Anti-depressants "of little use"

[morningpaper]

Anti-depressants 'of little use'

"New generation anti-depressants have little clinical benefit for most patients, research suggests. A University of Hull team concluded the drugs actively help only a small group of the most severely depressed."

I'm not surprised by these findings - I took antidepressants and various other drugs when I had a severe depressive episode over 10 years ago.

I know that people (incl. GPs) want to 'fix' depression but I strongly feel that drugs don't do it. Prozac especially was hailed as the 'wonder drug' at that time but it had no effect whatsoever.

Coming off the drugs was a massive boost to my ego (being dependent on antidepressants etc. I'm sure reminds you that you are 'mad' every morning and evening that you are popping them).

I was 'rescued' by 2 years of psychotherapy. I know it is expensive but when I see friends taking antidepressants I feel really frustrated that they don't spend money on therapy or counselling instead. People think it is 'too expensive' but then they are happy to get signed off work for months. Argh. When I rule the world I will make cheap therapy available to everyone.

Anyway that's my rant of the day

I was very down, VERY down and felt like I had a covering of black over me, like I was walking in a black cloud as if ... well, you get the picture. This was when I was in my early twenties soon after leaving college. I didn't leave the house for weeks.

Then I went to the Doctors and I remember lying down in the waiting room thinking 'no-one will mind if I just curl up here'
They ushered me in somewhat smartly, and I talked to the doc and broke down. He gave me prozac. I had little hope it would work.

In just over a week the black clouds simply lifted. I felt feelings of happiness which I hadn't felt for a decade or so ... stirring memories of being happy as a child. I had LOST that emotion for so many years.

Over the next three months I sorted my life out. I went to work in hospital radio ... which led me onto a post grad course in radio journalism ... which led to a really great career which I loved.

I was only on the things for three months and I swear they allowed me to turn my life around.

One thing I would very much like to know is whether they used one low standard dose of one AD to test this out, or whether it was different ADs at different levels.

It's certainly not accurate for anyone to say that this research shows 'ADs don't work' - the fact that there was no significant difference between AD group and placebo group doesn't show the drugs don't work, but simply indicates that some people's depression would naturally get better with or without treatment. If that makes sense?!
They're powerful drugs whether they help or not. And to echo others, dangerous to suddenly stop without medical supervision.

I had severe PND, was suicidal. I cringe to imagine what may have happened to me if someone said, 'Oh, AD's don't work,' because of one study.

Assuming the research was properly carried out and as persuasive as the media suggests - it might just mean the wrong people are being perscribed ADs.

A GP often has just one 15 minute long encounter to decide whether you are unhappy or clinically depressed. Sometimes they will get it wrong. And some people who really are clinically depressed won't respond to the drugs.

Great news about more CBT therapists!

Um, this research does show something very interesting. Everyone in the field knows about publication bias - that somehow, magically, studies that show a drug works are much more likely to be published in medical journals than studies that show no effect.

What these researchers did was get hold of the unpublished studies - the ones the drugs companies were sitting on. And when you look at the full picture, the drugs are not as effective as it was claimed.

Doesn't mean they don't work at all - but does mean they are much less of a magic bullet than they might appear. Same effect happens across medicine more or less - that when a drug is new on the market, there will be loads of studies showing it's much better than placebo. Ten years later, somehow, it's far less effective.

Btw, the makers of Seroxat also hid studies that suggested it might actually increase the risk of suicide in some patients, especially children. The truth gradually emerged thanks to some very doggged researchers - who got little thanks for their pains.

This was an earlier post but yeahbut - not everyone who has mental health problems caused by stuff in their life has had a huge traumatic incident, small stuff can have a huge effect too!

I think its good that therapy is being promoted more. I am not sure about ADs - they were not suitable for me, but for other people I am sure they are.

I think the issue is that so many people assume feeling 'depressed' = clinical depression with a chemical cause and thats not true. I have real problems with this at the moment because I am a bit suicidal and am self harming and so many professionals I encounter just assume I am clinically depressed and should be on tablets. Mental health is not black and white and its no bad thing if we move away from that.

