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Medicine Science

Major New Study Confirms Antidepressants Really Do Work (theguardian.com) 234

According to authors of a groundbreaking study, antidepressants really do work in treating depression, though some are more effective than others. "Millions more people around the world should be prescribed pills or offered talking therapies, which work equally well for moderate to severe depression, say the doctors, noting that just one in six people receive proper treatment in the rich world -- and one in 27 in the developing world," reports The Guardian. From the report: "Antidepressants are an effective tool for depression. Untreated depression is a huge problem because of the burden to society," said Andrea Cipriani of the NIHR Oxford Health Biomedical Research Centre, who led the study. The debate over antidepressants has unfortunately often been ideological, said Cipriani. Some doctors and patients have doubts over whether they work at all and point to the big placebo effect -- in trials, those given dummy pills also improve to some degree. Some people suspect drug companies of fiddling trial results. Some patients simply do not want to take pills for a mental health condition. The study published in the Lancet took six years, Cipriani said, and included all the published and unpublished data that the scientists could find. It was carried out by a team of international experts. They looked at results after eight weeks of more than 500 trials involving either a drug versus placebo or comparing two different medicines. The most famous antidepressant of them all, Prozac -- now out of patent and known by its generic name, fluoxetine -- was one of the least effective but best tolerated, measured by a low drop-out rate in the trials or fewer side-effects reported. The most effective of the drugs was amitriptyline, which was the sixth best tolerated.
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Major New Study Confirms Antidepressants Really Do Work

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  • by sheramil ( 921315 ) on Friday February 23, 2018 @06:09AM (#56174805)

    - between chronic depression, caused by imbalances in neurotransmitter production or reuptake, and depression caused by living in depressing circumstances. Antidepressants are routinely prescribed for both cases.

    I guess if your life sucks, it's easier to take pills so you won't bother anyone with suicide attempts, rather than address the problems of your circumstances. I'm glad I stopped taking them; my life sucks, but I can acknowledge that, and I'd rather deal with that knowledge than be a po-faced zombie again.

    • by swb ( 14022 )

      But is it a meaningful distinction? If you can't deal with your life circumstances because they induce a depression that disrupts your coping skills is it really that much different than a neurochemical imbalance which disrupts your life circumstances?

      • Meaningful distinction in what way? SItuational depression might have the exact same effects as neurochemical imbalance depression, but it has to be treated in different ways.

    • Actually, taking pill *helps* you to address the circumstances. It gives you the motivation to make changes in your life that depressed-you would never have gotten around to do. That is why professionals recommend a combination of pills and therapy as the most effective treatment for depression.

    • - between chronic depression, caused by imbalances in neurotransmitter production or reuptake, and depression caused by living in depressing circumstances.

      This distinction is not as clear-cut as you would like. Either can cause the other. Being persistently unhappy for valid reasons develops emotional habits which are encoded in neurotransmitter patterns, while neurological malfunctions can easily cause your life to fall apart. Many patients will need treatment for both.

    • I'm personally more worried about the people who don't take their prescribed medication and then decide that it's a good idea to go shoot up a school. We seem to be having a lot of those incidents lately.

    • by King_TJ ( 85913 )

      Couldn't agree more!

      I've been through a lot of difficult times in my life, and spent many years in a depressed "funk". But still, I think I realized there were legitimate reasons behind all of it. I dealt with bullies and just being a general outcast in school, from grade-school until changing schools half way through high-school. I was always introverted so tended to dwell on the "why?" questions, if someone looked at me funny or made a comment that bothered me. Even years after the fact, I might remember

  • by SumDog ( 466607 ) on Friday February 23, 2018 @06:14AM (#56174813) Homepage Journal

    Only 2% of studies showing antidepressants aren't effective get published:

    https://www.ted.com/talks/ben_goldacre_what_doctors_don_t_know_about_the_drugs_they_prescribe

    This is a meta-analysis. Back when I was in grad school, we'd throw these in the garbage. You cannot account for controls across tens of studies, much less hundreds of studies. Unless the authors legitimately did a replication study writing before the meta-analysis, they're next to useless.

    Beware of things that say things are confirmed without a doubt. Doubt is essential in all things involving science and research. You must continually doubt your axioms and question things; replication the true you think you know to be true.

    https://khanism.org/science/doubt/

    I know for me personally, anti-depressants were awful. The side effects were bad and I never liked taking them. I feel like regular behavioral therapy and talking with a good psychologist who'd help me see my options and my negative ways of thinking helped significantly more than anything else.

