The Truth About Antidepressants?

Dashing by Google News before bed, I noticed that the usually careful Washington Post had ran a headline saying, "Only Severely Depressed Benefit From Antidepressants: Study", which I, can only imagine, will lead hundreds, if not thousands of people to get off their anti-depressants -- and probably for the wrong reasons. Time Magazine, meanwhile, has reported that "Antidepressants hardly help."

Both stories report on a study that was just published in the well-respected journal PLoS Medicine. But neither shows anything like what the headlines suggest.

Which -- and this is the part that gets me -- would be obvious not only to anyone who read the original study (which is available online for free), but also to anyone who even bothered to carefully read the news stories.

Does the Washington Post article actually show that only the severely depressed benefit from antidepressants? Noooo.

Does the Time Magazine article actually show that antidepressants hardly help? Noooo.

Does the PLos Medicine study show either of these things? Noooo.

Let's consider first The Washington Post's headline -- "only the severely depressed benefit from antidepressants". Um, hello? Does the study really show that? Four paragraphs into the Time study, we find the truth (from a reporter who was far more careful than the person who crafted her headline), "The researchers behind this new paper did find that SSRI drugs [like Prozac and Zoloft - GFM] have a statistically significant impact for most groups of patients."

That's right, most groups of patients.

The effect is, to be sure small, for many people scarcely more than a placebo. But most people were in fact helped, at least a little. As a much more thoughtful blog on the Wall Street Journal put it, "for many patients, placebos work pretty well indeed."

The Time headline -- "antidepressants hardly help" -- is even more misleading than the Post's. It might be argued that antidepressants are only of mild help for people who are only mildly depressed (with less room for improvement). But the current study, because of its sheer scope. provides some of the strongest evidence to date that on average (individual mileage may vary), antidepressants are a great deal of help to those most severaly depressed --- and somewhere in between for those with intermediate levels of depression. All of which is pretty clear if you pause for a minute and look at this graph of the results.

The real story here is not that the antidepressants are ineffective, but that the magnitude of their effect is (roughly) proportional to the magnitude of the depression; if you're happy, there's no point in taking them, but the more depressed someone is, the more the medications may help. Isn't that true of most medicines?

The lesson here?

When it comes to mental health, never, ever trust what you read in the headlines. If your health (or the health of someone you love) is at stake, take the time to read what's behind the headlines.

Gary Marcus is a Professor of Psychology at New York University, and author of the forthcoming book Kluge: The Haphazard Construction of the Human Mind

Comments

[rimpoce]

Same kind of distortion in the same infos as reported in Italian media. Are media becoming syn. of dis-information or what? Finally Marcus is right: when your health is at stake, read behind ie see a good doctor before renouncing to take medicaments just because a newspaper says 'ain't useful'.

[Counselor]

Mr. Marcus--Please explain why it is logical that a drug would significantly help patients with severe depression but be of little value to patients with mild depression. I don't see the logic. If a drug is strong enough to reduce serious depression why wouldn't it completely cure mild depression in the same dosage?

[Guitarsandmore]

Your doctor may not tell you this but if your medication is in a capsule it can be much more effective if you take it out of the capsule and put it into some water and stir it up then drink it. gel capsules are difficult if not impossible to digest and different manufactures use different capsules.

There can be a huge difference in the strength and quality of the drug itself between manufacturers. So if you are taking one particular brand/manufacturer try to stick to it if you can.

The one I am thinking about is Temazepam, which is usually prescribed for sleep when you are in pain or anxious. Take it out of the capsule and stick to the same manufacture.

[OneWoman]

I used to sell central nervous system drugs. What some people fail to realize is that it is not the drug that "cures" depression, it's your body's response to it (i.e. down or up-regulation of receptor sites on the neurons). This is why there is such variability in outcome from person to person. I recall reading research that found 30 minutes of aerobic exercise 3X a week to be just as efficacious as Prozac for moderately to severely depressed patients. That took the wind right out of my sails (sales, LOL).

I question our reliance on psychotropic medications. Oftentimes, pills are used as the first line of defense and little or no thought is given to making changes in one's life and/or thinking patterns. Consider this: Every emotion has its own unique chemical signature. Each time you feel sad, it is because the chemicals for "sad" have been released throughout your body. If you think sad thoughts, you end up feeling sad; so if you change your thoughts, you stand a good chance of changing your feelings. (This is the basic premise of cognitive behavioral therapy.)

Research tells us that individuals diagnosed with depression tend to have negative thinking patterns (one can argue the chicken/egg thing here I suppose). Perhaps one of the reasons why antidepressants do not consistently work is due to the following process: A person frequently thinks depressing thoughts and s/he frequently feels depressed. This means s/he has an increased number of receptors on his/her neurons in order to process the "depressed" chemicals and feel depressed. Now, s/he takes an antidepressant, which blocks those depression chemicals from reaching the receptor sites; those sites, in turn, down-regulate, or close up shop because they are no longer needed. HOWEVER, the person continues to think depressing thoughts because it is a HABIT, so more "depression" chemicals are released, which leads to more receptor sites being needed... This could be why antidepressants seem to lose their effect over time. Something to consider...

[Boobaloo]

Here are more disturbing facts about anti-depressants: most Americans who take them have low grade depression and most Americans are given false diagnosis of Clinical Depression which is a serious mental disorder that completely incapicitates a person.

There is no happy pill and if you have a chronic low grade depression b/c you hate your husband and your kids are driving you crazy and your 50 pounds over weight, anti-depressants are not going to help you.

