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The Wisdom of Psychopaths
In this engrossing journey into the lives of psychopaths and their infamously crafty behaviors, the renowned psychologist Kevin Dutton reveals that there is a...
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Question: Are antidepressants effective or ineffective?
Answer: Yes!
In my view, both these statements are true: Antidepressants do work. And antidepressants don’t work. Not to put too fine a Clintonian point on it, but determining whether antidepressants work depends on the definition of the word “work.”
A controversial article just published in the prestigious Journal of the American Medical Association concluded that antidepressants are no more effective than placebos for most depressed patients. Jay Fournier and his colleagues at the University of Pennsylvania aggregated individual patient data from six high-quality clinical trials and found that the superiority of antidepressants over placebo is clinically significant only for patients who are very severely depressed. For patients with mild, moderate, and even severe depression, placebos work nearly as well as antidepressants.
There have been at least four other review articles published in the last eight years that have come to similar conclusions about the limited clinical efficacy of antidepressants, and one of the study authors, psychologist Irving Kirsch, has recently published a book on the topic, provocatively entitled The Emperor’s New Drugs: Exploding the Antidepressant Myth.
The recent review articles questioning the clinical efficacy of antidepressants run counter to the received wisdom in the psychiatric community that antidepressants are highly effective. Indeed, it wasn’t so long ago that psychiatrist Peter Kramer wrote in his best-selling book Listening to Prozac that this miracle drug made patients “better than well.” Prozac was a Rock Star. Its extraordinary success even led to a photograph of the green and white capsule on the cover of Newsweek Magazine in 1990.
The essential facts about antidepressant efficacy are not in dispute. In double-blind, randomized controlled trials – meaning that patients are randomly assigned to receive either drug or placebo, and neither patient nor clinician knows who gets what – antidepressants show a small but statistically significant advantage over placebos. The debate is over the interpretation of these findings, and it revolves around the distinction between clinical significance and statistical significance.
Statistical significance means that an effect is probably not due to chance and is therefore likely to be reliable. But statistical significance says nothing about the magnitude of the effect or its practical implications. Clinical significance indicates the degree to which an effect translates to a meaningful improvement in symptoms for patients. Although the superiority of antidepressants over placebos has been shown to be statistically significant, the observed differences are not clinically significant. In fact, the average difference between drug and placebo is approximately two points on a depression scale that ranges from 0 to 52. This difference does not exceed the commonly accepted standard for a minimally significant clinical improvement of a 3 point improvement on the depression scale.
But what of the testimonials from patients and their doctors reporting dramatic relief of symptoms in response to antidepressants? Such reports really aren’t in conflict with the data from randomized controlled trials. In clinical trials, patients treated with antidepressants do show substantial improvement from baseline. However, the clinical trial data also show that patients treated with placebos improve about 75% as much as patients treated with antidepressants, suggesting that only a quarter of the improvement shown by patients treated with antidepressants is actually attributable to the specific effect of the drugs. The rest of the improvement is a placebo response. In clinical practice, of course, there is no placebo group, and therefore patients and their doctors are likely to attribute all symptom improvement to the medication.
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39 Comments
Add CommentFirst the proper med must be matched with the patient. This sometimes requires multiple attempts with trial meds.
Reply | Report Abuse | Link to thisAfter someone is matched, they can worked wonders.
I took them for two months, and never needed them again after that. Without them, I probably never would have come out of my deep depression, which was only temporary thanks to sertraline, which was the proper match for me.
While I didn't see it mentioned, treating severe depression with placebos would surely be just as dangerous to the patient as discontinuing treatment.
Reply | Report Abuse | Link to thisFor mild depression placebos have the decided benefit of having few side effects. However, the article fails to consider that the effectiveness of placebos is entirely dependent on the patient's belief that an effective medication is being administered. Placebos cannot be effective in practice.
Unless this fundamental difficulty can be overcome, pharmaceutical industry profits are not in any serious jeopardy.
