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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Matthew Whalley writes "Researchers got hold of published and unpublished data from drug companies regarding the effectiveness of the most common antidepressant drugs.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 However, when the unpublished data is taken into account the difference between the effects of drug and placebo becomes clinically meaningless — just a 1 or 2 point difference on a 30-point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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  • This just in! (Score:3, Insightful)

    by n3tcat (664243) on Tuesday February 26, 2008 @08:05AM (#22556906) Homepage
    Thinking that you're going to not be depressed anymore makes you less depressed!
    • Re:This just in! (Score:5, Insightful)

      by Anonymous Coward on Tuesday February 26, 2008 @08:29AM (#22556996)
      Spoken by someone who's obviously never suffered from depression.
    • Re:This just in! (Score:5, Insightful)

      by DuncanE (35734) * on Tuesday February 26, 2008 @08:35AM (#22557036) Homepage
      As its been widely noted this study does not take into consideration as a variable those patients that talked about their depression with a psych or councilor and those that didn't.

      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: (Score:3, Informative)

        by dosius (230542)
        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.
        • 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.

          How do we know that those environmental issues aren't what causes the chemical imbalance?

      • Re:This just in! (Score:5, Interesting)

        by Aladrin (926209) on Tuesday February 26, 2008 @09:22AM (#22557316)
        I have to agree. My sister and mother are both are anti-depression meds... And I used to feel I was depressed, but wouldn't do anything about it.

        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:This just in! (Score:4, Insightful)

          by justthinkit (954982) <floyd@just-think-it.com> on Tuesday February 26, 2008 @10:10AM (#22557698) Homepage Journal
          I strongly agree about hobbies. In addition, I think there is a benefit to limiting contact with the news. As Steve Chandler said, "It's not the news, it's the bad news". This is of course related to having a hobby. If you disappear into the basement for 4 hours, you probably didn't fire up CNN every 10 minutes during that time.

          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)

          by popmaker (570147) on Tuesday February 26, 2008 @10:24AM (#22557824)
          I actually think this is a wonderful advice. Doing these things makes you forget how shitty your life is and when you actually get at them, your life isn't shitty anymore. The worst thing to do is to just lie around and sulk. You become focused on your own depression and that just makes it spiral out of control. Well, sometimes that actually IS the only thing I want to do when feeling down - and in that way it is maybe not so hard to understand how depression happens to people.

          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.
          • Re:This just in! (Score:4, Informative)

            by hesiod (111176) 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."
    • Re: (Score:3, Insightful)

      by SETIGuy (33768)

      Thinking that you're going to not be depressed anymore makes you less depressed!

      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.

  • by Anonymous Coward
    I don't care if it is a placebo - and I doubt it is - but I'm glad I finally went on Prozac.I'm a much more functional human being than I was five years ago before I started.
    • Re: (Score:2, Funny)

      by JustOK (667959)
      no, you're not.
    • by BeanThere (28381) on Tuesday February 26, 2008 @08:54AM (#22557146)

      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.

      • by Muad'Dave (255648) on Tuesday February 26, 2008 @09:35AM (#22557416) Homepage
        Prozac == fluoxetine, which is mentioned in the article.
        • by BeanThere (28381)
          Sorry, if so, then my mistake - I saw a similar article only about a week ago where it was claimed Prozac was not covered and it seemed like too much of a coincidence that these would not be related, so I assumed they must be referring to the same study.
      • Re: (Score:3, Informative)

        by Miang (1040408)

        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, prefer

  • Sooo... (Score:2, Interesting)

    by TubeSteak (669689)
    I guess Tom Cruise was right?
    • Re: (Score:3, Insightful)

      by Thyamine (531612)
      I think Mr. Cruise was ranting about post partum depression specifically. As I understand it, he actually had some details right (no one is certain why mothers get it), but you can't go busting on a new mom on national TV and come out as anything but an ass. And really, he was one.
  • I'm not really surprised that the drugs are overperscribed. However, I do find that the subject heading is misleading.
    • by arivanov (12034)
      The fact that they are overprescribed is very well known. In fact you are taking it even if you do not have it prescribed: http://news.bbc.co.uk/1/hi/health/3545684.stm [bbc.co.uk]. It hate to be cynical, but it is a healthy economy booster. After all what can be better than not getting depressed from the fact that you just about scrape for a living and balance your books at the end of the month. Joe Average consumer should go on, go out there, consume, enjoy buy and do not worry about bad thing.

