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Are Antidepressants Just Placebos with Side Effects?

The views expressed are those of the author and are not necessarily those of Scientific American.


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foil pack of ProzacI have first-hand experience of the devastation of depression, in myself and those close to me. Although I have been tempted to try antidepressants, I’ve never done so. Of course, like everyone reading this column, I know many people who have been treated with antidepressants—not surprisingly, because according to a 2005 survey, one in 10 Americans are now under such treatment. Some people I know have greatly benefited from their treatment. Others never find adequate relief, or they experience annoying side effects—such as mania, insomnia, emotional flatness or loss of libido—so they keep trying different drugs, often in combination with psychotherapy. One chronically depressed friend has tried, unsuccessfully, to stop taking his medications, but he experienced a surge of depression worse than the one that led him to seek treatment. He accepts that he will probably need to take antidepressants for the rest of his life.

We all, to greater or lesser degrees, have this kind of personal perspective on antidepressants. But what does research on these drugs tell us about their efficacy? The long-smoldering debate over this question has flared up again recently, with two medical heavyweights staking out opposite positions. In a New York Times essay, "In Defense of Antidepressants," Peter Kramer, a professor of psychiatry at Brown, insists that antidepressants "work—ordinarily well, on a par with other medications doctors prescribe."

Kramer’s article seeks to rebut a wave of negative coverage of antidepressants, most notably a two-part essay in The New York Review of Books (which can be found here and here) by Marcia Angell, former editor of The New England Journal of Medicine and now a lecturer in social medicine at Harvard. Angell cites research suggesting that antidepressants—including both selective serotonin reuptake inhibitors (SSRIs) and other medications—may not be any more effective than placebos for treating most forms of depression.

Angell highlights a meta-analysis, carried out by the psychologist Irving Kirsch, of trials of a half dozen popular antidepressants submitted by drug companies to the U.S. Food and Drug Administration. Many of the studies were never published because they failed to yield positive results. (The practice of burying negative results from trials is still quite common, as this recent Scientific American blog post points out.) After analyzing all the FDA studies, Kirsch concluded that placebos are 82 percent as effective as antidepressants. According to Kirsch, this difference vanishes if antidepressants are compared to "active placebos," which are compounds such as atropine, an alkaloid that blocks certain nerve receptors and causes dry mouth and other symptoms, that have distinct side effects.

Angell quotes from Kirsch’s new book The Emperor’s New Drugs (Basic Books), in which he states that "the relatively small difference between drugs and placebos might not be a real drug effect at all. Instead, it might be an enhanced placebo effect." This "startling" claim, Angell adds, "flies in the face of widely accepted medical opinion, but Kirsch reaches it in a careful, logical way. Psychiatrists who use antidepressants—and that’s most of them—and patients who take them might insist that they know from clinical experience that the drugs work. But anecdotes are known to be a treacherous way to evaluate medical treatments."

So how does Kramer begin his defense of antidepressants? With an anecdote—about a friend who benefited from antidepressants after suffering from a stroke. This rhetorical strategy should not be surprising, since Kramer’s 1993 bestseller Listening to Prozac (Penguin), which contributed to the surge in popularity of Prozac and other SSRIs, relied heavily on anecdotal evidence rather than clinical data. Kramer told story after story of patients transformed by Prozac. He suggested that SSRIs might be ushering in an era of "cosmetic psychopharmacology" in which patients are not only cured of disorders but become "better than well."

The Brave New World envisioned by Kramer was always a complete fantasy. When he wrote his book in the early 1990s, studies by Eli Lilly, Prozac’s manufacturer, showed that it was no more effective than older antidepressants, such as tricyclic drugs, or psychotherapy without drugs. Although Prozac was touted for its relatively mild side effects, it causes sexual dysfunction in as many as three out of four consumers. Kramer relegated a discussion of Prozac’s sexual side effects to the fine print, literally, in his book’s endnotes. His Times essay doesn’t provide any better data for antidepressants than Listening to Prozac did. Kramer delves into an arcane discussion of how difficult it is to distinguish genuine drug benefits from placebo effects, but he does not really grapple with the claim of Angell and Kirsch that antidepressants may be active placebos.

Kramer does not mention, for example, a recent analysis of STAR*D (Sequenced Treatment Alternatives to Relieve Depression), which has been called "the largest antidepressant effectiveness trial ever conducted." According to a group of four researchers, STAR*D data show that "antidepressants are only marginally efficacious compared to placebos," and even this modest benefit might be inflated by "profound publication bias." The authors recommend "a reappraisal of the current recommended standard of care of depression."

Angell agrees. She thinks that the surge in antidepressant prescriptions over the past two decades stems less from the drugs’ efficacy than from the marketing muscle of the pharmaceutical industry, which she says "influences psychiatrists to prescribe psychoactive drugs even for categories of patients in whom the drugs have not been found safe and effective."

She recommends that doctors be prohibited from prescribing psychiatric drugs "off-label"—that is, for disorders and populations, notably children and even toddlers, for which they have not been approved. She also urges that we "stop thinking of psychoactive drugs as the best, and often the only, treatment for mental illness or emotional distress…. More research is needed to study alternatives to psychoactive drugs," including exercise and psychotherapy (although of course studies of psychotherapy reveal that it may also work by harnessing the placebo effect).