Alcoholism: A disease of speculation
Reply | Report Abuse | Link to this"In 1976, the writer Ivan Illich warned in the book, Limits to Medicine, that 'the medical establishment has become a major threat to health'. At the time, he was dismissed as a maverick, but a quarter of a century later, even the medical establishment is prepared to admit that he may well be right. (Anthony Browne, April 14, 2002, the Observer)"
History and science have shown us that the existence of the disease of alcoholism is pure speculation. Just saying alcoholism is a disease, doesn't make it true. Nevertheless, medical professionals and American culture lovingly embraced the disease concept and quickly applied it to every possible deviant behavior from alcohol abuse to compulsive lecturing. The disease concept was a panacea for many failing medical institutions adding billions of dollars to the industry and leading to a prompt evolution of pop-psychology. Research has shown that alcoholism is a choice, not a disease, and stripping alcohol abusers of their choice, by applying the disease concept, is a threat to the health of the individual.
pot is way better then meds, i am 71 ,dont drink smoked pot all life never go to drs never sick, dont drink or cigs, wake up america your gov is your problem
Like almost any "disease", Major Depressive Disorder (MDD) is defined by a cluster of symptoms that are generally shared by a population, but which is actually a highly heterogeneous set of disorders. The traditional medical model has served us very well in the past, but MDD is a great example of how problematic heterogeneity can be in predicting therapeutic outcome. Depending on how you define response, antidepressants produce some sort of response in something like 60% of patients, and full response in about one third. So, if MDD is truly a single condition then why doesn't the same pharmacological approach work in everyone? The answer, of course, is that it ISN'T just a single condition. We simply lack the knowledge to better cluster patients into various definitions that will produce similar responses to a given therapy. So many of the criticisms of antidepressant therapy are missing the point: the drugs work in a subset, but how can we predict who will respond? Confident answers to this question are unlikely to arise using traditional observed symptoms of MDD. I've analyzed much larger data sets then the ones mentioned in this paper and I can tell you that we could see no subset of symptoms that tended to predict response (or placebo response for that matter). That is, to improve our definitions (and our treatment outcomes) we'll need to better understand the underlying biology of the cluster of diseases we call depression. Molecular biomarkers and imaging are obvious tools to move us in this direction, but we'll need to work with large data sets collected in carefully controlled studies along with access to DNA, RNA and other specimens appropriate for proteomics research. Only with such large scale investigations will we see the development of the "personalized" medicines - and better outcomes - the depressed populations need.
Reply | Report Abuse | Link to thisAntidepressants can have some tragic side effects.
Reply | Report Abuse | Link to thisThe Physicians Desk Reference states that SSRI antidepressants and all antidepressants can cause mania, psychosis, abnormal thinking, paranoia, hostility, etc. These side effects can also appear during withdrawal. Also, these adverse reactions are not listed as Rare but are listed as either Frequent or Infrequent.
Go to www.SSRIstories.com where there are over 3,600 cases, with the full media article available, involving bizarre murders, suicides, school shootings/incidents [53 of these] and murder-suicides - all of which involve SSRI antidepressants like Prozac, Zoloft, Paxil, etc, . The media article usually tells which SSRI antidepressant the perpetrator was taking or had been using.
Having spent nearly 10 years, until ten years ago, with a person periodically suffering from either severe depression or psychosis, depending on the diagnostician, your observations seem extremely valid to me.
Reply | Report Abuse | Link to thisIn my experience, severely debilitating permanent side effects are produced by the medications used to treat severe depression. These side effects often become significant after about 6-12 months treatment. At that time another effective medication must be found, effectively by trial and error, often producing serious errors requiring hospitalization. This method of medication roulette produces long term effects of repeated, accumulative suffering.
Any field of medicine that purports to follow scientific methods should surely develop more effective, even if less profitable, methods of treatment. I expect the current approach is more humane than the repeated electric shock therapy and frontal lobotomies of the not so distant past, but even recent methods are deplorable.
Science Geek - My preceding comment had been intended to be in response to your excellent comment.
Reply | Report Abuse | Link to thisRosiecee - I also commend your excellent comment.
I was glad to read this straight forward article. My clinical experience has been that practitioners have evolved to focusing on "getting the right med" for clients over other therapeutic dynamics. The focus is on meds, not "getting the right therapeutic intervention" or taking the time to establish a good therapeutic relationship with clients. I see this as a 'side effect' of managed care and the fiscal power behind pharm companies.
