Anti-depression drugs work about as well as a placebo

bokbadok · Senior Bucketkeeper

RE: Anti-depression drugs work about as well as a placebo

arbilad · Head Chef

A quick search turned up a lot of articles about anti depression medication over prescription in the UK.

UK Article

Now, we obviously have different medical systems. But the UK system usually differs from ours in denying medications and services, not in dispensing them too often.
There are more sources, but I thought you would prefer a more mainstream source.
Now, I admit that this is not conclusive proof. But surely you'll admit that this is different from "no proof"

bokbadok · Senior Bucketkeeper

Thanks for addressing my question arbilad. I realize that I am pressing hard on this; I appreciate that you are willing to discuss it.

The article you linked to is very interesting. Especially this:

In many cases doctors said they were forced to prescribe the drugs to patients with depression, anxiety and stress because other therapies and social care to help with milder conditions were not available in their area.
It seems that many of the surveyed UK doctors were prescribing meds because there was no other medical help available (for who knows what reason) for these patients. That's not the kind of over-prescription problem I thought we were discussing. It appears that much of the over-prescription issue in the UK may be more a symptom of the impotent National Health System than a lazy doctors peddling drugs issue.

Here's another article about the same issue. Of particular note are comments like this one from Brits (who should know better than you or I do) concerning the difficulty in getting therapy and other non-medicinal treatments in the UK's NHS:

It's all very well recommending counselling instead of anti-depressants, but what happens whilst people are waiting for counselling? An NHS waiting list for counselling can be up to 12 months. In the meantime, mild depression can become severe depression.
Carolyn, St Albans, Herts
When I was originally diagnosed in 2001, I didn't go to a doctor until I'd already been suffering for 6 months and was nearly out of my mind with desperation for some help. If I'd had to wait another 6-12 months to get counseling... well, I'm not sure I could have endured that. You've heard the phrase "better off dead." A severely depressed person really believes that they and everyone around them will be better off if they are dead. IMHO, it's better to prescribe an antidepressant alone than to put an individual on a months' long waiting list with nothing to help them stay sane (and alive) while they wait for "better" treatment.

But I don't think that's the kind of "overprescribing" you are thinking of when you say that, is it? Aren't you thinking of people who go on antidepressants for trivial reasons; they're sad because their boyfriend broke up with them, or because they lost a job and are feeling "down"? People who don't really "need" medication because they don't really have clinical depression but just want a quick fix for their problems?

I'm guessing here. But I don't think you believe that someone who is really suffering from a chronic, debilitating problem shouldn't be given immediate help.

Now, FTR, we probably agree more than the discussion thus far would indicate. I am not arguing that medication is the panacea for depressive problems. I highly value cognitive therapy and feel that it was immensely helpful for me. I also think that there probably are a lot of people receiving only medication that might get equal or perhaps better results from cognitive therapy and/or lifestyle changes either in concert with or in lieu of medication. But I don't have any guesses as to what proportion of individuals currently on medication that would be so I really hesitate to make blanket statements about something I know so little about.

What I do not care to hear is people who have never dealt with real depression insinuating that it isn't a big deal whether antidepressants work or not. It is a very big deal to people who need them. (I realize that you, arbi, were not saying that, so please don't misinterpret me.)

I'm also not crazy about opinions that are based on hearsay or rumor rather than fact. Hence my challenge to you. Thanks for not dodging it.

What an interesting discussion, don't you think? smile

arbilad · Head Chef

I admit that the Brits probably understand the problem better than I do. But neither do I think that prescribing anti-depression drugs in every case where the person is depressed and other treatment modalities are not available is appropriate.
Forgive me if I'm incorrect, but it seems that anti-depression drugs are prescribed where it is believed that a chemical imbalance is responsible for the depression. In light of that, how do you explain that study that says that Utah has a large number of anti-depression drugs prescribed? Utah is a heterogeneous population - people have moved to Utah from all sorts of populations, so it wouldn't be something passed on through genetics. One possible explanation is that the drugs are prescribed for other than physiological sources of depression. Or it could be a statistical fluke. But it seems to me to be an indication of overprescription.
It's not like it would be the first time that a treatment was used incorrectly. For instance, tonsillectomies used to be almost routine. Now they're done much more rarely. Doctors used to give antibiotics for pretty much everything, including viral infections, just in case. And that's one cause of antibiotic resistant bacteria.

hiccups · Future Queen in Zion

arbilad wrote:

Forgive me if I'm incorrect, but it seems that anti-depression drugs are prescribed where it is believed that a chemical imbalance is responsible for the depression.

