The antidepressant debate

By Felix Salmon
July 11, 2011
big essay by Peter Kramer, the author of Listening to Prozac.

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The NYT’s new-look Sunday Review led this weekend with a big essay by Peter Kramer, the author of Listening to Prozac. But for all its length and detail, it’s very hard to read — at many points, doing so feels like listening to one half of a telephone conversation. Which makes sense when you consider Kramer’s opening paragraphs:

In terms of perception, these are hard times for antidepressants. A number of articles have suggested that the drugs are no more effective than placebos.

Last month brought an especially high-profile debunking. In an essay in The New York Review of Books, Marcia Angell, former editor in chief of The New England Journal of Medicine, favorably entertained the premise that “psychoactive drugs are useless.” Earlier, a USA Today piece about a study done by the psychologist Robert DeRubeis had the headline, “Antidepressant lift may be all in your head,” and shortly after, a Newsweek cover piece discussed research by the psychologist Irving Kirsch arguing that the drugs were no more effective than a placebo.

I’ve included, here, all of the links that Kramer provides. Which is exactly one, to the NYT topic page on antidepressants. If you want to find Angell’s article, or the USA Today piece, or the Newsweek cover story, you’re on your own: Kramer and the NYT won’t help you. And Kramer, clinical professor of psychiatry at Brown University, takes care not to even mention part two of Angell’s two-part series, where she talks at length about how psychiatry has been captured by drug companies, who “are particularly eager to win over faculty psychiatrists at prestigious academic medical centers”. (After reading Angell’s second essay, you’ll certainly wonder why Kramer doesn’t disclose how much income he gets from pharmaceutical companies.)

In any case, if you read Kramer’s piece and wondered what on earth he was talking about, then I would highly recommend you now read Angell, both part 1 and part 2. In general, the NYRB is a bit harder to read than the NYT, but not in this case — Angell’s essays are models of clear and powerful empirically-based argument, while Kramer’s looks positively messy and incoherent in comparison.

Here, for instance, is Angell:

For obvious reasons, drug companies make very sure that their positive studies are published in medical journals and doctors know about them, while the negative ones often languish unseen within the FDA, which regards them as proprietary and therefore confidential. This practice greatly biases the medical literature, medical education, and treatment decisions.

And here’s Kramer:

Not long ago, I received disturbing news: a friend had had a stroke that paralyzed the right side of his body. Hoping to be of use, I searched the Web for a study I vaguely remembered. There it was: a group in France had worked with more than 100 people with the kind of stroke that affected my friend. Along with physiotherapy, half received Prozac, and half a placebo. Members of the Prozac group recovered more of their mobility…

Surprised that my friend had not been offered a highly effective treatment, I phoned Robert G. Robinson at the University of Iowa’s department of psychiatry, a leading researcher in this field.

Kramer knows Angell’s argument, of course — his essay is a direct response to hers. Yet he still feels comfortable cherry-picking a single obscure French study — which, again, he doesn’t link to — in order to prove that Prozac is “highly effective” in stroke victims. I would love to know what Kramer thinks of this xkcd strip; for all that Kramer complains about “the news media’s uncritical embrace of debunking studies”, the fact is that it’s the outlier studies that never get replicated which tend to get the most press.

Angell’s main argument, expounded at book length by Irving Kirsch, is that antidepressants are, amazingly, even worse than placebos; the main evidence for this is a massive database of FDA trials, which was obtained by Kirsch and his colleagues via the Freedom of Information Act. Kramer’s response to this is to say that the FDA trials are flawed, and that some large number of the subjects weren’t depressed at all.

Or, to put it another way, lots of people were diagnosed with depression and put onto a trial of antidepressant drugs, even when they were perfectly healthy. Which sounds very much like the kind of thing that Angell is complaining about: the way in which, for instance, the number of children so disabled by mental disorders that they qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) was 35 times higher in 2007 than it was in 1987.

