Do AntiDepressants Work?
A Sober Look at the Happy Pills
Your intrepid LiveReal Agents, asking the tough questions and seeking out the tough answers...
With so many people in our pill-crazed culture taking antidepressants...we just have to ask: Are they actually working?
Have we solved the problem of human suffering? Are we any happier? Is this the best solution we have?
So we went looking for answers,
and so far have found . . .
From How Not To Die by Michael Greger, M.D. with Gene Stone:
We’ve seen that saffron and exercise compare favorably to drugs in treating depression, but how much is that really saying? Thousands of published studies seem to have demonstrated that antidepressant drugs are effective. The key word here, though may be published. What if drug companies decided to publish only those studies that showed a positive effect but quietly shelved and concealed any studies showing the drugs didn’t work? To find out if this was the case, researchers applied to the Food and Drug Administration under the U.S. Freedom of Information Act (FOIA) to get access to the published and unpublished studies submitted by pharmaceutical companies. What they found was shocking.
According to the published literature, the results of nearly all antidepressant trials were positive. In contrast, FDA analysis of trial data - including the unpublished studies - demonstrated that roughly half of the trials showed the drugs didn’t work after all. When all the data - published and unpublished - were combined, antidepressants failed to show a clinically significant advantage over placebo sugar pills. This finding suggests that the placebo effect explains the apparent clinical effectiveness of antidepressants. In other words, improvements in mood may be the result of the patient’s belief in the power of the drug - not the drug itself.
Even worse, the ROIA documents revealed that the FDA knew that these drugs - such as Paxil and Prozac - didn’t work much better than placebo yet made an explicit decision to shield drug companies by keeping this information from the public and prescribing physicians. How could drug companies get away with this? The pharmaceutical industry is considered one of the most profitable and politically powerful industries in the United States, and mental illness is considered a golden goose: chronic, common, and often treated with multiple drugs. Indeed, antidepressants are currently prescribed to more than 8 percent of the population.
Just because antidepressant drugs may not work better than fake pills doesn’t mean they don’t work at all. Antidepressants offer substantial benefits to millions of people suffering from depression. And although the placebo effect is real and powerful, antidepressants do seem to beat out sugar pills in reducing symptoms in the most severely depressed - perhaps about 10 percent of patients (although admittedly, this statistic also means that about 90 percent of depressed patients may be prescribed medication with negligible benefit).
If doctors are willing to give patients placebo-equivalent treatments, some argue that it would be better for them to just lie to patients and give them actual sugar pills. unlike the drugs, sugar pills do not cause side effects. For example, antidepressants cause sexual dysfunction in up to three quarts of users. Other problems may include long-term weight gain and insomnia. And about one if five people have withdrawal symptoms when they try to quit.
Perhaps most tragically, antidepressants may make people more likely to become depressed in the future. Studies show that patients are more likely to become depressed again after treatment with antidepressants than after treatment by other means, including placebos. So even if the mood-boosting benefit of exercise is also a placebo effect, at least it’s one with benefits rather than risks.
This excerpt from
The Wall Street Journal, June 12th, 2002:
First there was Prozac. Then came Zoloft, Paxil, Effexor and Celexa. Now the FDA is poised to approve what could be the next blockbuster in the enormous antidepressant market . . .
The arrival of Lexapro, made by Forest Laboratories Inc., is expected as early as this month, and many patients and doctors are eagerly waiting. "Everyone's going to want to try it on some patient," says Philip Muskin, a Columbia University psychiatrist. He explains: "You keep hoping that the next one is going to solve all of the problems."
But both science and past experience suggest that many people are bound to be disappointed . . .
Though demand for antidepressants is huge and growing - they are now the second-most prescribed drugs after anti-infectives, such as antibiotics - the frustrating reality for many patients and physicians is that they either don't work very well or have intolerable side effects.
Few patients realize that half of the people who go on antidepressants stop taking them after three months. Add that to the fact that Lexapro is, in part, a marketing maneuver. It is nearly identical in its chemical make-up to Celexa, which Forest also makes. And Celexa works very similarly to the other top-selling antidepressants. But doctors and analysts expect demand for the new drug to be huge, partly because so many patients cycle through antidepressants . . .
Sibyl Shalo, 32 years old, ran through four different antidepressants between 1994 and 2000. They either didn't work well or lost their benefits over time. Now she's on Celexa, which improves her depression but also causes constipation, diarrhea and fatigue. "If this is the best I'm going to get, that's not such a good thing," says Ms. Shalo. So she's awaiting Lexapro. "Now there's something else for me to try," she says.
Even the most popular antidepressants on the market work on only about half of the people who try them. Though the medicines have been life saviors for some patients, as many as 30% of those who are clinically depressed aren't helped by any existing drug, according to Datamonitor PLC, a London market-analysis company. Moreover, all antidepressants can cause troubling side effects - for example, 37% of patients on antidepressants experience sexual dysfunction, according to a recent study by Anita Clayton, a University of Virginia psychiatry professor.
