Or demons. It wasn’t me – the devil made me do it. It was witches. It was caused by the moon being in Mars.

Part of the problem is that “self” is a bit of an illusion. We have these competing drives, and people want to know, which is “me” and which is other. The answer is that they are all “me” – me is precisely the interplay of these parts. My hormones, my self. No excuses.

All I know is that I’ve been leading a normal life for ten years on fluoxetine, and since you bastards started publicly slagging off SSRIs I’ve been feeling like shit. Causation or coincidence?

Another, separate question: if placebos are so effective, why do you – apparently – want them removed from the GP’s toolbox?

I now have very little faith in corporate funded science, unless the studies are replicated by people with opposing interests.

Or, to put it another way, Boom!

I -thought- I’d just -been- reading about this at BadScience… deja vu.

http://www.ukmicentral.nhs.uk/
headline/database/story.asp?NewsID=6834

Joanna Moncrieff has published some good material and we certainly need questioning professionals but her work attracts a lot of valid critiscism.

The Cochrane report quoted by inspiros was on TCA’s vs placebo – although I wouldn’t discount the validity entirely it wasn’t on SSRI’s – and the data they looked at looks very incomplete – 1966-2000 but only including 9 studies with 751 participants? Very curious.

I’m very impressed with the SMHP page – thanks inspiros! – very well balanced and making the point borne out in many trials that the more severely ill you are with depression the more difference the medicines make.

Consent to trials in mental health tends to lead to milder illness being trialled more commonly – somebody with really serious psychomotor retardation can’t consent to anything!

CBT and other talking therapies are not tested to anywhere near the same degree as medication.

In 1998 Kirsch et al found placebo was 75% as effect as SSRI. In 2002 a further analysis found it to be 82% effective as SSRI.

Add this to the concerns about most studies not including active placebos (Moncrief at el 2001) – and those that do showing NO difference between SSRI and active placebo. (http://www.cochrane.org/reviews/en/ab003012.html)

Here is a somewhat dated (2003) and fairly conservative summary of the studies and media coverage (with a notable mention of the Guardian… possibly pre-Ben G?)
http://www.srmhp.org/0201/media-watch.html

Comments on comments:
WONKO: you don’t explain the improvements people experience. I’m assuming you are saying that SSRI and CBT both are effective due to placebo. People do experience real improvement. That isn’t under question here.

guvno0or: “Do they work or is it just placebo?” They work – there is no doubt about that. However it is likely that your belief and expectation that they are going to work may be the “active ingrediant”.
Does knowing that weaken the “active ingredient”?
In SSRI/drug treatment possibly. In the case of CBT acquiring a meta-belief about the effectiveness of CBT – should be part of CBT treatment anyway.
If you undergo CBT and persist in the belief that CBT doesn’t work then I would predict lower outcomes.

The real question here is whether a complex mix of poor trial design, media hype, desperate GPs and patients, and unpublished studies have allowed GPs to prescribe substances where there is a very high expectation of positive outcome (with matching side effects) in an area where self-fulfilling prophecies hold sway (our psyche). It has worked and helped millions. But perhaps we can do better.

Shame about this recent research on suicidality and depression in young adults then (don’t think it’s been reported here):

In 2003 FDA and European regulators warned that antidepressants in younger people might increase suicide thoughts and attempts. The results were a 22% reduction in SSRI use in under 20s in The Netherlands and a 30% reduction in SSRI use in under 20s in USA

Unfortunately the suicide rate in creased in both nations – a 49% increase in under 20s in the Netherlands (from 0.86 to 1.28 per 100,000 population) and a 14% increase in under 20s in USA
(from 2.83 to 3.23 per 100,000 population)

This was reported as the largest annual increase in US suicide rates since the year dot (I paraphrase) and that the trends are similar in two different countries – an abrupt reversal of 20-year trend.
(Am J Psychiatry 2007;164:1356-63)

(Thanks to Steve Bazire for this ref)

a) All trials of all drugs, once registered, should be adequately reported, regardless of outcome

and, our old favourite,

b) journalists need to be a lot more rigorous.

We came across this before, months ago, where professional journalistic bodies talk about how their mission is to entertain, not to inform, and that journalism does not necessarily have anything to do with uncovering the truth.

At least 37 trials had positive results. The drugs clearly do something, for some people. However, some trials had positive results, some had negative. Similarly, some posters above have mentioned that these drugs worked for them, but they didn’t work for other contributors. We have all this inconclusive evidence – so why stop now? How can we work out what the differences are if the negative/inconclusive results remain unpublished?

It’s nice to think that once science or medicine has “an answer” then we don’t need to do anything about that problem any more. It’s unsatisfactory to those of us who like certainty, but progress must be allowed to continue. Treatments can always be improved – I would have thought it would have been in a drug company’s best interests to continue the research, make new and improved drugs which are demonstrably better than the ones which everyone now knows about and which other drug copmanies can make for themselves in a few years……

More short-term thinking going on, I fear.

I’m not sure that the source supports Tricyclics as a major method – as distinct from a significant one – and my quick mental arithmetic suggests that reduction in prescribing of T’s would not account for much of the downwards trend in suicides.
Still, I’ll concede that it is a factor and that anything to reduce access to means is good.
Unfortunately, we can’t ban the sale of rope, though.

The doctor initially suggested pills, but when I pointed out that this was unlikely to make my debts disappear, provide me with instant friendships, or make me feel any less alienated he relented and sent me for therapy.

Unfortunately that didn’t work too well either as both my parents were counsellors and frankly I was sick to the back teeth of talking about my problems in the hope that just talking about them would make them go away. In the end I stopped going out of pure irritation: I reasoned that if I spent most of my therapy time visualising how I was going to punch the counsellor in the face because their simplistic causal analyses were annoying me to the point of distraction it was probably doing me more harm than good.

So off I went and just ‘got on’ with depression and although I can’t prove it I reckon I’m at least as well off without drugs and therapy than I would have been with it. I still get the occassional bout but – after 20 or so years of having this stupid condition – I’ve come to conclusion that depression – like asthma – is something you’re likely to be saddled with for life: There isn’t a cure but this is not necessarily a problem as long as you can keep things in check.

It is most likely myth rather than lie – something is going on with serotonin in depression, but it is more likely a symptom than a cause.

Interestingly, a new cognition myth has grown up in opposition to the serotonin myth. But the new negative thinking = depression myth is no more valid. Again, what is being touted as a cause is most likely an effect. But hey, that isn’t going to stop a government that is looking for a quick-fix from ploughing £millions into CBT rather than improving general mental health.

Overdose with tricylcics is a major method of suicide even now (e.g. here).

I wonder where he plagiarised that from.

Perhaps, though overdose on tricyclics was never a major method of suicide. Barbiturates, yes,and these are less easily available.

All modern antidepressants seem to be about equally effective over the population, though not necessarily for an individual.
The main improvements in each class have been in reduction of risks and side-effects.

Maybe the massive decrease in lethality (in overdose) of SSRIs over tricyclics helps. They’re certainly no more effective.