Antidepressants may not work

[johnnymk]

Figures don't lie, but liars figure.

I bet the next big wave of class action lawsuits against drug companies will involve antidepressants and anti-anxiety meds. And I guarantee that it will bankrupt them.

http://money.cnn.com/2008/01/16/news/companies/antidepressants/?postversion=2008011618

NEW YORK (CNNMoney.com) -- Patients and doctors alike may have received some fuzzy truth about the effectiveness of antidepressant medication.

According to a report in The Wall Street Journal, many studies have found that best-selling antidepressants like Wyeth's Effexor and Pfizer's Zoloft may have little or even no effect on patients. Many of those studies, though submitted to the Food and Drug Administration, were left unpublished.

Researchers accordingly suggested in this week's New England Journal of Medicine that doctors and patients may not have been able to see the full antidepressant picture.

Both Pfizer (PFE, Fortune 500) and Wyeth (WYE, Fortune 500) told The Wall Street Journal that they will disclose all study results, but they will not necessarily publish them in medical journals. The FDA does not require pharmaceutical companies to publish the studies that they sponsor, which leaves many studies unpublished.

Separately, 74 studies involving 12 antidepressant drugs were submitted to the FDA between 1987 and 2004, 38 of which the FDA called "positive." Though all but one of the "positive" studies were published, only 14 of the 36 "negative" studies were printed in medical journals.

But even with the large disparity of reports that the pharmaceutical companies published, not all of the negative stories were all that "negative."

According to the NEJM researchers, at least 11 of the 14 "negative" studies presented unfavorable findings as beneficial ones by highlighting positive secondary outcomes and ignoring negative primary results.

The New England Journal of Medicine researchers believe this "publication bias" can complicate doctors' understanding of the effectiveness of medications. For instance, when considering all of the studies' data, the researchers found that Zoloft only has a "small" effect on patients as opposed to the "medium" effect that the mostly-positive results had shown

[molecularfire]

Yeah, there is probably going to be a lot of public backlash over this.

For the legal ramifications, part of it will depend on whether they even submitted those studies for publication. Fact is that the individual journals decide which studies they want to publish and journals are much more likely to publish positive studies (studies that show effects) than negative ones (studies that show no effect). If the drug companies sent the studies for publication to a couple of journals and they turned them down, I imagine it would take a lot of the legal burden off of the drug companies. As for the spin on the papers, that happens in pretty much all papers. The people who did the studies have their own agenda (whether it's financial gain, desire to make themselves look good, plain old self-delusion, etc...) and try to push it in the discussion part of the study. That's why when you read an article, you're supposed to look at the materials/methods section (they tell you how they did the study) and the results section (the raw data). Heck, most of the articles I read, I just skim over the discussion section at best. There's an art to reading scientific articles and most people who read a decent number of them know that articles try to bias you.

Honestly though, it really doesn't change the way I've been managing patients. Houdini might have a different viewpoint on this given that he deals with this on a much higher level than I do but I kinda look at antidepressants as a crapshoot anyways. You deal with the social stuff as well as you can, get them good support, and start them on an antidepressant. I tell my patients that the drug may or may not work and really pick them based more on side-effect profile than on published efficacy anyways. :shrug:

[zippyjuan]

The Scientologists will be at the front of the line for any lawsuits on this one. They believe all psychiatry a sham (except for programs they sponsor) and that all psychs dope up their patients unnecessarily. They will see this as vindication of their position.

[DarkFury]

I'm so depressed at hearing this news.... :sad:


:eek:

[ski]

I'd believe it based on personal experiences. It'd be great to see more scientific data though to appease skepticals, which there are going to be many.

[ArkiStan]

I'm so depressed at hearing this news.... :sad:


:eek:

HAHA totally. This news is definitely NOT gonna help people's depression.

[Houdini]

Hmm...too late at night to comment much, as I have to wake up early, but I'll say a few things, esp b/c I have a big interest in psychopharm. I've seen it save countless lives, both acutely and over time.

