Friday, 02.29.08
Prozac Nation
Photo by flickr user dennis under a Creative Commons license
The drug pushers
April 2006
Carl Elliott exposes the intimate ties between drug reps and doctors.
Listening to St. John's Wort
May 1998
Edison Miyawaki presents a natural alternative to pharmaceutical anti-depressants.
Don't hurl the Zoloft into the trash just yet. Though headlines trumpeted the paper as shocking news, in fact one of its authors published a study ten years ago showing the same results. The most interesting finding, in fact, is that for the seriously depressed, the drugs do have some effect. Moreover, critics have pointed to problems with the results of the study, which was really a "meta-study" that analyzed previous research, including unpublished work. Most notably, the studies it analyzed were often short (six weeks or less, which is about how long anti-depressants typically take to work).
What the study may really show is that if you aren't suffering from a chemical imbalance, pills aimed at altering your brain chemistry won't do much for you. Anti-depressants are dispensed freely by harassed primary care physicians with little psychiatric training; in most cases, they might do better to prescribe yoga or a change of scene.
The Prozac Myth?The Guardian compiles commentary on the rise, success, and effectiveness of Prozac. |
Spinning toward sanityCorporate spin or not, anti-depressants still work, argues Peter D. Kramer. |
Pharma fights backGlaxoSmithKline, of Paxil fame, faults the "alarmist" study for an insufficient sample-size. |
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I agree absolutely with Terry.Unless one has experienced this terrible state of mind you just cant comment looking from outside in.I have had 4 episodes and each one has been worse than the last.If it hadnt been for SSRI's I really dont what I would have done.
Your conclusion that “What the study may really show is that if you aren’t suffering from a chemical imbalance, pills aimed at altering your brain chemistry won’t do much for you” is interesting. To eqaute efficacy with a true chemical imbalance, as you do but which the Kirsh study does not, implies that about 90% of the people taking an SSRI don’t have a chemical imbalance and have probably been misdiagnosed with depression. As an example, take the typical clinical trial. You start with a group of patients, divide them in half, and assign one group to the drug treatment and the other to the placebo group. In the group taking an SSRI about 60% will improve. So, following your logic, right off the bat we can assume that 40% don’t have a chemical imbalance - but it doesn’t stop there. Because in the placebo group about 50% will improve (the specifics vary from study to study but there is usually about a 10% difference). Thus based on the difference between drug and placebo group (60-50 = 10) we can assume that only about 10% of drug group is getting a benefit from the drug while the other 50% who improved did so because of a placebo effect. Thus only about 10% of the patients really responded to the drug. Based on your logic, then this would presume that 90% of the patients taking an SSRI do not have a chemical imbalance and were misdiagnosed with depression. Rather than make a conclusion about who suffers from a chemical imbalance or not, the Kirsch study raises interesting questions about the theory. When the chemical imbalance theory was proposed it was largely based on the presumed efficacy of the medications, if the medications are not that efficacious then this should raise questions about the theory. If a theory does not apply to 90% of the cases how good is it? In addition, it should be noted that the Chemical Imbalance Theory is given much more credence in the press than it is in the scientific literature.
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Those who have not experienced depression should not write articles about dispelling the 'myths' about anti-depressants. The author here sounds very much like Tom Cruise: blame the ignorant doctors, just take vitamins.
Those who are the lucky outsiders to the frightening and hellfireandamning illness called depression should read Andrew Solomon's NoonDay Demon: Atlas of Depression to understand the paralysis of mind, body and soul that this illness causes.
The author, instead, treats it like a bad headache, or toothache--just suck-it-up and take a "yoga" class. The best analogy is that prescribing yoga for real depression is like putting a band-aid on a heart attack patient--you're pretending to play doctor if you think you are doing any good dispelling the benefits of SSRI's.
Posted by Terry Montelibano | March 4, 2008 1:37 AM