Feeling Neurotic? Then Take An Antidepressant
30 CommentsBy Ed Silverman // December 8th, 2009 // 9:44 am
A new study suggests that at least one antidepressant, GlaxoSmithKline’s Paxil, may help ward off neurotic feelings that may make someone more depressed to begin with. Neurotic feelings may lead to negative emotions and emotional instability, and studies have suggested people who are very neurotic have a higher risk of becoming depressed.
“Our data suggests that modern antidepressants work partly by correcting key personality risk factors of depression,” Tony Tang, a psychology professor at Northwestern University, who led the study, tells Reuters. “It’s the basic tendency towards having negative emotions.”
There is also some suggestion that people who are extroverts - those who tend to be both socially outgoing and have a more positive outlook on life - are less likely to become depressed, Reuters notes. The study was published in the Archives of General Psychiatry (see here).
The rsearchers looked to see whether Paxil, which has been linked to suicidal thoughts and birth defects, had any effect beyond just treating depression. They gave the pill to 120 volunteers with depression and compared their experiences to 60 people who underwent cognitive behavioral therapy and another group of 60 who took a placebo. Personalities and depression symptoms were assessed before and after treatment.
After 12 weeks, all of the patients experienced improvements in depression symptoms, but those given Paxil also saw significant drop in neurotic feelings and a marked increase in extroversion compared with those in the other groups. “Patients taking paroxetine reported 6.8 times as much change on neuroticism and 3.5 times as much change on extroversion as placebo patients matched for depression improvement,” the authors wrote.
Ian Cook of the David Geffen School of Medicine at the University of California Los Angeles, who was not part of the research team, tells Reuters the findings may cause some docs to rethink their assumptions about how antidepressants work.
“The conventional wisdom has been for many years that the changes in personality that one sees during treatment tend to be thought of as a reflection of getting the depression under control,” he tells Reuters, adding that, if confirmed in other studies, the findings could help better predict who is at risk for major depression and which patients may benefit from treatment.
Funding for the study came from the National Institute of Mental Health and the researchers reported there were no conflicts of interest.
UPDATE: We wrote Northwestern’s Tang with a few questions, and he responded:
Yes, (the trial was double-blinded) in terms of paroxetine vs. placebo. We, in fact, sometimes call it triple blind: blind to psychiatrist, patient, and evaluation interviewer (who rates things like depression severity). The CT (cognitive therapy) condition is much harder to be fully blind, for obvious reasons.
(The trial included) only eight weeks of placebo; but 16 weeks of paroxetine or CT. Put patient on placebo is considered an ethical issue, so as soon as the eight-week placebo comparison data is obtained, the placebo patients were de-blinded and provided free treatment of their choices. So, all key comparisons with placebo were done on week eight, but the active treatement went on till 16.
[We asked if he agreed whether Paxil failed to combat depression]. I disagree. It is very effective against depression. What is not so impressive is it’s relative advantage over placebo. In other words, its immediate effect on depression is large, but you can get about 75-80% of that effect just taking placebo. The same is true for all leading antidepressant medications; if you are interested, I can send you further references on this.
On changing Neuroticism and Extraversion, however, Paxil’s raw effect is substantial, and its advantage over placebo is also substantial, because these personality dimensions do not respond to placebo. So, academically, we say that neuroticism and extraversion differentiate between Paxil and placebo much better than depression.
[We asked about the impetus for the study in light of criticism that this presents Glaxo with an opportunity to market Paxil for another social disorder]. Lol, it is funny to see what people would say. This project is my personal pet project piggybacked on a large and expensive clinical trial funded by NIMH. Most such critics are unaware that neuroticism has been firmly established as a key risk factor of depression. It goes without saying that we want to know whether an effective treatment of depression (Paxil) can impact a key risk factor of depression. For most medical disorders, how the treatment impact known causes of the disorder is the default focus of treatment and research.
Plus, neuroticism and extraversion are both linked with the brain’s serotonin system, which happens to be targeted by Paxil, Prozac, Zoloft… So, there is an obvious neurobiological pathway for Paxil to impact neuroticism and extraversion. More reason to test whether Paxil actually does that.
SSRIs type of drugs are already proven effective for many anxiety disorders. Glaxo doesn’t need this study for that. Scientists like me and my co-authors, however, wonder why Paxil can treat such a broad range of disorders. Neuroticism potentially provides a parsimonious explanation here, because these disorders have all been associated with Neuroticism.
The original NIMH clinical trial was design to test whether Cognitive Therapy treat moderate to severe depression as well as medication, and whether cognitive therapy is better at preventing relapse. And Dr. DeRubeis and Dr. Hollon found both turn out to be true, as published in Ref 37 and 47 of my article.
