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Antidepressants Useless? An Interview with Glenn Treisman

I’m still bothered by all the hype awhile back about antidepressants not working any better than sugar pills (otherwise known as placebo) because I know that the people who need treatment — possibly those that will go on to take their lives — read that story and decided there was no hope in medicine.

That’s why I like to publish insightful articles like the one I found in John Hopkin’s newsletter, “Hopkins Brain Wise.” They included an interview with Glenn Treisman, professor of psychiatry and internal medicine who is best known internationally for his care of HIV-infected patients who also suffer from a psychiatric illness.

Here’s the interview…

16 Comments to
Antidepressants Useless? An Interview with Glenn Treisman

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  1. I am alive and a part of the world because of the miracle of medication.Without antidepressants i cannot function. I am very close to catatonic. Before if I moved at all it was attempting to take my life. I did something recently that is life-threatening for me. I decided to stop taking my medication. within 7 days I was non-functional. I do not think any study can ever be good. Why ? because at my worst I could not participate in a study because it involved a drive to the city an hour away. there are scores of people like me.It is dumb and naive to compare apples and oranges.It will get a lot of foolish people like me think they are cured and stop meds. Then relearn if i survive i need medication

  2. I remain unconvinced, and I’m shocked by Dr. Treisman’s naïve faith in the validity of clinical trials conducted by Big Pharma. Pharmaceutical companies are notorious for “cooking the books” with regard to research trials.

    For a different opinion on antidepressants (and other psychiatric drugs), see Robert Whitaker’s recent book, “Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America”. The book is an exposé of pseudoscience and corruption in psychopharmacology. The Amazon page is here:

    Disclaimer: Neither Whitaker nor I are members of that religious cult that is opposed to psychiatry. My disillusionment comes from having worked for a major pharmaceutical company. I was on the team that managed the company’s SSRI product.

  3. Ms. Borchard: Dr. Treisman’s affiliations with the pharmaceutical industry need to be disclosed. It’s irresponsible for PsychCentral to not publish such disclosure. Doctors receiving money from pharmaceutical corporations is highly relevant in weighing the integrity of their perspective.

  4. > Depression doubles your risk for cardiovascular death after a heart attack

    McNally L et al. “Inflammation, glutamate, and glia in depression: a literature review.” CNS Spectr. 2008 Jun; 13(6): 501-10:

    “Excess levels of inflamma- tory mediators occur in a subgroup of depressed patients. [..] Immunologic alterations in depression have been described for over 2 decades. [..] Disorders associated with excess inflamma- tion or other immune abnormalities, includ- ing diabetes, coronary artery disease, Crohn’s disease, rheumatoid arthritis, cancers, human immunodeficiency virus, and multiple scle- rosis36,37 are associated with an increased prevalence of depression. [..] Symptoms of post-MI depres- sion differ from classic depression, as post- MI depression is characterized by prominent fatigue, and irritable rather than depressed mood.38 Fatigue and irritability are also com- mon symptoms in IFN-α-induced depression.25,39 In cancer survivors, fatigue is associated with inflammatory mediators. Thus, it is possible that fatigue in post-MI depression and in other medical disorder, and during IFN-α treatment, is caused by excess inflammation. Consistent with this, neurovegetative symptoms of depres- sion, including fatigue and disturbances of sleep and appetite, predict development of atherosclerosis.41 It is necessary to study the associations between inflammation and specific symptoms, such as fatigue, sleep, and appetite, rather than depression as a categori- cal construct. Whether fatigue or other neuro- vegetative symptoms occur more frequently in depressed patients with elevated inflamma- tory mediator levels is a question that has not been answered.”

  5. Thanks. This might be helpful in explaining the utility of antidepressants. The anti-depressant stories will keep too many people from getting help, and expose a lot of us to continued skepticism about the need for medication.

  6. so basically, if I have tried 5 kinds of antidepressant, and they don’t work I’m either an ‘anomaly’ or ‘I don’t have real depression’?

  7. I know Dr Treisman peripherally, and he is a responsible psychiatrist from those interactions.

    That said, I read this as he “brushes the canvas with too broad a brush”, and that is the mentality of the program he is associated with, that being Hopkins. They are one of the original bed buddies with the biological model and psychopharmacology first and foremost, albeit they have backed off in the past few years, hopefully.

    The problem, in my opinion, with the suicidality issue with antidepressants, is due to one simple fact that is a primary player to the stats, and that is that 70% of antidepressant prescriptions written, in this country at least, are from non-psychiatrists. So, when you have doctors who are not specialized in evaluating depression and other psychiatric disorders that can have that symptomatology, seeing someone for 5-10 minutes and ushering them out the door with a script is not the standard of care. Even just asking someone “are you suicidal” is not enough when it comes to assessing depression and complicated sequelae.

    But, giving antidepressants is easy. Talking to and assessing people is a bit more work, eh? But, not if you work by a biochemical model. I have heard a lot of psychiatrists at these ivory towers of learning say they know there is more to it, but, you don’t really see it in their clinical care when patients of theirs come to you for further opinions and needs. That is NOT a comment directed to Dr Treisman, but, it is to some of his colleagues!

