Drug Policy

Is Antidepressant a Misnomer?

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A research review in this week's Journal of the American Medical Association finds a risk of increased "suicidal ideation" in children and adolescents taking antidepressants half as big as the already small risk the FDA cited when it ordered scary "black box" warnings for the drugs three years ago. A.P. reports:

The researchers analyzed data on 5,310 children and teenagers from 27 studies involving the antidepressants Prozac, Paxil, Zoloft, Celexa, Lexapro, Effexor, Serzone and Remeron. They found that for every 100 treated with antidepressants, about one additional child experienced worsening suicidal feelings above what would have occurred without drug treatment. In contrast, the F.D.A. analysis had found an added risk affecting about two in 100 patients. There were no suicides in any of the studies. 

SSRI boosters argue that the FDA's daunting label has resulted in more deaths by scaring doctors away from antidepressants that would have prevented suicides. That may be true, but this review shows once again that the benefits of antidepressants, like their risks, are overrated:

The new analysis found that antidepressants worked best when used to treat anxiety. They worked moderately well in treating obsessive-compulsive disorders. They worked less well, though still effectively, in treating depression….

In the studies involving depression, 61 percent of patients improved while on antidepressants. But 50 percent of depressed patients taking dummy pills also improved.

Among young patients with obsessive-compulsive disorders, 52 percent improved on antidepressants, compared with 32 percent who improved on dummy pills.

And in the studies of anxiety disorders, 69 percent improved on antidepressants and 39 percent improved on dummy pills.

If antidepressants work better in treating anxiety than in treating depression, and if they relieve depression only a little better than a placebo, antidepressant  is something of a misnomer, isn't it? Prozac et al. may be even less effective than these numbers suggest: Skeptics (including psychologists, who do not enjoy the legal privilege of prescribing antidepressants) argue that the  physiological side effects of antidepressants may tip off some subjects that they are getting the real thing, knowledge that could create an enhanced placebo effect that may account for the improvements attributed to the drugs. Then again, as Maia Szalavitz has argued in Reason, the clinical trials may underestimate the potential effectiveness of antidepressants because they throw together people who benefit dramatically with people who don't respond at all.

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  1. So many psychiatrists write off lable prescriptions that there is little relationship between a drug’s proported purpose and what symptoms it is used for. SSSRI is the better term, because it says what neurotransmitter the drugs boost. Classifying drugs by their neurotransmitter would also make it easier for the lay patient to understand what the drugs do.

  2. Well, all I know is that Zoloft utterly nuked 20 years of depression for me. Think what you will about big Pharma, but Pfizer is my fricken hero.

  3. Ditto what Quiet Desperation said. About a month after I started taking Paxil, I thought to myself, “Wow, so this feeling must be what people mean when they talk about being happy. This is nice. I could get used to this.”

    I’d keep taking the stuff even if the FDA found that it shortens life expectancy by 10 years.

  4. Take Prozac as an example. According to the FDA sight (http://www.fda.gov/cder/ob/default.htm) it is patented for depression (use codes 396 & 397) and PSM (use code 338). OCD and anxiety are off lable uses.

  5. If you like the effects, that’s up to you. I just think a more transparent labeling system would make it easier for patients to make informed choices.

  6. My analyst told me that I was right out of my head. But I said dear doctor I think that it’s you instead.

  7. Oh, my goodness! A reference to the indomitable Annie Ross!

    TWC is da man!

  8. Of course you’re going to see regression to the mean in clinical depression since it often occurs episodically, so when you look at improvement numbers, you have to keep in mind that there is a high baseline of spontaneous regression.

  9. Annie,
    I’ll take any oppertunity to link to Jane Monheit

    twisted

  10. Wellbutrin is ‘da bomb. Brought me out of a decade old funk and gives me a nice honkin’ libido to boot.

    And yeah, if it knocked 10 years off my lifespan, that’s OK by me. They would have sucked anyway.

  11. I used to sleep with a girl with bipolar disorder. She was pretty good…half of the time.

  12. Thanks guys. All us cows do our best for Jerseymaid.

    Jane Monheit is definitely worth a listen.

  13. As doctors should inform patients (and presumably do), anti-depressants are highly variable in individual effect. That means it takes time to find one that works for you; neither Zoloft nor Lexapro did as much as necessary, but Effexor finally put the giddyup back in my brain.

  14. “the physiological side effects of antidepressants may tip off some subjects that they are getting the real thing, knowledge that could create an enhanced placebo effect that may account for the improvements attributed to the drugs.”

    “Placebo” means “I please”; although most placebos are considered inert, that’s not intrinsic to its definition. If subjects improve because of what they feel, that is a drug effect as well as a placebo effect.

  15. Antidepressants aren’t 100% effective. Indeed, studies show that the majority of people on antidepressants still exhibit symptoms of depression. That means they are going to commit suicide despite being on antidepressants, but it doesn’t mean the antidepressants were the cause.

  16. What others have said. Worked well for me. The plural of “anecdote” is not “data” but since the controls found a significant if not dramatic improvement over placebo, I’m willing to pay for it (and I did, out of pocket, no insurance).

  17. “Placebo” means “I please”

    What is the error here? Anyone? Anyone? Grotius?

  18. “Placebo” means “I please”

    What is the error here? Anyone? Anyone? Grotius?

  19. I tried Lexapro and the side effects sucked so my doc switched me to Wellbutrin. It seemed to work for me since I got better. In my case I was experiencing depression and anxiety.

  20. Prozac literally saved my life.
    I don’t buy the alleged “placebo effect” of these drugs. I took it with ZERO expectation that it would work, and within a week I was experiencing emotions and a sense of optimism that I had never, ever felt in my life. Ever.
    No amount of wishful thinking could ever have done that to my brain.


  21. Prozac literally saved my life.
    I don’t buy the alleged “placebo effect” of these drugs. I took it with ZERO expectation that it would work, and within a week I was experiencing emotions and a sense of optimism that I had never, ever felt in my life. Ever.
    No amount of wishful thinking could ever have done that to my brain.

    Really? I thought it took several weeks to build up an effective amount in the bloodstream.
    Well, glad you’re feeling better anyway.

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