Anti-depression drugs work about as well as a placebo

arbilad · Head Chef

Anti-depression drugs work about as well as a placebo

rayb · Hot Air Balloon

Shhhh!!!

Organist · Senior Member

Don't throw out your fluoxetine just yet

There was no link to the study, so I'll wait till I can critique their actual study before casting judgement. This seems to run counter to many other studies, which means their techniques and statistics will be under greater scrutiny. Meta-analyses (comparing all similar studies in the same study) are notorious for using bad statistics, though when done correctly, they pretty much set the standard.

3 pillars of depression treatment:
Psychotherapy
Exercise
Medications

The first two don't seem to be emphasized too much.

Organist · Senior Member

And don't forget electroconvulsive therapy, which works better than any of the other chocies.

Pt314 · Senior Member

I take 40mg of Prozac a day for my Obsessive Compussive Disorder (actually pretty low for people with OCD), and when I forget to take it, I have a much harder time reigning in my obsessions and compulsions.

These types of drugs help people who have physiological reasons for depression or other disorders, not much for people who are just depressed. I don't know how much this was taken into account in the study.

-- Edited by Pt314 at 15:43, 2008-02-26

Duke of Mirth · Profuse Pontificator

Is electroconvulsive therapy where they put the electricity through the frontal lobe?

I had a guy tell me about how they would do that to post partum women and people with schitzophrenia and he swore the results were amazing.

bokbadok · Senior Bucketkeeper

arbilad wrote:

According to this study, anti-depression drugs work about as well as a placebo.

Sounds like a conspiracy.

/sarcasm

-- Edited by bokbadok at 18:22, 2008-02-26

Cocobeem · Keeper of the Holy Grail

Pt314 wrote:

much harder time reigning in my obsessions and compulsions.

You're joking, right? You're ... all ... joking.

*twitch*

Dyany · Senior Member

I know when I started back on anti-depressants 2 years ago the difference was like night and day. I kept telling my shrink, "do normal people really think this way?" Not only was my mood and outlook improved significantly, but I actually have noticed changes in the way I THINK -- the oppressive, raging thoughts that everyone hates me and I'm not good enough are once again pressed into their proper place of being silly, unrealistic thoughts.

I think that a lot of people get put on antidepressants when there really isn't anything much physically wrong with them, they just need some psychotherapy to learn to deal with things in a better way. (Psychotherapy helped me, too, it just couldn't take away all of the depression.)

Cocobeem · Keeper of the Holy Grail

You know, having a horse really helps with this, too. I'm not joking, either.

rayb · Hot Air Balloon

Heh. Imagine going to the pharmacy for one of those. :)

arbilad · Head Chef

I don't remember if the article mentioned it, but what I heard on the radio about this is that they're not saying that anti-depression drugs don't work, just that a placebo has the same effect.

bokbadok · Senior Bucketkeeper

Cocobeem wrote:

You know, having a horse really helps with this, too. I'm not joking, either.

If I had multiple acres of family land on which to keep horses, I'd have a few myself. Unfortunately, I have not yet been able to justify the $300/month boarding costs in order to keep an equine friend 3 miles from my home, let alone the initial cost of the animal. I'm not joking, either.

hiccups · Future Queen in Zion

Ok, so anti-depressants are cheaper than horses.

Cocobeem · Keeper of the Holy Grail

Yes, I am fortunate to have the place to keep them.

And hey! Placebos are cheaper than anti-depressants!

What does that mean, anyhow? The placebo thing.

It really is in your head?

bokbadok · Senior Bucketkeeper

In order for a placebo to work, the patient has to believe it is the real drug. Which means it would cost the same as the real thing - doctor prescibed, copay, the whole shebang. What I'd like to know, is does the placebo produce the same side effects as the drug?

Cocobeem · Keeper of the Holy Grail

Hmm... I'm thinking I could set up a new side business from home...

