Study finds medication of little help to patients with mild, moderate depression

[bananas]

Source: LA Times

Antidepressant medications probably provide little or no benefit to people with mild or moderate depression, a new study has found. Rather, the mere act of seeing a doctor, discussing symptoms and learning about depression probably triggers the improvements many patients experience while on medication.

Only people with very severe depression receive additional benefits from drugs, said the senior author of the study, Robert J. DeRubeis, a University of Pennsylvania psychology professor. The research was released online Tuesday and will be published today in the Journal of the American Medical Assn.
...
The study found that the magnitude of the drugs' benefit increased with the baseline level of depression. The effect of treatment was similar in people with mild, moderate and severe symptoms, regardless of whether they took an antidepressant or placebo. Only the people who rated very severe on the depression measurement at the start of the study showed measurable improvements after taking antidepressants.
...
One exception to the study findings, DeRubeis said, was people with dysthymia, or chronic, low-level depression. The current analysis assessed severity of symptoms, not chronicity, DeRubeis said. Other studies have established that people with chronic depression, no matter how severe, tend to respond well to antidepressants while other treatment may be ineffective.

Read more: http://www.latimes.com/news/nationworld/nation/la-sci-depression6-2010jan06,0,4335963.story

[napi21]

1. Boy are he drug co's going to be upset about those statements!

There are millions of people taking pacil & the other drugs like it, Drug co's are maing MILLIONS!

[flamingdem]

24. GOOD POINT! Get those people off those unhealthy meds nt

[Mari333]

2. Unqualified doctors hand them out like candy

the only person who should ever be able to prescribe those things should be a psychiatrist. general practitioners should NOT be able to hand those out. they are NOT qualified to make the diagnosis.
Pharma companies give kickbacks to doctors who get free samples .

and sometimes people need to realize that mild depression is a normal part of life and we have to go thru it sometimes i.e. grief, etc.

[niyad]

3. I just love the ads that say that 2 of every 3 people suffering from depression stilll have those

symptoms while on the drugs. . .

[denem]

4. "HUNREDS of studies have attested to the benefits of antidepressants" BUT

"MANY studies involve only participants with severe depression".

What a crock. As soon as you hear MANY get out your BS detector".
Many= Some, a minority. How much of a minority? Blank.

1. Robert J. DeRubeis is a psychologist - You know, the people who can't prescribe drugs, but get money out of counseling patients, including depressed patients.

2. He looks at SIX studies - that's right, a whole 6. The total 718 people had chronic mild, to moderate and Chronic depression. So the subject group were not even controlled?. Then the results. WOW Which anti-depressants? Over what period? Recidivism?

WHAT A JOKE

I have no doubt that anti-depressants aver over-prescribed, but starting with a psychologist who will cram Cognitive Behavior Therapy down your throat is hardly any better. Subject - Stimulus - Response? Fuck that.

Six months of CBT - You seem to be doing better this week. Bad week, what happened. End of the line - You know, you could be bi-polar.

Psychologists should not be the front line for assessing people who may have mental illness. Period.

[bananas]

10. The authors were both psychologists and psychiatrists

http://jama.ama-assn.org/cgi/content/short/303/1/47

Author Affiliations: Departments of Psychology (Mr Fournier and Dr DeRubeis) and Psychiatry (Dr Amsterdam), University of Pennsylvania, Philadelphia; Departments of Psychology (Dr Hollon) and Psychiatry (Dr Shelton), Vanderbilt University, Nashville, Tennessee; Department of Psychology, University of Colorado at Boulder (Dr Dimidjian); and Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque (Dr Fawcett).

There have been enough studies that this isn't even controversial anymore. Most of the effect of antidepressants is accounted for by the placebo effect, which is a psychological effect. When doctors prescribe antidepressants, they are practicing psychology.

edit to add conclusions of the study to keep the thread from going off the rails:

Conclusions The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial.

So keep telling us that the study was done by quacks...

[denem]

13. "Most of the effect of antidepressants is accounted for by the placebo effect"

FAIL. You know that the placebo effect is the first thing controlled in a double blind trial, don't you?

Both get tablets.

What are you talking about?

[bananas]

19. Do some research.

You can start here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2582668/

[denem]

21. Do you really think a man in pain

hasn't looked it all up?

I've read and read and read,
then I found Lamotrigine -
not a pull me - push you
anti-depressant:

It's generic
Big Pharma has little interest in it
but it's changed by life.

