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

Good analogy Custy!

Theory?? What do you actually believe theories are Diva? Evolution is a theory, it is also a consolidated factual theory. There are factual theories in psychology, neurology and many medical sciences.

Theory does not equate to quackery

As a long term depression sufferer for 7 years now, i strongly agree that anti-depressant tablets do not work in most cases. Depression is a state of mind and so therapy and counselling really are the best thing for it. Talking things through and trying to get out of that mind set is imo, the only way to fight it.

I once read that to really fight your depression you have to make life changes and get out of the habit ways you become attached to. If your just going to stay the same and do the same things you do when your severly depressed and taking the anti-depressant tablets in some hope they will be a miracle cure, you are going to be disappointed.

Anti-depressants are supposed to be abit of support to make you feel better about things while you make the appropriate changes in your life. They are not supposed to be taken soley on their own without you making any effort to change things. That's all they do, make you feel better about things. They are not a life long solution to cure depression.

MsSparkle, that's your opiniion. Would you really want medication withheld from those who it works for on the basis of such predjudice?

Perhaps what has led to this result it that SSRI's have been so widely prescribed in recent years, ie not just to those with severe depression, but to those with relatively mild symptoms caused by a variety of factors. For those in the latter category I think it is not particularly surprising that a placebo might be equally effective (see Ben Goldacre on how effective placebos can be for all sorts of conditions).

I took prozac in the 90's for what was probably relatively mild depression, and I'm sure that for me part of its effectiveness was as a placebo. I started to feel better before the drug could have had any real effect chemically. I think it's because the act of taking a pill is a statement to yourself that the depression is an imbalance that can be cured, rather than a condition all of your own making which you are somehow too stupid, lazy and generally deficient to rectify. Taking the pill can therefore relieve some of the guilt that is often such a big part of depression - it gives you permission not to be unhappy.

I think the reporting on this is really unfortunate though, and my heart goes out to anyone who is taking SSRI's at the moment.

totally agree with Ms sparkle.

If anyone wants to read the article, it's in an open access journal.

Alot of people do mix up depression with sadness though. I feel the word "depression" is used too often these days and most don't even know what it is. Saying that, it is very hard to describe what it is and few people understand it but i do know it doesn't just go away. It's like annorexia or like being an alcoholic, it never goes away completly and there's always a chance it will come back.

Doctors just give out anti-depressants now like a headache tablet. A couple of years ago i knew this guy who's girlfriend of 3 years had just gone off with another man. He was crushed and his mother made him see the doctor because he was so miserable. The doctor gave him anti-depressants.

All this guy needed was a few weeks to heal and get over her leaving him NOT anti-depressants because he wasn't depressed he was simply sad and upset. He didn't take the tablets in the end and suprise suprise he was fine after a few weeks.

My dp was offered anti-depressants a few weeks ago. Dp had gone to see the doctor because all his joints hurt and he just feels physically drained. The doctor said "oh you must be depressed, i'll write you a prescription for anti-depressants..." Dp told the doctor he wasn't depressed (my dp is the most un-depressed person you could meet) and so the doctor had to think again.

I agree, just as many people don't know what it is but still think their anti-ad comments are valid.

Good link GreenGlassGoblin. Interesting that in the severe cases the difference was that the placebos worked less well rather than that the medication worked better.

that was my take on it too Iorek - only skim read it because I was at work, but (like so many of these things) I don't think it says quite what the media are saying it says?

Thanks for the link GGG,
having skimmed through it (at work also), it looks like the reporting of this has been v. irresponsible, though it does highlight problems with publication bias.

see this diagram of the results Would anyone here, with a background in a quantitative discipline, be willing to fit curves to those clusters?

I think the crux of the report is saying that anti-depressants work no more than placebo with patients who are not depressed. It's more a call for stricter criteria between normal reaction to traumatic lifetienm events and chronic clinical depression.

The whole Jeremy Vine trend jumping to negative concusions is incredibly iresponsible and insufferebly smug

not clinically depressed

Monkeytrousers - but is the report really useful? The meta-analysis included: thirty-three trials of 6-wk duration, six trials of 4 wk, two of 5 wk, and six of 8 wk.

It takes 4 - 5 weeks from the time you start taking prozac to reach a steady state and I was advised that it usually takes between 4 and 8 weeks for it to start working. So very short trials might bias the study in favour of placebos.

Their conclusion that SSRIs don't work no better than placebos for those who are not severely depressed is based on a single study. "The curvilinear relation depended on only one trial of moderately depressed patients. When that outlier trial is excluded, there is no relation between baseline severity and antidepressant response." There is very little detail given about that study and whether there was anything else that could explain its outcome.

All this fuss is based on one trial which we know next to nothing about.

And I may be being overly harsh here, but the work had no specific funding (so no one ever had to peer review their ideas at that stage), and is published in an open access journal. I don't know much about PLOS Medicine

If 'naturally occuring' chemicals like adrenaline and seratonin (sp?) can affect your emotions, surely an extreme imbalance of these chemicals can affect you adversely?

I would think the "curvilinear relation" says more about the researchers prior beliefs than anything else

Meta analysis in itself need not be automatically a bad thing, but there are a few other elements which apparently make it dubious from a strictly scioentofic perspective.

I just wish the media would stop publishing everything that is thrust at it, the only criteria being that it causes alarm and confusion. This has to be the opposite of that media is meant to do.

I think the fact they had no funding is because no drug company wants to fund work that might show their products aren't as effective as claimed! That's the whole point - that drug companies hide studies that don't give the 'right' results and that studies in peer-reviewed journals suffer from publication bias. That's a widespread, established issue.

And Seroxat shows it at the sharp end - it was only when lawyers got involved that Glaxo were (eventually, after much obfuscation) forced to disclose the negative studies. They were covering up deaths.

Doesn't mean ADs don't work, or that there's anything wrong with a placebo effect - it's very powerful and jolly useful. But it does mean what we think we know about drugs is not, in fact, that accurate.

It was the media, in fact, who exposed Seroxat. People were dying and the regulators (and the relevant Royal College) were happy to ignore the problem.

The media report the studies that are published. This study happens to be negative but media reporting tends to favour positive studies. Because that's what's in the scientific journals and those are the papers the journals press release.

I agree with monkeytrousers about the normal sadness vs proper depression.

And also with mb about the combination treatment but they obviously do work for some people and no-one has come up with a magic formula for working out who they work for and who they don't.

And for some people, therapy does absolutely sweet fa.

It's such an imprecise science, mental illness.

I remember the Seroxat relevations. Just awful that they hid those side effects.

Edam - I don't mean the conclusions are wrong, my own personal experience of depression on the NHS leads me to suspect they might be right.

But read the study. It is less then convincing and I doubt it would get through peer review.

Why is it that the media no longer feel the slightest obligation to have scientifically literate people writing, or at least fact checking in relevant fields?

I haven't read the study YET, but in general, there are problems with making too many inferences from meta-analyses.
I don't believe that Prozac and citalopram have only a placebo effect anyway, I think they have a true effect in some patients. If they were only equivalent to placebo, it would be highly dodgy given the potential adverse effects- would you like a placebo that totally switched off your sex drive, for example?