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A cross post from Furious Seasons.

I'm not sure how many of you saw the item on my site late yesterday, but there is a very important study out in PLoS Medicine (meaning it's online and free), asserting that several anti-depressants aren't up to clinical measures of efficacy when it comes to treating depression. The study was lead-authored by Irving Kirsch, a psychologist at the University of Hull in the UK.

It is a very complicated study when it comes to the statistical analysis, but these were the very studies that the makers of Prozac, Paxil, Effexor and Serzone submitted to the FDA to gain approval for these drugs in treating depression. The researchers used as their clinical measure an index created by the National Institute for Clinical Excellence (NICE), which is a British agency. The NICE standard is that for an anti-depressant to be considered efficacious it has to beat a placebo by at least three points on the Hamilton Depression rating scale. Anything less, and it's all placebo effect that's being measured in essence, or it's very expensive pharmaceutical equivalent.

This study comes five weeks after a separate study in the New England Journal of Medicine examined clinical trials data submitted to the FDA for all 12 of the new generation anti-depressants and found that, owing to numerous unpublished studies, pharma companies had been overstating anti-depressant efficacy by about 30 percent.

I won't bore you with all the numbers from the British study but it basically concludes what the NEJM study did. Here's the conclusion from the PLoS paper:

"Drug–placebo differences in antidepressant efficacy increase as a function of baseline severity, but are relatively small even for severely depressed patients. The relationship between initial severity and antidepressant efficacy is attributable to decreased responsiveness to placebo among very severely depressed patients, rather than to increased responsiveness to medication."

In other words, if the drugs work at all, then it's for severely depressed patients, but they don't outperform placebo that much there either. That is simply a staggering conclusion--and validates much of what I've been writing for the last few years--but I need to be fair and point out that the study only examined four drugs and that these were only the FDA approval studies, not the post-marketing studies of these drugs which are much more extensive. Then again, given how badly post-marketing studies tend to be twisted and contorted to produce positive results, I have no problem with relying on these FDA studies.

The drugs in the study beat placebo by 1.8 points on the Hamilton scale.

Also, a couple of pharma companies had some thoughts for the British press (I've not seen any US press accounts of this study yet beyond this slim Reuters piece):

Lilly, maker of Prozac, was apparently steamed and issued a statement, which isn't on the company's website as yet, so here's the Guardian's account:

"'Extensive scientific and medical experience has demonstrated that fluoxetine is an effective antidepressant,' it said in a statement. 'Since its discovery in 1972, fluoxetine has become one of the world's most-studied medicines. Lilly is proud of the difference fluoxetine has made to millions of people living with depression.'"

GlaxoSmithKline, maker of Paxil/ Seroxat, was similarly upset:

"A spokesman for GlaxoSmithKline, which makes Seroxat, said the authors had failed to acknowledge the 'very positive' benefits of the treatment and their conclusions were 'at odds with what has been seen in actual clinical practice.'"

If there were very positive benefits in the data they'd analyzed, I expect the researchers would've reported it.

"He added: 'This analysis has only examined a small subset of the total data available while regulatory bodies around the world have conducted extensive reviews and evaluations of all the data available, and this one study should not be used to cause unnecessary alarm and concern for patients.'"

The Brit press has been having some fun with this story already today. So check these out. BBC Radio also had a small item, which was likely heard by many millions around the world.

For the last few years, the news on the anti-depressant front hasn't been good. There were the black box warnings in 2004 and 2007. Then, there were very disappointing results from the STAR*D and STEP-BD studies. Then, there was the NEJM study. And, now this one.

So at this point I think it's fair to ask: Why are anti-depressants the go-to choice for addressing depression when the evidence for their use is very shaky and the side effects of these drugs are well known? Why were they approved by regulators? And, have all of us who've taken anti-depressants in the last 20 years just been taking a big old placebo the whole time?

Any ideas?

Originally posted to Philip Dawdy on Tue Feb 26, 2008 at 09:29 AM PST.

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Comment Preferences

  •  I was on a few of them and it was REALLY BAD (10+ / 0-)

    Being Bipolar(whatever THAT means anymore) I had various degrees of suicidal thoughts, which I id not have before the meds. Along with that here was the hard physical symptoms like severe teeth grinding which created TMJ and ruinrd teeth, prostate problems and various infections and skin conditions.

    I was finally given Lamictal, which is an anti-seizure med and it works, with few side effects.

    Too much info?

    They are not conservatives they are REGRESSIVES

    by Goodbye Kitty on Tue Feb 26, 2008 at 09:33:30 AM PST

    •  Same thing for me (5+ / 0-)

      (Also bipolar).

      I didn't have bad side effects from the anti-depressant, but they didn't do a damn thing for the mania, and might actually have worsened it.  (Which of course I didn't mind at the time, but the results weren't pretty).

      Lamictal works pretty good as long as you don't get the potentially fatal skin reaction.  


