Antidepressant drugs don't work – official study

Old Sib

New Member
From the London Independent

By Jeremy Laurance, Health Editor
Tuesday, 26 February 2008


They are among the biggest-selling drugs of all time, the "happiness pills" that supposedly lift the moods of those who suffer depression and are taken by millions of people in the UK every year.


But one of the largest studies of modern antidepressant drugs has found that they have no clinically significant effect. In other words, they don't work.

The finding will send shock waves through the medical profession and patients and raises serious questions about the regulation of the multinational pharmaceutical industry, which was accused yesterday of withholding data on the drugs.

It also came as Alan Johnson, the Health Secretary, announced that 3,600 therapists are to be trained during the next three years to provide nationwide access through the GP service to "talking treatments" for depression, instead of drugs, in a £170m scheme. The popularity of the new generation of antidepressants, which include the best known brands Prozac and Seroxat, soared after they were launched in the late 1980s, heavily promoted by drug companies as safer and leading to fewer side-effects than the older tricyclic antidepressants.

The publication in 1994 of Listening to Prozac by Peter Kramer, in which he suggested anyone with too little "joy juice" might give themselves a dose of the "mood brightener" Prozac , lifted sales into the stratosphere.

In the UK, an estimated 3.5 million people take the drugs, collectively known as selective serotonin reuptake inhibitors (SSRIs), in any one year and 29 million prescriptions were issued in 2004. Prozac, the best known of the SSRIs made by Eli Lilly, was the world's fastest-selling drug until it was overtaken by Viagra.

In the study, researchers conducted a meta-analysis of all 47 clinical trials, published and unpublished, submitted to the Food and Drug Administration in the US, made in support of licensing applications for six of the best known antidepressant drugs, including Prozac, Seroxat – which is made by GlaxoSmithKline – and Efexor made by Wyeth. The results showed the drugs were effective only in a very small group of the most extremely depressed.

Two drugs were excluded from the study because of incomplete data. A third drug, chemical name nafazodone, has been withdrawn from the market because of side-effects.

Professor Irving Kirsch of the University of Hull, who led the study published in the online journal Public Library of Science (PLoS) Medicine , said the data submitted to the FDA would also have been submitted to the licensing authorities in Britain and Europe. It showed the drugs produced a "very small" improvement compared with placebo of two points on the 51-point Hamilton depression scale.

That was sufficient to grant the drugs a licence but did not meet the minimum three-point difference required by the National Institute for Clinical Excellence (Nice) to establish "clinical" significance. Yet Nice approved the drugs for use on the NHS in the UK because it only had access to the published trials, which showed a larger effect.

Professor Kirsch said: "Given these results, there seems to be little reason to prescribe antidepressant medication to any but the most severely depressed patients, unless alternative treatments have failed to provide a benefit. This study raises serious issues that need to be addressed surrounding drug licensing and how drug trial data is reported."

Five years ago, there were allegations that antidepressant drugs were addictive and could trigger suicides. All but Prozac were banned for children, although a major investigation on the safety of medicines cleared them of causing suicide in adults.

Alternative treatments for depression, such as counselling or physical exercise , should be tried first, Professor Kirsch said. The pharmaceutical companies had withheld data that was available to the licensing authorities so that doctors and patients did not understand the true efficacy, or lack of it, of the drugs.

"This has been the frustration. It has made it very difficult to answer the question of whether the drugs work. The pharmaceutical companies should be obliged when they get a drug licensed to make all the data available to the public. When you analyse all the trials of these SSRIs, both published and unpublished, it leads you to more sober conclusions," he said.

Tim Kendall, deputy director of the Royal College of Psychiatrists' research unit, said the findings, if proved true, would not be surprising. As head of the National Collaborating Centre for Nice guidelines on mental health, he said it had proved impossible to get access to unpublished trials in the past.

"The companies have this data but they will not release it. When we were drawing up the guidelines on prescribing antidepressants to children [in 2004] we wrote to all the companies asking for it but they said no. The Government pledged in its manifesto to compel the drug companies to give access to their data but that commitment has not been met."

The new finding would make doctors "much more cautious about prescribing the drugs," Mr Kendall added.

GlaxoSmithKline, makers of Seroxat, said the authors of the study had "failed to acknowledge" the very positive benefits of SSRIs and their conclusions were "at odds with the very positive benefits seen in actual clinical practice." A spokesperson added: "This one study should not be used to cause unnecessary alarm for patients.