I wouldn't exactly be a doctor, but hey! Look at Noni juice! Cha-ching!

bokbadok · Senior Bucketkeeper

Rent out horse rides as depression therapy. Cuz everyone knows getting bucked off makes you happy.

hiccups · Future Queen in Zion

Maybe it's the lobotomizing effect of landing on one's head?

bokbadok · Senior Bucketkeeper

That explains a lot about coco.

rayb · Hot Air Balloon

I think a lot of us need some "magic pill" to take the steps we know we need to take in order to improve ourselves. Dunno why, but it sure helps me to have some kind of a trigger (though I don't take drugs, I usually buy a new journal and start writing insane goals in it, or write a new story or something... :)

--Ray

bokbadok · Senior Bucketkeeper

How's that workin' for ya?

hiccups · Future Queen in Zion

The bottom line for me regarding anti-depressants is quality of life. I've seen them make a huge difference in my life and the lives of others. Threads like this make me concerned that people who need them won't get them. I've seen that happen too. And it's awful.

Cocobeem · Keeper of the Holy Grail

You watch Dr. Phil, bok?

Actually getting bucked off might just make you forget your troubles. In more ways than one... ahem.

Anyhoo, ftr, coco has never been bucked off a horse. Don't plan on it, either. I've lost much of my nerve now that I'm old, unfortunately. I did "fall" off once though. I had my Arab stallion El Kobre' opened up in a dead run in this plowed up field and noticed my saddle was slipping to the side (gotta remember to tighten the girth

) so instead of slowing him down (those runs when the tears are streaming out the sides of yer eyes are so dang fun) I thought I'd just shift my weight into the other stirrup and straighten 'er out on the fly, so to speak. The stirrup leather decided to break right then and I was too far past the center to recover. Sort of like a horse-wardrobe malfunction. If I was lying flat on my back I couldn't lift my head for about 2 weeks, but since then I've been better than ever!

Coco's Depression Killing Horseback Rides. $50 an hour. Buckers extra.
(Brought to you by Troxel riding helmets.)

mirkwood · Senior Bucketkeeper

hiccups wrote:

The bottom line for me regarding anti-depressants is quality of life. I've seen them make a huge difference in my life and the lives of others. Threads like this make me concerned that people who need them won't get them. I've seen that happen too. And it's awful.

I've seen this too and agree with your assessment.

Cocobeem · Keeper of the Holy Grail

hiccups wrote:

Threads like this make me concerned that people who need them won't get them.

How so? I'm not following you and I hope I'm not what you're specifically talking about. But tell me if I am. smile

rayb · Hot Air Balloon

Coco's Depression Killing Horseback Rides. $50 an hour. Buckers extra.

I wonder if my insurance covers it. :)

hiccups · Future Queen in Zion

I want to phrase this carefully. I'm not meaning to get after anyone here. There are certain stigmas (within and without of the church) about going on anti-depressants. Things that have come up on other threads, so I'll just nutshell them here:

the idea that if one was more righteous or religiously diligent they could overcome without needing medication

the idea that medication keeps the Holy Ghost at a distance (I've really heard that one.)

the idea that anti-depressants are a sign of weakness

the idea that because one person got through a depression without medication that everyone should be able to

the idea that a depressed person should just "cheer up"

the idea that it's better to just struggle through and fight the fight (even if one is severely affected) -- like it's somehow, I dunno, cheating? to accept medicinal help

AND

the idea that it is "all in your head"

This thread, or more accurately, the article in the OP, plays to the last one there. I'm not sure it's really helpful to anyone.

And yes, I am bitter. I have an extreme bias, because I just had someone die who didn't need to. This person basically gave up on fighting the good fight against health issues, because due to untreated depression this person didn't believe they could do anything about it. Even though there were many chances and plenty of opportunities to changes things over the past 20 years or more.

mirkwood · Senior Bucketkeeper

I'm in complete agreement with hiccups above post.

Cocobeem · Keeper of the Holy Grail

I appreciate your thoughts, hic. I am one of those people who apparently suffers from mild depression, and that only rarely. I thought it was a "big deal" at times, but the more I learn what others have and go through the more I think it's "nothing."

I remember a friend of mine who had PPD... she asked her Mom if she had ever experienced it too and her Mom said, "We didn't have time for that back then." I agree that there are people who need meds for help that are not getting them. There might also be people (and this may be more common??) who really don't need them but use them (abuse them) anyway. On second thought, I started a thread a while ago that dealt with the fact (yes, fact) that more people per capita in Utah were on anti-depressants than any other state and how the Church contributes to that statistic. So yeah. I don't really know what to think.

dianoia · Senior Member

Hiccups, you and I are on the same page with this one. Thank you for your post.