Some antidepressants work a little better than others. They are not cure-alls, but they can help with idiopathic anxiety and can elevate mood. If you prescribe enough of them and follow your patients close enough, you tend to see which ones work better than others. They also have great off-label uses that won't be in many studies. They're also poorly prescribed fairly often, usually by non-psychiatrists. I don't mind if a family practice doc or a pediatrician prescribe psych drugs if they know what they're doing, or if they work/consult with psychiatrists, but I've seen some really wacko stuff over the years. I don't prescribe chemotherapy very much, but I've seen plenty of oncologists prescribe antidepressants/antipsychotics in really strange doses, combinations, etc. Hell, I saw an internal medicine attending right for thorazine as needed for hiccups a couple of years ago. Yes, it has an on-label use for intractable hiccups - hiccups that last for months, but it's very irresponsible to write for it for every joe-blow patient who happens to be on your ward.

Yes, articles are usually biased. Like mf said, you really have to get used to reading them. There are rating scales for depression than work fairly well, but they are not bulletproof, as it's tough to be in someone else's head.

Some antidepressants work completely differently than others, so I'd like to see a more detailed report breaking this down by class.

Some of the newer drugs in development will likely work better than everything we've seen, as they will work on the actual chemical reactions that either produce certain neurochemicals or affect the ways the neurochemicals work via changing DNA in specific ways, etc.

Honestly I haven't kept up much recently with this news, but I have heard some murmerings about it. It's probably really overblown news, esp. because it makes for great headlines, and psych drugs are always in the spotlight for quick news articles.

Still, nothing works for depression as well as or is as safe as electroconvulsive therapy.

[beachgirl]

Many of these meds are prescribed by doctors who cannot make a correct diagnosis so they blame the symptoms on depression. Then they prescribe pills such as Zoloft or Effexor or even Neurontin in some cases. They also use anti depressants for a variety of ailments not originally designed for. I would say to anyone triple check and make sure they know all the other medicines you are taking. If you are not truly depressed from a chemical imbalance but from the a misdiagnosed or undiagnosed illness it can definitely cause one to contemplate suicide. And if they don't monitor closely(which they don't 99% of the time) you can be headed for disaster.

A family member was put on something called Lexapro and it helped a lot. Unfortunately you can't monitor a person taking the medication unless they are in house.

Class action suits for any medication mistakes is a joke. I learned the hard way and got nothing after 5 years. The fund ran out of money and the attorneys got billions. I on the other hand had to sell my home to pay for the medical bills and will need a heart transplant not to mention what it did to my liver. These were not antidepressants but through the years I have been prescribed over 4 different medications from different classes that have been pulled due to complications. I never got so much as an apology or any reimbursement. It has all but ruined my life. But one must go on and make the best of things.

Just make sure you watch your body for symptoms and changes no matter what medicine a doctor prescribes for you. They usually don't know much about them other than what the drug reps tell them. Call a pharmacist. They know much more. And make sure the benefits out weigh the risks.

I am not a doctor, I am not a senior, but someone who trusted in the medical community and got royally screwed by not becoming self informed and doing my homework. And for women (even young women), if you know your body is not right, DO NOT let doctors tell you it's depression or PMS. Go to another doctor until someone can diagnose you.

This is just my personal experience and opinion. I do not profess to be a medical professional and am not giving medical advice.

[Houdini]

Or go to a specialist in the field, or ask for a referral to one. Psychopharm changes so much each year. :shrug:

[Houdini]

I have noticed an anti-psychiatry slant in some threads recently, especially those and comments by johnnymk. Is there a particular reason? I hate to stir the pot, but I think there are a lot of misconceptions about what psychiatrist can and cannot do, often propagated by the media as well as Scientology (which, by history, is suspect in itself for many reasons, of which I'd be happy to explain) as well as other issues.

I'd appreciate hearing others' concerns, as it is one field in which I can claim some expertise, especially regarding psych drugs. Even articles like the one posted are riddled with errors and can be confusing to those who don't understand the ideas behind depression/psychosis/anxiety treatments, etc. This could be an interesting discussion if people keep open minds. :shrug:

H

[Houdini]

Hate to keep bringing this up, but another few articles have been making the rounds in major publications regarding the supposed ineffectiveness of antidepressants. I caution everyone who reads it to speak to his/her doctor and/or read up on the meds mentioned, as in the last article I read, released today, lumped some antidepressants in with others of a different class, yet called them the same class and said they work the same way. Nope.

