Antidepressants don’t work

From the earth-shattering news that got no “play” file: “Antidepressants Hardly Help,” says Time Magazine.

Researchers published their finding (in the journal PLoS Medicine), claiming patients “at the upper end of the very severely depressed category” experience benefit from drugs like Paxil, Efexor, and Prozac. For everyone else: not so much.

It was big news in Europe and elsewhere, but this topic is still a hard one to discuss — publicly — in the U.S., where mental illness rates a high reading on the “taboo scale.” It rated not a mention on the NPR “health” section.

But that doesn’t mean Americans aren’t heavily into antidepressants. A study in 2004 found one in every three visits to a doctor by women was for an antidepressant prescription.

  • Jacquie Fuller

    What? They don’t work? You mean all this time I’ve actually been happy? This is really depressing news.

  • http://bleeet.blogspot.com Brendon Etter

    Well, I guess we could always blame those with depression… tell them they’re no good and not trying hard enough. They’re easy enough to pick on.

    “The medicine doesn’t work because you’re a failure.” Should be any easy sell in that target market.

    Kidding aside: I’d like to see more data on this, but it doesn’t really surprise me.

    I’ve often wondered exactly how many drugs “work” primarily because we want them to work.

    The mind is a powerful ally or enemy.

    Thanks for covering this, Bob. It is important to so many of us.

  • Bob Collins

    As far as I know, treatment of depression also includes diet and exercise. So I wonder if we tend to ignore that aspect of it and just settle on one component of the treatment.

    It’s clear that the neurons requires chemicals and an electrical pathway for the mysterious parts of the brain to communicate with each other and we know that not all bodies are perfect in some way.

    So I wonder if there’s real danger here of falling back into the consideration of a neurological situation as being one of “just think happy thoughts.”

    Or as some might suggest, “just suck it up,” something we’d never tell, say, a cancer patient.

  • c

    I think that the right anti depressant will keep your head from seeking the noose or jumping off the Smith Street bridge but I don’t think that it was ever intended to bring a sense of euphoria or bliss.

    I think that they were intended to make up any chemical imbalances and not necessarily to seek out and activate your happy place within your brain.

    so what do you mean by not working? Not making an individual foot -loose -and -fancy- free, skip- to- my- lou, whistling- dixie on a daily basis?

    We live in a toxic world on the mend.

    I think that the anti depressants do their job. It is up to the individual to seek inner happiness. Whether it be through therapy, art, exercise, healthy diet, good relationships and meditation (or prayer whichever you are comfortable with)

  • Michael Wells
  • Bob Collins

    Cutting and pasting from CTV

    The researchers found that compared with placebo, the medications did not yield clinically significant improvements in depression in patients who initially had moderate or even very severe depression.

    They found significant benefits only in the most severely depressed patients. But they say that these patients did not necessarily respond better to the drug; they simply did not respond as well to placebo as the less depressed patients.

    “Although patients get better when they take antidepressants, they also get better when they take a placebo, and the difference in improvement is not very great,” Kirsch said in a statement.

    Another way of looking at — because you know I’m a half-full kind of guy is that “antidepressants work. And so do sugar pills.”

  • Bob Collins

    //In regards to things you can do besides the pharmaceutical route, don’t discount a good night’s sleep.

    Excellent point. In many cases anti-depressenats are combined with anti-anxiety medication with the goal being to allow the person to sleep, and the brain to heal.

  • V

    Yes, this was the top story on the BBC Word Service headlines when I was driving home at 1 a.m. Tuesday morning. The story also noted that information came from Freedom of Information Act requests for studies that the drug companies “declined” to published.

  • Mark S. Jungmann

    I think that depression is complex. There is a biological component to depression and as someone who has been helped by taking medication, medication should not be the only form of treatment. I was very averse about trying medication, but I coordinated care between my doctor and my therapist and then worked my tail off to build tools to deal with it. I can happily say at this point not only am I medication free, I have every confidence that I will continue to be so. Medication when used as a tool rather than the sole crutch is the way to approach this disease.

  • Minn whaler

    “Drug companies claim the review is still flawed, however. One massive problem: there are many more recent studies than those surveyed in the article, which looked only at pre-approval trials conducted before 1999.”

    Here we are 9 years later, psychotrophic meds have improved significantly and So little is known about the brain (the organ that keeps the rest of our organs operating), that studies even in the ’90′s were written to prove mind over matter.

    those who were found to be “significantly depressed” benefitted. As in any new research, discovery, etc. comes cynicism about possible treatments. since the ’90′s we have also found that therapy is an integral part of recovery… or perhaps managing the illness.