Dyany · Senior Member

Yes, thanks hiccups. And I still say: I have tried some anti-depressants that DIDN'T work. So...where's the placebo effect there?

rayb · Hot Air Balloon

So if it is scientifically proven that antidepressants really DON'T work any better than a placebo, then what?

What does that prove? IMO, it proves that many who take medications don't need them, they just need something to help them help themselves.

--Ray

-- Edited by rayb at 10:03, 2008-02-28

mirkwood · Senior Bucketkeeper

Just like those diabetics. They don't reallllly need insulin. Mind over matter.

rayb · Hot Air Balloon

I know you probably don't learn anatomy at the academy, but I'm pretty sure that insulin isn't produced in the brain...

--Ray

hiccups · Future Queen in Zion

mirkwood · Senior Bucketkeeper

They just taught us where the heart is located and the head.

rayb · Hot Air Balloon

bokbadok · Senior Bucketkeeper

One study does not proof make. I refer you to Dr. Jason's earlier post, which was excellent advice for dealing with new information.

Organist wrote:

There was no link to the study, so I'll wait till I can critique their actual study before casting judgement. This seems to run counter to many other studies, which means their techniques and statistics will be under greater scrutiny. Meta-analyses (comparing all similar studies in the same study) are notorious for using bad statistics, though when done correctly, they pretty much set the standard.

It's natural, when one comes across a study that supports one's opinion, to jump on that as "proof". That's not good science.

arbilad · Head Chef

And who has jumped on this study as proof of anything? While I'll admit that I'm wary of anti-depression drugs, and think that they're way overprescribed, my initial impression is that this study is wrong. I think that anti-depression drugs have a very strong physiological effect. But it's been interesting to discuss this study all the same, because it is proof that even on a fairly established area of study there can be wildly divergent opinion.

rayb · Hot Air Balloon

I just asked the question "what if" it were proven. Honestly I don't see what the big deal is, though... I mean, so what if placebos do have about the same effect? What does it say? I mean would it change the way you viewed antidepressant drugs to find out they have as much effect on the mind as a sugar pill in which the user THINKS they're getting a medication that will help them? Those who've been helped by "placebo" medications should probably take some comfort in the fact that they had it within themselves to get better. I just don't see how that's threatening anyone's world view.

I imagine that someday God will probably reveal a whole assortment of things we did in which the only real thing that made the difference in whether we succeded or not was that we thought we could do it... grain of mustard seed...

--Ray

zealia · Profuse Pontificator

Hiccups, I hear what you say loud and clear. It is very hard when one is seeking treatment to hear so many mixed messages. I would hate for even one person not to receive the needed medications than for somebody to take it without a real need. Taking anti-depressants when needed is part of taking care of oneself.

Ray, I can understand where you are coming from. I do think that there is a compelling case for the need for anti-depressants or other treatments for some.

And alternative medication may be the answer for some. It is hard as state of well-being is something that effects every person. Where do we draw the line? I guess that is why there are criteria for making such decisions.

It is so important not to generalize that because one person was able to get through something without the same treatments that others would not need a treatment.

I do think that medication at one time may have helped me through depression and to some degree with ocd.

Well, I don't have all the answers. I do know some wonderful people who have been helped by meds. :)

dilbert · Senior Member

The results of this study don't surprise me. There are many different anti-depressants, and each class of them has a different effect on the brain. a SSRI such as Zoloft may be very effective for one person and not effective at all for another. That may be due to a placebo effect, but it could also be due to the one person suffering from a serotonin deficiency while the other is not. Welbutrin might help someone if they are suffering from a dopamine and/or norepinephrine deficiency, but if they aren't then it probably won't do them much good.

The sad truth is that doctors have no way to determine which anti-depressant is right for a person suffering from clinical depression other than trial and error. That's also how they figure out the right dose--try one dose for a while, if that doesn't help, then try a stronger dose to see if that does. If the medication or the dose isn't what a person needs, then it isn't going to do much good, just like a placebo wouldn't.

It will be a great day when someone figures out how to diagnose the kind of depression so that a doctor can just say "Well, your lab tests show you are deficient on this neurotransmitter, so that means you need that medicine." The trial and error approach can be quite frustrating for someone suffering from depression.

