Anti-Depressants No Better Than A Placebo
Millions of people taking commonly prescribed antidepressants such as Prozac and Seroxat might as well be taking a placebo, according to the first study to include unpublished evidence.
The new generation of antidepressant drugs work no better than a placebo for the majority of patients with mild or even severe depression, comprehensive research of clinical trials has found.
The researchers said that the drug was more effective than a placebo in severely depressed patients but that this was because of a decreased placebo effect.
The study, described as “fantastically important” by British experts, comes as the Government publishes plans to help people to manage depression without popping pills.
More than £291 million was spent on antidepressants in 2006, including nearly £120 million on SSRIs. As many as one in five people suffers depression at some point. With that in mind, ministers will today publish plans to train 3,600 therapists to treat depression. Spending on counselling and other psychological therapies will rise to at least £30 million a year.
The study, by Irving Kirsch, from the Department of Psychology at the University of Hull, is the first to examine both published and unpublished evidence of the effectiveness of selective serotonin reuptake inhibitors (SSRIs), which account for 16 million NHS prescriptions a year. It suggests that the effectiveness of the drugs may have been exaggerated in the past by drugs companies cherry-picking the best results for publication.
The National Institute for Health and Clinical Excellence (NICE), which is due to review its guidance on treating depression, said that it would consider the study.
Mental health charities say that most GPs admit that they are still overprescribing SSRIs, which are considered as effective as older drugs but with fewer side-effects. SSRIs account for more than half of all antidrepressant prescriptions, despite guidelines from NICE in 2004 that they should not be used as a first-stop remedy.
American and British experts led by Professor Kirsch examined the clinical trials submitted to gain licences for four commonly used SSRIs, including fluoxetine (better known as Prozac), venlafaxine (Efexor) and paroxetine (Seroxat).
The study is published today in the journal PLoS (Public Library of Science) Medicine. Analysing both the unpublished and published data from the trials, the team found little evidence that the drugs were much better than a placebo.
“Given these results there seems little reason to prescribe antide-pressant medication to any but the most severely depressed patients, unless alternative treatments have failed,” Professor Kirsch said. “The difference in improvement between patients taking placebos and patients taking antidepressants is not very great. This means that depressed people can improve without chemical treatments.” He added that the study “raises serious issues that need to be addressed surrounding drug licensing and how drug trial data is reported”.
The data for all 47 clinical trials for the drugs were released by the US Food and Drug Administration under freedom of information rules. They included unpublished trials that were not made available to NICE when it recommended the drugs for use on the NHS. “Had NICE seen all the relevant unpublished studies, it might have come to a different conclusion,” Professor Kirsch said.
Tim Kendall, a deputy director of the Royal College of Psychiatrists Research Unit, who helped to formulate the NICE guidance, said that the findings were “fantastically important” and that it was “dangerous” for drug companies not to have to publish their full data. He added: “Three of these drugs are some of the most commonly used antidepressants in this country. It’s not mandatory for drug companies to publish all this research. I think it should be.”
SSRIs are not prescribed to patients under 18 because of the risk of suicide.Drugs watchdogs in Europe are considering tighter controls on the development of new medicines, The Times reported this month, and may soon require regulators to monitor psychiatric effects and the risk of suicide more closely during clinical trials.
A spokesman for GlaxoSmithKline, which makes Seroxat, said: “The authors have failed to acknowledge the very positive benefits these treatments have provided to patients and their families dealing with depression and their conclusions are at odds with what has been seen in actual clinical practice. This one study should not be used to cause unnecessary alarm and concern for patients.”
A spokesman for Eli Lilly, which makes Prozac, said: “Extensive scientific and medical experience has demonstrated that fluoxetine is an effective antidepressant.”
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I wonder if its due to Psychiatrists making WRONG diagnosis’s in the first place. I’d like to see that study.
What is amazing is that these drugs will work in a number of patients that ACTUALLY HAVE depression and not grief and or other “Normal” psychological issues.
Case in point: The amount of kids on Ritalin that are diagnosed with attention deficit that DON’T have it but rather have NO Amount of discipline in the years between 1 and 5.
Once again you see another set of “WONDER DRUGS”
over prescribed.
February 25th, 2008 at 6:35 pmYep.
ANyway, I think docs are a bit too quick to assume someone’s [need] for these drugs.
A couple months back (before the holidays and during) I had a bout of depression … My sister sent me some green tea blends from a tea shop near her. Did wonders. So, you don’t always have to reach for the pill … But if you DO need it, by all means …
Anyway, I saw in the news there has been, yet, another “post-term abortion” by a mother who drowned, slit the throat of of and poisoned her three kids (6, 5, and 1)in New York:
http://www.foxnews.com/story/0,2933,332390,00.html
Hard to say if she was in need of drugs, or drugs contributed to the “post-term abortion” of the three innocent children …
February 25th, 2008 at 7:00 pmMmmmm… I think that the life of someone very dear to me was saved by antidepressants.
