Depressing news about antidepressants?

[oneday]

Interesting article in the latest edition of American magazine Newsweek (8th Feb 2010). It's headlined "The depressing news about antidepressants" with subtitle "Studies suggest that the popular drugs are no more effective than a placebo. In fact, they may be worse." (http://www.newsweek.com/id/232781)

The article is followed by a one page editorial article by a psychiatrist who disagrees with the research findings outlined in the main article.

Is this depressing news? If so, who for? I think the importance of 'placebo' - of the faith, the belief in, the attachment to psychiatric drugs (by both professionals and service users) may be the most important element in how most psychiatric drug treatments 'work' (if work they can be said to do).

Medications have been described elsewhere as the "holy water of psychiatry" (Openmind 82, Mind 1996, Holmes & Newnes).

Discuss?

Oneday

 

[honeyquince]

Explains why they mostly had no effect on me! It took an accumulation of four anti-depressants before the placebo effect kicked in for me! I must just be way too cynical .

 

[rasselas]

...

The cat has been out the bag for some time. It's meow has been growing louder in the media, perhaps largely due to the rising number of lawsuits in the usa against pharmaceuticals - which has resulted in some quite sickening revelations - check out the furious seasons blog...

Apotheosis posted an article looking at this last week. The author of that article seemed a bit uneasy about the cat being out of the bag, suggesting ethical ambiguities. If the drugs work only as a placebo, should we deny that placebo to people with genuine suffering who may find some relief?

To me, that's a Santa Claus type dilemma. Do we tell children he doesn't exist, and ruin the magic of Christmas?

Of course not. But then, Santa doesn't have fangs, whereas antidepressants do. If these drugs were not damaging, physically, sometimes permanently, then it would not be a problem. But because they do, I think it's unethical to use them and the cat must stay out of the bag.

What's most worrying though is that psychiatry is now moving towards widescale prescription of so-called antipsychotics to treat depression.

Problem: The cat is out of the bag.
Solution: Get another cat and put it in another bag.

Problem solved?

 

[oneday]

Hi again. Good points.

If the drugs work only as a placebo, should we deny that placebo to people with genuine suffering who may find some relief?

If antidepressants are mainly working by placebo effect and, as you say, mark, they have nasty 'fangs', I reckon that would be a reason for psychiatry to start giving people nice harmless placebo pills (if it's going to remain attached to giving people pills).And they could always retrain as homeopaths!

Back in spring 2008 there was a big study reported across the media showing that the SSRIs are no more effective than placebo. There was a GP on the radio then who said it used to be common practice for doctors to prescribe sugar pills or coloured water for complaints they had no other treatment for, or considered to be psychosomatic. It often helped, he said, but this was no longer permissible in the world of 'evidence based practice' and the National Institute for Clinical Excellence. Ah progress....

I seriously think that concerted effort should be put into research exploring what elements make up the placebo effect, remembering the placebo effect is held to be important in talking therapies too.

I have lots of questions about the medical model approach to mental distress generally, but I was intrigued to find these quotes from Florence Nightingale:

"We know nothing of the principle of health, the positive of which pathology is the negative, except from observation and experience. And nothing but observation and experience will teach us the ways to maintain or to bring back the state of health. It is often thought that medicine is the curative process. It is no such thing; ... nature alone cures. ... And what [true] nursing has to do ... is to put the patient in the best condition for nature to act upon him."

and,
"Homeopathy has introduced one essential amelioration in the practice of physic by amateur females; for its rules are excellent, its physicking comparatively harmless--the "globule" is the one grain of folly which appears to be necessary to make any good thing acceptable. Let then women, if they will give medicine, give homeopathic medicine. It won't do any harm."

 

[Affective]

Excuse my ignorance people but what is a 'Placebo'?

 

[oneday]

Hi, Affective. Good question!

Meaning of placebo? Someone else might have to help me here 'cause I’m struggling to write a clear definition….

My dictionary (the Concise Oxford) gives definitions:

a. a pill, medicine etc prescribed for psychological reasons but having no physiological effect; [physiological = physical/bodily]
b. placebo [!as defined above, presumably] used as a control in testing new drugs etc
c. a blank sample in a test

The word comes from the Latin verb ‘to please’ and literally means “I shall be acceptable or pleasing”.

This is me again now, not the dictionary….. As I understand it, inert pills etc made of chalk or sugar have traditionally been used in research tests on new drugs – so one group of randomly selected people are given the ‘placebo’ pills and the other group of randomly selected people are given the actual drug being tested. Then the findings are compared.

