I always get a little irritated with articles like the one recently published in Time magazine: “Why Antidepressants Don’t Live Up to the Hype” by John Cloud.
Why?
Because I know that somewhere out there is a person who …
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I generally agree.
I think it can be disheartening to read about the lack of efficacy of many antidepressants. But STAR*D did indeed find that, if a patient finds the right medication, medication can indeed be helpful.
And that’s the primary difference between STAR*D and other clinical research on antidepressants — STAR*D was a real-world, large-scale research study conducted by independent researchers. Which is completely unlike most clinical trials research.
I’d say 70 percent is pretty darned good. It’s just a frustrating process for most patients when it takes months to find that right combination of meds.
thanks john. did you give me two stars? your ego can never get too big doing this, can it?
Yes, the general research findings and individual stories do not match. That’s because the research findings are made up of many (hopefully randomly selected) individual stories.
That was made clear to me recently in a personal way: I was taking Lexapro, which seemed pretty effective for me. But I started having a lot of fatigue, so my pdoc wanted to switch me to Pristiq in case the fatigue was a Lexapro side effect. Having read Dr. Grohol’s excellent posts on this blog on the research on Pristiq, I was pretty skeptical that Pristiq would work at all. But I trust my pdoc, who said his experience was that it helped many of his patients with fewer side effects than its predecessor, so I figured I would try it. I was definitely surprised that it actually worked better for me than the Lexapro, taking a little more of the edge off the mild dysthymia I seem to be stuck with (though both have been good for holding off major depressive episodes).
Responses to medication are extremely variable, and that has to be considered when you’re examining the results of the research studies. Carelessly summarizing a complex study result as “ANTIDEPRESSANTS DON’T WORK” (or, “ANTIDEPRESSANTS ARE MIRACLE DRUGS”) is not particularly helpful to the public.
I have found that patients with a very significant anxiety component to their depression often do very well on SSRI’s. But those with more anhedonia, fatigue, and mental dullness seem to improve more with venlafaxine (also with Pristique, it’s off-spring)or other less selective monoamine inhibitors, such as Wellbutrin, that have some dopaminergic effects as well as norepinepherine reuptake inhibition. There is still a role for MAOI’s (reversible and not) for patients with non-responsive depressions, and they occasionally provide relief when nothing else has done so. Also, I have had recent success adding aripiprazole to two different SSRI’s with very significant effects for what appears to be the old “atypical depression,” with weight gain, irritability, social anxiety and withdrawal.
in my point of view, anti depressants are like pain killers for a broken arm, yes they may make you feel better but unless you fix that broken arm you will either have to live on medication fore ever or you will feel bad when you stop taking them
Actually, I wish there has been articles like the one in Time Magazine when I was on ADS. Perhaps, there were but I wanted to believe my meds were working when they weren’t. Anyway, this article could have saved me alot of heartache from the side effects I developed, including a hearing loss.
By the way, I am not saying that everyone will get a hearing loss but I think serious adverse effects are greatly minimized and blown off by many mental health professionals.
Anyway Farouk, I totally agree with you and as I successfully taper off of what was an initial 4 med cocktail (currently, it is 1), I am doing exactly what you suggest. Great analogy.
AA
From my point of view, antidepressants are not pain killers for the hypothetical broken arm, they are the cure for the broken arm. It’s all about brain chemistry and not attitude. And brain chemistry changes over time…that’s why elders are more prone to depression; not their attitude. And if they need antidepressants (forever) for their lives to be normal, what is wrong with that? But, you do have to work hard to be certain that you are on the right path with the right meds. That takes educating yourself to see how the drugs are effecting you. I took Cymbalta and I was soon a ‘space case’. I use Wellbutrin now and I wouldn’t do without it. It ‘cured’ me.
Totally with ya, Steve. Been on Celexa for seven years and it changed my life. Doesn’t bother me a bit that I’ll be on it forever. The older I get, the more respect I have for conventional medicine and the less I buy the alternative therapies. Enjoy your homeopathic remedies and Bach flower essences and acupuncture. I’m sticking with pharmaceuticals.
It is frustrating to have to try several AD’s to find out what works, but that’s still a lot better that what they had in the 40′s (when my mom had her nervous breakdown after my dad left us).
I resent the writers to our local paper who claim that AD’s R responsible for the increase in gun violence; but a regimen DOES need 2B in place when people start and/or stop their meds. I wish I’d had someone w/me the 1st day I started on Effexor, tho it’s turned out 2B the one that really works for me.
Comments, anyone??
I disagree with Therese Borchard’s analysis. I think that antidepressants are ineffective, sometimes-dangerous drugs. They can cause bad side-effects (perhaps even violent acts, though this is controversial), and they can be very expensive. Moreover, the drugs may lull the patient into a false sense of security: a person who is being treated with antidepressants may think that there is nothing else that needs to be done. After all, if the whole problem is a deficiency of serotonin in the brain, then why do something like cognitive therapy?
I wish that we as a society would abandon dead-end approaches to treating depression and instead focus efforts on novel therapies that may actually work better than a placebo. I want to cry when I think about the countless billions of dollars that were wasted on these drugs.
It’s impossible to disentangle all the confounding factors for any person’s individual response. I’ve had recurrent severe depression since my teens, over three decades now, and swings into hypomania often following the crashes. A single antidepressant has seemed to consistently bring me out of these crashes.
