Studies suggest that antidepressants are no more effective than a placebo, and may be worse.
from newsweek.
Yet another study that contradicts another study. Next week a study will probably come out that says that flossing your teeth is bad because it could give you carpal tunnel syndrome.
I’m through paying attention to the latest study, I’ll probably live longer. As to the antidepressants, even if it is only a placebo effect for me, it works. Tra-la-la-la-la. 
Well, maybe it’s a placebo effect, but I had to try three different placebos till I found one that pulled me out of the darkness enough to start working on getting better. I’ll take it, thanks.
The difference between before I started my prozac and after? That ain’t no placebo. Nuh-uh.
Same here. I’d be dead without SSRI’s. There is a clear and marked difference between me on meds and me not on meds.
I’ve heard other people raise that same claim.
A potential problem is that there are about 14 different serotonin receptor types, and I think only a few are strongly involved in mood. Another problem is that some people do not have enough serotonin, so a reuptake inhibitor like an SSRI is not as effective on them.
Then there are issues of secondary signals and receptor sensitivity, etc. So an SSRI isn’t going to work on someone who has too few of a certain kind of SSRI receptor, or who produces too little serotonin to really make a reuptake inhibitor work in the first place.
I’ve heard SSRIs can increase levels of BDNF too, which can help with mood.
My point is that, from what little I understand of the subject it is fairly complicated and sadly I guess we are just beginning to find effective treatments. So the fact that these drugs barely work isn’t too surprising.
I do feel bad for all the doctors out there who want to help their patients and who will read that and feel even more impotent to help people with mood disorders like depression.
I don’t think it’s that they barely work. The problem is, different drugs do different things and different people have different needs. Right now, there’s no way ahead of time to test and tell which people will respond positively to which drug (or combo of drugs). Or resepond in any way, for that matter. Right now, the only way is just to try a bunch of different drugs until you (hopefully) find something that works.
I get why this is a scientifically unsatisfying answer but we’re still at the dawn of the medical knowledge. Twenty years from now things will be different. For now, we have to use the blunt tools we have at our disposal.
(And like the posters above, I went through a handful of meds before finding a combo that works for me. Most meds did nothing for me. One made my symptoms worse. Finding one that worked has been the difference between night and day. But I wouldn’t assume for a minute that my combo is right for anyone else.)
Are cats susceptible to the placebo effect? Because, after a year of no behavioral problems, I took my cat off his Prozac a couple weeks ago, and he went right back to gnawing the tip of his tail until it bleeds.
My antidepressants aren’t an expensive tic tac. They are $4 a month (its a generic), I’d spend that much on tic tacs. And they definitely seem to have a positive effect on depression and anxiety. If that’s a placebo effect, I don’t care. I sleep, have less anxiety, and feel joy.
And I spent eighteen months in psychotherapy (CBT) to try and manage the anxiety and dysrhythmia without meds. And spending an hour every week in therapy, plus all the CBT work, saw almost no improvement.
I think I’ve said this before the last time this was brought up… Is it likely that not everyone who takes anti-depressants actually has a biochemical issue? Very much so. This is a culture that wants to medicate itself in any number of ways instead of dealing with life. But for those of us who truly, truly, have a problem that cannot be willed away/coped with away, these medications are life savers.
You can pry my Lexapro out of my cold, dead hands.
I was just about to say this regarding my Abilify.
If antidepressants are just placebos… why does one antidepressant work better for me than another?
^ This.
Someone recently pointed out to me that I was showing some symptoms of depression. This is true - sleep disruption probably being the most prominent among them. Said person suggested drugs. I said no, because my problem isn’t biochemical it’s situational: I can’t find work and I desperately need money to pay my bills. The “cure” isn’t drugs for me, it’s obtaining an income. When I’m earning money the “depression symptoms” go away.
It’s rather like running a fever - a fever is a sign something is wrong, but all sorts of diseases and conditions can raise your body temperature and the appropriate treatment for, say, flu is different than for a kidney infection which is different than heatstroke. Likewise, if someone is showing signs of depression you have to look at more than just them - has a loved one died in recently, are they unemployed, did they get mugged last week, or are there indications this is biochemical in origin?
If you give a depressed person a drug for a serotonin deficiency when, in fact, that is NOT the root cause of their problem don’t be surprised if the pill doesn’t work. Ditto for any of the other magic wonder drugs. If it isn’t treating the true cause why would it help much, if at all?
These drugs shouldn’t be handed out like candy. They should, however, be available to those who actually can benefit from them just as diabetics should be able to have access to insulin when needed.
