Do Anti-Depressants Work?

For many patients, they do no more good than a placebo would.

I would suspect this is because some docs are too quick to prescribe them. For serious cases of depression, the study showed significant improvement. For others, no better than a sugar pill.

I’ve known many people on anti-depressants, mood stabilizers etc. The best doctors prescribed the meds to be used like a crutch, so that the patient could function and deal with whatever was causing the depression. As one psychiatrist explained to me, “It gets them to the point that they can work on things.” Doesn’t always work that way, of course. Patients with Bipolar Disorder, for example,  need to stay on the meds for life.

I do think some of the psychiatrists I worked with were hasty in simply putting the person on the pills. But I only thought that because they didn’t get better.

(…No, I wasn’t a patient.)

The human brain is spectacular in its complexity. Our level of tweeking it is about like the ape-men at the beginning of 2001: A Space Odyssey. We’re learning the tools and uses, but it’s still very crude.


17 Responses

  1. As the director of Novus Medical Detox we see many people addicted to alcohol and/or opioids, CNS, who are put on antidepressants because they are depressed. Generally, when they come off the alcohol/opioids, then they can stop taking the antidepressants because they don’t need them. Frankly, because of the studies that show they work no better than placebos and the side effects and the fact that there is no scientific test to determine if someone meeds seratonin. There is also the study of female suicides in Sweden in 2006 which showed that 52% were on antidepressants. Coupled with the fact that almost all of the school shooters were on antidepressants, we have a terribly dangerous set of drugs.

    Steve Hayes

  2. I think that antidepressants have their place; I just believe that they’re massively overprescribed. Too often we want to take a pill instead of going through a really painful process…such as recovery from an addiction, a divorce, grieving etc.
    I have known people who were helped by anti-depressants, but we’re talking about seriously depressed individuals, many of whom already had an Axis I diagnosis like bipolar disorder. For them, the AD med was one of many.
    I’ve also known people for whom the meds just “took the edge” off their depression long enough for them to do something about their cirmcumstances or change their self-defeating behavior.
    Like Eric Clapton says, “it’s in the way that you use it.”

  3. steve… steve… steve…

    I would hope that as a director of a clinic you have some type of social science degree, most of which require a basic statistics class. One of the first rules of statistics is that it takes more than a simple correlation of two statistics to establish a causal relationship. For instance, just because birds fly south for the winter and more babies are born in the Southern Hemisphere during those months, it does not stand to reason that the birds are causing fertility to rise (though perhaps the migratory storks are bringing the babies–I hadn’t really thought of that).

    It surprises me that ONLY 52% of suicides in Sweden occurred in people taking anti-depressants. After all, anti-depressants are usually the first thing prescribed for people reporting depression, and I would expect that around 99% of people who commit suicide are people who could be labeled as depressive (or who display another mental diagnosis for which SSRIs would be prescribed). So, in fact, you could argue that being OFF the medication is what caused 48% of the suicides… though I won’t argue that because (as I stated earlier) it is impossible to prove causality with just two statistics and an assumption.

    Just because 89.3% of people who die in automobile crashes possess driver’s licenses does not necessarily make the licenses themselves “terribly dangerous”.

    I do agree that studies strongly support that the chronic use of alcohol and/or unregulated ‘street’ drugs alters brain chemistry. It would thus stand to reason that when patients detox, their brains are chemically altered once again (and therefore may not need the prescription drugs the patient was using before).

  4. Dex,

    Incidentally when I became “newly single” in the separation/divorce process in 1999, that was also when I stopped taking my meds (an SSRI, a mood stabilizer, and a benzo). It was the right decision for me at the time because it allowed me to really assess myself and my life and my situation. But I took too long to go back to the meds, partly because of the idea that I needed to just “do something about [my] circumstances or change [my] self-defeating behavior” on my own. What you are saying about the meds taking the edge off and allowing the individual to take command of their own thoughts and actions is accurate, but I strongly believe the meds need to be part of a more holistic treatment plan, including talk therapy and/or some type of structured support.

    Virtually every study conducted on the subject has concluded that talk therapy by itself is at least as beneficial as the meds by themselves in most cases, and when the two are combined the patient has the greatest chance for long-term recovery.

    I myself am more strongly convinced than ever before that peoples actions are primarily their own responsibility, but that most feelings, impulses, attractions and addictions are chemically hard-wired into people’s adult brains through some combination of genetics and childhood psychodynamics.

  5. One more note:

    I should have mentioned in the paragraph starting with: “Virtually every study conducted on the subject… ” that these were studies where patients’ primary symptom was mild to moderate lingering depression, not Axis-2 disorders or psychotic disorders.

  6. (Caveat: I’m not talking about people with an organic condition that causes depression.)

    I’m sure Steve understands correlation and causation. In fact, I think much of his point has to do with that. Just because people start taking pills and feel better doesn’t necessarily prove the efficacy of the drug. Yeah, I know how that sounds, but other factors may very well be in place. Look at his sample population. They get off drugs; they don’t need the prozac anymore.