Also, in other news, some recent studies I was perusing today, published mainly for psychiatrists, neuropsychs, and psychopharmacologists, have shown that a small percentage of people will likely have no real response to some forms of antidepressants due to a specific isolated gene. Mice that have had the gene knocked out do not respond well to (well primarily) SSRIs (such as Prozac, Zoloft, Paxil, Celexa, Lexapro, etc.) Humans have the same gene in the same basic area of the DNA, and some preliminary studies have shown that those without the gene (like the mice created to not have it) don't respond well to that particular class of drugs. Very interesting. As far as other meds, such as Wellbutrin, Cymbalta, or Effexor, while lumped in with SSRIs in the major media, the studies aren't very clear cut (then again, neither are most of the others, primarily due to small n values.) IOW, the SNRIs and SSNRIs haven't been studied enough to figure out if they work on those resistant to SSRIs' actions.

And, to assuage the thoughts of some here who have voiced opinions before, while many of these do help alleviate anxiety, none of the above-mentioned meds or any in their classes are addictive. Often they are confused with other anxiety meds, like valium, xanax, klonipin, etc., which work entirely differently - in fact they work a lot like alcohol. I still prescribe them though, when appropriate. I've seen them do wonders for people.

H <--just passing along some interesting stuff I read today about this topic

[uncledaddy]

As some of you may know, I suffered a head injury at work about two years ago and my doctors have been experimenting, (don't know if that is the right term to use), with different antidepressants to alleviate anxiety, nightmares, and sleep problems. I've been on Effexor, Lexapro, and now Cymbalta. With the Cymbalta, I've gone from 20 mg then 40 mg, and now at 60 mg. To tell you the truth I don't feel any difference nor has there been much change in my symptoms and this is two years later.

You can tell it hasn't helped my sleep problems as I am on here at all different hours of the day and night. :D

So it has made me wonder as to the effectiveness of these meds. Fortunately I am not paying a dime for any of these meds. They are outrageously expensive.

Don't know if it has anything to do with the other meds, (Tegretol, Topomax, and Trazodone), but I'm sure the Docs would know. :shrug:

[Cheesypuff]

here dilbert...take this placebo.

-dogbert

[Houdini]

As some of you may know, I suffered a head injury at work about two years ago and my doctors have been experimenting, (don't know if that is the right term to use), with different antidepressants to alleviate anxiety, nightmares, and sleep problems. I've been on Effexor, Lexapro, and now Cymbalta. With the Cymbalta, I've gone from 20 mg then 40 mg, and now at 60 mg. To tell you the truth I don't feel any difference nor has there been much change in my symptoms and this is two years later.

You can tell it hasn't helped my sleep problems as I am on here at all different hours of the day and night. :D

So it has made me wonder as to the effectiveness of these meds. Fortunately I am not paying a dime for any of these meds. They are outrageously expensive.

Don't know if it has anything to do with the other meds, (Tegretol, Topomax, and Trazodone), but I'm sure the Docs would know. :shrug:

Hmmm...60 of Cymbalta is a standard dose, but is not high by any means. Cymbalta is pretty good for depression as well as chronic pain, but in my experience I'm not sold on its effects on anxiety. I'm sure it has some effect, but like Wellbutrin, it's a little activating. It's unlikely to help sleep, so take it in the morning. Trazodone will help with sleep, but a couple of other antidepressants, in very low doses (in one case, the lower the dose, the GREATER the efficacy for sleep,) are good for sleep and are not habit forming. If you have a lot of daytime anxiety, there are some other meds you could potentially take during the day to augment the antidepressant with minimal side-effects. Be sure to discuss all this with your doc.

As usual, the above should not be taken as direct medical advice, as I know very few of you on this board personally, nor have I examined any of you or your medical records. Just throwing out some info that may be helpful, but it should not replace any recs by your doc, of course. :)

H

[Houdini]

The Scientologists will be at the front of the line for any lawsuits on this one. They believe all psychiatry a sham (except for programs they sponsor) and that all psychs dope up their patients unnecessarily. They will see this as vindication of their position.

Heh...I have some friends who went to a recent national psych meeting in NOLA who were lucky enough to go to a lecture about Scientology, presented by ex-Scientologists who had their lives royally screwed up. It was an invitation-only lecture and very difficult to attend. VERY high security, as the Scientologists had made some violent threats and were actively protesting. Checked for weapons and everything. It's amazing how freakin' militant these people are. No psych meds, no therapy (unless you pay them a lot of money for their therapy based on questioning and galvanic skin response.)