And it’s getting worse: the editors of DSM-V, to be published in 2013, have written that “in primary care settings, approximately 30 percent to 50 percent of patients have prominent mental health symptoms or identifiable mental disorders, which have significant adverse consequences if left untreated.”

Those who would defend psychopharmacology, then, seem to want to have their cake and eat it: on the one hand it seems that serious mental health disorders have reached pandemic proportions, but on the other hand we’re told that a lot of people diagnosed with those disorders never really had them in the first place.

To a first approximation, I know nothing at all about psychiatry, psychopharmacology or the optimal treatment of depression. But as a lay reader with a decent understanding of statistics and as someone whose sister is one of those very rare people whose PhD was a negative thesis, I can tell you that Angell’s articles are vastly more compelling than Kramer’s attempt at a rebuttal.

Does that mean I now believe that antidepressants do no good at all? No — as a good Bayesian, I’m not going to let a single article do that. But I was looking forward to a strong response to Angell. And the weakness of Kramer’s essay only serves to confirm my suspicions that Angell and the anti-antidepressant crowd really are onto something.

27 comments

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Thanks, that just about covers my own irritations concerning this shoddy piece meant to make people mistakenly conclude that there is basically nothing wrong except ‘we don’t know enough yet, so we’d rather err on the side of “caution” (read:profit)’.

Posted by Foppe | Report as abusive

Good reference from Foppe. Pertinent point:
“Studies viewed by the FDA as having negative or questionable results were, with 3 exceptions, either not published (22 studies) or published in a way that, in our opinion, conveyed a positive outcome (11 studies).”

I think the average person, if they actually looked at the data in clinical trials (and just not for psychoactive drugs) would be amazed at the marginal benefit of most drugs. They would be amazed when the new drugs are compared (when they are directly compared) to generic drugs being equal or better in efficacy. and finally, they would be amazed at all the studies that show no effect that are simply ignored.

Posted by fresnodan | Report as abusive

Dan: The nyrb articles mention this as well:
Altogether, there were forty-two trials of the six drugs. Most of them were negative. Overall, placebos were 82 percent as effective as the drugs, as measured by the Hamilton Depression Scale (HAM-D), a widely used score of symptoms of depression. The average difference between drug and placebo was only 1.8 points on the HAM-D, a difference that, while statistically significant, was clinically meaningless. The results were much the same for all six drugs: they were all equally unimpressive. Yet because the positive studies were extensively publicized, while the negative ones were hidden, the public and the medical profession came to believe that these drugs were highly effective antidepressants.

Posted by Foppe | Report as abusive

Funny how the mainstream people always accuse the medication critics of cherry picking data. But here Kramer is doing all the cherry picking and ignoring mainstream data.

Posted by CorinnaWest | Report as abusive

I checked on ProPublica’s “Cash for Docs” and no one named Peter Kramer has received money from Pharma.

Posted by darbsnave | Report as abusive

I don’t think you’re treating Kramer’s comments fairly. Why do you refer to the stroke study as “cherry-picking a single obscure French study”. Does being French automatically means it’s obscure and doesn’t count? It was published in Lancet Neurology which is not an obscure journal. It was double-blind placebo controlled with 100 patients, and it wasn’t marginal significance like the xkcd strip, it was p=0.003. You can read the abstract here: http://www.ncbi.nlm.nih.gov/pubmed/21216 670. Nor was it cherry-picking, and this goes into the larger part of Kramer’s argument that you didn’t treat. One of his major arguments was that “narrow” studies, done on those with specific disorders, tend to be more reliable, and that these very consistently show clear effects. The stroke study is one example of such a study, and he mentioned many others; he wasn’t cherry-picking.

Re having their cake and eating it too, he wasn’t arguing that many people diagnosed with the disease in medical practice don’t really have it, he was arguing that drug companies have incentives to run sloppy trials and it turns out that many people in the studies didn’t really have the disease.

