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Enoch Choi, MD  
Male, 39
Palo Alto, CA

Specialties: Family Medicine

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Antidepressants may not be much better than placebo

Feb 26, 2008 - 51 comments
Tags:

antidepressant

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treatment

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depressed

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prozac

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Effexor

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serzone

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paxil

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placebo

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Depression



A fascinating research study was published today by Irving Kirsch of the University of Hull, questioning whether or not 4 popular antidepressants are any better than placebo, and found that they weren't any better.  Here's the study:

http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050045&ct=1

Both published and unpublished data on fluoxetine (Prozac), venlafaxine (Effexor), nefazodone (Serzone), and paroxetine (Paxil) were combined in a technique called meta-analysis, which brings together the data from many different research studies to see if they agree.

The researchers concluded that the antidepressants were not any better than placebo for mildly depressed patients.  They found that although there was a benefit from antidepressants, it was not significantly better than what a placebo (pill without any medicine in it) did.  The placebo treatments had a great deal of benefit, almost 80% improvement in depression symptoms.  The antidepressants didn't do any better than placebo.

They further concluded that the benefit that these antidepressants had on severely depressed patients was from these patient's lack of benefit from placebo treatment.  That is to say, severely depressed patients didn't get better from a placebo (pill without any medicine in it).  Since severely depressed patients got better at about the same rate as the mildly depressed patients, by comparing this benefit to the lower benefit from placebo, overall they showed a benefit.  Another way to think of it is that really depressed patients get better from antidepressants at about the same rate as mildly depressed patients get better, but since severely depressed patients don't get better from placebo, by comparing treatment versus placebo, the difference is greater.

It's important that patients on these medicines don't stop taking their medicines because serious side effects can occur, such as worsening of the depressive symptoms that they initially took them for, including thoughts of suicide for some patients.

This is just one study that will be further examined.  The great thing is that it's been published in the Public Library of Science online journal.  This is a place where the data and paper are publicly available, without any advertising or corporate support.

Reasons to think twice about the results of this study, is that the technique of meta-analysis is only as good as how well the 47 different data sets they've combined match.  These data sets have to be combined in a valid way, controlling for different factors in each study.  Some researchers disagree with this kind of process, saying that it's very difficult to control for confounding factors in the separate data sets, calling into question the validity of the results.  I'm expecting the drug companies to be fighting these studies powerfully, and be curious to see how they try to disprove the results.

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by Holly008, Feb 26, 2008
  Some thoughts:
    That is an interesting study as are all such studies. Some would say the results of any study are influenced by the anticipated result of the researchers. Quantum mechanics says that just by looking at something you alter it and all possibilities play out eventually.
  One perspective:
     I personally have been on and off antidepressants for the last 20 years. My family prefers me on them and so do I. I don't like the idea of being dependent on them and have wondered if maybe I really didn't need them. Last year I was off my Zoloft from Feb. through mid Nov. I thought I was doing okay for several months...not everyone in my family agreed. By fall I was feeling really pretty bad and since I've been back on I feel so much better and my family likes being around me again.

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by Hensley258, Feb 26, 2008
I find this funny considering that there is a ton of other data and studies (double blind studies) that prove this study as complete nonsence. I refer you to the paragraph in which it says, "were not any better than placebo for mildly depressed patients." This study was conducted using only (mildly Depressed individuals or test subjects.)

It comes as no supprise to me that a mildly depressed individual would not notice the difference between a placebo and the real medication. Reason being is that any experienced Psyciatrist can tell you that generally, only Severely depressed individuals benifit from AD medication.

I say if you trust this report and suffer from severe depression, then go ahead and take the Pepsi challenge.
I guarentee after less than 90 days you will fall back into a deep dark hole. If you don't then you didn't need the meds in the first place.

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by Enoch Choi, MDBlank, Feb 26, 2008
Hensley258, as I said, it's important that patients on these medicines don't stop taking their medicines because serious side effects can occur, such as worsening of the depressive symptoms that they initially took them for, including falling so deep into the dark hole that they act on thoughts of suicide for some patients. Just say no to the Pepsi challenge.



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by Hensley258, Feb 26, 2008
I just get worried when I see studies and reports such as that. Simply because some individuals that are less experienced with their depressive dissorder might use it as a reason to discontinue the very medication that was responsible for saving their life in the first place.

Obviously I was being sarcastic and I HIGHLY advise against anyone discontinuing their medications just to see if this study is correct for them too. Any tapering of AD meds should ONLY be done under a doctors supervision.

I really think it would be safe to conclude that the vast majority of Mental Health professionals, such as Psychiatrist would be able to shoot large enough holes in that study to drive a Hummer thru. I think most of us wise enough to detect changes in our condition, clearly understand what our medication does for us.

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by raggedclaw, Feb 27, 2008
I've always thought the only effect of SSRIs was a placebo effect. In fact, the placebo effect can exist in family members. My wife thinks I am much better taking Effexor, but when I fake taking it for months, she doesn't notice the difference. I don't notice the difference because I never noticed an improvement. Being a cynic, I'm not a good candidate for placebos.

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by Chelstar, Feb 27, 2008
        I personally am very suspicious of antidepressants.  Considering how much drug companies peddle them.  There are more commercials, billboards, and print ads for antidepressants than seems reasonable.  I think those ads and many doctors convince a lot of people who aren't depressed that they are.  (Which would cause these people to feel and act more depressed... I think that explains why some antidepressants actually increase suicidal thoughts in some people)  The level of depression is a hard thing to quantify.  That is why psychology and the study of mood is generally considered a soft science, isn't it?
         In my past, I have been on Paxil, Zoloft, Prozac, Wellbutrin, Effexor, Remeron,Cymbalta, Lexapro, Lithium (which technically isn't an antidepressant, I don't think, but I was on it to treat depression nonetheless.) and probably other ones that I don't remember any more.  Not one of them helped me with my depression, which I was hospitalized several times for.   I saw a number of psychiatrists, who would cart me in once a week, ask for a 5 minute explanation about how I'm doing, and prescribe higher doses or a new antidepressant.  I never had an appointment with a psychiatrist that lasted more than 20 minutes.  Counseling, on the other hand did a world of good.
          While I know depression is in part caused by a chemical imbalance, I do not believe it can be treated with a chemical.  Because I don't think that is the root of the problem.  From my experience with it, it is caused by series of distorted thoughts that build upon one another until you are tangled inside them.  The way you perceive outside stimuli causes you to have certain thoughts about it.  The thoughts you have influence your mood, and your mood is the result of the level of certain neurotransmitters in your brain.  For example, Joe hears about a fatal car accident caused by drunk driving. (stimuli) His perception of it is negative. He has a thought like this "The world is a horrible place,  there is nothing I can do to fix it.  Why should I go on living in a world like this?"  And then he feels sad.  When he feels sad, he is more likely to think negatively about other things too.  It is an endless cycle that can't be stopped until he changes the way he is thinking.  Not try to forcibly and artificially cause himself to have happy chemicals in his brain.

