[lonely-and-sad]

Hello,
There have been many posts of late saying that antidepressant medications do not beat placebo for mild to moderate depression and only just beat placebo for the very severe cases. This is simply not true. It is true that the response increases with severity but regardless these medications work. Unfortunately some people suffer very bad side effects and some get no help at all. I feel almost guilty that I have had success where others have not and I feel completely powerless.

Dysthymia is a chronic form of depression in which the symptoms are more moderate when compared to major depression. There is solid evidence (I posted a link to elsewhere) that 90% (or at least up to 90%) of people that suffer this condition also get major depressive episodes. Chronicity itself has been shown to be a poor responder to placebo. Anyway here is the evidence from the Cochrane Library. I actually have a copy but it has now been withdrawn for failing to comply with some technical publishing requirement. The 77 page review was published in The Cochrane Library 2005 in part concluded 'Drugs are effective in the treatment of dysthymia with no differences between and within drug classes.'
http://onlinelibrary.wiley.com/doi/1...otherversions=
Also the Journal of Affective Disorders:http://www.sciencedirect.com/science...6503271200451X

[francisR]

Hi Lonely

There is no reason to feel guilty because you have meds that work. The identification of those that work for any individual is very often a matter of trial and error.
As I do have dysthymia I can personally vouch for the accuracy of what you said about this chronicity and having major episodes from time to time. However, I rely now on therapy tools to manage the condition without medication. It is working okay so far. Take care. God bless and best wishes from your friend Francis

[lonely-and-sad]

The link does not seem to be working. However, there are many more.

Efficacy of antidepressants for dysthymia: a meta-analysis of placebo-controlled randomized trials. - Abstract - Europe PubMed Central

The conclusion is very clear: "These results support the utility of antidepressants for dysthymic disorder. In fact, the margin of efficacy of antidepressants for dysthymic disorder was larger than for MDD. Future studies providing longer-term data on the treatment of dysthymic disorder with antidepressants are essential". Antidepressants may be EVEN MORE effective for moderate forms of depression!

[francisR]

hi Lonelyandsad

The difficulty is finding the medication that works best for you. Which would be a matter of trial and error. I read on the Internet that they are working on a new medication presently being given to rats that have been given depression which cures it with in a few hours. However, it will have to be tried on humans and go through all of the procedures to get FDA approval, which will take a few years. I suppose but it is an encouraging development. Take care. I hope and pray your weekend will be really good. God bless and best wishes from your friend Francis

[vital]

Here is a letter from Peter Gotzsche, M.D., one of the co-founders of the Cochrane Collaboration dated September 2014 explaining that it is even questionable whether antidepressants work for even severe depression:

The Truth About Antidepressant Research: An Invitation to Dialogue - Mad In America

One of the things that has been uncovered in 2005 is publication bias. Drug companies were doing clinical trials, but just not publishing trials that showed the drugs having no positive effect better than placebo. Here's a popular explanation of what was going on:

Ben Goldacre: What doctors don't know about the drugs they prescribe | TED Talk | TED.com

A very nice history of this whole thing can be found here

including the essential point that patients who take antidepressants for long periods of time do worse than unmedicated patients.

Here is a summary of a paper explaining what your doctor should be telling you about antidepressants:

Negative Effects of Antidepressants | Mad in America

- vital

[francisR]

[ Hi Vital

This is a much disputed subject. A clinical psychologist told me that there is just one chance in seven that a particular medication would work. Identifying the right one is just a matter of trial and error. However, there are some people who swear by the medication that it is doing a good job for them. But over time, the body does build of a degree of tolerance to the meds resulting in its either having to be strengthened or changed. How is everything with you? I hope and pray today will be really good for you. God bless and best wishes from your friend Francis

[vital]

Originally Posted by francisR

[ Hi Vital

This is a much disputed subject. A clinical psychologist told me that there is just one chance in seven that a particular medication would work. Identifying the right one is just a matter of trial and error. However, there are some people who swear by the medication that it is doing a good job for them. But over time, the body does build of a degree of tolerance to the meds resulting in its either having to be strengthened or changed. How is everything with you? I hope and pray today will be really good for you. God bless and best wishes from your friend Francis

Hi FrancisR,

Your posts are so kind and helpful. Thanks very much.

I'm concerned for people who start taking antidepressants casually, assuming that this is the best treatment and not realizing the long term consequences. There may be no antidepressant that works in the long run and they may get trapped, suffering from depression anyway, suffering long term health consequences and not able to stop the drugs without withdrawal.

God bless you too.

