This guest article from YourTango was written by Dr. Deb Schwarz Hirschhorn.
What a difference a few years makes.
“New Cures for Depression” shouted the 1986 essay in New Woman magazine; “Dramatic Progress against Depression,” blared a New York Times Magazine piece in 1990. Its subtitle was revealing: “The success of new drugs is prompting debate on their overuse—and the value of talk therapy.” That story smugly said that the new wave of antidepressants, including the then two-year old Prozac, which took the country by storm, had “proved to be as effective as the older ones and often safer.” What’s more, the article went on to say that these amazing new drugs worked when old-fashioned talk therapy didn’t. Psychotherapy was relegated to the dustbin of history.
Fast-forward just a couple of years. Suddenly, the manufacturer of Prozac, Eli Lilly, was being sued by families of people who either committed suicide or tried to do so while taking the drug. In the next 15 years, lawsuits for other antidepressants piled up against other manufacturers for the same reason: Forest Pharmaceuticals, maker of Celexa; Lilly (again), maker of Cymbalta; Pfizer, maker of Zoloft; and GlaxoSmith Kline, maker of Paxil.
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Dr. Hirschhorn, could you share the citations to the studies to which you refer when you say, “And now, the latest blow to the pharmaceutical industry: research shows that not only are dummy pills, called placebos, just as effective in routing out depression as antidepressants, but in some cases they are even more effective! What’s more, the latest technology shows that both the dummy pills (used in scientific research as “controls”) and talk therapy change the brain’s wiring.”
Many thanks.
Charles
I am standing up and applauding this article!!
If I may be as bold as to add 2 cents (That yes, I have many times before here.) There is an silenced and neglected group of victims of these drugs, and the fact that the author alludes to the importance of relationships relative to depression, is worth mentioning. We are the spouses and children of the AD users. What damage is done to the collective psyche when a patient goes manic, or kills themselves. My mom went to the doctors 3 times in 3 months complaining about abdomen pain. The doctor told her it was stress, prescribe her MAOIs and told her to go on vacation. Vacation got cut short when we ad to come back with her “belly” swollen. She would fight 5 years before dying of ovarian cancer. A very treatable form if found early. My ex was my beast friend. We had grown and faced so many difficulties together for more then a decade. She was given Zoloft and then the big “P” after having the baby. (So many underlying psychological reasons for the birth of our daughter to trigger PPD that are “norms” in our culture that it was destined.) When she “went manic” it ripped the family apart. Depressed doesn’t begin to characterize the depth to which I felt. As I told a mutual friend who was also my GP of the story and how I blamed it on the meds, he agreed and was floored. Of course that didn’t stop him from trying to prescribe me some AD’s.
The problem in the US is the things that lay the foundation for a future of depression (two parents working, cold public schools, split families, emotionally absent parents, parents on AD’s, bombardment with reasons to be insecure, Survivor guilt driven PTSD caused by abortions, and on and on) have become “norms” in our culture. We have no concept that we have becomes a completely “communal” society. The things that we do and the behaviors we practice have ripples throughout the whole community. But we want to fix everything quick in this culture. Depressed, overweight, bad health? “Take these pills and get back to work.” If we can’t fix it with a pill, then it must be a genetic trait and your right to behave as such. Spend more of your resources then you can afford? In the natural world that would lead to your demise, but we have bankruptcy. It cost too much time and money to commission a therapist to work with you for years. Plus, how do you fix absent or destructive parenting?
The people who brought us AD’s are the same people who once won a Nobel Prize for lobotomies. The real problem is a lack of people in the mental health field who understand the human mind and what we know about it. They “repress” obvious observations. Go back to the classics (Freud, Jung, Milgram, Stevenson, ect..) and stop picking apart the things they got wrong and look at what they got right.
Thank you Dr. Deb Schwarz Hirschhorn
As Dr Hirschhorn has raised depression in animals, perhaps she would care to explain the increasing use of antidepressants in veterinary practice if these drugs act simply as placebos?
Are animals smarter than we give them credit for, or is there a problem with some of the research? Problems such as those raised in this exploration of the much quoted Kirsch I, 2008 study: http://tiny.cc/ai254
I would also point out that while the chemical imbalance theory was disproved before SSRI antidepressants became available, these drugs do facilitate a change in serotonin synthesis, expression, and brain levels. However, except in the first few weeks, they reduce these levels, not increase them as stated in the article. See: http://tiny.cc/ai256
I appreciate that Dr Hirschhorn is a psychologist and therefore has an interest in promoting psychotherapy, not medication, however, demonizing these drugs is not going to help those who have little or no access to therapists. Even in large American cities this can be difficult given health insurance limits, in much of the world therapy is simply unobtainable.
