A new clinical trial study published yesterday in the Public Library of Science Medicine suggests that antidepressants only benefit some individuals, mostly helping the severely depressed patients.
My professional experiences do not align with this study. Many in the mental and medical health fields feel the same way - read this MSNBC.COM series here and here - because understanding research can be a tricky and sometimes misleading experience.
There are clinical studies that say drinking coffee is bad for your health, while other studies say drinking coffee can be good for your health. Hey, what's up with that?
The key to understanding research is not only in understanding the numbers and the statistical design, but also in considering that clinical trials are artificial situations that don't mimic real-life. When I come across clinical trial research, I consider the data as a "possibility", not an "absolute".
So when you read research, or the latest breaking news, consider what YOUR own unique needs are and make decisions accordingly.
And if you're someone who might be considering stopping your antidepressant medications because of this recent study, please do so carefully with your medical professional guiding the way.
32 comments:
The study does not say that antidepressants didn't help people. It said that the help it provided was not clinically significant in comparison to placebo other than for the very severely depressed. In other words, a sugar pill helped a very large number of people. This will also line up with your experience as a therapist...when a person believes something will be helpful, it usually is.
I found that listening to the media is bad for my health. LOL!
Dear Anon,
Antidepressants were 18% more effective than the placebo in this meta-analysis. The Placebo Effect is indeed a very powerful phenom and something with which I've blogged about before. However, I have seen many depressed individuals feel hoepful and want positive outcomes with medication, but did not experience any positive benefits. In such cases, many trials of meds were explored and only certain mixes of medication proved to work. This postive results expeirenced were not from the Placebo Effect, but rather from specific medications that uniquely addressed the neurobiology of the patient's depression. I do agree that prescriptions can be tossed about too freely these days, but I caution anyone who reads research to know themselves.
Dear Lone,
I hear ya! An academic paper I wrote on the news media and its fear based and misleading content should soon be published in the journal "Psychoanalsis & Psychotherapy". I get my news from reading a variety of worldwide papers these days.
~Deb
What I was concerned about was when this 'report' hit the media yesterday was all those people who have been prescribed antidepressants and are living in 'hope' with those prescriptions. What will such news do to their state of mind? The irresponsiblity of such releases staggers me. Good post Deb, and much needed.
I was a severely depressed patient. I'm grateful I had Lexapro. I'm grateful I had professional help tapering off a few months ago, too, and getting onto SAM-e for both my joints and light mood support. I hope this doesn't make those idiots who think that depressives just need to "buck up, buttercup" feel entitled to their beliefs, but I know it will. *sigh*
Absolutely....
How long were people monitored for? (given that SSRIs can take 4 weeks to work).
Was the fact that different SSRIs affect different people differently taken into effect?
I take SSRIs and I know how important they are to my continued functioning. I know this because when I have tried to reduce them (with the full agreement of my drs and in the full belief that I wanted to and could cope with such a reduction) things ahve repeatedly gone pear shaped. I also know the importance for me of talking therapies. This study poses more questions than it answers, for me.
studies are nuts. One day something's good for you, the next day it's not.
Timely warning, Deb. The problem with media reports like this is that it can cause people to suddenly stop taking medications (and this relates to all types of medications, not just antidepressants). That can be quite dangerous, dependent on the drug. If we read something about drugs we take that concerns us, it is understandable to have questions. However, it's equally important to take those questions back to the person who prescribed the drug for us for further elaboration before acting.
Sometimes I grow weary of all the studies. If the meds help, take them. If they do not help, tell your doctor and either try another med or don't but please quit lumping all people into the same category. I know that research and studies need to be done and are very important but like palmtreechick said, sometimes my head spins from the it IS good for you and the following day it ISN'T good for you. Find what works for YOU and stick with it.
I'm on 'zac, and it works great for me, and my depression has never been severe.
As I am starting to learn a little about meds, I think it is AWESOME that the tricyclic antidepressants also work to relieve neurogenic pain!
Been there, done that. Whether it be the placebo effect or the drug's effect, does it really matter? The result is that a depressed person can climb out of the deep hole depression has put him in. The end result is the important thing.
Good point Anon. Well said.
I think Dr. Deb makes a good point as well about using caution when looking at research, however she failed to make the same point when she referred to a study that supported her pharmacological approach a couple of posts ago.
A couple more things:
The fact that you have had patients who do not respond to one medication and respond later after a different mix of pharmaceuticals, can not be used as any kind of proof that the medication solved the problem. The problem may have eased on it's own or for a variety of other reasons. That kind of reasoning would never hold up in any other scientific realm, so why should it hold up in psychiatry?
Last point, fear that people might stop taking their meds is no reason to hold back research results.
I will be back to read your post; just in a dash right now. I was very upset with the news about anti-d's the other day....
Anyway,
The littles of JIP have written a fantastic post and made an artistic impression of what you look like. It is very cool and good and worth a visit! :-)
I have found that using a trial and error approach for myself is a good thing, as studies are often conflicting. I didn't stop drinking coffee when I was pregnant, I just drank less, and usually decaf. I haven't stopped drinking alcohol since the study came out that links it to breast cancer, but I never did drink it often anyway. I do, however, put stock in studies that have been proven over time. I don't use any tabacco products. I have a weird phobia about eating microwaved food (I don't know why).
I feel Drug Company’s control parts of the government. Saying that here is a quote I once heard.
"Figures Lie and Liars Figure".
Anyone can manipulate data to make there product look safe. Remember the Viox drug problem, my good friend died at the age of 52 from heart problems. She never had a heart problem in her life but she had taken Viox for 6 years for severe arthritic pain. There is no accountability in the Pharmaceutical World.
