Hard News by Russell Brown

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Hard News: The drugs don't (always) work

99 Responses

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  • Craig Ranapia,

    No Right Turn has already slapped up a post declaring SSRIs to be "snake oil".

    To which my response is, fuck off and come back when you're Doctor Savant. Ironically enough, I'm due for the quarterly checkup where I pay careful attention to medical professional who aren't the bitches of Big Pharma who reach for the perscription pad as a first resort.

    SSRI's are part of how I manage my mental illness, and one I accepted with extreme reluctance BTW. While there are perfectly legitimate concerns around over-prescription, poor monitoring and unrealistic expectations, there are some of us out there who don't need to be told "talk a walk and cheer up". If it was that simple, that's what I'd be doing.

    North Shore, Auckland • Since Nov 2006 • 12370 posts Report Reply

  • Lucy Stewart,

    The danger here is that people taking these drugs will see only the headlines (and Radio New Zealand seems to have been about little else this morning) and just stop taking the tablets. I can't emphasise enough how dangerous this could be.

    Too right. I have a friend who's just started on anti-depressants, and she's struggling enough with the side-effects as it is. When she showed me the BBC article reporting this last night, I wanted to hit someone - this is absolutely the last thing she needs to see. I'm confident she's not going to just stop taking them, but it's hardly helpful.

    Wellington • Since Nov 2006 • 2105 posts Report Reply

  • merc,

    Thanks RB, I appreciate the effort and the thinking that you have put into this.
    On another note, 10.30 am! Arggggg.

    Since Dec 2006 • 2471 posts Report Reply

  • Tim Michie,

    In terms that this is a story of pharmaceuticals encouraging over-prescription of long term income products, isn't this the same old someold?

    Auckward • Since Nov 2006 • 614 posts Report Reply

  • Craig Ranapia,

    Lucy:

    Don't hit anyone, just be the best bloody friend you can be. I don't think anyone who hasn't been there can really understand how shitty and utterly powerless you feel at the very notion of choking down medication. It might not seem so at the moment, but it really does matter to know there are people around you who don't understand the fifty flavours of Hell you're going through, but care all the same.

    North Shore, Auckland • Since Nov 2006 • 12370 posts Report Reply

  • Jen W,

    I can only speak for myself when I say that my SSRI has been ESSENTIAL to making progress in living with anxiety, and is part of the overall strategy. I truly hope that people don't make rash decisions about stopping their meds because an ill-informed journo wanted to get paid. Would the newspaper be held responsible for the outcome? I think not.

    Since Feb 2008 • 1 posts Report Reply

  • Neil Morrison,

    What's being used is the National Institute for Clinical Excellence (NICE) criteria for clinical effectiveness. I think NICE's criteria take into account cost effectiveness.

    weighted mean improvement was 9.60 points on the HRSD in the drug groups and 7.80 in the placebo groups, yielding a mean drug–placebo difference of 1.80 on HRSD improvement scores...the standardized mean difference, d, mean change for drug groups was 1.24 and that for placebo 0.92, both of extremely large magnitude according to conventional standards. Thus, the difference between improvement in the drug groups and improvement in the placebo groups was 0.32, which falls below the 0.50 standardized mean difference criterion that NICE suggested.

    so, a bit complicated.

    Since Nov 2006 • 932 posts Report Reply

  • Ray Gilbert,

    The danger here is that people taking these drugs will see only the headlines (and Radio New Zealand seems to have been about little else this morning) and just stop taking the tablets

    This possibility is similar to the (incorrect) birth control pill/ breast cancer link reported in the UK several years ago, which lead to an increase in pregnancies in the following year.

    The problem with media reports of medical and scientific articles is that they often tout them as gospel truths but are either selective in their reporting, or unable (or unwilling) to place a single article in context with other peer reviewed literature also available. There is also a reluctance or to publish stories when a once topical article is refuted or challenged.

    Since Nov 2006 • 104 posts Report Reply

  • Neil Morrison,

    found the link

    In the depression guideline (National Collaborating Centre for Mental Health, 2004a), for example, comparing the efficacy of selective serotonin reuptake inhibitor (SSRI) antidepressants with placebo in the treatment of mild to moderate depression, there was a statistically significant difference, with SSRIs being superior in reducing depression scores; but the mean reduction in depression scores associated with SSRIs was only marginally greater than for placebo. The GDG considered the additional benefit from SSRIs to be too small to be of clinical significance.

    That was back in 2004.

    Since Nov 2006 • 932 posts Report Reply

  • BenWilson,

    I don't think anyone who hasn't been there can really understand how shitty and utterly powerless you feel at the very notion of choking down medication.