Hubbard was a weird dude, and was diagnosed during his lifetime and after through his writings with various mental illnesses. He actually confided in some of his writings as well as to some scientologists about his (likely) manic-depression. He was a grandiose guy, and, as some tell it, when he sought a psychiatrist, instead of going to a local doc for a referral, or even seeking out a local psychiatrist or hospital, he wrote a letter to the APA demanding to be personally seen by the president of the APA. Of course, that's kind of ridiculous, so they wrote him a letter advising him to go to a psychiatrist (but not the president of the national organization) or, as standard, to an ER if he feels suicidal, etc. Well, that made him mad - he felt snubbed by psychiatry in general because the head of the APA wouldn't drop everything to see him (imagine waking up with a sore throat and instead of going to your local internist or family doc, writing a letter and calling the American Medical Association demanding that the head of the organization personally examine you...weird) - so, feeling snubbed, he disavowed psychiatry and added anti-psych stuff to his growing volcano religion, though he kept in some weird therapy and brainwashing techniques (using his galvanic meter in auditing sessions, etc.)

Then again, IIRC, he claimed to be CIA, an Admiral, and all sorts of things during his lifetime. His biography would be hilarious if it weren't true. Interesting reading about him though. But the fact that his followers actually threaten to physically harm legitimate docs is scary. I know they had a rally outside the APA convention in SD when I was there last year, but I avoided it. I wish I had gone to at least part of it just so I could try to figure these guys out.

Then again, a religion started by a guy well known to have said that the best way to make money is by starting a religion....well...

[ShawnLee]

Hubbard... At the risk of being named an SP, Hubbard was a nutjob.

Let's let the science work it out and wait on the results. Is it disappointing? Yes, but not any more so than my finding out that some cold medicines don't seem to be effective and don't make me feel better.

[uncledaddy]

Hmmm...60 of Cymbalta is a standard dose, but is not high by any means. Cymbalta is pretty good for depression as well as chronic pain, but in my experience I'm not sold on its effects on anxiety. I'm sure it has some effect, but like Wellbutrin, it's a little activating. It's unlikely to help sleep, so take it in the morning. Trazodone will help with sleep, but a couple of other antidepressants, in very low doses (in one case, the lower the dose, the GREATER the efficacy for sleep,) are good for sleep and are not habit forming. If you have a lot of daytime anxiety, there are some other meds you could potentially take during the day to augment the antidepressant with minimal side-effects. Be sure to discuss all this with your doc.

As usual, the above should not be taken as direct medical advice, as I know very few of you on this board personally, nor have I examined any of you or your medical records. Just throwing out some info that may be helpful, but it should not replace any recs by your doc, of course. :)

H

Thanks H. As always, I do take advice and run it past the docs and then follow their recs. I do appreciate your input. Just can't wait until this is all over and done with.

[beachgirl]

I have noticed an anti-psychiatry slant in some threads recently, especially those and comments by johnnymk. Is there a particular reason? I hate to stir the pot, but I think there are a lot of misconceptions about what psychiatrist can and cannot do, often propagated by the media as well as Scientology (which, by history, is suspect in itself for many reasons, of which I'd be happy to explain) as well as other issues.

I'd appreciate hearing others' concerns, as it is one field in which I can claim some expertise, especially regarding psych drugs. Even articles like the one posted are riddled with errors and can be confusing to those who don't understand the ideas behind depression/psychosis/anxiety treatments, etc. This could be an interesting discussion if people keep open minds. :shrug:

H

What is Lexapro mainly prescribed for? I am not against psychiatry but so many of these drugs can do damage. And what happens when the patients taking a drug such as Lexapro stop suddenly or can't afford them any longer? Are they at higher risk for suicidal behavior?

[molecularfire]

Lexapro is mainly prescribed for depression. I'll leave the rest of the Lexapro question to Houdini because it's more his area of expertise than mine but yeah, Houdini (at least the guy who claims to be Houdini in this board) is a psychiatry resident (I think he's still a resident... third year if memory serves me correctly) in NOLA as well as an amateur magician and kinda funny guy. :thumb:

[beachgirl]

Any comments on the Lexapro?

[chrissy]

It might take him a couple days, but he will come back around.

He is a busy man, but well worth the wait ;)

[ShawnLee]

While we're on this thread about psychiatry...

