NationStates Jolt Archive

http://news.bbc.co.uk/1/hi/health/7263494.stm

Anti-depressants 'of little use'
Tuesday, 26 February 2008

Anti-depressant prescription rates have soared

New generation anti-depressants have little clinical benefit for most patients, research suggests.

The University of Hull reviewed published clinical trial data, and unpublished data secured under Freedom of Information legislation.

They found the drugs helped only a small group of the most severely depressed, and in most cases had no more effect than taking a dummy pill.

The Royal College of Psychiatrists said the findings were "very important".

In total, the Hull team, who published their findings in the journal PLoS Medicine, reviewed data on 47 clinical trials.

They focused on drugs in the class known as Selective Serotonin Reuptake Inhibitors (SSRIs), which work by increasing levels of the mood controlling chemical serotonin in the brain.

These included fluoxetine (Prozac), venlafaxine (Efexor) and paroxetine (Seroxat) - all commonly prescribed in the UK.
There seems little reason to prescribe anti-depressant medication to any but the most severely depressed patients
Professor Irving Kirsch
University of Hull


The number of prescriptions for anti-depressants hit a record high in England in 2006 - even though official guidance stresses they should not be a first line treatment for mild depression.

The researchers found that even the positive effects seen on severely depressed patients were relatively small, and open to interpretation.

The seemingly good result came from the fact that these patients' response to the placebo decreased, rather than any notable increase in their response to anti-depressants.

Lead researcher Professor Irving Kirsch said: "The difference in improvement between patients taking placebos and patients taking anti-depressants is not very great.

"This means that depressed people can improve without chemical treatments.

"Given these results, there seems little reason to prescribe anti-depressant medication to any but the most severely depressed patients, unless alternative treatments have failed to provide a benefit."

'Small subset'

Professor Kirsch said the findings called into question the current system of reporting drug trials.

Dr Tim Kendall, deputy director of the Royal College of Psychiatrists Research Unit, has published research concluding that drug companies tend only to publish research which shows their products in a good light.

He said the Hull findings undermined confidence in the ability to draw meaningful conclusions about the merit of drugs based on published data alone.

He called for drug companies to be forced to publish all their data.

The National Institute for Health and Clinical Excellence (NICE) is currently reviewing its guidance on the use of antidepressants.

A spokesman for GlaxoSmithKline, which makes Seroxat, said the study only looked at a "small subset of the total data available".

And Eli Lilly, which makes Prozac, said that "extensive scientific and medical experience has demonstrated it is an effective anti-depressant".


I was wondering what those of us on here who use antidepressants might think of this?

i've always heard that pills weren't the only answer to battle depression; that therapy was the only "cure"... but round here, despite having a world class hospital in the city, the NHS were unable to provide any form of therapy without being on a waiting list for a year. and even then, my doctor said she believed therapy created more problems than it solved. maybe this study will make the NHS (round here) pay attention to mental illness more.


my own experience with Citalopram (a SSRI, which i've been on about 2 years) has been quite positive. it has helped me 'even out', and i know when i don't take them my mood swings from suicidally depressed to giddily happy to violently angry at the drop of a hat. however, i am far from cured or properly better. its my way of thinking and my life circumstances which cause the depression in the first place, and while the former could be battled with therapy, the latter is much harder to change. so i guess i'd say the antidepressants help, but aren't enough.

what about your experiences?

what i did find surprising about the article was that it suggests SSRI's don't help most people at all...

I've never been on anti-depressants, never thought I was bad enough for it to be necessary, but I've always been of the opinion that they should be a temporary stabiliser of mood around which therapy should work to change thinking and improve in the longterm. However, based on that most depressives have a chemical/hormonal imbalance that may have originally caused the negative thinking, anti-depressants are quite necessary for some.

Study finds anti-depressants 'of little use'
That's depressing..

Anti-depressants 'of little use'

No shit. In other news, water is wet.

The one I'm on isn't one of those mentioned, but it ain't working, either.

