Thursday, March 06, 2008

SOTD: Anti-depressants don't work?

Today's Study of the Day comes to us courtesy of the U.K.'s Hull University, where an analysis of 47 separate trials purportedly showed that most treatment with SSRIs is little better than a placebo.

Here's the paragraph that caught my eye:

The study has credibility because it has included data which drug companies had chosen not to publicise possibly because it was less favourable than they would like, and it suggests that millions are needlessly taking powerful and potentially dangerous drugs.

I don't know if this is true, but it's a hell of a story if it is. Would it surprise anyone to know that drug companies withhold information?

On the other hand, I know people whose lives have been saved, literally, by meds for depression. I would hate to see a wholesale rush to drop them.

What do you think?


vesta44 said...

I think some psych meds can be helpful for some people. I was depressed for a lot of years (and didn't know it) and tried suicide twice. Then I finally found a couple of really good therapists and between 10 years of therapy and 10 years of Prozac, I figured out how to deal with life and what it throws at me without having to hide/cry at the drop of a hat/etc. I no longer take the Prozac, but I'm dealing with life pretty well without it. I think, in a lot of cases, it's a matter of trial and error to find the drug that works for each individual, and writing off drugs as useless is not going to help anything. It's just too bad that more independent studies can't be done, so that we get unbiased information on which to base decisions about our health (mental and physical).

Anonymous said...

First - it sometimes takes trying two or three SSRI's or SSNRI's before you find the one that seems to work for you. I used Paxil first, then Prozac. I still take Prozac, and I pretty much have consistently for the last 10-15 years. I probably always WILL take it. I still have depressive episodes, but they last for a week instead of a month. And I also did four years of therapy to learn some other coping skills and work through some of my issues.

What most of the clinical studies have shown is that a combo of talk therapy and medication is the most effective for long term management of depression.

Finally, not all depression is the same. Long term clinical depression is different than someone who has a bad patch when something awful happens...and they should not be treated in the same way. For those with chronic depression that has shown little to no improvement with talk therapy alone, meds are a lifesaver.

Anonymous said...
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Anonymous said...

I have become very critical of antidepressants over time - mostly because of personal experience. I have been chronically depressed for several years now without my depression ever lifting completely. During this time, I tried out three different antidepressants - two SSRIs and one NRI. All of them, particularly the NRI, caused side effects but nothing else.
What I found incredibly frustrating was that every single time I had to fight to be taken of the respective drug, although I had taken each of them for at least six months at increasing dosages without effect. Antidepressants do of course always take some time before they take effect, but that time is usually described as up to six weeks, not months. Yet, every single time my doctors wanted to keep on the drugs. In two cases I eventually stopped to take the drug without supervision (something one should never ever do with antidepressants), in case of the third drug I insisted on being taken off it. Although my doctor put me on a tapering regime I had really nasty withdrawal effects in this case – effects that I only was aware could occur because I did some research on my own, my doctors never informed me that withdrawal effects were usual for this drug.*
All this has made me really wary of psychiatry in general and antidepressants in particular. I also dislike that most doctors want you to stay on an antidepressant that works for the rest of your life although these drugs have not been tested for long-term safety.
In fact, as much as I want to get better, I am not willing to go on another antidepressant at this time, particularly not because I am unlikely to get all the information for an informed decision from my doctor. My psychiatrist wanted to put me on amitryptiline, a tricyclic antidepressant, last fall. One of the likely side effects of this drug is a craving for carbohydrates - which is again something I had to find out on my own. This would be not so bad if I did not have binge-eating disorder in the first place. I therefore do not think that this drug is in anyway suitable for me and I am not willing to try it out.

*Incidentally, the manufacturers of this drug claimed for years that withdrawal effect were mild and infrequent although the available data showed the opposite. They only admitted that withdrawal effects are frequent and often quite severe after they were forced to do so.

Rachel said...

Shannon Brownlee released a book recently called Overtreated, that discusses the shady dealings of the pharmaceutical companies amongst other medical-related topics. I quoted some relevant bits from an interview she did recently in a post here.