    Yeah, I felt that way when my doctor told me I was asthmatic. It was news to me since I've always been fit. I told him I don't get short of breath when exercising, or have any attacks or any of the other symptoms I've seen in people who are very asthmatic. He told me that it was a simple factor of my response to Ventolin, that it increased my capacity. He then put me on Flixotide. But I don't take it any more since the side effect of a permanent cough was not worth the unobservable-without-a-peak-flow-meter improvement to my already high lung capacity. And, as you say, the feeling of powerlessness and being chained to a medication was simply .... depressing.

    Auckland • Since Nov 2006 • 10650 posts Report Reply

  • FletcherB,

    The only thing I know about the effectiveness of SSRI's (Aropax to be precise) was that it was pretty easy to guess when my flat-mate hadnt taken them....

    West Auckland • Since Nov 2006 • 889 posts Report Reply

  • cushla,

    "The danger here is that people taking these drugs will see only the headlines (and Radio New Zealand seems to have been about little else this morning) and just stop taking the tablets. I can't emphasise enough how dangerous this could be."

    I really don't think people who are taking these meds will stop, because if they are like me, they know how much these meds have changed their life. Unless they have just started, as in the case of Lucy's friend. The initial side effects are horrific, really frightening, but in my experience ssri's have changed my life, and I was one who believed for many years that I could find a natural, spiritual, therapeutic solution (after the self-prescribed Class A, B and C drug treatment stopped working many years previous).

    I think there is serious overprescription of anti-depressants. My boyfriend says they had no effect on him when an exgirlfriend insisted he go on them. Maybe he just has a naturally dark pessimistic nature (err, he has! One of the many reasons I love him - there's too much forced (and false) positivity in the world!).

    For a really interesting, and disturbing, look at the implications of over subscribing anti-depressants watch Anthropologist Helen Fisher talk about the chemistry of love.

    www.ted.com/index.php/talks/view/id/16

    As I've always suspected - everything is chemical!

    Since Feb 2008 • 1 posts Report Reply

  • Tom Semmens,

    It seems to me its also probable that SSRI's are heavily over-proscribed to a society that thinks being happy is a right and that a pill can absolve them from also making the personal effort that dealing with depression requires. SSRI's certainly worked for me when I needed them - my six months worth of SSRI's provided the initial foothold that allowed me to then scramble me from the pit of blackness that my character had somewhat inconveniently cast me into (not that I mind being someone who suffers from the black dog - its bloody horrible - but then, no one who doesn't get depressed can possibly appreciate the world in the same way person who gets depression does - melancholy FTW!).

    Having said that, far to often I see people taking these SSRI's not to treat depression, but simply to mask its symptoms. taking Prozac, for example, for years is something I find deeply unattractive.

    Sevilla, Espana • Since Nov 2006 • 2214 posts Report Reply

  • Neil Morrison,

    i've been trying to decipher the line

    Thus, the increased benefit for extremely depressed patients seems attributable to a decrease in responsiveness to placebo, rather than an increase in responsiveness to medication.

    is this implying that the placebo effect is masking the drug effect in less severly depressed people?

    Since Nov 2006 • 932 posts Report Reply

  • Don Christie,

    I really don't think people who are taking these meds will stop,

    No, but there are people for whom these can be helpful that would use this as another reason to not take them. Oversubscription aside, the stigma associated in some peoples' mind with taking anti-depressants is still deeply ingrained.

    Wellington • Since Nov 2006 • 1645 posts Report Reply

  • Rob W,

    To really understand this metanalysis, you'd need to look at all the trials they include. There are often ethical problems with giving depressed people placebo medications, ie no treatment at all, and you'd need to read how each trial treated the placebo arm - it wouldn't surprise me if those people were carefully monitored and received support/input which may explain the very strong placebo effect, and would lessen any difference between the groups. After all it's well proven that cognitive therapy can be as effective as SSRIs in selected people.

    Auckland • Since Nov 2006 • 9 posts Report Reply

  • Peter Martin,

    Ben Goldacre in the Guardian too has been looking at ssri drugs. He is not convinced that it is seratonin that is necessarily at fault here and points out that

    there is a drug called tianeptine – a selective serotonin reuptake enhancer, not an inhibitor – and yet research shows this drug is a pretty effective treatment for depression too.

    There are some interesting links to research and papers published in his blog.

    http://www.badscience.net/?p=607#more-607

    Dunedin • Since Nov 2006 • 187 posts Report Reply

  • Shep Cheyenne,

    Less than 10% suitable for the study!

    Are they the margin for error of over prescribed meds?

    The otherwise healthy with no other messy factors for a period of 6weeks when they kick in in around a month.

    Why not a 6 month study?

    This is the normal min as stated above and workable for any study.

