prplchknz
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In 2008 Irving Kirsch and colleagues published a meta-analysis of published and unpublished trials of SSRIs that found overall a clinically significant difference between placebo and actual drug conditions only when people’s depression was severe. Kirsch and colleagues suggested those more depressed patients were less likely to respond to the placebo pills, meaning there was a bigger than normal advantage in that category for the actual antidepressants. Kirsch wasn’t saying that SSRIs weren’t doing anything, just that they weren’t doing very much and should be the final, not the first, option.
I read Kirsch's book; he's right. Anti-depressants work no better than active placebos (placebos that have a side effect similar to the anti-depressant). The most convincing evidence in the book was that current anti-depressants, past anti-depressants; drugs that increase serotonin levels, drugs that decrease serotonin levels, and drugs that have no effect on serontonin levels all perform at near identical levels.
I'd urge everyone on anti-depressants to read Kirsch's book first.
Frosty said:Ok. Until Im done reading the book Ill stop taking my medication. See what happens- fun little experiment.
That is one of the experiments. More depressed people recover on their own without anti-depressants than those using anti-depressants. I don't remember the exact numbers, but it's something like 82% vs 62%.
Frosty said:Id like to see those exact numbers if you have them.
Sure thing. Gimme about a week.
Frosty said:You can do better than that. You made a point- back it up so we can discuss.
On the basis of 234 studies, no clinically relevant differences in efficacy or effectiveness were detected for the treatment of acute, continuation, and maintenance phases of MDD. No differences in efficacy were seen in patients with accompanying symptoms or in subgroups based on age, sex, ethnicity, or comorbid conditions… Current evidence does not warrant recommending a particular second-generation antidepressant on the basis of differences in efficacy
The most commonly prescribed antidepressants are SSRIs, drugs that are supposed to selectively target the neurotransmitter serotonin. But there is another antidepressant that has a very different mode of action. It is called tianeptine, and it has been approved for prescription as an antidepressant by the French drug regulatory agency. Tianeptine is an SSRE, a selective serotonin reuptake enhancer. Instead of increasing the amount of serotonin in the brain, it is supposed to decrease it. If the theory that depression is caused by a deficiency of serotonin were correct, we would expect to make depression worse. But it doesn’t. In clinical trials comparing the effects of tianeptine to those of SSRIs and tricyclic antidepressants, 63% of patients show significant improvement (defined as a 50% reduction in symptoms), the same response rate that is found for SSRIs, NDRIs, and tricyclics, in this type of trial (Wagstaff, Ormrod, & Spencer, 2001). It simply does not matter what is in the medication – it might increase serotonin, decrease it, or have no effect on serotonin at all. The effect on depression is the same.
What do you call pills, the effects of which are independent of their chemical composition? I call them “placebos.â€
In March 2006, NIMH triumphantly announced that 50 percent of depressed people saw remission of symptoms after the first two STAR*D steps. However, NIMH failed to mention in its press release that in the same time it took to complete these first two steps—slightly over 6 months—previous research shows that depressed people receiving no treatment at all have a spontaneous remission rate of 50 percent.
“I found a cumulative sustained recovery rate of 43 percent after four treatments, using a method similar to the authors but taking relapse rates into account.†However, even 43 percent turns out to be an inflated rate.
But even taking the STAR*D data as is, Pigott’s analysis revealed that less than 3 percent of the entire group of depressed patients who began the STAR*D study can be ascertained as having a sustained remission
[MENTION=29687]Frosty[/MENTION]
This page discusses remission rates:
5 Myths About Depression Treatments
But upon further analysis:
Even further analysis:
So basically, 50% recover without ever taking antidepressants and anywhere from 3% to 50% recover while taking antidepressants.
Frosty said:You take a small sample- one that probably ISNT reflective od the general population- and based on the results of that you are able to dismiss all the people who have benefitted from the treatment.
And until you can tell me why it ISNT flawed- I dont think you, or anyone, has the right to dismiss- on entirety- the experiences of an entire group of people.
are you able to definitively say that every single person who thinks that they have been benefitted by an antidepressant would have been just as well served by a placebo?
Anti-depressants are really a big help for a lot of people, my own experience with three different anti-depressants wasn't good, however. I switched to Remeron after a fruitless try with another anti-depressant and aside from the excessive increase in appetite, they made feel empty inside or just apathetic to everything. After trying out those, I tried out some other anti-depressant, which doesn't seem to exist outside of Germany, that one however triggered my histamine-intolerance, so I had to taper them off. It also didn't make me feel better, nor worse. It just didn't have any effect, aside from histamine related symptoms... after these unsuccessful tries I decided to go without them and in the end I could get out of depression without them.
I think it's a shame that people still have to hide when they take anti-depressants. I wish this stigma would die off finally.
I don't think this is a black and white topic at all. I do however think that antidepressants are best used for those with extreme cases of mental illness (like bipolar or schizophrenia), or those who are in a crisis of situational depression and need extra help so that they are better able to care for themselves and commit to cognitive behavioral therapy and lifestyle changes like diet, exercise, and mindfulness.