Are Antidepressants Useless? Researchers Say Yes
46 CommentsBy Ed Silverman // February 25th, 2008 // 8:40 pm
Prescribing antidepressants to the vast majority of patients is futile, because the drugs have little or no impact at all, according to researchers at the University of Hull, The Financial Times reports.
Almost 50 clinical trials for four drugs, including Prozac, Effexor and Paxil, were reviewed by university psychologists, who found that the latest generation of antidepressants worked no better than a placebo for most depressed patients. Even the trials that suggested some clinical benefit for the most severely depressed patients didn’t produce convincing evidence. The study was published in the latest PLoS Medicine.
“The difference in improvement between patients taking placebos and patients taking anti-depressants is not very great,” Irving Kirsch, a psychology professor tells the paper. “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.”
Alison Cobb, the policy officer at Mind, a mental health charity in the UK that wants docs to favor alternative therapies, hailed the findings. “This study represents a serious challenge to the predominance of pharmacological treatments for depression. Anti-depressants have been shown to help many people, but by no means all. Too many general practitioners are being forced to dish out drugs because they don’t have proper access to psychological therapies services which are recommended by Nice,” the UK regulator.
However, Gary Bell, a consultant psychiatrist at Capio Nightingale Hospitals, which provides private psychiatry treatment, contests the conclusions of the Hull research. “Anti-depressants are one of the great breakthroughs in the treatment of depression in last 20 to 30 years,” he tells the paper. “They do not always suit everybody but the results are often life-saving. People who do studies do not have the hands-on experience of using these medicines.”
UPDATE: This is a belated addendum to note that the researchers are psychologists, who theoretically may stand to benefit if greater emphasis is subsequently placed on counseling instead of medications. In fact, the following day, the UK government disclosed plans to spend additional money to train therapists in response to this study (please look here). We should have noted the potential conflict when we first posted this item.
Hat tip to Furious Seasons
Nancy
Anti-depressants saved my life when I was 20. Having endured a depression so pervasive that I would cry for hours between states of emotional numbness, anti-depressants enabled me to begin the psychotherapy that allowed me to rebuild my life. The physical change in my being that came from taking first, an maoi inhibitor, and then Wellbutrin, allowed me to feel like the human being I am.
Lisa Van S
Nancy,
Sounds anecdotal to me. Maybe therapy was most beneficial
Matthew Holford
Psychotherapy can be enormously precise - it depends upon the quality of the therapist, in my experience.
Matt
James
Nancy,
Thank you for sharing your story. It is nice to see someone in the comments section describe the positive results that can come from a combination of therapy and medication, where appropriate.
Those on this board that simply distort facts, scream nonsense, constantly point to ssristories.com as a source of valid information, then dare to criticize someone for posting an anecdote do nothing to further serious discussion.
Lisa Van S
Hey James,
“Anecdotal” is the term most often used by Industry and FDA. Being as Nancy was not in a Placebo controlled clinical trial, her account of the drug and its effects are anecdotal. This issue goes both ways..
Nathan
Lisa says:
“Sounds anecdotal to me. Maybe therapy was most beneficial”
That’s funny Lisa, because I accuse you of that all the time! Yet you are CERTAIN that the drugs cause such negative effects. Funny how you like to see facts in light of your beliefs rather than form your beliefs in light of the facts…
BTW, I agree — it IS anecdotal. It’s not a controled test. Nancy’s story is (likely) real — but it’s just like all the stories you guys talk about on ssristories.com - anecdotal evidence that don’t mean much without running a control experiment for comparison.
Kelly
The headline of this post was misleading. The study showed that antidepressants were not better than placebo for *mild* depression. I don’t doubt that psych meds are over-prescribed. However, don’t deny that they do a world of good for some with more debilitating forms of depression. What Nancy describes is *not* mild depression.
Lisa Van S
Nathan,
Its amazing that you dont like it when the cheek is turned the other way..
Nathan
So here is an ethical delima: Placebo works. Drug works only as well as placebo. Should doctors start prescribing a sugar pill to depressed patients? Should the doctors be HONEST with the patient that the pill they are taking is a sugar pill, not an antidepressant? If they are honest, will the placebo work?
Placebo groups in clinical trials frequently seem to work because the patient BELIEVES that they are likely getting an effective treatment. If the patient knows upfront that the pill is just sugar, will it still work as well? I doubt it…
This study is certainly important — but it doesn’t leave a clear path forward. Clearly the drugs (or placebo) are benifiting. If you take away drug, you have to replace it with something else: either therapy or sugar pill. Many people lack commitment to follow through with the former, and it’s not clear that the latter will work if doctors give full disclosure to what the pills are.