Sample size = 1

(PS - Sex and drugs and rock'n'roll
are very good indeed)

[bananas]

22. Your experience confirms the OP - antidepressants didn't work for you

Lamotrigine is an anti-convulsant, not an antidepressant.
You spent decades of your life in a living hell,
wasting your time trying every kind of antidepressant,
only finding relief with an anti-convulsant.
Antidepressants didn't work for you.
I'm glad you found something that did.

[Name removed]

26. Deleted message

Message removed by moderator. Click here to review the message board rules.

[Psephos]

50. lamotrigine is also an antidepressant, but mainly for bipolar (not unipolar) depression

Its anticonvulsive effects are its primary on-label use, but its usefulness in bipolar disorders is well-established. It's somewhat of a mysterious drug; its anticonvulsive and antidepressive biochemistries are not understood very well. When it's used alone, it has the big advantage of causing very few side-effects.

I second your opinion that the search for effective agents should not take decades. People in the throes of depression experience psychic pain every bit as devastating as that from a major physical injury.

Best of luck to the O.P.

[Politicub]

28. It's a miracle drug for me

It was like the light finally went on when I started ramping up on Lamotrigine. I was depressed for so long, I didn't know what normal felt like anymore. I know I sound like a hokey testimonial, but it truly did turn my life around in so many positive ways - family, work, etc.

It's great to read that you had a similar experience.

[denem]

29. That was it exactly for me.

[RedSock]

46. same for me 15 years ago

i was able to become "me" again.

[agtcovert]

56. This is good to hear...

I hope my experience is the same. I started ramping up on it 2 days ago. Nothing else has ever worked for me.

[Iowa]

25. It's complicated...

I have had many years of experience as a professional in a mental health related field dealing with both inpatients and outpatients. I have worked with many psychiatrists and just as many psychologists. Here are just a few conclusions based solely on my decades of experience:

1) The quality of psychiatrists varies greatly from incompetent to mediocre. The best ones rely on a team of professionals to make a diagnoses. Treatment is trial and error. Try one medication, and if that doesn't work, try another; that's about it. They don't really know all that much. I never knew one who wasn't absolutely clueless about anything having to do with counseling/psychotherapy or even basic communication skills. Many can hardly communicate with their patients beyond reciting a checklist of questions that the patient could have completed with pen/paper... no depth, no probing, no suggestions, no feedback... just prescribe a med and wait to see if it works. The man on the street would be amazed at how little they really bring to the table. I would value the opinion of a good psychiatric nurse over that of a psychiatrist.

2) Some of the biggest disasters I ever worked with were psychologists. I'm talking "bag-of-hammers" stupid, lazy, unprofessional, clueless... I've seen it all. On the other hand, some of the very best professionals I ever worked with were psychologists. I never met a psychiatrist who could hold a candle to a truly good psychologist. Of course, I didn't meet them all, but I knew a lot of them.

3) If I encountered a mental health issue, the first thing I would do is get myself to a good psychologist who would coordinate my care with my family physician (along with a good pharmacist to make sure no meds conflict). But then... I know who the top psychologists are - and there are very few of them. In fact, there are only two in my area that I would use, and one just retired. Going to a psychologist who isn't one of the very best could be worse than doing nothing. For the average Joe it would be a crap-shoot with the odds stacked against him; it would be like playing Russian-roulette with a six-shooter, and with five bullets in the chamber. Nevertheless, a truly good psychologist working with an excellent family physician would be my choice. I was immersed in the field for decades, have the best insurance money can buy, and could go anywhere in the country - and that's what I'd do.

4) I never met a psychiatrist who I would wholeheartedly entrust to treat a family member. A lot of them are nice people. Some are friends. But while their quality varies tremendously, in my experience they just don't have all that much to offer. They can write prescriptions, which is helpful. And the very best ones rely on a team to sort it all out, and (consequently) get it right fairly often. But as a profession, they tend to be grossly over-rated, IMO.

5) Anti-depressants work. I wouldn't hesitate to use one if needed. These drugs save lives and dramatically improve quality of life. But depression is a complicated thing, and sometimes (not always) a top-notch psychologist can help unravel entrenched thinking patterns and habits that contribute to the problem. I wouldn't write off psychotherapy altogether - just bad psychotherapy (and much of it, as practiced in the real world, is crap - as you infer in your post).

So, for what it's worth...

[No Elephants]

33. Psychologists can prescribe medication in certain states and, IMO, should be able to do so

in all states, but the AMA fights it. Nurse practitioners can prescribe in all 50 states and the training of a psychologist is more rigorous.