Ian,
As you may know,there is a cliche’ the science and reality of psychology is “all in your head”. As if depression isn’t a hard enough thing to figure out when you can communicate (beyond basic commands and “Pavlovian triggers”) applying such diagnosis is good for one thing only, increasing the prescriber’s bank account. The animals are happier because their owners think they are. This was referenced in the post. It is a magic trick and “illusion” at best. If an owner starts paying more attention or more specified type of attention to their pet their pet will become more responsive. Plus when you pay $400 to to make your pet happy, you look for signs that you did the right thing. You will find what you are looking for.
Chemical imbalance was cited by my wife’s GP, her LIPSW, and her friends. I have read 3 books in the past year (that i won’t endorse) where the “imbalance” theory is alive and well. It is the driving force behind PPD. “Oh, your chemicals are just out of balance after the birth of your child.”
“These drugs” should be deionized. Feeling down, get stoned, better yet, get blowed. I have never once met anybody who was on a coke high (crack is cheaper if you must and way easier then SSRI’s to quit if you want.) who was “depressed”. The elements of the SSRI/ SNRIs work the same way. Added to that, I have never met anybody who was drunk that didn’t think they “were a better driver when drinking.”
That was a great article – thank you for writing it.
I would not say anti-depressants don’t have their place. I think some of the meta-analysis research indicates effectiveness in severely depressed people. But I have no problem working with therapy clients who come in asking if I can support their decision to not take medications. There are many other ways to work with depression that don’t have risks or side effects.
One thing that especially interests me is the idea of active placebo, a pill given to control groups that doesn’t address the symptoms being researched but does have side effects.
It seems that true tests of anti-depressants – and such research would likely reveal the anti-depressants to be even less effective compared to placebos – would be using active placebos in the control group. People who get side effects in ordinary trials usually conclude they are in the group getting the medication. Of course, that’s going to produce a placebo effect of it’s own. But if both groups are getting side effects, that potential is eliminated. My guess is that, at least for mild or moderate depression, active placebos would do just as well as the ADs.
“however, demonizing these drugs is not going to help those who have little or no access to therapists.” I agree and will go one step further. Demonizing these drugs will not help those who need them because the biological underpinnings of their illness are prominent enough to warrant medication.
The depressed patient population is not uniform, and discussions about treatment should not be generalized. While psychotherapy alone may be a sufficient course of action for some (and probably valuable for most people, mental illness or no), it is not sufficient for all cases of depression. If talk therapy is enough, that is great, but for some, medication is absolutely warranted.
Regarding the studies that are purported to show that ADs are no more effective than placebo, I have seen discussions that pointed out that the patients for those studies were not screened rigorously enough to exclude those who were mildly depressed and not likely to benefit from medication in the first place.
“The good news is that brain chemistry “imbalances” in depressed people have never been found.” Not yet! That argument is a red herring. Remember, germ theory wasn’t established until the late 19th century. That does not mean that people weren’t sick with infections before then just because science hadn’t yet identified the cause.
I’m not knocking the value of psychotherapy. A good therapist is worth their weight in gold. But medication plays an important role for the folks who need it.
Please fill in the information regarding mild and moderate depression is different and responds differently when compared with major depression and ADs. I delayed medication due to the bias I developed that meds were damaging, useless and without effects unless negative. I was misinformed.
I feel 100% that with clinical depression meds as the first line of treatment is not considered complete or ethical without talk therapy.
In my own experience I started with talk therapy and did not find any relief from my depression pain until medications were added to my treatment plan. At times professionals see what they want to see according to training and they do not ask the patient a year after leaving their service if they were of any help.
My greatest healing has come from being heard, whether in the asking if I would consider a certain medication, time to look up on the internet, bring back questions, and discuss the expectations for this medication. Listed second yet equal in value is being heard and trained in coping skills by my therapist.
While I agree with the general sentiment of the post, this has not been proven:
“When there is less serotonin (a neurotransmitter that signals good feelings) in their brains, it is a reflection of their depression, not a cause of it.”
Which way the causality goes is important (and it may very well depend on the individual and TYPE of depression). It is not unreasonable to expect that there are some genetic/biological factors that contribute to one’s depression.