Writes Brownlee:
…There is little reliable information about most things doctors do. The FDA does not require that a new drug be an improvement over other medicines that are already on the market, and the drug industry does not routinely conduct valid (translation: likely to be true) trials that compare one drug to another. When it does fund such comparative effectiveness trials, they are often so woefully biased that the results are meaningless; the drug manufactured by the funder of the study generally comes out on top. And the drug industry rarely, if ever, funds studies examining whether its products are superior to nonpharmaceutical forms of treatment— antidepressants versus therapy, for instance.

Anonymous said...

I used to take meds...they helped me realize what was going on. I am glad every day I got on those meds!

Howerver, with that said...

I do not feel they work for everyone...because I feel that too many people are being medicated for their feelings...and not because of depression. If you are sad for any reason there are those who are quick to offer a pill as a cure instead of trying to figure out why the person is sad (or angry or whatever). We are slowly being taught that if you are anything but happy you are depressed and need meds and therapy.

So, yea. I can see the study if many of the people it didn't work for weren't even chemically imbalanced to begin with.

viajera said...

I was skeptical about SSRIs for years, and still suspect they're overprescribed. But speaking from personal experience, I've found they work for me as well as other members of my family. I've suffered from depression for most of my life (as have both of my parents, and at least one grandparent). As a child I watched my mother buy one self-help book after another to no avail, and so I developed a hostile attitude to any kind of treatment, particularly self-help or counseling, but also including drugs. I was convinced that I could cure my depression through my own willpower (call it my Fantasy of Being Happy).

Needless to say, that would work for short periods, then I'd fall back into a deep and long-lasting depression. Finally, in my early 30s (yeah, I'm stubborn), after both my parents had positive results from Prozac, I gave in and got on it myself. I took it for a year, and it really made me feel better. I did a form of CBT (Cognitive Behavioral Therapy) on my own as well, which also helped, but the Prozac quieted my negative self-talk and allowed the CBT to work.

After a year, I was doing so well and my thinking patterns had altered so much, that I thought I no longer needed the Prozac, so I stopped. Within a few months, the negative thoughts had come back so strong that not even CBT would help - the positive thoughts would be overwhelmed by the negative. After months of futile effort, I got back on Prozac, and within just a few weeks was feeling better and able to successfully use CBT again.

So while SSRIs may not work for everyone, they do work for some. I don't believe it's a placebo effect, either - the changes to both my energy levels and thinking patterns are really dramatic, and unlike anything I've experienced when trying to alter my thinking while not on SSRIs.

Nan said...

Based on my personal experience and from observations of friends and students who have been prescribed anti-depressants, I know that for some people they can be a lifesaver. OTOH, far too many physicians have no clue as to how to properly manage patients who are prescribed these drugs. They're not familiar with the potential side effects, and they have a tendency to dismiss patients' complaints as being part of the illness and therefore not valid rather than actually listening to what people are saying. And for sure they downplay the effects anti-depressants can have in areas such as weight gain.

Anonymous said...

I suspect that when all the dust settles, it may well come down to an individual's genetic makeup as to how well a particular med works (or doesn't work) for them.

They're finding this with some cancer drugs - some patients respond very well to certain chemotherapies; in others, those chemotherapies don't help. And it's related to a particular gene.

I know people who tell me their lives have been saved by SSRIs. I also know people who found them not to help. (I had a cousin who was on them, who wound up taking his life. The general family consensus is that it's something he probably would have done anyway; perhaps the meds just made it "easier" for him because they moved him out of sort of a catatonic, paralyzed state where he couldn't do anything.)

I don't know - I'm lucky, I guess, in that I've never had more than the ordinary run of "down" days, which are not depression.

But I suspect one thing the medical profession is learning - and if they ignore it, it is at our peril - is that people do not all respond the same way to some treatment. That there need to be alternative treatments, there's no one-size-fits-all solution. And maybe genetics will allow for better tailor-made solutions. But you can't just put everyone with, say, depression in a box labeled "Depressive Patient" and treat them all the same.