The National Institute of Mental Health estimates about 19 million Americans - 1 in 10 adults - suffer from depression at some point each year. About half of them, eight million people used antidepressants last year, according to Datamonitor. If you count those who used the drugs to treat anxiety, such as panic disorder, as many as 10 million Americans may have taken the medications in 2001."
John Williams, a Honda salesman living in Seattle, enrolled in a Lexapro Trial after finding he couldn't tolerate the loss of sexual appetite he suffered taking Paxil. On Lexapro, the sexual side effects almost entirely disappeared and he felt he could handle the others - ringing in his ears and a spacey feeling in the morning.
When the clinical trial ended in April, he had to go off Lexapro, but began taking the closest thing on the market, Celexa. "They seem to be identical," he says. But while the drugs diminish his depression and anxiety, his symptoms aren't gone.
And so Mr. Williams is already wondering what new treatment is coming. His doctor just told him about a trial for yet another antidepressant starting soon, and he says he's thinking about enrolling."
- excerpt from The Wall Street
"Approval Is Near On a New Drug for Depression," June 12th, 2002
...and this excerpt from WebMD:
The latest scientific study to weigh in on the subject finds that the antidepressants worked only marginally better than placebos in a group of studies submitted to the FDA. Study participants taking the dummy pills had approximately 80% of the response seen in patients taking one of the six most widely prescribed antidepressants.
Lead researcher Irving Kirsch, PhD, tells WebMD that in many of the studies, while the difference between drug and placebo was significant from a statistical standpoint, it did not represent a significant difference for patients. His study appears July 15 in the American Psychological Association's electronic publication, Prevention and Treatment.
"We are not saying that people don't respond to these medications," says Kirsch, who is a psychology professor at the University of Connecticut. "On the contrary, the response is very large, and that is why there has been this so-called revolution in the treatment of depression. The catch is that the response to placebo is almost as large" . . .
"People may be better off exploring other treatment options such as psychotherapy or exercise, which has been shown to reduce depression. And the side effect of physical exercise is better health. That is much better than the loss of sexual function, tremors, agitation, diarrhea, and nausea that are side effects of SSRIs."
Psychologist Roger P. Greenberg, PhD, says it is understandable that the SSRIs have become so popular in such a short time, despite the lack of data showing them to be effective. Both patients and their physicians, he adds, have adopted a "fast-mood mentality," where the quick fix is expected for the treatment of depression. Greenberg heads the psychology division at SUNY Upstate Medical University and has written two books on the limits of treating depression with drugs.
"The notion that depression is caused by a biochemical imbalance that is easily treated with drugs has taken hold in recent years because it provides this easy solution," he tells WebMD. "Biochemical imbalance is a handy catch phrase, but there is not a lot of evidence that there is such a thing."
- excerpts from "Are Antidepressants
They're Just Slightly More Effective
Than Dummy Pills,
by Salynn Boyles, WebMD
...and this excerpt from USAToday, January 22nd, 2004:
(LiveReal Editor's Summary of the Article:
Could antidepressants - those very things that have so often been hailed as the cure for depression . . . cause suicide?
"We don't know," experts say. "Maybe.")
Could antidepressants prescribed for more than 1 million U.S. children and teenagers cause some of them to attempt suicide?
The Food and Drug Administration's first public hearing on this question Feb. 2 is expected to draw polarized and emotional testimony. But the evidence needed for an answer won't be in for several months, says Russell Katz, director of the FDA's neuropharmacological division.
The FDA is re-examining 20 studies of eight antidepressants used in children. The studies didn't document a single drug-related suicide. But preliminary findings suggested that suicidal thoughts and attempts, though rare, were more common in kids taking the drugs than those on sugar pills. . .
. . . The FDA has asked drug companies for more information . . .
Is there something wrong with this scenario?
Is the best way to gather real "information"
really to ask the folks whose very livelhood depend on the answers?)
. . . in December, Britain's equivalent of the FDA advised giving none of the SSRIs to children except for Prozac, saying it's the only one whose benefits outweigh risks . . .
. . . There's relatively little controlled research on SSRIs in school-age children "and zippo on kids under 5," says John March, chief of child and adolescent psychiatry at Duke University Medical Center in Durham, N.C. . .
. . . "The lack of supporting data, considering their widespread use, is surprising and disturbing," says Lawrence Diller, a behavioral pediatrician in Walnut Creek, Calif., and author of Should I Medicate My Child? . . .
. . . However, prescribing patterns and medical economics work against the eagle-eye monitoring needed, some say. General practitioners and pediatricians, often not experts in the field, write the majority of SSRI prescriptions for kids. Also, HMOs may restrict access to busy specialists and pay for pills but not therapy . . . says David Fassler, a child psychiatrist in Burlington, VT . . .
. . . Mark Miller, 54, of Overland Park, Kan., believes antidepressants cost the life of his 13-year-old son, Matthew. He'll testify at the FDA hearing.
After a family move in 1996, Matthew had trouble adjusting at his new school. On the advice of school counselors, the Millers took him to a psychiatrist the next summer, though he seemed happier.
