A new meta-analysis of research on modern antidepressants -- some of it unpublished by the drug companies -- suggests that the drugs have little advantage over placebos.
Why then do so many people consider drugs like Prozac to be miracle drugs for depression -- many putting up with serious sexual side effects in order to take them? Are they simply being duped by a placebo effect or avoiding withdrawal symptoms? And how could drugs which are little different from placebo also produce suicidal or even homicidal thoughts in some patients?
The answer reveals a key flaw of randomized clinical trials and meta-analyses: when you are looking at aggregated data, huge individual differences can be washed out. For example, let's imagine a drug that causes people with one genetic variation to have a profound positive effect -- but causes those with another to get dramatically worse and has little effect on everyone else.
A clinical trial could easily find that this drug has no advantage over placebo, depending on the proportion of people with each gene in the study. Another study of the same drug might find it to be a blockbuster -- while another found it dangerous. Same drug, different populations.
Indeed, researchers looking at antidepressants find exactly these results, according to researcher David Healy, whom I interviewed a while back for Reason. Healy is not known as a drug company booster -- his most recent book is titled Let Them Eat Prozac: The Unhealthy Relationship Between the Pharmaceutical Industry and Depression. It is widely believed he was not hired at one academic job because of his strong views on these medications.
But he continues to prescribe them because the right drug in the right person can be lifesaving.
Some people are strong responders to one drug -- but give them another in the same class, and they become actively suicidal. Most people have a slight positive effect; some have a slight negative effect. In aggregate, a drug that is a home run for one person and potentially fatal to another looks inert.
This doesn't mean that we don't need randomized clinical trials or meta-analyses: RCT's are the gold standard of evidence-based medicine with good reason. But it does mean that until we can better understand how genetic variation affects drug response, we will continue to have these boring debates about Prozac: Angel or Devil.
Especially in a context where the media often refuse to explain how ideological biases affect people's positions on these medications and conveys the story as a clash between two conflicting views of the world. Both sides are right -- but only about the response of particular people to particular drugs. This is why it can be true both that 80% of depressed people can find a medication that works and that clinical trials don't find these drugs much better than placebo when looking at the general population of depressed people.
Cross-posted from Scientific American's 60 Second Science
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Your life now has a purpose: trying to climb out of, and remain free of depression. Hey you! Back to work!
Another is that in the old days, opiates were prescribed for depression. In fact, for some they are the best anti-depressants, That is why some people wind up getting dependent on them, they finally feel not "high" but just normally good. I believe these are individuals who never had the right amount of neuroreceptors to ever really feel happy in life.
Having used both, I can say that any opiate provides a better effect than the modern anti-depressants.
With either substance, abrupt cessation will result in apathy and sadness. The modern anti-depressants are especially devious, as sudden cessation can cause a very profound depression. In some cases, the modern antidepressants like Venlafaxine are molecularly nearly identical to synthetic opiates such as Ultram, which has a horrifying withdrawal period. I was prescribed Ultram for arthritis and found that it was a very effective ant-depressant- I also found it took a long time to taper off using it.
Also, I agree that vigorous exercise is the way to defeat depression, but for those already flattened by the illness, they need something to get them up out of bed so they can start moving. Just remember that whether you choose opiates or a modern anti-depressant, you have to cut back your doses gradually until you are taking an 1/8 of a pill a day before you can quit.
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...
So lab tests are only to establish the "here's what it's supposed to do."
Medicine is an art not an assembly line. Journalism, on the other hand, is supposed to be an art but has turned into a business--whatever gets you published.
If we had many people reporting problems of depression, wouldn't we start by examining what is going on in their lives, and what is going on in society? Do we have more depression today than existed 100 years ago? Do the chemicals in our food create depression?
What about the lack of community that is now the norm in the U.S. I saw a great documentary on the 3rd ward in Texas (Houston?), a little neighborhood of tiny homes that have been taken over by a group of artists, renovated, made available for single moms, kids, artists, and a new vibrant community has sprung up. Did I mention this was mostly a black area? Child-care, child after-school courses, rent and home buying assistance, support for people to go to school, get skills. Community.
The average suburban neighborhood has no community. None. That's one of the reasons people flock to churches, because they don't know their neighbors, or their neighbors keep changing, and they basically have nothing in common. Their kids don't go to the same school, they don't even work in the same area.
Anti-depressants are big business. Just like hormones were for menopausal women, until it was disclosed that they caused cancer.
The idea that drugs can solve our problems or improve our lives is lucrative for the drug companies. And undoubtedly for people with serious depression, drug therapy might save lives.
If insurance and drug companies didn't run the whole system, I think we would prescribe diet changes, exercise, other activities, long-term counselling, possibly group counselling as well, before turning to drugs. We give drugs to our "problem" children, to our depressed adults, sleepless seniors. Are things getting better as a result? Or worse?
Are we all just manchurian candidates willing turning our brains over to industry? Is there any reason we should trust the drug companies? How many people have they killed? How many test results have they fudged or hidden?
Why should we trust this industry which pays so many bribes to our politicians? What protection are they paying for? Well, for one thing, they want Congress to make it impossible for anyone to sue a drug company if they take the drugs and die. Isn't that good enough reason to be very suspicious of these people?
I suffer from clinical depression and PTSD and currently am taking four drugs, one strictly for PTSD, to treat my illnesses.
I am not cured but I am also no longer chronically depressed, suicidal, hopeless, compulsive, negative, sleepless, angry or plagued with anxiety. I'd say my meds are working.
It's really important to figure this out. So that tests of how drugs work can take this into consideration.
For example: The ingredient in Benedryl and similar OTC sleeping or allergy aids happens to make me extremely hyper. It literally makes my heart race and totally guarantees that I will NOT sleep instead of vice versa.
(Plus, instead of stopping my sneezing it makes me sneeze!!)
Yet for my sister, genetically very close to me, 1/2 half a tablet of Benedryl is enough to knock her out for 8 hours.
Go figure!! I think the drug makers and drug testers need to start taking this sort of thing into consideration.
Of course there is a time and place for antidepressants, but many depressed people would improve remarkably by getting a half hour of moderate exercise in the sunshine every day and taking 1600 mg of EPA and 800 mg of DHA every day (check with your doctor for drug interactions, do not take high-dose fish oil like this if you are on blood-thinners, take a lot of OTC pain relievers, are scheduled for surgery, are allergic to seafood or have a defibrillator).
While anti-depressants may be overprescribed in patients exhibiting less-than-severe symptoms, many of us owe our productive lives to these medications. I am afraid that this meta-analysis, combined with a general ignorance of statistics, may lead to unnecessary suffering.
These drugs won't fix your life. You have to do that through your own actions.
These drugs are for people who would be bipolar, ranting, raving, screaming, sleepless, insomniac, lunatics without them.
If you are sad or lonely don't go down this road of heavy medication. Its not for you.
What I find especially troubling is how easily doctors will prescribe medications and for just about any reason you can come up with. You don't have to be depressed.
The best use I have seen for drugs is to get you over a temporary rough spot such as anxiety over and upcoming surgery or something similar and then quit the drug ASAP.
The other troubling thing I see with doctors is their "one size fits all" as far as dosage requirements go. Not all doctors think so narrowly but a fair amount will try to get you to take a certain dosage because it is the minimum effective dosage amount or some such nonsense. People are not one size fits all. What drug works for you might not be of any use to me and the same with the dosage. You have to learn your own body and what it can tolerate. Don't let the doctors bullshit you.