Overall, he had a fairly long and nuanced argument: the specific limitations of the broad studies and the meta-analyses of them, including debunking one particular meta-analysis by Rubeis; the greater reliability of the narrow studies and the consistent results they show across a range of specific conditions. One could try to look more carefully at to what degree those arguments hold up or not but it seems to me you really didn’t engage those arguments at all.

I’m a neuroscientist, but I don’t work on these things. I know enough to know that in animal models of depression and anxiety, which certainly have their limitations, these drugs have very clear and consistent effects, and a number of specific mechanisms are known. That doesn’t mean they work on humans and I don’t have a dog in that hunt. But reading as an educated layman (layman because it’s not my field), I found Kramer’s arguments interesting and convincing in making a good case at the level of a newspaper article that the debunking could be wrong.

Posted by ken61 | Report as abusive

ken61: the articles to which this op/ed was a reply never asserted that SSRIs were useless; they stated that they were being horribly overprescribed, and suggested why this was the case (big pharma profit margins, and because doctors don’t know any better than to prescribe these drugs pretty much every time they can find a “patient”. This last practice was what the nyrb article was trying to confront.
Yet all Kramer’s article does in reply (apart from several attempts at misdirection) is to say “but it’s useful in some cases”. Sure it is, but that was never the issue. The question under discussion was whether the amount of harm that is being done to all of the people who do not benefit from these drugs can be justified on that basis. Yet that issue is something Kramer never engages with.

Posted by Foppe | Report as abusive

In Marcia Angell’s recent “New York Review of Books” essay, she favorably reviewed Robert Whitaker’s book, “Anatomy of an Epidemic”. Robert Whitaker has written an excellent response to the piece by Peter Kramer. Whitaker’s post can be seen here:

http://www.psychologytoday.com/blog/mad- in-america/201107/the-new-york-times-def ense-antidepressants-0

Posted by AlexChernavsky | Report as abusive

Foppe: I don’t agree. He responds very clearly to the general claim that they’re not effective for mild or moderate depression, which is the claim underlying the claim that all those people do not benefit from the drugs. He argues that the “broad studies” that lead to this claim are not reliable for a number of reasons. He points to “narrow studies” of depression associated with a number of disorders (which can be mild or severe, but I haven’t looked at the studies to see to what extent they distinguish), to studies that show it works for mild depression that is “chronic and recurrent”, and also points to studies showing strong effectiveness in preventing relapse in those recovered from prior depression (again, I don’t know if those studies distinguish effects on mild vs. severe prior depression). In the end he leaves open the possibility that there might be a level of mildness where they don’t work: “Better-designed research may tell us whether there is a point on the continuum of mood disorder where antidepressants cease to work.”

I should also point out another thing. It is well established in animal models that these drugs increase neural plasticity — the ability of the brain to change — in various ways: they increase production of new neurons in the hippocampus; they open up a certain window of plasticity in cerebral cortex in adult animals that is normally open only in young animals. The stroke study was actually a test of this, of the idea that prozac could help open up plasticity in motor cortex that would facilitate recovery from a stroke, nothing at all to do with depression, and it did help recovery. The basic mechanisms identified in animals are very likely to carry over to us, because our physiology is so similar; the ability to carry over effectiveness in complicated psychological constructs like anxiety or depression from animals to humans is a lot less clear. But certainly a hypothesis making the rounds these days is that these don’t so much act specifically on mood as open up the brain to change, so that taking them and returning to a horrible environment can make things worse, but taking them in the context of a supportive environment can make things better. Kramer refers to that, for example saying “It may be that the drugs are “permissive,” removing roadblocks to self-healing” and saying the effects might involve eliminating “stuckness”. If that’s the real effect, you can imagine all kinds of ways broad studies might find no effect due to the environment in addition to all the problems with patient selection Kramer points to.

