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#43184 - 07/31/02 10:37 PM Light dawns on marblehead here....
orodo Offline
Member
MaleSurvivor

Registered: 03/15/02
Posts: 735
Loc: Imladris, The Safe Haven of Ar...
Are Antidepressants Effective?

They're Just Slightly More Effective Than Dummy Pills, Research Shows

By Salynn Boyles
WebMD Medical News Reviewed By Gary Vogin, MD

July 10, 2002 -- In the 14 years since they hit the market, Prozac, Paxil, and the other SSRIs have changed the face of depression treatment. Some 7 million Americans now take the antidepressant drugs for everything from generalized anxiety to PMS, but there is growing evidence that their effectiveness may be more marketing hype than miracle cure.

The latest scientific study to weigh in on the subject finds that the antidepressants worked only marginally better than placebos in a group of studies submitted to the FDA. Study participants taking the dummy pills had approximately 80% of the response seen in patients taking one of the six most widely prescribed antidepressants.

Lead researcher Irving Kirsch, PhD, tells WebMD that in many of the studies, while the difference between drug and placebo was significant from a statistical standpoint, it did not represent a significant difference for patients. His study appears July 15 in the American Psychological Association's electronic publication, Prevention and Treatment.

"We are not saying that people don't respond to these medications," says Kirsch, who is a psychology professor at the University of Connecticut. "On the contrary, the response is very large, and that is why there has been this so-called revolution in the treatment of depression. The catch is that the response to placebo is almost as large."

Selective serotonin reuptake inhibitors (SSRIs) are believed to relieve depression by increasing the effectiveness of the neurotransmitter serotonin in the brain. In a review published four years ago, Kirsch first suggested that the antidepressants are just slightly more effective than a placebo. The findings were widely criticized by mental health professionals at the time, and Kirsch says the latest review attempts to address the criticisms.

Kirsh and colleagues pooled data from roughly 40 studies of six SSRIs that won FDA approval between 1987 and 1999. The drugs included Prozac, Paxil, Zoloft, Celexa, Effexor, and Serzone. All of the studies compared depression relief among patients treated with the SSRIs with those given placebos. The patients were not told which treatment they were getting, and both groups improved. Using a standardized 50-point depression scale, the pooled results showed that patients treated with antidepressants had a 10-point improvement, while those given placebos improved by 8 points.

Kirsch concedes that the design of the placebo-controlled studies may mask the true effectiveness of the antidepressants and overstate the effectiveness of the placebos. But he adds that the finding also clearly suggests that too many people are relying on unproven drugs to treat the symptoms of depression.

"People may be better off exploring other treatment options such as psychotherapy or exercise, which has been shown to reduce depression. And the side effect of physical exercise is better health. That is much better than the loss of sexual function, tremors, agitation, diarrhea, and nausea that are side effects of SSRIs."

Psychologist Roger P. Greenberg, PhD, says it is understandable that the SSRIs have become so popular in such a short time, despite the lack of data showing them to be effective. Both patients and their physicians, he adds, have adopted a "fast-mood mentality," where the quick fix is expected for the treatment of depression. Greenberg heads the psychology division at SUNY Upstate Medical University and has written two books on the limits of treating depression with drugs.

"The notion that depression is caused by a biochemical imbalance that is easily treated with drugs has taken hold in recent years because it provides this easy solution," he tells WebMD. "Biochemical imbalance is a handy catch phrase, but there is not a lot of evidence that there is such a thing."

But psychiatrist Michael Thase, MD, defends the role of SSRIs in the treatment of depression, and says the latest study offers few new insights. The findings, he adds, are less of an indictment of antidepressant drugs than a commentary on the human aspect of depression treatment. In short, the studies show the power of belief in a clinician or a treatment.

Thase points out that the placebo effect is not as strong among patients with more severe forms of depression, especially those with psychotic features like schizophrenia. And he notes that studies evaluating the usefulness of nonpharmacological treatments like psychotherapy have similar limitations to drug studies. Thase is a professor of psychiatry at the University of Pittsburgh Medical Center.

"The placebo effect is nothing new," he says. "It doesn't mean a drug doesn't work."

HA HA HA HA HA HA HA....GUESS MY DOCS GOT ME GOOD NOW...

_________________________
It is better to be Dragon Master than Dragon Slayer. Some Dragons are meant to be mastered, others meant to be slain. Odin, Great Spirit, God, grant me the wisdom to know the difference. "May the Valar guide and bless you on your path under the sky"

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#43185 - 08/01/02 04:53 AM Re: Light dawns on marblehead here....
Broken Offline
Member

Registered: 03/25/01
Posts: 273
Loc: Huntingtun Beach, CA, US
Dont be taken aback by this. The placebo effect is powerful, but these medications are not inteded to fix things, they are intended to balance out your neurochemistry long enough for you to be able to function and solve the root of your problems. Depression as a biological illness and as a state of being need to be seperated. The reason i suspect the drugs arent working is because most people who are depressed are expecting the pills to fix things, but it can only help balance out the chemistry, it cant fix the neuroligical pathways that caused it in the first place. This requires time patience and a willingness to change. In essence, the "hard way." Besides, most science today, and throughout history, sadly, is more like pop-science. Very few studies have much validity, because in psychology, the data is a moving target, and is shaped by the observers expectations and assumptions. Without empiracle data and backing from sources you personally trust, or a gut feeling that it is true, assume all data is either misrepresented or improperly gathered.


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#43186 - 08/01/02 11:18 AM Re: Light dawns on marblehead here....
BlueOne Offline
Junior Member

Registered: 07/29/02
Posts: 27
Yeah, these studies come out all the time. Next month there'll be another one saying that placebos work far worse than the real thing, and the month after that there'll be another one saying that placebos actually work better. All I can go off of is my own personal experience.

My doctor put me on Paxil to help control panic attacks, which it definitely has done, but it also helped with some social anxiety and obsessive compulsive things I didn't even know I did until I stopped doing them (like counting the number of steps I took from one place to another, stepping on an even number of cracks with each foot, going over speedbumps the "right" way). So I know that it definitely works for me, that it's not just a placebo effect, because it helped with things I wasn't expecting it to. But, then again, everybody's brain chemistry is different.

I thought for a long time that my antidepressants weren't working because I wasn't happy all the time. Then a friend of mine said, "Look, nobody's happy all the time! If you have some good days, mostly blah days, and some shitty days, well, welcome to normal." I was expecting some miracle cure to make me 100% better, I guess, which isn't what they're intended to do.


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