Remember when we had that thread a little while ago that asked what pet peeves you had in movies? Or what ruined a movie for you?
I forgot one. When the film can't tell the difference between psychiatry and psychology. Cheers and Frasier was bad about this but they got better as time went on, Niles and Frasier were psychiatrists, but did a lot of psychology work.

[uncledaddy]

While we're on this thread about psychiatry...

Remember when we had that thread a little while ago that asked what pet peeves you had in movies? Or what ruined a movie for you?
I forgot one. When the film can't tell the difference between psychiatry and psychology. Cheers and Frasier was bad about this but they got better as time went on, Niles and Frasier were psychiatrists, but did a lot of psychology work.

I have that problem. I have both and can't remember or tell which is which. I just refer to them as my Docs. :D One talks to me, one counsels me, and one prescribes my meds. :shrug:

[beachgirl]

It might take him a couple days, but he will come back around.

He is a busy man, but well worth the wait ;)


I hope to hear some more insights on Lexapro.

[nickel]

He is a busy man, but well worth the wait ;)
very true.

as far as the original article, i don't think antidepressants work unless someone is severely depressed. this handing out of antidepressant meds to everyone who is feeling a bit melancholy is wrong. it is amazing the number of people who take antidepressant medication. i'd say it's almost at an epidemic level, at least here it is.

also, i don't agree with regular docs prescribing antidepressants. i firmly believe that only psychiatrists should. that way there would be some therapy first, as it should be.

(opinionated, aren't i? :P )

[johnnymk]

Antidepressants: fast food for the brain

[beachgirl]

I think the medical profession is dispensing way too many prescriptions. I agree that psychiatrists should be the ones to write px's for mood enhancing/altering drugs. I wouldn't want anyone but my cardiologist giving me heart drugs.

[Houdini]

Wow...didn't realize I was so sorely missed. :)

But yeah, I have been busy for a while now. It's good to be back.

Lexapro isn't a bad choice for some people, but it all depends on your symptoms, medical history (including your psych/family history) etc. I can't say it's any better or any worse than others, because I prescribe them for different reasons to different people.

As far as my creds, yeah, I'm a psychiatry resident, meaning I've finished medical school and an additional (almost) four years of training in psychiatry. (Hey, mf...I'm a PGY4! I thought you were keeping track! ;) ,) and should be continuing to work in hospitals and clinics in the coming months and years.

My primary interest is in psychopharmacology, and I know there's a lot of bad information out there. Some of it is propagated by some members of this forum due to confusion over some medications and bad outcomes with non-antidepressants suffered by family members, etc.

It is sad and angering when studies don't release their negative results, but plenty of independent studies do show OBJECTIVE data that certain antidepressants do work, and likely have saved hundreds of thousands of lives. Even non-antidepressants, but drugs that have antidepressant qualities, like lithium, unequivocally DO reduce suicide risk, for instance. Same goes for ECT (or electroconvulsive therapy...one of psychiatry's best treatments for depression, but isn't used nearly as much as it should be. It really is about as close to a miracle treatment as there can be, especially for pregnant women.)

Thanks for the complements everyone, and good to see you nickel. I'll check in more often and hopefully be able to provide more insight into this, as psychopharm is my specialty (along with magic/magic history/etc...:) )

I disagree wholeheartedly with the "fast food for the brain" comment, as antidepressants may work, but they don't work fast in the vast majority of cases. People often think that others must be depressed because of something...in other words, because of traumatic events, grief, money, jobs, etc. But in so many cases, people are simply miserable for NO reason. That's when it gets scary, and those who would have just checked out 50 years ago are now staying alive and living productive lives.

It's not perfect, but no field of medicine is perfect. But it is getting better, and like I said, the newer psych meds (especially antipsychotics and some antidepressants) on the horizon are very exciting...we're talking about re-wiring faulty brain cells, in some cases structurally, so that they work as intended, via DNA modification, etc. Very cool.

H <---has missed y'all too!

edit: oh yeah..it's not a good idea to abruptly stop any drug like Lexapro. As far as suicidal behavior, it's possible, but physical symptoms, such as stomach problems, are more likely, as well as nervousness, headaches, sadness, etc. It's best to taper the dose slowly, or if it's too expensive, asking a knowledgeable doctor to try switching (carefully cross-tapering the drugs) to a less-expensive generic to avoid any problems. Feel free to PM me for any questions, but my (and mf's) usual disclaimer is always in effect. ;)