It’s certainly not a study favorable to the pharma industry, but I’m not so sure that it is damning to them either.
Lisa Van S
Kelly,
Do you know Nancy Personally? Or are you diagnosing “willy nilly”.
Ed Silverman
Hi Kelly,
With all due respect, I believe the headline captured the study. This is from the study itself…
“..There was virtually no difference in the improvement scores for drug and placebo in patients with moderate depression and only a small and clinically insignificant difference among patients with very severe depression. The difference in improvement between the antidepressant and placebo reached clinical significance, however, in patients with initial HRSD scores of more than 28—that is, in the most severely depressed patients. Additional analyses indicated that the apparent clinical effectiveness of the antidepressants among these most severely depressed patients reflected a decreased responsiveness to placebo rather than an increased responsiveness to antidepressants.”
Regards
ed
Nathan
Quote:
“Additional analyses indicated that the apparent clinical effectiveness of the antidepressants among these most severely depressed patients reflected a decreased responsiveness to placebo rather than an increased responsiveness to antidepressants.”
That’s rather interesting, actually. The most severely depressed patients are the ones most likely to believe that they are “beyond help” — that the drug is NOT going to work on them. This is probably why the placebo effect is reduced. The placebo effect likely originates from the fact that a patient BELIEVES that the treatment is going to work. This also supports (my opinion) that prescription of a placebo is just not the answer. Patients just aren’t going to believe that a sugar pill will cure them. Since they don’t believe it will help, then it likely won’t help.
(in the case of a true placebo, the patient is led to believe that they are likely recieving a benificial medication)
By the way, this is also
Atlex
Like with every other study, it is worth noting the biases of the authors. They are all psychologists who have a financial incentive to diminish the value of drugs and endorse the value of psychotherapy. That doesn’t mean that their results are wrong; it just means that we need to understand that there are potentially biases in the research. No doubt if a group of psychiatrists published a similar study proving the value of medication, they would be scrutinized over thier biases.
truthman
Hey Nathan and Atlex, stop playing down the importance of this study..
The mainstream media have finally caught on to the SSRI hoax..
Of course the pro-pharma brigade will play down and discredit the importance of this..
But, it is refreshing to see the mainstream media catch up with what people have been soiunding off about on the internet for years..
truthman
Nancy. “Anti-depressants saved my life when I was 20. Having endured a depression so pervasive that I would cry for hours between states of emotional numbness, anti-depressants enabled me to begin the psychotherapy that allowed me to rebuild my life.”
Unfortunately Nancy for the vast majority of people who are pushed on these poison pills, they are not offered any psychotherapy ..
If you had just got the pills and no talk therapy do you think you would be praising the drugs ?..
I doubt it..
The drug gave you an artificial way of coping with the effects of depression..
But i bet it was the psychotherapy which addressed the core reasons why you were experiencing depression..
Which is exactly what i have been saying on this blog all along..
James
Yes, truthman, we’re all aware of what you’ve been saying all along.
You can feel free to stop now.
truthman
James
Yes, truthman, we’re all aware of what you’ve been saying all along.
You can feel free to stop now.
Never..
Nathan
Truthman says:
“Hey Nathan and Atlex, stop playing down the importance of this study..”
Evidently, in addition to his other faults, “Truthman” has trouble reading. Here is what I said in my post: (read it for yourself)
“This study is certainly important — but it doesn’t leave a clear path forward.”
Get a life Truthman and stop wasting our time with your ignorance.
Brian
Any benefit from psychotherapy must have a corresponding physical effect within the brain. If so called “talk therapy” was working, you would still expect an increase in neuronal firing and neurotransmitter release and capture in ventral tegmental areas of the brain. The problem here is that there aren’t enough competent counselors to handle the millions of mildly depressed folks.
When depression is do to the serious effects of genetics, trauma, stress and or damage during adolescence, simple counseling will not be effective. Medication can be helpful but since therapy is limited to serotonin based effects there will always be a population treatment resistant patients waiting for better therapies.
truthman
Nathan
Truthman says:
“Hey Nathan and Atlex, stop playing down the importance of this study..”
Evidently, in addition to his other faults, “Truthman” has trouble reading. Here is what I said in my post: (read it for yourself)
“This study is certainly important — but it doesn’t leave a clear path forward.”
Get a life Truthman and stop wasting our time with your ignorance.