Your friend, - vital

[lonely-and-sad]

Here is what the Cochrane Collaboration actually said from their own systematic review in 2005:

Authors' Conclusions

Implications for practise
The results of this review have important practical consequences. There is evidence to support drug therapy for this condition, which is associated with disability, comorbidity and high use of health services. Dysthmic patients can improve on antidepressants ...Doctors do not need to wait two years to consider pharmacological treatment for their patients

With regards to Peter Gotzsche: his position on anti depressants should not be taken seriously, it is so extreme it is hard to find any support in the mainstream medical community. The Lancet and the BMJ were just some of those that spoke out against him.
http://www.behaviorismandmentalhealt...6614702329.pdf

He actually wants to implement a policy in which large scale withdrawal clinics are set up and the vast bulk of patients taken off their psychotropic medications. He wrote a book which was reviewed here in the link below. Take special note of where the reviewer found an entire chapter unreadable

Book Review: ?Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare? by Peter Gøtzsche - Speaking of Medicine

Really you need to come up with some better sources. All you do is reference mad in America. Whitaker was wrong on almost every page of his book. I mean to get even BASIC things wrong is particularly disturbing

Anatomy of a Non-Epidemic - a Review by Dr. Torrey - Treatment Advocacy Center

Gotzsche relies on the Fournier studies but the GIbbons studies trumped them with longitudinal measurement. Usually, the Kirsch studies are brought up however they can be dismissed as well as researchers went back and looked at his work and could not even replicate his results. How is that for publication bias? Dear Vital you seem to think that only drug companies use publication bias, well that is not the case. In fact publication bias is seen mostly in CAM. For example, almost every study showing a positive outcome for acupuncture was affected by publication bias. There are thousands of them. What makes you think the Kirsch and Fournier studies are not biased?

[mrnobody]

^^^Nailed it, its the old yoga and meditation trope!

[vital]

Originally Posted by lonely-and-sad

...With regards to Peter Gotzsche: his position on anti depressants should not be taken seriously...

Dr. Gotzsche is the Director of the widely respected Cochrane Collaboration that you are quoting above. He is a very serious and widely respected scientist who has studied this issue extensively. Why should I take your opinion over his? His opinions are also shared by many distinguished psychiatrists including ex-heads of the APA. The fact that you can google something critical of him or critical of Robert Whitaker does not impress me.

If anyone is interested in this issue, just have a direct listen to R.W. speaking to a large conference of Danish Psychologists and Psychiatrists here

and see if he makes sense to you.

The wide-spread practice of immediately treating people with these drugs is, I believe, rapidly changing. See, for instance this story about PTSD

Are medications an effective PTSD treatment? - CNN Video

- vital

[lonely-and-sad]

I believe he is or was director of the Nordic Cochrane Centre. I quoted directly from the Cochrane systematic review itself! which I remind you is what this thread is about. I would be happy to email you a copy of the 77 pages.

You shouldn't take my opinions over his. You should look at the evidence yourself. You talk about publication bias and yet that somehow only applies to drug companies. Even if the studies are biased then that would be what Gotzsche is basing his opinion on.

His views on psychotropic medications are contrary to the following sample of organisations: World Health Organisation, the American Medical Association, the Black Dog Institute, National Institute of Mental Health, Royal College of Physicians, His views are opposed in the following journals just as a small sample: American Journal of Epidemiology, the Lancet, The BMJ, American Journal of Public Health, American Journal of Psychiatry and on and on... Out of interest have you have ever had depression? Views like those of Gotzsche only get the attention of poplar media such as mad in America. You are asking us to believe one man (Gotzsche) and one organisation (madi in America)against all of what I posted above? Or has everyone been bought off by big pharma?

Whitaker is easy to criticise, he got is so wrong its actually funny. His books are not a piece of academic work. I doubt members are impressed with your constant posts advising suicidal people to snap their fingers to get out of it. Your posts about snap club now where would we find that? Maybe Google scholar or PubMed? You are entitled to your opinion but I wonder how impressed members are.

Of course what they say makes sense. That's what pop media does they have to sell their message. Could you imagine if they told the boring story that all the journals above write? It would obviously not sell. I have absolutely nothing to do gain by posting the official position of the vast bulk of research and just about every official medical association on the planet. There really isn't any point in me continuing you made up your mind long ago.

The pharmaceutical companies stopped investing in research on more antidepressants and even other psychotropic medications quite a while ago. Despite some scaremongering medications such as SSRI's are actually pretty safe when compared with other pharmaceuticals. I know all about the shortcomings of anti depressants and antipsychotic medications. But lets not throw the baby out with the bathwater. Let's hope that there is more scientific discoveries so we can get something better than the psychotropic medications we currently have.

[lonely-and-sad]

Drugs versus placebo for dysthymia - The Cochrane Library - Silva de Lima - Wiley Online Library

trying an older version testing 123

[lonely-and-sad]

That one works. The updated version of the Cochrane Review can't be seen like I said before.for some publishing reason. But that's it there, albeit an older version, exactly as I said 'Drugs versus placebo for dysthymia.' and as it say antidepressants work for mild to moderate depression.