The presumption that someone is going to help you, and that a particular pill, injection or procedure is going to do you good, has a significant effect on whether you start to feel any better, whatever the ‘raw’ effects of any drug or procedure might be. So the doctor, with an authoritative air, gives you something (whether powerful drug or inert sugar pill) and says “Here, take this. It will make you feel better.” And if you have faith in, belief in, what the doctor says, and in the kind of treatment you’re given, you are likely to start to feel better. This applies to many physical and, perhaps especially, psychological problems

The placebo effect is said to create up to a 32% improvement in symptoms for many physical and psychological problems. This is why drug companies have the hassle of being required to test their new product against an inert substance in the first place – to show that it does significantly better than this baseline improvement which might happen whatever treatment you are given.

 

[firemonkee57]

http://psychcentral.com/blog/archives/2010/02/10/newsweeks-take-on-antidepressants-more-reactions/

http://psychcentral.com/blog/archiv...-do-antidepressants-work-for-many-people-yes/

 

[sakiww]

Is it?

It is a curious scenario.

Many of the pharmalogical solutions to mental imbalance give worse side effects - including depression that cannot actually be distinquished from the supposed diagnosis. It is a sad indictment that much of psychiatry actually boils down to profiteering on the part of drugs companies.

It is rather incredible that there are not any more gentle alternative treatments for depression(apart from cognitive ones). I can think of fish oils and omega 3,6. Are these impossible to replicate in a synthetic form without harsh inhibiting side-effects?

 

[firemonkee57]

It is a sad indictment that much of psychiatry actually boils down to profiteering on the part of drugs companies.

Whilst excessive profit making by drug companies is unacceptable and wrong i think it is simplistic to reduce psychiatry to being little more than a vehicle for drug company profiteering.
A drug company making reasonable profits and yet having a genuine desire to help people with mental illnesses don't necessarily have to be mutually exclusive things.

 

[rasselas]

...

The placebo effect is mind-bogglingly. It's bonkers.
But it isn't 'out there'. Strangely, effectively doing nothing can be doing everything. Just saying you are doing something, even though you are doing nothing, is doing something. It's the intention and the expectation. It's the interaction. Between people and between things.

This all sounds like mumbo jumbo, doesn't it? It sounds like the kind of wishy-washy, wooly jumpery, wind-chimery stuff of new age teepee-land.

The hippies deserve an apology!

Because it isn't wishy-washy. This is the stuff of science. Real, testable, do-able, exploitable science (pay close attention to what he says about the colour of pills - yes, the colour of your pills!)

Don't believe it? Think it's some sham dreamed up by anti-psychiatry communists in league with Satan?

Here's an NHS GP, Dr Ben Goldacre who does a great job explaining:

http://tinyurl.com/yhztyj4

This is truly fascinating stuff!

 

[firemonkee57]

http://www.psychologytoday.com/blog/in-practice/200902/more-naked-emperors

 

[rasselas]

...

You'll find dozens of psychiatrists all over the web posting frenziedly to try and wish this away. It's no wonder. This is a massive and bewildering and frightening challenge to their arrogance.

However, independent scientists (that is, not funded or connected to pharmaceuticals and psychiatry) have no reason to doubt its validity. And as Dr Goldacre says in the above video, it isn't just about taking one pill in place of another pill. It's about setting, expectation, colour even. I'll post some more stuff here.

I won't be linking to conjecture, although you're free of course to continue to do so.

 

[firemonkee57]

The idea that a scientist must not be linked to psychiatry to be independent is intellectually preposterous .

 

[rasselas]

...

The idea that a scientist must not be linked to psychiatry to be independent is intellectually preposterous .

Your last article was written by a psychiatrist not a scientist. He backs up his argument with one scientific study. That my friend, ironically, is bad science.

Anyway, here's some more from the good Dr Goldacre.

I think if you find all this kind of stuff frightening, disturbing, traumatic (I mean this generally, to no one in particular) or it brings about feelings of anger, frustration, tension etc

Don't watch it. But before you hurry off to find psychiatrists who want to debunk it you may wish to calmly consider it first.

http://www.badscience.net/2008/08/my-placebo-programme-on-bbc-radio-4/

 

[firemonkee57]

The fact that the last article i posted was by a psychiatrist is irrelevant to the issue of whether it is preposterous to say that a scientist must not be connected to psychiatry to be independent.

I don't happen to find what you post frightening, disturbing, or traumatic. I just can not intellectually agree with it.

Dr Ben Goldacre has some interesting stuff to say to be sure(I have his RSS feed) but that doesn't make him the sole expert on such matters.