One of the many ways that nearly all 'antidepressant medication' studies are unscientifically skewed is that they only compare the drugs to sugar-pill-type placebos. It's a good point that some so-called 'inactive ingredients' can have effects on some people, though even a horse pill can't fit more sugar than a few sips of soda. But when the variable in question is solely the way people feel, and therefore 100% susceptible to the placebo effect (unlike say a cancer study, where the amount that a person's feeling, belief, or attitude could actually physically shrink their tumor is pretty limited), a real scientific study needs to use an active placebo, which causes side effects like the drug being tested. Comparing a drug that causes side effects to an inert placebo is inherently not a blind study, because both patient and researcher will notice who's having side effects and therefore know who's getting what. And it's not a controlled study either, because there are so many possible confounds. Believing that you're on the newest wonder drug can have a huge effect on a condition that's largely based on feeling hopeless, totally independent of what ever it may be doing to your serotonin levels. Any middle-schooler who's playing Mozart to their tomato plants for the science fair knows that they have to control for every factor except the one they're trying to test.

If it's not double-blind, and it's not controlled, then it's not really a scientific clinical study; it's a propaganda exercise.

For several years now I've been pointing out that there is no genuine scientific evidence proving that these drugs work any more than marginally better than even an inactive placebo, and people call me deluded and paranoid and a crank and a luddite and a moron and murderer and a scientology flunky and an anti-psychiatry fanatic and all the worst obscenities and say that I'm just generalizing from my own aberrant bad experiences and that I don't know what I'm talking about and that I'm too ignorant to educate my self about all the 'research' that's been done and that I'd better shut up and take my meds.

Maybe what I need is just to work up a really convincing fake British accent.

Philip,

I love the bit where GSK tells us that we shouldn't set much store by a single study. And yet, as I recall, it's attempt to get Paxil (Seroxat) licensed for kids was founded upon [the travesty of science that was the write-up of] Protocol 329.

I guess these things cut both ways. Anyway, provided doctors become sufficiently committed to providing the best solution, rather than the one most readily avaialable (is this a big "if", when the Worshipful Company always has recourse to its cheque book?), then drugs, and SSRIs, in particular, will die a quiet death in the treatment of depression.

As long as counselling does become avaialable universally, then there's no reason why SSRIs shoudln't become the Betamax of depression treatments! Mind you, reading that back, that's quite a few big provisos.

Matt

Not to minimalize severe depression; I feel a good round of intensive self-help via therapy, lifestyle adjustments and personal reflection all through one's life can help lead to a balance, where a sub-group that might go to the PCP for "depression" is in fact needing to sort their lives out.

Men in particular, in my opinion often do not do much self-reflection, or "talk" therapy with friends or family or professionals; can end up in mid-life in a crisis, and it's a personal crisis, not the red corvette type-- one looks at accomplishment and failure and quite often it can send a person into a tailspin if these issues have not been addressed along the way.

So with regard to antidepressants working the same as a placebo, in some cases I feel that works because a person needs to believe in something and in my opinion, once self-esteem is leveled out, just by going to see a doctor or psychiatrist, or therapist,the placebo effect is not a mystery any longer, it was a person needing to self-reflect.

This is why many people who have removed psychiatric medications from their lives will also tell a story about therapy, meditation, and basically getting in touch with who they are and what they've done and want to do with a life called their own.

I think this proves what everyone suspected is these meds are worthless, and cause more harm than good.

I personally would rather see a person walk into a therapist's office than into a psych ward for pills, leaving with a false hope in their hand, and no change to the life and it's problems, or lifestyle changes needed that could have been the actual culprit for depression. I am also aware of people who succeed using antidepressants, and am not making a statement against medication use.

Just my opinion.

If governments were willing to spend the same amounts of money on Psychotherapy and proper mental health services (without evil psychiatry of course) , there would be no need for these useless and dangerous anti-depressants...

The problem has become not one of mental health..
but one of special interests, such as psychiatry in collusion with pharma having the monopoly on "mental health"..

And this monopoly does nothing but damage to the patients..
This has been the crux of why so many people have been prescribed psych drugs , because it serves the profit interests of pharma and aids the psychiatric regime in its desperate bid to be recognized as a genuine science..

I am so happy these independent studies are beginning to surface and come to light..

The days when a sufferer of depression and anxiety could be so easily duped down the psychiatric medication route are coming to an end..

It's one nail in the coffin for the psychiatric-pharma indusrty..
And it is a nail that i am quite happy to hammer further in...

I wonder if anyone will give any thought to abandoning the term "treatment resisant depression" now that we know no one was actually having their depression treated?

I'm fascinated by the placebo effect, still. As a child one of my favorite stories was Dumbo. You guys may remember Dumbo, the elephant who was duped into believing a feather held in his trunk was magic. When he held the feather, he really could fly. When he dropped the feather and was still flying he was learning to rise above the placebo effect. What is it about thinking you are getting medication that will make you feel better that makes you feel better. That's the most interesting question to me. I think the answer may lie in meditation, human relationships and neuroplasticity but only have my experience to back this up.