I wonder what the study is really concluding- the fact that the drugs don't work or the fact that many people think there's some "magic little pill" that will solve all of their problems. Me? I take the latter, given the breadth of the amount of pills available that's meant to resolve every pain imaginable- even the meaningless ones...

Really?

Edit:
If pills don't work, I've heard that exercise can help depression a lot.

not on anti-depressants but I know a few people who are (mostly just over the counter happy pills)

"Given these results, there seems little reason to prescribe anti-depressant medication to any but the most severely depressed patients, unless alternative treatments have failed to provide a benefit."

well its worrying that his bombshell has only just come out

however pills are cheaper than expensive (and time consuming) treatment so its not like anything will change soon...

As always it amuses me when the news suddenly starts reporting something that research has been saying for years. Although from the looks of it, this is probably one of the more comprehensive studies done on the topic. Independent (and that's an important word in this case) research has consistently found that the benefits of anti-depressants on their own are minimal at best. The benefits of therapy on it's own, assuming it's an appropriate type (CBT not psychoanalysis) does have a significant effect on it;s own. A combination of anti-depressants and therapy is generally best for sever cases since patients suffering from acute depression may lack the motivation/energy to effectively participate in therapy.


i've always heard that pills weren't the only answer to battle depression; that therapy was the only "cure"... but round here, despite having a world class hospital in the city, the NHS were unable to provide any form of therapy without being on a waiting list for a year. and even then, my doctor said she believed therapy created more problems than it solved. maybe this study will make the NHS (round here) pay attention to mental illness more.

Unfortunately the NHS lacks enough trained and chartered clinical psychologists. Pills are also, at least in the short term, cheaper and easier and finally, unfortunatly, a lot of doctors still subscribe to the purely medical model of mental disorders (including depression) which says it *just* a chemical imbalance. Psychotherapy also got a bad reputation due to studies in the 70s indicating that it did even less than anti-depressants, but that was with psychoanalysis and, shockingly*, therapeutic techniques have moved on since then.

my own experience with Citalopram (a SSRI, which i've been on about 2 years) has been quite positive. it has helped me 'even out', and i know when i don't take them my mood swings from suicidally depressed to giddily happy to violently angry at the drop of a hat. however, i am far from cured or properly better. its my way of thinking and my life circumstances which cause the depression in the first place, and while the former could be battled with therapy, the latter is much harder to change. so i guess i'd say the antidepressants help, but aren't enough.


Is that depression or manic-depression you have then? Because it sounds like the latter and I thought they tended to prefer using lithium on that? Just curious (please tell me if I'm being nosy).


*The rediculousness of the assumption that psychological interventions haven't changed in the past 30 years is a rant for another day

Very good friend of mine went on anti-depressants for awhile; she was extremely emotional and clinically depressed. The pills helped her alot curing those things, but it made her EXTREMELY apathetic towards EVERYTHING and gave her really bad dizzy spells. So in a sense, it solved one problem and created another.

I was on Prozac about ten years ago. To be honest, I preferred the symptoms to the (alleged) cure... side effect were a very dry mouth and mind-bogglingly awful constipation. In the end, I ditched the pills, changed jobs, stopped working 60 hour weeks, moved cities, and felt an awful lot better.

I've got the black dog back on my back again these days :(, but I found the better cure wasn't pills or even therapy. It was taking a good look at myself and my life, and changing it for the better.

And if anyone out there's got the black dog - you're not alone. Reach out. Talk to someone if you need to. Pills didn't work for me, but they might for you (even if it's only a placebo effect). But if you don't do anything, things'll stay the same.

what i did find surprising about the article was that it suggests SSRI's don't help most people at all...
Not exactly, the researchers claim that in most cases (notably excluding the most severe ones) they are no more effective than placebo. Look here:
http://www.badscience.net/?p=607
and here:
http://www.npci.org.uk/blog/?p=71
As I see it, the pill makers are pushing for publication – in big peer reviewed journals and with much fanfare - the studies with positive results. At the same time the ones that are not so good are published (because they have to be published) in less prominent places and together with some boring stuff nobody will read.
In my opinion the antidepressant market is in 90% created by marketing effort, just like the nutrition supplements market.
edit: for the record, I used to be depressed but never went to the doctor

I wonder what the study is really concluding- the fact that the drugs don't work or the fact that many people think there's some "magic little pill" that will solve all of their problems. Me? I take the latter, given the breadth of the amount of pills available that's meant to resolve every pain imaginable- even the meaningless ones...

indeed.


