Antidepressants work!

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This appears to have been a very good quality metastudy that demonstrates that antidepressants work (for moderate to severe depression, anyway).

It makes the point that different antidepressants have differing levels of effectiveness, and we all know that people respond in different ways, but it's an interesting study.

From personal experience, I know sertraline is very effective for me. Whether it's a placebo effect, I can't say. But I've started it twice now and both times it's had a very positive effect.


http://www.bbc.co.uk/news/health-43143889

[pulisa]

Interesting that amitriptyline is the most successful anti depressant and citalopram and fluoxetine not so good. Very "general" of course.

To be honest I thought when I first read this this morning that the fact that antidepressants mostly work better than placebos was hardly news to celebrate. I mean you would think that there would have been copious studies before the meds were actually prescribed to patients in the first place. I wonder how much money was spent on this study?

[ServerError]

That's an interesting point, pulisa.

There's always been debate around whether or not antidepressants work. This certainly isn't the first study that suggests they work, but it's the size of this one that lends it so much credence.

No doubt the debate will continue regardless.

Just as an interesting and entirely subjective observation, I've known a few people take citalopram and all of them had to switch to something else.

[pulisa]

One day we'll all have meds tailored to our brain's needs without having to endure the hell of trial and error prescribing! We'll just have an electrode placed on our skull and hey presto, instant prescription! Psychiatrists will be redundant as the digital age takes over..
I'll be long gone by then of course:D

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I suspect I will too!

[MyNameIsTerry]

Finally puts the issue to bed? How? It's a meta-study, effectively a bloke sitting at a desk in front of a database pulling out studies and then comparing them to look for commonalities? The only addition is information from the drug companies that they have been asked to provide :shrug:

If this solves the issue, the issue was already solved. So, sounds like some spin to me.

It's interesting that out of the most effective only two are easier to access and the rest are more after you've ridden the rollercoaster for a bit first. And Escitalopram is more expensive than Citalopram hence why they try you on the latter first. :whistles:

The trouble with studies is they are short term. They said this one is based on 8 week studies. So, it's only about reaction to the drug, which is what the drug companies do in their clinical trials to prove a med works. But we all know success is measured in the long term. That's what I dislike about these studies as they don't seem to follow up on anything. For all we know the patients could crash again after 3 months and end up switched.

I would love to know how exactly this proves anything:

"Importantly, the paper analyses unpublished data held by pharmaceutical companies, and shows that the funding of studies by these companies does not influence the result, thus confirming that the clinical usefulness of these drugs is not affected by pharma-sponsored spin."

Drug companies "gave" them information not previously published. :winks: So, was that a legal warrant with consequences or just asking them to be good and release everything they found? :whistles: So, if they had a paragraph in a piece of text somewhere that said "this drug pooped out after 9 weeks and therefore is a load of rubbish" are they going to release that? That statement is very convenient for the drug companies and you have to wonder what the relevance of this statement actually is since we are interested in the drug rather than the money trail.

One professor says this proves they have a role in managing depression. Yes, but only if you have depression for 8 weeks...

Studies are usually made with as much clean data as possible. Dirty data makes studies hard to get conclusions from. But the trouble is, this isn't a clear cut issue and "dirty" is how a lot of mental health patients are e.g. you may have multiple conditions = you can't go in our study. Great to prove an effect but in vivo that's not how we are.

Well worth a discussion but I think I'll go with sceptical on this one. It's a pity the BBC just parrot out what they are told rather than look into things.

EDIT: Just to say that I'm not being critical of you SE, just the study. It's well worth a post & discussion.

[WiseMonkey]

Interesting that amitriptyline is the most successful anti depressant and citalopram and fluoxetine not so good. Very "general" of course.

Interesting as it can be trial and error till you find one that works for you. I had to start antidepressants in 1987 when I had post-natal depression (and unknown to me, CFS as well). Back then there were only the tricyclics and MAO's if tricyclics didn't work.

I started on Prothiaden (which did nothing), then onto Doxepin (a cousin to amytriptyline), which worked well once it reached a substantial level. Since that time I've used it on and off at a low level 10 mgs, as it's helpful for autoimmune conditions (not depression, but helps sleep)

I remember trying an SSRI once and I was climbing the walls within an hour! Just gave me so much anxiety, I just can't take them.

Later when my father developed depression after heart surgery, they put him straight onto Doxepin as it had worked so well for me. The specialist said that family members often respond well to the same antidepressant. My dad did well on that.

[AntsyVee]

Well, I appreciate posts like this. There are so many anti-medication websites out there. It’s quite sad when you think that there are billion dollar industries like Scient ology putting out anti-med, anti-psychiatry information all the time. As a person who uses meds quite effectively, I sometimes get tired of having to explain to people that meds have not altered my personality or made me a zombie.

[MyNameIsTerry]

Something else I've come across in reading med studies is that those who drop out are excluded from the results. So, you get a comparison of placebo vs. the med but only of those that went the full term of the study.

So, what if some dropped out because it made them worse? Excluded. Head in sand, you didn't happen.

I think these people should be studied as part of standard to determine whether the drug contributed in any way to them dropping out of the study. But from the limited studies I have read, they make no mention of this.

Where are such people represented in metastudies? They likely aren't. It's "dirty" data. They can't easily be made sense of and they can split into a number of buckets. But I still think they could determine a % of this dropout % where they can prove the patient was made substantially worse without any environmental factors that could cause it.