      Left, not liberal. A liberal wants to redistribute wealth from bosses to workers. A leftist wants to stop redistributing wealth from workers to bosses.

      by slaney black on Tue Feb 26, 2008 at 09:42:44 AM PST

      [ Parent ]

    •  i took an anti depressant for a few weeks (2+ / 0-)
      Recommended by:
      True North, buddabelly

      and i couldn't stand it.  this was about twenty yers ago, and i can't remember the name of it, but it made me juttery and anxious.  i decided i'd rather be depressed, so i stopped taking it.

    •  Antidepressants are NOT for someone with Bipolar (10+ / 0-)

      unless you have a mood stabilizer in place.  AD's alone CAUSE mania.  They will never help mania.

      Lamictal (AD and mood stabilizing effects)
      Depakote, etc, are what is necessary to prevent mania.

      A burro is an ass. A burrow is a hole in the ground. Now can you tell the difference?

      by second gen on Tue Feb 26, 2008 at 09:50:32 AM PST

      [ Parent ]

      •  With bipolar 2 you don't get the mania-- (0+ / 0-)

        just constant background crap interspersed with episodes of really bad crap. And you're right, the antidepressants don't work alone until the underlying mood is stabilized--the prozac poop out.

        Oh, and as far as the lamictal rash, just google it--lots of photos and information. Scary stuff and the reason for the slow ramp when getting on it.

        Be bold, and mighty forces will come to your aid.
        --Basil King, Canadian novelist, 1859-1928

        by dallasdave on Tue Feb 26, 2008 at 10:02:23 AM PST

        [ Parent ]

      •  Just started Depakote (1+ / 0-)
        Recommended by:

        and the side effects aren't too bad after the first week of jitters. Does one have to wean off of it?

        Americans, while occasionally willing to be serfs, have always been obstinate about being peasantry. F. Scott Fitzgerald, the Great Gatsby

        by riverlover on Tue Feb 26, 2008 at 10:08:35 AM PST

        [ Parent ]

        •  Depakote - yes (1+ / 0-)
          Recommended by:

          It's also used for migraines and seizures. You have to wean off of it while bumping up the new meds so you don't end up having a bad reaction (including seizures).  I had to do that switching from Depakote to Lamictal for migraines.

          -6.88 -6.31

          "They're all crazy. They're all crazy except you and me. Sometimes I have me doubts about you." -- Garrett Fort

          by Spathiphyllum on Tue Feb 26, 2008 at 10:29:50 AM PST

          [ Parent ]

          •  Darn. I took the entire summer to wean off (1+ / 0-)
            Recommended by:

            an SSRI, only to have a manic episode at age 54. Thus, depakote. These psychoactive compounds are almost not worth the effort.

            Americans, while occasionally willing to be serfs, have always been obstinate about being peasantry. F. Scott Fitzgerald, the Great Gatsby

            by riverlover on Tue Feb 26, 2008 at 10:55:22 AM PST

            [ Parent ]

            •  It only took a few weeks to wean off of depakote (0+ / 0-)

              and switch to lamictal.

              But...then I got the lamictal rash and had to quit it cold turkey. My neuro switched me to keppra and a combo of other meds. Keppra alone doesn't work as well as the lamictal on my migraines, but the combos are getting closer to the mark.

              It's a very bumpy road finding the right treatment/combo for any conditions, but once you hit the mark it's all worth the effort.

              -6.88 -6.31

              "They're all crazy. They're all crazy except you and me. Sometimes I have me doubts about you." -- Garrett Fort

              by Spathiphyllum on Tue Feb 26, 2008 at 11:02:18 AM PST

              [ Parent ]

    •  There is a lot of confusion about these diseases (2+ / 0-)
      Recommended by:
      Spathiphyllum, AnnCetera

      that affect our emotions.  I think people like to think in simple terms about how the brain works, but nothing could be more complex.

      Briefly, our nerves use both electricity and chemistry to communicate from one nerve cell to another.  The electrical side is kinda like a computer, so people understand that better.  The chemical part is where all these emotional disorders happen.  Depression involves one set of chemicals, while Bipolar disorder (which has mania as well as symptoms similar to depression) involves a different set of chemicals.

      Each of these medicines is intended to change how only one chemical is used in the brain, so despite the fact that some of the symptoms of bipolar disorder and depression are very similar, any particular medicine for depression may have no effect whatsoever on bipolar disorder.  Research done by someone who isn't at all involved in selling the medicine is the only way, IMHO, for us to find out what really works and what doesn't.

      Honesty is still the best policy.

      by oscarsdad on Tue Feb 26, 2008 at 10:27:22 AM PST

      [ Parent ]

  •  Thanks for the info and links (6+ / 0-)

    I want publicly funded basic research back!

    "Homo sapiens is the only species on the planet that will follow ... an unstable leader." Cesar Millan

    by middleagedhousewife on Tue Feb 26, 2008 at 09:34:14 AM PST

  •  I had a family member on Effexor (4+ / 0-)

    for several years.  So, yeah... I'm not really surprised.