Given what science is telling us about antidepressants, Angell’s recommendations seem wise to me. I sometimes suspect that psychiatric drugs work, to the extent that they do, simply by making people feel different. The suffering person interprets this difference as an improvement, in the same way that someone who is in a rut may feel better by traveling to another country. But does that mean that any psychoactive drug—Caffeine? Beer? Antihistamines? Psilocybin?—can in principle produce the same benefits as an SSRI, as Angell and Kirsch seem to suggest? Even for a skeptic like me, that seems hard to believe. We clearly need more research not only on alternatives to antidepressants (yoga, meditation, jogging, reading groups, journal-writing) but also on the drugs themselves, to understand why some people benefit so much from them while others don’t. But more research will be helpful only if the results are reported—as all medical data should be but too often aren’t—with absolute candor and transparency.

Photo credit Wikimedia Commons





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  1. 1. nccomfort 4:11 pm 07/12/2011

    You’re right to question Big Pharma’s role in promoting the "epidemic" of depression, and also to question whether antidepressants are the best way of treating people who are depressed. SSRI’s, in particular, scare the daylights out of me (I’m not taking them).

    But saying that antidepressants don’t make you feel better, just different is mere hand-waving. There’s pretty strong evidence that upregulating serotonin in certain parts of the brain elevates your mood. See, e.g., David Linden’s new book, Compass of Pleasure. There’s a reason that SSRIs, benzodiazepenes, opiates, and nicotine are all addictive, and psilocybin and Benadryl are not. There’s a lot more to learn, but the basic physiology is pretty clear.

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  2. 2. tmonk 4:15 pm 07/12/2011

    While we know quite a bit about how anti depressants work-its an ongoing process.To your point about the need for further research, I agree-and it is currently being done by myself and others.
    What is not included in your potentially misleading article, unfortunately is the 20 yrs of documentation of bad outcomes from psychotherapy.
    Depression is a complicated, and potentially lethal illness.
    To bring any sort of personal prejudice (which sadly is not rare) on how to treat it is likely more harmful, than helpful as those in need of help might choose to take the "comfortable " choice-not the sound one.
    What is sound is currently being debated in a mostly helpful way except when done by ideologues who have, sadly on occasion, financial incentives either to prescribe a medication, or to dissuade one from doing so.I have seen the unfortunate consequences of both.
    Many in the field agree that pooling data is not the way to analyze the results.The STAR-D data seem to show that.

    Why something works very well in one person, and does not work at all in another will likely be a more fruitful endeavor.

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  3. 3. Rosiecee 4:20 pm 07/12/2011

    The Physicians Desk Reference states that SSRI antidepressants and all antidepressants can cause mania, psychosis, abnormal thinking, paranoia, hostility, agitation, etc. These side effects can also appear during withdrawal. Also, these adverse reactions are not listed as Rare but are listed as either Frequent or Infrequent.

    Go to a serach engine and type in SSRI Stories where there are over 4,600 cases, with the full media article available, involving bizarre murders, suicides, school shootings/incidents [65 of these] and murder-suicides – all of which involve SSRI antidepressants like Prozac, Zoloft, Paxil, etc, . The media article usually tells which SSRI antidepressant the perpetrator was taking or had been using but sometimes the media article just says "antidepressant" or "medication for depression".

    On December 15, 2010, PLoS Medicine released a study which showed that, in regard to prescription medications and violence, the FDA had received the most reports of violence from the SSRI & SNRI antidepressants (except for Chantix, the smoking cessation drug.) The evidence of an association with violence was weaker and mixed for antipsychotic drugs and absent for all but one of the mood stabilizers. Yet, the antipsychotics and mood stabilizers, given for the most serious mental illnesses, bipolar disorder and schizophrenia, would be the most likely culprit involved in violence but, instead, it was the antidepressants which had the most reports of violence. They were given to patients that traditionally were the least likely to commit violence, the depressed and the anxious.

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  4. 4. jtdwyer 5:16 pm 07/12/2011

    Certainly pharmaceutical companies are in business to generate revenue derived from selling drugs to those who suffer from illness – their assessments must be continuously scrutinized.

    Anecdotes and assessments from patients taking drugs to treat psychological conditions cannot be taken at face value, but the side effects produced by antidepressants can be serious and sometimes permanent.

    In my limited experience with people who suffer from very serious depression I can attest that medications can make the difference from being able to function reasonably well in protective conditions and not being able to function at all. Based on this experience, I cannot understand the assertion that antidepression medications may be no more effective than placebos.

    I do think that the most dangerous period for those who do suffer from serious depression is the period when medications must be changed to prevent permanently debilitating conditions from developing as a result of medication side effects. During the transition period patients are subject to ineffective medications or dosages that are in effect experimentally determined through outpatient treatment, not to mention new side effects. IMO the cumulative debilitating side effects of antidepressant medications are a critical issue in the effective treatment of serious depression.

    For any who are diagnosed with depression and successfully treated with ineffective medications, I can only say, shame on sham psychiatric medicine!

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  5. 5. niel_malan 5:20 pm 07/12/2011

    As somebody who’s been rescued from a very deep hole by Prozac, I don’t believe the rumours that they’re just placebos. What is a problem is that there’s not nearly enough distinction between different stress-related mental illnesses. At the moment many illness with a selection of a broad array of symptoms are diagnosed as depression, and treated with antidepressants. Of course, this leads to a great number of inappropriate treatments, and as the number of treatments grow, the observed efficay as a statistical measure will go down.

