Anti-Depressants Fail

A meta-analysis of SSRI anti-depressant medication, published in Feb ’08, found almost no effect.  Here is the data:

Following the Freedom of Information Act (FOIA), we requested from the FDA all publicly releasable information about the clinical trials for efficacy conducted for marketing approval of fluoxetine, venlafaxine, nefazodone, paroxetine, sertraline, and citalopram, the six most widely prescribed antidepressants approved between 1987 and 1999, which represent all but one of the selective serotonin reuptake inhibitors (SSRIs) approved during the study period. … Although sponsors are required to submit information on all trials, the FDA public disclosure did not include mean changes for nine trials that were deemed adequate and well controlled but that failed to achieve a statistically significant benefit for drug over placebo. …  we present analyses only for those [four] medications for which mean change scores on all trials were available.

Here are the results:

Compared with placebo, the new-generation antidepressants do not produce clinically significant improvements in depression in patients who initially have moderate or even very severe depression, but show significant effects only in the most severely depressed patients. The findings also show that the effect for these patients seems to be due to decreased responsiveness to placebo, rather than increased responsiveness to medication. Given these results, the researchers conclude that there is little reason to prescribe new-generation antidepressant medications to any but the most severely depressed patients unless alternative treatments have been ineffective.

And this doesn’t take any account of leaky placebo effects, whereby drug side-effects convince people they have the real drug.  Given their severe side-effects, I’m not sure I’d advise anti-depressants even when other treatments have been ineffective.  Hat tip to Michael Cannon.

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  • alex

    Wasn’t there another meta study published earlier this year (in Jan?), which suggested that anti-depressants had a small positive effect? I cannot remember much more on it than that though, but does this ring a bell for anyone else?

  • Someone from the otherside

    So where do you get placebo anti depressants, really?

    This is all nice and dandy, but until someone sells placebo without telling anyone, studies like these are somewhat irrelevant to the affected population.

    And some people claim that some of the side effects are actually beneficial to them. Lowered/near zero sex drive may not always be a negative and for trouble reaching ejaculation there is an obvious enough case where it would help…

  • iwdw

    A related question:

    I have a side question. Why is it that when an article says something works, people are suspicious of bias, but when an article says something doesn’t work, everyone thinks it’s objective science?

  • http://homepage.mac.com/redbird/ Gordon Worley

    I find this personally interesting since I take 200 mg of sertraline a day and have done so for the past few years to control OCD and GAD. It’s very effective on me, and given the changes I’ve seen in my mental state before and after taking it, I’d say that’s because my brain is underproducing (or over uptaking; whichever) serotonin, thus it brings me up to more normal brain function. When I tell people how much I like the drug, I’ve heard plenty of their stories about how they took it or another antidepressant (SSRI or other). The common theme seems to be that these drugs made them dull to emotions, which many people describe as making them feel “like zombies.” In the end all the antidepressants did for them was to help them not kill or otherwise hurt themselves until a therapist was able to help them work through their depression. This seems to reinforce the idea that most depression is a problem of beliefs and thought patterns in a normally functioning brain and cannot, therefore, be treated by altering brain chemicals.

    I would like to see a study comparing the effects of these drugs on depression patients who are suffering from persistent (and presumably chemically caused) depression and who are suffering from temporary (caused by events, changes in belief, etc.) depression. That would help us to know if my theory about the usefulness of the drugs is correct.

  • iwdw

    > So where do you get placebo anti depressants, really?

    I’m pretty sure any homeopath would gladly sell you something for depression.

  • http://www.allancrossman.com Allan Crossman

    iwdw: With a gigantic drug industry, it’s obvious where bias in favour of drugs might come from. It’s less obvious why there would be bias in the other direction.

  • Sociology Graduate Student

    I’m having a hard time reconciling this study with the fact that many people I know feel they benefit from antidepressants. Is the placebo effect really that strong, even after years of taking it? Maybe the drugs help some people but hurt others?

    Also, see Jens Ludwig’s work on antidepressants and the suicide rate using longitudinal data from numerous countries.