Again, I don’t have a dog in this hunt, but I think if you read Kramer’s article carefully and without a strong prior that most people who take these don’t benefit from them, you’ll find it’s a pretty solid article (for a newspaper article). Not saying it settles the issue, but it should be taken seriously.

I probably don’t have time to continue the discussion further, but thanks for the discussion.

Posted by ken61 | Report as abusive

I agree with Ken61, for a variety of reasons, not the least of which is that Prozac had a clear and consistent effect on my dog’s behavior. To put it mildly, he wasn’t experiencing the placebo effect, unless you think that getting little piece of cheese every morning (in which the drug was hidden) was enough to make him snap out of some very bad behaviors that had accumulated over a five year period. He got better as the dose increased. He also reached a plateau, but the drug very clearly had a positive effect.

This is not to say that Angell’s point isn’t, ultimately, more accurate, and that is: it’s not enough for Prozac and its ilk to help some people (or dogs) when drug companies make it their business to obscure the specific conditions and symptoms in which ADs can be helpful in order to expand the market to the widest range of people possible, whether the drugs are really helpful or not. That is THE problem — you take something that is effective in certain cases for certain symptoms and you exaggerate until the vast majority of people taking the drug are almost certain not to derive a benefit from it. This is how drug marketing works, and I have no doubt that the DSM is exaggerating just like pharmas are. There is virtually no one who is disinterested enough to make these judgments in the medical field, and in no field are there fewer disinterested people than modern psychiatry. It absolutely sucks.

Posted by rb6 | Report as abusive

The problem with broad studies in the behavioral sciences is that they are always deeply contaminated by rapidly changing and pervasive social conditions, such that true replication is never possible. This opens a gap within which the new DSM edition steps forward to create topical diagnostic categories through which to churn new generations of me-too drugs. In his comments Kramer simply takes for granted the existence of the very epidemic that Angell questions, that something like 30 to 50 percent of all medical patients would benefit from some form of psychopharmacology.

As mentioned, he ignores the second article entirely, where the economic and intellectual crux of the issue lies: questionable science, and pharmaceutical profits. Taking a broad view, and even offering some juicy insider knowledge of the silliness of much psychological research, he deliciously suggests that psychopharmacology may be mood enhancers “also for healthy people”.

It appears he believes that about 25% of those that take antidepressants benefit directly and about one third more benefit simply from the placebo effect, and that this is a good reason to continue prescribing and doing further research.

He is quite unwilling to dive into theory. He believes that dysthymia is underlaid with “neuroticism” and that is all ye need to know. In short, a skillful psychologist/priest, he pours oil on troubled waters and dispenses the wafer.

His book on Freud is full of insight into that great magician.

Posted by MarkShulgasser | Report as abusive

Ken: Thanks for the lengthy response.
Let me grant, for the purpose of argument, that you are correct. At that moment, there is still the issue that it is impossible to know for whom, why and when the drugs will be effective. As the nyrb article (and the nejm study I linked to) make abundantly clear, a large amount of the studies that are submitted to the FDA do not show any positive effects whatsoever, while a decent subset of the studies are being distorted to seem more positive than the results warrant. Now, it is entirely true that this may be because the SSRIs are being tested on the wrong kinds of patients; however, this does not excuse the FDA’s policy of counting these studies when considering whether or not to approve some drug. And when the approval process requires no more than that 2 trials show a positive result (without considering null results and without looking at the effect size — see nyrb article 1), then the chance that these two will be false positives, or positive results that show no real effect for most people is enormous, while the social cost of approving them for general use is disproportionately large (given the way marketing impacts prescription rates).
It may well be that prescribing these drugs is sometimes useful, but it seems to me that, when there is so little good evidence telling you why and who might benefit from them, there is something seriously wrong with the practice. (And yes, I know this can happen with other medications as well, but the problem with SSRIs especially is that they’re often prescribed long-term.)

