Antidepressants not much better than placebo?

[Jackpine Radical]

The FDA finally owned up to what a lot of people in the profession have known for at least 15 years: SSRI antidepressants tend to increase the suicide rate in those who start them, particularly in the first few weeks.

But not a lot of people seem to be aware of how relatively ieffective the antidepressants (tricyclics, SSRIs, atypicals, MAOIs, whatever) are in treating depression. Check out these two papers.


http://www.journals.apa.org/prevention/volume5/pre0050022i.html

In the Kirsch and Sapirstein (1998) meta-analysis, 75% of the response to active medications was duplicated in placebo control conditions, and the placebo effect (i.e., the placebo response minus changes observed in no-treatment control conditions) was about double the active drug effect (i.e., the drug response minus the placebo response).

and

http://www.journals.apa.org/prevention/volume1/pre0010002a.html

ABSTRACT
Mean effect sizes for changes in depression were calculated for 2,318 patients who had been randomly assigned to either antidepressant medication or placebo in 19 double-blind clinical trials. As a proportion of the drug response, the placebo response was constant across different types of medication (75%), and the correlation between placebo effect and drug effect was .90. These data indicate that virtually all of the variation in drug effect size was due to the placebo characteristics of the studies. The effect size for active medications that are not regarded to be antidepressants was as large as that for those classified as antidepressants, and in both cases, the inactive placebos produced improvement that was 75% of the effect of the active drug. These data raise the possibility that the apparent drug effect (25% of the drug response) is actually an active placebo effect.

[soleft]

1. I disagree with these findings based on personal experience

Myself and others I know.

[yardwork]

2. I can only speak for myself.

Antidepressents have helped me a great deal. I sometimes felt suicidal before I went on SSRIs - since then, I never feel suicidal, and I am much, much better.

I distrust anything this administration says. I suspect that there may be a hidden religious agenda behind this attack on antidepressents, as in "the power of prayer is all you neeed." Also, what a lovely excuse to stop covering antidepressents through private insurance, Medicaid, and Medicare if they've been "proven" not to work!

Count me as deeply suspicious of this study at this point. I'll wait to see a lot more corroborating data.

[Classical_Liberal]

3. I disagree

I would be alive without ssris!.

This is a responce to the Scientology crowd.

[adriennel]

4. thanks but no thanks

I have tried a variety of anti-depressants over the past 15 years. Some work, some do not. One medication in particular saved my life. When I tried to go off of it, I got depressed. When I started the medication again, my depression lifted. This was not due to placebo effect, as I tried a number of medications that did absolutely nothing.

[Frances]

5. Anti-depressants have made a HUGE

positive difference in the lives of 3 people that I know.

[lazarus]

6. Heh

65 posts already discussing this over in LBN, just to let you know.

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=102x437983


On edit: Hopefully Snow will weigh in soon, he did a nice job clarifying exactly what is meant here by "placebo" effect. It's not what I thought of as a classic placebo, at all.

[xultar]

7. I think for the people where they didn't work they had a wrong diagnosis

I take an SSRI. My meds works for me. I haven't had problems except when I don't take them.
That's all I can say.

[nothingshocksmeanymore]

8. While I appreciate the sentiments of everyone that says these things work

I have personally seen people declaring they work while all the while demonstrating bahavior indicative of the fact that they don't.

I don't believe all sufferers should be generalized in the same category...people suffer from depression for a variety of reasons and people come to develope personality disorders for a variety of reasons...some organic some not.

The only point I would make to those that compare SSRI's to drugs for diabetes and hypertension is this:

We don't treat diabetes without a glucose tolerance test.
We don't treat hypertension without testing your blood pressure.

Why are 30 million people taking medications treating a chemical in the body for which there is no measurement?

The drugs MAY work for SOME people ...but there are a GREAT many people in need of BEHAVIORAL modifications (just like diabetics and hypertensives ALSO modify behavior in order to be successful in their treatment) and I see MANY people taking drugs and doing NOTHING to address the behavior modification necessary to insure the drug's efficacy.

[windstrider13]

9. SSRIs are worthless?

Six months ago I was on the verge of suicide. Today I am happy and healthy, with a more or less positive outlook on life.

Celexa changed my life for the better.

I had tried therapy, changing behaviors, etc. None of it worked.

Were the authors of the study aware that not all SSRIs work the same way for everyone? Zoloft did nothing for me, but Celexa did.

I would want to read the study before putting any kind of faith in it, especially in this politically-charged government.

Bryan

[rucky]

10. Where can I get some of this Placebo stuff?

because if they work as well as antidepressants, sign me up.

[SoCalDem]

11. They did nothing for me..and I tried several

I know they help some people, but I was not one of them..

[prodigal_green]

12. I participated in a double-blind 1 year study

and trust me--they do work. I had no idea when I was on or off the drug, but I nearly died when I went off. The only thing that prevented me from taking my own life was the fact that I knew there had to be something going on within the study.

I told the researcher and they immediately unblinded my case. Turns out I was great while on, hit rock bottom when off. They can say what they want, but I know what I need to do to manage my health.

I agree that they are probably often prescribed for people who don't need them, but that doesn't mean they don't work.

[Snow]

13. Like all meds, some things work well for some people,

and some things don't. I note that the meta-analysis article is from a defunct journal, 1998, and was accompanied by some interesting commentary.
http://journals.apa.org/prevention/volume1/toc-jun26-98.html

See what you think. I think the placebo effect is an interesting and under-utilized phenomenon, but I'm a bit suspicious that the authors are recommending a psycho-therapeutic approach. There are some major turf wars on this issue between the drug/biochem types and the talkers. Seems a shame; I know a number of people who use both approaches together with excellent results - usually an ssri and CBT - cognitive behavioral therapy.

Those of you who don't like the med use, would you espouse banning the anti-depressants? If not, what would you prefer, and what is your evidence for your position?