      On a side note I have f
  • People seem to miss something that seems very obvious to me... They think "Oh! You're depressed.. there's something wrong with you, maybe these drugs can help it" ... but depression is a _natural_ state in most living beings. Just look at dogs, they can get severely depressed, just like their owners. Sometimes, yes, a chemical imbalance is to blame and drugs can help. But more often than not a human being is depressed for a reason... bad relationship, money problems, reading about too much pain in the world
    • by adpe (805723) on Tuesday February 26, 2008 @08:52AM (#22557136)
      I think you're confusing depression as in "Man, I'm pissed off today" and depression as in the medical condition. "Real" depression is a horrible thing and needs treatment. It's as if you're saying cancer neends no treatment, since the cells grow very naturally.
      • Re: (Score:3, Insightful)

        by Merritt.kr (1120467)
        I agree with you, clinical depression is a very serious thing. I should know, I've been diagnosed as bipolar, manic-depressive, and, I quote "SEVERELY clinically depressed". To the point where I don't mention feelings to my doctors, cause they start asking me about razor blades and the like. I've tried the drugs -- believe me, I know what I'm talking about. I'm not talking about "Man, this is a crappy day" I'm talking about a never-ending, life long dysphoria with LIFE. You get occasional pick-me-ups in the
        • by Grym (725290) *

          I agree with you, clinical depression is a very serious thing. I should know, I've been diagnosed as bipolar, manic-depressive, and, I quote "SEVERELY clinically depressed"... I'm talking about a never-ending, life long dysphoria with LIFE. You get occasional pick-me-ups in the form of the people you life, a funny cartoon, etc... but in general, life seems to kind of... suck.

          So, going back to your original post, do you feel that this is a "natural" state of being? More specifically, do you think that yo

    • by Negatyfus (602326)
      Your definition of depression is off.
    • Re: (Score:2, Offtopic)

      by MrHanky (141717)
      This comment exemplifies how broken the Slashdot moderation system is.
    • Yes, there is a clear distinction between feeling a little depressed because your team lost, and being Clinically Depressed, yet most people don't get the difference, and these drugs are then "abused".
      I really hope more research is done using these findings, because there could be an unwanted side effect (pardon the pun). The last thing we need are more ignorant anti-psychology/psychiatry types screaming "See! I told you it was all a scam!". Clinical depression is as real as Cancer or AIDS, and it's just
    • by Cadallin (863437)
      At the same time, if one is to suggest that they find the world a very disturbing and dystopian place, and that the current trends in society and its effects on the world at large are only likely to magnify these traits, and that as a result one has decided to kill to kill oneself, well, their feelings are immediately regarded as irrational and society hospitalizes them.

      The possibility that those individuals have come to a rational decision about a course of action to take as a response to the world aro

    • Re: (Score:2, Insightful)

      by erase (3048)
      just because something is natural doesn't make it inherently desirable or even tolerable - there are plenty of natural diseases you would certainly choose to seek unnatural medical treatment for and there are plenty of natural things that will kill you outright (poisonous mushrooms, bears). you probably wrote this post on an unnatural computer in your unnatural living or working space, bathed in unnatural light from an artificial source, while wearing unnatural clothing and using the wholly unnatural slashd
    • Re: (Score:3, Insightful)

      by ChrisMaple (607946)
      Regardless of whether there is an external cause of depression, drugs can sometimes make a depressed person feel less depressed. This is true even of a weak herb like St. John's Wort. If someone feels too depressed to get out of bed, an antidepressant can give him the mental boost to get up and solve his problems.
  • Further evidence... (Score:5, Interesting)

    by inviolet (797804) <slashdot@ideasmat[ ].org ['ter' in gap]> on Tuesday February 26, 2008 @08:38AM (#22557060) Journal

    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.