(And then there are additional issues, such as why toddlers are being prescribed antipsychotics, etc., which have nothing to do with ‘insufficient knowledge’ and everything to do with unethical behavior and bad science.)

Posted by Foppe | Report as abusive

Lastly, I would really urge you to read the response by Whitaker linked to above your own post. To quote:

So how does Dr. Kramer, in his essay, “defend” antidepressants in the light of Kirsch’s report? Let’s go over this point-by-point.

First, he writes that Kirsch “found that while the drugs outperformed the placebos for mild and moderate depression, the benefits were small.” This, of course, is not what Kirsch found at all. The studies didn’t involve patients with mild to moderate depression (except for the one study.) What Kirsch found was that in the FDA trials, the antidepressants didn’t outperform placebo, in a clinical meaningful way, for patients with severe depression.

That, of course, is a finding that would cause readers to seriously wonder about the merits of the drugs. But rather than write about Kirsch’s actual findings, Dr. Kramer crafted a sentence that tells of how the drugs provide a small benefit even in mild to moderate patients. As such, he is reassuring readers — even though falsely so — that antidepressants provide a benefit to the larger universe of patients that take these drugs. And the implication is that the benefit must be quite marked for the severely depressed.

Having misrepresented Kirsch’s findings, Dr. Kramer then writes that “the problem with the Kirsch analysis — and none of the major press reports considered this shortcoming — is that the FDA material is ill suited to answer questions about mild depression.” The reason, Dr. Kramer explains, is that “companies rushing to get medications to market have had an incentive to run quick, sloppy trials,” and in their haste, they “often [enroll] subjects who don’t really have depression.” It is these non-depressed patients who then become counted in the trial results as placebo responders, because, Dr. Kramer writes, “no surprise — weeks down the road they are not depressed.”

I have to confess that this is a paragraph that took my breath away. Dr. Kramer makes it seem that Kirsch’s review focuses on mild to moderate depression (it doesn’t); then he explains that the reason that Kirsch found that the drugs provide only a slight benefit to those patients in the FDA trials is that the drug companies enroll patients who aren’t really depressed at all (when in fact the study criteria required patients to be severely ill); and finally he concludes that when those non-depressed patients end up in the placebo arm of the study, they show up as improved and thus as placebo responders. The “improvement” of the placebo group, Dr. Kramer writes, “may have nothing to do with faith in the dummy pills; it is an artifact of the recruitment process.”

Posted by Foppe | Report as abusive

Forgive me for mentioning upfront that I wrote and produced a documentary about this very subject called ‘Generation RX.’ I lead with this to underscore the decades-long research I conducted on SSRIs and the science behind antidepressants. I agree with Mr. Salmon’s sentiments — SSRIs should be freely available to whomever wants or needs them. This comes with a caveat, however: that all of the science—dating back to the early 80s—be released so that MDs and consumers can judge for themselves whether this drug is appropriate for depression. Consumers should also be made aware that individuals within the FDA secretly helped Lilly with “public relations” advice surrounding the high suicide and death rates during Prozac’s infancy as a “wonder drug.” The conflicts-of-interests are real—and staggering.

Thanks for an excellent post.

Posted by kevinpmiller | Report as abusive

Everyone is arguing about the wrong thing and therefore have no chance of coming to a sensible conclusion as to whether or not there is a problem and if so what a solution might be.

The real problem is the model under which we allow/force pharmaceutical companies to operate. “Big Pharma”, in order to operate with the profit margins that Wall St. demands, have to get indications for their drugs that maximize the potential population that physicians can prescribe to. This is true for all drugs for all diseases. The result is that trials will be designed to achieve this result. For example, suppose a company has an asthma drug that has a 100% success rate for a narrow group of patients who have a particular sub-type of asthma that represents a fraction of asthma patients. The company will design its trials to include all asthma patients such that it achieves a smaller apparent effect when all patients are included and it will resist all attempts to narrow the target population. All the company needs, all the company wants is a sufficiently positive result that will get approval from the FDA and a clean set of prescribing instructions – meaning approval for use in all (or at least a maximum posssbile number of) asthma patients.