The one I'm on isn't one of those mentioned, but it ain't working, either.

i did note the article suggests the study wasn't conducted on the one i'm on either. i don't know about the other two mentioned, but Prozac is certainly of an old generation of SSRI drugs. Citalopram, for example (my one), is said to be much better than Prozac, better targeted with fewer side-effects.

if the other two drugs mentioned were old-generation SSRI's as well, its not fair to run a study on drugs which are out of date

I was on Prozac about ten years ago. To be honest, I preferred the symptoms to the (alleged) cure

Not the first time I've ever read that...tell me (if I may), did the drugs leave you "emotionless"? That's what one other person said (on another message board)- the drugs took away her "feeling" so she stopped taking them, feeling it was better to "feel depressed than nothing at all".

indeed.

Exactly. These drugs weren't designed to cure "I'm having a bad day"...they're meant to cure people who have significant issues, the ones many of us will never truly have an idea of "what it's like".

This was reported as saying that they had no more effect than placebos.

Do placebos stop working once you know that they are placebos?

In which case are a lot of people going to have problems because of this being so widely reported?

That's depressing..

Here, take these pills.

http://news.bbc.co.uk/1/hi/health/7263494.stm




I was wondering what those of us on here who use antidepressants might think of this?

i've always heard that pills weren't the only answer to battle depression; that therapy was the only "cure"... but round here, despite having a world class hospital in the city, the NHS were unable to provide any form of therapy without being on a waiting list for a year. and even then, my doctor said she believed therapy created more problems than it solved. maybe this study will make the NHS (round here) pay attention to mental illness more.


my own experience with Citalopram (a SSRI, which i've been on about 2 years) has been quite positive. it has helped me 'even out', and i know when i don't take them my mood swings from suicidally depressed to giddily happy to violently angry at the drop of a hat. however, i am far from cured or properly better. its my way of thinking and my life circumstances which cause the depression in the first place, and while the former could be battled with therapy, the latter is much harder to change. so i guess i'd say the antidepressants help, but aren't enough.

what about your experiences?

what i did find surprising about the article was that it suggests SSRI's don't help most people at all...

That's interesting that you were prescribed an SSRI for mood swings. Generally they prescribe mood stabilisers, like lithium or even epilespy medication. However, I found epilespy meds did very little for me.

Fluoxetine (Prozac) worked very well in controlling my anger and helped lift me from a severely depressive state, and also helped a little with bulimia, but it caused me to shake, twitch and reduced my attention span.

The reason why anti-depressants are more commonly prescribed is because:
1. More people are being diagnosed with depression.
2. More psychiatrists are choosing the medication option rather than therapy or a combination of the two.

The reasons (I think) they're finding anti-depressents aren't working are:
1. It's very hard to find a medication that works for a specific person.
2. We don't fully understand the brain and the way medication works.
3. You have to actually be depressed (have low seretonin etc.) for drugs to work! Being sad because of a bad day every now and then is not depression.

my own experience with Citalopram (a SSRI, which i've been on about 2 years) has been quite positive. it has helped me 'even out', and i know when i don't take them my mood swings from suicidally depressed to giddily happy to violently angry at the drop of a hat. however, i am far from cured or properly better. its my way of thinking and my life circumstances which cause the depression in the first place, and while the former could be battled with therapy, the latter is much harder to change. so i guess i'd say the antidepressants help, but aren't enough.

what about your experiences?

what i did find surprising about the article was that it suggests SSRI's don't help most people at all...

I take the same, and it doesn't make any difference. I didn't need to read a study to tell me that they're a waste of time, though I'm happy they work for you. My original solution was alcohol, and I only even bothered going to the doctors because my family coerced me into it, and surprisingly enough it was a waste of time. So now I just combine the pills with alcohol, which seems to work just as well.