  • Hairibo Gummy Fungus? Seemed to work for Amy Wong....
  • by zombie_striptease (966467) on Tuesday February 26, 2008 @08:44AM (#22557096)
    I was on Zoloft for a couple of years way back when I was a teenager. It did fuckall to help my depression, I still hated life and still contemplated suicide, but I noticed something funny after I stopped taking it (due to severe gastrointestinal side effects). A few days after I'd quit the pills cold turkey, I was thinking of something I was stressed about, and along with the common wave of emotional despair, felt a physical sinking in my chest that I realized I hadn't felt for... about two years. I laughed when I realized that that was probably the chemical reaction that the SSRI had been halting, and laughed harder the longer I contemplated what a drop in the bucket it was in the scope of the depression I was struggling with. It made me understand the extent to which the Zoloft was just targeting a symptom of a larger problem, like any number of other medications do. There may be some people whose depression truly does stem from such a one-note imbalance, and I truly hope that the medication can help them, but it doesn't surprise me that antidepressants could be so insignificant to so many others.
    • Re: (Score:3, Interesting)

      by andphi (899406)
      > I was on Zoloft for a couple of years way back when I was a teenager.

      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 ra
    • by Ieshan (409693) <ieshan AT gmail DOT com> 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.
  • 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.
    • Re: (Score:3, Funny)

      I just listened to the CEO of Eli Lilly speak for an hour last night,

      My condolences. Here's a translation for you.

      and he said most prescription drugs work at best in 80% of patients who are diagnosed with the disease it's supposed to treat.

      "Don't blame us if it doesn't work as advertised"

      Selling drugs that don't work is an unsustainable business policy.

      "Trust us, what we give you really works as advertised, honest"

      He talked about Strattera, [...]

      "Look, shiny thing"

      Anyw

  • by 192939495969798999 (58312) <info@devinm o o r e .com> on Tuesday February 26, 2008 @08:50AM (#22557124) Homepage Journal
    (SIGH) nothing ever works, its hopeless!
  • 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: (Score:3, Insightful)

      by Henry V .009 (518000)
      No, it's unlikely to be the placebo effect. It's more likely to be something called 'withdrawal.' Try the same thing with alcohol, caffeine, or tobacco. You won't be any happier because you've started taking it, but your friends will notice one hell of a decline once you stop.
  • Anafranil (Score:5, Interesting)

    by SharpFang (651121) on Tuesday February 26, 2008 @09:06AM (#22557200) Homepage Journal
    I don't know about deep depression, but with rather mild depression I took a 25mg pill of Anafranil and had some 2 days of pretty much silly euphoric high.

    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 :)
  • by ubrgeek (679399) on Tuesday February 26, 2008 @09:06AM (#22557204)
    Sorry, I have a considerable amount of experience with family members who went the counseling route for years without seeing improvements. After finally deciding to try anti-depressants, anti-anxiety, etc., the problems they had most of their lives went away or were reduced to levels that made it easier for them to have a better life. The biggest problem I've seen is not whether they work or not, it's that GPs are the ones issuing the Rx. GPs are just that - GENERAL practitioners. The good ones admit that their knowledge of the nuances involved with the "low-level" chemical behavior of the brain is limited. A psychiatrist, someone with a medical understanding of the topic (not knocking psychologists, but their understanding is in a different area: the non-biochemical causes of issues) should be the person making the determination of just what a person should be on. They're aware of more of the potential "cocktails" of drugs (one particular drug is not enough) - both in terms of what works and what needs an additional medication to target secondary causes/effects of depression....
  • Missing the point (Score:5, Insightful)

    by Hebbinator (1001954) on Tuesday February 26, 2008 @09:07AM (#22557208)
    The point is not that antidepressants don't work - the point is that diagnosis criteria for depression has been to lax for too long. "Everybody gets depressed, not everyone needs antidepressants" It makes sense that the only people who respond to antidepressants designed to fix chemical imbalance are the ones with severe depression.... who are likely to have a real chemical imbalance. These are not "happy pills" they are formulated to fix an insufficiency. Normal, mild depression from events (death, divorce, etc) has always been treated best by cognitive behavioral therapy (aka psych visits), unless you just want to zonk someone out. But, in our society, if you have a problem you get a pill. No one wants to hear "go talk to someone and get over it," so doctors write the scripts and the generally malcontent get them filled.
  • At least prozac worked for me, infact it worked too well and I've been take off of it and put onto something that doesn't work at all.