    What is urgently needed is a system of classifying mental illnesses according to their neurogical basis. From this medicine can then build up a roster of treatments from the available drugs.

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  6. 6. KarynRH 5:52 pm 07/12/2011

    I take a tricyclic antidepressant and have for 27 years. For 14 years prior to that, I did everything I could to combat my depression short of taking meds – positive thinking, psychotherapy, cognitive behavioral therapy, wishful thinking, and anything I had heard helped someone else, no matter how silly it might have sounded. I finally gave up and agreed to try the medication (along with continued therapy) because I genuinely, honestly, just didn’t want to live anymore. Medication was my literal last resort, and even though I didn’t expect it to make a difference, after a fair amount of trial and error with different medications and dosages, it did.

    It’s not a magical potion that means I never feel depressed, but it keeps the depression manageable. It is literally the difference between life and death for me. While it’s true that when I couldn’t afford the medication and had to go without it I crashed lower than I had been before, that just means I’m stuck taking it forever. I consider that better than my personal forever ending 27 years ago – more importantly, so does my family.

    People want a wonder drug that works completely and immediately, all by itself. That’s not a failing of the medication.

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  7. 7. Marc Barre Levesque 6:54 pm 07/12/2011

    "There’s pretty strong evidence that upregulating serotonin in certain parts of the brain elevates your mood"

    Serotonin has so many effects, I wonder what if you can list the studies that show strong evidence?

    "There’s a reason that SSRIs, benzodiazepenes, opiates, and nicotine are all addictive"

    I’ve heard about patients feeling awful if SSRIs are cut abruptly, but not about SSRIs being addictive in the sense of opiates or nicotine, are there any studies on this
    -

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  8. 8. Feurmann 7:33 pm 07/12/2011

    I would like to second KarynRH’s comments above. I have been taking an antidepressant for several years and I definitely feel it helps me manage my moods. I concur also that the transition between medications, when the most appropriate dosage is being established, is a potential danger period. When changing medications to one with fewer side effects I went off the first medication altogether (with a "soft landing" as recommended by my GP). I found that, in period between the first drug wearing off and the second one beginning to take effect, I was reverting to the kind of acting-out of anger and frustration that had strained my relationships. I still feel these emotions, but am now much better able to deal with them. I am learning an instrument, and my teacher says she has noticed that I am more patient now as well.

    Ideally none of us would need medication. In practice, however, maintaining the quality both of one’s of life and relationships with loved ones can depend on having appropriate medication. This can help preserve and enhance one’s enjoyment of life, instead of just clinging on for mere survival.

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  9. 9. Marc Barre Levesque 7:37 pm 07/12/2011

    "What is not included in your potentially misleading article [like every article potentially is], unfortunately is the 20 yrs of documentation of bad outcomes from psychotherapy"

    Yes, and the bad or neutral outcomes of anti-depressants, and the studies that never get reported, or even submitted for publication too

    "Many in the field agree that pooling data is not the way to analyze the results.The STAR-D data seem to show that"

    How does STAR*D show that pooling data is not a useful way to analyse data ?

    "Why something works very well in one person, and does not work at all in another will likely be a more fruitful endeavor"

    Personally, I also feel any blanket claim of efficacy is misleading at best, and we surely don’t need doctors or patients feeling a particular therapeutic regimen is the best way to go.

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  10. 10. chernavsky 8:43 pm 07/12/2011

    For an excellent response to Kramer’s essay ("In Defense of Antidepressants"), see this blog post from author/journalist Robert Whitaker:

    http://www.psychologytoday.com/blog/mad-in-america/201107/the-new-york-times-defense-antidepressants-0

    Whitaker’s book, "Anatomy of an Epidemic", was one of the three books that Marcia Angell reviewed recently (John Horgan links to her review above). Of the three books, I think Whitaker’s is the most interesting. Whitaker cites the research by Irving Kirsch, but Whitaker goes on to make the case that antidepressants are worse than placebos — they are actually harmful in the sense that they hinder long-term recovery.

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  11. 11. Altostrata 9:32 pm 07/12/2011

    "One chronically depressed friend has tried, unsuccessfully, to stop taking his medications, but he experienced a surge of depression worse than the one that led him to seek treatment. He accepts that he will probably need to take antidepressants for the rest of his life."

    John — This happens all the time. That abnormal surge of depression is characteristic of antidepressant withdrawal syndrome. Your friend does not need to take antidepressants because they stave off mental illness, he needs to take them because they stave off withdrawal. He is physically dependent on his medication.

    While antidepressants are not technically addictive, they do cause physical dependency and withdrawal symptoms, which may last far longer than the few weeks claimed by psychiatry.

    Millions of people all over the world are taking antidepressants unnecessarily for years because they get withdrawal symptoms when they try to quit, and their doctors convince them these withdrawal symptoms indicate relapse or emergence of an even more severe mental illness.

    The patients may even be escalated to ever-more destructive combinations of psychiatric drugs causing even worse side effects and withdrawal symptoms.

    This is the invisible elephant in the room in terms of "relapse" after going off antidepressants. The only way to reduce withdrawal symptoms is very gradual tapering. Some sensitive individuals can tolerate tapering by only a fraction of a milligram per month.

    Medicine largely ignores this problem because it has been much more convenient and remunerative to call it "relapse" and remedicate. Doctors know little about effective tapering. Patients resort to peer support Web sites such as SurvivingAntidepressants.org to learn about how to taper off antidepressants and other psychiatric drugs.