Reply | Report Abuse | Link to this@cliff kirley: You also represent a sample of size of one. There are people who've smoked cigarettes most of their lives, are seldom, if ever sick, have lived to very old age, etc., etc. That does not negate the research demonstrating the physical dangers inherent in smoking tobacco products. While I'm not against use of marijuana, it's ludicrous to suggest that it is entirely without dangers or purely beneficial.
Reply | Report Abuse | Link to thisThere is evidence that not all cases of alcoholism are purely choice, though choice does tend to play a role in most, if not all cases. To apply the disease definition to every case of alcoholism is as foolish as claiming that anyone who's overweight is that because of a genetic predisposition. However, that does not justify swinging to the other extreme and saying that no cases of alcoholism are a disease.
The leap to defining numerous other "failings" as disease is not specifically an American phenomenon, it's a human phenomenon. Most people, if given the opportunity, will jump at the chance to absolve themselves of responsibility for their actions. A sense of responsibility for oneself and one's actions is something instilled in a person, not necessarily the default state of affairs.
I disagree with the notion that the medical establishment has become a major threat to health. It has always been that because knowledge has always been partial - there was a time when the medical establishment rejected the idea of germs as a cause of illness.
Some in the medical profession do actively threaten health but so do many outside the medical establishment who offer alternatives. The remainder may in some cases threaten the health of patients, but blanket application of the label is counterproductive since much that the medical establishment does is to the benefit of general health.
The problem of the efficacy of antidepressants may well be based in ignorance, as Science Geek says. This is borne out by the fact that generally doctors don't hit on effective antidepressants first time, they go through several options before finding one that works. However, that same fact brings into question the validity of the conclusion that antidepressants are not clinically more effective than placebos based on the studies mentioned; the lack of matching medication to patient is likely to skew the results.
Some doctors are actively threatening the health of their patients. I think most are simply doing the best they can with the tools they have.
I suspect I've been clinically/chronically depressed the better part of my life (not surprisingly, online depression test scores over the last decade consistently confirm it); but for decades I've resisted suggestions & pleas from well-meaning friends to medicate or talk to shrinks. Why? A litany of problems and hurdles - the outrageous cost charged by pharmas and shrinks, the potentially adverse side effects, the guinea pig approach to trialing medications, and the vague open-endedness of the whole talk therapy concept.
Reply | Report Abuse | Link to thisWhat is most frustrating and discouraging (to me at least) are the mary poppins-like PSA's touting "solutions are available" and urging us to seek them out, without any acknowlegement that DEPRESSED PEOPLE are the least inclined to uncurl themselves from foetal position and leave the comfort of gray caves on a quest for elusive, ephemeral, costly and possibly placebo-related solutions.
BTW- Potsmoker Cliff Kirley's naive claim that "research shows alcoholism is a choice" suggests he's reading too much junk science in a drug-induced haze of his own choice. I knew an alcoholic quite intimately for a number of years. While the self-destructive spiral of those with addictive predispositions isn't itself a "disease" per se (that's enabler-speak) it is also NOT a choice. The autonomic and often powerfully irrepressible urge buried within the brain to belly up to the bar (be it gambling, alcohol, smoking or hard drugs) is essentially unpredictable and uncontrollable for a huge chunk of the population. Like the (pot)smoker who's "quit" hundreds of times, alcoholics can control their drinking only until an internal/external trigger causes them to let their guard down. They don't fall off the wagon.... they're pushed by an inner demon. I'm not excusing their illogical actions, but I witnessed it and the shock/humiliation aftermath too many times to mischaracterize alcoholism as a choice.
Clarification - I meant that using the term "disease" is enabler-speak. It does give a pass to those too weak-willed to even attempt to maintain some semblance of normalcy.
Reply | Report Abuse | Link to thiswhat's the independent variable in this experiment?
Reply | Report Abuse | Link to thisCliff Kirley, you are living in the past with very old information. It has been 34 years since that book was written and yet you still quote it as if it were still viable. I remember well the debate about "alcoholism is a disease versus just a bad choice". For me the debate was personal, my Mother was an alcoholic. I lived with her behavior every day, and for me it was not even an issue, I knew she had an addiction and it could be treated. She was self medicating a problem with depression, as did her father who drank. I'm glad pot works out for you, I don't have an issue with you smoking it. You have a distrust for the establishment that goes back a long way. Distrust is a choice on your part, it is not a very balanced view of life, just as complete unblinking faith is a poor view to have. You are a dinosaur who has changed little with time. Your view is outdated.