    Research like this perseverates the stigma that so many consumers of mental health services fight everyday. “All you have to do is but your pants on and deal with it.” Go ahead say that to someone with thyroid disease, diabetes, Parkinsons, etc.

    the problem with research is it takes too long to have studies published and by then we have entered an entirely new age of scientific discovery.

    and if SSRI’s do nothing for those with serious depression..

    why do they nearly immediately send someone with manic depression (i.e. bipolar) into psychotic rages, etc. ????

    Perhaps in 1999, too many people were being diagnosed with clinical depression, therefore no positive results???

  • Mary Pat Forkin MD

    For the doubters that believe this story I would invite you to participate in a real life study. Sit on a stool across from a real live patient and tell them that their antidepressant isn’t what has changed their life. I have had patients volunteer to be spokespeople for the medications that have improved them to a level of normal function. Always beware of an all or none result of a study. In medicine you never say “never” and never say “always”.

  • Ari Koinuma

    I know doctors and psychiatrists and even perhaps pharmaceutical companies mean well, but in my experience the medication route to treat mental health issues has the danger of being a crutch. It’s sort of the “treat the symptom, not the cause” kind of thing.

    I personally know of both cases — one that medication made it worth (regardless of trying many different kinds and doses) and one that really helps a person stabilize his/her swings. But in both cases, drugs were suggested as the first “go-to” treatment, instead of traditional or alternative forms of therapy.

    I don’t think that that many people are born with chemical imbalance in their brains that prohibit them from being balanced and/or being capable of experiencing joy. It is caused by what happens during one’s life time. And if that is the case, then therapy should be explored FIRST to get to the source of the problem, not just simply suppress the symptoms.

    Perhaps the drugs are being less effective because it us overused. I know that’s what the pharmaceuticals want, and it’s more efficient and profitable way to treat.

    But it’s really not the cure for many people. It’s simply a painkiller that one has to keep taking in order to function.

  • Bob Collins

    Ari:

    Curious why you think the most complex and misunderstood organ in the human body can’t get sick just because? I mean, people get leukemia and cancer and Alzheimer’s because that’s what happens to bodies.

    I’m not saying therapy is NOT part of an answer but one of the reasons for the stigma of mental illness is there’s some fault of the person that’s ill involved.

    You’re saying it’s not a neurological disease? Ever? Is that something you just feel, or something you conclude as a result of some research or reading?

    Keep in mind in this study, by the way, there were a limited number of actual drugs that actually were part of the research.

    In treating people with mental illness, the first step, it seems to me, is to stabilize the individual. If a person is having a heart attack, the EMT doesn’t talk to him/her about how to reduce stress in their lives, right?

  • c

    some people who have been abusing drugs and alcohol, using them as a coping mechanism for a good portion of their life and decide to go sober, many times will find out that the root was depression. this is where therapy is helpful in seeking out where the source of pain came from. and maybe this is the case that ari is giving us. and maybe this person will need meds in addition to therapy. in other incidences the patient might be hugely suicidal and will need meds right away. some people will go on meds, feel better after some time maybe even a couple years and experiement by going off of them (who wants to take a pill fro the rest of their life) only to find themselves after a period of time back in the same hole they started in. bob, like the doc said there is no ALWAYS or NEVER just individual cases.

    The morning bible show lady on the TV next to me and the PC just said, “what have you done to make someone else’s life easier, lately” I am not pointing any fingers this applies to me as well.

  • Ari Koinuma

    Bob,

    >In treating people with mental illness, the first step, it seems to me, is to stabilize the individual. If a person is having a heart attack, the EMT doesn’t talk to him/her about how to reduce stress in their lives, right?

    That’s true if antidepressants worked like Tylenol, but they really don’t. Antidepressants are powerful medicine that has to be taken over a long period of time (often takes weeks before any effects surface) and have to be eased into from smaller dosage and eased out by reducing amount little by little over a period, before quitting.

    It really creates a chemical dependency in a person’s life.

    My position is that it’s sometimes effective and is necessary to treat neurological disorders (which I never said that it doesn’t exist). But it’s really not appropriate for treating depression stemming from life events and conditions, which can still display disorder-like symptoms. At best, it covers up symptoms and makes true cure harder to reach. Otherwise, it doesn’t work at all.

    It’s not necessarily mental health practioners’ fault, I’m sure. People want easy cure. Going to therapy to sort things out in your mind is hard work, to say the least. But it can cure and cure permanently, without chemical dependency, even the most severe depression, if it was caused by life events and conditions, not a brain disorder.

    That’s been my experience (well, not my own, but of people I know well) and this study happens to support my theory.