February 25th, 2008 at 7:30 pmMmmmm… I think that the life of someone very dear to me was saved by antidepressants.
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I can / do believe that. I also know a few people that have been saved by such drugs. I also know far to many people that have had them prescribed to them that never needed them. Be it the Dr made the wrong call or the patients “Self Diagnosed” and told the Dr information that was not correct and thought a pill was going to be a cure all.
As with EVERYTHING, a second opinion is ALWAYS needed in the case of any diagnosis.
February 25th, 2008 at 7:50 pmRE:
A couple months back (before the holidays and during) I had a bout of depression … My sister sent me some green tea blends from a tea shop near her. Did wonders. So, you don’t always have to reach for the pill … But if you DO need it, by all means …
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True. I have never really studied alternative medicines / holistic treatments, so I can not give a pro or con on that subject.
It seems to me that many people these days don’t understand that having ups & downs in life is normal.
If we as humans didn’t exhibit emotions: Sadness, Happiness, Anger ETC. we would NOT be humans.
You can’t be happy all the time. And NO ONE is.
February 25th, 2008 at 8:02 pmWhen your depression interferes with your ability to interact with others or gets in the way of your professional life, then that is the time to seek medical attention. A lot of times medication is not needed when you hear from someone else that has gone through the same problems you have. It gives you a sense of ‘Yeah, I am OK” and “Yeah, I can work through this”.
I’m all for the patients OWN natural human made dopamine.
Its when the brain does NOT produce dopamine / or the neurotransmitters do not pick it up, that you see the chronic cases of depression. That is where the prescription drugs are needed.
I wonder if its due to Psychiatrists making WRONG diagnosis’s in the first place. I’d like to see that study.
What is amazing is that these drugs will work in a number of patients that ACTUALLY HAVE depression and not grief and or other “Normal” psychological issues.
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Bingo!
Anti-depressants also don’t work for people with bipolar disorder and some anti-depressants can trigger mania if taken by people with bipolar disorder, who are incorrectly diagnosed with clinical depression.
February 25th, 2008 at 10:47 pmAs a person that has been diagnosed bi-polar, I have been proscribed and taken a good number of pharmaceutical remedies.
Personally I have found that judicious use of tetrahydrocannabinol is more effective on my symptoms, than anything I have received from a pharmacy.
Besides my monthly prescription is cheaper than any insurance co-pay I have had.
Of course it could all be a placebo effect.
February 25th, 2008 at 11:19 pmBack around 77/78 I was experiencing what I thought to be depression. But, I really had nothing to be depressed about which in itself can be depressing. I was missing a lot of work even though I was just driving a taxi. I don’t what made me think of a hypnotist, but I thought I’d go to one and be hypnotized to go to work everyday. The woman I saw did an hour interview reviewing my family, medical and present history. To make a long story short she suspected that even though I was eating adequately it wasn’t a diet suited for me. It turns out that everything that puts weight on others does the opposite to me and leaves me nutritionally deficient. I changed some things around and she put me on a vitamin schedule. A mega-dose at first but it was cut down after a while and it made the biggest difference in the world. I was mistaking a run down feeling as depression. My diet still isn’t the proverbial three balanced meals a day, but the one constant since then is the vitamin schedule. There have been times since then that I’ve “forgotten” to keep the schedule going and when I get back on track things get better. There’s definitely something to it, I’m not imagining it. And, needless to say, there was never any need to get into hypnosis.
February 25th, 2008 at 11:39 pm“Placebo” doesn’t mean “no effect”. It means the effect you cause on yourself when you THINK you’ve taken something that will help. And placebos work better when they’re offered by medical personnel in traditional white coveralls, etc., the more formal and impressive the better.
February 26th, 2008 at 6:25 amwell, from my experience, most of the speudo-depressive persons have a feeling of no-adequaty in the life they are projecting ; I found very useful to study the stoician philosophers, so that I have a more realistic view on the events that may occur ; it freed an instinct of surviving and optimism is my motor.
Though I understand that some persons need real medicine care : there are depressions that can’t be cured without medicaments.
It uselly take years to get better then, I got a cousin that had the kind of trouble, he managed to surpassed it at the age of 40, after about 15 years of depression
February 26th, 2008 at 6:38 amI’m sure my bout of a few months back was mild, compared to the typical “depression” …
I was/am on a radical diet that completely abolished those “feel good” carbs/sugars … which caused (probably) the old hormone adjustment too … and then winter set in … yeah …
But I found letting my family know how I was feeling also helped because they understood and gave me space … and I didn’t have to put hardly any effort into ‘hiding’ those bad moments (which can make you feel worse).
My whole thing was trying NOT to go the direction of the meds because I KNEW it was temporary. When [things] finally ‘leveled out’ it basically just went away. I was lucky.
As John said, fatigue IS a big factor too.
February 26th, 2008 at 8:54 am