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 Drugs for depression don't work
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From The Times
February 26, 2008
Millions of people taking commonly prescribed antidepressants such as Prozac and Seroxat might as well be taking a placebo, according to the first study to include unpublished evidence
The new generation of antidepressant drugs work no better than a placebo for the majority of patients with mild or even severe depression, comprehensive research of clinical trials has found
The researchers said that the drug was more effective than a placebo in severely depressed patients but that this was because of a decreased placebo effect
The study, described as “fantastically important” by British experts, comes as the Government publishes plans to help people to manage depression without popping pills
More than £291 million was spent on antidepressants in 2006, including nearly £120 million on SSRIs. As many as one in five people suffers depression at some point. With that in mind, ministers will today publish plans to train 3,600 therapists to treat depression. Spending on counselling and other psychological therapies will rise to at least £30 million a year
The study, by Irving Kirsch, from the Department of Psychology at the University of Hull, is the first to examine both published and unpublished evidence of the effectiveness of selective serotonin reuptake inhibitors (SSRIs), which account for 16 million NHS prescriptions a year. It suggests that the effectiveness of the drugs may have been exaggerated in the past by drugs companies cherry-picking the best results for publication
The National Institute for Health and Clinical Excellence (NICE), which is due to review its guidance on treating depression, said that it would consider the study
Mental health charities say that most GPs admit that they are still overprescribing SSRIs, which are considered as effective as older drugs but with fewer side-effects. SSRIs account for more than half of all antidrepressant prescriptions, despite guidelines from NICE in 2004 that they should not be used as a first-stop remedy
American and British experts led by Professor Kirsch examined the clinical trials submitted to gain licences for four commonly used SSRIs, including fluoxetine (better known as Prozac), venlafaxine (Efexor) and paroxetine (Seroxat)
The study is published today in the journal PLoS (Public Library of Science) Medicine. Analysing both the unpublished and published data from the trials, the team found little evidence that the drugs were much better than a placebo
“Given these results there seems little reason to prescribe antide-pressant medication to any but the most severely depressed patients, unless alternative treatments have failed,” Professor Kirsch said. “The difference in improvement between patients taking placebos and patients taking antidepressants is not very great. This means that depressed people can improve without chemical treatments.” He added that the study “raises serious issues that need to be addressed surrounding drug licensing and how drug trial data is reported”
The data for all 47 clinical trials for the drugs were released by the US Food and Drug Administration under freedom of information rules. They included unpublished trials that were not made available to NICE when it recommended the drugs for use on the NHS. “Had NICE seen all the relevant unpublished studies, it might have come to a different conclusion,” Professor Kirsch said
Tim Kendall, a deputy director of the Royal College of Psychiatrists Research Unit, who helped to formulate the NICE guidance, said that the findings were “fantastically important” and that it was “dangerous” for drug companies not to have to publish their full data. He added: “Three of these drugs are some of the most commonly used antidepressants in this country. It’s not mandatory for drug companies to publish all this research. I think it should be.”
SSRIs are not prescribed to patients under 18 because of the risk of suicide.Drugs watchdogs in Europe are considering tighter controls on the development of new medicines, The Times reported this month, and may soon require regulators to monitor psychiatric effects and the risk of suicide more closely during clinical trials
A spokesman for GlaxoSmithKline, which makes Seroxat, said: “The authors have failed to acknowledge the very positive benefits these treatments have provided to patients and their families dealing with depression and their conclusions are at odds with what has been seen in actual clinical practice. This one study should not be used to cause unnecessary alarm and concern for patients.”
A spokesman for Eli Lilly, which makes Prozac, said: “Extensive scientific and medical experience has demonstrated that fluoxetine is an effective antidepressant.”
http://www.timesonline.co.uk/tol/life_and_style/health/article3434486.ece
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Re: Drugs for depression don't work (Re: Mohamed Omer)
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Jagged little pills
Ariane Sherine
The Guardian
February 26, 2008
I'm more anti-anti-depressants than the Pope is anti-femidoms. Except, while the Pope wouldn't be directly harmed by femidoms (unless we all launched thousands of them at Vatican City, twanging them like rubber bands), anti-depressants depressed me till I prayed to God to make the pain stop. To my mind (which produces decidedly more seratonin without them), SSRIs like Prozac are the devil's own medication, the bitter, useless soul-destroyers he glugs down with his Alpen. As today's major review concludes, they don't make anything or anyone better, yet doctors dish them out like Chat magazine
Aged 19, I couldn't stop crying. I didn't tell my doctor why, and he didn't ask. I just remember saying, "I just want to feel better. I don't want to be like this any more." I know less about medicine than Ann Widdecombe knows about threesomes, but I do know that if a friend came to me in pain, I'd try to find out what was wrong. I'd listen to them, attempt to convince them life was worth living, then encourage them to stop taking any and all mind-altering substances (including drugs and alcohol), drink lots of water, get some sunshine (or bright light), cut out junk food and exercise for at least an hour a day
But I wasn't the doctor's friend: he was time-poor with a queue of half-dead people pressed outside his door, and I was probably number 18,753 that week in the Everybody Hurts brigade. To his credit, he asked whether I'd tried psychotherapy. I replied that I had, and that it hadn't worked. So the doctor stared at his screen, tapped away at his keyboard, and handed me a sheet of paper. Next!