    That being said, I know they help some people too, either real of placebo, with major depression. Doctor's are afraid to try therapy without drugs because of the liability if the patient harms themselves. I think this is really sad and that these drugs are way over prescribed. It's a tough issue to balance, but claiming crap like this study does (which is probably funded by the industry anyway) just leads to more confirmation bias and less incentive to come up with more effective treatments.

    • Amen. i'm out of points or i'd mod you up. this was probably funded by the drug cartels..

      • Re: (Score:3, Insightful)

        by Megol ( 3135005 )

        The drug cartels that want to promote their new generation drugs that are under patent protection?

        Then why is an old generic drug shown to be the most efficient?

        • Because if people realize how ineffective they generally are (often about as effective as the placebo effect) they might stop taking them altogether. and they'd certainly stop allowing them to be prescribed for every emotional bump on the road of life.

          And we might even stop breaking children, by forcing them to take mood stabilizers instead of allowing them to be children. :Shrug:

          Why else?

    • by bluegutang ( 2814641 ) on Friday February 23, 2018 @07:55AM (#56175029)

      Doctor's are afraid to try therapy without drugs because of the liability if the patient harms themselves.

      Doctors would LOVE to try therapy without drugs, but it's too damned expensive. $200/hr or a 20 cent pill? Insurance only covers one of those.

    • by Anonymous Coward

      What I rarely see in these studies is comparing the outcomes with other things, like aerobic exercise. There have a been a couple of studies that showed at least for mild depression, aerobic exercise was just as effective as an anti-depressant or talk therapy. Even more so for folks who joined groups.

      So, for the price of a pair of great running shoes ($150) you saved a lot of money and time. One session with a therapist will cost you the price of a pair of running shoes and running doesn't have those pesk

    • Only 2% of studies showing antidepressants aren't effective get published:

      From TFS:

      We did a systematic review and network meta-analysis. We searched Cochrane Central Register of Controlled Trials, CINAHL, Embase, LILACS database, MEDLINE, MEDLINE In-Process, PsycINFO, the websites of regulatory agencies, and international registers for published and unpublished, double-blind, randomised controlled trials from their inception to Jan 8, 2016.

      I know for me personally, anti-depressants were awful.

      Study is not about antidepressants being good or bad - it's about them being effective. It's about antidepressants not being placebos.

      The side effects were bad and I never liked taking them.

      That WAS a part of the study.

      Primary outcomes were efficacy (response rate) and acceptability (treatment discontinuations due to any cause).

      As for...

      Beware of things that say things are confirmed without a doubt. Doubt is essential in all things involving science and research.

      ...they know that.

      We assessed the studies' risk of bias in accordance to the Cochrane Handbook for Systematic Reviews of Interventions, and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework.

    • There's lots of antidepressants around. My doctors would change meds if I had bad side effects or they didn't seem to be working.

      There are forms of psychotherapy that are very useful, also. One problem is that they're a lot more expensive than a prescription, so some people can't get decent psychotherapy. I found a psychotherapist I could talk to, studied cognitive therapy, and took the pills. I'm a lot better now, but it's still there.

  • Meh (Score:5, Funny)

    by NoNonAlphaCharsHere ( 2201864 ) on Friday February 23, 2018 @06:16AM (#56174817)
    Who cares?
  • Rich World? (Score:2, Interesting)

    by dcw3 ( 649211 )

    The counter to Developing World isn't "Rich". There's a vast middle ground between rich and developing. So, what's the agenda behind calling what's not developing rich, other than giving those living there a guilt trip?

  • Sure (Score:5, Interesting)

    by MrKaos ( 858439 ) on Friday February 23, 2018 @06:55AM (#56174897) Journal

    Anti-depressants are like being told oh, you're sad, here's a pil, now shut the fuck up and get back to work.

    After having to tolerate a sibling on antidepressants for over 25 years, I'm in the camp who's experiences differ from what the study says, I see no difference and in reality deterioration. Having also had to deal with a somatic and a cerebral narcissist, I can also tell you no matter how strong you think you are, other peoples mental illness *will* cause you to have a mental illness. In my case PTSD, which made me somewhat dangerous.

    In other words, mental illness is contagious.