I know drug companies are not popular, and many drugs have serious side effects, but some of these drugs have some positive effects as well :-)
Lisa Van Syckel
“Patients who took paroxetine reported greater personality change than placebo patients”
Sure, its called Mania, a pretty dangerous change indeed!!
Oh, what a bunch of nutty Professors…
talbot
Clever, clever, clever. First depression is caused by an imbalance of chemicals–hence the need for the meds. Now “ways of thinking” (as in talk/behavior therapy?) appear to have a role? Which can be treated by meds….
patrons99
This is a great example of depraved marketing logic: Paxil to “ward off neurotic feelings”. Neurosis as a preventable prelude to depression. Why wait until we actually manifest neurotic behaviors? Why not use paxil to prevent neurosis, not just prevent depression? Isn’t this the ultimate in preventative healthcare? Soon we’ll be asked to complete questionnaires, to deduce who might have neurotic leanings, e.g., undesirable political persuasion, wrong-headed thinking. Of course, this screening must begin in the preschool years. Once someone is labeled with a certain disagreeable predisposition, that will necessitate a lifetime of special “treatment”.
truthman30
Jesus..
GSK would do anything to flog this pill…
Not content with suicidal teenagers on Paxil, Paxil induced suicide rampages, withdrawal symptoms from the hell of hells and Paxil causing birth defects, they still want to squeeze every last drop out of promoting this poisonous crap..
Is there no low too low to go?..
Apparantly not…
Mr Tony Tang sure is a clever guy ain’t he? ..
Depressed people have negative feelings?
Negative feelings can lead to depression ..
Oh really, wow, that’s groundbreaking research Mr Tang.. truly astounding..
… I thought that depressive types did cartwheels to work in the morning , smiling their heads off, all the while singing the theme tune to Sesame Street?…no?… hmmmmm .. .
“Neurotic feelings may lead to negative emotions and emotional instability” .. .
Another nugget of insightful wisdom from Mr Tony Tang …
I thought woody Allen invented Neurosis? …
Or maybe it’s just part of the human condition..
I’m pretty sure that most peopel would be aware that neurosis could lead to negative emotions and emotional instability, but I’m not so sure that this is a new discovery Mr Tang…
I’ve got a humdinger of a question for Tony Tang … could this personality change and “drop in neurotic feelings” be because Paxil NUMBS ALL FEELINGS AND EMOTIONS”? …
And also I wonder, if you Numb all feelings and emotions, personality traits and clarity , could this also mean that the very feeling of “Empathy” that binds us together as a species is also obliterated in the process? …
And also if this Numbing and Dumbing Down of the mind and feelings from Paxil is so great , could it also lead to the many, many tens of thousands of reports of suicidal impulses, homicidal acts and negative behavior changes that people have been reporting all over the internet for the past decadede? …
Analyse that Mr Tang… if you will..
Anonymous
Truthman is on target.
This story was picked up also by Health Day/US News and World Report. Here is what Bernard Carroll had to say about the study.
… any excitement over the results should be tempered by the fact that the improvements in depression from taking paroxetine weren’t much better than from a placebo or cognitive therapy.
“The study confirms that paroxetine is not an especially effective antidepressant drug,” said Carroll, past chairman of the U.S. Food and Drug Administration’s (FDA) advisory committee for psychiatric drugs. “In this sample, it barely beat the placebo.”
Instead, paroxetine is more commonly prescribed for anxiety disorders, which is why researchers may have noted the personality changes. “Paroxetine wouldn’t be anybody’s number one choice for depression,” Carroll said. “But it just might make sense that improving certain personality dimensions helps the patient’s resilience against future relapse.”
Deciding whether to take an SSRI or not has to be weighed against possible side effects, Carroll said, citing a recent study in the British Journal of Psychiatry that found that many people taking SSRIs reported feeling that the medications had blunted their emotions, both negative and positive ones. Other side effects may include headache, changes in sleep patterns, gastrointestinal upset and changes in sexual functioning, according to background information in that study.
“This business about the drugs affecting personality is not all necessarily good,” Carroll said.
Atlex
Truthman,
You may not like the results, but the study was done independently by a psychologist (Dr. Tang, not Mr. Tang) who only received pills and placebos from GSK. He received no financial support from GSK and none of the authors report any financial ties to pharma.
As usual, you blame pharma without knowing the facts.
Atlex
Lisa Van Syckel
Atlex,
Mr. Tang, oh excuse me, Dr. Tang a Psychologist, who has no medical degree, or specialty in Psychiatry. Heck,.. he doesnt even have prescribing priviledges!
Like I said before, He’s just a nutty Professor..