Reply | Report Abuse | Link to thisI was told a few years ago about a clinical trial in patients with not extremely severe depression, comparing Fluoxetine, St John's worth extract and a placebo. Fluoxetine scored significantly better than St John's worth, but neither Fluoxetine nor the herbal remedy scored significantly better than placebo. Many years after Robert Spitzer's research diagnostc criteria (RDC) and after several DSM editions, mental disorders diagnoses are not fully clearcut
Reply | Report Abuse | Link to thisIn my experience doctors tend to either increases the does or change the medication when the patient does not report much improvement with anti depressants. Sooner or later unpleasant or damaging side effects are bound to show up with this approach. Not only that, many (all?) of these drugs have to be withdrawn from carefully - rapid withdrawal has been linked to increased risk of suicide in some cases eg. Effexor. I would say the precautionary principle applies.
Reply | Report Abuse | Link to thisHey guess what? Medicine is not the answer. Get rid of the cause of depression and no medication is necessary. Sometimes this takes courage but it is really the only answer. So, change jobs, find a new spouse, move to a better neighborhood, or do whatever it takes to remove the source. It will work miracles, I assure you.
Reply | Report Abuse | Link to thisabyssalmystery - Great advice for reasonably functional folks dealing with manageable misery! Unfortunately, some are incapable of responding to adversity, shutting down Windows & booting a backup version of DOS. Must be a MS software bug.
Reply | Report Abuse | Link to thisPsychosomatics. Placebos are effective because they treat a psychological disorder with a psychological solution. Depression is not nearly as physiological as it is psychological. Sure, depression meds do help the small physical and chemical aspects of depression, but their effect is largely due to a positive change of mind. This article was interesting because the results are not surprising.
Reply | Report Abuse | Link to thisScience Geek decries the old mythology with the new mythology: "That is, to improve our definitions (and our treatment outcomes) we'll need to better understand the underlying biology of the cluster of diseases we call depression. Molecular biomarkers and imaging are obvious tools to move us in this direction, but we'll need to work with large data sets collected in carefully controlled studies along with access to DNA, RNA and other specimens appropriate for proteomics research. Only with such large scale investigations will we see the development of the "personalized" medicines - and better outcomes - the depressed populations need."
Reply | Report Abuse | Link to thisar5skier - I suspect you're associating the term depression with the effect you suffered last week from some disappointment. Until you see the effects produced by severe depression in someone you know you can't comprehend how physiological it is. I shared your view until I could compare before and after observations of an individual. These are not simply weak willed people: they suffer a physical impairment in the processing of their brains. The have no more control over the affects depression than do epileptics over seizures.
Reply | Report Abuse | Link to thisDr. Kelly,
Reply | Report Abuse | Link to thisThanks for your extremely well-written article. I've been active in mental health advocacy for years and am becoming very discouraged by the clear evidence that the industry that is responsible for producing drugs that do seem to be very effective, even life-saving for some (those with psychotic disorders, for example), is suppressing information about harmful side effects, such as suicides in healthy clinical trial volunteers (http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm114970.htm), diabetes (http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/EnforcementActivitiesbyFDA/WarningLettersandNoticeofViolationLetterstoPharmaceuticalCompanies/ucm055315.pdf) , and weight gain leading to obesity-related ill health and possibly a more limited life expectancy.
My hope is that eventually more people will come to realize that our focus on treating emotional problems with medication has come about from ...trying to figure out how to say this without sounding too paranoid...those market forces which make America great. In my opinion, it's time for the average "consumer" to learn more about the reasons why our own personal assessments of the risk/benefit ratio may be off, and time for psychiatry to address its ability to be influenced by big business.
My desire to keep hoping leads me to believe that there must be effective alternative, safe and hopefully affordable treatments for various levels of mental illness. If we have more voices such as yours, perhaps we can start figuring out ways to combat the economic power that is currently driving the focus on meds and expand to include new and different techniques that can help people recover as much as possible.