  • eric falkenstein

    I thought that suicide rates have dropped significantly since Prozac. Big datapoint if true.

  • Z. M. Davis

    This is the strangest blog. On the one hand, modern science is incompetent at producing effective medical treatment, and on the other, modern science will soon be able to create an AGI which will bootstrap itself to godlike powers. Yes, I know that Robin and Eliezer are different people, and the reasoning supporting the “intelligence explosion,” and that the claims aren’t literally inconsistent, but still, given everything here on the agreement theorem (cf. TGGP’s quip), I find this a little unsettling.

  • Someone from the otherside

    > I’m pretty sure any homeopath would gladly sell you something for depression.

    Well technically they would sell me placebo but they would have no effect on me because I know them to be placebo…

  • Someone from the otherside

    > With a gigantic drug industry, it’s obvious where bias in favour of drugs might come from. It’s less obvious why there would be bias in the other direction.

    Drugs are bad, mkay.

    Not obvious? Not really.

  • http://theviewfromhell.blogspot.com Sister Y

    SGS: I have friends who feel they benefit from acupunture. Robert Carroll calls it the pragmatic fallacy.

    I thought that suicide rates have dropped significantly since Prozac. Big datapoint if true.

    A lot of people thought that. It’s not true.

  • Dmitriy Kropivnitskiy

    > With a gigantic drug industry, it’s obvious where bias in favor of drugs might come from. It’s less obvious why there would be bias in the other direction.

    This is not a reasonable argument. Just because we cannot imagine a reason for studies to be biased this or that way, doesn’t mean they aren’t. We might have imperfect information. Unfortunately this line of argument comes up more and more often.

  • http://profile.typekey.com/bayesian/ Peter McCluskey

    Sister Y, the abstract you link to may look like indirect evidence of unchanged suicide rates (via evidence of unchanged suicide attempts), but the full article includes this more direct evidence:

    There has been a roughly 6% reduction in the period prevalence of suicide in thes United States among people in the sample age range (18-54 years) during this period, from approximately 14.8 per year per 100 000 population in 1990-1992 to 13.9 per year per 100 000 population in 2000-2002

    This report shows a correlation between that decline and increased SSRI use.

  • http://www.allancrossman.com Allan Crossman

    Dmitriy: “Just because we cannot imagine a reason for studies to be biased this or that way, doesn’t mean they aren’t.”

    Of course not. However, other things being equal, isn’t p(bias|obvious reason for bias) bound to be higher than p(bias|no obvious reason for bias)?

    Someone from the otherside: “Drugs are bad, mkay.”

    You make a fair point. There is a large anti-drug movement in our culture, which could also cause bias in the studies.

  • http://dl4.jottit.com/contact Richard Hollerith

    Depression is such a costly problem worldwide that I will share what worked for me even though it has nothing to do with the topic of the blog.

  • http://theviewfromhell.blogspot.com Sister Y

    Peter McCluskey, sorry, that was a bit lazy of me.

    Two questions:

    1. How could antidepressants decrease the effectiveness of suicide attempts but not affect any other form of suicide-related behavior? Note that “cry for help” insincere suicide attempts decreased during the period of the JAMA study, though not very much.

    2. The percentage of people who’d made a suicidal gesture who received treatment rose from 40.3% to 92.8% during the period of the study. Why only a 6% decrease in completed suicides, if treatment is so effective? (I suppose the concern here is cost/benefit.)

    Of course, reducing suicide isn’t the same as effectively treating ordinary depression.

  • Adam I

    I know all about anecdotes and how they’re not evidence, but I took antidepressants for a while when I was suffering from moderate depression.

    The turnaround in my life was really extreme. All the sudden I was better able to socialize, to remember things, more productive at work, etc.

    Did I become less depressed? Yes, but I don’t think it was caused directly by the medication. I think it was caused indirectly by the medication. I was depressed because it felt like my brain didn’t work. The medication helped that, and so I became less depressed.

    I know all about the placebo effect too (I’m a biologist BTW) but I find it hard to believe that the placebo effect could be that extreme. The effect was quite dramatic.