    I'm not dating Edwards anymore, but I still call out his name when I vote.

    by sagra on Tue Feb 26, 2008 at 09:34:18 AM PST

    •  I was on prozac when first diagnosed (1+ / 0-)
      Recommended by:

      and then effexor after that.  I'm at the point when I don't feel terribly good EVER, and have bouts of pretty dark moods.  I've been wondering if these meds are any good.  At first I was also getting cognitive therapy to change my thought process and I graduated.  I need  to give myself a kick in the pants to get some help.

      Can anyone tell me what's "centrist" about using the Constitution to wipe your ass? - ActivistGuy

      by billlaurelMD on Tue Feb 26, 2008 at 10:22:29 AM PST

      [ Parent ]

  •  I still take my Paxil just because I couldn't (3+ / 0-)
    Recommended by:
    True North, peace voter, oscarsdad

    handle the withdrawals. I am not sure they do much for me. Has anyone else experienced the withdrawals from these drugs?

  •  Although I know these drugs are (1+ / 0-)
    Recommended by:
    True North

    prescribed as anti-depressants, I view them as more mood stabilizers than more traditional anti depressants and, therefore, are used more for bipolar depression than 'regular' depression.

    You are a child of the universe; no less than the trees and the stars... Desiderata

    by byteb on Tue Feb 26, 2008 at 09:37:04 AM PST

  •  as my friend kim once said... (3+ / 0-)
    Recommended by:
    demnomore, Pris from LA, slaney black

    as she was smoking a joint:

    "stay away from prescription drugs."

    •  And I bet that all natural joint.... (0+ / 0-)

      made her pretty happy with no adverse side effects.

      I have known a joint to make me sleepy from time to time, but it has never caused hemmorrhaging in my nether regions or made my heart explode.....

      "I'd rec you if I could." - cometman

      by cometman on Tue Feb 26, 2008 at 10:38:06 AM PST

      [ Parent ]

      •  Funny. (0+ / 0-)

        I've never known a prescription drug to do those things to me, either.

        The heart exploding part might be kind of cool, though.

        •  Well they happen to some people.... (1+ / 0-)
          Recommended by:

          otherwise they wouldn't bother rapidly going through the list of nasty possible side effects at the end of every drug commercial on the TV.

          I will admit to a wee bit of hyperbole in my first comment however...;)  

          "I'd rec you if I could." - cometman

          by cometman on Tue Feb 26, 2008 at 11:04:39 AM PST

          [ Parent ]

          •  They go through the list of nasty possible ... (0+ / 0-)

            ... side effects because that's an FDA requirement for advertising prescription drugs.

            Come to think of it, nobody requires cigarette ads (do they have those anymore?) or alcohol ads to contain a full list of side effects.  Maybe they should.

  •  Can you link the NEJM study? (1+ / 0-)
    Recommended by:
    True North

    That would be the one with the most validity.

  •  Best evidence for the OVERdiagnosis of depression (1+ / 0-)
    Recommended by:

    Dudehisattva... <div style="color: #0000a0;">"Generosity, Ethics, Patience, Effort, Concentration, and Wisdom"&l

    by Dood Abides on Tue Feb 26, 2008 at 09:44:53 AM PST

    •  I would agree with that (2+ / 0-)
      Recommended by:
      Dood Abides, oscarsdad

      They seem to hand them to people who are just in a down period of their lives, not chronically, chemically depressed.  You can still get plenty depressed while on them if you have things in your life making you depressed!  

      "The great nations have always acted like gangsters, and the small nations like prostitutes." - Stanley Kubrick

      by Inky99 on Tue Feb 26, 2008 at 10:20:12 AM PST

      [ Parent ]

    •  disagree (5+ / 0-)

      This work investigates the effectiveness of anti-depressants, not the validity of diagnosis.

      "They can't do anything to me. I don't work for them." - Charles Barkley, on catching flak from hypocritical judgmental fake Christians.

      by DrReason on Tue Feb 26, 2008 at 10:34:07 AM PST

      [ Parent ]

      •  So the validity of the diagnoses... (1+ / 0-)
        Recommended by:

        of the participants in the study, or outcomes reviewed is impeccable...? How so?

        Dudehisattva... <div style="color: #0000a0;">"Generosity, Ethics, Patience, Effort, Concentration, and Wisdom"&l

        by Dood Abides on Tue Feb 26, 2008 at 10:43:41 AM PST

        [ Parent ]

        •  The diagnoses are not impeccable, just not tested (2+ / 0-)
          Recommended by:
          Dood Abides, Myz Lilith

          The right way to diagnose these diseases is by looking at each person's brain chemistry, which is quite difficult to do without killing them and dissecting their brain.

          So the doctors go with a series of spoken questions about how the person feels, and judges their behavior while answering the questions as well.  It is a very imprecise means of diagnosis, far from impeccable, but it is far better than just guessing.  It is also the best people seriously concerned with helping people with their disease have figured out how to do so far.

