Anti-depressants: Major study finds they work

For most people's sake I do hope they work and save lives.  For me though they're worthless.  Tried many kinds and doctors begged me to stick with them long enough.  But I had reaction from the first dose, felt worse, more anxious, more depressed, was hot and sweaty and out of breath, plus horrible insomnia and irregular heartbeat.  Each time I couldn't wait to quit and be done with them.  I guess in that sense they "worked" for me.  They showed me how much worse I could feel and my original depression and anxiety seemed trivial in comparison. What really worked for me then was anti-psychotics, which lower serotonin level.  My anxiety was all gone while I took them.  I guess that explains why anti-depressants didn't work as they raise serotonin level, which I didn't need.

Here is another article that appeared in the New York Times, March 12/18.  It discusses the efficacy of antidepressants and is fairly balanced in its reporting.  There are 327 comments that follow, accessible if you click on the small dialogue box with the number "327" inside at the bottom.

 

Do Antidepressants Work?

"The most comprehensive study on them has recently been published, showing mostly modest effects."

 

https://www.nytimes.com/2018/03/12/upshot/do-antidepressants-work.html

 

This study is and isn't new. It is a meta analysis. It is not a new study but an "analysis" of the data of several previous studies.

 

Do antidepressants work? In my opinion they not only work but save lives too. They do not work on a small minority though. However, this fact can never be captured statistically. Statistics will always show that ADs do not work as desired. Statistics will show ADs are no better than placebo. I know this sounds ludicrous but regulators and the medical community know this. I am forgetting how statistics get skewed -- I will google some other time to find the name of the term. So read what lies beyond assuming it is hearsay (for I do not have reference right now):

 

If I can give an analogy, take the stock market. Now financial analysts will say that stock prices respond to PE ratio, EPS, M&As, the fed, interest rate, currency rate. But a statistician might say that the stock market curve for the last so many years has been nothing but purely random. The statistician will even have mathematical, statistical proof for its randomness. So who is right? Is the market predictable or unpredictable?

 

The problem is with the proximity of the stock index to the human mind (as opposed to body for standard pharmaceutical drugs). No matter how much doctors might try controlling the mind with ADs, it will twist out of shape to evolve into its own peculiar shape that we see reflected in stocks, bitcoin prices (and even in mathematical number theory) etc.

 

If you hate stocks, you can shout down a Wharton professor with -- don't lie its all random! (as Warren Buffet does incidentally). The professor, who is aware of the limitations of statistics here, will not be able to answer; but he will also not stop teaching finance. Because he knows information, in the stock market, matters.

 

p.s. another example -- this might be far fetched, but for what it's worth... take it lightly -- is the failure of pure communism (and conversely pure capitalism).

 

 

a lot of us also have a tendency to blame ourselves for everything, and I think that can lead to increased depression, increased anxiety/panic and more and more suffering.

 

I agree. This tendency can very quickly spiral out of control. Sometimes it is a bane (if not all the times).

a lot of us also have a tendency to blame ourselves for everything, and I think that can lead to increased depression, increased anxiety/panic and more and more suffering.

 

I agree. This tendency can very quickly spiral out of control. Sometimes it is a bane (if not all the times).

 

so true, 

and anxieties are often caused by blaming ourselves for everything, not being like everyone else, etc

and is eventually anxiety producing and  depressing and easily spirals out of control.

 

 

My biggest issue with who irresponsibly the study was reported, this is a good article on it - https://www.theguardian.com/science/2018/feb/23/why-we-are-sceptical-of-antidepressant-analysis

 

To say that they "work" is a massive over simplification. Yes they work for some people, but for many people they work with massive debilitating side effects or don't work at all or make them worse. I think the aim of this narrative is to dismiss the people who are like "depression isn't real, these are happy pills" which is fair but there is a bunch of people who are skeptical because they have ruined their lives or someone close to them (I went from being mildly anxious to depressed to the point of suicide on them). How does the message effect those who are depressed, have tried ADs and they didn't work at all. It says that nothing will work for them and they have the problem as the medication definitely "works", where do they turn next. I think it's good that people are willing to try medication with regards to depression but this seemed like an attempt to shut down discussion, but it was far from conclusive and the discussion is necessary to get better funding and resources give to the area. I asked a few people more in the know than me (and without my negative bias). A friend who studied pharmacology said this:

 