This same process is at work with antidepressants, statins, anti-hypertensives, drug treatments for diabetes type II etc.

There is nothing unique about psychiatric medications from a discovery or marketing standpoint. For some reason “over-treatment” with psychiatric medications bothers people more than the “over-treatment” with these other classes of drugs. But nothing will change until a different model is adopted for the discovery, testing and marketing of drugs of all types.

Posted by fredmertz | Report as abusive

I highly recommend also reading Marcia Angell’s Jan 09 expose entitled “Drug Companies & Doctors: A Story of Corruption”

http://www.nybooks.com/articles/archives  /2009/jan/15/drug-companies-doctorsa-st ory-of-corruption/

Posted by dedalus | Report as abusive

@fredmertz:

Nail on head, fred! But add to “statins, . . . etc.” many surgeries, most of the social sciences, and a substantial, irrational fraction of physics. The big deception, at the moment is that the DSM-5 in favoring dimensions over categories is more “scientific”
and therefore is the different model you are calling for, when nothing could be further from the truth.

If reading is being recommended, I would urge “Medical Nemesis” by Ivan Illich. Illich there worked up the concept of iatrogenesis, to which all talk about the existence of a mental health epidemic and its relation to pharmacology should look back.

Posted by MarkShulgasser | Report as abusive

Fredmertz, yes, of course, you are right and that was what I was alluding to — but you more directly note that the pharmas attack the issue from two directions — the first is to expand the notion of who might benefit from a drug, but the other, much more insidious one, is to expand the very definition of who has a disorder that falls within the approved indication of a drug. The Seattle Times had a terrific series of articles on this, called “Suddenly Sick,” so I will just link to it: http://seattletimes.nwsource.com/news/he alth/suddenlysick/

The third phenomenon, even more insidious, is how FDA has adopted a “proxy” model for evaluating the effectiveness of drugs, particularly cholesterol and heart related drugs that more or less accepted as a given that certain biomarkers were themselves sufficient to show that the drug was efficacious, the most notable being the supposition that lowering cholesterol corresponds with fewer heart attacks, etc. This model is increasinly being exposed as highly flawed but the FDA has no idea how to respond.

Posted by rb6 | Report as abusive

If antidepressants work for some people, isn’t that good enough? What does it matter if it’s entirely a placebo effect? Who cares if we ever learn their “real” biochemical mechanism of action so long as they’re generally safe at the doses prescribed?

Yet both drug companies and patients seem to be resistant to the idea of an overriding placebo effect for two quite different reasons.

A business model that depends on regular incoming profits will, in the case of health care, usually favor a view of diseases as chronic entities that require regular, often life-long treatment regimens. Presumably if many psychiatric medications were acting as placebos, doctors would quit prescribing, and patients would stop taking. (Note: presumably.)

However, patients are themselves resistant to admitting a placebo effect because they’re reluctant to consider any illness as being “all in my head.” (After all, if it’s “all in my head,” I must really be an idiot.) In other words, patients want to pop pills because the implication is that it’s not in their head, it’s in their malfunctioning brains/bodies, over which they presumably have no control. (Note: Presumably.)

The upshot is clear (and always has been, as long as placebo-controlled studies have existed): As a patient, I prefer to take a pill provided by a profit-driven company because that allows me to believe I’m still an okay person despite my illness, which presumably I have no control over anyway. (Note: Presumably.)