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by Pieater, Feb 27, 2008
          I was interested when I saw this study in my email so I read more.  I caught myself being defensive when I read that taking AD was no better than not taking them.  I'm living proof that AD meds work.  As I suffer from cruel depression and bipolar disorder, I can tell you that AD along with other meds have saved my family life, my relatinships, my sanity and my mortal life.  I've tried stopping my meds and not telling anyone, it didnt work for long.  I could tell a difference within days. Others around me as well. If you are aware of yourself, you can tell the thoughts in your head change into anger, saddness, worry, suspision, rage and suicide. Thoughts come into your head that wouldnt if you were on the meds.  I think the disorder tells you to stop taking the medication, you'll be fine, you don't need it, you were just angry or in a rut for a while.  If and when you fall into that belief you are on a path to distruction and chaos.  I hate taking medication everyday, and when I take that handfull and try to swallow them all at once so it will not take much time and I dont have to think about it, I realize I have to do this for the rest of my life beause without them, that rest of my life part, wouldnt be for long.  So when I read this study, it upsets me that someone could read this and stop their meds,  it scares me to think about someone falling back into that deep dark hole of not leaving the bed for days, let alone the house, thinking about suicide,because of the results of one study.  I hope they do read further and see the comments made against stopping meds or not getting help for their depression.  I do agree that therapy is a huge help along with medication.  You have to change the way you think, and the meds help you realize that you can, and want to. I'm no specialist on depression or AD meds, I'm just a survivor.

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by hipgirl, Feb 27, 2008
I don't think there is any disagreement here, really depressed people benefit from the meds, slightly sad people do not. Sometimes we are entitled to be sad, when it becomes monumentally overwhelming, then it is depression. Antidepressants did help me understand that negative thinking created negative thinking and after I understood what looking at things in a more posiitve light could do, I became considerably better. I am okay with being sad occassionally, sometimes I am happy too! If I find myself stuck back in the dark hole again, bring on those SSRIs!

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by Enoch Choi, MDBlank, Feb 27, 2008
I agree that psychotherapy and counseling is very helpful to untangle the distorted thoughts that influence mood.  

I think that medications can be very helpful for some patients.  Especially more depressed patients.

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by kramer10, Feb 27, 2008
I found the student interesting and felt like I needed to put in my two cents worths about Effexor.  I was put on it after I had my daughter.  I took it for three years only having to increase the dosage once.  I was doing fine until my insurance company changed and the new one didn't want to pay for Effexor.  They wanted my dr. to try something else.  Since I have been living off of the samples my dr. gave me to slowly taper off.  The withdrawals are miserable.  I have been Effexor free for five days now and I feel miserable.  Has there ever been a study done of the horrible withdrawals and is there someplace that offers solutions instead of just other miserable stories from people suffering from the same thing.  So far I'm just treating the symptoms as they happen like nausea and headaches but the worst one is the "brain zaps".  I can't find anything to relieve those.

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by cora3223, Feb 27, 2008
I have found there seems to be a continual need to prove that antidepressants do not work.  Often I wonder if it is the stigma of mental health and the need to not be broken..There is much more research from more than drug companies to support the scientific basis of the mechanism of antidepressants.  I prescribe these meds and people will go off them after 6-9 months and arrive back in my office within 3-9 anxious depressed and miserable. If people seek treatment after 5 years of untreated or under treated depression the chances of  them achieving remission is only 5-6 per cent of the time.  Statistics can be skewed to anyway they will prove a point,especially in a meta analysis. If antidepressants are so bad then why have they continued to be used for over 30 years.  And where is the university of Hull and who funded the meta analysis?  

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by bikermomma, Feb 28, 2008
cora3223... this is a great point. But they never worked for me for postpartum depression. Is th b/c I wasn't that severe?
kramer10...My doc put me on Effexor and I took them for a few months, but then ran out of meds.
I didn't have any withdrawls.  Did you find something that works? Just wondering???
Thanks,
Jen

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by Nikki8, Feb 28, 2008
I AM A PERFECT EXAMPLE THAT THEY HELP DEPRESSION/ANXIETY,,,,..AFTER HAVING FOUR CHILDREN I HAVE HAD A LOT OF ANXIETY AND NERVOUSNESS OVER THE YEARS AND I HAVE  TAKEN PROZAC AND IT MAKES ME FEEL MORE LIKE MYSELF AND NOT LIKE SOME  NERVOUS SYCHO-PATH WONDERING IF LIFE IS WORTH LIVING! WITHOUT PROZAC I AM SO NERVOUS AND EVERY LITTLE THING THAT SOMEONE SAYS OR DOES I TAKE IT TO HEART AS IF ITS THE END OF THE WORLD!!!  I DON'T KNOW IF ANYONE ELSE AS EXPERIENCED THESE NERVOUS/ANXIETY FEELINGS AFTER HAVING CHILDREN ..BUT I DON'T REMEMBER FEELING LIKE THIS BEFORE I HAD MY FIRST BABY!!! EVEN IF I WATCH THE NEWS ..I FEEL REALLY BAD ALL THAT NIGHT... PROZAC TAKES ABOUT 75% OF THOSE BAD FEELINGS AWAY ...WHICH IS BETTER THAN NOTHING.  IT GIVES ME A REASON TO LAUGH AGAIN AND NOT BE THINKING ABOUT ALL THE BAD IN THE WORLD AND LETTING THAT AFFECT ME.   THE ONLY DISADVANTAGE  IS THAT IT CAUSES REALLY BAD URINE RETENTING AND DISCOMFORT WHICH IS MUCH BETTER THEN HAVING ANXIETY!!

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by skeeterbit, Feb 28, 2008
I have been suffering the long-term affects from the West Nile Virus, and one of the symptoms that always popped up was depression.  I was a macho guy that always considered depression as the result of someone feeling sorry for themselves.  Hey, pick yourself up by the boot straps and get going.  Boy, was I wrong.  After two solid years of fighting the depression associated with WN, and someone who never believed in taking medicines, I finally accepted the fact that I needed help.  So, at age 54 I began taking Lexapro.  However, the low dosage resulted in anxiety problems, so I was also prescribed Buspar.  It took months to regulate and find a balance between the two.  I have to take a high dosage of the Lexapro and a medium dosage of the Buspar.  If I miss a couple of dosages, I can definitely tell the difference.  If I miss one dosage my wife can tell the difference.  For me, these two drugs are a life saver.

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by Judy1942, Feb 28, 2008
Judy 2/27/08
Slightly off the initial issue, but what is known about depression being hereditary?  My dad had severe depression (in his 70's!) and both my daughters take meds for it and claim that it is necessary.  I have "needed" meds, periodically, in the last few years -- mainly for anxiety and my daughters say that I am much calmer.  In my case, I wonder if I just have a hyper personality! :)  My daughters become "bitchy" (sorry!) when off of meds.  My dad was on Norpromine (sp.?) -- doctors claimed that his body was not producing enough of the chemical needed in the brain, for mental equilibrium (as in serotonin).   He was a guinea pig -- it hadn't been gov't-approved, at the time.  Maybe, we're just a dysfunctional family and should blame our upbringing?!

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by Judy1942, Feb 28, 2008
Judy1942

PS -- I'd like to sneak placebos into my daughters' perscription bottles and see what happens!  