The first drug was the SSRI citalopram, which made me shake and sweat as though I were being chased down an ever-thinning tunnel by a furious ten-foot group of shotgun-toting pro-life Republicans. So I returned to Doctor Drughappy, who decided a trip on the anti-depressant rollercoaster was just the ticket, with paroxetine (Seroxat - one of the drugs studied in the review) as the first bend. It made me feel even lower, though this might have been because I was vomiting hourly (I couldn't eat without throwing up) and lost about 12 pounds, giving me a BMI of 17.7
And so I went back to the middle-aged man with the computer. I was hoping that maybe he might say, "Miss Sherine, these drugs are clearly very bad for you, and probably for everyone else too. Shall we try something completely different?" But he was truly at a loss as to what else to suggest, and merely tapped at his keyboard again, muttering determinedly, "One of these will be right for you, it's just a question of finding out which one."
I was his guinea pig for five in total. And if I lost weight on Seroxat, Mirtazapine made up for it - I was lying awake at night with what felt like evil gerbils gnawing at my stomach, then giving in to the hunger and coming down in the dark to eat the fridge. Ironically, Mirtazapine (not an SSRI, but a tetracyclic) was the only drug to make me feel happier, but if I'd kept taking it, I'd now be taking up the whole back row of buses. But if that was the rollercoaster's highest peak, the last two prescriptions took me down lower than I'd ever been. I just remember thinking, "Enough. Drugs can't make me better - I have to make myself better." That was in 2000, and I haven't taken an anti-depressant since
I'm no saint (I don't think the Pope's going to touch me after this). I do a lot of stupid things on a daily basis - but taking SSRIs isn't one of them, and I'm a lot happier without them. And if you're depressed, I'd urge you not to take them either. Scream, cry, accept that life is sometimes painful and unfair. Get good people around you and talk to them - if not family, then friends - and please be kind to yourself. Just don't put anti-depressants in your mouth, unless you want to end up in hell
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Re: Drugs for depression don't work (Re: Mohamed Omer)
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Prozac and the placebo effect
The Guardian, Friday February 29 2008
As a GP and therapist with over 30 years' experience, I feel the media have, in the main, missed the point of Professor Irving Kirsch's recent work (Prozac, used by 40m people, does not work say scientists, February 26) - that it is not that antidepressants may not work but that, in many cases, placebo works just as well
Why has placebo such a bad press? Far from being something we should try to avoid or play down, the placebo effect should be celebrated. It is of supreme importance in medicine. Thirty years ago GPs could prescribe an innocuous vitamin pill with plentiful suggestion to generate expectation of healing and on many occasions it would work. But it was not "scientific" enough and with increasingly slavish adherence to "informed consent", and side-effect leaflets in all prescribed medications, it became no longer possible to use this
Expectation has been shown to be a key factor in the success of any counselling or psychotherapeutic approach; why not in every aspect of medicine? The placebo effect, mediated by intention, expectation and suggestion, enables and potentiates the person's natural healing capabilities - and is arguably the mechanism by which many "complementary" approaches work
What a wonderful thing, the placebo effect - no side effects and works successfully at least a third of the time. Let's use it, not knock it!
Ann Williamson
Ashton-under-Lyne, Lancashire
In the debate on antidepressant medication one important point has been overlooked: "depression" may not actually exist as a valid, discrete clinical concept. Those who are collectively termed as suffering from "clinical depression" are a remarkably diverse range of individuals. Some have problems with drugs or alcohol. Others can trace their depression to experiences of loss or abuse. Still others seem to display a biological vulnerability to low mood for no clear personal reason. Lumping them all under a single heading of "depression" may be convenient for the healthcare and pharmaceutical professions, but we should not be surprised if we find that a simple pill - made of sugar or anything else - fails to make a real difference to something as complex as a troubled mind. We know antidepressants have a very clear effect upon fear, motivation, sleep, appetite and so on. Rather than asking what these drugs do to "depression" we might be better off asking just what they do to many processes in the brain for which we have much more reliable names
Dr Mark Salter
Consultant psychiatrist, City and Hackney Centre for Mental Health, London
"Depression" is used to describe the feeling of distress in response to adverse life events as well as a brain disorder - two completely different entities. Human distress is not relieved by medication, but equally psychological therapy won't help someone with a brain disorder. The medicalisation of distress by social psychiatrists has served the interests of drug companies who don't care who antidepressants are prescribed to, so long as they are prescribed plentifully
Richard Hackett
Consultant psychiatrist, Manchester
It is ironic that as the evidence base for antidepressants is seriously questioned, the "army of therapists" who will "push the pills aside" (Report, February 27) will largely be offering cognitive behavioural therapy. It is claimed CBT has a stronger evidence base than other psychological therapies. In fact this evidence has, like the antidepressant evidence, been "massaged". Only in the small print of the National Institute for Health and Clinical Excellence guidelines that are pushing CBT as "the" psychological therapy do we find statements like "the clinical evidence review showed no overall superiority for CBT alone on treatment outcomes over antidepressants". Out of the frying pan
Malcolm Learmonth
British Association of Art Therapists
Why do comments such as "These drugs worked for me" and "The SSRIs definitely help" make headlines (February 27), while similar anecdotal comments on the efficacy of, say, homeopathic remedies, are condemned as "bad science" and followed by comments on the power of placebo effects?
David Wheeler
Manchester
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Mohamed Omer
Osman Musa
فيس بوك
تويتر
انستقرام
يوتيوب
بنتيريست