Atlex
Lisa,
First you complain about psychiatrists (because we all know they are all paid off by Big Pharma). Now you complain about psychologists, who as you state don’t prescribe and, in this case, have know financial ties to pharma. All I can assume from that is that you choose to denigrate any expert who disagrees with your viewpoint. By the way, if you go back and read my comment, it was focused on Truthman’s insinuation that somehow Big Pharma was behind this story when clearly they weren’t. I made no comment regarding the conclusions of the study.
Atlex
Lisa Van Syckel
I’d like to see further review of this study,. with the raw data included!!
Lisa Van Syckel
Atlex,
Actually we dont know if these folks have financial ties to Pharma. Others have stated no conflicts in the past, only to find out at a later time, that, oh they forgot to disclose,.. an honest mistake,.. really.
“denigrate” nah.. What I am doing is questioning, their, so called scientific evidence.
Ive said it before, and I will say it again.
A greater change in personality, is mania, and a dangerous one indeed.
Evelyn Pringle
One thing I notice with these studies, is the competency of the therapist providing cognitive therapy is never discussed.
If the participants end up with incompetent therapists it could make all the difference in the world in the results.
Making sure this happened would be the easiest way to swing the results in favor of pills.
Funny nobody ever seems to mention this factor when discussing studies that compare “therapy” to drug treatment.
I wonder why.
Justice in MI
I would like to see their “neuroticism” scale and the raw data (which I will look at). What we’ve got is some relative benefit numbers which may represent very little, both in terms of actual numbers and the significance of what’s being measured.
I am, btw, a clinical psychologist.
Justice in MI
re: Evelyn’s point, it’s a good one. Competence is also hard to measure but, like pornography, you generally know it when you see it.
Evelyn Pringle
But the problem is Justice, we have no window in which to observe these so-called “therapists.”
I for one would love to participate in these studies to check out the quality of therapy provided.
As it stands now, I’m having a bit of difficulty accepting that a person’s neurotic thought processes could be changed more with a pill than by focused approaches in therapy
Justice in MI
First impression from skimming the study–the results are enormously more complex than the news summaries suggest–especially in terms of statistical significance, endurance of reported benefit, dimensions of observed change measured, and more.
As I read it, the core interest of the researchers has less to do with promoting a particular treatment than providing evidence for physiologic/genetic predispositions to “neuroticism” and the relationship between “neuroticism” and major depression.
How the study may be used in marketing is a separate question.
Anonymous
In reply to Justice in Michigan:
The reporting of results was not exactly transparent. Did they report the pretreatment or posttreatment depression severity scores? No.
If they won’t even do that and if the Archives of General Psychiatry doesn’t have the wit to require them to do it, then a pox on all their houses. Talk about sloppy peer review! AGP has slipped from its pedestal.
Justice in MI
The particular test which is the core in this study was a 10-15 minute agree/disagree survey. The “neuroticism” dimension has all of twelve questions.
But, in the spirit of “get the hell out of Framingham,” the big problem may be Joisey. With a hat tip to Wiki, here is a comment on the geographic distribution of “neuroticism.”
“Neuroticism, along with other personality traits, has been mapped across states in the USA.[12] People in eastern states such as New York, New Jersey, West Virginia, and Mississippi tend to score high on neuroticism, whereas people in many western states, such as Utah, Colorado, South Dakota, Oregon, and Arizona score lower on average.”
Look forward to South Dakotaxil.
Evelyn Pringle
Instead of accepting a term like, “physiologic/genetic predispositions to ‘neuroticism’”, I’ll stick with the common sense explanation of learned behaviors as a result of being raised by a neurotic parent.
There are no “genes” involved.
Justice in MI
Hey, Evelyn, I go back to the bygone psychodynamic days, so I’m a complete dinosaur.
These are obviously not exclusive options. One could have whatever genetic cards that “predispose” to a certain intensity or vitality (not personality).
In one family, you become a high energy leader, artist, teacher, etc.
In another family, you become just another overwrought dude in New Jersey.
Lisa Van Syckel
Justice,
Im curious, why did you choose to reference NJ?
Justice in MI
Look up the thread–it’s one of those “neurotic” states. I suppose I hoped to give Ed a bit of a rise too.
raw data
LVS SAID “I’d like to see further review of this study,. with the raw data included!!”
Yes, every study ever published puts out all of the raw data for you to examine…. As someone who has actually done a little “clinical research” - i.e. examined trials and put together data for a meta-anaylysis - I can tell you most researchers are comfortable providing the raw data to you. Now I have actually been trained to examine the data and they might not release that info to just anyone, but it hasn’t been a problem for me. Many things are available if you ask nicely
Lisa Van Syckel
raw data,
I’m “L.M.A.O”,… Thank You, I needed it.
truthman30
Truthman,
You may not like the results, but the study was done independently by a psychologist (Dr. Tang, not Mr. Tang) who only received pills and placebos from GSK. He received no financial support from GSK and none of the authors report any financial ties to pharma.
