Anti-depressants' 'little effect'

[almaty 19]

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

A University of Hull team concluded the drugs actively help only a small group of the most severely depressed.

Marjorie Wallace, head of the mental health charity Sane, said that if these results were confirmed they could be "very disturbing".

But the makers of Prozac and Seroxat, two of the commonest anti-depressants, said they disagreed with the findings.

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

Reviewed data

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

There seems little reason to prescribe anti-depressant medication to any but the most severely depressed patients

Professor Irving Kirsch

University of Hull

Q&A: Anti-depressant study

Popularity of 'happy pills'

Alan Johnson, the Health Secretary, has announced that 3,600 therapists are to be trained during the next three years in England to increase patient access to talking therapies, which ministers see as a better alternative to drugs.

Patients are strongly advised not to stop taking their medication without first consulting a doctor.

The researchers accept many people believe the drugs do work for them, but argue that could be a placebo effect - people feel better simply because they are taking a medication which they think will help them.

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

They reviewed published clinical trial data, and unpublished data secured under Freedom of Information legislation.

They focused on drugs which work by increasing levels of the mood controlling chemical serotonin in the brain.

These included fluoxetine (Prozac) and paroxetine (Seroxat), from the class known as Selective Serotonin Reuptake Inhibitors (SSRIs), alongside another similar drug called venlafaxine (Efexor) - all commonly prescribed in the UK.

The number of prescriptions for anti-depressants hit a record high of more than 31 million in England in 2006 - even though official guidance stresses they should not be a first line treatment for mild depression.

There were 16.2m prescriptions for SSRIs alone.

The researchers found that the drugs did have a positive impact on people with mild depression - but the effect was no bigger than that achieved by giving patients a sugar-coated "dummy" pill.

People with severe symptoms appeared to gain more clear-cut benefit - but this might be more down to the fact that they were less likely to respond to the placebo pill, rather than to respond positively to the drugs.

Send us your commentsLead 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."

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

Reviewing guidance

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.

These medicines have been licensed by a number of regulatory authorities around the world, who looking at all the evidence, have determined that they do work better than placebo

Dr Richard Tiner

Association of the British Pharmaceutical Industry

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.

Marjorie Wallace of Sane commented: "If these results were upheld in further studies, they would be very disturbing.

"The newer anti-depressants were the great hope for the future.... These findings could remove what has been seen as a vital choice for thousands in treating what can be a life-threatening condition."

Dr Andrew McCulloch, of the Mental Health Foundation, said: "We have become vastly over-reliant on antidepressants when there is a range of alternatives.

"Talking therapies, exercise referral and other treatments are effective for depression.

"It is a problem that needs a variety of approaches matched to the individual patient."

Dr Richard Tiner, of the Association of the British Pharmaceutical Industry, said there was no doubt that was a "considerable placebo effect" from anti-depressants when treating people with mild to moderate symptoms.

But he said no medicine would get a licence without demonstrating it was better than a placebo.

Dr Tiner said: "These medicines have been licensed by a number of regulatory authorities around the world, who looking at all the evidence, have determined that they do work better than placebo."

[Jenn! 918]

I was looking for how many people actually take antidepressants and found this:

As of 2004, 10 percent of women and 4 percent of men over 18 take antidepressants, according to the Centers for Disease Control and Prevention.

That's just staggering to me.

[AnewKINDofFEELIN 0]

They work great if suicide is the ultimate goal.

[~Jackie~ 30]

I will weigh in here on the use of these pills. I was always against them and their use, I used to think depressed people should get off the couch and get over it whatever 'it' was. Until........

Last August I stopped eating, sleeping, and I was on the floor, not the couch. One of my bestest friends told me, Jackie, you are depressed. I did go to a doctor after going from a size 20 to a 12. The doctor gave me Lexapro and soon I was eating again and smiling. I am scared to death now to go off them....but scared to stay on them. Does that make sense? Without the pill, I cried nonstop, everyday for a lost love. I was dying of a broken heart. So if anyone has ideas how to get off the medication, let me know.

jJ

funny how they are referred even here as 'happy pills' ........."i go running for the shelter of mother's little helper..."

SUICIDE?

Edited February 26, 2008 by just_Jackie

[AnewKINDofFEELIN 0]

SUICIDE?

Just about every anti-depressant has issues with takers committing suicide. My whole issue with it, though, is that the people are taking it for depression, so they're probably more likely to commit suicide to begin with.

The problem I have with them is that they treat symptoms instead of cause. Outside of severe cases, the depression has many non-chemical causes that the drug will just mask. So people end up staying on the drugs for many years, throwing off their chemical balance.

Some people need them, but they're definitely over-prescribed.

[~Jackie~ 30]

With all due respect, just because I was crying and not eating/sleeping,,,,I NEVER would have thought of taking the life God has given me.