Nathan “BTW, I agree — it IS anecdotal. It’s not a controled test. Nancy’s story is (likely) real — but it’s just like all the stories you guys talk about on ssristories.com - anecdotal evidence that don’t mean much without running a control experiment for comparison”
You consistently insult anyone who has reported , documented or described their bad experiences with these drugs Nathan..
You consistently try to belittle anyone who does not conform to your pharmaceutical agenda..
You do yourself or your industry no favours Nathan..
I have a life Nathan..
And it is a good life..
I can sleep soundly at night(without the aid of drugs) because I do not advocate these “treatments” which you defend and promote ..
Treatments which have harmed countless numbers of people since their shameless promotion and conception almost 20 years ago…
I have a clear conscience Nathan..
And no matter how many insults you try to throw at me..
or how much you try to discredit my opinion and the opinion of those who have had experiences and knowledge of your poison pills..
You will not stop me from bringing awareness..
So maybe it is you who should get a life..
And a maybe find a decent way to make a living too..
(one that doesn’t involve snake oil and deception)
And Brian…
Your “treatment resistant patients” theory is a good deflection angle..
But we both know thats all it is…
Brian
Truthman,
Since SSRI’s are the only medication available currently for depression and the causes are so varied as I’m sure you would agree, I would expect work currently underway on new treatments for depression will help those with no hope. What new counseling methodology are you working on?
truthman
Brian
Truthman,
Since SSRI’s are the only medication available currently for depression and the causes are so varied as I’m sure you would agree, I would expect work currently underway on new treatments for depression will help those with no hope. What new counseling methodology are you working on?
Actually Brian..
I believe yoga and meditation can be very effective in the management of anxiety and depression, also exercise, healthy eating habits , changes in lifestyle etc can all benefit and increase the quality of life and change the perspective of a depressed individual to a more positive one..
Brian.. my main gripe with the pharmaceutical agenda is.. the way they have “bastardized” the human condition..
They have bought, sold and squandered it..
And with that destroyed and deceived many lives ..
What was once “melancholy” or “sadness” has become depression which needs drugs to fix a dubious and scientifically unprovable “chemical deficiency” ..
What was once “shyness” (an endearing and beautiful human trait) has become a pharmaceutical marketing agenda in the guise of the dreaded “social anxiety disorder” ..
What was once “teen angst” has become the bi-polar or psychotic teenager..
Do you not see how wrong this kind of stuff is?
Do you not see how damaging it is to medicalise human behaviors , traits and characteristics ?..
What does it take for you to see the big picture?.
Brian
Truthman
We are just trying to find out the real physical reason why people are depressed. So far not too bad and improvements are on the way. People died from gall bladder surgery in 1898, now it’s done as a drive by. If mild depression is cured by yoga all the better..You’ve never personally seen the really depressed patient because they are in a bed somewhere..not at yoga class. You are ignorant of the BIG PICTURE MAN..have some compasssion after all you are just selling an idea..
“Don’t sell crazy ideas here, we’re all stocked up”
truthman
We are just trying to find out the real physical reason why people are depressed.
People get depressed from life traumas , crisis , sadness, disappointment , greif etc ..
I have explained to you these factors many times Brian..
Now please bring your ignorant propaganda to a place where people will actually be naive enough to believe that you actually care..
Your pharma rhetoric doesn’t wash anymore Brian..
Nathan
Truthman says:
“People get depressed from life traumas , crisis , sadness, disappointment , greif etc ..”
What an insight. I’ve been through each one of those emotions — but never experienced prolonged depression. Mmmm…
Truthman, this website is for those who are interested in the pharmaceutical industry. (hence the name PHARMalot.com) If you don’t want to listen to the opinion of those in the pharmaceutical industry, please go elsewhere. Unless you have personally heard something new from Ed, this is NOT an antipharma website. There are plenty of those kind of sites out there. Please visit them and stop bothering us.
truthman
Nathan says
Truthman says:
“People get depressed from life traumas , crisis , sadness, disappointment , greif etc ..”
What an insight. I’ve been through each one of those emotions — but never experienced prolonged depression. Mmmm…
Not everyone will get depressed over these things Nathan, we are all different, and wow aren’t you the big man with the big balls ?..
Maybe your suffering was not quite enough to tip you into a depression..
How fortunate..
Nathan says
“Please visit them and stop bothering us.”
Nah..
I think i will stay put Nathan..
With propagandists like you about the public needs the BS to be exposed..
And i quite enjoy debating with you..
Particularly when you display your dubious links with their various and obvious conflicts of interest..
The only thing agenda you have Nathan is to deflect bad news which affects the profit and reputation of your employers..
You are not here to debate the issues ..
