Anti-depressants: Study Casts Doubts (But Even Pets Get Them Now)
Study casts doubt on anti-depressants
By Salamander Davoudi
Published: February 25 2008 19:25 | Last updated: February 25 2008 19:25
<script type="text/javascript" language="javascript"> function floatContent(){var paraNum = "3" paraNum = paraNum - 1;var tb = document.getElementById('floating-con');var nl = document.getElementById('floating-target');if(tb.getElementsByTagName("div").length> 0){if (nl.getElementsByTagName("p").length>= paraNum){nl.insertBefore(tb,nl.getElementsByTagNam e("p")[paraNum]);}else {if (nl.getElementsByTagName("p").length == 3){nl.insertBefore(tb,nl.getElementsByTagName("p")[2]);}else {nl.insertBefore(tb,nl.getElementsByTagName("p")[0]);}}}}</script>Prescribing anti-depressants to the vast majority of patients is futile, as the drugs have little or no impact at all, according to researchers.
Almost 50 clinical trials were reviewed by psychologists from the University of Hull who found that new-generation anti-depressants worked no better than a placebo – a dummy pill – for mildly depressed patients.
Even the trials that suggested some clinical benefit for the most severely depressed patients did not produce convincing evidence. Professor Irving Kirsch from the university’s pyschology department said: “The difference in improvement between patients taking placebos and patients taking anti-depressants is not very great.
“This means that depressed people can improve without chemical treatments. Given these results, there seems little reason to prescribe anti-depressant medication to any but the most severely depressed patients.”
The researchers focused on four widely prescribed anti-depressants and the clinical trials that were submitted to win licensing approval from the US Food and Drug Administration.
The drugs included fluoxetine (Prozac), venlafaxine (Efexor), and Paroxetine (Seroxat).
All belong to a family of drugs known as Selective Serotonin Reuptake Inhibitors (SSRIs). These drugs have become popular over the past 15 years as doctors consider them to be safer than tricyclic drugs that carried a high risk of overdose. In 2006, 31m prescriptions for anti-depressants were issued in England, up 27 per cent since 2001.
Alison Cobb, policy officer at mental health charity Mind, said: “This study represents a serious challenge to the predominance of pharmacological treatments for depression. Anti-depressants have been shown to help many people, but by no means all.”
“Too many GPs are being forced to dish out drugs because they don’t have proper access to psychological therapies services which are recommended by Nice.”
Mind is urging GPs to consider alternative therapies such as exercise – particularly outdoor exercise – which it believes has shown to be very effective in combating depression.
However, Dr Gary Bell, consultant psychiatrist at Capio Nightingale Hospitals, the provider of private psychiatry treatment, contested the conclusions of the Hull research. “Anti-depressants are one of the great breakthroughs in the treatment of depression in last 20 to 30 years,” he said.
“They do not always suit everybody but the results are often life-saving. People who do studies do not have the hands-on experience of using these medicines.”
According to the Royal College of Psychiatrists, at least one person in five will suffer from a depressive illness at some point.
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Edit: I thought I would add story about giving antidepressants to pets now:
"Suicidal pets get anti-depressants"
PETS at risk of self-harm are increasingly being prescribed anti-depressants because they cannot discuss problems in their lives with others, a leading veterinarian says.
Zoo and wildlife medicine specialist with the UK’s Royal College of Veterinary Surgeons, Romain Pizzi, told the Telegraph that more pets were being prescribed Prozac.
Last year, Eli Lilly released a beef flavored, chewable anti-depressant for dogs onto the US market.
Efexor made me worse, but I feel much better on mirtazapine, much calmer and can sleep.
So they must make some difference!
Of course psychotherapy is helping alongside.
The fact is, 3 years ago I was severely depressed, now I am still depressed, but mostly much more mildly, and the more severe episodes are shorter.
Venlafaxine is an SNRI, not an SSRI... kinda makes me wonder how much the person writing that story actually knows about antidepressants...
Yeah, antidepressants definitely aren't a miracle cure for depression. But they have preformed significantly better than placebo in clinical trials. They don't help everyone, and its unfortunate that they are prescribed so much as a stand-alone treatment, but they do help some portion of people beyond what would be expected from a purely placebo effect. It's a relatively small margin between placebo and antidepressants, but it is still statistically significant.