The doctor gave Mark antidepressants, and he began to act fidgety, Miller says. The morning after Mark took his seventh pill, Mark's mom found him hanging by a belt from a laundry hook in his closet.
"We have no family history of depression and didn't even have a package insert because he gave us samples," Miller says. An autopsy showed his son's body had SSRI levels suitable for a 250-pound body, though the boy weighed less than 100 pounds, he says.
But other parents will tell the FDA that SSRIs saved their kids' lives.
Sherri Walton, 45, of Paradise Valley, Ariz., says major depression runs in her family. Walton's daughters, Jordan, 14, and Katie, 12, started Prozac in the past 18 months after episodes of severe depression.
"They didn't even want to dance anymore, even though they're avid dancers; they didn't want to live, and now they're normal kids," Walton says. "I'm going to tell the FDA, 'Don't take away what gave my kids their lives back.' "
The agency expects to have enough evidence to answer the questions on suicide risk by summer, the FDA's Katz says. Another hearing is likely then, and at that time the FDA might issue a new recommendation on SSRIs and children.
Parents who want their kids off the antidepressants now should consult doctors on how to do it gradually because stopping abruptly can be harmful, he adds.
For undecided parents, new interim guidance might come Feb. 2, Katz says. "All we can say right now is, use with caution."
- excerpt from USA TODAY,
January 22nd, 2004
"Antidepressants and Suicide"
by Marilyn Elias
Appendix I: Does it all come down to "brain chemistry"?
It's very fashionable nowadays for modern psychologists to explain everything in terms of biology - every feeling, thought, impulse, perception - essentially everything you and I experience, says many psychologists - can eventually be reduced down to neurochemistry, synapses, hormones, and essentially, biology.
And there are many advantages to this approach. It's easy, it's blame-free, it let's almost everyone (except maybe God) off the hook, and when doctors start talking synapses and hormones and such, it's easy to sound intelligent and like you know what you're talking about.
But is it true?
Well, it does seem clear that there is a profound "connection," in a way, between what is normally called "mind" and "body." This is a huge topic, but we'll leave it there for now.
At the same time, this get totally, totally blown out of proportion nowadays.
This is further explored in our article on therapy - but to briefly summarize some points:
* In general, many folks who call themselves "psychologists" nowadays - apart from clinicians - are actually just biologists. They don't study the human "mind" or "soul," they study bodily fluids, body organs, chemistry, neuroanatomy and etc. Conrete, physical things, typically because they want to consider themselves and be considered by others as "scientific," aka credible in their circle of peers. But them calling themselves psychologists doesn't make them real psychologists.
* It's much easier to be a biologist (and study body fluids) than it is to be a true psychologist (and study human beings).
* To say that all human emotions, feelings, thoughts, disorders etc are "caused by" various brain chemicals is like saying that all car crashes are caused by gasoline; that symphonies are "caused by" brass (horns, trumpets, etc), that the plays of Shakespeare are "caused by" letters/black marks on white pieces of paper. Sure - in a warped, twisted, academic way it's "true," but it's definitely not the whole picture.
At the same time, it's an easy solution to a complex problem,
it's completely blame-free, and it lets psychologists who
talk this way sound intelligent . . . so really, we don't
expect this mindset to go away anytime soon.
Appendix II: Modern PsychoTheology
A LiveReal Agent Opinion:
When we once confronted the question "Why do we suffer?", theologians and ministers in old times used to talk about "man's fallen state." While this has generally become unfashionable to speak about (due in no small part to the science-religion debate - and a general in trend where science is generally gaining ground on religion) it has actually merely been replaced by a new, "scientific" version.
Meaning, instead of saying the "you were born into a fallen state," the experts (now doctors instead of priests or theologians) now say "you were born with "defective brain chemistry."
And instead of offering salvation through prayers, scripture, and sermons, they offer "salvation" through selling prescriptions and pills.
But they often fail to mention that, in addition to the possibility of "defective brain chemistry," there are many other possible reason why we suffer. And then, when certain problems come around that make us suffer, there are many other things to do to alleviate that suffering . . .
- if this is the case . . . then, what's a person to do?
Well, we believe the whole question of mental health is a bigger issue than is generally spoken about in polite society.
For example, there's the issue that our modern culture itself may be a little insane, and living in this culture can become a battle for your own mind . . .
Well, many folks suggest therapy, which brings up many other questions - primarily, Does Therapy Work?)
We strongly suggest a do-it-yourself approach (after all, you're really doing-it-yourself even if you do see and trust many doctors and experts) - an approach which does have its hazards as well . . . but then again, you have LiveReal, and our immensely valuable LiveReal Products as well . . .
And ultimately, the issue of mental clarity and emotional strength - the very "goals" of the LiveReal Psychology Arena, and especially our section on What's the Problem - but ultimately has what could be called a "spiritual" component.
But modern spirituality is a whole other furry animal - and one that we, your trusty LiveReal Agents delve into in the LiveReal Spiritual Arena.
So talk to us, keep posted, and stay tuned . . .
To be continued . . .