My anti-depressant saved my life, but I don't think it was an SSRI.

1. It's very hard to find a medication that works for a specific person.This is a good point - perhaps the people on the SSRIs shouldn't have been on them. This is totally different than saying they don't work.

I've been on an SSRI (Sertraline hydrochloride, under various trade-names) three times before this, for several months at a time, and am going to the doctor to ask for a new prescription again tomorrow. It works well for me, with only mild side-effects (including a reduced appetite for food that's definitely helped me to get my waistline down from 40" to a slightly healthier 36" during the last few years) and given the extent to which I was getting depressed without it I'm dubious about whether a placebo would have worked as well in my case.

Is that depression or manic-depression you have then? Because it sounds like the latter and I thought they tended to prefer using lithium on that? Just curious (please tell me if I'm being nosy).

not nosy at all... i tend to share far more than most people on this forum :p

seems to me to me to be regular major depression with some dysthimia thrown in for fun

That's interesting that you were prescribed an SSRI for mood swings. Generally they prescribe mood stabilisers, like lithium or even epilespy medication. However, I found epilespy meds did very little for me.


no, i was prescribed SSRI's for long term suicidal major depression. the mood swings have come 2 years on after taking the meds... or, more specifically, when i'm not on the meds.


This is a good point - perhaps the people on the SSRIs shouldn't have been on them. This is totally different than saying they don't work.

very good point...


3. You have to actually be depressed (have low seretonin etc.) for drugs to work! Being sad because of a bad day every now and then is not depression.

...as is that one

(including a reduced appetite for food that's definitely helped me to get my waistline down from 40" to a slightly healthier 36" during the last few years)
wish mine did that :p

Well, this certainly comes as a surprise. :P

I was on SSRIs for a while, back in high school. They did more to hurt me than help me -- in addition to the assorted side effects, such as bowel problems, headaches and severe apathy, I ended up alienating every friend I'd ever made, got extremely poor grades (I was an A student before going on meds, and ended up averaging a C in my two classes...), and got almost no work done during the whole time I was on them. And I don't think the mental issues really went away, either; only were slightly reduced in scope.

As it turns out, therapy didn't work for me either, so I ended up ditching the meds, changing my diet, and doing more exercise. Now the only times at which I feel particularly "depressed" are on days when I don't exercise or eat improperly, which is definitely an improvement.

tl;dr: SSRIs work for some folks, don't work for others, and here's some anecdotal evidence you probably won't read to prove it!

SHHHHH!!!! Don't say that out loud, the placebo effect will be totally ruined!!

my own experience with Citalopram (a SSRI, which i've been on about 2 years) has been quite positive. it has helped me 'even out', and i know when i don't take them my mood swings from suicidally depressed to giddily happy to violently angry at the drop of a hat. however, i am far from cured or properly better. its my way of thinking and my life circumstances which cause the depression in the first place, and while the former could be battled with therapy, the latter is much harder to change. so i guess i'd say the antidepressants help, but aren't enough.

Citalopram sucks:) lol

I take it but it definately didn't help, now I take some other one in addition to the citalopram and that's working a bit better to even me out. and with your last sentence, they aren't enough for most, that's for sure. I'm glad that psychological services are completely covered in my university's health plan, yay!

I was wondering what those of us on here who use antidepressants might think of this?

The fact that the placebo effect exists is not news. Nor is the fact that placebo effects tend to impact psychological disorders even more than non-psychological disorders. Neither of these actually means that anti-depressants are of little use.

Nor does the fact that some people don't benefit from SSRIs. Nor does the fact that SSRIs are over-prescribed.

The article you cited is simply another case of mainstream media misinterpreting and/or misrepresenting medical reality.


i've always heard that pills weren't the only answer to battle depression; that therapy was the only "cure"...

For many people, there is no "cure" to clinical depression. Many people experience chemical imbalances which simply will not be "fixed" by therapy alone.