Lots of interesting posts

dizietsma my experience was similar to the one you are describing - I went to the GP with severe depression/self-harming issues asking for talking therapies. I ended up being given more and more harder drugs and getting worse and worse side-effects, until I ended up having a full-blown psychochotic breakdown and ended up under psychiatric hospital care. Some of the drugs I was prescribed are now banned. In the end the GPs/etc gave me an ultimatum that basically they thought I needed inpatient treatment on lithium. It was then I found myself a psychotherapist and I was then on the road to recovery. I often wonder whether the side-effects of the drugs just made me worse and worse, which could have been avoided if I'd been given proper talking therapies in the first place. The trouble was, I had a lot of family history of depression/psychosis so I think I was authomatically assumed to be 'broken' on some chemical level, and it was just a matter of finding the right drug to 'fix' me.

Agree with posts that say that for some people, drugs ARE helpful (I have friends that swear that certain drugs have lifted them completely and turned their lives around) - but I think that the 'right' people are probably rarer than is generally thought

I once worked with a fantastic psychiatrist who said that ADs were helpful as they often allowed to patient to see what was possible re change, and should only really be used in conjunction with talking therapies.

He felt that they had their place in helping to facilitiate other therapy, not as a sop.

He also felt that their use was largly futile when people were depressed for very obvious social reasons, isolation, povertly abusive relationshops etc

well i agree generally that SSRIs are no better than placebo. unfortunately we can't prescribe placebos. There is some evidence that the name 'antidepressant' is therapeutic. the placebo effect includes not just a response to being on a drug, but also the people who would get better anyway.

there is no way of knowing if you would have got better anyway.

the paper reviewed papers of other studies which looked at participants with moderate or severe depression - so not mild depression or problems in living

it is important to bear in mind the provenance of the study too - people who are against antidepressants and have previously written against the prescription of antidepressants which have no doubt affected the way in which the results have been presented. Also the media have exaggerated that antidepressants are ineffective- the actual results are that SSRIs are less effective than previously thought, not that all antidepressants are useless.

these studies were of course for unipolar depression and not bipolar. although the evidence is clear that SSRIs are not effective in bipolar I or that the risks far out-weigh the benefits.

The paper is specifically about SSRIs (fluoxetine, paroxetine, sertraline, citalopram, escitalopram). I don't like these drugs very much. It is not about TCAs (which include lofepramine) or mood stabilisers (like lithium or lamotrigine) or the other newer antidepressants such as mirtazapine, trazodone, moclobemide, reboxetine etc. which are often underrated.

I think the reporting has been slightly irresponsible in that it will have confused thousands of people who are currently on antidepressant medication.

The best study we have of antidepressants in real world situations (not clinical situations) show that they do have a role, but are not as efficacious as claimed, and take much longer to take effect (6-8 weeks as opposed to 3-4weeks). In the future we will be able to know which individuals will benefit from medication and which antidepressant they will benefit from at the beginning of treatment.

i think there is defo an argument for cheap therapy. I was on AD's after te birth of my eldest and the twins.

i did it the second time becuase i was desperate

but they didn't work the first time

you really seriouslyge to aplace ( for me rocking in front of the washing machine for instance) where you have to say to yourself " i can be this anymore." and you make you better not anythin else

i have ben told its a chemicle imbalance andso maybe itdoes work on v. severely depressed people - maybe i wasn't depressed enough ont he depression scale - i dunno.

but i do think that lfe gets hard sometimes - i know its al relative - but even taking that into consideraion - tere is a degreeo normal sadness and unhappyness that we must endure - thats life. and i think some some mistake that for clinical depression and maybe it isn't so

I agree with you there custardo

I read through a lot of threads here before I recognised that I probably had PND. I also read the (many) threads on depression and medication before taking the ADs. Obviously it's not any kind of scientific study, but I took from it the firm conclusion that ADs really do help many people, while there are (in this case a smaller group) who feel little or no benefit, or that the side effects outweigh the good effects.

I took Citalopram after 3 years of depression, and bonding issues with DD2, and I felt totally better within weeks.
I don't think it was a placebo effect, as I had already tried the Patrick Holford HTP5(?) tablets with high hope of a cure, but no effect.

I really do think this has been wrongly reported. I have worked in the mental health field for many years and have seen ant-depressant therapy of all classes work very well. Efficacy is increased dramatically when used in conjunction with one of the psychotherapys, and I would never advise any of my patients to rely on chemical therapy alone.
I think the fault lies with many primary care services, depressive disorders are wrongly diagnosed by over-worked and under funded GPs. I see many patients in A&E who have been prescribed ADs with little or no evidence of depressive illness, even pre-medication. Socio-economic and environmental factors have a far greater effect on an individuals mental state than some GPs acknowledge.