Janey · Senior Member

dilbert's idea for a lab test would be great, except you can't measure the amount of serotonin in a live person. Serotonin measurement is done by looking at the compounds serotonin breaks down into in cerebrospinal fluid. You'd need a spinal tap to measure your serotonin.

To further the conversation, here's an article about how scientists don't really understand the link between serotonin and depression. Maybe anti-depressants work because they build new neurons, not because they affect serotonin levels.

http://online.wsj.com/public/article/SB113226807554400588.html?mod=todays_free_feature

bokbadok · Senior Bucketkeeper

And who has jumped on this study as proof of anything?
It seemed like Ray was, but he's clarified that.

I'll admit that I'm wary of anti-depression drugs, and think that they're way overprescribed...

What makes you think they are overprescribed? Do you know a lot of people who are taking medications who don't really need them? How did you arrive at this opinion?
...my initial impression is that this study is wrong. I think that anti-depression drugs have a very strong physiological effect.
Huh. I assumed that you posted the link because you agreed with the article. My mistake.

But it's been interesting to discuss this study all the same, because it is proof that even on a fairly established area of study there can be wildly divergent opinion.

"Fairly established" is debateable. After all these years of researching the phenomenon of mental illness, we still know precious little about how the brain works and what goes wrong when it doesn't.

As far as wildly diverging opinion... I see a mere three opinions on this thread. Hiccups and those who agree with her, Ray and his "I don't take drugs, but some people need a magic pill" silliness, and the undecided.

-- Edited by bokbadok at 00:32, 2008-03-02

bokbadok · Senior Bucketkeeper

rayb wrote:
Honestly I don't see what the big deal is, though... I mean, so what if placebos do have about the same effect? What does it say?

It says that I am weak. It says that if I just had more faith that I could have healed myself without the "crutch" of medication. It says that I am a failure.

I mean would it change the way you viewed antidepressant drugs to find out they have as much effect on the mind as a sugar pill in which the user THINKS they're getting a medication that will help them? Those who've been helped by "placebo" medications should probably take some comfort in the fact that they had it within themselves to get better. I just don't see how that's threatening anyone's world view.
In an effort to help you see, I'll share a brief summary of my experience. Please don't throw this back in my face.

It took me five years to decide to try antidepressants. I was very wary, and afraid of side effects and possible permanent damage. So I tried therapy. And while that provided me with the tools to keep my head above water, it didn't provide complete relief. I tried exercise. I tried desperate prayer. Priesthood blessings. Repentance. Obedience. Temple attendance. Scripture study. None of these, either alone or in combination, returned me to health. Life was gray and bleak. I didn't feel love for my family. I wasn't interested in formerly enjoyable activities. I didn't care about my appearance, how clean my home was, or whether I lived or died. I couldn't even think straight. I wasn't actively suicidal (and I credit my faith in the gospel for that), but I looked forward to death.

I finally decided that my family was being cheated out of the mother and wife they deserved, and I was missing out on the simple joys of life. So I went to my doctor and began the process of trial and error to find a medication that would help. It took a few months to find the right dosage, but at last I began to come alive. A sunset thrilled me again. The work of nurturing seeds into plants was enjoyable once more. And most importantly, I loved my husband and children like a wife and mother should. I found joy in daily life after more than five years of agonizing dullness.

The idea that a sugar pill would have done all that for me is threatening because it means that I may have suffered during those years for no good reason. That if I'd only exercised more faith - nevermind that I have no idea how I could have done that - I could have been normal all along.

Additionally, if it is someday "proven" that antidepressants are not effective, then that treatment option could get yanked. The key point with a placebo is that the person receiving it has to believe it is the real thing. If the real thing is proven not to work, the placebo effect will cease to work also. Then what?

Perhaps you don't see why this issue is such a big deal is because you don't understand depression. If my little story hasn't helped you "see" a little better, might I suggest that you continue to study the issue until you do see. You claim this great gift of empathy. Use it.

-- Edited by bokbadok at 00:35, 2008-03-02

palmon · Senior Member

An article on webmd.com responding to the research results.
http://www.webmd.com/depression/features/truth-about-antidepressants

From the article:
-------------------
Does this study contradict numerous positive studies on antidepressants?

