Is there any effectiveness to antidepressants other than a placebo effect?

[artemesia2]

I read in various studies that ADs are only effective because of placebo.  I hope this is wrong  Anybody here truly helped with their depression by taking an antidepressant?  

[specialmom]

The only way that a medication can get approved for an indication by the FDA is if during controlled clinical trials, it was more effective than placebo.  Keep that in mind.  Double blind studies with a placebo control group area always used and the group with medication attached must outperform and of a significant level in patient populations in order to then be approved for that indication.  And the placebo group that is blinded also has side effects from their placebo  . . . go figure.  

I know many personally that have true clinical effect from the medication they have been prescribed.  It's anecdotal as they weren't part of a clinical study or trial but enough for me to feel confident that medications do work for many people.  But it is individual.  And self reporting how you feel is subjective.  Some think that if they take an antidepressant they should never have any sadness, blues or anxiety.  It mellows those things out for people but it should not eliminate all feeling to numbness in my opinion. But that is some people's expectation.

I feel these drugs can save lives and have.  :>)  And I did take Prozac and it helped significantly with two areas--  low level depression and social anxiety.  

[Paxiled]

What studies?  There are no studies that prove antidepressants are a placebo.  As Mom says, all approved medications have to do clinical trials to prove the drug beats placebo in double blinded studies.  Now, they don't beat placebo by very much, that's true.  That's one reason why so many have been approved -- none work all that well, but there are a lot of them to try so you have a good chance of one of them working for you.  Another thing to consider is that placebo effects tend not to last -- they stop.  Drugs keep working.  Drugs do have significant downsides and taking them should be done with great care.  But they do work when they work.  Now, can you have a placebo effect with an approved drug?  Yes.  You can.  That happens when a drug hasn't actually kicked in yet and you feel better.  Or when the drug doesn't work at all and you feel better.  It happens.  It's not a bad thing, because placebos, not being active, don't harm you.  Drugs can harm you even when they work.  But don't let a life go completely down the toilet because you avoid taking a drug that might be the best thing for you based on false information.  Peace.

[specialmom]

Artmesia, do you have someone in your life that is treatment resistant or are you having difficulty?

[del677]

Yes when you find the right one that works for you.

I tried a dozen different ones with no real benefit, but kept trying them one by one until we tried one that was actually a very old antidepressant, and THAT one actually started working for me, and I slowly started getting better and better, and I thought, "I could live with this", and I continued to get better still, and I thought, "Wow, this is pretty good!", and I got even better than that! And I thought, "Oh my God I had no idea this is better than I ever imagined!" And it got even better than that!

I kept getting better for an entire year, and it absolutely changed everything.

A few years later my doctor took me off it, I went into decline. We went back on it, I got better.

A few years later we went off it again (don't ask, we were stupid back then), we tried every other medication there was, nothing worked, I went downhill and got really bad, we eventually restarted the one antidepressant that DID work for me, I slowly got better again.

All those other antidepressants I tried, they didn't work for me. They would have worked as well as any placebo. But this one that works for me, definitely works for me.

The problem is, in other fields of medicine, we have one pill that works for everyone. You have a problem, you take this pill, it works for everyone. Doesn't matter who you are. In psychiatry however, it matters who you are. You have a problem, there are two dozen pills out there that have been found to work for others, one of them might work for you, but most of them probably won't. We have no way of knowing which one will work for you. We just have to try them all, one by one, until we find the one that works for you.

From a study point of view, this means, take any pill and try it on a group of random  people, that pill isn't going to be the magic pill for most of those people. It's not going to work any better than a placebo. (By the way placebos are pretty effective! I've decided I'd by them if they were for sale!) The setup of the study is wrong. The setup is assuming all people are the same, and the pill should work for all people, like pills do in other fields of medicine.

In psychiatry, we're looking for a pill that works for SOME people. We find a pill that actually works like magic for SOME people, it's the magic cure for those lucky people, and it definitely works for those people. But there are other people that pill didn't work for, so we find another pill that works for SOME people, and then another pill that works for SOME people, and we get this whole collection of pills, each pill is the magic cure for a subgroup of people, and it definitely cures them. We shouldn't study the effectiveness of these pills using random groups of people. Doctors and patients know if a pill is working or not. When a pill works for an individual it DEFINITELY works. There's no question then pill that works for me DEFINITELY works for me. We did the "Try taking me off it" test 3 times, and the result was pretty definitive. That's the kind of test that convinces one the pill really does work. Don't need a random sample of people.

Instead of testing a pill on a group of people, we flip it and test a group of pills on a person.