    Here’s what I think the problem is:

    Antidepressants are not antidepressants. They appear to be some form of stimulant, though one that operates on a different set of brain chemicals than caffeine, amphetamines, etc. At least that’s what it felt like– it felt like caffeine for my emotional cognition and short-term memory functions.

    If you are depressed because these aspects of your cognition feel slow, then these drugs might help you. If that’s not the cause of your depression, then they probably won’t help.

    So to summarize:

    I doubt that these drugs do nothing, and I doubt that they are useless. However, I also think they are probably over-proscribed and mis-proscribed. They might even be miscategorized.

  • Adam I

    Oh… I forgot to mention but this is important…

    Before trying antidepressants (Celexa) I tried a number of “natural” alternatives such as St. Johns’ Wort, etc. If this had been the placebo effect only, why did those not work?

    That’s why I don’t think it was placebo.

  • http://michaelgr.com/ Michael G.R.

    “Before trying antidepressants (Celexa) I tried a number of “natural” alternatives such as St. Johns’ Wort, etc. If this had been the placebo effect only, why did those not work?

    That’s why I don’t think it was placebo.”

    Placebos don’t have a 100% success rate.

  • Unknown

    Z. M. Davis, what you said is important and interesting. But besides the fact that Robin and Eliezer are different people, I think Robin has made it clear that he thinks it unlikely that “modern science will soon be able to create an AGI”, except perhaps by brain emulation, which isn’t exactly AGI. And given the already unlikely possibility that an AGI happens soon, Robin has made it clear that he thinks it unlikely that it “will bootstrap itself to godlike powers” anytime soon.

    Eliezer refuses (quite reasonably) to give his confidence intervals, but he certainly speaks regularly as though there is at least a 75% chance that an AGI with essentially unlimited powers will exist by 2050.

    So there is substantial disagreement between Robin and Eliezer in this respect. And TGGP’s comment bears on this: in fact, I think it is true that Robin would hold more extreme opinions if he hadn’t moderated by looking to common opinion. But Eliezer refuses to moderate his opinions, and this results in the disagreement in question. It is natural that Robin would moderate his opinions while Eliezer wouldn’t, because another disagreement between Robin and Eliezer is about the implications of the disagreement theorem itself.

    What makes this blog so strange, then, is that both Robin and Eliezer are involved, rather than just one or the other.

  • http://blogjack.net Glen Raphael

    Adam: Depressive episodes can have a finite length. For whatever reason, some people get depressed, they get worse, then a while later they get better. Further assume there is a perceived progression of drugs – some drugs are seen as more severe than others. Patients will try or get prescribed stronger and stronger drugs until at some point their depression has run its course and gets better, whereupon both patient and doctor take it as evidence that they finally found a drug strong enough to cure that particular person’s depression. But maybe it was just the passage of time or other changes in the person’s life unrelated to the drug.

    Person A gets depressed, takes St. Johns’ Wort for a while, and feels better. Concludes that “natural” remedies work.

    Person B gets depressed, takes natural remedies for a while, is still depressed, takes takes prozac, feels better. Concludes that “real” drugs work better than “natural” ones.

    Person C’s depression takes longer, but eventually ends while still taking Prozac. Concludes that Prozac takes a while to take effect.

    Person D’s depression lasts long enough to give up on Prozac and cycle through several other “real” drugs; concludes that Celexa works best.

    The above four case studies don’t rule out the possibility that the drugs are entirely useless.

  • http://home.att.net/~sdgross Stephen Grossman

    Dmitriy: “Just because we cannot imagine a reason for studies to be biased this or that way, doesn’t mean they aren’t.”
    —-
    or maybe an evil demon is screwing w/your mind. how many arbitrary hypotheses can you imagine? knowledge is contextually absolute. Identify your context. bias exists relative to knowledge. You must have some knowledge of reality to even consider the issue of bias. And then of course, theres rands solution to the problem of universals. Knowledge, not bias, is the primary epistemological issue. How do you recognize bias?
    In a context of knowledge. Man had plenty of knowledge prior to seeking a method to guide him when common sense was too narrow.