Anonymous said...

As others have said, I think that some anti-depressants work for some people. I personally believe that I have a genetic predisposition to depression that is chemically based. My father suffered for years from depression, even though he had no "reason" to be depressed. When he described how he felt to one compassionate physician (who happened to be a proctologist of all things!) the doctor shared his own experiences with depression and offered to monitor my dad on anti-depressants if he wanted to try them. Within a couple of months, he felt like a new man. He didn't need talk therapy, he needed the chemical imbalance fixed.

I had a similar experience with Wellbutrin (not an SSRI), which I started after several years of unreasonable anger, sadness and anxiety. Within a few weeks, it was like someone had flipped a switch in my brain. Now I'm going off of them due to late pregnancy, and I can really feel the difference.

Until there is an actual "test" for chemical depression--if such a thing exists, and I think it does--it will be hard to know if these drugs are over-prescribed, useful, useless...whatever. What I do know is that Wellbutrin--while it didn't exactly save my life--has made my daily life so much better and more productive that I would fight tooth and nail to defend it. And I know my dad would do the same for Zoloft.

Anonymous said...

My anti-depressant has improved my life dramatically. I suffered from terrible anxiety for years, and now I can act like more of a normal human being.

With that being said, I believe it does boil down to the individual.

MigiziNse-ikwe said...

I've always been suspicious of any kind of drug that messes with your brain chemistry, be it over the counter, prescribed by your doctor or bought from a guy on the street. I wont take them for any reason (and I realize that this seems unreasonable). When I suffered from severe post partum depression after my son was born all my doctor wanted to do was prescribe me Prozac. Great idea except the common side effects were all symptoms I was already experiencing! There was no suggestion for therapy or an attempt to find out where my feelings were coming from, just "Hey, you're unhappy? Have some meds!" This study confirms what I've always suspected; most people are being overmedicated and for no good reason.

bookwyrm said...

My husband and I have a pretty good doctor; when the dosage he put my husband on worked sorta well, he said he thought h should up the dosage, but also said that it was possible that that particular med wasn't the right one for him. Since it was working a little, upping the dosage was a the better thing to try, first, since they don't have a test to find the best one for you.

And my psychiatrist and therapist know that I *want* to go off my drugs if I can function without them and the seemed to accept that. I've only been in this game for a couple of months.

Callicebus said...

I was just reading a blurb about this in Nautre this morning. The author was addressing both the poor way the media handles science information (as in this instance - they took the conclusion that because the drugs often performed no better than a placebo as evidence that they didn't work. They completely ignored the placebo effect - which was substantial, and as a result many people have abandoned their therapy altogether), and the inconsistency in groups publishing results (as with the statins trials recently) and is recomending that clinical trials be registered and databases open to the public. That way the media has no excuse for misreporting and funding groups can't withold the results of studies.

Katy said...

Well, it would hardly shock me that drug companies withheld information, but I'm a touch skeptical of any study that says there are NO effects. I'm pretty sure (and this probably isn't something I should say w/o the evidence, but I don't have time to go digging right now!) that there have been brain imaging studies that have shown brain changes in patients on ADs indicative of links b/w depression remission and the drugs...

My guess is that the relationship b/w the drugs & depression is more complicated than meets the eye. Depression is not a single gene disease nor is it an infectious disease, ergo there are a lot of unknowns and individual variabilities (much like EDs and most mental illness). Individual depression drugs don't tend to work much better than placebos even in published studies--they show a difference, but we're not talking huge here. Some of the improvement that comes from AD use is the result of brain changes that happen when people believe they have a chance to feel better. Hope is a powerful thing, emotionally and apparently neurochemically. (Not that those two can be separated anymore.) Depression waxes and wanes--a person might be improving anyway and the improvement recorded with the drug is coincidental. Again, I probably shouldn't assert this without the evidence, but I'm not going study hunting right now, but I THINK that in studies where multiple drugs are used, allowing for use of a different drug if one doesn't work and therefore allowing for individual variability, there is a greater difference from placebo than with just a single drug. (This could just be something my psychiatrist told me and not a study...but I'm pretty sure there was some evidence for it!) SSRIs all do basically the same thing, but often when one doesn't work for someone, another does. I also think that if a certain drug works for someone in your family, it's more likely than others to work for you. Anyway, what I'm rambling and trying to say is that depression is modified by so many factors, and so individual, that I would hazard a guess that drug outcomes for targeted groups would be different than studying ALL depressed patients. I'd be curious if there actually were studies looking at who was helped by particular drugs and perhaps trying to figure out why and then being able to tailor new prescriptions to a person's profile rather than a psychiatrist's favorite first round drug.