As usual, you blame pharma without knowing the facts.
Atlex
As far as I can see Atlex, there are no concrete facts at all from this study, it’s over blown sensationalism …
Oh .. and I only ever address someone as “Dr” if I feel that they embody the ethos of a “Doctor” …
I don’t see any ethos here, I see pseudo-research masquerading as science…
There is one thing that we can draw from this sudy though…
Paxil certainly does change personalities and behavior … Unfortunately NOT IN A GOOD WAY …
Betsy Jacobson
First, I’d like to know the extent of the pharmaceutical’s financial benefits from the manufacturing and marketing of Paxil as a result of its trials. I’d also like to be sure how much we actually know about the Paxil trial results, because we often don’t know how much is actually published about them. Pharmaceuticals have a nasty habit of often omitting negative trial results even from the FDA for obvious reasons.
In 1998, a Professor/psychiatrist/researcher from the University of Oslo in Norway came to New York to speak at my Fibromyalgia conference about Paxil, and by the time he arrived in the U.S. he had to sadly report to the assembled doctors and patients that his university’s trials didn’t work at all for depression (and all its permutations). This was 11 1/2 years ago.
We know now that most SSRI’s and SNRI’s can cause suicidal ideation and depression, speaking of neuroticism, so this is very dangerous stuff.
Marcia Angell, MD wrote in her book, The Truth About Drug Companies, How They Deceive Us and What To Do About It, that between 2002 - 2004, researchers found that placebos for SSRO’s were 80% as effective as the drugs tested, and Paxil was one of these.
Dr. Angell is Senior Lecturer in the Dept. of Social Medicine at Harvard Medical School, and used to be editor-in-chief of the New England Journal of Medicine.
Lisa Van Syckel
Betsy,. Your singing to the choir.
Atlex
Ed,
Nice job on your follow-up with Dr. Tang. He comes off as a sincere researcher looking to improve medical care.
Atlex
Justice in MI
I agree that the interview with Dr. Tang is a good follow.
I would continue to suggest, however, that this remains a study that is limited and ambiguous. The definitions of “neuroticism,” and its links to “depression,” are “established” in the minds of those who have made it their career to think in such terms. None of this is news to people in the field–it has been asserted for more than a dozen years. Likewise, the various imaging studies that purport to give it credence.
None of that enhances the significance of this particular study, or makes it more convincing to those among clinical and personality psychologists who begin with different premises and define the “what” of personality in different ways.
None of that is a criticism of Dr. Tang’s personal dedication.
Chay in MI
Did anybody ask if these test subjects were really depressed? Or how it was determined that that they were depressed?
Well, I was recently diagnosed as severely depressed and immediately prescribed Zoloft.
Yes, I was tested, I did the 6 questions or was it 8? Anyway, the questions were few and no matter how you answered them you would be determined depressed to some degree.
The good doctor never asked what might be bothering me, didn’t inquire about any life events that might be depressing, or anything about my life at all.
Shame, if he had I would have told him that 7 weeks ago I lost my closest, dearest, and longest friend suddenly. Someone so close she might as well have been my sister.
It hadn’t been a year since I lost my father, my aunt, and 3 of my cousins and barely 2 years since the death of my mother.
Forgive me for being a bit down on some days, ya know. Not to mention that I lost my best friend a few days before my own birthday and Thanksgiving. This will be the first Christmas we didn’t go shopping together.
In my book, grieving is normal, not diseased.
I understand that they have a similar test for kids for ADHD.
Aren’t we lucky to have advanced to the point where it’s so easy to be diagnosed as a mental case based on less than 20 questions.
I’m surprised I wasn’t given Paxil.
It wouldn’t have matter much anyway, I haven’t and have no intentions of taking any antidepressants ever.
I’m not crazy.
Ana
I am a neurotic and I did 20 years of psychoanalysis that ended in 2008.
I’m amazed that GSK has the guts to use the word neurosis and Paxil at the same line.
There is no medicine for neurosis. Maybe a diazepam, never clonazepam because it is too damn addictive but physicians say it is not, to help anxiety.
The word “neurosis” is not used any longer and now soldiers are not diagnosed “war neurotic”. They are diagnosed PTSD because a disorder can be treated with pills.
Where is the DSM-5? Some psychiatrists want it to end and it would be the right thing to do.
Seriously.
IF psychiatrists don’t don anything to stop the crimes they are promoting I don’t know what to think about humankind.
If those who are supposed to help… blah blah blah….
Nemeroff, Biederman… Shame, to say the least.
Thank you for the great work Ed Silverman!
I’m always commenting at Furious Seasons and never commented here I don’t know why.