    What I learned is it is essential for your sovereign individuality to minimise contact with mentally ill people in your life before you can begin to recover your own sanity. Then you do the last thing you want to do, face the pain. Face what the deceitful actions of what others did to you and write it all down event by troubling event. What this does is help you process the emotions in a controllable way, this is difficult if you are living with an abuser. What this helps with is state control, preventing Amygdala hijack [wikipedia.org] and re-regulate your HPA axis [wikipedia.org]. You can die if you end up in a state of adrenal failure.

    I was on the receiving end of two narcissists because of the child abuse I endured. When I claim that, I'm refering to the DSM and mean they both exhibited 5 of the nine traits of a cluster B abuser and are probably diagnosable by a trained professional. Trouble is, they don't think anything is wrong with them and they lie lie lie all the time. One was a covert narcissist and destroyed my life twice before I figured it out.

    Worst thing about it though is realising that it made me attracted to these type of people and opened me up for further abuse by other anti-social people and one probable occupational psychopath. I was part of the problem. In writing it all down I processed the emotions and that made me a lot harder to manipulate because it is the unprocessed emotions that 'Those people' can detect in you and use to manipulate you. Once you clear that, you are less prone to abuse and you can start to develop boundaries and coping strategies. If you are depressed, check to see if you have too many assholes in your life. Chances are there are more than one. You know the ones who constantly stoke anger in you - "Those People" who get their thrills by trying to put you into a state of Amygdala hyjack. That want to show everyone how crazy you are so they can indulge in being right. That's all they have and they are usually losers - no you can't fix them.

    So, what I am saying here is it's all too easy to just take a pill, it's bullshit. Face the pain and become a fully functional human being before you become as damaged as I was. You will feel fucking terrible while you do it, however a few weeks afterwards you will be amazed at the good things that start happening to you. The narcissists will still be losers.

    If you are hurting and you are reading this, please know, it's possible to escape. It's not easy but you owe it to yourself.

    • Re:Sure (Score:5, Insightful)

      by bluegutang ( 2814641 ) on Friday February 23, 2018 @07:58AM (#56175035)

      Taking a pill *helps* you to "face the pain". It gives you the motivation to make changes in your life that depressed-you would never have gotten around to do. That is why professionals recommend a combination of pills and therapy as the most effective treatment for depression.

      • by MrKaos ( 858439 )

        Taking a pill *helps* you to "face the pain". It gives you the motivation to make changes in your life that depressed-you would never have gotten around to do. That is why professionals recommend a combination of pills and therapy as the most effective treatment for depression.

        I hope so. However if that person is around the source of their depression, how can they heal when they are constantly being psychologically damaged? All that does is allow them to sustain more damage. It also enables them to damage others and I have seen it.

        The real question is for those people who do take the pill, do they face the pain? In my personal experience it is extremely unpleasant and you will be in a very alien emotional state until you come out the other side, where you finally feel free

        • I hope so. However if that person is around the source of their depression, how can they heal when they are constantly being psychologically damaged?

          Everyone has negative experiences in their life.

          Those who truly suffer from clinical depression have a lack of resilience to handle and bounce back from them.

          Depression doesn't have a "source"; it's not caused by negative experiences. It's a syndrome that makes it difficult to deal with and bounce back from negative experiences.

          • Correction... People who suffer from clinical depression are affected ALL THE TIME, no matter what is going on. Some depressions do bounce; people with bi-polar disorder swing wildly from happy to sad.
      • Taking a pill *helps* you to "face the pain". It gives you the motivation to make changes in your life that depressed-you would never have gotten around to do. That is why professionals recommend a combination of pills and therapy as the most effective treatment for depression.

        Precisely.

        One way to look at depression is as a syndrome causing a lack of resilience. It's a physical syndrome that affects your brain and nervous system (you know, which are physical things in your body). It is affected by medication, like your other body systems are.

        • If it were just lack of resilience, it would have gone away when things were going well for me. It didn't. It does cause impaired resilience.

      • And when a person is feeling pain when there is nothing to feel pain about?
    • by MrKaos ( 858439 )

      I forgot to mention. A cluster B personality type is one that seeks a reaction from you to feel better about themselves, you feel a lot worse so they can feel a little better. From what I understand it causes a release of dopamine and peptides in their brain. In other words, they're loser junkies addicted to their own brain endomorphins.