Anecdotally & personally, SSRIs did zip for my depression. I tried 3 different SSRIs, 3 anti-anxiety meds, an SNRI and an SSNRI at various doses for various lengths of time in various combinations with no effect whatsoever over the period of three years. What finally helped me was a drug used in bipolar disorder (I'm not bipolar) and a drug for ADD (I don't have ADD), and neither solved my depression--but they did allow me to function, gave my moods a "floor" and allowed me to do the work and engage in the self-care, etc. that pulled me out of my perpetual depressive misery. There are some interesting possible physiological theories I have on that, but I won't go into that since I've already written wayyyy too much, but what I'm getting at is that we know very little about how psychotropic drugs work and not a whole lot about variabilities in depression types/manifestations/individual differences and how that relates to drug effects. So while I'm all for suspicion of drug companies and all for a whole hell of a lot more transparency in their research, I'm also wary of anything that rejects drug efficacy out of hand.

Whew. Sorry for the treatise, I hope I at least made sense somewhere in here!

Chanda (aka Bea) said...

A few years back I went to my Dr to request, what was then very popular, phen phen or redux for weight loss. She was adament about refusing my request(rightly so) but then suggested and prescribed a low dosage of prozac for it's particular side effect of loss of appetite, and to help with my anxiety surrounding all things food. Im not sure this is a standard practice, but at the time it worked fairly well for about 3 months, but I did no like how I felt on the drug. Disconnected is the best word I can use for it. I wasn't hungry, or anxious, but I wasn't anything else either. I never smiled, never got angry, I felt like a robot. So, I went off them.

I've never heard of prozac being used for disordered eating before, but from personal experience, I can't say it was that great.

As far as the drug companies being less than forthcoming on their respecitve drugs, that does not surprise me one bit. It's all about the all mighty dollar. And while I know antidepressants have helped countless people, I do think they are over perscribed, and misused regularly. And the fact that insurance companies will pay to have a client on drugs for the rest of their lives, but no therapy, speaks volumes about where the corporate mindset is on mental health.

tori_927 said...

I was never depressed, but I had anxiety and OCD, and it was getting so bad that I couldn't relax, couldn't sleep, couldn't watch TV, literally couldn't do ANYTHING...because my mind was racing so fast that I couldn't pay attention. My counselor suggested I try an anti-depressant, and I was PISSED, because I was convinced that I was fine and didn't need anti-Ds. After a while though, it got so bad I couldn't even function, so I decided to give it a try, and I feel great. You never realize how bad it's gotten until you're reminded of how you used to be.

Harriet said...

Tori, that's interesting. mMny docs now feel that anxiety and depression are points along the same continuum. I've had anxiety all my life, pretty much, and at one point i took anti depressants and they helped a lot. Others in my family have used meds with varying results.

I do wonder if part of the issue with SSRIs is that they're often prescribed by family docs or internists who don't follow up properly. OTOH, I've also had the experience of having a psychiatrist prescribe a higher and higher dosage of something that clearly wasn't working or was creating side effects.

I agree with callicebus, that the media reports on this equate not working with placebo effect. Nothing wrong with the good ol' placebo effect.

Brains are such complicated things. Thank goodness.

Katy said...