Mr. Dick Turpin

Posted by Dickturpin | Report as abusive

My opinion, just as EVERYONE’S in the world is only an opinion in regards to antidepressants, is that they are bunk. I say this from having suffered a myriad of strange physical and mental conditions (diagnosed with CFS, Fibromyalgia, Affective disorder, peripheral neuropathy, etc.). I also state this on my knowledge, which is just as limited to the best psychiatrist or neurologist from studying Physiology of the brain in college and many, many, articles.
First off, pertaining to the effects on me, I may be biased. As nothing, no drug, exercise, food or anything else gives me pleasure or puts me in a focused, or happy body or brain state. With that said, I have never felt anything in my brain, or have my brain effected in any noticeable positive way from either SSRI’s,SNRI’s,MAO inhibitors, or tricyclic’s. The only thing I believe I ever felt were side effects, some subtle, and some extreme.

I would like to know, how everyone of these drugs were initially being developed for a medical problem (high blood pressure, etc), and because somebody noticed that some people’s moods improved from them (couldn’t it have been the care they were receiving in the studies like a sugar pill is all they needed?). They then worked backwards, trying to find anything in the brain that was altered by these drugs with the limited technology at the time and even now. As in the latest SSRI’s they were able to observe an increase of a basic amino acid, serotonin remaining in the synapse. Viola! That’s the reason for depression! Give me a break! How can anyone even put any kind of label on depression, let alone treat it with pills that the manufacturer has no idea what depression is within the brain, nor how these pills work, if at all. The whole science community, and the human population have bought into the large manufacturing companies bogus studies.

The bottom line, despite all the hoopla over Serotonin, and other basic amino acids is all propaganda. Unless someone has the blues, in which talk, attention, a sugar pill will cure, someone that has a true structural change within the brain is wasting their life and suffering on these placebo pills, with absolutely no scientific evidence on how they work.

If structural changes occur within the brain, where people can not enjoy things, or feel pleasure, or think or feel like they used to it is much more than any of these pills, if any can cure. There are many chain reactions that occur within all different areas of the brain, and many pathways, and many glands in the brain that play a key role in mental health. To simplify the answer to a pill, that can be shown to do nothing downstream in the brain, and change key brain areas is equivalent to the lobotomies they used to perform. Also, “depression” if it truly exists should be a medical disease, and differentiated from people that are “down” for whatever reason, and people that have real structural changes in the brain. Unfortunately, the latest technology, which is still crude, is the fMRI, which is relegated to a few university research centers.

Anyone that says these pills work, did not need them in the first place. How a pill can be put on the market and not even know how it works, is strange to me. How depression, true cognitive changes, have not been researched further is incomprehensible to me.

So you all can continue your debates. Realize this, you are debating nothing. Because we know nothing about the real medical and structural changes that may occur downstream in depression and the glands involved, and only know very crude, basic amino acid evidence on a rudimentary, superficial level of how any antidepressant does anything to the brain, let alone “cure” anything.

Posted by markums069 | Report as abusive

My opinion, just as EVERYONE’S in the world is only an opinion in regards to antidepressants, is that they are bunk. I say this from having suffered a myriad of strange physical and mental conditions (diagnosed with CFS, Fibromyalgia, Affective disorder, peripheral neuropathy, etc.). I also state this on my knowledge, which is just as limited to the best psychiatrist or neurologist from studying Physiology of the brain in college and many, many, articles.
First off, pertaining to the effects on me, I may be biased. As nothing, no drug, exercise, food or anything else gives me pleasure or puts me in a focused, or happy body or brain state. With that said, I have never felt anything in my brain, or have my brain effected in any noticeable positive way from either SSRI’s,SNRI’s,MAO inhibitors, or tricyclic’s. The only thing I believe I ever felt were side effects, some subtle, and some extreme.

I would like to know, how everyone of these drugs were initially being developed for a medical problem (high blood pressure, etc), and because somebody noticed that some people’s moods improved from them (couldn’t it have been the care they were receiving in the studies like a sugar pill is all they needed?). They then worked backwards, trying to find anything in the brain that was altered by these drugs with the limited technology at the time and even now. As in the latest SSRI’s they were able to observe an increase of a basic amino acid, serotonin remaining in the synapse. Viola! That’s the reason for depression! Give me a break! How can anyone even put any kind of label on depression, let alone treat it with pills that the manufacturer has no idea what depression is within the brain, nor how these pills work, if at all. The whole science community, and the human population have bought into the large manufacturing companies bogus studies.