    I feel sorry for your friend. It is so demoralizing, as well as physically damaging, to be caught up in an eternal merry-go-round of unnecessary medication for iatrogenic "mental illness."

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  12. 12. spooz 9:38 pm 07/12/2011

    As much as I appreciate anecdotal evidence, here I find it very unconvincing. Looking at the evidence presented by Dr. Angell in the New York Review of Books, I would guess that the anecdotal evidence here could be based on placebo effect.
    My own anecdotal evidence, as a parent who has grown up seeing my kids friends being started on amphetamines at an early age, throwing an antidepressant into the mix when the side effects from the amphetamines get a little tough to deal with, and then by the time they get to high school or college getting the bipolar diagnosis (I can’t believe how many bipolar kids my kids have as friends)and adding in anti-anxiety and/or anti-psychotic meds, I am disgusted by the professionals who make a living off of this and by Big Pharma for inventing it.

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  13. 13. Bops 11:12 pm 07/12/2011

    Any drug, in too high a dose will cause brain problems.

    Many of the people who need anti’s are already addicted or have other very serious problems.

    Think more clearly about the reality of what you read.

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  14. 14. Bops 11:16 pm 07/12/2011

    Antidepressant medications help, that’s why so many people are helped by them.

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  15. 15. Bops 11:19 pm 07/12/2011

    Prozac, is helping with panic attacks for my friend. Talking about it doesn’t help at all. Prozac really works for the right person.

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  16. 16. Bops 11:40 pm 07/12/2011

    Spooz’s,

    People enjoy the company of people who are like themself.
    Kids that are bipolar…find friends to keep the comfort zone.

    Bipolar diagnosis can not be induced by drugs.
    It has to have a childhood history, starts about age 12, and later in life, you know something is not ok.

    Like any other hobby, sport. addiction, they like to share it with friends.

    You will see for yourself, if your kids friends make it ok in life or are really biopolar. Normal kids outgrow the drug stuff, it gets old.

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  17. 17. OBagle 12:28 am 07/13/2011

    I was prescribed Prozac in an attempt to help me quit alcohol and smoking. I felt no different for ten days, and then suddenly, at age 45, I felt like I was 18 again. I found that, quite mysteriously, my decrepit health was miraculously transformed; 45 push-ups were nothing, although they were when I was in the army, and running 3 Km non-stop felt better than it did when I was 18,

    Unfortunately, it also meant that I suddenly started spending money like a Navy Seaman in port. I felt like I was really 18 again and that I was indestructible. Instead of half-liter of vodka per day, I started drinking a full liter. That’s the part that scared me. I quit Prozac after 4 months, and immediately fell into a total systemic collapse. I wanted nothing more than to jump from any nearby rooftop. I decided to keep myself unconscious by drinking day and night for about two months, and that returned everything to normal. 5 years later, I was hospitalized for alcohol related stuff.

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  18. 18. spooz 12:45 am 07/13/2011

    Studies? I don’t think there is any evidence that what you say here is true. All conjecture. IMO, your opinion here is WRONG.

    "Bipolar diagnosis can not be induced by drugs.
    It has to have a childhood history, starts about age 12, and later in life, you know something is not ok."

    My kids are in college now, and those friends that didn’t get the diagnosis in high school are getting it now. After years of being on amphetamines and a host of other psychopharmaceuticals, they are the kids who are willing to experiment with the most addictive drugs. One of them just got introduced to Xanax by her doctor. Now she LOVES bars and can’t get enough. She has to write down how many she takes so she doesn’t overdose. I’m glad my kid sticks with weed.
    We have no information how these drugs are affecting young brains. How do we know that early exposure didn’t make them more likely to abuse drugs or develop other "disorders" which may be side effects from the first drug? How can we be sure what the outcomes are if nobody bothers to do long term studies? I remember following the multimodal study back when my kids were younger, eagerly waiting to have proof that drugs were not a good long term solution for this "disorder" ADHD. As I recall, they finished it after 14 months and called that a long term study. BS.

    Anyways, your take is simplistic and shortsighted, imo.

    "You will see for yourself, if your kids friends make it ok in life or are really biopolar. Normal kids outgrow the drug stuff, it gets old."

    .

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  19. 19. spooz 1:04 am 07/13/2011

    Sounds like you could have got a bipolar diagnosis if you had gone to the wrong doctor.
    During my daughter’s freshman year of college, she decided to borrow her roommate’s Adderall for studying. The roommate is bipolar and has been on drugs since she was diagnosed with ADHD in third grade. Now she is on 40mg slow release Adderall, which she sold to my daughter.
    At first, during the honeymoon phase, she felt like she could conquer the world and really wanted to see a doctor to get her own prescription. A month later, after several weeks of experimenting, she quit. Thats when she had her first panic attack. She came home for Christmas break and I nursed her though it, refusing to take her to a doctor who would slap her on Xanax. I researched everything I could find on relaxation, mind and body and meditation, and, although she also became obsessed with her symptoms and had to be convinced she did not have one of the many other psychicatic diseases she googled. She got through it and went back for second semester. She saw a psychiatrist at school who convinced her that the episode was caused by the drugs and would it would take a few months before she felt normal again.
    I have other similar anecdotes. What I don’t have is anecdotes about people I know who were successfully helped with psych drugs. I know alcoholics who have had success with the 12 step program. If that was my problem, this atheist might look for a higher power too.