    Was the agenda to scew he results to a particular end?

    Was it sponsored by Tom Cruise?

    Since Oct 2007 • 927 posts Report Reply

  • Joanna,

    Craig, I am really, really feeling you today. Making the decision to go on an antidepressant is never easy, even if it's your third round. I'm lucky in that side effects for me - dry mouth, dizziness and muted orgasms - aren't very severe and fade after a month or so, but it's really hard to come to terms with the fact that I require medication to get through every day. Although of course every doctor and every counsellor ever will give you a diabetes talk - "You wouldn't think it was pathetic for a diabetic to need to take insulin every day would you?". It was really hard for me to start taking the medication, and while I accept it now, I find it's really difficult to get friends to deal with maybe I will have to take a pill, or a pill and a half every day for the rest of my life to be okay.

    Wellington • Since Nov 2006 • 746 posts Report Reply

  • Lyndon Hood,

    RNZ did eventually talk to a chap who phoned in to say how whichever SSRI it was changed his life, and had a few emails too.

    It occurred to me to wonder what this will do to the people in that famously hard first few weeks.

    My resident psychologist certainly wasn't surprised, remarking that (depending on the person) if you're not seriously depressed the side effects can be worse than the disease.

    I do recall that people point to SSRIs + cognitive behavioural therapy as very reliable, but I don't have a citation for you.

    Wellington • Since Nov 2006 • 1115 posts Report Reply

  • Sue,

    taking Prozac, for example, for years is something I find deeply unattractive.

    yes because so many of us WANT to have drugs in our life for years, we love that every day/night/both we have to take X Xpills.
    yes it's so fun.

    here's the things for people with mental health issues, drugs do not make you happy.

    for some people the right medication simply ensures that they don't live down in the dark places. They have highs, they have lows, they have normal moods.

    For some people drugs mellow them out they don't don't get too hyper or too black.

    yes there are misdiagnosed people, yes some GPS over prescribe. but , better a few extra prescriptions than a few extra deaths eh.

    Wellington • Since Nov 2006 • 527 posts Report Reply

  • Joanna,

    I do recall that people point to SSRIs + cognitive behavioural therapy as very reliable, but I don't have a citation for you.

    Oh yeah, SSRIs by themselves probably won't fix you, but they might make it a little easier to get out of bed and get to your cognitive behavioural therapy appointment. Although god yes, the first couple of weeks after you've been diagnosed and are waiting for the meds to kick in are pretty much harder than the weeks leading up to the diagnosis. But then as Tom Semmens says, there's that glorious glorious invincible euphoria that people who aren't depressed probably don't get to feel.

    Wellington • Since Nov 2006 • 746 posts Report Reply

  • Russell Brown,

    It strikes me that another weakness in this study -- probably a reflection of the vintage of the trials -- is that it does not consider at all the use of SSRIs to ease anxiety disorders, only clinical depression.

    A significant group of people on the autistic spectrum -- including the wonderful Dr Temple Grandin -- regard low-dose SSRIs as allowing them to actually function without the terrible anxiety that can accompany an autistic experience of the world.

    The Herald is getting a bit of a roasting in its Your Views section already. I think there are people talking about Press Council complaints.

    Auckland • Since Nov 2006 • 22825 posts Report Reply

  • Paul Williams,

    I have a great deal of respect for people who'll talk about their health, and particularly mental health, in a public way. I've had a few friends struggle with mental health challenges and am certain that they'd have found it easier if there was less stigma attached. Craig, Joanna I'm sure you're not fishing for respect, but you have mine.

    Sydney • Since Nov 2006 • 2273 posts Report Reply

  • david w,

    Thus, the increased benefit for extremely depressed patients seems attributable to a decrease in responsiveness to placebo, rather than an increase in responsiveness to medication

    is this implying that the placebo effect is masking the drug effect in less severly depressed people?

    It's certainly a bit wierd, the evidence is in figure 2 of the paper (btw, Public Library of Science (PLoS) journals like this one are all open access anyone that has a pressing need to give themselves a headache can read the actual articles behind the headlines).

    I have no special authority to interpret the data but it seems plausible to me that the small improvement found in people with mild symptoms are masked by the placebo effect but for more seriously ill people, the majority of whom would get worse without intervention, the SSRIs are more effective. Or something like that.

    RNZ did eventually talk to a chap who phoned in to say how whichever SSRI it was changed his life, and had a few emails too.

    I wish they'd report the story properly in the first place instead of falling into the journalistic cliché "anecdotal evidence trumps what we thought study said" Can't wait for the <i>Listener's</i> inevitable front page story...

    In the lab • Since Feb 2008 • 3 posts Report Reply

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