    Medication is more invasive than talking, BUT, it also is part of the treatment process for people with clinical depression, as he says above. What he and other Key Opinion Leaders need to start saying, and demanding of their colleagues at these institutions of learning, is to tell non-psychiatrists to stop writing for psychotropics like they are antibiotics!

    Hey, they should not write for antibiotics easily either! Maybe that could be the analogy that gets through to them!?

  8. Why is there so little talk about using neurofeedback to treat mental illness? It’s far more effective than psychotropic drugs and has no side effects for most people. We’ve seen some amazing results in our clinic. Here’s a good article on using NFB to treat depression:

    Neurofeedback is challenging to learn because it is so technical, a deterrent for many therapists. But it is an amazing intervention for many challenging conditions, and it has a permanent place in my practice. SYMPHONY IN THE BRAIN by Jim Robbins is an excellent overview of neurofeedback.

    The Whitaker book on the epidemic of mental illness in the US is a very revealing book, well-documented with credible sources — a must-read for everyone in mental health.

    • True that. Neurofeedback can be especially helpful with drug-resistant depression. Neurologist Jonathan Walker MD published a case series of 183 patients treated for only 6 sessions with a 1 year followup. Very impressive results. Google Jonathan E. Walker drug-resistant
      depression. Article is 4 pages long.

  9. As an upcoming, aspiring licensed practical counselor (beginning my practicum/internship for Masters in Mental Health Counseling), there is total agreement in Dr. Treisman’s statement, “Each patient is entitled to expert tailored treatment, not a recipe derived from the average response from the average clinical trial subject.” Further, with key emphasis on “expert tailored treatment”, each patient is a unique, diverse individual, that has learned behaviors that effect their psychological and physiological systems. Therefore, the brain being the utmost important component that is in operation for both systems. The brain regulates both systems. The brain has options in which submits messages from within in which the individual ignores, or follows through. The effect of re-training the brain, so to speak, from being majorly depressed to living with depression and / or frustation that comes from daily living situations can in fact come from short term medications, but over time, excellent postive feedback / reinforcement in which individuals re-train their brains.

  10. Back about six years ago, I had a major depressive episode (one of several in my life — one of the worst, thought), and I firmly believe that Zoloft may have saved my life. I felt immense relief within three days, actually. I had been crying constantly and waking up with a tidal wave of sorrow in my stomach every morning that made it difficult to get out of bed, much less go to work. Antidepressants aren’t useless by any means. I’m on Pristiq now, but I’d have to say the Zoloft worked much better. The only problem with Zoloft was weight gain. Pristiq does keep my moods steady. I can live with that.

  11. Hello,

    I have been diagnosed with a few problems along with major depression made worse from PTSD. I have tried several antidepressants. Not only were the side effects such as headaches, severe cotton mouth, made my nightmares (from PTSD) worse than they already were, made me tired and to boot did nothing for the depression it was supposed to be for. Then there was a problem with the doctor and pharmacy screwing up time after time leaving me without medication for a week at a time before it was fixed and got a new refill. And stopping cold terkey is hell and made the depression and suicidal thoughts worse. All in all it just wasn’t worth it to me. In the past, in my case I found psychotherapy to be most helpful. I wish you the best.


  12. I’d be dead if it weren’t for my psychiatrist’s foresight in turning my life around with antidepressants. Would you rather I be dead?

  13. I don’t know if anyone of the people arguing against the use of antidepressants have ever had a real major depressive episode. I have and it is because of antidepressants that I am able to live my life at all. And this doesn’t mean that I or any of my treating doctors have ever just used antidepressants in order to not have to deal with underlying psychological issues. I have been lucky to have had the opportunity to attend many years of CBT- and this was definitely very helpful in many ways, but did NOT free me from recurring depressive episodes. When this happens I need medication- or, of course, I could spend a few months in hell until the episode has reached its natural end, and hope I’m still alive when that happens.
    I completely agree with the opinion that antidepressants should never be used as the single treatment, psychotherapeutic treatment is of paramount importance.
    My impression is that of a vast spectrum of depressive disorders, with varying degrees of psychological and/or biological factors leading to the manifestation of “depression”.
    And, on the other side, unfortunately, antidepressants appear to not work for everyone.

    My heart goes out to everyone who has to deal with this predicament and I wish for everyone of you that you will find the right treatment specifically for you, be it pharmacological and/or psychological.

  14. i use anti-depressents for the last three years. they work slow, but steady and firm.

  15. so much talk about how dangerous is to publish how anti-depresants don’t work… well, I think the pharma lobby is much more dangerous. Forcing “help” for problem that does not even exist, is much worse than publishing a study.

    Often people with depression just need to change something in their lifes… the thinking patterns they are stuck on (upbringing or bad experience causes this, no “chemical imbalance”). Or even do some major step to get from their “Castle” (see: Kafka, Franz). They need direction, not pills that dangerously mess with the body’s chemistry… yes, there might be some trully biochemical depression, but that is rare. Most of today’s depression is caused by the rapid world we live in. Coping strategies are needed, not chemistry.



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