That headline is seriously the most infuriating thing. I study pharmacology and believe me I've read a heeeelll of alot of literature on antidepressants and I'm 99.9% sure they're no more effective than placebo let alone psychotherapy. I haven't looked at the meta analysis but a metaanalysis isn't proof of anything. Use the correct statistical approach and you can prove pretty much anything. What proves the efficacy of a drug is a good well designed clinical trial and proving your hypothesis correct, which antidepressants consistantly fail to do. When they do work it's for certain  subsets of patients which are usually characterised after the trial is done. Science journalism pisses me off because they assume that any deviation from accepted truths is some sort of conspiracy talk, but with this if you actually look at the literature - evidence is weak to non-existent. I doubt if antidepressants were new they would even get licenced for their intended use. But of course they are pretty much the golden goose of drugs for pharmaceutical companies and nobody can deny that. Antidepressants are still used I think aswell because they based the whole pathology of depression on what drugs alleviate symptoms and came up with a theory that a serotonin deficit must be the cause. But now it's well understood that this is way way oversimplified and the antidepressants exert SOME effect probably due to secondary changes in the brain. But medical science is still talking in 'theories'... So really pharmacologists nor anyone else even know what exactly antidepressants.

 

Again I think there is a place for them, but they are massively over prescribed already which is understandable given that GPs are under so much pressure already, they don't have time to cover how complex depression can be.

I think the aim of this narrative is to dismiss the people who are like "depression isn't real, these are happy pills" which is fair but there is a bunch of people who are skeptical because they have ruined their lives or someone close to them (I went from being mildly anxious to depressed to the point of suicide on them).

 

So did you recover from suicide or was it permanent?

I had suicidal thoughts after taking them but had never had them before taking them and never them after stopping them.

I had suicidal thoughts after taking them but had never had them before taking them and never them after stopping them.

 

Notwithstanding the fact that having suicidal thoughts for the first few weeks on an AD is natural (they carry a black box warning), after which time they begin to show positive effects, why are you letting your experience cloud the fact that there are other people who have benefited from it and are alive today because of their AD? I will grant you here that they hurt you instead of benefiting you, but does that necessarily mean all those others who benefited from it are not saying the truth? Doctors are humans, not Gods. If this is the best AD that they have (one that hurts a person temporarily for every person it heals), then should you not be grateful to them instead of railing that they are unethical etc.? If they had an answer to your problem, would they not have used that instead?

I study pharmacology and believe me I've read a heeeelll of alot of literature on antidepressants and I'm 99.9% sure they're no more effective than placebo let alone psychotherapy.

 

Research has taken placebos from being a methodological tool in scientific research — a way to figure out if an ingredient in a drug really works — to now something that may be a treatment in itself. How did that happen?

 

“I’m really tired about doing research that people say is about deception and tricking people”

I feel like you didn't read what I said. I didn't say they should be banned or that they don't work for people. I said they should be used with caution and that the reporting of the study was irresponsible.

 

I believe they have there place but saying they categorically work (without caveats) is misleading and dangerous to people already suffering from mental illness who found that they didn't work, who already blame themselves enough as it is.

 

I'm basically saying more nuance in the discussion is necessary not that they categorically work or don't work. 

 

"If they had an answer to your problem, would they not have used that instead?"

Well I feel they rushed into diagnosing me with anxiety without looking into the factors that caused my anxiety, gave me a drug that made everything a lot worse and now I'm suffering the consequences 8 months down the line.

I believe they have there place but saying they categorically work (without caveats)

 

Nowhere is it stated that any drug works categorically. This feeling is entirely in your mind. It is only when an antibiotic or a chemo or a surgery fails on us that we realize that we are alone in the universe and how foolish it was of us to even assume that someone else could solve all our problems.

 

Well I feel they rushed into diagnosing me with anxiety without looking into the factors that caused my anxiety, gave me a drug that made everything a lot worse and now I'm suffering the consequences 8 months down the line.

 

In a universe in which communication is primitive (language) and we wonder how we at all manage to communicate, you expect that a disorder of the mind can be communicated so easily to a doctor? And be treatable without ambiguity? Maybe it was your fault and not the doctor's? Maybe you did not know that that feeling is called depression and not anxiety? Which is why the wrong drug was prescribed to you? How do you exonerate yourself?

 

If 100 people march up to a doctor and complain they are depressed, how is the doctor to know that they tell the truth? How does the patient know that he is depressed enough for pharmacological intervention? What if he is incorrectly volunteering for a drug which cannot treat him and that he does not know that he has been misinformed by Hollywood romantic movies?

 

We find it easier to lose money in stock markets that are demonstrably not predictable than suffer when being treated for a mental malaise. We are hypocritical, then the doctors.

"Anti-depressants: Major study finds they work" was the title of the article and this thread. Many other articles had similar conclusions. I was debating the messaging used.

 

I'm not really sure what you're even talking about now, stock markets and hollywood movies?

 

My point is that ADs work for some, not others and have some very serious worrying side effects, and should be reported as such. That's it.

 

Again this article covers what I'm saying in a more articulate manner.

 

https://www.theguardian.com/science/2018/feb/23/why-we-are-sceptical-of-antidepressant-analysis

 

Have a nice day.