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by Enoch Choi, MDBlank, Feb 28, 2008
Judy1942:  don't do it!  don't slip placebo's in, that could end in tragedy

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by Donna355, Feb 28, 2008
My strong, healthy mountain climbing, marathon running, well educated son has Lyme's Disease. It took a long time to diagnose--even the Mayo Clinic couldn't figure out what was wrong with him!  (After 12 days of miserable tests). Finally, the correct blood tests by a neurologist in our hometown were done and discovered he had Lymes. He was put on long-term antibiotics.  As a result of his suffering and depression with Lymes and no longer able to participate in many activities--even going for a walk-- or holding a job-- he saw a doctor who put him on Paxil.  It has helped him tremendously. He is now starting to enjoy life again thanks to the wise doctor and the help of the anti-depressant.  My advice is only go off or change meds with the help of your doctor. Using the correct medications can make a huge difference in your life. Good luck!

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by Peaches5036, Feb 28, 2008
Hi,
Any studies on Wellbutrin ?
I took Zoloft and/ or Prosac for several years, was hard to tell if there was any improvement with either of these meds, or much if any difference.. I was quite suprised that  when Wellbutrin was added , that I felt major improvement. I had not anticipated any changes with another medication (Welbutrin). I've phased out the Prosac, and enjoyed being relieved of the dry mouth side effects.
Thanks, Peaches

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by Pseudopal, Feb 28, 2008
Like this study and I'll tell you why. ANY medical professional who takes the time to read his updated PDR(not outdated- which I have seen in too many doctors offices)  will know anti depressants are recomended for use in SEVERLY depressed persons who are unable to function in a normal day. In addition they were designed for short term use, maximum of 6 months, to allow the patient time to see a good therapist, etc, to work through their emotional trauma. A good example of a candidate for anti depressants would be a male/female who just lost a spouse or child.

Not example of good candidate: 17 yr old girl who is "bummed out" because she fights all the time with her mom about "stuff". the "stuff" being things like not being allowed to spend the night a her boyfriends house, having a curfew, etc. Since when did teenage angst become a catalist for drug therapy? Believe it or not, I saw this often. Or better yet, teens getting put on birth controll and then Prosac since the birth controll made them moody..ARG!

I whole heartedly agree with the main point of the study- refering to those who are mildly depressed. We all have bad days, some of us have bad runs for a while. But it's no reason for the prescription pad.

I am reminded of my moving to Oregon at the age of 19 for a college program that was only offered in this state at the time. The year I got here, the program was dropped due to lack of enrollment. I could have gone home, but I opted to stay here for a year, learn to be a grown up, stand on my own, etc. It was one of the worst years of my life. I cried a lot, wanted to be anywhere but here. At my first flu bug, I told my newdoctor how I was feeling, he offered an rx for Prosac. I turned him down and got myself some friends instead. My year didn't get better right away but with friends and activity I made it through that tough year. I shudder to think of what could have happend had I opted for the Prosac for my mild depression/ unhappiness.


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by Twitch744, Feb 28, 2008
I wholeheartedly agree with Pseudopal.  I've been writing up a research paper on depression using the latest research and I came to the same finding, that such meds are for those who have a severe depression with reasonable functioning.

Dr's are too quick to prescribe Anti-dep meds for anyone feeling a bit low.
But we should be more concerned about the backlash about to occur. I fear people in their hundreds or more coming off the med too quickly, with no hope for improvement.  I think someone should arrange a press release to advise people how to go about coming off their meds if they wish and seeking different forms of help for their depression such as secular and spiritual counselling, exercise, financial advice and so on while highlighting the risks of going off them suddenly.

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by SurvivorGirl, Feb 28, 2008
Personally? From my experience of being "drugged" up with so many DIFFERENT damn pills for so many years ( 5) now, i have to say that i have had to do most of the research on my own. And i am thinking that why in the hell do they NOT have patients who are severe in a THERAPIST office laying DOWN on the couch just like the OLD DAYS when you babble on and on and THEY LISTEN to you and TAKE REAL NOTES. Sometimes they even will tape what you say. Then they will gather all that information and compile it into something and be able to come up with a reason of why you are having the anxiety and the depression to begin with.

INstead? You go into the office and you tell the doctor. "doc i am having anxiety and i am not sleeping and i am miserable!!" So they immediately diagnose you as being depressed or bipolar or manic or a variety of other things and then dish out medications. Well guess what? Those medications don't RESOLVE anything. You may as well open up a good bottle of Scotch and sit at a bar. IT is relatively the same thing. You are going in one big slow circle of nowhere. And the damage to your body and MIND are the same. IT was for me. And meantime? I was on the computer and in the library doing extensive research finding out what kind of meds i was on and WHY and what the side effects were.  And how much money have i dished out over the years on these medications?? OMG i cannot even tell you!!! For how much i have paid for doctors visits and medications and hospital stays etc..? I coulda had a college degree of my own and been a Psychiatrist by now!!

Why just the other night in Ballet i was talking to a girl about her meds and she asked me, " are you a Pharmacist or something?" HA!

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by harmonytx, Feb 28, 2008
Just my thoughts, but I personally can't help but wonder when someone talks about how much their meds 'help' them is it REALLY the meds, or is it possibly because they have grown to BELIEVE the meds help...and when they try to discontinue them on their own and really do feel worse, is it not then possibly withdrawal symptoms that factor into the way they feel?

I am one who does not rule out the power of the mind/body connection.  Of course I do not forget that there are those who may really need medication, but I honestly feel many more probably do not.

I appreciate Dr. Choi's opinion and that he took the time to address such a controversial and common issue.  I do not fault him in his opinions in any way, he is certainly entitled to them, as we all are.

In regards to defending these medications based on them being around for such a long time, etc, I would be inclined to argue that 'big pharma' making money is likely to be a factor.  The power of the big drug companies is not something I would rule out.

The reason this subject especially bothers me is that I have noticed through friends/family a growing trend where medical doctors are prescribing antidepressants to patients they barely know.  I don't feel it is right for a general doctor to prescribe these medications, instead I feel a patient should be sent to a therapist for further evaluation.  I strongly believe a medical doctor is out of line if they casually prescribe psych. medications without doing a detailed patient assessment through a specialist.  

For those who feel they cannot do without their meds and would rather risk the possibility of harmful side effects, I wish you the best.  For those who would hope for a better alternative and may be willing to look for help elsewhere, I applaud your efforts and sincerely hope you find relief in a safer, healthier manner.                

  

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by mosesgt, Feb 28, 2008
We need to look at people more than studies. Look at what happened in the last few years:

-FDA put black box warnings on all antidepressants (can cause suicidal thinking in children)
-Use of antidepressants in children plummeted.
-Child & adolescent suicide increased.

Do antidepressants do anything? Ask these kids parents.

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by M.E.L., Feb 29, 2008
I am a Master's level Counselor and personally a comsumer of metal health services.  I have taken an antidepressants steadly for about 15 years.  For about 10 years prior to thses 15 years, I played the game of taking meds, feeling better and stopping them, feeling bad and startng them again... I finally decided I did not want to go through having panic attacks and the really dark days of getting stabilized on meds again and decided to quit that game.  I recognized depression is like many other diseases - for most cases, you can have a full, "normal" life if you work at managing the condition.