As a person living with mental illness I will add my anecdote (as I am wont to do): I'm fortunate enough to live in Maryland, where I was able to take a course in Mindfulness-Based Stress Reduction, a form of meditation based on mindfulness and acceptance. Having lived with bipolar disorder with severe anxiety for thirty years, this course was life changing for me. The University of Maryland is currently studying the use of MBSR in survivors of childhood sexual abuse (http://www.compmed.umm.edu/research_clinical.asp#AMWELL). I hope that this and other trials of low-risk interventions will provide us with more opportunities to feel better.
Michelle Colder Carras
Dear Michelle,
Reply | Report Abuse | Link to thisThank you for your kind words and thoughtful response. I'm very glad to hear that Mindfulness Based Stress Reduction has been helpful to you.
Best wishes,
John Kelley
I think that most clinical investigations of antidepressants suffer from a lack of specificity when selecting subjects. I believe that too many people are included whom don't have the biological illness being studied. Often, the diagnosis of Major Depressive Disorder is left to the administration of primitive questionnaires comprised of 21 questions or less. No biological tests are given. Hopefully, this will change soon as more diagnostic markers are discovered. It is interesting that, statistically, people with more severe depressive symptomatologies respond better to antidepressant treatment. My guess is that these subjects are more likely to have Major Depressive Disorder. Therefore, the greater the proportion of the study population to present with severe depression, the more the results will demonstrate a greater effectiveness of drug treatment versus placebo.
Reply | Report Abuse | Link to thisI agree. That's probably one of the reasons there are so many antidepressantes in the market. Not all of them work for every patient.
Reply | Report Abuse | Link to thisFurthermore, even though I do believe in the placebo effect and how it can virtually "cure" different illnesses, I also believe that antidepressants do work in mild to sever depression cases as well.
Whenever I forget to take my pills for instance, it only takes one day for me to notice. Not only because of the dizziness this forgetfulness causes, but a noticeable change in my mood and state of mind occurs, even when I haven't yeat realized I didn0t take the pill in the first place.
Time seems to generally help depression. With or without medications. Perhaps if we stated that "With or without medications, most depressed patients tend to improve over time," now try to add meds to the formula. Difficult.
Reply | Report Abuse | Link to thisA cycle is involved here. "Biorhythms" may have been an attempt to describe depressed states as variations from normal, to happy, to sad. With sad being called depressed.
There no longer seems to be an mention of the differentiation of exogenous depression from endogenous depression.
Lee Brown, MD
Your statements seem to reflect the experience of a general practitioner, who most often treats slightly ill patients. I think that in the more severe cases, untreated depression tends to worsen in time, but I'm just guessing from limited experience. I can only guess that you refer to exogenous depression as the normal, healthy response to traumatic experiences... Thanks for your comment, but additional explanation would benefit us laymen.
Reply | Report Abuse | Link to thisDid they take into consideration if a medical condition was directly related to being depressed? Such as: traumatic brain injury
Reply | Report Abuse | Link to thisYou are talking about the platinum research standard (tongue in cheek here) - which trumped the gold research standard of double blind, random assigns etc. The platinum standard should also have a group of people from the chosen population being researched, that is randomly assigned to do nothing different - neither placebo nor drug. Then we can effectively measure what the effects of time actually are. It will be some time before this research standard comes into being.
Reply | Report Abuse | Link to thisEndogenous depression does not improve with time! In fact, as there is no "cure" for it, all one can really do is try to live with it - with or without meds. I've had depression since childhood (am now 50) and probably the only things that have really helped (am on meds, but question the effectiveness) is exercise, music and light. The anhedonia characteristic of major endogneous depression is extremely pervasive and does not get better with time.
Reply | Report Abuse | Link to thisFohnnora,
Reply | Report Abuse | Link to thisSee, that's where I wonder how much of our attitudes about mental illness come from insidious influences to keep us ill. There are all sorts of alternative techniques, such as the ones you have found, that offer relief. Is man meant to be truly "well"? What is normal? My psychiatrist has said that the goal of psychiatry - and it seems this comes from Freud's Studies in Hysteria - is to turn our hysterical misery into common unhappiness.
I also wonder whether newer movements, like the science of positivity, might have promise. But consider how much funding is available for a study of, say, counting your blessings every night vs. not. No one's going to spend $36 million dollars a year pushing that sort of thing (the amount spent to market Lexapro in 2004 JUST on providing "lunch and learns" to doctors, see http://www.nytimes.com/2009/09/02/business/02drug.html for more detailed information including a link to the how tens of millions were spent on other aspects of marketing Lexapro in that year).