Chanda--interesting that your doc prescribed Prozac b/c it had the side effect of appetite loss...I had the exact opposite experience with it! On Prozac I was so hungry I could've eaten the paint off the walls--I found it incredibly ironic that this was a drug approved to treat bulimia!

Just goes to show how individual this stuff is--not only can people have/not have side effects or intended effects of a drug, but they can also have OPPOSITE effects! Brains ARE complicated. :-)

we_be_toys said...

I have an innate horror of being controlled by a drug.
Having said that, I do realize that antidepressants can be the jump-start to getting back to normal for some people.
Having said THAT, according to the only shrink I've known for my entire life; my dad; antidepressants should ONLY be used for short term periods, and undergoing therapy/ or remaining under a doctor's care should be mandatory, for the duration of the prescription, if not after.
I think we have become afraid of feeling anything intense, be it fear, joy, pain, depression, anxiety,etc. The problem with that is Life is all about HOW you deal with all those things, and if you're doped to the bejesus and don't give a damn about anything, how is that preferable?
That's just my two cents!

Anonymous said...

I hope that people don't confuse "no better than placebo" with "don't work".
My best understanding of the emerging literature on SSRIs is that:
1) Getting treatment for depression helps. Placebo patients do better than untreated general population.
2) SSRIs almost certainly do work for some (as yet undefined) people, but in a different way from what was initially thought.
3) We don't understand enough about who will benefit, and who will not. A variety of factors, including genetics and severity, are likely to prove to be key to understanding who will benefit from what kind of dose of which medicine.
4)Don't stop taking meds without talking to your doctor.

BTW,points 2 and 3 are also emerging to be true of Statins, the other most widely-prescribed class of meds.

Anonymous said...

We Be Toys, I was on antidepressants for 15 years. At no time was I ever "doped to the bejesus," and I only wish I ever, even for a few minutes of my life, didn't "give a damn about anything." Nobody who knew me during that period could have accused me of not "feeling my feelings." I felt them and felt them and felt them and felt them, believe you me.

I'm now on an amino acid regimen instead because I grew weary of the side effects after 15 years, but you know what? If not for these drugs, I couldn't have held a job that would have allowed me the health insurance and the income to step up to treatment that worked better for me. Was it a "forever" solution? No. Was it a solution that was way better than no solution at all? You bet.

Which is not to say the drugs will work for everyone. Obviously that's not the case. And there is probably some misuse and abuse, and it would be nice if more people had access to the kind of treatment I am having now, and more options in general. But they don't. And an imperfect line of treatment beats hell out of none at all.

Niika said...

Apparently pharmaceutical companies are now trying to put this spin on antidepressants not because antidepressants don't work, but because they want you on NEW meds -- aka, atypical antipsychotics.

Harriet said...

I've seen it from both sides. One of my children has been on an SSRI since age 8, when she started having major panic attacks. We've tried taking her off them a couple of times, and you know what? Her life is pretty awful without them. Which is what my life was like when I was a kid having panic attacks, only there were no SSRIs. For her, these things are a life saver, literally, at least in the sense that she will get to grow up with a life not totally twisted around anxiety. I'm envious of her sometimes, frankly.

My own experiences have been more mixed. I took an SSRI for five years after a serious postpartum depression, and it was a godsend. The side effects, though, got to be more than I could handle, so I went off it. I've tried a couple of others since then and none have been good for me. I wish they were! I'd settle for the placebo effect any time.

What disturbed me most in the original piece was the fact that drug companies suppress information. I'm grateful for the research and creativity that goes into designing medications that people like me need sometimes, but I hate the fact that the almighty dolleh leads to decisions that hurt people rather than help them.

Anonymous said...

I take Zoloft, never have had a problem with it. I think these people who are getting hysterical over the idea that psychoanalytical drugs have side effects, like any other drug. Will be putting themselves in deep s**t, if they try pulling SSRIs off the market.

They don't want to see people going back to cutting or other self-destructive behaviours to cope.

Frankly I'm not too worried, it seems like these are the same kind of fear mongerers, that go around telling you that all artificial sweeteners except Stevia will kill you. Not to mention that the psychatrists would raise holy hell over it.