For me, managing depression (with extreme anxiety) means - taking meds, periodic counseling to help me work through life issues, meditation, exercise and eating right.  (Initially, I had about a year of cognitive/behavioral therapy to learn how to think more positively, resolve some issues and learn to meditate).  About eating "right"...for me, I learned I had to stay away from eating too many carbs (foods with lots of starch and sugar).  They really affected my thinking and how I felt.  Heavy intake of carbs made me feel like I had a hangover - sluggish, low energy, moody, irritable and easily agitated.    

In getting my graduate degrees (2 Master's Degrees), I had to conduct some studies and research for some classes.  Doing the research I did does not make me a research expert, but it was enough for me to learn to question the initial findings of research done by comparing data sets of multiple studies (as was done for this particular study).  There are too many variables that have to be matched in order for such a study to be valid.

Anyway, bottom line for me is that I believe antidepressants are as important to effectively managing chronic, major depression as certain medications are in effectively managing diabetes, high blood pressure, etc...  

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by chigirl29, Feb 29, 2008
I told my husband when he approached me about this study that they probably used 'mildly' depressed people--people who can control their depression with diet, exercise, and socialization.

I took Prozac and it was not a good fit.  I got sick on the high doses of it; I have Major Depression--have had it for about13 years now.

Anyway, TEN years later, I decided to try Lexapro--after being urged to go on it by a doctor.  I was on it for about six months and was about to go off because I was on a low dose and it wasn't working--then one day--it just kicked in--and I don't need the high dose at all.

I think Lexapro is surprisingly effective.  I have had trouble sleeping, but that could be because my recent TSH was 0.02. I moved to a new state--again--so my next endocrinology appt. is 26 days away--the soonest I could get in--even after being seen in an emergency room--go figure.

If I were mildly depressed, I would do what I already do for my Major Depression--eat right, try to socialize--even when I really don't want to, and exercise some (can't do that right now--heart is racing from TSH level).

Personally, I wouldn't attack Dr. Choi for posting on this.  A lot of people take ADs and don't need it.



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by chigirl29, Feb 29, 2008
Someone posted about the black box warning:

I have two family members who have committed suicide.

I have a past attempt--about a decade ago--

When I first began Prozac and Lexapro--I had about three weeks of the suicide dark days...but I was open about it and hung in there--and it went away. I also increased my prayer life during this time; I pray 4 or 5 small prayers a day, and I think that prayer can help anyone who believes in it--for whatever medical, scientific, or religious reasons.

I think suicide feelings happen (on ADs) in more adults than is publicly known, but I still think it is mainly from the Depression rather than the medication itself.



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by Robyn560, Mar 01, 2008
Has anyone on antidepressants tried getting acupuncture? While not the complete solution, it can certainly help and assist in the healing.

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by xanweaner, Mar 01, 2008
First off, I would like to thank Dr. Choi for his post and interpretation of the data. There are just so many variables in depression - from the most severe to the mildest forms. I think patients are put on antidepressants far too quickly these days for many of the wrong reasons. Unfortunately, it seems that psychiatry now uses drugs as the answer for just about all of their patients and are no longer practicing therapy. Many patients then are just taking drugs that can cause them serious side effects that then compound their depression, as they wonder why these drugs are not treating their depression as their Dr. says they will.

What I worry about is what the long-term usage does on our body's own ability to then regulate its neurotransmitters when the antidepressant is stopped? I have read that long-term usage of an antidepressant can cause a permanent dependance  because the neurotransmitters have become dependent upon chemicals to regulate their uptake of the seratonin, dopamine, etc.vs. the body regulating it own its own.
I just don't know the answers.

Also, I am concerned about the huge increase now in the diagnosis of bi-polar disorder. I find it fascinating that if an antidepressant causes 1 manic episode, suddenly you are now bi-polar and should be taking a mood stabilizer for life. The bi-polar disorder diagnosis from a psychiatrist tells the patient that they are now bi-polar for life and must take a mood stabilizer and many times antidepressant for life.

Where can the funding come from to study these issues? Certainly, the pharmaceutical industry will not fund it. With the dramatic cutbacks in funding for our researchers at the various universities, how will we get the answers to what long-term usage of the antidepressants can cause?

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by nuttylady, Mar 02, 2008
I believe depression can indeed be hereditary, Judy 1942. I married into a depressive family - Grandmother was weepy all the time, during 25 years I never saw my husband's aunt not cry at some point in our visit, several of my brothers-in-law are on ADs. My husband was suicidal in 1994. He was put on Prozac. The change was evident in much less than one week. Later that year a medical person took him off all sugars - even fruit. During that time he worked his way (slowly) off the Prozac. When he carefully reintroduced them four months later his face became long enough to eat oatmeal out of a coke bottle in less than 1/2 hour! Needless to say, he now avoids all processed sugar. Fruit does not induce depression. Forget the Prozac for us. Somehow, his brothers would rather medicate themselves than change their diet. So sad.
"Happily" sugar free.

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by songwriterdelta, Mar 02, 2008
For Kramer who is off of Lexapro pf effexor for 5 days.  gO -- TO-- THE Road Back websight AND get some of their supplements. Especially if you have to go back on the anti depressant for a few days. You can wean your self off of them with their Body Calm Supreme capsules that stop the Brain ZAPS.    THey will stop them. You can order their supplies from Global in LA.--Check it out quickly. It has helped me tremendously in easing acture anxiety and withdrawal symptons. songwriterdelta

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by uniqueflower, Mar 03, 2008
Many antidepressants have known withdrawal effects when they are discontinued. It even has a name: Discontinuation  Syndrome. The effects can be extremely unpleasant, including severe depression and rages, "brain zaps", and/or flu-like symptoms that last for weeks.

But, you say, depression isn't a withdrawal effect, it's the reason I'm taking antidepressants! Let me explain.

It is no wonder people often feel depressed when they discontinue antidepressants, because what the drug has done is altered the synapses so that serotonin lasts longer in the synapses. The receptor cells, in order to protect themselves from being bombarded with so much serotonin, signal the serotonin producing cells to stop producing so much serotonin. Then the patient quits the medication, and all of a sudden they have a severe drop in the amount of serotonin reaching the receptor cells. Their poor brains is screaming out desperately for the needed serotonin that the drug caused them to produce less of, and now isn't there to prolong it.

I am troubled by the fact that many people take this experience to mean that they "need" antidepressants, when it is very possible it is actually withdrawal. The irony is that they believed as they were told - that they were taking antidepressants to correct a "chemical imbalance" (no such chemical imbalance has ever been measured, demonstrated, or otherwise proven as a cause of depression), when in reality, the drug actually *causes* an imbalance, to which the brain eventually adapts, but which becomes very apparent when the drug is withdrawn. The depression that comes with rapid discontinuation of an antidepressant is often much worse than the depression that caused the person to go on the antidepressant in the first place.

I don't advocate anyone suddenly discontinuing antidepressants without a carefully thought out plan and if possible, medical supervision because the withdrawal effects can be so severe. But I think people need to be aware what powerful drugs they are dumping on their brain, on pure faith. It is unconscionable that typically patients are not warned about Discontinuation Syndrome before putting them on SSRIs, and worse, they are often misinformed that the withdrawal they experience when they attempt to discontinue the drug is "depression" and therefore evidence that they "need" antidepressants, perhaps forever.