          Honesty is still the best policy.

          by oscarsdad on Tue Feb 26, 2008 at 10:50:19 AM PST

          [ Parent ]

        •  I didn't claim that, not even close (0+ / 0-)

          So the validity of the diagnoses... of the participants in the study, or outcomes reviewed is impeccable...? How so?

          That's now what I wrote (and for the record, I don't believe it, either). I wrote that the validity of the diagnoses was not addressed by the paper, therefore I found it odd that this work could be evidence of overdiagnosis.

          "They can't do anything to me. I don't work for them." - Charles Barkley, on catching flak from hypocritical judgmental fake Christians.

          by DrReason on Wed Feb 27, 2008 at 01:24:24 PM PST

          [ Parent ]

      •  correct (1+ / 0-)
        Recommended by:
        Dood Abides

        dr reason is correct. the study only addresses efficacy. that's it. nothing more, nothing less.

    •  This is what I absolutely hate about these (1+ / 0-)
      Recommended by:


      Every time someone posts something, there's a massive pile-on about how big pharma is conspiring to increase the number of people hooked on dangerous drugs.  (And a side pile-on, generally, about the cures for cancer which big pharma is hiding.)

      And, of course, when anti-depressants or other drugs turn out to be useful, there's a pile-on about how high drug prices are.

      This doesn't provide evidence for the overdiagnosis of depression.  This doesn't say anything about depression rates, any more than the success of a particular antibiotic says anything about the overdiagnosis of strep throat.  

      Judith Warner had a nice bit about this.  We're not particularly overmedicated today.  People have always turned to drugs -- we just have more (and, generally, safer) varieties available today.

      •  judith warner on drugs (0+ / 0-)

        warner is in my opinion a crackpot who needs to do some more skeptical reporting. i responded to the post of hers you link to here and the one from last friday here. she will not rest until every boy in america is medicated! ok so i am being hyperbolic there.

        •  Give me a break. (0+ / 0-)

          And your 'rebuttals' seem to consist of opinions rather than facts.

          It's possible that mental illnesses are culturally defined.  It's possible that, in the right society, things like visual impairments or scizophrenia or ADHD might be considered positive traits rather than disabilities.  It's a fact that we don't live in such an ideal society.  Consequently, we have glasses, and medication.

          Yes, a lot of boys are on Ritalin.  If this helps them study, is it necessarily a bad thing?

    •  Horseshit. (2+ / 0-)
      Recommended by:
      Dood Abides, shigeru

      That just buys into the often-espoused but seldom tested theory that depression is widely overdiagnosed.  I've met a lot of therapists in various disciplines, and none of them would diagnose depression unless the patient met the DSM criteria.  Now you could argue that depression doesn't really exist, that the DSM is a fraud, and that we've medicalized "just being sad" or that depression is just a vitamin imbalance, but then you'd be in Tom Cruise territory.  

      "...we all of us, grave or light, get our thoughts entangled in metaphors, and act fatally on the strength of them."

      by beagledad on Tue Feb 26, 2008 at 11:12:05 AM PST

      [ Parent ]

  •  It's even worse than reported! (2+ / 0-)
    Recommended by:
    Mikecan1978, Eloise

    Irving Kirsch was my advisor when I was a graduate student at the University of Connecticut. His team did the initial analysis for this study when I was there. It turns out that if the placebo has a built in side effect (which convinces participants that they must have gotten "real" medicine and not the placebo), then there is no difference between placebos and the anti-depressants.

    Interestingly, when members of our team looked to see if the same thing held true for ritalin and anxiety medication, they found that there really was a meaninful difference between placebos and medication.

  •  paxil kept me from committing suicide ... (6+ / 0-)

    ... and literally saved my life and gave me back a higher quality of life; don't tell me antidepressants are a placebo; paxil saved my life.

    •  i'm not telling you that (0+ / 0-)

      prominent researchers writing in peer reviewed journals are.

      •  No, they're not. (0+ / 0-)

        They're saying they're not as widely effective as drug companies claim them to be.

        There is a massive difference.

        And now it's back to work.  My Adderall should kick in any day now....

      •  no, it's your interpretation (2+ / 0-)

        those studies don't say paxil is not efficacious, and, all i'm saying is, i know, first hand, depression is real and paxil, in my case, eradicated it, and i had tried many other types of medications and supplements, including prozac

        •  for a lawyer.... (0+ / 0-)

          you don't read really well. the study clearly states that paxil and the other drugs in the study do not outperform placebo by a clinically acceptable amount. in other words, they aren't efficacious, except in the several depressed. if you don't believe go google the press accounts of this study and see what the lead researcher is saying in his own words. i'm glad paxil worked for you however, but please don't toss around that little 'depression is real' gibe which is essentially accusing me and other commenters of claiming that depression is somehow not real. no claim that depression isn't real is being made by me.