I am..
pg
Hehehe Truthman. Let them be, they need time to adjust their pharma rhetoric lol.
Laurie
The article speaks for itself. Nothing else to add.
Jenny
Acupuncture is a wonderful, highly effective treatment for depression.
Nathan
Truthman,
Fine. If you won’t go away, then lets debate the issues. Please respectfully re-read my post (below) and provide a reasonable feedback. No insults to my employer and accusations of bias. Just simply tell me what you think. Thank you.
——————
So here is an ethical delima: Placebo works. Drug works only as well as placebo. Should doctors start prescribing a sugar pill to depressed patients? Should the doctors be HONEST with the patient that the pill they are taking is a sugar pill, not an antidepressant? If they are honest, will the placebo work?
Placebo groups in clinical trials frequently seem to work because the patient BELIEVES that they are likely getting an effective treatment. If the patient knows upfront that the pill is just sugar, will it still work as well? I doubt it…
This study is certainly important — but it doesn’t leave a clear path forward. Clearly the drugs (or placebo) are benifiting. If you take away drug, you have to replace it with something else: either therapy or sugar pill. Many people lack commitment to follow through with the former, and it’s not clear that the latter will work if doctors give full disclosure to what the pills are.
It’s certainly not a study favorable to the pharma industry, but I’m not so sure that it is damning to them either.
truthman
Nathan..
The dilemmas which pahrma creates are dilemmas which it must fix itself..
But i will say this..
The reason why this study is so important to me and other campaigners because it means that the benefit of SSRI’s does not outweigh the risks…
If a drug is only marginally as good as a placebo effect in the treatment of depression or anxiety, that means that patients have the ability to believe they will get well, which also goes back to my point about thoughts, feelings and emotions influencing mood changes in the mind , brain and physical body.
This backs up my opinions that depression is a symptom of the individuals perception of self. The risks of SSRI’s include addiction, withdrawal and intolerable side effects. The benefit is little more than a believing you are getting better…
Which is less damaging?..
Empowerment through self belief and positive thought?..
Or disempowerment on an inadequately tested , ineffective medication which could make you much worse?..
I know what i would choose..
Matthew Holford
I don’t care whether or not it’s ethical to give placebos. What I do care about is the fact that I was not given the full information, at the time. I could have dealt with my depression just as effectively by taking regular exercize, but I was never advised of that.
Instead, I was given a placebo, with side effects. I’m very angry about that, and nothing can justify what happened next, not even the “millions of people worldwide” who have been helped by SSRIs. Incidentally, that sort of claim, unsupported by any evidence, really pisses me off.
I’m also deeply concerned that I appear to have been deliberately misled by the UK regulator, as I have sought to research what went wrong. This, more than anything else, arouses my suspicions about these drugs. The Worshipful Company (including regulators), is either hopelessly incompetent, or irredeemably corrupt.
Matt
truthman
To echo what Matthew said and the excellent points he has raised..
What i find most disturbing is how it has taken 17 years for an independent meta-analysis of clinical trial data on SSRI’s (which was available before these drugs were licensed) to make it to mainstream attention and the wider public consciousness ..
The Pharmas have already made their BILLIONS on these crap meds..
Many millions of people have been duped, conned and ultimately damaged by ingesting these drugs..
But i suppose that is of no consequence to the pharmaceutical companies as most of these drugs are off-patent now..
They have made their profit and will just carry on , business as usual..
Unfortunately there are hundreds of thousands of people so damaged by these drugs that they cannot..
Nathan
Truthman,
Thank you for a well reasoned responce. Let’s continue in this manner rather than the name calling that has predominated our previous discussions.
I agree this report is quite troubling and it does back up some of what you have said in the past. By the way, this report only dealt with depression — not anxiety. In my mind, this study means that:
a) In cases of moderate depression, SSRIs should only be used as a second-line therapy after excersize and/or counseling have failed.
b) In cases of severe depression, SSRIs still seem effective as a primary treatment, but only in conjunction with excersize and/or couseling.
Would you disagree with either of those assertions?
truthman
I would agree with most of it Nathan..
truthman
a) In cases of moderate depression, SSRIs should only be used as a second-line therapy after excersize and/or counseling have failed.
b) In cases of severe depression, SSRIs still seem effective as a primary treatment, but only in conjunction with excersize and/or couseling.
This is the way they should have been prescribed 17 years ago Nathan..
And that is why people like me are so angry at the overprescription and aggressive marketing of these drugs..
Nathan
Thanks Truthman — that’s fair. Let’s have civilized discussions more often.