Ultimately I believe these drugs will be proven to far less effective than claimed, and far more harmful.

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by Enoch Choi, MDBlank, Mar 04, 2008
To SongWriterDelta:

The Road Back program claims to offer a safe way to taper off of antidepressants using a supplement called Body Calm which contains in 2 tablets: Tart cherry concentrate 1064.8 mg and Other ingredients: Rice Bran, Silicon Dioxide, accordint to their website.

It would be dangerous to stop medication without the guidance of your physician, not only due to the side effects of stopping the drugs but also due to the return of the symptoms they were intended to treat which can include life threatening symptoms of wanting to commit suicide.

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by bad eyes, Mar 04, 2008
As a psychologist and researcher, I just want to add my "two cents."  I believe the controversy surrounding the efficacy of antidepressants only highlights the ethical problems inherent in how research is conducted and interpreted by the medical community.  The number one problem, IMO, is the financial sponsorship of research by pharmaceutical and medical device companies.  This very fact introduces bias at every level of the research study, and puts into question the results.  As painful as it may be, this symbiotic relationship needs to end to have valid science. (A footnote at the end of a study admitting financial ties just doesn't cut it)

Additionally, physicians need to take more responsibility to stay on top of their field by actually READING their own medical journals, and not relying on pharmaceutical sales reps to be the source of their "continuing ed."  (It would help if med schools actually taught how to critically discern research)

Finally, most meta-analyses raise more questions than answer.  The best study is a head-to-head or placebo controlled double blind study financed and conducted by a nonbiased party, with results and conclusions being couched in terms of "clinical" efficacy, not merely "statististical" significance.

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by Enoch Choi, MDBlank, Mar 04, 2008
I very much agree with bad eyes, that

- financial sponsorship taints perception of trustworthiness, but I wouldn't jump to the conclusion that the results are invalid

- MDs absolutely should keep up with the literature

- well controlled meta-analysis can provide valid and interesting results, but I agree that placebo controlled double blind study financed and conducted by a nonbiased party, with outcomes that really matter such as death or effects on ADL, is the best.  But who's going to finance the study?  the government?

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by xanweaner, Mar 04, 2008
I absolutely applaud Bad Eyes for his/her comments. Coming from the pharmaceutical and medical device industry where I sold for over 25 years, I know only too well on how we were groomed to "sell" our products.
I sold not only neuroleptic agents but also a brand new (at the time) tetracyclic antidepressant that was supposed to be revolutionary. After getting into medical device field and away from pharmaceuticals, I have later found that this "wonder" drug caused tardive dysconsia (sp) in elderly females. HORRIBLE!! After we had told our physicians that the drug wouldn't cause this side effect. I only cite this as one example.
This muti-billion dollar industry of antidepressants is absolutely frightening. The drug companies never should have been allowed to promote these agents to GP's, IM's, and other specialties. We now have an entire population of people who are taking many, many medications where the long-term usage has not been sufficiently studied. It's a sad fact that the field of psychiatry has become one of drug management vs. getting to know their patients and utilizing talk therapy...what will become of us?


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by bad eyes, Mar 05, 2008
I do not purport to have immediate answers to the "funding" problem regarding medical research.  I only argue most ardently that a complete disentanglement needs to occur between companies (e.g., pharmaceutical) that stand to profit and medical research and medical schools.  This is the only ethically and scientifically valid way to ensure that science progresses in the most accurate manner that both benefits and protects the potential patient.

In order to fix the problem, one must openly acknowledge that the problem exists.  I hope that the medical establishment takes ethics to heart and to uphold the Hippocratic oath.  I would hope that altruistic motives trump the financial and egotistical ones.  

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by bad eyes, Mar 05, 2008
I must also add that if you look at the literature in research methodology, there is very compelling evidence that a funding source (e.g., pharmaceutic or medical device company) that stands to profit from the findings does introduce measureable "bias" into research findings.  It is NOT merely a perception problem.  Additionally, when a funding source is used to sponsor symposiums and continuing education workshops, the information disseminated to physicians is also biased and skewed in favor of the products produced by that company, and often excludes other equally effective treatments.  

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by xanweaner, Mar 05, 2008
That is absolutely true, as I know first hand coming from the industry!!! What needs to happen is that we need more research dollars coming from the government so scientists, researchers can conduct proper studies to measure true safety, efficacy, without being beholden to the sponsoring pharmaceutical/medical device firms. We spend billions in munitions and defense, yet the funding dollars continue to be cut back. Things need to change in this country.

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by pwave, Mar 31, 2008
Interesting discussion, but remember, this is one study. Science doesn't rely on one study to come to hard and fast conclusions. I am curious to see what kind of follow up studies are done. The problem is it is probably unethical to give placebos to patients who are depressed and possibly having suicidal thoughts, which makes double-blind studies difficult. I know for a fact that Effexor works well for me, but it has taken years of talk therapy (after finally finding the right therapist), trials with different medications, connecting in a substantial way with family, friends and community, lots of exercise - both physical and spiritual -  and watching my diet. Even after all the hard work, I still experience terrible depressive episodes at predictable times of the year if I am not on an anti-depressant. If anyone would ask my advice, I would say be persistent (hard to do when depressed), keep an open mind, remember it is temporary, and trust your gut. If a solution sounds too good to be true, it probably is. If a medical professional's advice sounds creepy or inappropriate, try someone else. If one study tells you the medication that works for you is no better than a placebo, who cares? Placebo or not, if it works it works, and there will surely be another study soon that will claim just the opposite.

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by ratdog, Apr 03, 2008
I have been on three antidepressants over the last four years, Lexapro, Cymbalta, and supposed to be taking Wellbutrin. I have gained 39 lbs while on the first two, went into hypothroidism, had blood pressure go sky high, and testosterone level nose dive. I even quit my job of 22 years and now am unemployed because I felt I just could not deal with it any more. Last month my endo said I want you to stop taking Cymbalta and try 300mg per day of Welbutrin. Three days later I wished I were dead. Since then I have discovered many others here on the web that could not handle stopping Cymbalta. That drug should be banned. I split the capsules, tapered down and now for 3 days I have not took any. I would have gave in last night but I flushed them all because I knew I was too weak to stay away from them. Withdrawal feels like someone has a switch to turn your brain on and off at random, or little electric shocks. I am still too scared to drive. I am taking large doses of multi-vit and cod liver oil. I know I should be taking the Welbutrin but I am going to try not to do it. On the positive side, I have noticed more energy the last two days and my libido has increased. Anyone else had a bad experience with Cymbalta? Any opinions on Welbutrin?

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by SMERILA_6, Apr 06, 2008
     Does anyone have problems with there meds making them kind of brain fog...Or do you feel that your meds make you think better.  
I am going to school and I don't know if its my hectic life or if its my meds that I can not focus.
I work 48hours, and 4 kids (2stepkids and 2 are mine) and going to go to school online and am getting behind.  I have a job as soon as I am done just cant get motivated.

Any suggestions would be great.