    Sadly the doctors think my depression is because I smoke a couple of spliffs a week, it just shows how you can talk intimately to people and yet they never really know you, I was depressed long before I knew what a spliff was.
    • Re: (Score:3, Insightful)

      Sadly the doctors think my depression is because I smoke a couple of spliffs a week...

      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

  • 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.
    • Re: (Score:3, Insightful)

      by Jah-Wren Ryel (80510)
      Interesting side-effect of nationalized health-care.
    • Re: (Score:3, Informative)

      by Jizzbug (101250)
      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.
  • a placebo pill when I have a headache.
  • This fits with what some other studies have shown in the past... in the short run. Depression is often cyclical; people get more or less depressed over time and will often be fine for long periods of time. So simply by taking nothing and waiting, they'll often start to feel better soon. This is why taking anti-depression meds is almost indistinguishable from a placebo in the short run, except in the most severe cases.

    The real test is how effective the meds are at preventing future episodes of depressi
  • "A man (or woman) is as happy as they make their mind up to be"
  • Antidepressants work no better than a placebo."
    "He's delusional! Quick, give him some Thorazine! Or sugar! Whichever you can get faster."

  • by dandv (1246510) on Tuesday February 26, 2008 @10:29AM (#22557852) Homepage
    I don't get this - the same news has been published by USA Today in 2002 [usatoday.com]. Still, the PLoS article appears published on 2008-02-26.

    Can someone explain?

  • by Cultural Sublimation (884893) on Tuesday February 26, 2008 @10:29AM (#22557856)

    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.

    • by deuterium (96874) on Tuesday February 26, 2008 @11:44AM (#22558708)
      Well put. Depression, because of it's overlap with "normal" human experience, is wildly misunderstood. Most people never experience psychotic symptoms, so they don't harp as much on the utility of antipsychotics, or, by the same token, anti-seizure meds for epileptics. They *do* feel bad from time to time, and so they feel they have depression figured out. Perhaps it's the fault of GPs who diagnose those people with depression, thus reinforcing their belief that depression is exactly what they've experienced.

      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.
  • 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 Phanatic1a (413374) on Tuesday February 26, 2008 @10:43AM (#22558014)
    Everyone needs to read the Last Psychiatrist's article [thelastpsychiatrist.com] on this study. He's a forensic psychiatrist, and a great blogger, and he makes some very interesting points:

    It's the exact same data they had 10 years ago, the exact same data. This isn't a discovery, this isn't Woodward and Bernstein, this is a bunch of academics who are no longer on Pharma payrolls who have now decided that they have nothing further to gain from pushing antidepressants.

    Now they can pretend to be on the side of science. We reviewed the data, and found some of it was not published.

    You knew that already. You were the ones who didn't publish it [thelastpsychiatrist.com] -- it's your journal. Turner worked for 3 years as an NIH reviewer. He just notices this now?

    Is no one wondering how it is that this study comes out now, when all antidepressants but two are generic?

    As suspicious of Pharma as everyone is, no one seems to see that they are no longer getting Pharma money, they are now getting government money-- NIH-- so they're going to push the government line. No one finds it at all suspicious that the two biggest NIH studies in the past two years both found the generic to be the best?

    You think that in 2000 those studies would have been published? But now-- 2007, 2008, if they'd found Cymbalta to be the best on the NIH's dime, you think that they'd get re-funded? What's the difference? Same authors, same studies, same data. All that's changed is the climate.

    People want a direct financial link to show bias, not realizing that bias is much more prevalent and more powerful elsewhere.
  • The Black Dog (Score:5, Insightful)

    by MrKaos (858439) on Tuesday February 26, 2008 @10:46AM (#22558044) Journal
    A close relation in my family has suffered from depression for well over 10 years, it is a tragic malady and it has an effect on the people around him. His diagnosed conditions include Manic depression, Psychotic episodes, Paranoia and auditory hallucinations, but worst of all when you are around him you can sense the terrible sadness that afflicts him. He has regular visits to a Psychiatrist to assist him.

    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, Funny)

      by big_paul76 (1123489)
      Did you ever see the Simpsons episode where they diagnosed Bart with ADD?

      The scene where the two doctors are advocating a medication called "focusin", that they describe as being "the best possible treatment, except for (roll of the eyes, and dismissive shrug) *snort* regular _exercise_."

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