      It completely destroys your ability to map reality and causes your ability to detect threats to constantly generate false positives. That's why you become hypersensiti

  • by humptheElephant ( 4055441 ) on Friday February 23, 2018 @07:30AM (#56174959)
    Amitriptyline can have side effects for people with urinary problems and should be used with caution as with any drug. For example, if you have a swollen prostate it could make urination much more difficult.
    • by Megol ( 3135005 )

      Yes tricyclics in general have many potential side effects. They are more poisonous than most more modern drugs and so should not be used for people that willingly or otherwise are likely to overdose.

      But they are still used and for good reasons.

    • Amitriptyline can have side effects for people with urinary problems and should be used with caution as with any drug. For example, if you have a swollen prostate it could make urination much more difficult.

      Most/all meds have side effects. You need to work with your doctor to weight the risks and benefits.

  • by Anonymous Coward on Friday February 23, 2018 @07:50AM (#56175017)

    For anyone reading the comments, you should listen to your doctor and trust your experiences. There are different types of depression, and the stigma that you can see prevalent in these comments that you should 'just stop being sad' is a plague in of itself. I am bipolar, and spent the majority of my life being a useless piece of shit who would wake up one day and start training to be an engineer and fall asleep that night alone under a bridge trying to kill myself. I would miss a bus and decide that was a sign that I was a failure in life. None of this is normal, and none of it was my fault. It is a genetic condition, and I spent years telling myself the medication would be a crutch that would make it worse, and that I was strong enough to 'do it on my own'. I didn't want to be one of these pathetic people that everyone talks about.

    But then I found a job I loved, and I didn't want to ruin it like I had so many times before. I decided to get help. I saw a doctor. I started seeing a therapist. I started taking my medications. I wake up now and take my pills and sometimes I forget how hard life used to be, and I can never say enough how amazing it is to be in that position. Not everyone will find the right combination of medications. Maybe your therapist or doctor sucks. Keep fighting. Get a new one. Ignore these trolls who don't struggle the way we struggle and keep pushing yourself.

    There are communities out there to support, help, and guide you. Become a part of those communities and don't let the ignorance of the masses tell you that you can't get better. If you are still reading this, the odds are that you have a voice in the back of your mind that keeps tell you that, anyway.

    • Well-posted. Of course, no one will respond to you. I have an uncle that went through the same thing. Of course no one will reply to you because you make too much sense. I'm glad you found your way.
    • by sl3xd ( 111641 )

      As someone who's been on antidepressants for nearly 20 years, had talk therapy for about as long, I thought I could leave the stuff behind. I was in a good place in my life - things were going very well, both personally and professionally.

      About two years ago, I asked my Doctor if I could try going off my antidepressants. I wanted to stop taking them. I thought that 20 years of therapy had helped, and that I'd be able to cope, because my life was so much better than when I started antidepressant use.

      I tapere

  • A study of studies (Score:4, Interesting)

    by ebonum ( 830686 ) on Friday February 23, 2018 @07:58AM (#56175033)

    So a study of a bunch of studies (run by industry insiders) that showed antidepressants work showed that after analyzing these studies that antidepressants work.

    So studies that individually come to a positive result also collectively come to a positive result? I think this is a phenomenon we need to study!

    How about a novel approach. Have people who understand statistics, medicine and psychology (but have no links to drug companies or reason for bias) try to recreate the results of past studies or run large-scale, carefully controlled new studies. And don't use drug company money to fund the study.

    • To translate this into plain English: "This study irritates me, so I'll make stupid assumptions about the authors without bothering to see if they might be true or not. I'll also assume that the authors were dumb, and didn't think of obvious things."

      More studies would be nice. Who's going to pay for them?

  • They appear to be working GRRRREAT! (/Sarcasm off)
  • by jblues ( 1703158 ) on Friday February 23, 2018 @09:19AM (#56175227)

    "Study A", referenced in the article notes that only one in six Americans are treated for depression. And here "Study B" observes that one in six Americans already take anti-depressants [nbcnews.com]. Therefore we can conclude that the authors of Study A will be satisfied when 100% of Americans take anti-depressents.

    Yet I say that's not going far enough. Something that I learned in college is that if one pill is good, three pills are better, and that American Society will only reach its potential when 300% of its members are taking anti-depressents.

  • At creating basket-cases who like to go on mass-murdering sprees, that's for sure.

    Antidepressants should be banned.