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  20. 20. OBagle 2:13 am 07/13/2011

    Spooz,

    A few months? I tried to quit Xanax cold turkey and 5 days later, my leg muscles went into such painful contractions that I couldn’t stand up at all. The worst thing was, they weren’t intermittent spasms, my legs seemed to be mummified. Taking a Xanax pill solved the problem immediately, and so I resolved to quit (after 6 years). Valium has been working for me, cutting down slowly over two years, but if I quit the valium, I suffer muscle pain a week later (much less than with Xanax). Anyway, a few months?

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  21. 21. spooz 2:41 am 07/13/2011

    The few months was how long it took before the derealization lasted. That was the main symptom, perceptual abnormalities that freaked her out and led her to obsessive googling to figure out what mental illness she must have.
    It happens that her father also experienced a panic attack before we had kids, after using cocaine. He went to the ER, was hospitalized for a day and put on Xanax. He didn’t like Xanax and only took a couple, but I was afraid that somebody would be talking us into putting my daughter on it and I wanted nothing to do with it. I knew it was withdrawal and her chemistry would need to normalize before she would feel right again. It didn’t make any sense to kick the can down the road and have to deal with Xanax withdrawal later.

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  22. 22. spooz 2:52 am 07/13/2011

    Sorry for the sloppy grammar OBagle, that last post was directed to you.
    What I was trying to say was that her derealization hung on for a couple months. Other symptoms, like chest pain, nausea, hot and cold flashes, trembling and difficulty breathing came on intermittently and only lasted a couple days. After that the obsessive googling and fear of losing control lasted a few weeks. The derealization stuck around longest. She was worried that she would never feel normal again, but over time it passed.

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  23. 23. DickTurpin 9:30 am 07/13/2011

    To bluntly answer the title of this piece: "Does it matter?" In other words, if antidepressants work for some people, isn’t that good enough? What does it matter if it’s entirely a placebo effect? Who cares if we ever learn their "real" biochemical mechanism of action so long as they’re generally safe at the doses prescribed?

    Yet both drug companies and patients seem to be resistant to the idea of an overriding placebo effect for two quite different reasons.

    A business model that depends on regular incoming profits will, in the case of health care, usually favor a view of diseases as chronic entities that require regular, often life-long treatment regimens. Presumably if many psychiatric medications were acting as placebos, doctors would quit prescribing, and patients would stop taking. (Note: presumably.)

    However, patients are themselves resistant to admitting a placebo effect because they’re reluctant to consider any illness as being "all in my head." (After all, if it’s "all in my head," I must really be an idiot.) In other words, patients want to pop pills because the implication is that it’s not in their head, it’s in their malfunctioning brains/bodies, over which they presumably have no control. (Note: Presumably.)

    The upshot is clear (and always has been, as long as placebo-controlled studies have existed): As a patient, I prefer to take a pill provided by a profit-driven company because that allows me to believe I’m still an okay person despite my illness, which presumably I have no control over anyway. (Note: Presumably.)

    Mr. Dick Turpin

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  24. 24. spooz 9:43 am 07/13/2011

    It would be fine if you could receive a real placebo, but when the "placebo" you take has real side effects I don’t find that acceptable. And there are many other non drug ways to deal with mental illness, as simple as exercise and learning relaxation techniques. I would explore them thoroughly before resorting to medication.

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  25. 25. ImproperUsername 1:36 pm 07/13/2011

    How very interesting. I’ve had depression for most of my lifetime. Prozac has been a blessing. When I reduce my dosage, I continue to feel fine for a few weeks and then the intrusive, morbid thoughts return. I have accepted that Prozac helps me to be the person whom I choose to be. So, I am intrigued by this article. If I feel relief by taking Prozac, what is really happening?

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  26. 26. spooz 2:13 pm 07/13/2011

    Irving Kirsh reviewed published and unpublished clinical trials on Prozac and other antidepressants in his meta-analyses and found that the difference between antidepressants and placebo are not clinically significant and argues that the theory of depression caused by chemical imbalance is wrong. A lot of people don’t realize that there is no evidence of chemical imbalance, only theories. Draw your own conclusions.

    "If I feel relief by taking Prozac, what is really happening?"

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  27. 27. karlpopper 4:06 pm 07/13/2011

    May I suggest the addition of two favorite books to your summer classics list?

    1) "Medical Nemesis" by Ivan Illich, which sheds light on the anti-depressant issue, too much light, in fact, to be taken seriously; and

    2) "The End of Science" by John Horgan. A great book I always recommend.

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  28. 28. karlpopper 5:11 pm 07/13/2011

    This issue has resulted in an article in Al Jazeera English a few days ago, by Mother Jones journalist James Ridgeway, titled ‘Mass Psychosis in the US".

    http://english.aljazeera.net/indepth/opinion/2011/07/20117313948379987.html

    A website called PharmedOut.ORG collects the confessions of shamefaced former pharmaceutical executives and representatives.

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  29. 29. Altostrata 9:58 pm 07/15/2011

    More to the point, what is happening when you quit Prozac? Are you experiencing withdrawal symptoms rather than relapse? Antidepressant withdrawal syndrome is almost unvariably misdiagnosed as relapse and the patient is convinced lifelong medication is needed. However, in that case you don’t need the drug to stave off "depression," you need it to stave off withdrawal. This is called physical dependency.