After having used antidepressants for several years, I am now able to identify my Depression, and separate it from my "real" feelings. There are plenty of times when I'm bummed or upset or sad, but it's not Depression. It actually feels different.

All the therapy in the world couldn't have shown me this difference, because I simply did not know what it felt like to not have my Depression. I didn't know what "normal" feels like, until I started on antidepressants. Now I'm able to identify when I'm normal-sad or normal-depressed, versus when it's my disorder going wonky on me.

Therapy absolutely positively DOES have an important role. I have had a lot of success with therapy. But I think that in my case I needed a combination of both therapy and medication. Neither would have been fully successful alone.

It's kind of like if you have an injury to your leg, the doctors patch you up, and then you also need physical therapy. Your leg might have healed alone, possibly, but odds are it wouldn't have healed as well without the doctor's helping. And you could have regained mobility alone, but you recover faster and better if you have physical therapy helping you out. The combination of both is what gives you the best success.


my own experience with Citalopram (a SSRI, which i've been on about 2 years) has been quite positive. it has helped me 'even out', and i know when i don't take them my mood swings from suicidally depressed to giddily happy to violently angry at the drop of a hat. however, i am far from cured or properly better. its my way of thinking and my life circumstances which cause the depression in the first place, and while the former could be battled with therapy, the latter is much harder to change. so i guess i'd say the antidepressants help, but aren't enough.

This is spot-on.

I've had external problems in my life that needed sorting out, and therapy really helped with that. But I also have something out of whack internally, and my therapist was the one who convinced me to try antidepressants to see if maybe they could help. I will be thankful to my dying day that he did convince me.


what about your experiences?

what i did find surprising about the article was that it suggests SSRI's don't help most people at all...
I think the problem is that a lot of people don't fully understand what SSRIs are supposed to do, so the drugs don't measure up to their expectations. People like the idea of a magic happy pill that stops you from ever feeling bad. But that's not how this stuff works. If you have real external problems bumming you out, SSRIs aren't going to magic them away, and you might not feel any better until your external situation gets sorted out. You might not need SSRIs in the first place, or you might need them but you also need other help too.

Citalopram sucks:) lol
Heh, it works great for me!


I take it but it definately didn't help, now I take some other one in addition to the citalopram and that's working a bit better to even me out.
This is another key point:

SSRIs don't work for everybody's depression!!!

SSRIs impact serotonin reuptake, but serotonin isn't the only neurotransmitter that is linked to depression. Dopamine and norepinephrine are also important players. Some people don't respond to SSRIs (like Celexa or Prozac), but they do respond to norepinephrine-dopamine reuptake inhibitors (like Wellbutrin).

Heh, it works great for me!


This is another key point:

SSRIs don't work for everybody's depression!!!

SSRIs impact serotonin reuptake, but serotonin isn't the only neurotransmitter that is linked to depression. Dopamine and norepinephrine are also important players. Some people don't respond to SSRIs (like Celexa or Prozac), but they do respond to norepinephrine-dopamine reuptake inhibitors (like Wellbutrin).

That's what I'm on. This is after trying everything else on the market. It's no longer working, and I can't help but wonder if I've built up a tolerance for the drug. They can't increase the doseage, however, because I'm already taking the maximum safe doseage.

Because it sounds like the latter and I thought they tended to prefer using lithium on that? Just curious (please tell me if I'm being nosy).

Just so you know, it's not terribly uncommon to treat bipolar disorder with a combination of mood stabilizers and antidepressants, since it doesn't help the patient terribly much if their mood levels out to "constantly miserable."

(Also, lithium has some freaking nasty side effects, so a lot of people with bipolar disorder can't take it.)

Heh, it works great for me!


This is another key point:

SSRIs don't work for everybody's depression!!!

SSRIs impact serotonin reuptake, but serotonin isn't the only neurotransmitter that is linked to depression. Dopamine and norepinephrine are also important players. Some people don't respond to SSRIs (like Celexa or Prozac), but they do respond to norepinephrine-dopamine reuptake inhibitors (like Wellbutrin).