Um, not really. For that to be true, there would have to be a another set of depression symptoms so doctors could differentiate between regualr depression and chemical imbalance depression. The way it goes is that doctors suspect that depression can be attributed to chemical imbalances in some cases and they also suspect that imbalance is acted upon by certain meds. It seems like it's speculation about why the medications are working (when they do) after the fact.

Now, if you still want to talk about Utah's anti-depressent usage, that's fine. I have a lot to say about that as well. If we're going to speculate that because the usage numbers are so high that they must be overprescribing, let's speculate on what factors might cause a statistical high need for meds as well.

Oops. Time to be taxicabMom. More later.

Pt314 · Senior Member

arbilad wrote:

In light of that, how do you explain that study that says that Utah has a large number of anti-depression drugs prescribed? Utah is a heterogeneous population - people have moved to Utah from all sorts of populations, so it wouldn't be something passed on through genetics. One possible explanation is that the drugs are prescribed for other than physiological sources of depression. Or it could be a statistical fluke. But it seems to me to be an indication of overprescription.

I think it is a combination of several factors.

Some people have suggested that Utah has a culture where seeing a psychiatrist has less stigma then in other places, thus more people get diagnosed (Both people who need it, and people who may not need it).

Utah also is pretty high in per capita ice cream consumption. Perhaps its because its our replacement for alcohol and tobacco for relieving stress. In other places clinical depression may be overshadowed by these things.

Honestly I don't know.

bokbadok · Senior Bucketkeeper

Arbilad, I think you may be trying to simplify the definition of depression too much. It's really very complex, and attempting to categorize it into neat black and white categories doesn't work.

Here's what I'm seeing based on your posts: It seems like you believe there are two types of depression that people go to doctors for. Type #1 is "true" physiological depression, which is relatively uncommon, and results solely from a chemical imbalance in the brain, resulting from a genetic or some other organic cause. Type #2 is "false" depression, resulting from a sad event or mental laziness on the part of the person experiencing it, and which shouldn't be treated with medication as a "quick fix".

I tend to break it down into three groups: Types #1 & #2 above; and a broad group #3, which encompasses many varied manifestations of "real" depression that may not have it's root cause in physiology, but in which brain chemicals are nevertheless out of balance, perhaps due to trauma, abuse, cognitive distortions, false beliefs, poor thinking habits, and other environmental causes. Within this third group, symptoms vary wildly; one person may have the classic depressive symptoms, while another may have severe anxiety instead.

The difficulty, as hiccups pointed out, is that it is impossible to tell whether a person is in the #1 type or the #3 type just from looking at symptoms. And, antidepressant medications very often do help people in the third category, and this is why: a chemical imbalance in the brain can distort thinking, but the reverse is also true; distorted thinking can lead to a chemical imbalance in the brain. Once the brain is out of balance, it can be impossible for a person to think logically and clearly. Hence the inability to "just get over it". The person has very literally lost the ability to think straight. When this happens, it is an illness that requires professional medical help to recover from. Medication can help restore chemical balance, at which point the individual can benefit from counseling therapy to retrain their thinking patterns. After that, medication is often no longer needed.

That last paragraph is vitally important in understanding depression. I believe that depression is more common in modern times than in centuries past because of this third group, and I think that this kind of depression can actually be learned from, or at least caused by the family of origin. I believe it is passed down from parent to child - a legacy of emotional abuse and/or negative distorted thinking - that cripples minds and lives. I think this kind of familial depression could be at the root of the Utah numbers (A recent study reported that it isn't just antidepressant use that is high in Utah - actual reports of depressive symptoms are higher in Utah than the rest of the nation.)

dianoia · Senior Member

I've been watching this discussion closely, because this hits close to home for me. I had a bout of clinical depression after son3's very rocky beginnings, as I've related before, and had some of my most cherished spiritual experiences during that time.

But I'd often wonder, "Why me? What part of my personality and physiology led to this?" Because another sister in my ward had a sick child at the same time, and didn't struggle afterwards. Because my sister went through a horrible divorce from an unfaithful husband who played some serious mind games, and she didn't get depressed. And so on. Priesthood blessings were my lifeline and my assurance that I should stop comparing and stop beating myself up.

However, in my quest for understanding, I did a lot of reading. And speaking sociologically, there is one factor in depression that hasn't been addressed yet - the cultural one. There are societies where depressive symptoms are far less common, but it's been discovered that when people emigrate to the US, within a generation depression numbers rise to meet the general populace. Because of that, it's been said, "Depression is the price we pay for prosperity." I don't totally buy that.

