Study: Antidepressants, Placebos Near Equally Effective

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Study: Antidepressants, Placebos Near Equally Effective

Postby Maddy » Wed Jan 06, 2010 12:00 pm

Study: Antidepressants, Placebos Near Equally Effective
Commonly Prescribed Antidepressants Had 'Negligible' Effect on Patients With Mild, Moderate, Even Severe Depression
By JOE TUZZO and LEE FERRAN
Jan. 6, 2010

http://abcnews.go.com/GMA/OnCall/study- ... id=9486601

A new analysis found that commonly prescribed antidepressants had little effect on people with cases of mild to severe depression compared to those treated with placebos.

The analysis, published in the Journal of the American Medical Assocation, combined the findings of six different previous studies of two commonly prescribed treatments -- paroxetine, similar to common Paxil, Prosac and Zoloft, and imipramine, an older antidepressant drug.

"The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial," the study concluded.

The findings do not mean that the drugs or the placebos were frivolous for most users, "Good Morning America" chief medical editor Dr. Richard Besser said today. Rather, both the antidepressants and the placebos had a positive effect on the patients.

"You hear that headline and you think, 'Oh, my God, there is nothing out there that works for depression," Besser said. "The study actually found the exact opposite; that both placebo and medications were extremely effective at treating mild to moderate depression. What you can't tell from this study is what else is going on. Were these individuals getting what is most effective, which is talk therapy?"

The analysis included a pool of 434 patients from the antidepressant group and 284 patients in the placebo group.

Dr. Gary Kennedy, a professor of psychiatry and behavioral science at Montefiore Medical Center, Albert Einstein College of Medicine, said that analysis seemed logical, but was cautious of its conclusions.

"The finding that more severe depression is more likely to respond to antidepressant medication seems sound," Kennedy said. "But only six studies were used to generate the conclusion, and three of those studies used an antidepressant that few practicing physicians would prescribe nowadays.

"However... This is a major line of enquiry at present and offers the hope that we can prevent severe depression if we could identify the trajectory from minor to major depression," he said.

[Video at link]
A new study suggests the drugs affect only severely depressed patients.

The Value of Therapy and Social Support

One criticism of the study is that by simply participating in the trial, the patients are getting a secondary form of therapy that is not measured: talk therapy.

"The most effective thing for mild to moderate depression is being in a therapeutic relationship where they can talk through their problems with someone who is really skilled," Besser said. "What they found in [the study], and you can't really tell from this, is that it didn't really matter the drug. You were getting better if you had this and that should give people hope with mild to moderate depression."

Harold Koenig, a professor of psychiatry and behavior sciences at Duke University Medical Center, said the study coordinators are often extremely kind and encouraging of participants to make sure they comply with the study.

Image
A new analysis found that commonly prescribed antidepressants had little effect on people with cases of mild to severe depression compared to those treated with placebos.
(Getty Images)
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Re: Study: Antidepressants, Placebos Near Equally Effective

Postby Burnt Hill » Fri Jan 08, 2010 1:29 pm

Of course the meds are supposed to be used along with other foms of "talk" therapy.
]"The most effective thing for mild to moderate depression is being in a therapeutic relationship where they can talk through their problems with someone who is really skilled,"

Talk therapy and the placebo effect are huge in recovery, and good psychiatrists know this.
The problem is that many people who go off the meds have real withdrawal issues. This may go to the efficacy of the meds. Not sure if any studies have been done on withdrawal from placebos.
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Re: Study: Antidepressants, Placebos Near Equally Effective

Postby Maddy » Fri Jan 08, 2010 2:09 pm

Giving out meds is cheaper than spending the money on decent therapy. Most of the people on medications who are at poverty level or below have no choice, since therapy is virtually non-existant, and when it is existant its less than adequate (20-45 minutes, once a week to once a month, depending upon the state you live in, and depending upon the amount of clients vs. therapists available). Not enough to deal with serious anxiety or depressive issues, or to really learn anything. Even with "support groups" a lot of the time you're left with nothing but a 30 minute class on 'do this instead of getting angry' (for example), then clients are left with to their own devices. Its really pathetic - but Pharma is raking in the bucks off of it!