Yes, it does. In a statement, American Psychiatric Association President-elect Nada Stotland, MD, maintains that studies like this one, which compare a single drug to placebo, do not accurately reflect the way doctors prescribe antidepressants today.

Stotland says many people who are depressed do not respond to the first antidepressant they try. "It may take up to an average of three or more different antidepressants until we find the one that works for a particular individual. Therefore, testing any single antidepressant on a group of depressed individuals will show that many of them do not improve."
What do other findings show about using antidepressants?

Numerous studies support the benefit of antidepressants in improving mood, increasing ability to function socially, and easing physical complaints of joint pain, insomnia, and low energy
--------------------------

-- Edited by palmon at 15:04, 2008-03-03

zealia · Profuse Pontificator

Dilbert, I think I saw something about a way to look at a person's DNA as a way to know which treatments help a person the most. Sorry that I don't have exact details. I know someobody who has the opposite effect with some medications.

I think that Alan Alda did a special once (Nova?) about how placebos work almost as well as medications(don't think medications were defined). Yes, positive thinking and the mind can be very powerful. And I think Ray is saying that is a good thing. And it is if we use the mind to our best ability. However, I still believe that some people need help by medication or other therapy.

There is someone who I respect in the blogging world(don't think she is LDS) who commetns a lot on Dolphin's (piebolar) blog. She cautioned people about a study that seemed to indicate that only those severely depressed need medication. She said that studies are artificial and do not always mimic what they see in real life. She and others feel that medication does make a difference in the lives of patients.

The right medication can help someone have a quality of life. There may be a time when they with professional help may be able to go off the medication.

I do think that the meds I was on years ago helped me become more stable at the time. I think that I had major chemical imbalance with depression and ocd. I went off them cold turkey as I got be tired of being switched around all the time. The comment by someone who used to be a person with stewardship over me(though not at the time) where he called my Psychiatrist a "pill doctor" did not help my decision. He did sort of take it back saying that maybe some people need it. I was already forced to stop seeing my therapist at the time. Generally pills alone are not enough.

I do think that I have gained a lot from omega 3's in my diet.

mirkwood · Senior Bucketkeeper

I've watched medication stablize several members of my family. That is sufficient proof to me that it can be an effective treatment.

arbilad · Head Chef

I guess I'll expand a bit on what I meant about being wary of these drugs, and thinking that they're way overprescribed. Granted, I have not conducted a medical study, these are just my impressions, so take them with a grain of salt.
Note, I am not trying to say that anyone here is weak, or that if they just were more faithful the problem would go away. I read the article in the Ensign about depression a while back, and it seems that there are definitely factors other than choice involved, and some of them are definitely biological. However, even the most ardent supporters of anti-depression medications do not claim that they are a cure all, or that the same medication works for everyone in every situation.
It's just that, in my opinion, many people do not take these medications seriously. They are, when you get right down to it, mind altering drugs. Whatever good the medication does or does not do for a person, it is altering their state of mind. And so I am shocked by what I see as a cavalier attitude towards these medications. For instance, I have, in popular culture, seen many jokes such as "We should just put Prozac in the drinking water" or "Hey, calm down, have some prozac. I would think that people with a biological condition causing depression would also be shocked at popular culture equating normal depression with clinical depression. It minimalizes it. Popular culture portrays anti-depression medication as simply a "feel good" pill that you take to feel happy. In other words, in movies, stand up comic routines, etc. the popular perception of these medications is simply that they're a legal version of the illegal drugs that people use to feel "happy". Now, I know that's not the reason that anyone in this thread takes such medication. But there is a strong popular perception to the contrary in the media.
And I know that Hollywood doesn't make reality, even though they help mold public perception. However, to my mind there is real evidence of overuse. I think it was a town in England that had high levels of prozac in the town waste water. You'd have to have a lot of people in the town using a lot of prozac to get those levels. And it makes me think that there can't really be that many legitimate cases of clinical depression in that town.
And I strongly believe that medications prescribed for attention deficit disorder are overprescribed. For instance, they were suggested for my son when he was a behavior problem at school. We changed his learning environment, built up his self confidence, and he is no longer a huge problem (I would be shocked if somewhere there was a 12 year old boy who never had a behavioral problem).