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  30. 30. jepricer 2:33 pm 07/16/2011

    Thank you for posting your insights. I have linked to your article on my website because it is a good example of pharmaceutical company driven diagnosing and prescribing.

    James Pricer
    http://ThePsychReport.com

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  31. 31. ensmingr 3:33 pm 07/16/2011

    1) Horgan quoted the article in Psychother Psychosom (2010;79:267-279) as saying that "the STAR*D data show that ‘antidepressants are only marginally efficacious compared to placebos,’".

    This is not correct. In fact, there were no placebo groups in STAR*D (see: http://www.clinicaltrials.gov/ct/show/NCT00021528). The authors made this conclusion based on their meta-analysis of other clinical trials, not the STAR*D study.

    2) Horgan’s characterization of Peter Kramer’s July 19 article in The New York Times was overly simplistic.

    First, Kramer’s defense of antidepressants was based on much more than an anecdote, as he seems to imply. In fact, Kramer refers to many recently published clinical studies in stroke patients, cardiac patients, and more.

    Second, Kramer argues that the high placebo responses in many anti-depressant studies is likely due to an artifact in the recruitment process. Yet, Horgan wrongly dismisses this as an "arcane discussion". In fact, recruitment is a very important aspect of clinical trials, and artifacts in recruitment seem to be the best explanation for the increasingly positive placebo responses in anti-depressant studies since the 1990′s.

    3. Finally, like Kramer, I fear that people who read unbalanced articles on the use of psychiatric medications, such Horgan’s "Scientific American" piece or Angell’s "The Epidemic of Mental Illness", will conclude that psychiatry is nothing more than quackery. This would regrettably lead to under-treatment of patients with very treatable mental illnesses.

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  32. 32. spooz 11:33 am 07/17/2011

    It seems that artifacts in recruitment are often explained away by over eager researchers with confirmation bias.

    Psychopharmacology is big business for drug companies and doctors who dream up new disorders to sell their wares. The revolving door, where a patient sees the doctor for five minutes and walks out with their prescription is the most lucrative model for all so it makes sense that would be the direction health care would move.

    If I was having problems with my mood, the first thing I would do is force myself to get more exercise. Then I would seek out a relaxation or yoga program to get in touch with the mind/body connection. This is the direction psychology should be going, IMHO. Towards alternative methods that don’t require a lifetime of drug dependency.

    Link to this
  33. 33. AngelaMRGN 4:01 pm 07/18/2011

    i agree. I have been enduring abuse all of my life and only recently finally become free of my abusers – psychiatrists that my mother – a hard core pill popper who loves the company of doctors and is addicted to surgeries and any procedures she can have done. I believe seriously that if many of those put on antidepressants or any other mind-altering drugs were instead met WITH those insisting there is something wrong with them – and addressing any control issues or abuses that have led them to a state that it is insisted that they take drugs so that they can tolerate the abuse (my case absolutely) – they might find through exercise, time to really examine their own genuine thoughts and feelings – that they don’t need drugs – they need to get away from people insisting there is something wrong with them any time they don’t agree or comply with controlling family or friends. If I had known this when I was sent to a shrink as an adolescent after years of being the only adult (starting from about age three) and "comforter and rescuer) in my family of drunks and pill poppers – I might have had a life. Now after being free of mind-altering drugs prescribed to me and many offered as samples from one visit to the next to "try" even when I objected stating that clearly some had warnings that pertained to me – I feel even at the late age of 47 that I would rather spend the remaining years of my life alone and in poverty but allowed to live abuse-free and that would be a preferable way to heal the past than to further supress emotions until my liver can’t take any more and I have to endure withdrawal and the torture of realizing and remembering so much abuse that I only endured because I was drugged and that I had allowed my family to do the same to my daughter BECAUSE of those drugs and their threats and abuse and her learning that this is the kind of treatment she should accept. It was their serious abuse of me in front of her at her age of three that woke me up initially to the reality of why people see shrinks. Like in the 60′s when you could have your wife institutionalized, given shock treatments and possibly forever drugged into a stupor because she did not orgasm.

    Link to this
  34. 34. rwstutler 11:30 pm 07/18/2011

    "I sometimes suspect that psychiatric drugs work, to the extent that they do, simply by making people feel different."

    Many persons with self described (or even diagnosed) mental disorders resort to self medication. I conclude that many if not most persons with "mental disorders" who receive antidepressants experience symptomatic relief similar to that experienced by those who "self medicate". In short: antidepressants are little more than recreational drugs made legit by a prescriptioon pad.

    When specific persons with "mental disorders" can be studied on a neurological level, and their disorder can be described in specific neurological terms than, and only then, can medication that alters brain chemistry and neurotransmitters be reasonably, safely and therapeutically prescribed for sufferers. As the state of mental health care stands now, antidepressantys are little more than voodoo medicine. They may work efficacially for some, as a placebo for others and as fun recreational drugs for others.

    With all that said, I know that some individuals have found symptomatic relief from their meds, and I would not wanrt to deprive them of that relief, but I do not believe that allowing such people to live in blissfull ignorance is an acceptable longterm solution for their very real problems.

    Link to this
  35. 35. rwstutler 11:31 pm 07/18/2011

    "I sometimes suspect that psychiatric drugs work, to the extent that they do, simply by making people feel different."