[HysteryDiagnosis]

5. A little assistance.

http://www.lef.org/protocols/emotional_health/depression_01.htm

Treatment for depression is usually multifaceted, and there is no doubt that nutrition plays an important role. Research has shown that the body chemistry of depressed people is altered in various ways and that deficiencies in neurotransmitters, hormonal imbalances, and other nutritional deficits can contribute to clinical depression. Also, many people with depression do not eat enough, overeat, or eat nonnutritious foods. New research has also connected depression to inflammation and oxidative stress, which are both appropriately managed with nutritional supplements.

Finally, the role of hormones in depression is underappreciated in the medical community. Many people who suffer from depression that cannot be treated effectively with conventional antidepressants may actually be suffering from hormonal imbalances that are causing their disease. Unfortunately, few physicians routinely test their depressed patients for hormonal imbalances.

Ultimately, the treatment of depression usually touches on many facets of a person’s life. Exercise is important, and treatments such as massage and acupuncture have a long history of effectiveness when used as part of a treatment program. Counseling and psychiatric therapy can also help people deal with the feelings of anxiety and hopelessness that accompany depression.

[Name removed]

7. Deleted message

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[Name removed]

9. Deleted message

Message removed by moderator. Click here to review the message board rules.

[mopinko]

32. no, no, no

these threads make me crazy because i hate anything that makes it seem like these meds are a bad idea, and that the people who take them are just being fooled by some placebo.
that poster posts all manner of quackery in health all day long. s/he also make sells woo woo products.

many people depend of these meds for their existence. most have mixed feelings about them at least some times. a shoddy study like this that tears them down causes a lot, lot of harm.

the best to you. i do know. that's why i hate to see people posts bs about this subject.

[Lurks Often]

6. Low dosages worked and are working for me

There is a HUGE difference between having to deal with depression due to an isolated incident such as the death of a loved one, loss of a job, etc and chronic depression, in which you are depressed for weeks, months or years on end.

I should know because I have been on a low dosage of an anti-depressant since the middle of 2006 and my life has never been better. Looking back I am hard pressed to remember a time I was happy for an extended period of time prior to the pills. There was no particular cause, I wasn't abused or molested, I had (and have) loving parents and all the other things that one would associate with a middle to upper-middle class life. I was just depressed virtually all of the time, I let the little things get to me, I slept a lot, hated my job and generally just didn't like my life (I was never suicidal). Now most days are good days and I don't hate my job. I still have a bad day every once in a while for the same reasons other people have bad days.

And after discussing things with the psychiatrist and going over the various side effects of the drugs that might work, we both agreed on a drug and she gave me some free samples to try for a couple weeks, so sometimes free samples are a good thing.

On those rare days I forget to take my pill, I start noticing myself get all worked about the little things again, so the pills do work.

And yes, there was about 3 1/2 years of counseling which, with my counselor's agreement, I just recently stopped, since she agreed that the visits were no longer needed.

[denem]

16. You lie.

DU knows better,
from personal experience
:sarcasm:

+8 and counting.

[Lurks Often]

43. LOL

:rofl:

Not that I give a rat's ass if other people think it is all some sort of trick being pulled on me. The important thing is that I am happy and if that doesn't fit into other people's agenda's and beliefs oh well

[Lisa0825]

20. I agree.

Been there, done that. Meds worked for me.... like a charm.

[RaRa]

30. Ditto

I went to a counselor not even thinking I was depressed. There was a definite disconnect that the counselor recognized and she mentioned the neurotransmitter issue. It clearly worked for me. I'm staying on them indefinitely because they have given me the added benefit of drastically reducing the frequency of my migraines. I agree that drugs are often too readily dispensed, but our brains are chemical (sorry Tom Cruise, you idiot) so it stands to reason that sometimes that chemistry gets out of whack and can be corrected with drugs.

[EFerrari]

38. Yep. Me, too. It makes a big difference for me. n/t

[bananas]

53. Yes, as the OP clearly states,

One exception to the study findings, DeRubeis said, was people with dysthymia, or chronic, low-level depression. The current analysis assessed severity of symptoms, not chronicity, DeRubeis said. Other studies have established that people with chronic depression, no matter how severe, tend to respond well to antidepressants while other treatment may be ineffective.

Thanks for confirming the article with your own personal experience!

[Socal31]

8. Maybe people actually need to make a fundamental change

in their life, instead of taking powerful chemicals?

[Psephos]

51. What needs changing is the way we live.

For many, depression is a natural, ancient reaction to a milieu that provides little of what we actually need for emotional and physical health, and way too much of what we don't need. Our way of living, with its inescapable pressures, artificial stresses, disjoint and distorted nutrition, and overspecialization does not provide the environmental, physical, and emotional elements necessary for a meaningful and healthy life. We evolved in tribal groups with strong cross-group bonds, extended families, meaningful roles for each member, daily challenges that kept us physically and mentally sharp, and little doubt about what we were on Earth to do. Take these away and the epidemic of anomie, depleted energy, and dull dread is more understandable.