  • Douglas Knight

    Z. M. Davis,
    Actually, they have to me to have quite similar views on the incompetence of “modern science”; the difference is that Eliezer’s response is to work alone or in small groups, while Robin’s response is to design better large institutions.

  • http://home.att.net/~sdgross Stephen Grossman

    chronic depression and chronic anxiety are psychosomatic responses to the volitional evasion of reason. See Nathaniel Branden’s _Psy. of Self-Esteem_, a study of human nature as important as Rand’s _Virtue of Selfishness_ and Aristotle’s _On The Soul_. Man’s basic method of survival is reason and it is volitional. Nature has, very kindly, given man a warning when one _chooses_ to evade reasoning. These are illnesses of the misuse of the mind. You cannot think anything you please. you cannot have any cognitive style you please. and get away w/it. Modern education, with its anti-conceptual nature, does not provide students with a conceptual content and, more importantly, habits of focusing outward and intellectual integration. The resulting random associations, excessive memory, contradictions, floating abstractions, and irrational fantasies cause chronic depression and chronic anxiety. Its nature’s way of wagging her finger at us. See Rand’s phil. of education, “The Comprachicos,” in _Return To Primitivism_. Pills, of course, offer merely temporary relief. See also _Coping With Anxiety_ by Objectivist psychologist Ed Locke. His solution after identifying the contextual virtues of introspection and meditation,etc. is rational _action_. Not fretting and kvetching, not flopping about like a fish on a pier. Philosophical subjectivism is so widely destructive to a person’s life that many people will have to change their life as a whole to end chronic depression and chronic anxiety. And that, of course, is more than the current willpower of many people can handle. We are not talking about cleaning one’s fingernails more frequently. Philosophy, rational philosophy, is not a luxury for neurotic intellectuals. Its more of a need than bread and water.

  • Nick Tarleton

    On the one hand, modern science is incompetent at producing effective medical treatment, and on the other, modern science will soon be able to create an AGI which will bootstrap itself to godlike powers.

    Very different sciences, plus, like Douglas said, Eliezer doesn’t expect AGI to come out of “modern science” as a monolithic whole, plus you make it sound like “AGI which bootstraps to godhood” is significantly harder than AGI by itself, while Eliezer’s contention is that it’s not.

    BTW, the Modesty Argument/majoritarianism really has little to do with the Agreement Theorem.

  • http://theviewfromhell.blogspot.com Sister Y

    In addition to considering whether a given treatment for a condition is effective in alleviating the condition, we should consider the epistemology of the condition itself (as Robin Hanson points out here, for osteoporosis). Depression, with its vague diagnostic criteria and uncertain etiology, deserves to be scrutinized. This is especially true when positing depression as a cause of suicide, since suicidal thoughts or behavior or attempts are themselves a criterion for diagnosing depression. (It’s a similar problem to the one you have when trying to draw correlations between antisocial personality disorder and prison populations – criminal behavior is a criterion for diagnosing some personality disorders in the first place.) Suicide is too confidently used as a hash for depression.

    As for all those ecological studies on SSRIs and suicide, here are another couple: warning labels on SSRIs about suicide risks have apparently decreased SSRI prescriptions to young people. One study found that counties where more antidepressants were prescribed had fewer suicides, and predicted that fewer prescriptions would mean more suicides; but a criticism of that study reported that the overall drop in prescriptions to young people in 2004-2005 was associated with an overall decline in suicides for those age groups. Most outlandish of all, one of these studies finds no correlation at all (literally r=0.00) between regional rates of suicide and regional rates of major depression.

  • Z. M. Davis

    Nick et al., I admit, “modern science” is a ridiculously sloppy phrase, and I shouldn’t have used it. To put the sentiment more precisely: the scientists and engineers of an era are probably similar enough in abilities such that it seems reasonable to speak of different problems as being comparatively easier or harder for “science” to solve, even though in fact there is no such unified entity. It certainly seems as if working antidepressants or blood transfusions or vitamin supplements are much easier problems than AGI. If this assumption is correct, it would be somewhat awkward to simultaneously be skeptical about the efficacy of present-day medicine and optimistic about the prospects for near-future AGI, and yet both these positions are well-represented on this blog. Just an observation.