But let's consider some of the more negative aspects of our North American culture: chronic sleep deprivation, materialism, the loss of an extended support system in terms of family and community, constant pressure from media to be richer, thinner, more cosmopolitan and sophisticated. More and more confusion about what is right and moral. I don't believe these necessarily cause depression, but they definitely wield influence. And as an LDS people, we're not immune from those pressures.

bokbadok · Senior Bucketkeeper

Excellent points, Dianoia. We're not immune to those pressures, and the LDS culture adds pressures of it's own.

hiccups · Future Queen in Zion

Ok, so back to that Utah has higher depression med usage, so they must be overprescribing thing... I've got a bee in my bonnet about that.

First off, what's the point of taking anti-depression drugs you don't need? They don't actually elevate your moods, btw. It's not a high. In my experience, and from what I've heard from other about their experiences, anti-depression medication simply blocks off access to the lowest of the lows. For me, it also blocked off some of the pointless and damaging anxiety. And also, it gave me the ability to begin working on my issues because I wasn't stuck cowering any longer.

Now as to why Utah might have a genuine need for a higher rate of anti-depression medication. Some have mentioned that culturally LDS folks might seek out medication because they'd be less likely to seek out alcohol or illegal drugs. Culturally, LDS people might have a higher expectation of happiness because we have more understanding of the plan of happiness. Maybe that just means they see it sooner or are harder on themselves for perceived weaknesses. Also, I'd like to point out that Utah has a very high birthrate and PPD might account for a good chunk of that medication. (PPD is real and more common than most know. It is potentially very dangerous and I'd really rather err on the side of medicating vs. not. That's another topic, though.)

Even assuming that depression meds are being overprescribed in some instances, I highly doubt that it would be being overprescribed at a higher rate in Utah than other places or that the overprescribing is what's responsible for the high rate of depression med usage there.

Janey · Senior Member

And, antidepressant medications very often do help people in the third category, and this is why: a chemical imbalance in the brain can distort thinking, but the reverse is also true; distorted thinking can lead to a chemical imbalance in the brain. Once the brain is out of balance, it can be impossible for a person to think logically and clearly. Hence the inability to "just get over it". The person has very literally lost the ability to think straight. When this happens, it is an illness that requires professional medical help to recover from. Medication can help restore chemical balance, at which point the individual can benefit from counseling therapy to retrain their thinking patterns. After that, medication is often no longer needed.
Excellent point, bok. I think I was in that category - where my distorted thinking started a downward spiral that resulted in a chemical imbalance. I find this
category to be hopeful, because it means that once you can identify and control the distorted thinking, you are more able to avoid getting out of balance again. I was pretty bummed when I thought my depression was entirely physiological and I'd need meds regularly. Ideas like this one you've articulated here gave me the 'oomph' to quit meds. I've been okay. I've had bad days, but I'm under control.

Pt314 · Senior Member

hiccups wrote:

First off, what's the point of taking anti-depression drugs you don't need? They don't actually elevate your moods, btw. It's not a high. In my experience, and from what I've heard from other about their experiences, anti-depression medication simply blocks off access to the lowest of the lows. For me, it also blocked off some of the pointless and damaging anxiety. And also, it gave me the ability to begin working on my issues because I wasn't stuck cowering any longer.

It's the same with my experience. It isn't that when I take my meds that I feel 'happy', its a misconception. However when I forget to take it, it takes far more mental effort to be in control. Usually it becomes too much, and I give in to thinking about whatever my brain wants to think about. It is hard to do anything that requires thinking, when you can't think about it. Usually this leads to a nasty form of depression if I am trying to work under this condition.

Even if I am on my meds, and I 'hold it in' for too long, they become less effective. I came home from my mission early because I was a nervous wreck. Thankfully I didn't get like my aunt who also has OCD and depression, was constantly contemplating suicide on her mission (this was before she was diagnosed).

That isn't to say there aren't downsides to my meds. I used to be on a higher dosage as a kid, but I had siezures at the time. I also feel less creative when on my meds (I might be most creative when not on my meds at all, but it's no good.).

dianoia · Senior Member

(Here comes another long post. I've tried to be brief, but... it just ain't happening.)

I've going to chime in on the fact that antidepressants don't give you a "high".

Like bok said, they get rid of the lowest of the lows. But she didn't mention that they do this by "flattening" emotions, in a sense. Which means the highest of the highs are gone as well. I noticed that while I was on Zoloft, my dreams seemed far more realistic, so much so that sometimes I had a hard time remembering if certain conversations actually happened, or had just been a dream.

When I asked my therapist BIL about it, he replied that the dreams weren't getting more vivid, but that the antidepressant made life less vivid, in a way. Drugs can be very beneficial to those who need them, but the side-effects are still there. So yes, these are medications that shouldn't be taken lightly.

