sleep. He only slept 4 hours. He'd work as a lawyer in the morning, build pcs in the afternoon, sleep for 4 hours, and then work on mainframes at NASA (Clear Lake, TX) through the night.
Re:This just in! (Score:2, Interesting)
And not that it has much relevance to your comment, but I did this every month for 14 months, not just one week.
Re:This just in! (Score:3, Interesting)
Read the study again; its not that the pills did nothing, its that the placebo had the same effect as the pills. So yes, certainly seems to suggest you can "think yourself out of it." But remember, some people don't want to.
Re:This just in! (Score:3, Interesting)
No, sorry. Read the study. We don't know what causes depression. Hell, even the TV commercials for anti-depressents tell you that. The chemical imbalance theory is just that. Its just as likely that the chemical imbalance is a symptom, not the cause. We don't know.
Just because it's in your brain, doesn't mean it's really in your control.
To some extent that's true, to a large extent not. Certainly our mood is under our control. Some have been known to control their heartbeat [time.com].
You would be suprised at the number of things people do everyday and never know it.
I did say part of it was subconcience; the trick it to make yourself aware of it.
People EAT without knowing it. Snack really. All kinds of things that take a consious outside effort to change.
Nonsense. You know how I know its BS? Because they know RIGHT AWAY when they are out of snack. They choose to pretend they aren't eating as much. There's a reason why writing down what you eat works when you're trying to lose weight... it makes it so you can't lie to yourself, but there's certainly no external force in that... you need to CHOOSE to lose weight, and write down your diet.
Re:If you can DECIDE not to be depressed (Score:2, Interesting)
But I suppose you are right about evolution of our society and trauma. Evolution cannot operate without punctuated equilibrium.
And sure, more people are literate today than 100 years ago, even if handwriting on average is much worse than before. But the civil war actually started because the North wanted to count slaves as 3/5ths of a person, while the South wanted slaves to count as 1 whole person. The constitution doesn't actually say whether a slave is a citizen or property or has the right to vote or not. The obfuscation of these facts among others only evidences the declination of our society as a whole.
But we will have World War very soon, so all this muck will be cleared up through violence and bloodshed and massive death, and we can move on to a Brave New World Order. Beware the Double-Headed Eagle of Hattusa & Lagash (and of Albania & Serbia)!!
What? (Score:1, Interesting)
No. I have an irregular heartbeat which is taxing my nervous system and has caused deep depression for nearly all of my life. It's not an uncommon occurrence according to the various psychs and cardiologists I've seen.
I also run, lift weights, bike, hike, and generally enjoy physicality.
It's not as simple as getting physically fit. Sure, working out is a great way to keep your mind and body in a better place than just sitting there, but telling someone with depression that it's as simple as hitting the gym is setting themselves up for even more pain and yourself up for an egg on the face. This is one of the most depressing thing about depression, in my experience and those of acquaintances I know in similar situations : People telling you to cheer up or hit the gym in order to solve your problems really have no clue what they're talking about. Are you in the mood to really ruin the day of someone suffering true depression? Tell them to "cheer up" or hit the gym to solve their ills. This makes it very, very difficult to relate to a great deal of those around you because it simply *has* to be as cut and dry as "getting in shape and keeping occupied". It's not. It simply is not.