Given that modern culture is not going away, the knowledgeable use of meds that can help restore some of the physiological states made absent by an ill-fitting environment is both sensible and humane.

[wroberts189]

11. The only cure is less republicans and more cowbell.

http://en.wikipedia.org/wiki/More_cowbell

[patrice]

12. That's pretty much my experience.

[Odin2005]

14. What a crock.

[denem]

15. Indeed. But it's profitable

for psychologists. Big Pharma ain't the only interest group out there.

[Odin2005]

17. Good point.

[denem]

18. The Golden Rule -

follow the money.

Big Pharma = Obvious
Psychologists = White Knights
and I do mean White.

[bananas]

40. The Pharma Marketing Blog: "A Common Goal of Research and Marketing: Fool the Doctor"

(larger image at the link)

http://pharmamkting.blogspot.com/2010/01/common-goal-of-research-and-marketing.html

A Common Goal of Research and Marketing: Fool the Doctor

<snip>



"What makes our findings surprising," say the authors, "is the high level of depression symptom severity that appears to be required for clinically meaningful drug/placebo differences to emerge, particularly given the evidence that the majority of patients receiving ADM in clinical practice present with scores below these levels."

What about all those clinical trials trials that "prove" effectiveness? It turns out that to be eligible for these trials, patients must have pretty high depression scores (HDRS greater than 18). These are precisely the patients most likely to benefit from treatment. "Such cutoffs," note the authors, "can be expected to exclude nearly half of all patients who meet diagnostic criteria for MDD ."

But it is not likely that marketers of antidepressants point this out to physicians, especially not to general practitioners who often prescribe antidepressants.

As the authors note: "This important feature of the evidence base is not reflected in the implicit messages present in the marketing of these medications to clinicians and the public. There is little mention of the fact that efficacy data often come from studies that exclude precisely those MDD patients who derive little specific pharmacological benefit from taking medications."

<snip>

[denem]

49. SIX Studies

vs Hundreds.

[bananas]

23. So, you are anti-psychiatry, anti-med, and anti-science?

See post #10.
The study was done by a team of psychiatrists and psychologists.
Part of their conclusion: "For patients with very severe depression, the benefit of medications over placebo is substantial."
There are many other peer-reviewed scientific studies with similar results.
Perhaps you are one of those anti-science woo-woos who does not believe in the placebo effect.

[denem]

27. They review SIX studies!

Spare me.

[depakid]

47. It's well known among clinicians that anti-depressants have poor efficacy for certain conditions

Hence the term refractory depression.

Sometimes patients may respond favorably to one of the anti-depressants for a period of a few months, after which mood levels drop and dythymia returns. Other times- there's little or no effect on mood.

This is why effective treatment courses need to include talk therapy- cognitive behavioral therapy being one of the more common approaches, along with a focus on Axis IV psychosocial and environmental problems.

No 'lil magic pill is going to without taking negative thought, feeling and behavioral patterns into account- and it ain't going to help with strategies to improve the quality (or breadth) of one's relationships or environment.

[Odin2005]

31. I'm anti-bad science.

[Psephos]

52. If that's true, then you should read up on dynamic feedback loops in neurotransmitter systems

Your view is Newtonian and not applicable here. The actual mechanisms that control emotions are fractal and nonlinear, and their homeostatic endpoints cannot be determined from initial conditions. Cause and effect don't work the way one might think in this realm.

You might google "strange attractors" for a start. What you find about chaotic systems will not seem intuitive, but then, neither does quantum physics.

Take a look for William Calvin's books on the interplay of physiology and psychology as well. Wise, enlightening, and readable.

[Blue_Tires]

34. in my case, it was a combination

of mixing and matching meds until i found something that worked, getting out, cutting a lot of bad habits, lifestyle changes, exercise and the like...

[Jim Lane]

35. I was an experimental subject in a study of depression meds

It was a double-blind study of the efficacy of Wellbutrin for mild to moderate depression.

This was no placebo effect. At first I felt no difference and I thought I was probably on the placebo. As they upped the dosage, though (ending at 450mg/day), I definitely felt an improvement. By the time of the unblinding (the moment at the conclusion of your trial when you and the psychologist in charge find out which pill you were on), I was guessing that I was on the drug, and I was right.

Some people in this thread have commented that the quoted article was based on only six studies. It just seems to me that there must be more research out there. There are many drugs that would have to be tested thoroughly before you could make a sweeping dismissal of medication as a treatment for mild to moderate depression.