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by Happy_32, Jun 04, 2008
Dear depresso and Dr's:
I started taking anti-depressants eleven years ago.  Into the seventh year I had taken multiple different anti-depressants I was still extremely depressed and suicidal and I had gained seventy pounds.  So eventually I started taking mood stabilizers, anti-psychotic, and a little anti-depressant.  I regained much strength back and began to heal and lost seventy pounds.  Of course exercise, religion, and service has been very important to help me heal.  Four years later, now, I am not taking any of those medications.  My emotional problems were so bad that I was on disability for two years.  I am doing better now.  I have had several years of counseling.  I believe I actually have Post Traumatic Stress Disorder.  From years of a stressful Childhood.   Although, no kidding around I have seen things on walls, heard things that were not real, and been absolutely paranoid about people going to hurt me.  

Anyway I was tired of the brain fog, fatigue, and drug dependency.

The medicine's seemed to help control my nightmares for many years.   Although, the nightmares still managed to surface and I still managed to get very angry.   The answers aren't easy, but I have decided to go all-natural.  I am treating my anemia with some mega iron pills from Costco, mega Vitimin B, fish oil, multi-vitamin, some natural female hormones, and mega vitamin e.  I might pick up vitamin c here soon. And the big one Exercise and take life easy, laugh.  Yes, I am laughing and smiling without the drugs!

Make a list of things you have wanted to do all your life, as long as, they are healthy for you and others you should explore the possibilities and work toward your goals.  Really ask yourself if they are healthy choices and maybe right now is not the right time.  Don't overwhelm yourself.  Know your limits, enjoy your life, include your family in your goals.  Ask them what they think, get the support of your family before you jump into something new.

I didn't want my kids to know I was dependent on drugs to keep me stable. I did talk to a doctor before I quit my med's.  She thinks I have emotional issues from childhood.  So no more med's!  Suck it up and deal with it!
God bless you!  

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by melos, Jun 06, 2008
About the hereditary of depression, well I have had 11 different family members on one side of the family (my father's) attempted suicide and that is just between two generations. Of the 11 relatives 3 have committed suicide. Being  of the third generation myself, I have severe depression, anxiety , panic attacks, agoraphobia etc and have contemplated suicide many times. My sister attempted to twice that I know of and refuses to take meds though she was alot more 'stable' on them she felt different on them and disliked taking them. I have been taking antidepressants for 7 years and was told I can never get off them considering my family history and my two attempts to not take them anymore which both times required hospitalization. My sister controls her panic attacks but her moods and other syptoms are so severe she becomes agressive, enraged and overly stressed. I on the otherhand have my moodswings but am rarely upset emotionally. I can't afford to because of my panic attecks. I get panic attacks when I exercise, do yoga or even when I think! The mind and the body are not to be taken separately nor lightly. I guess my point is everyone is different, every body reacts differently because of our minds even if we all are suppose to have like bodies. one type of meds can work wonders for one person and create chaos in someone else. Many people are abusing the practice of psychotherapy etc to make money or for power etc not thinking or caring about the consequences of there actions. The same can be said  of some who take meds for a quick fix (myself included since I would have killed myself had I not gon on meds) and proclaim to have been saved because we do not know better.Honesty and responsability is hard to come by or even live by.  One has to learn to listen to oneself and others. I talk and watch my sister but try to never judge her even if we differ in opinion and life managing skills. Our ancestors are alike but our upbringing and present environment differ immensely. Neither of us are right or wrong unless we are being dishonest with ourselves and eachother. Our DNAs may be alike but studies do show DNA strands adapt. There is no line to be drawn, no right or wrong, no black or white. I will enjoy the grey area as much as I can. I always wanted to know why? Now I try to live because I can until genetics, life etc catches up with me.

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by connie721, Nov 04, 2008
by Connie  Nov 4 08
Hi, I've been on 3 different AD for 9 years, I started weaning off Prozac and maybe didn't do it right, too fast??
I experienced dizziness, food cravings, not sleeping, crying and weeping, anger and rage, whole body
aching, numbness and tingling in fingers. I hadn't had the AD for 2 weeks when this started but because I have CAD, diabetes and osteo-arthritis, and have had eating issues for years didn't realize it could be the AD as a cause.I went to the walk-in for the dizziness after I found out the blood work was ok, diabetes numbers ok, heart cardiograph ok and talked about my history and read on line about withdrawal and I've been able to stay off for another week, but today I couldn't handle it anymore and filled a prescription and started back on 10 mg. I can't get an appt with my GP for a bit and the pharmacist suggested this.
Hope I'm doing the right thing. I feel like a failure that I couldn't get off. But can't handle the symptoms.

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by quiact, Dec 17, 2008
Serotonin Enhancing Psychotropic Pharmaceuticals