I can see where arbi's concerns are coming from. We had a LDS social services counselor do a fireside in our ward where he talked about depression. It was one of the best firesides I've ever been to.

As has already been mentioned, he divided those who suffer from depression into two general groups: 1) those who have a genetic propensity 2) those who have suffered major trauma. And there was a basic difference between the two groups: those with a genetic propensity tended to have depression hit quickly and severely, without any obvious external factors. Whereas those who have experienced major stress have a long, slow slide into depression that others around them can practically see.

The potential danger with group 2 is that a lot of people have poor habits or thinking patterns that keep them from healing once they've become depressed. If there is no effort to fix the bad habits, the medication stops being effective, and needs to be increased, and so on and so on.

I'm not saying that only those who experience depression have those bad habits, I think they're common in the general populace. Some of my errors in thinking come from my upbringing, and I see some of these same ideas shared by my parents and siblings, but they've never had to confront them (things like perfectionism and an overemphasis on external appearances.)

Depression provides the opportunity for reflection, and some very painful but needed self-appraisal. So I also feel concerned about the idea of "pop a pill and you'll feel better." That just won't happen without work.

Cocobeem · Keeper of the Holy Grail

I knew a middle aged lady once who was on prozac. She was a master of avoidance. She avoided solving problems with her children or facing past wrongs she'd committed in regard to her marriage. She was all about appearances. If the family "looked" good at Church, the callings were high and holy enough, the roots dyed and the nails done, she was "happy" because she looked like she had everything together. She could have been so much more. I think there were things in her past she didn't want to face. Hard things in her current life that take work and maturity and depth to overcome that she just didn't want to work that hard to overcome. It was so much easier to take the pills (And thanks for the clarification that the pills don't make you happy - I thought they'd be similar to Percocet that way - I'll be sure to hang on to my extra Percocets!) and grumble with her "friend" about how life sucks and everyone's truly unhappy if you just knew enough about them and let's go get ice cream and talk about our problems.

It's interesting to me the possible connection with nutrition. Ice cream was brought up. I know sugar messes with me. Everything is more dramatic when I've been eating sugar. And there is a lot of obesity in Utah, too.

hiccups · Future Queen in Zion

dianoia wrote:

Like bok said, they get rid of the lowest of the lows. But she didn't mention that they do this by "flattening" emotions, in a sense. Which means the highest of the highs are gone as well.

...

Depression provides the opportunity for reflection, and some very painful but needed self-appraisal. So I also feel concerned about the idea of "pop a pill and you'll feel better." That just won't happen without work.

Actually, that was me, not Bok.

And I wasn't meaning to imply "pop a pill and you'll feel better." What I've said about my own experiences includes mention of the medication enabling me to do other things towards improving my mental health. It just had occurred to me that people without the experience of taking anti-depression meds might be thinking the meds were giving a "high" and that might be contributing to negative stigmas. I wanted to be clear about the fact that anti-depression meds aren't effective as an escape from reality.

dianoia · Senior Member

I've met a couple of people like that too, coco. Which makes it all the more frustrating because there are those who genuinely benefit from the SSRI's.

I've debated even including this experience, but knowing the kind of person my MIL was, I'm decided to go ahead.

My MIL was a fantastic, spiritual woman. As far as mother-in-laws go, she was perfect. (She died of a heart attack 12 years ago, about 6 months into her mission.) And she was firmly in camp 1 in terms of genetic propensity to depression - in fact, she had brain surgery in the early 60's because of "faulty wiring." In the years my husband grew up, she was occasionally hospitalized when things got too bad. Despite that, Dh's memories of his mom growing up were loving and positive - but he was quite a bit older before it dawned on him that not all moms sometimes spent days in bed.

When Prozac was still in the testing period up here, the local university hospital asked her to be part of a double-blind study. Half the participants were given a placebo, and the other half were given Prozac, but only the doctors conducting study knew which was which. My MIL was part of the group given Prozac, and it made such a dramatic difference for her - over and above the results of those taking the placebo - that when the study was finished, SHE WAS NEVER TAKEN OFF THE DRUG. Her quality of life after that was so much better that her family is grateful to this day that she had some wonderful years near the end of her life.

So when people say that those who experience depression just need to ____________ (insert idea of doing better at something here), I've got the example of my MIL so that I may respectfully disagree. I've never met someone who had a closer relationship to the Savior, who was more in tune, more real, more loving and warm and genuine.

It's been twelve years, and I still miss her horribly.

ETA: whoops, sorry hiccups. And just to clarify, I didn't mean that you were endorsing "pop a pill". We're on the same page in terms of this topic. I was just responding to arbi's concerns over those who do have that sentiment.

-- Edited by dianoia at 10:33, 2008-03-05