But that wouldn't sell drugs though, would it? :winks:

[WiseMonkey]

Something else I've come across in reading med studies is that those who drop out are excluded from the results. So, you get a comparison of placebo vs. the med but only of those that went the full term of the study.

So, what if some dropped out because it made them worse? Excluded. Head in sand, you didn't happen.

I think these people should be studied as part of standard to determine whether the drug contributed in any way to them dropping out of the study. But from the limited studies I have read, they make no mention of this.

Where are such people represented in metastudies? They likely aren't. It's "dirty" data. They can't easily be made sense of and they can split into a number of buckets. But I still think they could determine a % of this dropout % where they can prove the patient was made substantially worse without any environmental factors that could cause it.

But that wouldn't sell drugs though, would it? :winks:

Somewhat similar (although different) was a 'large study' that was conducted in the USA, where elderly persons in rest homes, taking antidepressants (all types) were monitored for signs of dementia. The findings stated that even small amounts (10 mgs) taken over 2 years could result in dementia. It also found that benzodiazepines, antihistamines, blood pressure and muscle relaxant meds could contribute to this.

When I read this, my brain did a small 'oh dear' I've been on this low dose for many years!

The article was published in the Herald here in New Zealand. When I next saw my Dr, she strongly suggested that I stop taking my 10 mgs of Doxepin. This lead me to swapping to Amitriptyline, cutting it into pieces (as it's a solid pill, Doxepin is a capsule) then stopping it. A couple of weeks afterwards I had an awful attack of IBS, which subsided when I started Doxepin again!

I mentioned this to my rhumatologist (about the study) and he said he may have seen the article, but there was nothing in any recent medical publications which indicated that antidepressants at a low dose caused dementia.

Tricyclic antidepressants have been around since the early 1960's. Many people have taken large doses for many years, along with antihistamines, blood pressure meds and even muscle relaxant meds.

I like to think that there are more variables in these studies than are allowed for when conducting these.

[MyNameIsTerry]

Somewhat similar (although different) was a 'large study' that was conducted in the USA, where elderly persons in rest homes, taking antidepressants (all types) were monitored for signs of dementia. The findings stated that even small amounts (10 mgs) taken over 2 years could result in dementia. It also found that benzodiazepines, antihistamines, blood pressure and muscle relaxant meds could contribute to this.

When I read this, my brain did a small 'oh dear' I've been on this low dose for many years!

The article was published in the Herald here in New Zealand. When I next saw my Dr, she strongly suggested that I stop taking my 10 mgs of Doxepin. This lead me to swapping to Amitriptyline, cutting it into pieces (as it's a solid pill, Doxepin is a capsule) then stopping it. A couple of weeks afterwards I had an awful attack of IBS, which subsided when I started Doxepin again!

I mentioned this to my rhumatologist (about the study) and he said he may have seen the article, but there was nothing in any recent medical publications which indicated that antidepressants at a low dose caused dementia.

Tricyclic antidepressants have been around since the early 1960's. Many people have taken large doses for many years, along with antihistamines, blood pressure meds and even muscle relaxant meds.

I like to think that there are more variables in these studies than are allowed for when conducting these.

That's very interesting.

There was a recent study into benzos and dementia across a large sample which they stated showed a correlation between dementia and benzo use. The trouble is the devil is in the detail and they had only performed a statistical analysis therefore there had been no attempt to make a real world connection between the two.

The same researchers concluded it is still unproven because many of the elderly taking benzos could have been prescribed them due to signs of dementia.

Some journalists chose to omit that second part... a result was we start getting threads about it on here.

It is also interesting what your rheumatologist said. Not all studies pass peer review and so I wonder how many of these have in the OP. They will be pulled from databases so we have to trust in peer review where any bias would be spotted.

Another example is Pregabalin. This med has a reputation for being a drug of choice by substance misusers and it has had some biased studies & reports which make me suspicious of what the medics are trying to push.

For instance, the BBC reported on the NHS in Northern Ireland as well as took personal interviews with former substance misusers. This was then grouped up into "Pregabalin is a bad med" without removing the misusers from those who take the med responsibly. Misusers take massive doses of this med to get a high from it as well as combine it with other substances. But who cares? Benzos are used the same and there is less resistance to prescribing those.

The BBC then went on to show how Pregabalin prescribing is split by England, Scotland, Wales & NI. This showed NI was far higher. The NHS concluded they needed to cut down on it's use. Why? Surely they should conduct further study into why that is? For instance, it's a pain med and NI has suffered terrorism. Terrorists were known to torture people as well as kill them and this could be a contributing factor.

Then there was a study somewhere in Europe at a university. This seemed quite credible and there were no conflict of interests or funding concerns. But if you read the paper you would see how their conclusions didn't match the numbers they reported in the study. Again "Pregabalin is bad" yet all the bad was due to overdose in those suicidal and gave no consideration to responsible use. So, who was pushing for Pregabalin to be restricted further?

With a metastudy it is easy to create bias. You search the database only for studies that suit the result you want to provide. Any problematic studies, you omit without stating it. We just have to hope the nature of peer review means any psychiatrists pushing bias get picked up. I would hope this to be the case with this being published in The Lancet and I seem to recall they have a comments section where other professionals place their comments.