Like Steve, I do understand and somewhat agree with what you’re saying. But as a few others said, there are just too many variables with this mental disorder.
A close friend of mine suffered from mild depression after breaking up with his significant other after a fairly lengthy depression. He simply need someone to talk to, and eventually the symptoms subsided.
I’ve seen others who have try the whole “talk therapy” approach, but only medications were able to provide the relief they needed. This is obviously more common in major and severe cases of depression.
Very informative article. Thank you for sharing your expertise with us. One point I would like to add is that there are so many variables to this mental disease that it takes a bold action of an individual to challenge the treatment plan of mental disorder and decide how and what they are willing to do. Society had dictated how we should feel and what we should feel yet we are in demand for fast fixes and yet we seldom take the time in understanding the person. Those that post how they leaned to live with their disease and those that figured out how to conquer their disease seem to get involved with their “inner self”.
After lots of time with wonderful therapists, my inner self and I are pretty well acquainted!
That doesn’t mean that meds are not an absolutely crucial part of keeping my mood disorder under control. As you say, there are many variables involved in mental illness.
Perhaps the most practical way to look at mental illness treatment is not whether you’re challenging a system or not. I prefer to simply consider that we have an array of tools at our disposal:
Talk therapy
Prescription medication
Non-prescription drugs such as St. John’s wort Supplements such as fish oil
Exercise
Light therapy in the winter for those with S.A.D.
Whatever else works for you.
The best treatment is whatever option or combination of options works for the individual, and a good psychiatrist (and I’ve had them) and good therapist will work with the patient as a team.
It’s not about looking for a quick fix (which meds most certainly are not), but about getting relief from brutal, debilitating agony.
This is the best article I have read on depression and its treatment. I think pharmaceutical companies are mostly just interested in making money and therefore promoting one drug or the other as the new magical cure for depression. Exactly what I feel about depression and how to overcome it is what has been expressed in this article. Very interesting read.
To cure depression or overcome it you simply identify the cause and take care of the cause, simple.
I agree talk therapy is the best also because it helps someone greatly to vent things out and especially to a professional that can help. Some if not most of the depression is caused by some personal stuff. I can relate very well with the example you gave about animals and their mate.
Not too long ago I was in a relationship and suddenly my very sweet love, became someone else, someone not so sweet. I was always worried about why. I couldn’t get any work done anymore and I was always feeling down as a result. I knew I hard to do something, try to find out what is wrong and get things back to normal or break up. I ended up breaking up, which left me feeling bad for a few days but it would have been worst if I was still hoping things will work out and getting miserable.
I am only showing how right the points in this article are. Sometimes the cause of depression starts off with small issues, and then when not handled causes the person to become severely depressed.
I am going to re-tweet this right away. Thank you for this informative article, people need to understand what depression is really about and how to effectively cure it, else a time will come when people will just start popping drugs for even mild depression and then have to deal with the side effects.
This is a great thread. Thanks everyone for your commentary. I am finally, after years, in therapy with someone that is helping me. I am seriously depressed and currently suicidal and different meds over the years have not worked, but we are now trying a new one. In combination with my weekly psychotherapy, I expect something has to give. Meds alone never helped and I always stopped taking them due to expense combined with the fact that I just never found someone with whom I could share completely. As to to the availability issue raised: insurance is a major factor. My doctor is amazing I am so thankful to have found him. He does not, however, work with my insurance. He is charging me 3/5 of his usual going rate which equals what insurance would pay him anyway. Due to my current suicidal proclivity, I decided it was best to pay the man despite the fact I work two jobs to make ends meet normally without this added expense. Also, here’s is something I am having a big problem understanding… as we are weaning me off the one med and while starting a new one; five pills of a 20mg “new med” cost me $25. A 90 supply of the 30mg “new med” cost me $30. How can the drug companies get away with charging $5 for one pill but 33 cents for another? Dosage notwithstanding, that is crazier than I am right now!
I am constantly told by my partner that she can not be responsible for making me happy. I have to figure that out on my own. (saying that If I am not happy with myself then I will not be happy with others) I feel this is true to a point, but I also agree with the fact a partner should be a positive influence on the other person rather than a negative emotional provoker. When told, “It is not my job to make you happy.” It immediately sends the other person deeper into a slump, because the person he or she is trying to look to at a given moment for a smile or anything positive is smashed to the ground. (How dare you even think of looking to your partner for happiness, you will never find happiness with the person you love)