I think these morons should take a look at the side effects for pain killers sometime. Every single medicine, ever made, has side effects. These people must not understand what it means to need to take drugs, in order to keep your sanity.

I think they're sick to suggest, they take away the lives of thousands of people like me, who need SSRIs to function. It's like, suggesting the idea of submitting people to a vacation at Guantanamo. That might be a rather egregious exaggeration, but unless you've been depressed to where you have scabs up and down your arms, you have no right to be discussing taking SSRIs away from people.

Anonymous said...

That's the think Violet Yoshi...most of the time people who make these proposals don't know anything about what they are talking about ...and only talk from their opinion.

Anonymous said...

Exactly Sandy.

Anonymous said...

Hi,My name is Jack, well, I'd like to know if the following Anti-depressants are approved by FDA Celexa,Effexor-xr, Elavil,Fluoxetine,Lexapro,Paxil,Paxil CR ,Prozac,Remeron,Wellbutrin,Wellbutrin-sr,Zoloft

Anonymous said...

i suffer from crippling depression. ihave been on every antidepressant and they actually make me worse. when i went on effexor i tried to kill myself. every thing since, it has been a struggle to get up and also to not commit suicide.

i can assure people that sometimes antidepressants work, and sometimes they don't. i have friends that take what i have taken, and it works miracles for them. stuff that didn't work but made me hyper puts some friends to sleep, they can't take them because they will sleep 20 hours a day.

i have no faith in the drug companies. sure, of course the antidepressants work for some people, and not all. there are benefits to be had. however, i have no faith that the drug companies care whether or not these drugs work. i believe the drug companies are only interested in revenue streams, in getting us addicted to things we can never stop. i do not believe drug companies have any interest in helping people, just guaranteeing a revenue stream for life.

still, they sometimes work, and sometimes don't. and there is no real telling if someting will work or not. it's different with each person. everyone will have different side effects too. what worked on my parents and grandparents does not work on me at all.

therapy is good, cognitive behavioral therapy is good, forcing myself out of bed and into the sunlight helps. being extremely careful about the quality of friendships and relationships i maintain is critical. eating right and staying on a really strict schedule is most important with me, or i will end up on illegal drugs or drinking and staying in bed for weeks, sometimes peeing in my bed because it's too hard to get up.

i don't have any answers, all i can say is i believe the drug companies are purely evil. i also know for a fact that the drugs they peddle sometimes actually are miraculous for some people. sometimes these miracle drugs stop working, sometimes they keep working for years and years, and havne't stopped yet.

i can also say that i'm not the only one i know who is completely non responsive to antidepressants. i also know people for whom shock therapy works, and some for whom it doesn't do a bit of good. some forget everything, others have no memory loss.

actually, the one *good* thing i could testify about is that celexa defnitely reduced my chronic physical pain. it made me suicial and an incredible insomniac (another friend on celexa can't wake up!, and a coworker is on celexa with zero bad effects and is a brand new, wonderful light of a person on it). but i have read that celexa helps with fibromyalgia, or at least they suspect. i would say, if yo ucan tolerate the celexa, then it really did actually help my pain. i didn't realize this until i came off it and had a headache and backache for six months without letting up.

i have no faith in this world. my religious faith has kept me from killing myself, and it has also in some weird way made me not so worried i would kill myself. if i do then it's my illness, not me. so the only thing i can say is, being off antidepressants is hell, but it has not really hurt my faith. it's challenged it in many ways, and destroyed it a few times, but the faith always comes back rebuilt and stronger.

i'm learning to live with the depression.

i'd say watch it, they dont' work for everyone and they may stop working for you so be on the lookout without being paranoid about it.

also just do your best and learn to seperate you from your illness. and don't give any 'friend' the time of day if they ridicule you for your depression.

the beswt thing i can do is be around compassionate people who don't mind me crying again this week. and if you are not depressed then i challenge you to use that blessing to bless others who are sad, and treat them with dignity and compassion. that will help both of you.