    • It's difficult to say whether this individual would have done the same thing without antidepressants or not. The thing that is for sure is that his doctor didn't do a very good job in giving him the meds for his condition. It sounds like a lot of medications are prescribed for profit in the US, and Americans really need to figure out how to solve that problem, one solution being a single payer system. If you really knew how many people ALL AROUND YOU get diagnosed correctly and are able to move on with t
    • by Z00L00K ( 682162 ) on Friday February 23, 2018 @11:21AM (#56175875) Homepage

      Of all those under treatment a small fraction end up being in that category.

      And we don't know if that figure would have been higher or lower without treatment.

  • Certainly it does cost society, but what about the burden to the people suffering? Should not that be the paramount factor in treatment rather than profits for Pharmas?

  • The only thing that makes me more sad than how ignorant Amaricans are about guns, is how ignorant Amaricans are about mental health.
  • Mass Shootings (Score:2, Informative)

    by Anonymous Coward

    The majority of mass shooters have been under the influence of - or withdrawing from - SSRI based anti-depressants.
    One of the (side) effects of SSRI's is "emotional blunting" which, in essence, causes sociopathy.
    While SSRI's may not directly cause people to become mass murderers (there would be thousands of mass shootings as opposed to dozens), there is certainly a link here.

    It is also interesting to note that stated side effects of SSRI based anti-depressants are "violent and/or suicidal behavio

  • A lot of people here need to take a good read on what depression is. Too many people here are confusing sadness with real depression and it's not even worthwhile having a conversation. If you can change something about a person's life and they become happy, then they were never depressed in the first place.
  • NO! NO! NO! NO!!!
    They're already handing out SSRIs like candy for everything imaginable. People with PTSD do not need anti depressants. Also, MANY people who are put on these things are NOT monitored for behavioral and mental changes. The more we hand these things out without FREQUENT monitoring, the more problems we're going to have with grandiose suicides. According to things I keep reading, nearly ALL of the mass murderers (especially the ones that suicide) are on SSRIs.

    I have a friend that was put o

  • Wiki [wikipedia.org] says:
    Several studies have associated paroxetine with suicidal thinking and behavior in children and adolescents.[10]

    and

    GlaxoSmithKline has paid substantial fines, paid settlements in class-action lawsuits, and become the subject of several highly critical books about its marketing of paroxetine, in particular the off-label marketing of paroxetine for children, the suppression of negative research results relating to its use in children, and allegations that it failed to warn consumers of substan
  • From what I've read about sleep deprivation therapy, that's effective. Spend three weeks, and 70% of people are cured of their depression. The problem with it, is it's not patentable, so there aren't any market forces to push it.
  • Doctors prescribe antidepressants as a lifesaving measure. A person suffering depression has an absurdly higher probability of committing suicide than somebody who doesn't. In fact, an overwhelming majority of people who commit suicide suffer from depression. When a doctor prescribes antidepressants, they aren't rubbing their hands together waiting for a big payout from big pharma. They are doing it because they want the patient to not die, which is a noble gesture on behalf of a doctor. Antidepressants "d
  • No true Scotsman (Score:4, Insightful)

    by wwalker ( 159341 ) on Friday February 23, 2018 @01:22PM (#56176625) Journal

    Quote from the actual study:
    "We excluded quasi-randomised trials and trials that were incomplete or included 20% or more of participants with bipolar disorder, psychotic depression, or treatment-resistant depression". (emphasis mine)

    So yeah, it works, unless it doesn't, in which case we'll exclude those instances. No true Scotsman indeed.

  • DISCLAIMER: This is JUST MY OPINION. Agree or disagree all you like.
    READ EVERY WORD CAREFULLY BEFORE YOU COMMENT.


    Cognitive therapy, and learning how to deal with the shit that life hands you, is a better long-term strategy than taking pills.
    Furthermore: the pharmaceutical industry dearly loves people buying medication from them forever. They've been pushing antidepressants for decades now, and HMOs would rather give you a bottle of pills than have you sit down with an expensive counselor or psychiatri
  • Another issue with antidepressants is that they get an undeserved bad reputation for promoting violent behavior - because some people committing horrendous crimes turn out to have recently been put on a course of them.

    What's happening there is that psychopathy and depression are separate issues and a few people have both. So you have this handful of psychopaths who'd commit atrocities but are too bummed out to get around to it. Treat their depression and you have a fully functional psychopath. Oops! (Th

  • There is TWO part to depression treatment. The first is anti depressive, the second is a psychotherapy. If you take/get only the pill then somebody in the health care dropped the ball. A pill without therapy is nearly worthless.

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