The National Institute for Health and Clinical Excellence (NICE), in the UK (which has as one of its roles the assessment of drugs for approval on the NHS), has long said the same thing. It's also responsibile for drafting advice to quacks and its official guidelines on the treatment of depression recommend that drugs be used as a last resort (I'm paraphrasing, obviously).

It's stopped short of saying that they're completely shite, because by the time that NICE gets to look at them, they've already been passed as "safe and efficacious" by the MHRA, the UK "regulator". Any hatchet job by NICE would result in lawsuits from The Worshipful Company, I imagine.

Matt

Shades of a study published in PLoS sometime ago, Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration though the results for severe depression in the PloS study were far from robust, "Thus the increased benefit for extremely depressed patients seems attributable to a decrease in responsiveness to placebo, rather than an increase in responsiveness to medication." [Last line of the PLoS article.]

What a shock!
I know many patients with MDD that after trying all antidepressants on the market and having a little relief end up in an ECT session.
I'm amazed that although the chemical imbalance hypothesis has already been put is already history they keep on prescribing SSRIs/SSNIs.
No. I'm not amazed: I'm appalled!

I can already anticipate one of the most vocal critiques from psychiatrists-- "Imipramine? Why imipramine??? Nobody uses imipramine." (And, of course, in the accompanying article, Mischoulon says almost as much.)

The fact, however, is that decades of data show that all antidepressants have approximately the same efficacy, so the results obtained with imipramine & Paxil should easily be generalizable to other antidepressants. The failure or success of any one agent in mild depression is likely due to the side effect profile or placebo effect, respectively.

We psychiatrists have to learn that when our patients with mild depression "improve" on a medication, it's just as likely to be due to factors separate from the medication than to the med itself. When we figure out what those factors are, then we can successfully treat depression. Unfortunately, there's no publicly traded company or multimillion dollar marketing budget devoted to that task.

This information fits with my own experience so I am not surprised by it. The thing is, severe *anything* responds best to *anything.* Why are we wasting time on this crap?

SteveBMD, thanks for adding a much appreciated voice of reason from the psychiatric field to this discussion.

This study plays like a broken record ("decades of data"), further underscoring the profit motive involved in the pharmaceutical racket.

In addition to drug efficacy data, I'm curious why our social scientists are not contributing more to this vital health issue. Having lived and worked abroad, and travelled extensively through foreign cultures, I can say from first hand experience that 'depression' as we define in the West is viewed, and treated very differently in other cultures, many of which don't have nearly the rates of psychotropic drug (ab)use the USA does. In countries where extended families and more social cohesion are the norm, I never witnessed the endless parade of neuroses seen here in the West. I would love to see more cross-cultural anthropological studies done on mental illness.

"Having lived and worked abroad, and travelled extensively through foreign cultures, I can say from first hand experience that 'depression' as we define in the West is viewed, and treated very differently in other cultures, many of which don't have nearly the rates of psychotropic drug (ab)use the USA does."

Skeptic,
Could you be more precise about the countries and cultures you have been exposed and your conclusions?
I will tell you why social scientists are not, or some are and you don't know, publishing their views.
Thank you in advance.

Bhutan... Bhutan measures its success, not in GDP, but in "National Happiness," or somesuch measure. I don't know how "happiness" is measured, nor how precise that measurement is. And I don't know how one improves one's happiness, if one perceives oneself to be unhappy. However, other countries are now eyeing Bhutan's success (and it has improved in the happiness stakes, apparently), and are appointing "Happiness Tsars," and the like - the UK, for one.

I should have thought the answer was relatively obvious, if one wishes to make the greatest impact, in the shortest period of time: establish what it is that makes people unhappy, and substitute something that makes them happy, instead, but WTF would I know?

Matt

Imagine Imipramine being given to an 11 year old for bed wetting prevention and not being told it was a psychiatric medication, an anti depressant of all things!

I read this study in full. It is very difficult if not impossible to carve out the extent of HDRS changes described as being very significant in placebo vs. med responders. The study takes great pains to demonstrate that this "statistical" effect occurs at or around a baseline HDRS of around 25-27 and not below but says very little about details of the med placebo response difference. It also says that NICE has defined a difference of 3 pts on the HDRS as being clinically significant. If I start at a 26 and I get to a 23 on HDRS I still have "very severe"depression but I am now described as a TXD responder. It would appear from a single graff that in the most severe groups there was about a 7 pt difference in HDRS on regression analysis. They write the NNT for the "very severe depression" cases is 4. This means I have to give 4 people meds to get one legitimate response of perhaps a drop in HDRS of 3 points. This appears to be pathetic. Perhaps it was not the authors intenet to even make mention of the actual real world response that people have to these meds and instead simply tell us they have no "statistical" response unless people are in horrible shape. As someone expecxted to prescribe these meds I want to be able to tell people how much better if at all really they can expect to get from them. A drom in the HDRS of 3 pts may be meaningful to NICE but it does not mean shit in the real world. The authors appear to be trying to avoid making even limited comment on this critical question. This is pathetic.