From the article itself:
Only in patients with very severe symptoms (scoring 23 or above on the standard scale) was there a statistically significant drug benefit. Such patients account for about 13 percent of people with depression. “Most people don’t need an active drug,” says Vanderbilt’s Hollon, a coauthor of the study. “For a lot of folks, you’re going to do as well on a sugar pill or on conversations with your physicians as you will on medication. It doesn’t matter what you do; it’s just the fact that you’re doing something.” But people with very severe depression are different, he believes. “My personal view is the placebo effect gets you pretty far, but for those with very severe, more chronic conditions, it’s harder to knock down and placebos are less adequate,” says Hollon.
The article does maybe make the point that perhaps there is an over-treatment of the milder cases of depression, but for the severe ones, using the drugs is what seems to be working.
Also, the best approaches for treating depression seem to be a combined approach- using drugs AND psychotherapy (such as CBT and such) tends to work w/ greater efficacy than either alone, so I’m curious to know if they simply used drugs on patients alone or if they went with a combined method (it’s also suggested that psychotherapy be used on milder forms of depression first as it’s the less invasive method, but if that’s not enough to go into the usage of medications as well).
So the study does raise a few questions, because depression along with other mental disorders DO tend to have very high placebo rates, it comes with the territory. The problem is knowing that fact that placebo rates are commonly high in mood disorders, does that mean one should discontinue treatment for all? I think that’s highly inadvisable and not being suggested. Perhaps we could try to better manage our patients, but to simply dismiss the group as a whole and say “anti-depressants don’t work” that’s incorrect.
They may not be the best method of treatment for MILDER cases of depression perhaps, but they’re certainly not the only option available for those cases. Perhaps there is an over-reliance on medicating? That’s plausible, but to simply say “well, the studies show that in a group that’s normally highly susceptible to the placebo effect to begin with, our treatment using medications seem to be equal to the placebo effect!”
That’s the problem I think with the study, there is a known higher rate of placebo effect in mood disorders, and so in a study one should try to account for those variables. I would have rather liked to have seen the study and how they’re controlling for those variables.
But for the reporter or the OP to come out and simply say that Antidepressants don’t work- that’s painting with a broad brush over an already volatile category and dismissing many people whose depression actually DOES get treated quite well by the medications.
The key is to improve the patients quality of life- if you can limit the side effects to a minimum, but have the patients quality of life improve, then the medications are doing their job, I believe. To simply go up to a group and tell them “Well it’s all fake, and it’s probably likely that these medications don’t work at all, so sorry that you feel better, it’s all in your head” is a very risky thing to do and slightly irresponsible if they don’t have an alternative treatment that works just as well.
I’ve said a lot of uncomplimentary things about psych meds over the years on this board but I’ve never said they are just placebos. They aren’t. They are psychoactive.
Any given one (no matter how well-touted) may not help you, and for that matter the medication that appears to help you now may be interfering with your emotional growth and stability later, or may be helping you in one sense while worsening your experience in other ways, generating a mixed-bag result.
No doctor has a magic gauge that will predict any of the above. A good conscientious doctor would perhaps start you on one and then check with you persistently both short-term and long-term to see whether or not it is helping at all, is continuing to help, is not harming in some ways while helping in others (or at least is attaining a balance between harm and help that is acceptably beneficial overall), etc. A good conscientious doctor would perhaps not think in terms of “you should EITHER continue on the medication regimen I put you on OR ELSE I should change you to a different med or a different dose” but would also always consider the possibility that today’s best answer is “no meds”. (Even if tomorrow’s best answer is to put you back on something else).
Sorry, the pharmacology is clumsy, our understandings of the processes and phenomena that we call “depression” are murky, and people are individuals. There is totally NOT a “one size fits all” solution and for the most part there’s not a bit of it that’s any more “sure-fire” than “what food, if I prepare it and serve it to my date, will put my date in a romantic mood?” or “Which color shirt will land me this job I’m interviewing for”. Depression appears to correlate with some low-level neurotransmitter chemistry conditions, but thinking of “depression” as BEING — or even BEING CAUSED BY — a specific neurotransmitter or its uptake antithesis is not really more useful than attributing ingenuity, writer’s block, or compassionate pragmatism to what you had for breakfast. You DO NOT GET to have quite that close to a total control over your state; it is a reactive condition that is affected by a huge constellation of factors, some of which may work WITH your antidepressant, some of which may work AGAINST it, and quite a few of which may work at right angles to it, to to speak, CHANGING how it works on you.