The first time I was diagnosed with depression it surprised me - I knew I didnt feel well but wasn't "sick", was uninterested in things that I was usually keen on, Having trouble doing work I loved, living in a grey fog and with a constant feeling of doom. I suspected I was being given a placebo when my doctor prescribed pills, but 10 days later bounced into his office and invited him to tell me they were sugar pills. I have been on and off various depression medication since. When the pharmacy gave me pills with a different name and assured me they were exactly the same I totally believed that, but within two weeks I was in my doctor's surgery feeling much worse. Was told I wasn't the only patient who had experienced this. Different proportions? Different delivery system? On another tpye l was fine, except when the brand name changed again. ON a slightly higher dose of that brand, much better. Recently came off the low dosage which kept me sane as my doctor suspected a side effect, and after a gradual weaning off lapsed into a deep, black depression: can't eat, can't sleep, can't function or do normal tasks, despite getting sunshine, grimly exercising having a beloved adult child visit from abroad, and trying to live a normal life; thinking about death constantly. Doc tried a different anti-depressent that caused burning pain in the abdomen and a fainting episode.
Reply | Report Abuse | Link to thisApparently had a stomach ulcer caused by something else, very soon cleared with medication.
Back on the previous pills (gradually until on a dose of 3 a day) I began to feel better, then normal, and have cut back the dosage with no ill effects.
I don't believe I would have survived, lost 15 kg during the depression, and I am underweight" normally. Mentally and possibly physically I don't believe I would have survived without the appropriate medication, and I doubt a placebo would have helped at all.
I do think sometimes pills are prescribed improperly and unnecessarily, but please don't play ducks and drakes on the basis that placebos may be 75% effective or other stats. Each patient is an individual, not a statistic. That extra 25% may be vital.
jtdwyer- There's no denying that as you said, some people have physical impairments that alter their brain processing and chemical imbalance. But you also can't deny the effect of a placebo in many cases. Why does the placebo work so well if there is not a significant psychological aspect to depression? No doubt there's both physical and mental issues here, but in many instances, the psychological dimension is quite relevant. That was all I was trying to say
Reply | Report Abuse | Link to thisI dont believe antidepressants work by mainly placebo effect. These drugs are potent and strong and have many effects on the nervous system. What I have noticed is that articles that claim antidepressants are mainly "placebo" are usually written by psychologists or old school style psychiatrists who are angry they cant do the psychotherapy they used to do, because insurance refuses to pay for it anymore. Also, there is institutional bias within psychology that talk therapy is better than medication for most mental disorders. Always ask "who is this person" when you read articles, scientific or not, that claim antidepressants are "placebo." Because the odds are, the writer is a touchy feely psychologist and not someone who has regularly dealt with severe mental illness.
Reply | Report Abuse | Link to thisI battled severe depression for years and still am battling it in fact. After battling it for ten years and treating it exclusively with psychopharmacology/psychiatry, I found out something disturbing. A large percentage of my problem was actually medical, not psychiatric. I found out that treating obstructive sleep apnea with CPAP equipment prescribed by a pulmonary specialist improved my mental and physical condition by probably 50% at least. I was able to work for the first time in over ten years after being put on CPAP gear.
Reply | Report Abuse | Link to thisAll those years I WASTED with psychiatry, lost the prime of my life because I went untreated for sleep apnea. And I was originally diagnosed with it only three years after being diagnosed with "depression." But my insurance refused to pay for CPAP gear and the doctors I used at the time refused to advocate for me and push it past insurance.
Fast forward seven years after being originally diagnosed with sleep apnea, put on CPAP. BOOM! Starting getting better. After that, gradually got better over a year and a half period. Still not normal, but hey, what do you think all those years of oxygen desaturations and fragmented, poor sleep did to my brain, body and mind?
Also, I found out I have other medical conditions. Testosterone deficiency, vitamin D deficiency. When these were treated, they added to the CPAP improvement. Now I am able work again, but sadly, I lost my late twenties and my entire thirties because of the blunders of psychiatry and because of health insurance that refused to pay for the treatments I really needed.