          •  for whatever it is you are-what is it by the way? (0+ / 0-)

            i am very familiar with this study and countless other studies on this very subject; also, i am an attorney for a top 10 research institution in the country; your interpretation is severely skewed, and when "tossed around" as your conclusions are do a terrible disservice to people who depend on the efficaciousness of such medications for survival; asshole

          •  except in the severely depressed... (0+ / 0-)

            Some people are, and if these medications work for them, that's a good thing. No medication is a blanket anodyne for everyone and antidepressants are being passed out as if they were.

    •  I'm with you (2+ / 0-)
      Recommended by:
      N in Seattle, Eloise

      I don't get this study at all.  They are powerful drugs.  If you've ever had one that DIDN'T work for you, you know that.  They can really mess you up if they're not right for you.

      "The great nations have always acted like gangsters, and the small nations like prostitutes." - Stanley Kubrick

      by Inky99 on Tue Feb 26, 2008 at 10:13:49 AM PST

      [ Parent ]

    •  I never got suicidal, but Paxil (2+ / 0-)
      Recommended by:
      DrReason, Eloise

      makes a difference for me every day.  If I forget to take it for a day or two, I (and everyone around me) can tell the difference.  I don't get the zombie like withdrawal some folks upthread are talking about.  I just cry at the drop of a hat and get much more anxious and irritable than usual.  

      I think my symptoms fit GAD better than just depression, but Paxil works very well for me.

      Cancer research, prevention and treatment. Make it an issue. ACS Cancer Action Network

      by KeepingItBlueKrstna on Tue Feb 26, 2008 at 10:28:32 AM PST

      [ Parent ]

    •  My aunt likes her Paxil (0+ / 0-)

      I used to take Prozac and Zoloft.

      I didn't think they were very effective. I got insomnia too.

      I decided in the end to cut off the drugs and give myself a $100/month [~cost of the drug at the time]spending allowance.

  •  Addictive? (0+ / 0-)

    Why are anti-depressants the go-to choice for addressing depression

    Because they're much cheaper than psychotherapy.  Some work...for a period of time.

    Anyone else notice that increasing dosages of certain AD drugs are necessary?  And the messages of difficulty ending the medication are widely agreed upon by users.  Some users wishing to end the medication need to shave the tablets with a razor blade to very gradually reduce the dosage.  Of course, most doctors will argue that they aren't addictive, 'cuz the literature is mute on that point.

    •  Actually, my anti-depressants cost about the same (2+ / 0-)
      Recommended by:
      northsylvania, lemming22

      as therapy.  Cost my insurance company, that is.

      As I say down-thread a bit (because so many people have responded above me :), therapy isn't capable of treating the cause of the depression, only a limited set of the symptoms.

      Anti-depressants are the go-to choice for three reasons:  

      1. They aren't, actually; in my experience anti-depressants are not usually prescribed until after therapy has been tried, and often are prescribed in conjunction with therapy.
      1. Western medicine believes in better living through chemistry, largely because body chemistry is where diseases actually occur, and
      1. They work for a lot of people.

      Honesty is still the best policy.

      by oscarsdad on Tue Feb 26, 2008 at 10:57:18 AM PST

      [ Parent ]

  •  i do not trust any of the "New" (1+ / 0-)
    Recommended by:

    mood elevators, anti depressants, impulse control
    DRUGS. I spent from 11 yr old to 23 on earlier
    medications (1970's), went cold turkey at 23, and now watch in amazement as so many of my friends and Family survive on their daily meds. Affect is dulled, no one really happy, all are worried about 1 thing or another, and All are now Republicans
    What ARE they adding to these medications?
    could the "Trust" hormone be an ingredient.
    They are all "dems will tax us to death" republicans
    just repeating the mantra
    i can't stand to visit, or be around them anymore
    they have become pod people also known as
    Good Germans of the 21st century, and they are my family.
    I am the Blue Sheep of my family
    Don't drink the water ( i am on well, not municipal)
    Don't take their pills
    Don't eat the packaged, reconstituted foods

    Bush/Cheney04 Because it takes 8 years to Destroy the Country Download GeckosAgainstBS song

    by demnomore on Tue Feb 26, 2008 at 10:08:24 AM PST

  •  Latest in series of studies (1+ / 0-)
    Recommended by:

    The National Institute of Health and Clinical Excellence (Health was added but the acronym NIHCE is still pronounced NICE) has a series of recommendations for the treatment of various degrees of depression. They even include a decision tree chart. It is available in .pdf format on their site.

    For mild and even moderate depression the first choice should be talking therapy possibly linked to increased activity/exercise. On the other hand antidepressants are important in moderately severe and severe depression.

    The other thing to note is that the placebo effect is particularly effective in the treatment of depression. If you consider a lot of depression to be the absence of hope, then the hope provided by being given a pill is halfway there.