Great post deb. Made me really think.
Antidepressants really help me, without them life would be rough.
Dear Ian,
I worried too.
Dear Cracker,
Bucking up should be one of the phrases that should never be uttered. It implies that you are just lazy or weak. I so get you and how you think.
Dear Dis,
I agree the study poses more questions than answers for me as well.
Dear Palmtree,
I know.
Dear HP,
Your comments are always so wonderful and helpful. You rock.
Dear OHN,
I know, contraditory studies occurr often. We can find "trends" in research, and that is helpful though.
Dear Scott,
You are learning SO much!
Dear BB,
The point is for the depressed person to feel better, I agree.
Dear Anon,
To each his/her own. Depression does not get better on its own, nor does diabetes or heart disease. Evidenced-based studies in psychotherapy and psychiatry are available for you to read on the subject, should you like. I caution the reader of any research to be informed and make decisions accordingly. I'd never censor anyone's research or comments. See, even your comments remain here :)
Dear Kath,
I'll head over there in a while.
Dear United,
As I've said before, to each his/her own. The important thing is to be educated, informed and empowered.
Dear Nancy,
I never heard that phrase. It can be said for some, not all though, that Figures Lie and Liars Figure".
Dear Mysti,
Made me think too.
Dear Kawana,
For some, they are lifesavers! So glad you continue to recover!
~Deb
The research got a lot of media coverage here in the uk. The underlying message / "soundbite" was around the ineffectiveness in the majority of cases of anti-d's and that you may as well take a dummy pill.
I found that to be really irritating at best, upsetting at worse. I felt that my depression was minimalised and played up to peoples prejudicism on the subject, that you should just "pull yourself together."
As a statistical modeller, I know about the limitations of studies, but that didnt stop my feelings as a person. Yes, blame it on the media rather than the researchers, but it left a bad taste in my mouth nonetheless. And yes, for a while I did consider tossing my Celexa away.
Dr. Deb, my kid brother has diabetes. When relatives said those awful "up" phrases to me--buck up, cheer up, etc.--I would reply that I have a hormonal imbalance just as much as my brother does, and if they wouldn't tell him to "cheer up" in order to heal himself, they shouldn't do it to me. It stopped pretty quickly after that.
I saw a car with a bumper sticker that said "Cheer up, emo kid" recently, and was glad I didn't have either my Louisville Slugger or X-acto knife with me so I could, um, address the owner's misguided opinions about mental health. :-)
Thanks for your professional advise Dr. Deb. It surely comes in handy in confusing times such as this. God bless you and your loved ones always.
Some of the studies drive me nuts. For example...anti-d's cause suicidal ideation. Umm... I don't think so. I would have to say that a severely depressed person has no motivation; when anti-d's start to work, some energy and motivation returns, but not enough to TRULY feel better, yet. Just enough to seriously consider SU. I think that passes after a little more time on the anti-d's. I know there will be people that will argue with me, but that is my own, personal experience talking!
And that is a great segue to my next point!
I find it amusing how any post, just about anywhere that can be construed as even the tiniest bit pro-psych med is immediately pounced upon by anti-psych med commenters! It's even more amusing that they never seem to be willing to state who they are...always "anonymous".
I truly believe that any kind of meds no matter what they are, work differently for everyone. That is why so many bipolars and so on - change their medication continuously because it just doesn't agree with them or it just isn't do the job at that time for them.
Anti-depressants do work for the most part, I do agree with that, but it doesn't work for everyone.
We are made up of our own chemistry, body funtions, genes and so on...we are all different when it comes to stuff like this.
But with anti-depressants should come therapy, cognitive therapy and so on...ONE thing is not a cure for all.
Interesting post, i like you Deb.
Just wanted to give you a hug..
{{{{{{ Deb}}}}}}
well sometimes they dont work, because some of us are misdiagnosed and really need an antipsychotic and/or a mood stabilizer instead LOLOL. Seriously. No antidepressant has ever worked for me. They make me worse. They make me dysphoric. However I went thru years of trying them all as I was misdiagnosed with major mental depression. Later my diganosis was changed to bi-polar 2 and now it is possibly being changed again to schizoaffective-bipolar type. The problem was not so much that the antidepressants did not work, as that they were not the appropriate drugs for the actual illness I had. They just triggered the nasty form of mania or mixed episodes which were misdiagnosed and made a huge mess. This does not mean they wont help others. It means I needed a totally different type of medication. Perhaps some of the people they are not helping are also misdiagnosed.........?
thanks for posting on this matter. I've stopped flinching when reports like this one come out.
After more than 17 years practicing medicine, I can say unequivocally that antidepressant medications are effective. The expertise lies in choosing the clinically correct patient population to benefit from a given medication.
Unfortunately, for many mental health providers the old adage applies "when all you have is a hammer, everything looks like a nail". SSRI's are but one tool. We have the neuropharmacology correct, it's all about implementation now.
Good post. Most people probably take these news reports reporting on studies as gospel.
The studies can be skewed toward a desired outcome for the people running or people backing the study-for their gain.
How DOES one really know?
I feel that a very severly depressed person should first understand that medications can and cannot help to the fullest. I know in my case, my medication has brought me to a great place but it does not cure all evils. Therapy is a very big part of healing and in my case the meds only brought me so far. I am on one of the highest doses of two different anit depressants and I am in therapy weekly. I am getting there but it is a lot of work and understanding of myself. So in my case I feel both meds and therapy work habd in hand. I also feel that once prescribed medication, you need to ask the most important question of "what if I stop taking it"? We need to be warned of its side affects, in which case some are suicidal.
Dear Queen,
You make a excellent points!
~
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