So from my history, do I have recurrent major depression with antidepressant induced mania, bipolar disorder where the antidepressant may, or may not, have triggered the mania, or bipolar disorder where the presence of an antidepressant was more (or less) coincidental, or …
I know it’s very flip but it’s the truth, Antidepressants don’t work except when they do, and you can’t tell anyway.
Be knowledgeable, find a doctor you can work with and work with it together.
I was dead set against antidepressants, and I certainly had a lot of support in my suspicions. However, when my lifelong major depressions were exacerbated by the hormonal changes of perimenopause, I could no longer control my severe suicidal urges.
Antidepressants saved my life, and I feel wonderful now. I don’t want to go off them, and since I have no side effects, I don’t need to. It’s been a complete turnaround, and I’m as quick, funny, and smart as I every was.
My husband and son, seeing the change in me, went on antidepressants suited to their specific issues. My husband hit a home run in one prescription (I had treatment failure on my first AD, and success on the second), but my son is on his tenth for his double depression and anhedonia.
He has gained weight, his blood sugars and cholesterol have soared, and his symptoms have not been addressed. It’s really awful.
These drugs are not a panacea for everyone, but for those they DO help, the help can be rather miraculous.
Of course my husband and I do therapy and use all sorts of loving and psychologically sound practices in our lives. Our work isn’t done just because our brains have been calmed down a bit. But the antidepressants have made our lives easier.
And they’ve helped us deal with the possibility that our son will not get well.
When I finally decided that I needed to start therapy in Dec 2008, I was dead set against using medication to help me. I did some research and decided to start out with a small dosage of Prozac. It started to help me almost immediately. I was expecting it to take about a month, since that’s what the doctor said, but it began lifting me after about 10 days. I’m seeing my therapist for anxiety, along with some other issues, and this drug has really helped me to level out and not have such a massive swing of emotions. I was seeing everything in extremes and it was scaring me.
I don’t expect to be on this drug forever, but for now it’s helping me.
Reading negative articles about medications is part of the reason I put off therapy AND medication help as long as I did. I felt like there was no point. I’m glad I didn’t listen to myself, in this case.
Agree or disagree with the pro-med or anti-med views on psychoactive medications, it is still very encouraging to me that these questions are being asked, that people are examining just what is going on in terms of the big picture of what is being prescribed, to whom, why, and what the outcome is, both for the individual and for society as a whole.
On a personal level, for me, it is just so difficult to know what to do when anti-depressants either don’t work, are too hard to take in terms of side-effects, stop working, or just fade off and cease to really take the torture off the everyday hell of depression.
I have been clinically depressed with major depressive disorder for over 20 years now, and I am still at a loss as to whether or not it is worth taking anti-depressants. I have tried them all. I have been through severe side-effects that are far, far worse than the depression itself. I have had some success with SNRIs, but the efficacy wears off after long term use and so now I find myself back at square one – facing the prospect of starting on a new drug. To tell the truth, at this point, I would rather crash and burn – fall into the pit of depression and suicide – than to go through the false hope, the initial side-effects, the total physical and emotional investment that is commencing another new anti-depressant. I am so tired of going through the same things over and over. Psychiatrists are always so very keen to put us new drugs but they are not the ones that have to live with the side-effects. They say, well if this one doesn’t work, we’ll try another one. Years go by and I go through this over and over again. I can’t do it anymore. Tricyclics, SSRIs, SNRIs, MAOIs, none of them really make life worth living. The most relief I get is the blankness of no depression… but there is nothing else; I may not want to kill myself anymore, but I don’t feel like doing anything else either. On anti-depressants I no longer despair, but it puts me in a state that I term sub-despair, like a form of despair but with the edge taken off it. Sure, my life has been “saved” through medication, but I am now at the point where I wonder if that has been a good thing. At this point I would take a short, emotionally painful yet authentic life rather than a long, medicated, deadened one, any day.
The debate over anti-depressants and their use must continue. The definition of what depression actually is must continue. So far, I think that both the medical/psychiatric profession and the drug companies have let us all down; they still have absolutely no wisdom or expertise to offer those us who are stricken. All they do is hand out pretty pills. Meanwhile, we continue to suffer.
I could have written Maxine’s post myself (I HAVE tried to commit suicide twice; feel like a failure at that, even!).
Anyone considering taking or prescribing psych meds of any kind should first read Dr. Timothy Scott’s book, “America Fooled: The Truth About Antidepressants, Antipsychotics and How We’ve Been Deceive.” I think that much what what is in there (it’s a long read) are things we probably already know, but want to pretend are not true.
i myself have been on and off antidepressants since1992.prozac,paxil,effezor,cumbalta and now pristiq. pristic has helped me more than any other.the time i sis not take anything 1994-2000,i self medicated with alchohal and pills.i thought i was through with the depression. then came the time i could not drink anymore(made me sick as hell),i realized i was just using the alchohol to cover my depression. i havealso had panic attacks since 1984. awful ones. i am now on pristiq and feel like my life has changed.but like the others i am afraid that after a while on these they will stop working. i have already made my decision that if this happens i am not trying anymore ad’s. as long as pristq is helping me i will take it for life if i have to. i also practice conscious breathing daily,especially when i feel panicky . i found that it is very helpful.if i have to i take a anti anxiety pill.seems to run in my family, grandmother ,mother, myself and now my daughter.i also suspect my son,although he won’t admit it. i also know GOD is a big factor in my felling better.