[Paxiled]

Not sure in other fields of medicine there is one pill either.  Medication is very individual in all fields and there are multiple meds for almost all conditions because of this.  There is no medication for anything, as far as I know, that works for all people.  Also, very few meds are cures for anything.  There is no drug that cures any mental illness, they just tamp down the symptoms.  The biggest reason for this is that science hasn't yet found whether there is a biological cause for mental illness, so there is nothing causal to target.  Only symptoms can be targeted.  But if you have, say, high blood pressure, there are a great deal of different meds out there and none of them "cure" the problem either.  They just lower the BP when they work, but don't eliminate the cause of the BP.  A cure means you take the drug, the problem is cured, and you st0p the drug and don't have to take it anymore.  That's a cure.  If you have to keep taking a drug to get a positive benefit and if you stop taking it the problem is still there, it hasn't been cured.  An example of a cure is an antibiotic, when it works, and they don't always work, but when they do the harmful invader is killed off and you're cured.  That's a cure.  There are very very few of these in medicine.  And even with antibiotics, because of their action, they also kill off good things that protect us from the thing they're curing us of, and so it very often causes that problem to come back over and over again.  So even these are often not only not a cure but often an invitation to more disease.  When it comes to most things in life, we do the best we know how to do at the time.  Medicine isn't an exception.  The best cure is not to get sick in the first place, which is called prevention, but eventually we're all going to get something and hopefully our own bodies will fight it off, as they are designed to do.  When they can't do that, we do the best we can with what we've got, and if that means managing it with a drug, that's what we do.  But never stop looking for a cure, and that will often not come from medication but instead from lifestyle changes and strengthening the body's own defenses.  Some of us will never be cured, only managed, but others will find a permanent fix that allows them to stop taking medication, which is the best outcome.  Otherwise, you're spot on -- there are so many drugs out there that we all can hope we find one or two that do work for us.

[artemesia2]

Your comments were quite comprehensive.   Yes there is definitely a difference between a cure and treatment.  I too believe in strengthening the immune system.  I take alpha lipoic acid , an antioxident.  for my immune system. I take Echinacea for the same reason.     An excellent example imho of treatment vs cure is diabetes types1 &2.   I can personally relate.

[del677]

Good point that "cure" is not the right word. Perhaps "control"? might be a better word? What would insulin be called for a type 1 diabetic? They can live a full long normal life with it, and die without it. It's not really a "cure" as in take it once and you're cured. It's a solution. Perhaps "solution"?

When I was originally sick with depression I figured the best I could get was treat the symptoms and make me as comfortable as possible and I'll suffer through life. I never imagined a medicine would fix me to the point I no longer think about it anymore.

It definitely fixed whatever was wrong, and after a year of recovering, getting better, and better, and better, beyond anything I could imagine, I have to pass on hope to other people suffering, -- keep trying different meds. There might be one out there that will work better than you could ever imagine.  

[Paxiled]

Yeah, I didn't really mean to get bogged down in details as much as to make sure everyone is aware that very few drugs cure anything, which means taking a drug isn't necessarily the stopping point of treatment.  Some diseases are incurable, such as Type 1 diabetes, but taking insulin not only doesn't cure it but taking it doesn't actually give someone the same length of life or health they would have had if they hadn't been unlucky enough to get the disease -- most people with this disease will get many problems because of it and die younger even though they take insulin and it works.  But without it, they wouldn't have any life, and you can live a good long time before the negative stuff starts to happen.  Any of us can get hit by a car and die tomorrow, so length of life isn't guaranteed even if you do everything right, but if you do everything right you greatly increase your chances of a lot of years without problems.  Now, Type 2 diabetes is a different story -- that one can be caused by lifestyle and also fixed by lifestyle for many people, while for others it can't be.  For that one, if you get to the point you need insulin, you're not doing the right things.  Psychoses are more like Type 1 diabetes -- probably not curable.  Anxiety and depression, on the other hand, have been beaten by a ton of people, so it is possible, but there's no guarantee that will happen.  It does mean we keep trying, and no drug cures it at the moment.  Artemesia, ecchinacea shouldn't be taken on a regular basis.  It should only be used when you have a cold or other virus.  When you're better, you stop.  Taking it regularly can overtax the system, or at least is thought to do that.  There are herbs that do help the immune system when taken regularly without overtaxing it, but that's not one of them.  Alpha lipoic acid isn't for the immune system per se, it is a potent antioxidant that prevents oxidation and is also liver protective.  A great supplement, I also take it every day, but it doesn't directly affect the immune system.  Not everything that protects us from harm does it by working on the immune system.  Peace.

[Paxiled]

By the way, for those who don't know it, alpha lipoic acid is so effective because it protects both fat soluble and water soluble nutrients from oxidizing.  It protects Vitamin C, one of our most crucial nutrients, from oxidizing.  And again, it has specific liver protection.  It's a very good supplement to take regularly.