I've been seeing occasional studies go by about the use of anti-depressants in treating depression. Some seem to imply that they are at least over-prescribed (which may in itself not be all that bad, if the side effects are negligible), and that the primarily work by the placebo effect. Anybody know something definite on this?
asked Mar 11, 2011 at 3:04
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It would be helpful to elaborate on what you have read. It saves us from reiterating what you have read, and most of all it helps you get a more specific and relevant answer!– Borror0Mar 11, 2011 at 3:09
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The evidence base for different antidepressants is very different. Given that we closed the E-Number question I would also close this question and recommend to instead ask a question about a specific antidepressants.– ChristianMar 11, 2011 at 12:44
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1 Answer
Yes. Antidepressants have been around for more than fifty years and are effective in treating depressive disorders. They do absolutely work.
I've been seeing occasional studies.. ..that the[y] primarily work by the placebo effect.
I think I know where you might be getting this idea.....
Some members of the press and general public are questioning the efficacy of all antidepressants based on the conclusions of a 2010 meta-analysis* in which two antidepressants, Imipramine and Paroxetine, where used in the six studies analyzed. The analysis team concluded the following (emphasis mine):
“[E]fforts should be made to clarify to clinicians and prospective patients that whereas [antidepressant medication] can have a substantial effect with more severe depressions, there is little evidence to suggest . . . specific pharmacological benefit for the majority of patients with less severe acute depressions.”
Much of the confusion about the use of these drugs comes from using the term "depression" out of a medical context. There is a big difference between feeling depressed for a few days and having a depressive disorder. From the NIMH:
When a person has a depressive disorder, it interferes with daily life, normal functioning, and causes pain for both the person with the disorder and those who care about him or her.
Some general forms of depressive disorder (also from the NIMH)...
- Major depressive disorder, also called major depression, is characterized by a combination of symptoms that interfere with a person's ability to work, sleep, study, eat, and enjoy once–pleasurable activities. Major depression is disabling and prevents a person from functioning normally.
- Dysthymic disorder, also called dysthymia, is characterized by long–term (two years or longer) but less severe symptoms that may not disable a person but can prevent one from functioning normally or feeling well.
- Psychotic depression, which occurs when a severe depressive illness is accompanied by some form of psychosis, such as a break with reality, hallucinations, and delusions.
**Meta-analysis can never follow the rules of science, for example being double-blind, controlled, or proposing a way to falsify the theory in question. It is only a statistical examination of scientific studies, not an actual scientific study, itself.*
Anybody know something definite on this?
JAMA Psychiatry is a good starting point for researching the research.
Some random supporting research on antidepressants.....
Long-term antidepressant efficacy and safety of olanzapine/fluoxetine combination: A 76-week open-label study Conclusions: The olanzapine/fluoxetine combination showed rapid, robust, and sustained improvement in depressive symptoms in patients with MDD, including patients with TRD.
Treating Major Depression in Primary Care Practice Results: Severity of depressive symptoms was reduced more rapidly and more effectively among patients randomized to pharmacotherapy or psychotherapy than among patients assigned to a physician's usual care.
Cognitive Therapy vs Medications in the Treatment of Moderate to Severe Depression Results: The advantage was significant for medication relative to placebo, and at the level of a nonsignificant trend for cognitive therapy relative to placebo.
Serotonin Function and the Mechanism of Antidepressant Action
Antidepressant classifications:
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Second this. Apart from provably and observably working, one has to consider that most antidepressants have some quite serious and uncomfortable counter-effects. That's the major reason (besides having little or no effect on "normal" people) that there is zero abuse potential in them. No healthy person would take them. Yet, people with depressions do take them. Why would they? Because the drugs help them, and they help much more than the adverse effects impact them.– dm.sktMar 11, 2011 at 13:37
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There's a further classification that I know of, namely NMDA antagonists. Ketamine is the best known member of this class. Ketamine has some effects that make it fairly unsuitable as a therapy in the community but it does hold out hope that other NMDA antagonists will be added to the antidepressant armoury.– user2466May 14, 2011 at 6:07
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I have been reading a bit about all the buried and biased studies that was exposed a few years back. (rense.com/general81/1v.htm) Do you have any comments on that?– NostrumNov 15, 2011 at 17:56
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Here to add that studies which show negative effects never get published. This is the same with medicine. Its actually a huge problem– Xitcod13Jan 12, 2013 at 1:59