From the “What the…?!” file, new research we reported on today found that two antidepressants — Paxil (still commonly prescribed) and Tofranil (not commonly prescribed) — seem to only really work for the most severe kind of depression. When prescribed for mild to moderate — the vast majority of depression diagnosed today — these two antidepressants did not any better than a sugar pill placebo.
The researchers for this new study pooled together the results of six previously published research studies that compared the effects of antidepressants to placebo for 718 adults with varying levels of depression — from very severe depression, to moderate depression, to mild depression.
Three of the studies looked at paroxetine (Paxil) and the others looked at imipramine (Tofranil). Paxil is an antidepressant known as an SSRI (selective serotonin reuptake inhibitor), while Tofranil is an older medication, known as a tricyclic antidepressant.
The researchers were looking for clinically significant differences in the rating scales used to measure depression, typically of 3 or more points. They found that for mild, moderate and even severe depression, both the sugar pill and the antidepressant were about equally effective. That is, they both helped relieve a person’s depression (suggesting that it’s the act of treating someone — not the drug itself — that is actually helping the person feel better). Only for very severe depression was there a clinically significant difference in rating scale scores for antidepressants.
One of the limitations of the study is obvious — it looked at only two specific antidepressant medications, one of which is not commonly prescribed in the U.S. However, since Paxil is in a class of similar SSRI antidepressants, it would not be unreasonable to suggest that other SSRI antidepressants are likely to suffer from the same issues.
The upshot is simple — doctors and psychiatrists should think twice before prescribing one of these two antidepressants for the vast majority of patients who present with mild to severe depression. This doesn’t mean no treatment is available for such patients — other types of antidepressants are available that weren’t included in this study, and psychotherapy has been shown quite effective in the treatment of mild to moderate depression alone, without any medication.
Will these results hold up in future studies? Time will tell. This is the first study to come to this surprising conclusion and it’s likely more research — and more robust research — is needed before we have the final word on the matter.
Read the full story: Antidepressants Work Better than Placebo for Severe Depression
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Depression Overcoming with Medication - Depression Overcoming (3/29/2010)
8 Comments to
“Placebo as Good as Paxil, Tofranil for Most Depression”
Jude at 11:57 pm on
January 6th, 2010This study makes sense to me, based on my experience with SSRIs (not these two specific ones). I was as depressed as a human can be, and thus received an ongoing assortment of prescription drugs, none of which helped much. When we finally hit upon the correct drug combination (after two years of trying), I experienced a significant improvement in my depression. For example, for the first time in a lifetime of dysthmia, I rated a 7 on the Beck Depression Inventory. I theorize that I was too skeptical to be susceptible to the placebo effect, so a drug had to be genuinely effective for me to improve. (Now I’m drug free and use meditation, exercise, and diet to maintain a modest equilibrium).
Hmm, well give me some of them placebos. A wanna’ get a buzz on.
Seriously: Antidepressants where made for people with real clinical depression however most people who take antidepressant are not clinically depressed. They are people who because of allot of stress, the way there life is going, basically because of the crap in there life they are depressed. yes they are depressed but its not clinical depression, its not the kind of depression that even when things are going good, your still depressed. Antidepressant are not for these people, they are for people with strong clinical depression.
nice study, i have always believed in the effectiveness of psychotherapy more than medication.
This reform must be appropriate because many families depend on it, the health system a long time that is weak and patients suffering from cancer, chronic fibromyalgia, rheumatoid arthritis, Parkinson’s, diabetes, chronic pain, chronic anxiety among many other diseases, Need proper medical attention, according to the measure should be findrxonline for 80% of patients with these diseases.
Hope is the main ingredient for healing. Placebos provide hope and hope heals.
Pharmaceutical companies have struggled for decades to beat the placebo effect. One way they sometimes succeed is by using totally inactive, inert placebos that have no direct physiological effects at all to compare with their medications. Thus, it isn’t difficult for many patients to realize that they are in a “placebo” group because they experience no side effects. Thus, the effectiveness of the placebo is somewhat diminished.
The solution? Run studies with “active” placebos that at least cause some mild effects–such as benadryl. That makes it harder for patients to know if they’re receiving a placebo or the real thing. Of course, this approaches reduces the chances of finding signficance for the drug vs. placebo. And not surprisingly, this procedure is rarely used.
KateWS at 1:29 am on
January 10th, 2010Hmm, Paxil worked wonderfully for me. That makes me think that maybe I’m even crazier than I already knew I was!
K at 10:09 am on
January 25th, 2010After much experience with SSRI’s I can safely say that they only ever made me WORSE. I regret so much having gone on them now. I originally went on for social anxiety, but the side effects and withdrawal was horrendous. I didn’t realize that you can’t stop them cold-turkey, and I suffered from horrific depression, panic attacks, de-realization, memory and attention problems, brainfog…for a long time after. I recently went on Lexapro, and on wanting to come off it, have only just found out that all my problems were caused by SSRI withdrawal.
It seems that taking an SSRI affects your serotonin receptors somehow, so once you stop taking it, you become low in serotnin, your brain chemistry gets messed up, and it takes a long time to stabilize. I am now suffering from depression/anhedonia BECAUSE of SSRI’s. I don’t know how long it will be until I recover. Someone should seriously research the potential DAMAGE SSRI’s can cause to the brain and body, but no one seems to consider that. So often I hear things like “well if it even helps a few people it’s worth it”. But is it? Is it worth potentially making your depression WORSE and damaging your body? Maybe we should all ponder that.
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Last reviewed: By John M. Grohol, Psy.D. on 6 Jan 2010