    Depression is naturally occuring but not spontaneously so. There’s always a reason for it, much like experiencing pain. Might be life circumstances, might be prolonged grief, might be the GOP nominee sucks, lots of things. And like pain, it’s there to tell you something.

    Talk therapy helps, exercise helps, a heathy diet helps, increased exposure to sunlight helps…all of them with results similar to taking antidepressants.

    This is why I think the pills are overprescribed. It’s easy to get compliance with “here, take this pill” than it is with “get some exercise and sunlight and quit living off of Butterfinger Blizzards.” (Guilty, Dex pleads). But they aren’t necessarily the right long term answer.

    “Just because 89.3% of people who die in automobile crashes possess driver’s licenses does not necessarily make the licenses themselves “terribly dangerous”.”

    Obviously, you haven’t known many teenagers…

  7. exactly… it’s the teenagers, NOT the 2″x3″ plasticized card in their wallet (now with 13 extra anti-counterfeiting features!)…

    Just as it’s depressed people who take the meds and depressed people who are the huge, huge majority of suicides, not necessarily the medication CAUSING the suicides, which is where I think Steve’s “terribly dangerous” comment was aimed.

    also, as for your caveat, isn’t the question of an “organic condition” largely what we are disagreeing about? whether chemically induced, nurtured from childhood, or genetic, I would argue that all of those depressions are “organic” because the brain has wired (or re-wired) itself on a neuro-cellular level.

  8. incidentally, it is interesting that your initial article is from a UK source about a UK study. it may or may not be related, but there is a significantly smaller percentage of people in the UK who have tested positive for AD/HD on the same tests they use in the US (on the order of about 2-2.5 times fewer). there are two prevailing theories on this:

    1. Somehow the higher-stim culture of America turns pseudo-ADD into actual ADD, or

    2. Differences in gene pools.

    If the correct answer is #2, it could affect the initial argument you’ve made. Not sure if this is relevant or not, though.

  9. I’m only picking on teenagers because of the ones who hotdog down my street at 3 a.m.

    As for all depression being chemical, yes, in the sense that we’re all $67 worth of chemicals put together in an interesting design. No, in the sense that you can rewire the brain yourself without any pharmaceuticals. In fact people do it all the time without realizing.

    Organic – sorry, bad choice of words. Meant chemical imbalance, chronic condition, probably inherited or as a result of physical injury or as a symptom of another mental illness

  10. So, I guess a good question is, do 52% of depressed people commit suicide when not medicated? There’s your baseline. If there’s a spike when they begin taking the meds, then you have your answer. I haven’t looked that up, but since all the anti-depressant ads now run “increased risk of suicidal thoughts” in their disclaimers, I would suspect that there’s some causal effect. Perhaps its as simple as the patient now having enough energy to kill themselves. I don’t mean that to sound callous, but many people with major depression simply CAN’T get out of bed in the morning. Or the afternoon. If the meds alleviate that without addressing the source of the depression or suicidal ideation, then I can see an increased risk.

    As for terribly dangerous, I don’t know. Steve was saying that there’s no way to test and see if someone’s serotonin level is too low or high before the psychiatrist begins monkeying around with it. Could be very dangerous, depending on the patient. Then again, might just help them sleep better. I think, in re-reading his comment, that was his point.

    I have no idea if American kids are more stimulated that British kids are. Difference in diagnosis rates could be as simple as differing tests administered in different countries, or perhaps Americans are more willing to put their kids on drugs, might be a difference in diet (for instance Omega-3 seem to help with ADD and American kids may not consume enough fish-n-chips). Or it could be a gene pool thing.

  11. But that’s kind of my point: There are many factors involved and too little investigation before the family doctor or ob/gyn or cardiologist prescribe antidepressant medications. Roughly 43% of prescriptions come with NO diagnosis and no follow up. Cite
    That’s how you get this result from this study. It’s being prescribed to people who don’t need it and don’t benefit from it.

    You’ll have a hard time getting me to say the same isn’t true of ADD as well.

  12. thanks big D… I actually think we’re on similar pages here… I agree with just about everything you’ve said; I think our differences may be semantic and the elements we stress more than anything else.

    I also agree that there is a culture of treating patients like guinea pigs with certain drugs to “see if this will work or not”… but I think the reasons for this are part of a larger picture consisting of the FDA, AMA, health care availability and drug company tactics, not to mention the ominous threat of malpractice hanging over every physician and the culture of litigiousness that has blackened that cloud.

    It is very, very easy for doctors to “just prescribe something” and our culture has become conditioned to that. Unfortunately our culture also stresses (party because of financial burdens) that we don’t see doctors until we are really, really sick, and the average patient doesn’t want to pay the bill (or the copay) for a follow-up visit if they can help it.

    Thanks for a good conversation, gents. Now I’m taking my Ritalin and going home.

  13. Ritalin? Heh. I get my speed the old fashioned way, brewed fresh every morning.

  14. …and now this story in one of our local “alterna-weekly” papers:

    Let the piling on begin… 😉

  15. that article, the one from your alterna-weekly, seems to be more damning of big pharma than AD meds. Which one expects from the alterna-weeklies, I suppose.

  16. Thanks for the heads-up on Mrs. Peel… fun stuff!

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