    I understand that the agreement theorem and modesty are separate issues. I think Eliezer has it right: A-implies-B does not imply B-implies-A; Bayesians would agree, but that does not mean we can become more Bayesian by agreeing. Persistent disagreements are still–a tad worrisome, I’ll say–if only because there’s only one reality.

  • Jason

    It should be noted that non-SSRI drugs (e.g.Bupropion, aka Wellbutrin) were not included in this study. So I don’t think the blanket statement that “Anti-depressants fail” is appropriate since there is no evidence offered in this blog post supporting such a general statement. I think “SSRI Anti-depressants Fail” would be more accurate. I only point this out because we already have enough inaccurate medical information floating about on the blogosphere, we don’t need to add to it, esp. on a blog that is usually so dedicated to the truth as this one.

    Don’t mean to be snarky, it’s just that the headline is not accurate, even as a generalization (“SSRI Anti-Depressants Fail” wouldn’t be 100% accurate either since not all SSRI’s were tested, but it’s at a level of generalization that is fairly reasonable (I know that is somewhat arbitrary, sorry)).

  • iwdw

    Don’t mean to be snarky, it’s just that the headline is not accurate, even as a generalization (“SSRI Anti-Depressants Fail” wouldn’t be 100% accurate either since not all SSRI’s were tested, but it’s at a level of generalization that is fairly reasonable (I know that is somewhat arbitrary, sorry)).

    While we’re at it, it should be “SSRI Anti-Depressants Fail for Depression”.

    This says nothing of their effectiveness in treating anxiety disorders, OCD, etc.

  • http://scienceblogs.com/corpuscallosum/ Joseph j7uy5

    There are problems with the Kirsch study, of course. For one, they included nefazodone and venlafaxine in their analysis and called them SSRIs. They are not. That is such a fundamental error that it makes me think that the authors do not know what they are talking about.

    Even so, it is not a critical error, because it does not affect the math.

    However, the study only includes premarketing studies. That is, it only looks at studies that were done before the drugs were widely available, before anyone figured out how best to use them. It is much more valid to look at a naturalistic study, such as Star*D.

    Also, the study ignores all the studies done on the drugs after they were released. (The studies submitted to the FDA for approval are, by definition, premarketing studies.) Ignoring information generally is not a good way to conduct science. With this, I am not saying that the study is not valid; rather, I am saying that it is not possible to draw sweeping conclusions from it. Specifically, it is not possible to say whether it makes sense for a depressed person to undertake a trial of an antidepressant, based on the limited data in considered in the Kirsch paper.

  • http://hanson.gmu.edu Robin Hanson

    Joseph, are you suggesting one should not act on the basis of any study if there is any relevant data anywhere that is not included in the study?

  • Jim

    Sertraline has worked wonders in my life. I’ve been taking it for nearly 10 years now. I wish I had found it 20 years earlier. Life is good.

  • Caledonian

    I’d say that’s because my brain is underproducing (or over uptaking; whichever) serotonin, thus it brings me up to more normal brain function

    Unlikely – the brain is extremely good at adapting to different levels of neurotransmitters.

    Perhaps you have a defective capacity to compensate, or perhaps the drug is causing parts of your brain to react in ways they wouldn’t normally, but it is extraordinarily implausible for your claim to be true on its own grounds.

  • Douglas Knight

    Robin,
    Your quantifiers are a ridiculous interpretation of Joseph’s comment. This is a meta-analysis, which should be held to higher standards of inclusivity and it is a large class of data that they ignored. When a meta-analysis drops data, it is a warning of over-fitting.

    On the other hand, the study is explicit that its choice of data is to avoid publication bias.