[fascisthunter]

36. so much is misunderstood in regards to depression, and unfortunately it's mainly due to...

big pharma's reputation. People really do need medication for clinical depression, medications out there do work for some while not others. I'm not disputing the findings of this report, I just can sense a general disdain for Big Pharma and by extension those who rely on big pharma for depression.

With that said, I also know for a FACT, that some folks put their kids on meds for just about anything because the parent is mislead by people they are surrounded with or because they just want a quick fix for their kid's problems.

[RattusRattus]

39. Yuppers

The woman talking about nutrition, hormones, etc., is correct, they do play a big role in depression. I feel better now that I have a better diet, am not on birth control. When I start exercising and meditating again, I suspect to also feel an improvement. I go see a therapist regularly, and with her I tackle some of my "big issues." But...you're going to have pry my Wellbutrin out of my cold dead fingers if you want it. The impression given by pharma is that you can take a pill and be done with it, and maybe that's true for some people, but not myself, by any means. Then you have the anti-pharma crowd who are touting cures, which as I said, in some cases aren't totally crazy, but they're not interested in the role that medications play, and demonize them because of their source. Depression is much more complex than this study makes it out to be; and why they're studying tricyclics (old school antidepressants) is beyond me, when you have drugs like Wellbutrin, etc. out there, that aren't technically SSRIs, but are proving efficacious. Of course, the fact that people are finding relief from anti-convulses should high light how very little we understand about the brain in general. We know very little about sleep for that matter, although we spend about 1/3 of our lives engaged in this activity. Of course, we've all heard about insomnia, but still, there's not a lot known about it. I read a great book, the author's name escapes me, called "Insomniac" on this subject, and it was mildly terrifying.

[fascisthunter]

41. you know, you just made me aware of something

the fact that they are studying something out dated is a bit strange.

Insomniac is written by Gayle Greene... thanks for that.

[Demeter]

37. Depression is a Symptom, Not the Disease

Feelings of depression, or behavior that is called depressive, says something is wrong. We don't have any good means of testing the brain chemistry to figure out what exactly it is.

So the game of trial and error starts: try a med, vary the dosage, wait for results.

It's a brutal way to a cure; my daughter suffers the effects of a genetic disorder which has the added problem of making it nearly impossible for her to discuss how she is feeling with any accuracy or useful information.

A very patient Psychiatrist who listened to her mother helped test out various neurotransmitter-changing drugs and construct a drug regimen which has brought her great relief. It took YEARS, and is ongoing, as weight-changes, diet changes, etc. alter the dosage that is effective. She now takes 3 drugs with noticable relief due to each.

This is an area where medicine is still an art, not a science. Alas, that psychiatrist has since retired. Her new shrink is not as experienced, but she's learning to listen to the mother...which is another story.

[fascisthunter]

42. it does take years

it's been a long road for me.

[BlueIdaho]

45. I was lucky...

I was able to work with some talented people who helped me find a Prescription that worked on the first try. I also spent quite bit of time with a counselor doing "talk therapy" and behavior modification exercises. The medication was the key to getting me to a place where the other therapies had a chance to work.

My sister's road has been a more difficult but in the end she too found the right combination of medication and talk therapy to improve her life.

Depression is absolutely paralyzing - anyone suffering from long-term chronic depression should seek out any and every kind of solution and use what works for them. To hell with any "outsider" who decides they couldn't possibly benefit from a course of action.

[fascisthunter]

54. I've Lost Years of my life to depression

I remained creative during the process, but if you asked me to remember something else during those years, I would probably have a hard time remembering due to all the trial and error I put myself through. But in the end it was worth it for me... I felt I had no other choice and just pushed forward.

[denem]

55. Gee. My sister's currently getting ECT for her 'Symptoms'

2007 enjoying her work as a Geneticist, good relationship with her boyfriend. Now it's once every six weeks. Why didn't someone just tell her to snap out her 'symptoms'.

No Doubt Big Electricity Utilities are behind her doctor's advice. And yes, BTW, her boyfriend has stuck with her. She's worth it, symptoms and all.

[Demeter]

57. Either your Post is Misplaced and You didn't intend to respond to mine specifically

Or your reading comprehension has suffered due to your sister's distress.

[krabigirl]

44. I always wondered why psychologists don't study the society itself, which is sick.

People become depressed as a result. It's not sustainable or healthy.

[depakid]

48. They do- and coping strategies (or strategies to change one's environment)

are (or should be) part of any course of treatment where these sorts of factors turn up.