Psychotherapy has consistently been shown to be far better than antidepressants alone for treating depression. The mental healthy community knows that. Unfortunately, HMOs don't give a flying f***, and antidepressants are cheaper, so that's what most people end up with. But it's not exactly breaking news that antidepressants don't work for a lot of people.
And I think it's hilarious that they suggested exercise as an alternative to antidepressants, cause it definitely has less empirical support than antidepressants do. That's not to say I don't think that exercise is a really good thing, and I think it probably does help with depression, but it's a bit hypocritical to suggest something with even less empirical support as an alternative to something that supposedly doesn't have enough empirical support.
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Mm I heard this on the news this morning.
I do think GPs are very fast to presribe people with drugs such as anti-depressants here in England. A lot of the time when you go to the doctor I find they'll hear you, prescribe you something, and hope you don't come back. Without maybe even offering other options/potentially doing other tests which could help, because ultimately it is cheaper.
I guess on this study it's also possible that with the drugs, something psychological is included, for example someone 'making' themselves feel better because they believe that's what the anti-depressants should be doing.
On the whole anti-depressants have been known to help and work for some people so they can't be completely useless because in altering the levels of substances in the endocrine or the neurotransmitter systems, the depression may be helped.
At the end of the day however, a biological answer may not always be the 'cause' of depression for some people, accountinf for the times maybe when the drugs do not have an effect.
"Be nice. Think happy thoughts. Champion silver linings. Love all things (not just cute things like babies and kittens) & when you do love - love like they do in power ballads (you know like on a cliff with the wind in your hair and your eyes shut, knowing you'll never know love like this). Watch out for dog poo. Smile at people - even grumpy ones. Remember anything is possible & whatever you do always try to look on the bright side."
I think it's good that the working of anti depressants gets questioned more, that doesn't mean they're completely useless they're just overprescribed...
I agree with everything mentioned by "Hikiko" above.
I have been in a simillar situation from a young age aswell and the therapies never seemed to help, saying that, when I was on Flouxetine it seemed to have little effect but the time i forgot to take it for a few days it was apparently obvious I hadn't been taking them as I was more volitile.
*shrugs* at the end of the day they dont all work for everyone which is why alot of the time paitents are tried on several before they find something that works for them.
Also, how long was this test done for? 'Cause surely it would need a good 6month span to get results worth having, I know that several anti-depressants take a month if not more just to start working.
The authors of this report didn't do any clinical trials themselves. What they did was an over-all review (they call it a meta-analysis) of the already existing clinical trials that were submitted to the US Food and Drug Administration (FDA) for the licensing of 4th generation antidepressants.
Included tials were of varying durations: "4-, 5-, 6-, or 8-wk trials. Thirty-three trials were of 6-wk duration, six trials were 4 wk, two were 5 wk, and six were 8 wk... Thirty-nine trials focused on outpatients: three included both inpatients and outpatients, three were conducted among the elderly (including one of the trials with both inpatients and outpatients), and two were among patients hospitalized for severe depression. No trial was reported for the treatment of children or adolescents."
The main piece of the article is about how anti-depressants don't work effectively on mild depression... but this is not new - anti-depressants aren't meant to be prescribed for mild depression
hmmm this isn't as concerning as the headlines make out, eh?
Maybe A.D's are over prescribed... but - you go to the doc they have to do something, otherwise what are they meant to do? Tell you they understand and that you'll see a counsellor in a year? You can only work with the resources you have
the way the papers have blown it up they make it sound as if its the anti-depressants don't work. Well i can say for certain that's total bullshit. Depression is very hard to diagnose , of course there may be some people on them who don't actually need them.
maybe people are taking placebo's but that doesn't matter because they feel better on them than they were off. because depression can make you feel everything is hopeless and the pill gave give you that hope, which in turn will lift your mood.
as long as it works, why the heck does anyone care?
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Letting it get to you - You know what that's called? Being alive. Best thing there is. Being alive right now that's all that counts. ~ Doctor Who "The Doctors Wife" 06.November.2011
To touch on what englishwitch said, I guess as long as someone improves, even if it is by self belief, is good. That's an up side, but, I can't say the idea of swallowing these chemicals is touching to me when I could be swallowing sugar-pills just as easily.
But how does one then explain the behaviour of someone who has come off their medication and had a very-serious mood dip? would that then be psychosomatic?
It's probably worth saying that, while people begin antidepressants have gone through a huge stage to get there, support has increased professionally and usually in relationships too. Antidepressants are never really prescribed alone, it usually also involves therapy and behavioural changes.