This was a good article. In plain English, the research shows that antidepressants do about as good as a sugar pill, but once in a while, they do a little bit better. This is not really news. I have heard of such studies for many, many years.

In contrast to real scientific evidence, people on antidepressants are made to believe that the pills work for everyone and that there is no other way to fight depression then to help the drug companies make larger profits.

Thank you for getting this article on this webpage so that the truth can spread.
Jim S

I left a comment yeserday but I think it got eatten by spam blocker-I wont repeat it but Ive been on ssri"s for many things but not depression-
I took it when I had bad hep c-but it knocked my eating disorder on the head-Aka--No throwing my food up-also worked very well for my OCD-so I stayed on it-did the change over as each new ssri hit the market.Dec 2007 I ened up in public hos becos of terrible side4-effects, I had been on
Effexor-2 a day when the psy added buspar I near blew my own bains out-terrible-Remined me off having far too much Cocain-Any way Iam now on older anti-d-Iam not havig too use anti-pys pills as Iam not reved up any more. What using ssri"s did get me was a Dx of Bi-polor 2. Ive tried too say many times too psys that I am not bi-polor-ya take the ssri away and my moods more even-but they never listen.

placebo effect-I dont know cos Ive only been down related too hep c.ALL I know who are on ssris have had their doses upped after the first year till they get 2 max dose-then its time for a new dance partner but same dance-my last one was Effexor--never again-I came so close too blowing my brains out-also I wanted 2 hurt other ppls and thats not me-Sorry 2 go on Phil--love ya blog-

Sally wrote:
"...I'm fascinated by the placebo effect, still..."

Yes, this has been interesting me for a while, too. Human beings evidently have the ability to heal themselves, with no external aid (because the placebo effect isn't limited to mental illness), but for some reason unless patients are given something tangible, which they can believe will cause them to get better, they find it difficult to repair themselves, sometimes. It's like they need to be told that it's OK to be well, again. Almost as if there was some message there telling them to become ill, and a countermanding message was needed to override it.

Hmmm. That doesn't capture what I wanted to say, but still.

Matt

After all of the $$$ I spent on antidepressants, mood stabilizers, etc. I am disappointed that I didn't at least get to experience the placebo effect. Oh, well.

Did I read somewhere that he said the effect size from antidepressants was 0.32?

That's actually bigger than I was expecting.

How short are our memories, back in 2004, we have:

'
December 08, 2004
Print this article
The Antidepressant Fraud: No Better Than Placebo

...

From Cassandra Casey:

This is the response that Karen Barth-Menzies sent to Jonathan Mahler and the New York Times. It's my understanding that the Times did not publish it. So, please help me get this into circulation!

=========================

In Response to the November 21, 2004 NewYork Times Magazine article: "The Antidepressant Dilemma," by Jonathan Mahler

Properly researched, this article would have been entitled "The Antidepressant Fraud: No Better Than Placebo." However, the November 21, 2004 New York Times Magazine cover was the first clue that the article inside was inadequately researched. The cover stated: "Warning: Antidepressants increase the risk of suicidal thinking and behavior in children and adolescents with major depressive and psychiatric disorder.

Caution: The very same antidepressants are helping thousands of kids who might think of killing themselves - and now doctors are nervous about writing prescriptions."

In fact, only 3 out of 15 trials examined by UK regulators and the FDA, which led to suicide warnings, demonstrated any efficacy in children and adolescents. UK regulators were clear that their summer 2003 ban of the antidepressants for use in children and adolescents was due in part (in addition to the suicide risk) to the fact that the drugs had not been shown to be effective. FDA itself has stated that "effectiveness has not been demonstrated." Notwithstanding, the article quotes Graham Emslie, one of the authors of the "TADs" (Treatment for Adolescents With Depression Study) Prozac study as stating: "This study should put to rest doubt about whether these drugs work in teenagers with severe depression."

etc
http://www.newmediaexplorer.org/chris/2004/12/08/the_antidepressant_fraud_no_better_than_placebo.htm

There was a short article about this study in my local daily paper. It said that the older drugs such as tricyclics are "highly effective" but cause more side effects than the newer antidepressants. Wow, "highly effective"?. That's news to me.

Just a few thoughts:

First, the NEJM article showed that most antidepressants DID work, but that their effect sizes were exaggerated to varying degrees depending on the drug in question. The average effect size was still 0.31, and for some medications was even higher (e.g. Effexor 0.40).

Second, the new study only includes the FDA studies performed BEFORE the drugs were FDA-approved, and thus do NOT include the dozens and dozens of newer trials that have shown efficacy. Those studies are typically poor and are skewed towards showing ANY efficacy in order to get approved, and then better studies are performed.

Third, the FDA studies typically lasted only 4-6 weeks, and prospective longitudinal studies carried out afterwards showed that most antidepressant efficacy occurs after this time period, and so it is unsurprising that there was a small statistical difference between placebo and medications.

Fourth, it did not even include all SSRI's, including Citalopram, Escitalopram, and Sertraline. Thus, it's data is incomplete.

All in all, it is not a very impressive study.

The study conclusion that antidepressant effect sizes are not 'clinically significant' by NICE criteria also seems to be somewhat dependent on analysis method.