I am aware that the condition that lands a person with a psych diagnosis of clinical depression is not (usually) “just a case of the blues”, but they aren’t massively foreign states to either other, either; there is SOME relationship, in part that of a continuum of degree and in part the addition or subtraction of additional factors, but it would be silly to assume that the types of stimulus that would normally GIVE YOU a normal rotten case of the nonclinical mopey ol’ despondent blues would not have any effect on a clinically depressed person. And as life’s immediate situation all around you changes, you feel different as a consequence and that modifies how your brain and its electrical ocean of neurotransmitters are behaving, which in turn has consequences for how an antidepressant is going to interact. And being on an antidepressant has consequences for how you experience and react to those everyday-life stimuli as well, which in turn has consequences for the actual environment in which you live (because how you feel has consequences for your behavior and your behavior has consequences for the behavior of others, and for more structured things like decisions that get made and so on).
They aren’t for everyone. They may help you, in some way, now. Or rather one or another specific antidepressant may help you, in some way, now. Or perhaps not. They aren’t magic bullets, no matter how badly the pharma industry would like you to believe that they are. Lower your expectations and then try to make an assessment about whether or not you’re getting good results, on balance, for what has been prescribed for you. And if the answer is “no”, take charge of your care plan and do something about it. Educate yourself. No one on this planet is in more intimate contact with how you feel than you are, so you’re the expert on how well you’re doing.
I had panic attacks at one point and I was amazed not only that they worked but they worked so quick. So I’m willing to admit, for me it could be a 100% placebo effect.
I recall the first time I took imipramine, they told me it could take up to six weeks. It took about 30 minutes. I remember taking it and feeling all nervous and I took it at 9pm and by 9:30pm I noticed I was watching TV and calm and by 10pm I had no more panic.
I realize that was probably a placebo effect, but who cares it worked. Oddly like 10 years ago when I took Prozac to get over a fear of flying, it did nothing for me, but kill my sex drive. The doc switched me to Paxil and in about a day, the fear was gone and in five days I was on a plane.
I don’t take them any more, and the fact that imipramine and Paxil worked so fast on me, probably means if it was them that worked there was probably a strong placebo effect as well
Fascinating article. The author showed some lack of knowledge about the subject, though, in this quotation:
It’s all well and good to point out that psychotherapy is more effective than either pills or placebos, with dramatically lower relapse rates. But there’s the little matter of reality. In the U.S., most patients with depression are treated by primary-care doctors, not psychiatrists. The latter are in short supply, especially outside cities and especially for children and adolescents.
Very, very little psychotherapy is performed by psychiatrists. It is done by psychologists, licensed clinical social workers, etc., who are in short supply in some areas, but not nearly as much as psychiatrists. This weakens his point about “maybe we have to keep the placebo effect going”.
I was prescribed several different kinds of antidepressants over time in an attempt to find something that really worked for me. For all but two the results were… ambiguous. Which is to say, I couldn’t really tell if they were working. Which does make you wonder about their effectiveness. Maybe I’m just naturally skeptical, so the placebo effect doesn’t really work for me.*
As for the two that had an effect:
[ul]
[li]Zoloft - Whoa. Bad trip. This stuff made me a complete, utter basket case. After about a week of it in my system, I started to bounce off the walls – and it got worse from there. Is there an opposite of the placebo effect? If so, that’s what this was.[/li][li]Lithium - Don’t know if this really fits the same categories as antidepressants, but it’s some sort of psychoactive drug. Anyway… whoa, this is a friggin’ miracle drug. I obviously can’t rule out a placebo effect, but I should point out that I didn’t have much hope for the stuff. You see… it didn’t make sense to me to take a drug that’s supposed to treat manic episodes when I’d never had a manic episode (unless you count what happened on the Zoloft). Nevertheless, that drug was like a calm wave of peace. Heaven on earth. I’ll tell ya: if it didn’t have such terrible health effects I would still be on the stuff. [/li][/ul]
Caveat: I was severely depressed when I went for these treatments. And the article does acknowledge that there is evidence that these drugs do have an effect on the severe cases.
*Come to think of it, I’ve never had much use for drugs, beyond the odd time when I’ve really needed an antibiotic, because I don’t really find that they help much. Maybe that’s because I’m skeptical that they work all that well.
Way back in the day when I was going through the end of my marriage, I spent six months fighting my depression. I got to the point where if I wasn’t at work or grad school and therefore in front of people, I was lying on the bottom of the tub in the bathroom under a running shower to hide the sounds of my weeping.
I spent the last three of those months watching myself get closer and closer to following through with my plan to suicide.
My therapist finally told me that he wouldn’t work with me anymore, because I had a deeper depression than he felt therapy alone could touch, unless I at least spoke to an psychiatrist. I reluctantly agreed, and the psychiatrist managed to convince me to give Prozac a try.
Within one week, I was functioning more clearly and stably than I had in six months, I had stopped crying non-stop, and my suicidal ideation was almost completely gone.
That “placebo effect” saved my life. I despise it when people attempt to tell anyone that’s in pain and suffering that they shouldn’t try everything to alleviate that agony.