But how does one then explain the behaviour of someone who has come off their medication and had a very-serious mood dip? would that then be psychosomatic?
People who come off smoking also have mood dips and even rages (people giving up SI can report this too). People can use things to dull and suppress their negative emotions - just to have them resurface latter when the tranquilising mechanism is removed) .
Antidepressants often dull peoples faculties and keep them from experiencing their feelings. People on Paxil often complain about feeling "unreal" - its like a chemical lobotomy.
In my business I can often tell when a client is on meds ( I call it Prozac Charm) because within 5 minutes of meeting them they are telling me intimate details about their life that have no relevance to my purpose meeting them. We can be discussing the cost of a project and the client will start talking about their personal banking affairs and then jump right into their sex life with their spouse. Its like they have no inhibitions or sense of the reality of the moment. However if I mention that "it might rain" that day the client can flinch and squeak "oh dont be negative". Many of them just cant even handle incidental negativity so easily do they over-react to it.
Keep in mind the "chemical imbalance" as a cause of depression has never been proven (just lots of "may cause" phrases in studies) - which is why people given meds are never tested for any imbalance - never.
If you look at some of the questions studies can use to substantiate a benefit to meds (better mood, more sex) the same questions could get positive answers to people drinking beers each day to feel better (which describes half the people on my MSN lately).
In severe cases some people need dulling down and meds can smooth them out awhile. Giving meds out like candies to younger and younger kids (and now pets) who will get no supervision is selfish. Eli Lilly was caught hiding documents that showed an increase in suicidal thinking and when people dropped out of studies due to ill effects such people were not even counted in final results. The closer one looks into meds the worse it all looks imo.
Anti-depressants are certainly over-presrcibed! So many other therapies are being over looked; counselling, art/animal therapy and even for severe conditions, vitamin therapy (proven to aid schizophrenia and eve anorexia). Even worse, i think, is these medications being prescribed to under 18s, other avenues aren't being explored and i think that's criminal. Along with, more recently, the seeming increase in teenagers no longer just being "moody", there has to be a diagnosis and part of this does stem from parenting; kids just aren't prepared for what's out there and it's taking away from the people who really are suffering mentally.
I've not lost my feelings on medication. It's my experience, that, along with psychotherapy and in depth reflection, that medication helps me cope with my intense feelings more safely.
Saying that, when I was a depressed and anxious teenager, a bit of human support and understanding was much more needed than medication. It's when all that was unaddressed and I had several breakdowns in my 20s, that I really started getting to that edge where medication was also necessary.
However because the way things were for me, I didn't get therapy, and then medication alongside, until I was in my early 30s.
our lecturer had a rant on this last week. apparently a good load of meds actually work like a placebo, and only realy work when people have proper clinical depression - rather than when a doctor just prescribes them so he doesnt have to spend time or help.
he actually told us that for all those studies that show how great meds are, theres a ton that show they might no/dont work - just things without a significant finding of working dotn get published.
i dunno how much a agre with it, simply because ive never used meds myself, but surely this being such big news will make people stop using them without telling their doctor and that pretty harmful - even if its just a placebo effect it still works for that person so whats the harm? tho i dont agree with the number of people getting them for things that arent really requiring them - esp with kids and stuff.
It's interesting how this is continuing to be portrayed in the news as "anti-depressants don't work"
The study, which is not exhaustive, only mentions SSRI medication, not tricyclics, MAOIs or atypical antidepressants, are we to assume that they DO work....?
I thought the arguement, although portrayed as "antidepressensts dont work" was actually "anti depressents have little effect on mild to moderate depression but are most effective on severe depression" :s or am i confusing that with somehting else
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The fact they don't work isn't anything new!! Its a cheap and easy way for governments to deal with those they see as 'abnormal'. All anti anxiety drugs do is give the patient the psychological support that they need. Masking the symptoms at most!! This then leads the person taking them to become dependant. The only solution is to get to the root of the problem, via biofeedback or hardiness training. Thus, why do government even endorse them when they also have many side effects. Therefore, they're not a viable option -Just the cheapest and easiest. How fast can you sign?! Now isn't that quicker than waiting lists and higher demand upon the NHS!!?
I've been doubting the effect of them myself since I began using fluoxotine. there's no doubt they have some effect on me but they aren't a magic pill that will solve everything. i think they sort of balance things out for me. But i really think you get better if your life does too.
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