    If you are taking anti-depressants, withdrawal should be done under medical supervision as several have recorded incidents of self harm or agression following stopping (there is also a similar phase when starting them so the initial prescription should be monitored as well) This effect is particularly acute in young adults and the most recent college killings were committed by somebody who had stopped and SSRI.

  •  They've worked for me (3+ / 0-)

    in the past.  

    They definitely affect you.  I tried Paxil back when I was prescribed them, and it made me spacy and zoned-out as all hell.  No placebo effect there.  It was very WEIRD.

    After that I tried Zoloft and then ended up taking Celexa for this period of time.  It was VERY effective.

    This study baffles me.  

    "The great nations have always acted like gangsters, and the small nations like prostitutes." - Stanley Kubrick

    by Inky99 on Tue Feb 26, 2008 at 10:12:54 AM PST

  •  western civilisation (0+ / 0-)

    if man was really made to live like we are in western civilisation, why would so many of us need to medicate ourselves just to get through the day?

    Personally I think all this mental illness is combination of our terrible diets and our terrible social environment.

  •  SSRIs carry risks of aggravating Alcoholism. (1+ / 0-)
    Recommended by:
    Leo in NJ

    First and foremost, let me state that I am an alcoholist. A recovering one, mind you, but I fully well know that one drop is one too many for me.
    Besides that, I am diagnosed with suffering from depression and PTSD.
    "No problem", the medical caste proclaimed gleefully and put me on an SSRI anti-depressant with presumed anti-anxiety effects.

    Next thing I knew was that my urge to consume alcohol went through the roof en kept climbing.
    I went "off-the-wagon" and predictably cratered.

    A year and a half later and after many, many useless and ineffective trial and error adjustments and changes in dosage, I switched away from SSRIs and nearly immediately my acoholism became manageable again.

    The alcohol cravings totally disappeared and I have been sober since. And with the least amount of difficulty this time, I might add.

    It so appears that the Selective Serotonin Re-uptake Inhibitors are not that selective and impact not only the brain, but the patient's entire system and since serotonin/dopamine household is hugely important for a person's metabolism, it is likely to be adversely impacted by SSRIs.

    Certainly with people who are predisposed towards the affliction of alcoholism, that can create tremendous problems.

    Unfortunately, depression and alcoholism very often go hand-in-hand and therefore the issue of whether or not SSRIs should actually be used on those who are so disposed is one that should be very thoroughly be investigated.

    I for one am glad to be off them.

  •  My personal experience with depression (8+ / 0-)

    I have suffered from what is classified as "major clinical depression" from my early teen years on.  There is a lot of stigma associated with having depression:  a lot of people (myself included, initially) think that depression is an emotion, and people should be able to control their emotions; pull themselves up by their bootstraps; "deal with it".  However, my depression has both emotional symptoms and other symptoms, such as a constant, dull pain in my stomach and tightness in my shoulder muscles (I know because those feeling went away when I started taking medication).

    Please don't discourage people from seeking treatment for depression.  The stigma itself is quite difficult to overcome, and some people, myself included, go from constant thoughts of suicide to a happy and productive life through seeking treatment.

    Major depression is a potentially fatal disease; it can cause suicidal thoughts that are way out of line with reality.  Its cause is well understood:  my nerves don't produce enough of a neuro-transmitter named serotonin.  Only some of our nerves use serotonin at all, including those in the parts of the brain that control emotion and the "smooth muscles" that we have in our stomach and across our backs (but not, for example, in our heart, fingers, or face).

    I want it to be clear I'm not talking about the kind of depression (predictably enough called "minor depression", although I'm sure it doesn't feel minor at the time) that comes after losing a loved one, that lasts a month or two and goes away until some other situation triggers it again.  I'm talking about depression 24/7; it feels like my battery is always running on empty, that there isn't any use in getting up in the morning.  Every day, rain or shine, happiest day or most miserable day.  It may be that these anti-depressants do very little for "minor" or situational depression, I can't speak to that; but that kind of depression isn't nearly as likely to lead to suicide, anyway.

    My history of coming to understand that I was depressed, that it was a disease, and that it was treatable is long and boring, so I won't give it here.  At the end of it I was part of blind tests of anti-depressants, when I was too poor to afford them and had health care that had reached the limit of what it would pay for "mental illness benefits" (The only mental illness I have is depression; I also have a Ph.D., a wife, two children, a house, pets, and a very fulfilling life).

    I participated in three consecutive studies, with different results in each one.  In the first, I had both relief and a painful side effect.  In the second, I had no relief and no side-effects.  In the third, I had relief without any obvious side-effects.  After the studies were over I was permitted to know what I was given in each.  in the second I was given a placebo, in the other two I was given different prescriptions, both of which were in the test you've described.