I wish I could find/remember the link that I had found once, basically saying that these SSRIs were doing the identical job of benzodiazepines (valium, et. al.), just in a different way, and they all are nothing but sedatives.
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Re: Study: Antidepressants, Placebos Near Equally Effective

Postby Burnt Hill » Fri Jan 08, 2010 3:15 pm

Most of the people on medications who are at poverty level or below have no choice, since therapy is virtually non-existant,

Not true, this group would qualify for medicaid, which allows for quite a few therapies. The individual has to be motivated to participate in therapies offered. The quality of the therapies offered does vary, but with the various paid for therapy and free support groups, a client can recieve daily help if wanted, the biggest problem can be transportation for those in rural areas. Those with
"serious" problems may require hospitalization, where they would recieve many hours daily of therapy. If therapy works, as the article you posted suggests, than this is no boon to he pharmaceuticals.
and they all are nothing but sedatives

Not true, in fact many of them act as stimulants, such as Zoloft, and it is typically not prescribed at bedtime.
Another problem is the prescribing practices of general health practitioners, who prescribe antidepressants at clients request, with out offering therapy.
Also, its hard to argue against those that say the medications have really helped them.
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Re: Study: Antidepressants, Placebos Near Equally Effective

Postby Maddy » Fri Jan 08, 2010 3:50 pm

How long have you worked in the county mental health systems, BH? Because I've worked in them and with clients for most of my life. There is nothing but complaints, both from clients and from staff, about the availablity of working therapy, the hours worked, the low pay levels, long hours, the amount of clients vs. staff, not to mention funding (or rather, lack thereof). Most of the people who come into these places are on gov't assistance (medical/medicaid). Most of them are only able to be given a minimal assistance, unless they're 5150, which is only a temporary solution (I'm not talking of clients who are psychotic, but clients who have various anxiety/depression disorders). Most of these clients do not have a good support system, and little to no family support. Many are also on drugs/alchohol to self-medicate due to the inability of these medications to address the underlying issues which cause the anxiety/depression, which is dangerous. They're bandaids, and poor ones at that.

Because that's the way you treat these disorders, is by addressing the underlying causes, not bandaging them with pharmaceuticals. The drugs are fine for a short-term interim while addressing the issues, but without the ability to address the issues, you just end up with clients continuing on the drugs to no avail.

And yes, they are depressants. Ask anyone who has been on them what happens to their emotions while on the meds. I didn't say they were the same thing, I said they have the same effect.

Google: SSRIs emotional numbing

Don't listen to the doctors, listen to the patients. :wink:

(Edited: because I hate typos)
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Re: Study: Antidepressants, Placebos Near Equally Effective

Postby Burnt Hill » Fri Jan 08, 2010 6:28 pm

And yes, they are depressants. Ask anyone who has been on them what happens to their emotions while on the meds. I didn't say they were the same thing, I said they have the same effect.

Well lets be clear: there are depressants and stimulants. We were discussing
antidepressants which can offer both as side effects. If and when a client achieves some measure of success from a medication, they typically state feeling increased energy, both mentally and physically. If the depressive side effects are too strong, they should discontinue that medication. I know, I have listened to literally hundreds of clients that have used them.
Comparing antidepressant medications to placebos as presented is misleading.
Someone who woudn't benefit from a placebo could very well benefit from a medication.
addressing the underlying causes

therefore the emphasis on talk therapy.
Believe me I am no fan of the pharmaceutical lobby.
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Re: Study: Antidepressants, Placebos Near Equally Effective

Postby Burnt Hill » Fri Jan 08, 2010 7:09 pm

Maddy, I am keenly aware of the issues and problems with the 'system' as you stated. Ultimately recovery depends on the client. If someone is not motivated to use the available resources, as limited as they may be, then they will have litle success. Personal resposibility has to be emphasized from the start. And again- the medications are to be used as an adjunct to therapy, not as a cure all.
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