Do AntiDepressants Work?
A Sober Look at the Happy Pills
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Your trusty LiveReal Agents
asking the tough questions
and searching 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 . . .
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
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
. . . and this excerpt from
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.")
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,
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 biologists. They don't study the human "mind"
or "soul," they study bodily fluids and chemistry.
* 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
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
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
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 in . . .
To be continued . . .
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