  • http://explorations.chasrmartin.com Charlie (Colorado)

    Um. Robin, first of all, this is one meta-analytic study of questionable methodology, producing a weakly positive result, and referring not to SSRI data as a whole but to four new antidepressants, only two of which are SSRIs, during clinical trials. It produced a result which is very strongly contradicted by both clinical trials and extensive clinical experience over the last twenty-odd years. So it’s inappropriate to draw any very strong conclusions; consider it as a good Bayesian would: how much should your posterior probability change given this one study and the large number of priors?

    As to your question to Joseph, you’re erecting a straw man there. The issue is not whether you ought act on a study if any relevant information was missing; the question is whether you ought act on this study, when extremely central information is missing or explicitly wrong.

    There’s a further question whether one ought to draw conclusions about all antidepressants (“Antidepressants fail”) given that this only examines a selected data set for a small number of antidepressants. On that basis alone, your initial assertion and headline are mistaken and should be corrected.

    As far as your other, rather risible, clinical advice — “Given their severe side-effects, I’m not sure I’d advise anti-depressants even when other treatments have been ineffective” — I’m tempted crankily simply to note that I wasn’t aware that you had an MD degree. That’s not really sufficient, however, considering how supremely ignorant that statement truly is. First, SSRIs in general have rather mild side effects: in most people, most of the time, the side effects are a lot less troubling than the depression. Frankly, in a disease as generally debilitating as depression, things like tremors, abnormal sleepiness, and loss of sexual desire are mild. The mortality rate from extended chronic depression is comparable to some lesser cancers; a chemotheraputic agent for low-mortality cancer that had a similar side-effect profile to the SSRIs would be considered a godsend.

    The notion that SSRIs lead to an increase in suicidal thoughts and actions is somewhat hard to identify clinically, although it has gotten a lot of anecdotal play in the press; what’s usually forgotten is that people moving from an acute depressive episode to remission are inherently more prone to suicide than the general population even if there has been no treatment at all, and young people with depression are apparently more prone to suicide than older people. Thus, even if SSRIs had no side effects whatsoever, and only caused gradual remission from an acute depressive episode, you would still expect an elevated suicide rate, and especially so in the young.

  • http://dl4.jottit.com/contact Richard Hollerith

    consider it as a good Bayesian would: how much should your posterior probability change given this one study and the large number of priors?

    It is technically incorrect to write, “the large number of priors.” You mean, “the high prior probability” (that antidepressants work, at least partially, at least for some depressions). There is only one prior in a Bayesian update; there is only one prior in Bayes’ theorem. Since Bayesian updating is such a central concept for this blog, I decided to offer a correction even though everyone probably knows what you meant.

  • Ari

    I’m really puzzled by their claim that statistically and clinically significant improvements were due to a “decrease in the response to placebo rather than an increase in the response to medication.” What else could “responding to a drug” possibly mean, other than a difference compared to the placebo group?! The placebo doesn’t go up or down; it doesn’t go anywhere; it’s your baseline. You don’t measure it; it’s what you use to measure other things. It’s like saying, “I didn’t gain weight, the kilogram got lighter!”

    In summary: nope, that wasn’t in my statistics class.

  • http://www.churchofrationality.blogspot.com LemmusLemmus

    A lot of critical commentary about the study is at this blog.

  • Caledonian

    There have been quite a few independent studies showing that antidepressant drugs are only barely better than placebos. Even if this particular study has holes knocked in it, you’d need to account for the entirety of the available data.

  • Doug S.

    SSRIs definitely do something. Whether that something is better than placebo at alleviating symptoms of depression remains an open question, but I keep taking my pills because they seem to have an effect that helps me somehow and they have some nasty withdrawal symptoms.

    (Technically, I’m taking an SNRI rather than an SSRI, but they’re similar enough.)

  • http://www.iphonefreak.com frelkins

    @Charlie

    “things like tremors, abnormal sleepiness, and loss of sexual desire are mild.”

    Clearly you’ve never talked to the wife of a guy on an SSRI long-term – now that’s depression. Dropping coffee cups everywhere and nodding off on the job or while driving really aren’t a party. But may I gently say it seems condescending of you to decide on your own authority that these issues are “mild” and should just be endured. Yikes!

    @Doug S

    “an effect that helps me somehow and they have some nasty withdrawal symptoms.”