  • minn whaler

    Dr. Ari? I understand your cynicism or perhaps a kinder description would be the theory that helps you accept or not accept certain practices in the treatment of mental illness. However I have to ask a couple things here…

    You stated in your first post:

    ‘I don’t think that that many people are born with chemical imbalance in their brains that prohibit them from being balanced and/or being capable of experiencing joy. ‘

    What has led you to that conclusion? People are born with FAS, Down Syndrome, etc. and also the genetic propensity to develop illnesses further on down the line. Take for instance the breast cancer dilemma.. One gene has been found to increase the risk of developing breast cancer sometime in one’s lifetime regardless of life experience to the point that women are actually taking the extraordinary step of complete double mastectomies in order to not worry about it.

    In your second post you remarked:

    ‘That’s been my experience (well, not my own, but of people I know well) and this study happens to support my theory. ‘

    Not sure what you have read, follow or what your “experience” that isn’t directly yours but that of people you know.” I absolutely agree that sometimes life’s situations cause a mental illness diagnosis that can be treated by therapy. But more often those “life situations” or “environments”" or “experiences” trigger the genetic propensity to develop a serious mental illness.

    Situational anxiety, depression, etc. are not necessarily aided by any medication. Therapy, and lifestyle changes can often be the key. However if there is a genetic history of mental illness, these triggers set in motion an irreversible change that not only requires therapy (when able to participate), but medication. Just like diabetes can require insulin, diet change and exercise.

    Since you are postulating only on “others’ experiences” perhaps you should visit with some psychiatrists, neurologists, and consumers with serious mental illness, who are contributing members of society, working, taking meds, exercising and following all of their physician’s recommendations, before zeroing in on one study about meds… especially one without any other information about the participants, etc.

    BTW, Placebos and Anti-depressants are both quite worthwhile in the first couple weeks, because when given a prescription… a consumer finally feels validation and relief. Since anti-depressants take many weeks to measure significant improvement, that initial data doesn’t surprise me.

    Someday you will have symptoms that no one can explain. You will go here, go there, up, down, etc. and basically feel written off by physicians and then a doctor.. some specialist.. will say.. “my goodness, you have all the signs of blankety blank,” run the appropriate tests, and bingo your malady has a name. You will feel better immediately (it won’t last) but finally someone heard you.

    namaste

  • c

    Well put Minn.

    But what is with the “Mental Illness” bit? Calling “depression”, MENTAL ILLNESS makes it sound like the person’s running around with an axe while singing London Bridge is Falling Down. This just doesn’t happen to the typically depressed. And what is wrong with admitting that you have to take anti-depressants? The only guy who came square out in the open and admitted to ever taking them was that Jung dude and he said that “he took them for awhile and will NEVER have to go back on them” (hah, we’ll see about that! especially with the job that you have)

    Really, I will admit, I lack in Seritonin….it could be worse.

    Some people have no sense of humor.

  • Bob Collins

    “Mental illness” and “insane” are not the same thing.

    Perhaps one of the reasons people fear the stigma is because if they were open enough to say ‘I have a mental illness,” people will treat them as if they are axe murderers.

    Who stops the stigma?

  • Lily

    Equating mental illness to running around with an axe is like equating fheart disease to Tarzan

    Depression is the common cold of mental illness, but it is a brain disorder, commonly called a mental illness.

    Folks, we’re are missing a huge factor here and that is money. It is cheaper to give people antidepressants than it is to start with talk therapy and then move on to meds (anti-depressants or other meds). The best outcomes for patients include both. For folks with major mental illnesses this includes a competent, comassionate provider who works with the patient over a long period of time. Some of the best psychiatrists I know will see patients, even when they are refusing meds. As they get to know them, trust may build and they will accept meds.

    We need humanity and meds. The efficacy of meds is greatly affected by the relationship between doctor and patient (ie, better professional relationship equals better outcome).

    One last thing……… if antidepressants don’t work, why did they make my bipolar child acutely manic???

    Lily

  • http://novusdetox.com steve hayes

    All of us have different DNA and different metabolisms. Some herbs and vitamins work better than others. The first thing that is needed is proper nutrition and a good physical exam. As the director of Novus Medical Detox, I often see patients who are on alcohol or opioids, central nervous system depressants, also taking antidepressants. When they detox they find they don’t need the antidepressants.

    This is good news because a Swedish study showed that 52% of the 2006 suicides by women on antidepressants. Since antidepressants work no better than placebos and are less effective than exercise in dealing with depression.

    There is a prescription drug epidemic and these are leaders in the list of terribe abuses.

    Steve Hayes

    http://novusdetox.com

  • Brian

    Hey Lily:

    If a drug makes your child manic and that constutes “proof” of its efficacy, then I think you need to be taking anti-psychotics!

    (Collins: Folks, what do you say we engage in debate on a more intellectual level? There are plenty of other blogs to go to if you want to hurl insults.)