The bottom line, despite all the hoopla over Serotonin, and other basic amino acids is all propaganda. Unless someone has the blues, in which talk, attention, a sugar pill will cure, someone that has a true structural change within the brain is wasting their life and suffering on these placebo pills, with absolutely no scientific evidence on how they work.

If structural changes occur within the brain, where people can not enjoy things, or feel pleasure, or think or feel like they used to it is much more than any of these pills, if any can cure. There are many chain reactions that occur within all different areas of the brain, and many pathways, and many glands in the brain that play a key role in mental health. To simplify the answer to a pill, that can be shown to do nothing downstream in the brain, and change key brain areas is equivalent to the lobotomies they used to perform. Also, “depression” if it truly exists should be a medical disease, and differentiated from people that are “down” for whatever reason, and people that have real structural changes in the brain. Unfortunately, the latest technology, which is still crude, is the fMRI, which is relegated to a few university research centers.

Anyone that says these pills work, did not need them in the first place. How a pill can be put on the market and not even know how it works, is strange to me. How depression, true cognitive changes, have not been researched further is incomprehensible to me.

So you all can continue your debates. Realize this, you are debating nothing. Because we know nothing about the real medical and structural changes that may occur downstream in depression and the glands involved, and only know very crude, basic amino acid evidence on a rudimentary, superficial level of how any antidepressant does anything to the brain, let alone “cure” anything.

Posted by markums069 | Report as abusive

Also, a reply to the comment above. If it works for some isn’t that good enough? No, because what about the people that may have a real mental condition that affects mood, which really should only be labeled as depression. If you don’t understand how something works, nor anything about a potentially life threatening mental illness in people that aren’t cured by sugar pills, it is imperative to find the root causes in brain structures of a large subset of these “real” depressed people and then develop drugs to target these regions. For others, you can put sugar into a capsule, and put the label Prozac on it, and they will improve. Kudos to them. Talk therapy, care, attention, exercise, etc. would have done the same. So it does matter finding the cause of the “real” depressed people and finding “real” medications that will correct and target these areas.

Posted by markums069 | Report as abusive

Also, a reply to the comment above. If it works for some isn’t that good enough? No, because what about the people that may have a real mental condition that affects mood, which really should only be labeled as depression. If you don’t understand how something works, nor anything about a potentially life threatening mental illness in people that aren’t cured by sugar pills, it is imperative to find the root causes in brain structures of a large subset of these “real” depressed people and then develop drugs to target these regions. For others, you can put sugar into a capsule, and put the label Prozac on it, and they will improve. Kudos to them. Talk therapy, care, attention, exercise, etc. would have done the same. So it does matter finding the cause of the “real” depressed people and finding “real” medications that will correct and target these areas.

Posted by markums069 | Report as abusive

Drug companies will always seem to do what’s right for them and not for their customers. The fact that the percentages for Paxil Birth Defects are high as they are is a good example. I don’t know if I’ll ever go back to antidepressants.
http://www.paxilbirthdefectlaw.com

Posted by JosephineOsborn | Report as abusive

I have heard about this side effecst from Zoloft, but most of what I know is a few different articles but I have seen some commercial ads regarding a pharmaceutical lawsuit regarding any SSRI’s effecting a child if the mother was taking them during her pregnancy. If it is something that has impacted your family then I would suggest contacting an attorney by the name of Chad Pinkerton, I believe he is in the Webster area close to where I live. I have had the chance to see some of his previous cases and the power and enthusiastic attitude he presents is uplifting and comforting. The commercial I saw the other night for him said you can contact him at 1-855-Zoloft1. Hope this could be of some help to you.

Posted by Penelope373 | Report as abusive