    Many persons with self described (or even diagnosed) mental disorders resort to self medication. I conclude that many if not most persons with "mental disorders" who receive antidepressants experience symptomatic relief similar to that experienced by those who "self medicate". In short: antidepressants are little more than recreational drugs made legit by a prescriptioon pad.

    When specific persons with "mental disorders" can be studied on a neurological level, and their disorder can be described in specific neurological terms than, and only then, can medication that alters brain chemistry and neurotransmitters be reasonably, safely and therapeutically prescribed for sufferers. As the state of mental health care stands now, antidepressantys are little more than voodoo medicine. They may work efficacially for some, as a placebo for others and as fun recreational drugs for others.

    With all that said, I know that some individuals have found symptomatic relief from their meds, and I would not wanrt to deprive them of that relief, but I do not believe that allowing such people to live in blissfull ignorance is an acceptable longterm solution for their very real problems.

    Link to this
  36. 36. OldSquid 8:33 am 07/19/2011

    Dr. Hall from Science Based Medicine just posted on Krisch. However, the result remains a grey area.

    Kirsch recently looked at the FDA data for 4 of the 12 drugs that Turner examined. In spite of the smaller sample, where Turner found an effect size of 0.31, Kirsch got 0.32. So they got almost exactly the same result. But it was their interpretations of that result that were very different. Kirsch concluded that antidepressants are ineffective, while Turner found that the drugs were indeed superior to placebo.

    The discrepancy between Turner’s and Kirsch’s interpretations hinges on what these effect size numbers mean in terms of clinical significance,. Values of 0.2, 0.5, and 0.8 were once proposed as small, medium, and large effect sizes, respectively. The psychologist who proposed these landmarks admitted that he had picked them arbitrarily and that they had “no more reliable a basis than my own intuition.” Later, without providing any justification, the UK’s National Institute for Health and Clinical Excellence (NICE) decided to turn the 0.5 landmark (why not the 0.2 or the 0.8 value?) into a one-size-fits-all cut-off for clinical significance. In an editorial published in the British Medical Journal (BMJ), Turner explains with an elegant metaphor: journal articles had sold us a glass of juice advertised to contain 0.41 liters (0.41 being the effect size Turner, et al. derived from the journal articles); but the truth was that the “glass” of efficacy contained only 0.31 liters. Because these amounts were lower than the (arbitrary) 0.5 liter cut-off, NICE standards (and Kirsch) consider the glass to be empty. Turner correctly concludes that the glass is far from full, but it is also far from empty. He also points out that patients’ responses are not all-or-none and that partial responses can be meaningful.

    http://www.sciencebasedmedicine.org/index.php/antidepressants-and-effect-size/

    Link to this
  37. 37. kebil 8:39 pm 07/19/2011

    "All in my head"? Of course mental illness is all in ones head, that is where the brain is, that is where the mind is. Confusing the discussion with dualist terminology clouds the issue. Just as talk therapy is aimed at "retraining" the brain to quite thinking in counter-productive or hurtful ways, so to do antidepressants (when they do work) alter the way the brain works. These are two different routes to the same endpoint. And yes, mental illness is all in ones head, where else would it reside.

    Link to this
  38. 38. Rich_Fisher_Marketing 4:39 pm 07/20/2011

    I had a bout with depression and/or anxiety. I took Wellbutrin for a long time but it made me either very up or very low. When my health insurance ended, I had no choice but to give up taking the drug. Welcome to the black hole. Then I went to a local health and nutrition store and bought a bottle of St. John’s Wort. It works very well for me with no sexual side effects (unlike Welbutrin) and it’s very affordable. I’ve since told a number of people who have last health insurance about the benefits of St. John’s and they have all thanked me profusely.

    It’s incredibly difficult to understand or describe depression – that is probably why it is so hard to study effectively. I know what works for me: St. John’s. I keep some in my car, in my desk, and in my medicine cabinet. I take 600 mg. in the morning and 600 mg. in the evening.

    It just plain works.

    Link to this
  39. 39. Rich_Fisher_Marketing 4:40 pm 07/20/2011

    I had a bout with depression and/or anxiety. I took Wellbutrin for a long time but it made me either very up or very low. When my health insurance ended, I had no choice but to give up taking the drug. Welcome to the black hole. Then I went to a local health and nutrition store and bought a bottle of St. John’s Wort. It works very well for me with no sexual side effects (unlike Welbutrin) and it’s very affordable. I’ve since told a number of people who have last health insurance about the benefits of St. John’s and they have all thanked me profusely.

    It’s incredibly difficult to understand or describe depression – that is probably why it is so hard to study effectively. I know what works for me: St. John’s. I keep some in my car, in my desk, and in my medicine cabinet. I take 600 mg. in the morning and 600 mg. in the evening.

    It just plain works.

    Link to this
  40. 40. rosemagdelene 3:53 pm 09/1/2011

    I completely believe in what you have to say. I was put on Effexor and Buspar for anxiety and depression 5 years ago. As a result I had a psychotic break. A psychotic break is the same thing that happens to a person who uses Meth. Intense Paranoia, Delusions, and Hearing voices. It is extremely terrifying. I went through this for 6 months straight, day and night. The psychiatrists thought I was a paranoid schizophrenic and I was prescribed Risperoal, an anti-psychotic, on top of the Effexor and Buspar. Over time, the terrifying side effects went away and I stopped taking all medications, but it took a few years to get all of these drugs out of my system.