    Let me politely ask: are you saying you pay lots and lots of money to Big Pharma every year for an addictive substance with “nasty withdrawal symptoms” for an effect you can’t really describe? Does this mean you keep taking these expensive medications with unclear results simply to avoid the pain of withdrawal? I don’t mean to criticize, because I am sure you know what is best for you, but doesn’t something seem strange in this scenario?

    Stuff like this moves me more and more towards Robin’s counter-intuitive “we have too much medicine” position.

  • Doug S.

    No, my parents’ insurance company pays lots of money to Big Pharma. I don’t pay a cent. I went on my first antidepressant in high school when my parents demanded it; I didn’t want to take it, insisting that there was nothing wrong with me, the problem was with the rest of the world. (What I wanted to do was stop going to school. My parents wouldn’t let me, referring to a family friend who got summoned to family court because his daughter was late to school every day.)

    It might just be post hoc fallacy, but my attempts to go off medicine have always been followed fairly quickly by trouble (or, at least, what my parents call trouble). The only thing that I can identify as having any effect on me at all during my sophomore year of high school was the pills I was given. After all, life still sucked, but I now I was cheerful about it!

  • wellbutrin-saved-my-career

    Why is “Overcoming Bias” perpetuating the pervasive anti-drug bias that keeps so many people from seeking treatment? The very same skepticism and fear of stigma kept me from going in for treatment for a very long time. By the time I did, things were not going well in my professional life, and I’d tried and tried to “cheer up” or “snap out of it” on my own. Now I wish I’d gone in for help years earlier. Maybe it is a placebo effect; but I was astonished to find that I felt better than I had in years. I feel like wind is at my back. I am able to think about the problems in my life without getting sucked into a stomach-wrenching depression, and I even feel excited about facing the challenge and growing through it. My mood and perspective has changed in ways I couldn’t have imagined. Now I have the emotional energy to keep my life together, eat healthy, and take care of myself even while I face some real challenges ahead. I’ve had friends who took sertraline and saw similar transformations in their lives.

    I have a friend who has been suicidal on and off for months now, and I can’t convince her to go get help, precisely because of all this anti-drug bias and stigma. And the very fact that sertraline can cause manic episodes if you overdose or if you’ve got misdiagnosed manic-depression, tells me that there’s something real going on. Even if it IS a placebo effect, let’s figure out how to harness that power without the side-effects.

  • http://www.iphonefreak.com frelkins

    @wellbutrin

    “Why is “Overcoming Bias” perpetuating the pervasive anti-drug bias that keeps so many people from seeking treatment?”

    Forgive me, I’m not very intelligent. Robin & others here present actual evidence that SSRIs don’t work for mild-to-moderate depression (the cases for which they are most often prescribed) and you describe this as anti-drug bias? Are you arguing a pro-drug bias is better? That we should take drugs even when they don’t work?

    Robin is not arguing against treating dysthymia or moderate depression – the discussion might soon shift to what kind of treatments have been proven to work. The problem is in medicine, which is supposed to be scientific, society often pays through the nose for that which actually doesn’t have adequate scientific evidence behind its efficacy.

    This is my 3rd comment, so I’m outta here. But please instead of so many chiming in with “I’m a happy placebo lover who believes in my impressive shaman-psychiatrist,” I’d be interested in seeing what has been proven to work for dysthymia, and if nothing has been studied, I’d like to hear commentators tell me why not.

  • Jor

    alex: There was study in the NEJM that appears to me to use the exact same data set, but makes much more cautious conclusions. The PLOS article is sensationalist

    SisterY: Acupuncture can be effective for controlling pain. Mechanism is unclear, but I believe there are trials already showing it works.

    The study is based on change in a numeric scale for depression. If I had to make a guess, I would say the measuring instrument they are using is just not sensitive for important changes in peoples mood/behavior, rather than SSRIs don’t work. The drugs themselves have probably undergone more rigorous study than the measuring instrument. Also, the drugs have also probably undergone more thorough study than any alternative treatment.

  • Jor

    methodological flaws in the study are reviewed at log base 2