Also ... now, this is going to blow the top off of your head but .... being depressed is not the end of the world. Sometimes being human comes with having ichy feelings.

Other than real Clinically Depressed patients, Americans need to stop pill popping, stop looking for the magic quick fix and grow up and mature and realize that life sucks sometimes and you can't always feel good.

[MsLiz]

"this is going to blow the top off of your head"

This is the absolutely worst choice of words I have seen this century in a comment about depression. In the case of suicide, being depressed is "the end of the world."

Readers, if someone in your family is depressed, take them to the doctor and get them into affordable counseling. Take them out for a walk everyday. Under no circumstances tell them "stop looking for the magic quick fix and grow up and mature and realize that life sucks sometimes and you can't always feel good."

[freeheeler]

An addendum: the rate of suicide for people with bipolar disorder and schizophrenia is 15 to 20 times that of the general population, yes, 15 to twenty times! Our medications do often have side effects. As these side effects are often unpleasant, many folks look for any excuse they can find to stop there meds. Lithium, Lamictal and many of the drugs that we bipolars take have been shown to work. That was not stressed enough. People will die because of this article.

[FDRbyGodDemocrat]

So we can conclude one or more of the following is true:

Headline writers don't read the stories.
Scientologists have infiltrated the journalism community.
Journalism training just plain sucks.

[freeheeler]

As a highly functional person (two masters degrees) with a severe mental illness (bipolar disorder), I have to say that this is a dangerous article.

According to research cited by the Bipolar Foundation, between 17 and 19% of us commit suicide. Between 25 and 50% of us attempt suicide during the course of our lives. The physical pain that I've experienced, the broken bones, etc., is nothing compared to the pain of depression.

Lithium has been shown to lessen the risk of suicide in folks with BP. My meds, along with exercise, diet, etc., allow me to be a productive member of society. My meds keep me alive!

[Boobaloo]

I question your usage of the term 'severe'; it's not possible for you to be highly functionally AND severly mentally ill. That is not possible psychiatrically, even perfect dosage of meds will never take a 'severly mentally ill' person into the realm of 'highly functional'.

Not possible.

[rixhex56]

This might depend on your definition of "highly functional". These are vague terms being used.

[ibivi]

I am particularly troubled when I see headlines like this. Antidepressants work for many people who seriously need them. I think it may be that antidepressants are being prescribed to those who don't really need them and as a result there is minimal effect. Medication is only one aspect of overall treatment. MSM need to be more responsible when they report on these studies.

[UkieOlie]

Thanks for a more even-handed approach to this story.
I hope no one throws out their medication.
I hope no one puts all their trust in drugs.
We need national healthcare. Mental illnesses have been particularly ignored.

[SamThornton]

Several years ago I was diagnosed with severe clinical depression, the result of a congenital physical condition involving neuroreceptors in the brain, and prescribed anti-depressants.

Unfortunately, the anti-depressants made me feel spaced out all the time, I became extremely aggressive, and began confronting nearly everyone I met. Flushed the stuff.

Shortly thereafter, I read an article that claimed there were natural substances in potatoes that seemed to help people with my condition. Damned if it didn't work. An occasional baked potato with sour cream changed my life.

[lillianjane]

What was the condition? I am interested in reading more about this. Potatoes (and whiskey)are part of my heritage.

[Mori]

HAD RAN?

[resonate]

I took antidepressants and felt dependant on something that gave me horrible side affects. I began to bruise easily, have vivid realistic dreams, slept for the first week of taking them, and no sex drive. I stopped taking them and had instant withdrawals and long term withdrawal affects years later. It wasn't a good experience for me and I advocate against them for the most part now.

[innerealm]

I started taking antidepressants when my doctor suggested them to help me lose weight. That was more than 10 years ago and every time I have tried to stop them....and it takes some skill and time to stop them...I have started taking them again because of the horrible side effects of stopping.
However, my husband, who suffers from depression, has been helped tremendously.

[SILVANUS]

We're overmedicated, and my personal experience with antidepressants was scary, and the pills almost sent a relative to the madhouse when a doctor prescibed her Paxil, and then tried to blame it on HER(!). And a neighbor on Lexpro stalked me for two years, 'played' my compassion for her madness until I almost lost my mind and had to sell my home to get away from her.

These frigging academic whitecoats peddling pills for everything are the mad ones. Don't lend them anymore power than you would a tent preacher or a politician.

ADP's are just another form of speed that boomerangs and makes a lot of folks even crazier and more delusionary by the third day..or later. No thanks: I will handle my grief with art, tears, whatever is naturally at hand. These pills are still a dangerously inexact boom-boom-­school-cal­amity-give­-him-Rital­in-honey-o­h-he-has-a­n AK47!-oh!-­she-sudden­ly-drove-i­nto-my-hou­se-IN-her-­SUV-scienc­e.

[Idytme]

What gets me is that this is hardly news. People - who are scientists and not scientologists - have been reporting in off journals the sad statistics already available for anti depressants. Studies already showed that their efficacy was barely better than a placebo - the problem has always been what had been cut and shaved and manipulated in studies to get to the statistics presented.
Someone had to go out and do a whole new study to prove what many researchers already knew from the existing studies.
Now though, we are sure the results are "clean" and not bantered about with wacky statistical modeling.
A problem though with people now trying to get off their medications, some may find that they have become addicted to them, and they cannot get off them or are going to have to slowly reduce their dosage. Maybe the news will be responsible in reporting this aspect of it next.