We were told in hormones and behavior class that SSRIs perform better than placebo, and just as well as... calcium supplementation! Probably don't have the citation. I took the class in 2003.

Sorry for all my typos.

What all of you said!!

Regarding what Stephany said (and here's a cyber hug, I read about Lindsay today!). One of my pet peeves with psych meds is the need for prescribing docs to give patients full disclosure.

You said you weren't told that the "bed wetting" med was an AD. I recall that years ago my mom had unexplained dizziness/vertigo. They couldn't find anything, but they gave her a pill and said to take one each day. Upon visiting, I asked to see the bottle. It said Diazepam.

"Mom, that's Valium!" I told her. "They think you're a crazy old lady nervous hypochondriac!"

I don't recall what happened after that except that I felt angry at her doctor. Eventually, the dizziness stopped. I think it may have been an inner ear issue, who knows. BUT THE DOCTOR DID NOT TELL HER HE WAS PRESCRIBING A PSYCH DRUG. Thankfully it didn't seem to do much either way.

Regarding:
"'depression' as we define in the West is viewed
and treated very differently in other cultures"

I just posted this on another thread, so pardon
the duplication, but it is highly relevant here:

all: fyi: fascinating article in today's NYT
about psychiatry, culture, and the ontologic
status of what is called "mental illness".

http://www.nytimes.com/2010/01/10/magazine/10psyche-t.html
The Americanization of Mental Illness
By ETHAN WATTERS
Published: January 8, 2010
AMERICANS, particularly if they are of a certain leftward-leaning, college-educated type, worry about our country’s blunders into other cultures. In some circles, it is easy to make friends with a rousing rant about the McDonald’s near Tiananmen Square, the Nike factory in Malaysia or the latest blowback from our political or military interventions abroad. For all our self-recrimination, however, we may have yet to face one of the most remarkable effects of American-led globalization. We have for many years been busily engaged in a grand project of Americanizing the world’s understanding of mental health and illness. We may indeed be far along in homogenizing the way the world goes mad.
SNIP

Matt,
Thank you for the info about Bhutan. I know nothing about this country and heard that their stamps are very beautiful.
I will search the stamps... Off- topic... but who cares about beautiful stamps when a nation is unhappy? lol
A new field is born: Philately Sociological-Ontological Studies on the Happiness pattern of Nations.

Alan,

Yep. Boredom is one of the symptoms. We go to Jordan, Italy, France, UK, Nigeria, blah blah China (China? Yes, china) and people are wearing western closes and eating at Macdonald.
Architecture is almost is not being preserved... blah blah...

Errata: Architecture is not being preserved... blah blah...

PS And the diseases being diagnosed and treated in western way.
Of course there are still local medicine being practiced but pharmas are arriving in Japan... blah blah....

Sorry, back pain is telling me to get out of the computer.

I also read the full study and agree with Dr. John that it is truly pathetic. I mean yeah, I'm happy with the conclusion, that a/ds are not effective, but the evidence as it's presented? It's meaningless like just about every other psych study I've ever read in a journal. I cannot believe the statistical machinations authors get up to in the name of psychiatry. It is so laughable. Not one case example is ever presented (they used to be 15-20 years ago) and it's near impossible to tell what really happened at the clinical level in the trials that are being analyzed. Sure it's a milestone to have a study published that says a/ds are ineffective in mild depression but the argument appears to be so weak it almost helps a/d supporters rather than hurts them. Maybe this was the intention? Look at articles by Warner quoting Kramer, Friedman, and even Danny Carlat, all rushing to the defense of a/ds in mildly ill people as a result of this study.

JAMA Says SSRI Antidepressants Work No Better Than Placebos For Mild to Moderate Depression

This JAMA article provides evidence that Premenstrual Dysphoric Disorder and other common forms of hormonal imbalance such as PMS are poorly served by SSRI antidepressants. An SSRI drug is simply the wrong treatment for PMS. The benefit of SSRI antidepressants for this group is the same as the benefit from placebo. In many cases, bioidentical progesterone works quite well for PMS with none of the adverse side effects associated with SSRI antidepressants. Adverse effects of SSRIs include sexual dysfunction, weight gain and sleep disturbance. Another troubling issue is increased suicide risk with SSRI drugs... For More:

http://jeffreydach.com/2010/01/21/jama-says-ssri-antidepressants-are-placebos-by-jeffrey-dach-md.aspx

hi, got one hand 2 type due 2 cut but want 2 say i have had major depression over 20 years. best meds yet have been riding a horse. awesome therapy. i wrote an article in my blog about it. "Anti-depressants don't always come in a pill," but I will say 2 that my 74 year old mom is taking Pristique and she feels like living again. i worry bout her but i want her 2 feel happy. Sometimes it is hard 2 know what is best. 4me-- horses rock and soon as i get well i'm back 2 riding. i enjoyed reading here. thanks and sorry 4 grammer but good 4 one finger typing!
http://dogkisses.wordpress.com/2010/01/04/antidepressants-dont-always-come-in-a-pill/