"Anti-depressants: Major study finds they work" was the title of the article and this thread. Many other articles had similar conclusions. I was debating the messaging used.

 

I'm not really sure what you're even talking about now, stock markets and hollywood movies?

 

My point is that ADs work for some, not others and have some very serious worrying side effects, and should be reported as such. That's it.

 

Again this article covers what I'm saying in a more articulate manner.

 

https://www.theguardian.com/science/2018/feb/23/why-we-are-sceptical-of-antidepressant-analysis

 

Have a nice day.

 

I think I got carried away. If you consider yourself holding a "negative bias," then it is my "negative-negative-bias" that made me pointlessly digress. : )

 

But that guardian article is also in poor taste (though I still get your point about "being more careful" and "discussing effectiveness more openly") because of quotes like these:

 

I know I can only speak from my own personal experience, but I see no difference between taking antidepressant medication and taking, for instance, calcium channel blockers to control hypertension.

 

and

 

Big pharma must be rubbing their hands with glee at the report about the effectiveness of antidepressants.

 

It is a bit weird but what we mean by depression and anxiety in this forum is not at all clear. The experiences are unimaginably varied in intensity. I do not think even adjectives or ratings can help us distinguish between different types of depressions members are going through, or have gone through, in their benzo withdrawal here. The fact that they must be strikingly different in intensity (but are being regularly misunderstood) can probably be gauged from the remedies members think are sufficient to treat a vast majority of them:

 

- someone thinks a candida diet will fix it,

- someone thinks therapy is enough,

- someone thinks exercise will cure it,

- someone feels only prayer and good wishes can fix it

 

It is all the more difficult, then, I feel, for outsiders to understand what depression, in the context of benzos, could mean.

... is necessary to get better funding and resources give to the area.

 

... How does the message effect those who are depressed, have tried ADs and they didn't work at all. It says that nothing will work for them and they have the problem as the medication definitely "works", where do they turn next.

 

... But of course they are pretty much the golden goose of drugs for pharmaceutical companies and nobody can deny that. Antidepressants are still used I think aswell because they based the whole pathology of depression on what drugs alleviate symptoms and came up with a theory that a serotonin deficit must be the cause. But now it's well understood that this is way way oversimplified and the antidepressants exert SOME effect probably due to secondary changes in the brain. But medical science is still talking in 'theories'... So really pharmacologists nor anyone else even know what exactly antidepressants.

 

 

Please do not think I am arguing. The above points from your post are subjects that I think about often -- that is why I have highlighted them. I am only thinking aloud in this post.

 

The recent meta analysis that reported ADs are effective was done chiefly for SSRIs and SNRIs. It is a valid question for you to ask -- well now that it has been demonstrated that this class does not work on me, am I doomed or are there other meds that I can try?

 

Research in psychiatry has been slow. I cannot profess to know the reasons. But I can see there has been no celebrity campaigning for funding in this area as there always seems to be for every other obscure illness. Perhaps mental illness is still a taboo. I was reading about Christopher Reeves the day before and I learnt that he died disheartened with stem cell research because there was the money available, but no political will (Bush). He realized things were not as simple as he had thought. So, here in psychiatry, we are stuck with serotonin based ADs that were discovered in the seventies I think. But, psychiatry is a huge industry and it has many prime movers, of which commercial interest is certainly one (and I do not think capitalism is always evil). So even though it might seem that nothing has changed since the 70s, things have. Many new SSRIs and SNRIs have been invented. The problem of rough start ups with them has been acknowledged because rough start up = poor patient compliance = loss of revenue for pharma (it also means poor performance in clinical trials). These days mood stabilizers and anti psychotics are being tried as first line (over SSRIs) because they do not have start ups. I myself had a very bad experience with lamictal (mood stabilizer) that was tried on me for 2 months last year to treat my depression (lamictal made me suicidal and I was moved to prozac). I became a little disenchanted with this new approach by doctors and thought it was being pushed by pharma only to keep its cash registers ringing. Then I saw a member here claw out of depression with the help of an an anti-psychotic. She had been mixing her benzo with alcohol for years. She fell into a mixed anxiety plus depression state the day she quit drinking -- classic case of tolerance withdrawal and exactly like me. This is her ID - Heaven2017 I was impressed and realized that the new approach was right. So it would not be fair to say, I think, that pharma is sitting on serotonin based drugs because "they are touted as being effective" and pharma isn't bothered about inventing newer approaches to treat those who do not respond to SSRIs or who reject them.

 

One more thing regarding effectiveness of ADs. Doctors do not try only one AD on a patient to cure his depression or anxiety. But clinical trials report effectiveness of only one drug. It is possible that a doctor's effectiveness might be much higher than a particular class of ADs's effectiveness.