Study: Antidepressants no better than a placebo for many patients
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Many millions of people use antidepressants, but do they work, and if so, for whom? JAMA has just published the results of a recent study on the question.
Many millions of people use antidepressants, but do they work, and if so, for whom? JAMA has just published the results of a recent study on the question.
Antidepressants most likely have little or no effect on the majority of those suffering from slight or non-severe forms of depression, and placebos were often observed to have just as much perceived beneficial affect.
Antidepressants are, however, very efficient in combating severe depression. Those are the conclusions of an analysis of six randomized placebo-controlled trials of antidepressants approved by the Food and Drug Administration in the treatment of major or minor depressive disorder. The analysis was carried out by a team of researchers from Pennsylvania University led by doctor Jay Fournier. The study was published Wednesday in the Journal of the American Medical Association (JAMA.)
Included in the analysis were the results of six therapeutic trials (involving a total of 718 patients) lasting six weeks each and designed to compare the relative effects of antidepressants and placebos.
Various drugs were used in the different studies, including Imipramine, which is a common trycyclic antidepressant from the dipenzazebine group, and Paroxetine, a drug from the selective serotonin reuptake inhibitor family which is used to treat severe depression. Prozac is a well-known example of that class of drugs.
Trial end results showed that whatever the drug used, the conclusions were the same -- in cases of severe depression, antidepressants were much more effective than placebos, but on the other hand, the beneficial effects of drug molecules was observed to be minimal, or even nonexistent, in patients treated with drugs adapted to conditions of mild depression, and placebos worked just as well.
In the complete version of the study, Fournier expressed his surprise at the severe levels of depression necessary to be able to observe superior results from drugs over placebos. Another conclusion by the research team is that it appears that neither patients or healthcare professionals are aware that most studies which claim to demonstrate the efficiency of various antidepressants only used patients suffering from severe forms of depression, which would spin the study conclusions.
It was also pointed out that that information is not included in marketing efforts employed by the drug producing companies concerned.
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Oh I am sad to read that you suffer from pain like that Valentines, and I know that the climate up there can be (and is right now as I understand it) very tough.
Fentenal duragesic and loritab are opiate-based pain relievers as you know, so they won't help your need for antidepressants if you need antidepressants to combat the negative side of pain if the pain relievers don't relieve your pain, that's for sure.
I must emphasiise strongly that I am not at all qualified to say what you should do here but I do know that prolonged and/or severe pain can lead to a depressive state. That's why the discipline of 'pain management' exists, and it includes treating various types of depression that can result from pain.
I interviewed a pain management expert a while back and published the article here on F&S.
You may find it interesting and you can read it here;
http://www.fleshandstone.net/commentary/1661.html
Take care of yourself,
Michael
I understand why you study just those with depression but when you do and it's volunteers, then that's not even close to the reality of clinical psychiatry and psychotherapy. Most people with depression have an anxiety disorder or other diagnosable condition, even if it's prominent sub clinical anxiety, PTSD, etc. These are the people who are at the greatest risk and who need to be subjects of research, multiple diagnoses an all.
People need to accept that the brain is connected to the body and that there are conditions involving the brain, mind, and the outside world, which includes the individuals history. As such, medication can play a role and does. The notion that anti depressants either work or don't work is primitive.
There were similar findings for adolescent use of anti depressants in the 1990's. That did'nt deter those select adolescents who were having an early onset major depression from benefiting from medication.
If someone wants to do beneficial research, they'll study the fact that SSRI's and stimulants can kick in a manic or psychotic episode in someone who is either undiagnosed or latent for those conditions. If you work in the field, you know this but it's the 800 pound gorilla that no one wants to talk about.
But "they work" or "they don't work" is not even worth discussing. Anti depressants work well and are life savers in every sense of the term for some people. The people who benefit most, however, are systematically excluded from study. Something is very wrong with that.
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