    I am currently on the one I was given in the 3rd trial, Effexor.  The one I had in the 1st trial was Prozac, however I must point out that I know people who have had side effects with Effexor and NOT with Prozac.  People vary enough in their body chemistry that it is very difficult at this time to predict which person will respond well to which medicine.  But for me, the contrast between being on either one or on a placebo was quite stark, and there is no doubt in my mind that these anti-depressants are not placebos.  As for their long-term side effects, all I can say is that I would rather live to find out what they are than kill myself due to the depression.

    I should also say that I have had a lot of counseling; in fact, I had over five years of counseling before I was persuaded to first try an antidepressant.  The counseling was useful for dealing with my emotions, but it did nothing for the primary symptoms:  constant thoughts of suicide (it did help me make good choices, but it didn't make those thoughts disappear), dull pain in my stomach, tightness in my shoulders, battery perpetually on empty.  My experiences showed me that counseling and medication treat different parts of depression, and the medication was for me absolutely essential to get to what I consider a normal quality of life.

    I share my personal experience with this whenever it seems appropriate because I consider myself very lucky to have survived my disease through my teens and twenties.  I don't know why these several studies in reputable medical journals are coming up with conflicting evidence about these medicines; all I can say is that in my personal experience, anti-depressants have made the single biggest difference in my quality of life of anything I have ever done.

    Honesty is still the best policy.

    by oscarsdad on Tue Feb 26, 2008 at 10:19:30 AM PST

  •  it requires monitoring (4+ / 0-)

    I don't think anyone has figured out which SSRIs are going to be of value for any particular (unipolar) depressive.  The effects are generally subjective, which makes it all the more difficult to predict.

    I took Prozac in the mid-1990s, with some small benefit for a short time.  Somewhat later, I switched to Zoloft, with appreciably better outcomes.  I took no SSRIs for 10-plus years, but recently began to realize that I needed some mood elevation.  My doctor prescribed Celexa, which I found to be completely worthless; recently I decided to try Zoloft again, and it has again been a net positive.

    I've never had any negative responses to SSRIs.  The issue for me is whether there will be any positives, and Zoloft is the clear winner in that regard.

    The way to win is not to move to the right wing; the way to win is to move to the right policy. -- Nameless Soldier

    by N in Seattle on Tue Feb 26, 2008 at 10:23:09 AM PST

  •  Rec'd because of all.... (4+ / 0-)

    the interesting, informative comments. I suffer from depression/possibly bipolar and have a doctor's appointment on this Friday where I'll be requesting meds and a referral to a counselor. I guess you may be wondering why I'd still want to do this when so many have made unfavorable comments about various meds--but the way things have been going (see this diary and the previous one, "I Hate Writing About Myself..." for more) I'm willing to give them a try. Having read quite a bit about depression and bipolar, I'm aware of how one must be patient because it usually takes time to find the right med or combination of meds--and that it's best to treat them with a combinaqtion of meds (which, if they're working, will still the negative voices in one's head) and counseling.

    Don't miss my new blog! "We are all New Orleans now."--Barbara O'Brien

    by Louisiana 1976 on Tue Feb 26, 2008 at 10:24:43 AM PST

  •  I'm on an old-school antidepressant. (4+ / 0-)

    Tricyclic. It's not a miracle cure or anything, but it puts a "floor" under my moods. I'm unipolar so my depression is relatively uncomplicated. Without the antidepressant, I am all right most of the time. However, if I hit a "trigger" for my depression, I fall down into what I metaphorically refer to as "the pit." It's not a pretty place. I'm glad I have this help to keep me out of there.

    My current Psychiatrist wanted to put me on an SSRI. However, after a considerable amount of reflection on both our parts, we came to the decision to not fix what isn't really broken. It works, I have minimal side effects, and the one reason for concern can be ameliorated by increasing my activity level.

    It doesn't work for everyone but it works for me.

    Remember Nataline Sarkisyan! Cure This!

    by Pris from LA on Tue Feb 26, 2008 at 10:25:25 AM PST

    •  This seems to be true about each available med... (2+ / 0-)
      Recommended by:
      KeepingItBlueKrstna, Leo in NJ

      It doesn't work for everyone but it works for me.

      If anyone is on a med that doesn't work for them, complain; ask your doctor to switch.  If they won't, find a new doctor.  I had to do that to find one that worked for me.

      I have heard that fewer people have side effects on Prozac than most of the others that were available when it came out.  But on Prozac I had a constant, sharp pain in my shoulders.  I asked my doctor to switch, but she doubled my dose instead.  The pain doubled.  After a month, I couldn't stand it anymore and went off the Prozac on my own.  Don't do that, at least not cold turkey; it was horrible.  Your body thinks it shouldn't have as much serotonin as your medicine is making you feel like you have, so your body adjusts; when you go off it, you end up with extremely low serotonin levels and extremely bad symptoms as a result.

      I found another doctor, described my experiences, and we tried Effexor.  It has worked for me quite well for over six years now.  Different people react differently to these medicines.

      If you don't have depression, don't take these medicines.  They don't make you happy, they fix a chemical imbalance in your brain.  If you don't have a chemical imbalance to start with, you will create one by taking an anti-depressant.  Your body generally knows what is good for you better than your pseudo-rational mind does.