When at least half my problem was sleep apnea, low testosterone and low vitamin D, all most of my docs did was push Prozac type drugs on me.
Its really, really important to distinguish between mild or moderate depression and the real thing, clinical depression. They are apples and oranges. Clinical depression is a genuine medical illness and will kill you fast left untreated. You just cant compare mild to moderate "depression" to say, the severe kind of clinical depression that would get you referred for an ECT doctor or get you referred to a psycho-pharmacologist psychiatrist.
Reply | Report Abuse | Link to thisAlso, anyone with clinical depression who does not simultaneously investigate physical causes of their depression is probably going down the wrong path. Investigation of sleep disorders such as possible sleep apnea, endocrine disorders like low testosterone or thyroid or parathyroid illness, or even very simple things like iron deficiency and mild anemia can impact "depression."
Also, depressed people tend to stay indoors a lot and that can lead to vitamin D deficiency. There is a lot of evidence linking low vitamin D and mood problems. I know taking high dose vitamin D boosts my mood and gives me more energy.
In my experience, psychiatry does a awful job of investigating physical contributors to depression, anxiety, psychosis and mental illness in general.
No, people who draw outrageously broad conclusions on the basis of their own limited experience--THAT'S a problem.
Reply | Report Abuse | Link to thisThe standard for science in the lab has always been to check if cause and effect is at play by repeatedly making the change then withholding the change i.e. I change the pressure in a system and get an unanticipated effect. Change it back and it goes away change it again and it comes back. That is considered proof of cause and effect.
Reply | Report Abuse | Link to thisAfter years on anti-depressants my doctor thought I no longer needed them. That precipitated several years in hell. Back on the anti-depressants the symptoms go away. The placebo effect doesnt explain this because I was also convinced I didnt need the drugs.
While I suspect that there would be a higher effectiveness rate if western doctors had a way of matching patients to pills- something akin to the pattern diagnosis of Chinese medicine or the constitutional medicine of Ayurveda, it is clear to me that most doctors don't cover the basics. I can't tell you how many clients or family members were prescribed SSRIs without basic blood tests for thyroid, adrenal function, allergies, hormonal balance, Vitamin D, Omega 3s or minerals like magnesium, lithium or other trace minerals involved in neurotransmitter transport or cell membrane resistance.
Reply | Report Abuse | Link to thisThere is usually no discussion of changing the objective situations of life- no antidepressant will make up for a bad marriage or the loss of a close friend. Nor is there acknowledgment that sometimes depression is the appropriate response to the slings and arrows of life. Sleep disruption can be a primary cause of depression- not just a result. Exercise usually helps, especially out of doors in the winter. And finally, drugs won't make up for a lack of purpose.
When the basics are taken care of, then and only then does it make sense to consider medication. (Doesn't it occur to anyone that the sexual side effects of Prozac et. al. can make things worse? And people with SSRIs are more likely to get Viagra headaches when it is mis-prescribed for Prozac sexual dysfunction because they use the same CYP40 pathway to detoxify.)
And lastly, medications can be useful when they show the brain different ways to function, but are not treated as lifetime crutches. No one has a Paxil deficiency. It is possible to use medications short term and to stop them before they interfere in the body's ability to manufacture its own chemicals.
I practice a form of medicine that individualizes prescriptions and stresses lifestyle and dietary modifications. Until western medicine stops the one size fits all treatment of depression, and stops throwing medications at patients until they see what sticks, we will fail to treat effectively.
3,600 cases where antidepressants are linked to murders and killing sprees. Are you kidding me? Have you any idea how widespread the prescribing of antidepressants is? Not only is does this represent an incredibly small number of cases (nonetheless anything that happens during clinical trials must be mentioned as a possible side effect, even when no causal relationship can be established) but can we agree that these people were being treated with antidepressants because they had mental or emotional difficulties in the first place!? I have been on these drugs for years with NO ill effects, including no problems with withdrawl. I agree with the one comment that states that depressives are not all the same and that depression is not a uniform disorder. Some peoples' depression may stem from environmental or situational causes, some from early childhood traumas and yet others (like myself) can truly have disruptions in brain chemistry leading to a host of undeniable symptoms. Symptoms which can be greatly alleviated with the use of antidepressants.
Reply | Report Abuse | Link to this