In the 1930s, physicians approached the mental illness of depression a bit differently that we do today.  While acknowledging a cause of depression is often due to some great misfortune, they seemed to focus on what is called a complex.  A complex is disturbances of ideas and impulses that are the cause of consistent habitual patterns of thought, feelings, and behavior.  An example of this state of mind of one who is depressed is one who experiences an exaggerated or obsessive concern or fear.  And the etiology for this mental disorder was often undefined.  In the 1930s, psychotherapy such as cognitive therapy was recommended for treating the depressed patient, and not pharmacological therapy.  Also considered for the depressed patient was positive lifestyle changes that would lessen the pain that the depression was causing them.
Times have changed since then.
Presently, for the treatment of depression and other what some claim are other types of mental disorders that are may or may not exist, selective serotonin reuptake inhibitors (SSRIs) are the drugs of choice by most prescribers today for a variety of mood disorders, including and primarily for the treatment of depressive disorders.  The most severe of the depressive disorders is when one has a major depressive disorder, also called clinical depression or major depression.  Symptoms of this type of depression, which is the most concerning due to its severity, include decreased or flat affect, decreased interest in activities once enjoyable, worthiness, guilt, regret, helplessness, and hopeless, to name a few of the diagnostic features that may be present with one who has such a major depressive disorder.
These SSRIs are known by some as third generation anti-depressants.  Such drugs, drugs that affect the mind, are called psychotropic medications.  SSRIs also include a few drugs in this class that include the addition of a norepinephrine uptake inhibitor added to the SSRI, and these drugs are referred to as SNRI medications, which combined with SSRIs, are the number 1 top therapeutic class of prescriptions presently, it has been reported.  While there are several available SSRIs presently, it is believed that only two SNRIs are available, which are Cymbalta and Effexor.  Some consider these classes of meds the next generation mood enhancers- after the benzodiazepine hype decades ago.  Furthermore, regarding SNRIs, adding the additional agent of norepinepherine is presumed to increase the effectiveness of SSRIs by some.
Some Definitions:
Serotonin is a neurotransmitter thought to be associated with mood.  The hypothesis was first suggested in the mid 1960s that this neurotransmitter may play a role in moods and emotions in humans.  Yet to this day, the serotonin correlation with such behavioral and mental conditions is only theoretical.   In fact, the psychiatrist’s bible, which is known as the DSM, states that the definite etiology of depression remains a mystery and remains unknown with complete certainty.  So a chemical imbalance in the brain is not proven to be the cause of mood disorders, it is only suspected  as a result of limited scientific evidence.  In fact, diagnosing mental diseases such as depression is based on subjective assessment only, as interpreted by the prescriber, so one could question the accuracy of such diagnoses.
Norepinepherine is a stress hormone, which many believe help those who have such mood disorders as depression.  Basically, with the theory that by adding this hormone, the SSRI will be more efficacious for a patient prescribed such a med, as suggested earlier.
And depression may be combined with related mood disorders that may exist with certain patients.  Anxiety usually exists with one who has a major depressive disorder.  A objective diagnosis of these mental conditions lack complete accuracy, as they can only be defined conceptually, so the diagnosis or impression concluded by the patient’s doctor is dependent on subjective criteria, such as questionnaires and patient observation by the health care provider.  Such questions come from what is known as a DSM book created by psychiatrists.  Screening programs that have been used for identifying depressed patients have proven to be largely ineffective.  A social patient history is uncertain and tricky as well, some have said.  There is no objective diagnostic testing for depression to validate as to whether or not the disease is present.  A health care provider has to assess as to whether certain diagnostic features are present to offer the diagnosis of major depression.  This is further complicated by the fact that the exact cause of major depression is unknown.
Yet the diagnosis of depression in patients has increased quite a bit over the past few decades.  Some have asked themselves and others- actually how many people are really and actually depressed?  What is believed is that if one is determined to be cognitively impaired from a mental paradigm, then it may be major depression.  If this is determined by a health care provider, than pharmacological therapy is considered reasonable and necessary, as well as psychotherapy either used with or in place of medicinal therapy.  
It has been reported that around 10 percent of the U.S. population will at some point be affected by a major depressive disorder.  Due to such factors as the likeliness of others being depressed often being discussed recently in the media and medical literature, that may not be completely accurate or thorough, depression and the treatment and diagnosis of this disorder has increased remarkably in a short period of time in the United States.  This depression issue is further encouraged by those pharmaceutical companies that market medications for major depressive disorders.  So more people seek treatment now for what they believe is a major depressive disorder they are experiencing, when in fact it may be intense sadness, perhaps, due to a loss of some sort in their lives.  There is a difference, and health care providers should have the appropriate tools and knowledge to discriminate between the two states of mental conditions.  Sadness is not a medical problem.  Symptoms associated with an unfavorable mental state need to be excessive and chronic to be considered to have in fact the medical problem of a major depressive disorder, as stated by others.
In Time magazine’s June 16th 2008 cover story, it was reported that the military personnel in the Iraq war are pounding down SSRIs often.  Every time there is a new war, there is a new drug, it seems.  Yet the story may illustrate the frequent usage of these types of medications in a variety of different areas for different reasons.  Some reasons may be valid and appropriate, yet others perhaps may not be reasonable for such medicinal therapy.
In regards to those pharmaceutical companies who make and market such psychotropic drugs in the manner that they do that largely is unknown to others, what is known is that the psychiatry specialty is the one specialty most paid to by certain pharmaceutical companies for ultimately and eventual support of their psychotropic meds that they currently promote to these doctors, as this aspect of the pharmaceutical industry clearly desires market growth of these psychoactive medications.  Front groups to expand the market for these types of drugs have been known to occur as well, which have on occasion been developed if not supported by such companies.
Regardless, SSRIs and SRNIs are the preferred treatment methods if depression or other mood disorders that may be suspected by a health care provider- regardless of their specialty.  Yet these drugs discussed clearly are not the only treatments, medicinally or otherwise, for depression and other related and suspected mental disease states or disorders.  Patients should be aware of this fact as well as caregivers.
Over 30 million scripts of these types of meds that enhance serotonin saturation in the brain are written annually, and the franchise is around 20 billion dollars a year now, along with some of the meds costing over 3 dollars per tablet, it has been reported.  There are about ten different SSRI/SRNI meds available, many of which are now generic, yet essentially, they appear to be similar in regards to their efficacy and adverse events.  The newest one, a SNRI called Pristiq, was approved in 2008, and is believed to be launched as a treatment for menopause.  The first one of these SSRI meds was Prozac, which was available in 1988, and the drug was greatly praised for its ability to transform the lives of those who consumed this medication in the years that followed.  Some termed Prozac, ‘the happy pill’.  In addition, as the years went by and more drugs in this class became available, Prozac was the one of preference for many doctors for children.  A favorable book was published specifically regarding this medication soon after it became so popular with others.
Furthermore, these meds have received upon request of their makers to the FDA additional indications besides depression for some really questionable conditions, such as social phobia and premenstrual syndrome.  Also included with indications that now exist with these types of medications include both generalized and social anxiety disorders, Obsessive Compulsive Disorder, Panic Disorder, Agoraphobia, Post Traumatic Stress Disorder, Bulimia, and stress disorders in general.  I understand they are seeking indications for pain management as well with these SSRI or SRNI pharmaceuticals.  This may need further review before the use of these drugs are expanded into other conditions that have not been considered or thoroughly studied in the past, I believe.
With some of these indications for these classes of drugs, I question as to whether or not they are actual and treatable disease states or non-medical problems.   Yet with additional indications for particular drugs in these classes o medications, one can be assured that the market for these drugs will continue to grow, as more are prescribed these particular classes of drugs, even though some have suggested that these types of drugs are effective in only about half who take them.  And some of the indications granted to drugs in these classes of medications may be considered disease mongering to grow the market share for particular drugs of this type.  This is combined with drug companies who make these types of meds either forming or creating front groups in order to have more diagnosed with various medical problems that may not exist so their medication can be utilized to a greater extent through such methods as screening others, or exaggerating the prevalence of a particular medical condition that their medication may be indicated for and authorized by the FDA.  Needless to say, such activities by pharmaceutical companies are deceptive, inappropriate, unreasonable, unnecessary, and clearly dangerous to others.
Perhaps of greater concern and danger with these particular psychotropics primarily involves the adverse effects associated with these types of drugs, which include suicidal thoughts and actions, violence, including acts of homicide, and aggression, to name a few, yet devastating, events that have occurred while one is taking a SSRI or SRNI.   It has been reported that the makers of such drugs are suspected to have known about these toxic and dangerous effects of their drugs and did not share them with the public in a timely and critical manner.  While most SSRIs and SNRIs are approved for use in adults only, prescribing these meds to children and adolescents has drawn the most attention and debate with others for understandable reasons, which have included those in the medical profession as well as citizen watchdog groups.  The reasons for this attention are due to the potential off-label use of these meds in this population of children, yet what may be most shocking is the fact that some of the makers of these meds did not release clinical study information about the risks of suicide as well as the other adverse events related to such populations, combined with the true decreased efficacy of SSRIs in general, which is believed to be only less than 10 percent more effective than a placebo.  Paxil caught the attention of the government regarding this issue of data suppression some time ago, this hiding of such important information- Elliot Spitzer specifically was the catalyst for this awareness, as I recall.  Furthermore, that drug is in the spotlight once again years later.  Some believe the drug maker knew about possible risk to the youth as early as 1991. Yet did not disclose such danger associated with their drug to the public or the FDA, and this was done with intent.
And there are very serious questions about the use of SSRIs in children and adolescents regarding the possible damaging effects of these meds on them.  For example, do the SSRIs correct or create brain states considered not within normal limits, which in effect would possibly cause harm rather than benefit a patient on such a drug?  Are adolescents really depressed, or just experiencing what was once considered normal teenage angst?  Do SSRIs have an effect on the brain development and their self identity of such young people?   Do adolescents in particular become dangerous or bizarre due to SSRIs interfering with the myelination occurring within their still developing brains?  No one seems to know the correct answer to such questions, yet the danger associated with the use of SSRIs does in fact exist.  It is observed in some who take such drugs, but not all who take these drugs.  Yet health care providers possibly should be much more aware of these possibilities, possibly, along with the black box warning now on SSRI prescribing information for the youth that has existed since 1994.  
Finally, if SSRIs or SNRIs are discontinued by a patient rapidly and without medical supervision, withdrawals are believed to be quite brutal that follow soon after the drug is not taken anymore by a former patient of these types of drugs, and may be a catalyst for suicide in itself, as not only are these drugs habit forming, but discontinuing these meds abruptly, I understand, leaves the brain in a state of neurochemical instability, as the neurons need to recalibrate after existing in a brain over-saturated with serotonin. This occurs to some degree with any psychotropic medication, yet the withdrawals can reach a state of danger for the victim in some classes of meds such as SSRIs and SNRIs, it is believed.  And this seems to concern many.
SSRIs and SRNIs have been claimed by doctors and patients to be extremely beneficial for the patient’s well -being regarding the patient’s mental issues where these types of meds are used, yet the risk factors associated with this class of medications may outweigh any perceived benefit for the patient taking such a drug.  Before these medications mentioned were developed, doctors praised trycyclics, another class of anti-depressants, in a similar manner some time ago.  Considering the lack of efficacy that has been demonstrated objectively with these newer psychotropics, along with the deadly adverse events with these SSRI and SSNI meds only recently brought to the attention of others, other pharmacological and non- pharmalogical treatment options should probably be considered, but that is up to the discretion of the prescriber.   And the perception of the benefits derived by these types of drugs may be flawed, as there has been no decrease in incidences of suicide or remission of depression since these drugs have been available, many have concluded.  Furthermore, recent studies have suggested that the supplement, St. John’s Wart, has shown to be as effective as medicine for major depression.
It is my hope that such a prescriber rules out possible other etiologies for their patients’ mental conditions before they conclude that such a patient is suffering from true mental illness requiring the medications mentioned earlier, such as asking their patients about life stressors and other medications these patients have taken or are presently taking.  Because at times, a doctor can in fact do harm without intent.
“I use to care, but now I take a pill for that.”  --- Author unknown
Dan Abshear
Author’s note:  
Addendum to this article based on the following link:

http://www.medicalnewstoday.com/articles/132005.php

There are greater than 60 symptoms associated with one who is or may be depressed, and there are different degrees of depression. The number of symptoms expressed by one who suffers from depression determines the severity of their depression.

The characteristics associated with depression are affective, cognitive, and somatic.

For example, affective symptoms are the core symptoms of a depressed mood, and the term that one has a flat affect is an indication that one may be suffering from depression. These symptoms may include sadness, dissatisfaction, crying episodes, irritability, as well as social withdrawal. It should be noted that many events could cause the expression of such symptoms besides depression in itself.

Cognitive symptoms associated with depression may include pessimism, a sense of failure as well as guilt, suicidal ideation, and dislike of self.

Somatic symptoms may include insomnia, fatigue, weight change, and loss of interests, such as sex or other activities engaged in historically with a depressed patient. It should be noted that stress can cause such symptoms as well, in my opinion,

http://www.nimh.nih.gov/health/trials/practical/stard/index.shtml

Dan Abshear



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by wat389jlt, Jan 06, 2011
Warrren; 1-6-2011      been married 52 yrs  wife has had history of bad teeth from teens .  Her partents would not has her teeth extracted.  After many yrs. of problems two misscarages and having thyroiad ideices and lose of the thyrioad. then came historectamy .  with out knowing the infection from the teeth had caused bad eye sight, all of the other problems.  Had her upper teeth pulled in 1981 help her health some for awhile. a few yrs later removed most of the lower teeth. I wanted them to remove all but they insested not too.  infections still was there and her eyes got worse.  we are in the process of have the catracts remove from both eyes.  We have had the rest of her teeth pull and new plates . this has caused a lot depression.  have several antidepressentrs.  Found that Remeron has work will but has to be taken around 8:00 so to kickin about 10:00 has help keep subconious in check at night .   Memory lose had occoured, after eye sergry is completed we start work regement to get her start her memory in order.

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by benprozac, Aug 28, 2011
Drug companies tend only to release

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by benprozac, Aug 28, 2011
Sorry about last post. Drug companies tend to report positive trials and not the negative ones yet noone questions this use of manipulative reporting to show them to be more beneficial than they are. Even considering this bias placebo performs very well in these trials. David Healey points out how manipulative drug companies are in his book " let them eat prozac......"
Noone also questions the Double Blind studies done. They are done with an inert placebo, not active, which can clue doctor and patient alike into whether the patient is on the active drug. So much for double blind. Introduces immediate bias.
Also drug companies fund university research. Bias. Dont bite the hand that feeds you.
Any time someone questions there efficacy there seems to be a large contingent of pro pharma lobbyists trying to discredit them. David Healey was fired from a University post in the United States due to his criticism of the Pharmaceutical industry."let them eat prozac"
Some like Joseph Glenmullen and Peter Breggin are harder to discredit though they are often labeled as "controversial" more emotive pro pharma rhetoric.
People should look into "Ghost writing" in the pharmaceutical industry. Many psychiatrist written reports of drugs are not even written by them, but merely signed off on.
If you look at all trials given to the FDA for antidepressants and not just the positive ones modern antidepressant advantages over placebo become questionable.
Medicine is a science so emotive rhetoric should be left out of the argument and we should instead look at the facts.
One disturbing fact is in order to approve an antidepressant the FDA requires only two positive studies. In other words you could have a hundred negative studies and still get a drug approved. Im sure any statistician would be shocked by this approach. It is like a shot gun approach to statistics. Run enough trials and you will inevitably get a positive trial.



Avatar_m_tn
by benprozac, Oct 05, 2011
It is a curious thing that people doubt the results of this study as i believe these 47 studies were submitted to the FDA for approval. The author had to use the official information act to gain access to all studies as drug companies do not release negative studies very often.
I do not see the problems with the meta analysis. In 6 out of 10 studies of prozac there was no difference in efficacy between prozac and placebo (Moore,1999).  Given the bias toward drug over placebo this is hardly resounding evidence.
STILL WAITING on the drug companies to disprove the results of this study of their own drug trials, instead of attacking the meta analysis and saying it was "controversial".
You can rest assure they will never disprove it now that most of the ssris are off patent.
I would challenge anyone to put themselves in the placebo group who got better. Some of these people would have sung the praises of the drug in question and how it saved their life and how it worked wonders for them. Only one small problem; they never took it. Depression for me was a loss of hope and the placebo effect demonstrates hope being restored.



Avatar_m_tn
by benprozac, Oct 06, 2011
The minutes also revealed that during the approval process, Eli Lilly's trial subjects were put on tranquilizers to counter the akathisia (and presumably skew the drug trial findings in their favor), though no warning was given when the drug came on the market in the US. In Germany, however, Eli Lilly was obliged to put this caveat on its package insert.
From company minutes brought to light in legal trial.
Given all the bias in favour of ssris, it is comical how they still struggle to show advantage over placebo.


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