      Honesty is still the best policy.

      by oscarsdad on Tue Feb 26, 2008 at 10:40:12 AM PST

      [ Parent ]

  •  Variable results... (0+ / 0-)

    On the older meds.  Sustained-release bupropion, however, seems to work very well.  Wish they'd tested that, too!

    "You can't teach an old dogma new tricks." Dorothy Parker

    by AnnCetera on Tue Feb 26, 2008 at 10:28:22 AM PST

  •  Personally, we've had better luck with our neuro (1+ / 0-)
    Recommended by:

    I'm not trying to diss anyone's career or choice of doctor, but my husband has major depression and while he has a very good psychiatrist, our neurologist who treats us for migraines and sleep disorders has always been one step ahead of the game in terms of recommending medications. I suspect it's because neurologists get much more intensive training.  She doesn't believe in the one pill quick fix. She tweaks treatments with small amounts of different medications...combinations that currently do not exist in single pill form.  Of course, big pharma makes out like a bandit with combination treatments.

    -6.88 -6.31

    "They're all crazy. They're all crazy except you and me. Sometimes I have me doubts about you." -- Garrett Fort

    by Spathiphyllum on Tue Feb 26, 2008 at 10:40:54 AM PST

  •  website (1+ / 0-)
    Recommended by:
    If you're looking into meds for depression, bipolar, anxiety, seizures, or migraine, check out this website:

    I found it very helpful when I was trying to figure out what I should try for my migraines.

    •  I've used that site (0+ / 0-)

      It's been very helpful because it gives the dirt on meds that I use to treat migraines (AEDs) that you won't find on a PI.

      I highly recommend it.

      -6.88 -6.31

      "They're all crazy. They're all crazy except you and me. Sometimes I have me doubts about you." -- Garrett Fort

      by Spathiphyllum on Tue Feb 26, 2008 at 10:51:26 AM PST

      [ Parent ]

  •  Trying supplements instead (0+ / 0-)

    I was tired of the weight gain from antidepressants. Currently I'm trying a combination of L-Tyrosine and 5-HTP. I've been taking them for about a month and can honestly say I feel good. I'd love to hear from anyone else who takes either or both.

  •  They worked for me for anxiety (2+ / 0-)
    Recommended by:
    KeepingItBlueKrstna, Leo in NJ

    I had big problems with anxiety, social and otherwise, and my doctor started me on Paxil just over a year ago, along with therapy (more recently he switched me from Paxil to Lexapro, to lessen side effects), and it's made a remarkable difference in my life.  I don't get the nasty anxiety attacks I used to, I've been more social and involved with people, I did some political campaigning, I have a girlfriend and am in love for the first time life, and we're discussing marriage and buying a house together.      

  •  Your conclusions from the study are over-broad (0+ / 0-)

    In other words, if the drugs work at all, then it's for severely depressed patients, but they don't outperform placebo that much there either.

    That's not what the study concluded. It concluded only that for mild and moderately-depressed patients the (statistically-significant) improvement shown by the drug over placebo did not meet NICE's cut-off for "clinical significance." (NICE doesn't believe drugs are worth paying for unless they meet their definition of clinical significance).

    An important additional point is that the reason for not meeting NICE's criteria for clinical significance in the overall population may well be that different drugs work for different subgroups of patients. Thus for an individual patient a particular drug might work very well (and achieve clinical significance for that patient), but another might not. In clinical practice, generally one drug after another would be tried until one (or a combination of drugs) that worked was empirically discovered or the patient and doctor decide to give up.

    •  um no they aren't (0+ / 0-)

      go back and read the study mister. it definitely asserts that the drugs studied work better in the several depressed as opposed to the moderately depressed and that's also what the lead author is telling the press.

      •  no contradiction (0+ / 0-)

        There is no contradiction between what you wrote here:

        drugs studied work better in the several depressed as opposed to the moderately depressed

        and what I wrote which was to rebut the claim that:

        if the drugs work at all, then it's for severely depressed patients

        In fact the drugs beat placebo in a statistically significant manner in the overall population. All the article claimed is that in the milder population the improvement didn't meet the NICE standard for clinical significance.

        And yes I did read the paper.

        Further, subgroup analyses across non-homogeneous populations and trials are always fraught with difficulty. You can often find spurious results - that's why in true randomized studies you have to pre-specify the analyses - you can't go back and prove anything definitively by analyzing subgroups. (That's what drug companies do in failed trials - "but it worked in older men!" - the FDA rightly ignores such post-hoc analyses).

        The problem with depression trials is the large placebo response and the overall variability of the condition (partly because some patients improve without treatment, partly because measurements of depression are inexact). So if you had a drug that outright cured 20% of patients you would be hard pressed to show significance over placebo in mild-to-moderate depression. But if you are one of the patients the drug cured, then you would think very differently about the statistics.

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