Lilly said in a statement: "Extensive scientific and medical experience has demonstrated that fluoxetine [Prozac] is an effective antidepressant.

Wyeth said: "We recognise the need for both pharmacological and non-pharmacological treatments for depression."

On the new training for therapists, Mr Johnson said the programme signalled a decisive shift away from drugs in favour of non-drug treatments for depression. "We are not taking the decision away from clinicians," he said.

"For many, medication is successful. But talking therapies can have dramatic effects. We have put a lot of emphasis on medication in the past and it is about time we redressed the balance and put more emphasis on talking treatments."

The treatments that do work

* Exercise: Helps some people with depression. Douglas Adams, author of The Hitchhiker's Guide to the Galaxy, said running helped him cope with depression.

* Friends: Talking through your feelings can help in mild depression with a friend or relative or in a self-help group.

* Cognitive behavioural therapy: Teaches you to challenge negative thoughts and feelings of hopelessness.

* Interpersonal therapy: Focuses on relationships and problems such as difficulties with communication.

* Counselling: Helps you think about the problems in your life and find new ways of dealing with them.

* Antidepressants: Increasingly seen as a second-line treatment, if exercise or talking treatments do not work.
 

mozzia

Voluntary Member
Without going into too much personal detail, I was in the more severely depressed category, and I really needed help.
I was prescribed anti-depressants by the doctor, on my first visit (last July..i think), and have been taking them ever since. I had a bad time in the first few weeks, with fatigue, inability to sleep, aching e.t.c, but that gradually went away.
I've also had talking therapy. Sadness is becoming much less of a problem, and i'm starting a self-esteem class today. It could be one or all of the following things that have helped me: finally seeing a doctor after years of needing to; being on medication; talking therapy; or other options. But, I feel better...and whether i would have without pills or not, i don't really care. I feel better, and thats what matters the most....even if i'm on these pills forever, and then find out i might have never needed them at all...whatever, i'm happy :D
 

nugz

SUPAHSTAR!
ok and what about all those "official" studies that say they do??? :cool:

you can't say they do or dont either way. depression is such a complex disease, it's different with everyone. i for one, have taken anti depressants during a few different periods in my life and the effects were different each time, with the same exact drug. so really, who the hell knows.

don't get all tom cruise on our ass, please. :rolleyes:
 
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snowfallsoon

motherfucker approved
Mozzia,
glad you're feeling better.

The truth is, the ones who are doing these studies can make them say whatever they
want. Of course SSRI's work. Having someone try to deal with depression without ever
trying meds is just cruel IMO. Especially when you are so depressed the last thing you
want to do is drag yourself to therapy.

Good luck getting any information on unpulblished trials for any drug.
 

snowfallsoon

motherfucker approved
ok and what about all those "official" studies that say they do??? :cool:

you can say they do or dont either way. depression is such a complex disease, it's different with everyone. i for one, have taken anti depressants during a few different periods in my life and the effects were different each time, with the same exact drug. so really, who the hell knows.

don't get all tom cruise on our ass, please. :rolleyes:


LOL he's an ass!
 

PregnantForTheLastTime

Hideous trait.
The hell they don't.


Putting my rational hat back on- in order to be considered clinically effective, a drug only has to be more effective than a placebo. And the placebo effect is good for an improvement something like 30% of the time. And quite frankly I don't care if I take pills made of nothing but NutraSweet as long as they work.
 

Zelda Zonk

New Member
Is it April 1st??

No, but seriously, interesting reading. I do not like to trust medical companies at all...particularly Eli Lilly...however, while I would advise people to go on alternative routes first, I can say that prozac certainly gave me a lift and a kick up the backside. My energy levels were at an all time high. I'm interested in knowing the different reactions the drug has had on individuals.
 

Busy Clippers

New Member
Prozac, the best known of the SSRIs made by Eli Lilly, was the world's fastest-selling drug until it was overtaken by Viagra.
I once interviewed a homeless guy about getting help, but he said the only drug that ever lifted his depression was Viagra and if we wouldn't give him that then he might as well stay under the expressway. Who says those guys don't have a sense of humor?
 

bogdana

Finer Things Club Prez
Antidepressants are quite effective, one "Study" does not a proven theory make.
Happiness pills my ass, btw. Its "deal with life without wanting to kill yourself, and finally feel like normal" pills.