I think there is a place for antidepressants when appropriate. There are many types of depression, some of them are reactive to life's events, or learned negative thinking, while other types I believe are genuinely related to a chemical imbalance in the brain. I've had depression on and off for the past 15 years and I use a lot of things to deal with it: regular exercise, healthy diet, not too much alcohol, active social life. However, I occaionally have times when the black moods take over and only an antidepressant helps. When I took Prozac it really helped; however I have tried some other SSRIs which had no effect.
I also had CBT, but had to wait 15 months for it!

The report should not be taken at face value. Anti-depressants do work for people with chemical imbalances.

And that's really good for you MP, but the price of private therapy excludes it being a choice for many.

i hate all this! i have struggled with 'unhappiness' for most of my adult life and finally got fed up and went to the doctor, am on prozac and tbh it does work. it is not a fecking placebo. i works for me the same way taking a paracetamol works for a headache. i am crazy weeping mess so i take prozac and i am abit better.

now i am being made to feel like an even crazier fraudster wtiha middle class malaise that is all in myl head. just when talking about mental health got more acceptable we all have to scuttle back to the embarrassed and ashamed tent.

I have been to the place where you say I just cannot do this any more, I cannot live through another day and what got me out of there was SSRIs. Were it not for them I would never have got out of that dark hole and would have continued to ruin my own life and those of my children and husband. I don't care what the scientific evidence is, the strong anecdotal evidence is that they do work and I'm going with that.

STG, i sincerely hope this report doesn't do that. As MT says its a chemicle imbalance.

i think paracetemol can't cure everyones headache - the same analogy (maybe) could apply to ADs

sadly cost prohibits choice in most instances

but You have come to a point of recognition and saught help, i think that you should be applauded.

thanks custard, if you actually look at the research it makes sense but most folk just see the big headline 'prozac doesn't work' and write off folk like me.

Sheherazade I understand your point of view.
Regrettably this sort of media announcement is likely to bring about the Tom Cruise type hysteria against ADs.

However, what they arre saying like martianbishop explained is just that ADs are not as effective as advertised.

And as Custy added not for everyone and not every situation. Life brings about lots of challenges and that's not necessarily clinical depression.

It's still a matter of choice. Just like seriously depressed people previously had the choice to just pop the pill and forever postponing the therapy when they and their doctor perfectly knew that ADs would just be buying time and not addressing the underlying issues.

x posted

Sadly I really think some GPs will use this to withhold ADs in cases such as PND were depression is considered as a mild transitory phase. iykwim?

I'm not so sure it's so black and white that depression is due to a chemical/heredity cause OR a circumstantial one, is it?? For most of us, it can be a mixture of both.

In my v. limited experience, there is definitely a place for ads for those with severe depression. As already said, you need to be able to get up and out of bed to benefit from alternatives.

Hwr, and I know it's an unfashionable view, but I still think proper psychotherapy is the best way forward despite it being hard to find someone good with whom you 'click' and it being a considerable investment in time and money.

Psychotherapy done properly is often misunderstood: there are too many cliches surrounding it. It's not about hand-holding, offering wishy-washy "empathy", nor is it necessarily about exploring trauma in your past (although this may come in to it). It's about emotional intelligence and resilience and being brutally honest. It's about how you deal with yourself, your thoughts, your circumstances and with those around you every day in the "here and now". It's about "who you really are and why". Without those sorts of insights, it's quite difficult to change significantly.

Although I'm sure there are many good things about CBT and it also has its place, I am also suspicious of these very short cures. Most of the problems they are used to fix (such as depression, anxiety, phobias) do not just occur in a vacuum. It takes time to get to the bottom of the causes rather than just treat the symptoms.

But in these cash-strapped times (for mental health anyway!) resources are short and no-one wants to know.

but the chemical imbalance thig is just a theory still.yes there are some types of depression that appear out of the blue for no apparent reason,but it is only assumed that these are caused by a chemical imbalance.

i am not against ad's,they have helped me in the past,but they have also in the past made me worse.i now believe that AND developed into PND this time because i was still on ad's when i no longer needed them.

and i think its awful that people are being told they have to stay on a 'maintenance' dose of ad's for life-becuase they are addicted to them and get withdrawal symptoms when they stop them,but are told these syptoms are a relapse.its not the same as being dependent on insulin,we are talking about forever taking drugs that may or may not be helping.that is just greed on the side of the drug companies IMO.