    The drugs prescribed by doctors are man made, the same as Meth is man made. They have the same side effects as Meth. They are a legal form of a mind altering, man made, chemical, and there is more proof than not that they do more harm than good. These powerful drugs are meant for true schizophrenia, and people with severe manic-depression, not the general public, who have mild anxiety or depression.

    Today, through actually listening to my body, I have found all natural vitamins and herbs, that work so much better than any pharmecutical drug that I was ever prescribed. Inositol, Withania Somnifera, Panex Ginseng, L-Theanine, and Magnolia Bark are a few of the amazing and powerful natural herbs and chemical compounds already found in the body that treat anxiety and depression, with no side effects and no withdrawal symptoms.

    The only thing we need to do to treat anxiety and depression is balance the serotonin and dopamine levels in our bodies and this can be done naturally, because we are all, but of the Earth.

    Link to this
  41. 41. Penelope373 9:36 am 10/27/2011

    I enjoyed this article, I was already aware of the effect it had if you took it while you were pregnant but I wasn’t aware of the fact that it could still effect a child even if it was taken prior to becoming pregnant. There are all sorts of commercials now concerning Zoloft and other SSRI lawsuits contributing to serious health issues but only one attorney that I saw was effectively reaching out for specifically Autism was a attorney named Chad Pinkerton. I would suggest that if any ones family has been affected in this way because of the antidepressant that was prescribed to them to contact his firm at 1-855-Zoloft1.

    Link to this
  42. 42. xydis 5:18 pm 01/17/2012

    Every drug has side effects or some adverse effects in some one. That doesn’t mean all. Fact of the matter is, IF it WAS placebo then I wouldn’t have needed ECT (which only helped some) and even more extreme treatments AND STILL not be well. You should also be pointing out that antidepressants treat more than depression, just like antipsychotics/neurleptics (atypical/typical) treat more than psychosis.

    Your nonsense is a disgrace and absolutely disgusting to anyone who really does a) understand mental health (You clearly do not) and b) has been thorugh all sorts of classes of antidepressants, stimulants, benzos, and procedures – still not even close to well. You say you suffer from depression? Well you might, but resisting antidepressants shows you are either not seriously depressed or you’re someone who takes health for granted or doesn’t really care.

    Ever had psychosis? I bet you you haven’t. I have. Its not fun, and it IS IMPOSSIBLE to tell someone and actually convince them – if they’re psychotic – that they are so, UNLESS they are either a) not psychotic or b) have been treated (see a).

    They ARE NOT placebos. Not even close! They actually alter certain chemicals KNOWN to effect the mood. Kind of like exercise releases endorphins (which hey – also are known to help mood and other things). I guess that’s a placebo too, right? And its no worry if you’re overweight and/or obese, and you shouldn’t exercise as well, right ? WRONG! The only time you actually should not exercise is if you have high bp (blood pressure in case [as I suspect] you weren’t aware) as that can kill you.

    Are pharmacies a problem? Well let’s see. HUMANS are. And since robots don’t work in pharmacies… then, huh, I wonder why there might be a problem?

    And as a matter of fact, there’s a LOT of bad psychiatrists and equally so there’s a lot of BAD doctors and BAD pharmacists and BAD of every thing.

    And what is absolutely hilarious is you implying / stating that doctors should use more than medications. Hello? Are you bloody kidding me? THEY DO! That’s why there’s even more than one kind of mental health professional. Psychiatrist – a medical doctor with specialty in mental health. Psychologist and therapists are not MD’s (more like PhD’s) who are also more specialized in mental health (and different types of therapies). The fact X Y or Z doctor doesn’t do this doesn’t mean its not known its best as a combination, nor does it mean all doctors are that way.

    In fact, as I recall (been some years since I read it in full) – even the DSM states different types of treatment options.

    Lastly, the reason dx (again in case you don’t know: diagnosis) count is increased is not because of pharmacies. It happens to be that the world KNOWS more. Imagine that. Doesn’t take a rocket scientist to figure out that if you know more about X topic then you will be able to discern different points, different things, different things in general, in a more specific way. Example: severe mental illness runs in my family. Years ago they would have (and go figure – DID) lock up people with a now common disorder. Common = about 1% of world population I might add. The reason they don’t now is .. yes, they know more.

    Please, if you’re going to speculate SAY SO. You potentially could end up having someone DEAD because you say “its only placebo” just like I could do the same if I told people that I lost 50lbs by an apple sauce [or grapes or anything low in calories] diet – in less than a week. It’s also a reason there is STILL stigma attached to mental illness – if it was placebo then it’s mostly “imagined” or “not real” or “not in need of real treatment”.

    And to those who think its shocking that treatment options can cause what it is designed for, observe these:

    diazepam (valium) is at times used to help with seizures. Guess what happens ifyou get hooked and go off too quickly? You can end up with … seizures.

    Certain chemotherapies can cause cancer.

    Other drugs that treat life threatening diseases can cause cancer (xolair comes to mind).

    Other things.

    THIS IS HOW IT WORKS!

    Your article is irresponsible and disgusting. That is all. (And for those who think I’m someone who works in the medical field, I”ll add I HAVE NEVER EVER had a job. Not once. I turn 30 in February and I live with my mom to this day! So much for your ‘medical field’ claims).

    Link to this

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