I have 2 wonderful kids and a grandaughter that adores me. And a 5 year loan on my Nissan

jJ

[almaty 19]

lexapro is one of the best pills and i do not agree with the study..i see many folks be able to function where 1-1 or group therapy was not effective...

[almaty 19]

lexapro is one of the best pills and i do not agree with the study..i see many folks be able to function where 1-1 or group therapy was not effective...

[Caladan 19]

SUICIDE?

Just about every anti-depressant has issues with takers committing suicide. My whole issue with it, though, is that the people are taking it for depression, so they're probably more likely to commit suicide to begin with.

The problem I have with them is that they treat symptoms instead of cause. Outside of severe cases, the depression has many non-chemical causes that the drug will just mask. So people end up staying on the drugs for many years, throwing off their chemical balance.

Some people need them, but they're definitely over-prescribed.

Most medications treat the symptoms instead of the cause. Anti-depressants ideally shouldn't be used without therapy, but they can be helpful in getting someone whose brain chemistry *is* out of whack to stabilize enough to be able to figure out what to do about the underlying problem. Personally, I don't think of it as much different from any other medication. We wouldn't tell someone not to take pain medication because pain is just a symptom.

Jackie, that's a question for your doctor, but usually going off the meds involves slowly tapering down the dosage so your body readjusts smoothly.

[DeadPoolX 9]

My issue with the study quoted is that I don't see important details, such as how many people were involved in the trial or trials, what age group, socioeconomic group, relationship and/or marital status, etc. The study above just says, point blank, that psychotropic medication "does this" and that we should believe it. I'm sorry, but I have trouble with that.

I'm not going to sit here and champion the different types of psychotropic drugs. There are some that can be very effective and some that aren't. There isn't one "cure all" band-aid that can be applied to any psychological issue. Some medications work for some people; some don't. You don't (and won't) know until having tried them, so just because Prozac didn't work for Bob down the street and he was switched to Wellbutrin, that doesn't mean Prozac won't work for Jim next door.

Having said that, there are some medications that shouldn't be prescribed unless absolutely necessary (such as clozapine, which can cause agranulocytosis, a condition which results in a severe reduction of white blood cells) and many can have potentially nasty side-effects (MAOI's are notorious for this). Fortunately, these negative aspects are generally somewhat uncommon. If someone has failed to respond to therapy alone (and it's been noted that both therapy or medication by itself is nowhere near as effective as a combined approach), then perhaps it would be smart to include medication in the mix somewhere.

Edited February 26, 2008 by DeadPoolX

[Nessa 23]

I used to think depressed people should get off the couch and get over it whatever 'it' was.

many people think like that. I understand that for someone who never had to deal with it, they have a hard time understanding.

It's different having the blues and being clinically depressed. I've seen people using the words "I felt depressed or am feeling'', but being sad for a couple of days because they got a C on a paper or their boss gave someone else that promotion is completely different from being depressed.

I also believe that medicine don't fix the problem. It helps giving people the chance to function, being able to work, study, eat, sleep, things like that. But not alone, it has to be with some sort of therapy, not the pills alone.

[almaty 19]

I also believe that medicine don't fix the problem. It helps giving people the chance to function, being able to work, study, eat, sleep, things like that. But not alone, it has to be with some sort of therapy, not the pills alone.

excellent point sister nessa

[one...two...tree 2,762]

lexapro is one of the best pills and i do not agree with the study..i see many folks be able to function where 1-1 or group therapy was not effective...

Years ago, I went to see the doctor after feeling overstressed and suffering from insomnia. It was after my divorce and a recent relocation where I didn't know anyone. She put me on Celexa and then later, with a psychiatrist's care, was switched over to Lexapro. I do believe it really helped calm my nerves enough to where I wasn't so anxious, but I was fearful of becoming chemically dependent on it so I stopped taking it after being on it for a few years. I try to keep my stress level to a minimum now through exercise, getting plenty of sleep, but there are times when I wonder if I should go back on it.

[~Jackie~ 30]

A few years? I have been on it .....4 months and wanting off. I think. I don't know. I'm too confused to decide.

jJ

[Chica Yeyé 41]

lexapro is one of the best pills and i do not agree with the study..i see many folks be able to function where 1-1 or group therapy was not effective...

I was about to ask for your professional opinion brother almaty.

I find it quite annoying that people with no experience with depression -or any other mental illness for that matter- can make completely off the chart comments as if it was either funny or nonchalant. The "why don't you just think happy thoughts?" one is my favorite. When folks say that, my usual response is: "Next time you have diarrhea, just tighten the sphincter and it will go away".

And I completely agree with Nessa: medications are part of the treatment, but talk therapy is necessary as well. Mental illness is NOT something we invent, it is as real as Cancer. But people seem to think it has to do with lack of will power or some other equally idiotic #######. Pardon my French, but this topic hits home quite closely.

And Jackie, keep up the good work sister. Your DOCTOR is the best source of information. And mind you, I don't like doctors very much, but they know their stuff (in most cases )