Prozac wasnt taken over by viagra. Prozac is still Eli Lilly's. However, it is widely available generically and they reformulate it so they can sell brand drugs at higher prices.

and Viagra doesn't own shit. Viagra is made by Pfizer. This article is a load of subjective garbage.

Most doctors agree that combination therapy, ie antidepressants and cognitive therapy together, work very well. I'd like it if people who are not psychiatrists or medical doctors would stop posting ridiculous articles like this.
 
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Mmmmmm

Dangling Member
The article doesn't quite capture the conclusion of the meta-analysis in question. SSRI's are indeed effective for acute care treatment of depression and dysthymia but appear to be no more effective in the long term than RET or CBT or any of a number of other clinical psychological practices - and may in fact be as effective only because most prescribing doctors engage in some form of 'talk therapy' during the diagnosis and treatment of depression.

This doesn't exactly make Prozac a placebo as the article implies (not that prescribing placebos is an unsound practice). The article vilifies drug companies without acknowledging the mechanism that drive prescription. Insurance companies would prefer to buy pills by the bucket rather than pay for a 20 hour CBT program (at $150/h). You think those guys don't read efficacy studies?
 
The study is arguing that the pills are not as effective as the drug companies would like us to believe. That they do work for some people, but are best combined with other therapies. The main argument of the article is that the drug companies would not reveal the full results of their own trials showing how their research figures had been manipulated to give a stronger "result".

It's true statistics are used to justify opposing assertions. Finding a reliable source is difficult.
Everyone has their personal experience, which contributes to the debate but does not prove a case either way. I know people who have taken anti-depressants short term and had a good result. But also others who came to rely on them and were unable to resolve the causes of their depression.

My own experience. I tried Prozac and it made things ten times worse.
 

bogdana

Finer Things Club Prez
The study is arguing that the pills are not as effective as the drug companies would like us to believe. That they do work for some people, but are best combined with other therapies. The main argument of the article is that the drug companies would not reveal the full results of their own trials showing how their research figures had been manipulated to give a stronger "result".

It's true statistics are used to justify opposing assertions. Finding a reliable source is difficult.
Everyone has their personal experience, which contributes to the debate but does not prove a case either way. I know people who have taken anti-depressants short term and had a good result. But also others who came to rely on them and were unable to resolve the causes of their depression.

My own experience. I tried Prozac and it made things ten times worse.
sometimes antidepresssants do make it worse. bodies are very specific machines. something may work for one and not at all for others. sometimes the opposite effects occur. Some drugs work and people dont know why. They understand and theorize how it works but they cant say why.

I think my main point is this is a terribly written, one sided, flighty article and no one should garner one iota of truth out of it. I don't even see references.
 

hatfull

HIM-full
ok and what about all those "official" studies that say they do??? :cool:

you can't say they do or dont either way. depression is such a complex disease, it's different with everyone. i for one, have taken anti depressants during a few different periods in my life and the effects were different each time, with the same exact drug. so really, who the hell knows.

don't get all tom cruise on our ass, please. :rolleyes:
this is just one study. I've tried antidepressents, I'm not afraid to admit it, and they didn't work for me. They might have made me less depressed, I'm not sure, but they made me ill physically. I know a few other people who have tried them and not had them agree with them, but I also know a few people who they work for.
 

almareallymatters

Active Member
this is just one study. I've tried antidepressents, I'm not afraid to admit it, and they didn't work for me. They might have made me less depressed, I'm not sure, but they made me ill physically. I know a few other people who have tried them and not had them agree with them, but I also know a few people who they work for.
I agree...it's a very individual thing...they worked for my Mum but a nasty side-effect of the drugs she took was that they caused her to gain a lot of weight very quickly....so she got depressed about that and would stop taking them...then get depressed again...round and round she would go....ultimately though I would say that they did work for her.
 

HIM

New Member
 

Musley

wild and free
I've had various anti-depressants over the yearrs, and you know what, they don't bloody work most of the time. I don't have them anymore. I refuse to take them. If I feel down I feel down, it passes. I can do a lot of things to help myself and listening to Morrissey is great therapy and that is the honest truth.
 
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