Haha obviously SSRIs don't work for everybody's depression. I'm on citalopram and just started wellbutrin. thanks for the post because for some reason I keep forgetting the name wellbutrin. I usually just call it "you know, the pill that starts with a w" lol

I've known this for a long time, but no one takes anecdotal evidence seriously. I'm glad they did this study.

Now I hope someone will do a study showing exactly how useful therapy is. I doubt there is anything therapy can do that talking to someone who actually pays attention to what you're saying can't do.

What a load of bullshit.

I've been taking Paxil for a little over six months for severe anxiety and accompanying depression. It's been miraculous for me. I used to constantly worry, about every little thing, obsessively. I had panic attacks daily. It was terrifying. Paxil, ativan, and therapy have all helped me immensely. I'm not perfect, or even close, but I'm beginning to glue the pieces back together so I resemble an actual human being.

When I was diagnosed, I didn't take medication, I went to counselling, which both worked and didn't. It saved me a lot of physical and mental anguish and pain, and stopped me self-harming, but I still wasn't actually happy. That's only come at university, and even then I still have as many days where I feel grindingly low and bitter.

I do agree that giving people pills because they're blue (and people expecting pills to make them happy) is a major problem. I had to go through two evaluations, the first with a LCSW, and the second with a psychiatrist before anyone would give me meds. I just wish others were as thorough. It probably helped that I went to my local Community Mental Health center because I didn't have a doctor at the time.

People like the idea of a magic happy pill that stops you from ever feeling bad. But that's not how this stuff works. If you have real external problems bumming you out, SSRIs aren't going to magic them away, and you might not feel any better until your external situation gets sorted out. You might not need SSRIs in the first place, or you might need them but you also need other help too.

I totally get that. I was on SSRIs (or 'normal person pills', as I preferred to call them) after a whole string of tragedies among my family and friends. They helped me get through things.
Now I've come off them, only to discover that once again I have a lot of grieving to get on with, and a lot of issues to tackle. This week, I started looking for counselling. And long overdue it is too.

I've known this for a long time, but no one takes anecdotal evidence seriously. I'm glad they did this study.


If you'd bothered to read the thread, you'd know that the study was misreported. What it actually said was that SSRIs don't work on people without clinical depression and on people whose clinical depression isn't linked to serotonin.

Which is really a "duh" thing.

If you'd bothered to read the thread, you'd know that the study was misreported. What it actually said was that SSRIs don't work on people without clinical depression and on people whose clinical depression isn't linked to serotonin.

Which is really a "duh" thing.

Indeed. All the article has informed us is that SSRIs are frequently misprescribed, because we don't know enough yet to tell whether it's lack of serotonin causing your brain to go wacky, or lack of something else. (My theory is dopamine/norepinephrine deficiencies in my case; also possibly explaining why I hated the taste of chocolate while depressed, -- it either contains or stimulates norepinephrine, I forget which -- but now eat far too much of it. Of course, that's most likely completely unrelated.)

If you'd bothered to read the thread, you'd know that the study was misreported. What it actually said was that SSRIs don't work on people without clinical depression and on people whose clinical depression isn't linked to serotonin.

Which is really a "duh" thing.

I saw the professor who conducted the study live on TV, and he was very insistent and stated specifically that antidepressants work no better than placebos in helping with depression, even with those with severe clinical depression (this doesn't mean it isn't beneficial I guess). And isn't beneficial to those with moderate depression.

Antidepressants have done basically nothing for my chronic pain. I chose not to renew that perscription (amytriptyline (spelling? Dunno.)) after the first month. So I'm "meh" about them for pain. Whether they treat neuroses, I don't know.

I'm not surprised. I think they do more harm as the side-effects can be worse than what they were treating.

Antidepressants have done basically nothing for my chronic pain. I chose not to renew that perscription (amytriptyline (spelling? Dunno.)) after the first month. So I'm "meh" about them for pain. Whether they treat neuroses, I don't know.

Amitriptyline? That's heavy duty stuff. They give it to prisoners serving life sentences, and even they often don't take it because of the nasty side effects.