Do Anti-Depressants Work?
Posted March 20th, 2008 by aptana
A recent study led Professor Irving Kirsch suggested that leading brands of antidepressants worked little better than placebos in all but the most depressed patients when examining both published and unpublished clinical trial data. So have we been fooled by pharmaceutical companies who have deliberately withheld results that question the efficacy of antidepressants? Or is this a highly irresponsible study that could jeopardise the lives of people suffering from depression?
Self Sufficiency Needed to feed oneself***
What will we do when peak oil affects us directly?!* We have only so much fossil fuel left in the world. We have still to find an alternative form of energy which can replace the power & strength of oil the world over.
Every known dependant which we now rely on is entirely because of the power of oil!!*
Who do you know can and does grow their own food?!*
What happens if our shops no longer received oil fueled cargo's carrying survivable food?!*
Who do you know that can support themselves?!*
Fact: The country produces 95% Meat Food and 5% Veg, Fruit & Grain Food.
Which will help us to survive most if we have no way of cooking?!*
depression pffft....
I have an opinion on this, strong enough to voice.
Its true, that depression is linked to a chemical imbalance in the brain, and the ensuing emotions. That’s natural. Mostly people are depressed because they do not get what they want out of life, or because circumstance has thrown a spanner in the works. When things are beyond your control and going in a direction you do not want, you are probably going to be depressed about that.
There is an art then to losing ones mind through depression. One may trick themselves into believing that they want the bad thing to came about, so that when it does, they may say to themselves, “I got it right, thing are going the way I expect them too; and even if that is not very nice for me at least I can trust that I know what will be, I’m so clever, I’m OK” .
This sadness cannot be cured by chemical means, absolutely not as a long term therapy, just look at alcoholism and addiction in general to see the truth in that.
In the long term pharmaceutical treatment of depression is probably more tragic then the depression itself. I never allowed myself to be treated with emotional state altering drugs, and it made me cry when I found out a friend did. Well done Dr Kirsch.
Just say no.
Just say no.
Depression pfffffffft...
JonnyC, have you or anyone else that you know ever suffered from depression? If yes, then I'm sure you would know how we feel and what you said is very valuable. But what you just wrote is very painful for me - as a sufferer of endogenous depression - to read.
In my specific case of depression, I have been this way from day one. I have always been scared. I have always wanted to kill myself to avoid embarassment or conflict. I have ALWAYS felt like I am trapped somewhere and only death can secure me. If I sleep less than 10 hours a night, my body aches like I've been playing three NFL games. I walk at least 2 miles every day, not for exercise. I just pace around. Thinking about ending my life. I can't keep a relationship. I CANNNOT keep a job. I just can't can't do anything.
What do you think?
Evidence and depression: Pills work!
The media coverage of the Kirsch et al. (2008) work seem to me as a layperson to be very misleading. Headlines such "As no difference between anti-depressants and sugar-pills" really did seem to be saying that the whole promise of the new anti-depressants was a fraud. That would be really important if true but from lookin at the paper itself I don't think it is.
I think a fairer headline for reporting the Kirsch et al. (2008) work might have been "Recent Study Confirms effectiveness of SSRIs for severely depressed despite hidden data". That seems to much more fairly capture the Kirsch et al. (2008) paper - at least what I gathered from looking at it.
The 'despite hidden data' is a really vital bit of the news: An important aspect of the study was that it used evidence that the drug companies had – to put it politely – not highlighted. Those anxious to sell the drugs tend to push evidence that show the drugs work and hide the evidence that drug does not work or that the drug has unpleasant side effects. This is really important and governments should ensure that there are independent drug researchers and all information on drugs are made available to drug researchers, regulators, doctors and the public. Science needs true independence and integrity.
The other bit of my alternative headline 'Recent Study Confirms effectiveness of SSRIs for severely depressed' I gathered from a brief look at the paper. I'm an academic (economics & management) but not a psychologist or mental health expert so be warned I'm no expert but then I suspect neither were most of the headline writers! The story seemed clear enough from Figure 2 from the study (Thanks to the public spirited way the paper has been published you can get for free on the internet - the full reference is below)
Figure 2 (see the Kirsh et al paper) is a complicated figure but essentially the solid red line shows the improvement from taking a SSRI anti-depressant whereas the dashed green line shows the ‘placebo’ effect from taking a sugar pill.
Studying the lines on Figure 2 (I’m ignoring the more complicated circles and triangles because I don't understand those bits) I see a number of things
(1) With patients suffering from very low severity (very mild) depression the ‘placebo’ or sugar pill actually seems to do them more good overall than the SSRI anti-depressant. For this point of the diagram the media seem right about this particular study . It might seem to surprising but I think it might be explained by the following: The placebo effect or belief that you are getting treatment improves most diseases even if there is no physical effect from what is really just a sugar pill. The great thing about this placebo effects is that it is very unlikely to have any side-effects so you get all the benefit from getting a treatment you can believe in without any of the side-effects. The anti-depressants are thought to have powerful effects on your body and although they might be doing you good, and you may also get a good feeling from being treated they are bound to have some unpleasant effects. What I think this study shows is for those with very mild forms of depression the unpleasant side-effects of the anti-depressants seems for the period of the study to outweigh any positive effects of the SSRI pills
(2) For those with moderate depression the solid red lines is above the dashed green line. This means that those moderately depressed patients taking SSRIs improve more than those sugar pills. That means the SSRI anti-depressants improved those with moderate depression more than the placebo effect. So how did the media conclude that these anti-depressants were no better than sugar pills? The explanation, or excuse, for the media error was I guess because the better performance of the anti-depressants pills as calculated in this study was not big enough to statistically prove that the anti-depressants were better than placebos. In other words it was possible, according to this study’s calculations, that the better performance of the anti-depressants was just a matter of luck. The media was incorrect: What this study definitely does not do is prove that anti-depressants is the same as a sugar pill: In fact the study shows that even for moderately depressed patients the anti-depressants worked better than a placebo (see the difference between the two lines) – it just showed that this better performance of the anti-depressants might have been a matter for luck.
(3) For severely depressed patients this study shows that beyond all reasonable doubt those on anti-depressants did better than those on the placebo or sugar pill. Alas you would have to study the media a lot before this fact was found.
Of course this is just one study and what is annoying about media coverage of research is that they tend to take the latest study on its own rather than listening to the whole debate. As a non-expert I'm a happy to thank Dr. Kirsch and his/her team (especially for highlighting the importance of getting all the data out in the open) but I do hope people are more careful and evidence-based in policy and caring for those suffering depression than the media was in dealing with this study.
Reference.
Kirsch, I., Deacon, B. J., Huedo-Medina, T. B., Scoboria, A., Moore, T. J., & Johnson, B. T. (2008). Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration. PLoS Medicine, 5(2), e45.