Most of us that work in pharma aren’t the evil bastards that you paint us to be. Those of us that do research for pharmaceutical companies have little or no influence over how our drugs are marketed.
truthman
I wasn’t trying to imply that everyone who worked in the pharmaceutical industry were evil bastards Nathan..
Two of my very good friends are both doing Phds in science..
One in genetic schizophrenia , the other in microbiology (he works a lot with putting tumors in rats brains) , both will probably get jobs in the pharma industry as thats where most of the work and money is..
But, i do think the CEO’s and decision makers of pharma have a lot to answer for..
(its bad reputation was very much in place before i began my research)
That said, yes, I am willing to have civilized debates if you are..
:)
Bulldog
Drugs are not the only treatment for depression.
http://www.doctoryourself.com/depression.html
Kelly
Lisa,
I never diagnosed, I took Nancy at her word:
“I would cry for hours between states of emotional numbness,”
Does that sound mild to you? Granted, I’m taking her at her word and perhaps she does or does not have mild depression.
My point was that the study is talking about the effects of SSRIs on mild depression. You cannot automatically extrapolate that into other degrees of depression.
Others who are advocating meditation and yoga for severe depression are ignoring the fact that you have to get the person to the point that they can move, express and feel. I’m not advocating medication alone, and I agree that far too many docs have thrown pills at people too easily. We Americans seem to be stuck on the idea that a “magic pill” can make everything go away. It doesn’t work like that and our society needs to get clued in that life isn’t always going to be comfortable. But medication can change the person’s chemistry to where they *can* do the work.
I’ve experienced effects that were not helpful, I’ve experienced helpful reactions and I’ve experienced meds that had 0 effect. I’ve witnessed the same in others. If it was all a placebo reaction, shouldn’t I have had the same result no matter what the medication?
Someone
To Truthman and Nathan,
The other reality is that exercise, good eating habits and a healthy dose of spirituality (connectedness and a friendly social network) can have a positive impact on all sorts of diseases. Recently a young gentlemen I know was “arbitrarily” put on a cholesterol drug but never received any information on the role of diet and exercise. In fact he wasn’t even given a choice.
So, what you are saying about anti depressants is true for some other drugs as well.
Additionally, you may be interested in looking at the fantastic research that is going on in the area of epigenetics. There is much that we are learning about our environment, food, air water and emotions that impacts our DNA. We are not what we seem and we can change ourselves.
This is a critical point for many of the reasons that you already raised. If we continue to be fed these drugs that in fact are useless in most cases, then we are also interfering with our bodies ability to heal itself. This creates another “dependency” on yet other drugs to correct the problem caused by the first drug.
There are some “good” drugs out there, but there are very few drugs that can stand on their own, which speaks volumes.
We need to foster a more holistic approach to health care. Drugs alone are not the answer. Many doctors rely on drugs to make their jobs easier. They would argue that they do not have the time to educate the patient. Others argue, patients cannot afford the time that would be necessary. It is just so much easier to use the ol’ “take two asprins and call me in the morning” approach than doing their job. Apologies to any doctor out there who does take the time, but know that you are in the small (and rapidly shrinking) minority.
I think what we have learned this week with anti depressants should serve as the “watershed” for many other drugs.
The opportunity created this week is for us to help put research back on track and focused on obejctives and goals that can truly deliver benefits and results to patients and doctors.
We need to seize this opportunity…
truthman
We need to foster a more holistic approach to health care.
I couldn’t agree more..
Kelly
Please read a good analysis of what this meta research does and does not say written by a pharmacy student:
http://secundumartem.blogspot.com/2008/02/some-depressing-news.html
He points out that the articles do no indicate that all of the studies that were examined only studied effects for 6-8 weeks. Thus, the meta research indicates that placebo is 80% as effective as SSRIs in the short term. According to other studies (see the linked blog article he provides a link), the longer the study runs, the more distance grows between placebo and SSRI.
Laurie
“According to other studies (see the linked blog article he provides a link), the longer the study runs, the more distance grows between placebo and SSRI.”
And the more adverse reactions and side effects that are seen. I think the bottom line that we all agree on is that the studies that resulted in approval of ssri’s were woefully inadequate in regards to efficacy and risk.
Now we as a society are forced to face problem of millions of people on a drug that was prescribed based on flawed, or at best, misinterpreted data.
What is going to be needed now is a revelation of the needs of those who want to get off these drugs. If people discontinue these drugs without a full understanding of how devastating withdrawal can be, there is going to be a HUGE problem.
So while we have the current information on lack or overstatement, of efficacy, we have not even started to deal with the withdrawal that people are facing.
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