Antidepressants not much better than sugar pills

[UndertheOcean]

Dr. Amen's Brain Blog
A discussion of neuroscience, mental health and the brain issues of the day.
http://amenclinics.com/wp231/?p=34


Antidepressants not much better than sugar pills


I hope you have been able to see the new PBS special. It is doing very well and has helped raise a lot of money for PBS in just its first week of airing. I am thrilled, because it helps get our message out to the general public and raises money for PBS, one of my favorite venues for lifelong learning.
Now comes a large study from England that basically says antidepressants are no better than sugar pills. How does the study below have any validity. I have been a psychiatrist for a long time, now more than 25 years. I know antidepressants work when prescribed properly. But I also know that I can help people heal with natural supplements, exercise and psychotherapuetic interventions.
Most doctors prescribe antidepressants as if depression was a single or simple disorder. Our brain imaging research says it is at least 7 different disorders and giving everyone the same treatment invites failure and often making people worse. We need to tailor the treatment to indivual brains, not vague diagnostic categories. Enjoy the article.
LONDON (AFP) — Best-selling anti-depressants like Prozac and Seroxat are barely more effective than placebos in treating most people with depression, a study led by a British university said Tuesday.
The research, which analysed 47 clinical trials, breaks new ground by incorporating data not previously released by drug companies which researchers obtained under US freedom of information laws.
Its findings prompted some academics and mental health campaigners to question whether people with mild and moderate depression should be prescribed drugs like Prozac, which has been taken by 40 million people worldwide.
“The difference in improvement between patients taking placebos and patients taking anti-depressants is not very great,” said Professor Irving Kirsch of Hull University, in northern England, who led the team.
“This means that depressed people can improve without chemical treatments.
“Given these results, there seems little reason to prescribe antidepressant medication to any but the most severely depressed patients unless alternative treatments have failed to provide a benefit.”
The study, published in the journal PLoS (Public Library of Science) Medicine, looked at Prozac, Seroxat, Effexor and Serzone and found the drugs were only better than a placebo for some people with severe depression.
Kirsch’s team said it was one of the most thorough probes into the impact of new generation anti-depressants or selective serotonin reuptake inhibitors (SSRIs).
But drug companies strongly questioned the findings.
A spokesman for Eli Lilly, which makes Prozac, said that “extensive scientific and medical experience” had shown it is “an effective anti-depressant.”
And GlaxoSmithKline, which makes Seroxat, said the study had not acknowledged the “very positive benefits” of the drugs.
“Their conclusions are at odds with what has been seen in actual clinical practice,” a spokesman said.
“It is widely recognised by experts in the field that studies in depression are challenging and very difficult to conduct.”
One leading academic who has studied why drug companies only publish some of their data on new drugs said in the wake of the findings they should be obliged to provide full details.
Doctor Tim Kendall, deputy director of Britain’s Royal College of Psychiatrists research unit, said the study was “fantastically important.”
“I think it’s too dangerous to allow drug companies — where profit is a key factor — to be able to withhold data which shows that a drug is ineffective or harmful,” he said.
Alison Cobb, of British mental health charity Mind, hailed the findings as “a serious challenge to the predominance of drugs in treating depression.”
“Anti-depressants do help many people but by no means all and some people experience severe side-effects with them,” she said.
“Nine out of 10 GPs (general practitioners) say they’ve been forced to dish out drugs because they don’t have proper access to ‘talking treatments’ such as cognitive behavioural therapy, which are recommended as the first-line treatment for mild to moderate depression.”
Another mental health charity, Sane, warned the findings “could remove what has been seen as a vital choice for thousands,” adding people should not stop taking their drugs immediately.
As the study was published, the British government published details of a 170-million-pound (225-million-euro, 335-million dollar) programme to improve access to counselling and therapy for people with depression.
Officials say this should see 900,000 more people receiving such treatments over the next three years.

[Forkboy]

1. I could have told them that and saved them the trouble.

I've tried five of them with no luck. If anything they make things worse, so I won't take any again. I'll just try to deal with it on my own like I always did before.

[hunter]

2. Inappropriate prescriptions are very common in the United States.

Marketing works, which is why many pharmaceutical companies spend more on marketing than they do on research.

If a man walked into a doctor's office asking for the latest brand of oral contraceptive he saw advertised on television, "Yep, that Yasmin looks right for me, doc!" he wouldn't get a prescription for it.

But many people have anti-depressant prescriptions that are ineffective and/or inappropriate.

A catch-all diagnosis of "depression" does not suggest a specific drug or even that any drug will be effective, much as a catch-all diagnosis of "cancer" does not suggest any specific treatment. We know quite a bit about all the various sorts of cancer, and which treatments are effective for each kind, but in comparison we know hardly anything about depression. There's no lab tests to suggest what the best course of treatment might be for someone's depression.

[qb]

3. Prozac helped me when I was very depressed in my 20s.

More recently I have been to doctors who view SSRI's as a simple cure-all for any emotional or behavioral problem, and they hand it out like candy with little concern about counseling or follow-up. They are clearly influenced by the pharmaceutical companies. I am all for a reality-based administration and more regulation of big pharma.

[hedgehog]

4. Naysayers ask us to simultaneously believe that SSRIs are

less effective than sugar pills but also drive people to suicide. Which is it?

[EFerrari]

5. Prozac changed my life. YMMV. n/t