[francisR]

hi Vital

I share your concern for people on medications. It just takes the edge of depression and therapy skills are necessary to manage the condition. I just use those skills and am off medication for four years now. I do know from Internet research that they are in the process of developing a medication that if it is successful, would bring depression. Under control within a few hours it will be five or six years before this goes through clinical trials and is approved for use. I think the way to proceed is to have the help of medication. Then get the appropriate therapy and when the depression is under control. Have a gradual withdrawal so that you depend on therapy alone to maintain stability. Take care. I hope and pray your week will be really good. God bless and best wishes from your friend Francis

[vital]

Originally Posted by francisR

hi Vital

I share your concern for people on medications. It just takes the edge of depression and therapy skills are necessary to manage the condition. I just use those skills and am off medication for four years now. I do know from Internet research that they are in the process of developing a medication that if it is successful, would bring depression. Under control within a few hours it will be five or six years before this goes through clinical trials and is approved for use. I think the way to proceed is to have the help of medication. Then get the appropriate therapy and when the depression is under control. Have a gradual withdrawal so that you depend on therapy alone to maintain stability. Take care. I hope and pray your week will be really good. God bless and best wishes from your friend Francis

Hi Francis,

That sounds sensible and healthy to me and I'm really glad it worked for you. I haven't tried that Acceptance and Commitment therapy that you use, but I really like the sound of it. It's clearly closely related to meditation and mindfulness which I do use and find very helpful. I'm always looking for new things to try and to keep improving.

- vital

[BudFox]

I read Whitaker's "Anatomy of an Epidemic" earlier this year. The evidence is so overwhelming and compelling that outcomes are worst for people on psych drugs long term, that I cant imagine anyone arguing with this.

Apart from analyzing outcomes literature in a truly comprehensive way, he includes quotes and admissions from insiders at major institutions about the lack of efficacy and the lack of any real support for the very notion of a known biological origin to mental illness. And so much more in the book just puts Psychiatry in general in an utterly horrible light.

A lot of the published studies that people link to seem to be missing study duration. Thats the first thing I want to know. Otherwise what is the point.

[BudFox]

Also i often see people defending SSRIs or other drugs by linking to some published study online. But can a layperson just read some abstract or summary of a study and assume the published conclusion has any legitimacy?

Who ran the study, who really paid for it, what info was omitted, what was distorted, what biases corrupted the process?

I think we need people like Whitaker to dig deeper and make some sense out of the collective data. And if you say Whitaker is no good, then who do we trust?

I'm concerned for people who start taking antidepressants casually

I suppose I tend to think that the side effects of antidepressants are bad enough that no one would take one "casually", but I suppose that's not true for everyone.

I'd like to see a holistic approach to mental illness promoted (including antidepressants when warranted) and not the divided camps that we seem to be stuck with today.

From reading these forums, I know that a lot of people individually take on the task of treating their depression holistically.

I suppose most of us end up viewing this question through the lens of our own experience.

I think that people end up on psych meds so often because, at least in the US, that is what our health care system advocates. We don't have any institutions in place to treat mental illness with both drug and non-drug means or a combination of both.

Even though it's been nearly 30 years ago, I can still vividly remember my dilemma deciding whether or not to take antidepressant medications. I had been depressed for over 18 months and was continuing to get worse. I had been seeing a psychotherapist for over a year. I was getting lots of exercise and eating as well as I knew how. I read self-help and religious books and examined my soul.

I can look back now and know that there were many other things I could have done, but at the time, the choice seemed to be to try antidepressant medication or lose my job and end up moving back in with my parents, and I knew very well that that wasn't going to be good for my mental health.

I don't know what the answer is.

[BudFox]

Originally Posted by jo_thorne

I'd like to see a holistic approach to mental illness promoted (including antidepressants when warranted) and not the divided camps that we seem to be stuck with today.

Yes, holistic approach. In fact, the very term "mental illness" implies separation where there really is none (mind-body).

“Many mental hospitals are living museums of undiscovered bodily disease.”
--FMR Walshe, MD

[lonely-and-sad]

I will be come back later and address a few points. I am not aiming to cause an argument, I am hoping to provide a sense of proportion and some perspective. I like to think l have an open mind and I am willing to consider all the available information. In case I am seen as only pro-medication I will give an example of where I helped choose something else. My girlfriend has panic disorder (she was examined thoroughly after turning up at the ER several times before we met) and we decided not to use medications. We are focusing on lifestyle and 'alternative' methods. I don't like the use of that word but I will address that some other time. My own background is as a personal trainer and a remedial massage therapist. With that in mind and in the interests of brevity we have focused on reducing stress (part of this was actually getting my depression treated lol), supplements such as fish oil, sleep hygiene, mindfulness, exercise and massage therapy. In my biased opinion massage helps very much with anything anxiety related. I instinctively knew that my GF would have huge muscular tension with adhesions and trigger points. It has worked out very well for her.

[lonely-and-sad]

Originally Posted by BudFox

I read Whitaker's "Anatomy of an Epidemic" earlier this year. The evidence is so overwhelming and compelling that outcomes are worst for people on psych drugs long term, that I cant imagine anyone arguing with this.

Apart from analyzing outcomes literature in a truly comprehensive way, he includes quotes and admissions from insiders at major institutions about the lack of efficacy and the lack of any real support for the very notion of a known biological origin to mental illness. And so much more in the book just puts Psychiatry in general in an utterly horrible light.

A lot of the published studies that people link to seem to be missing study duration. Thats the first thing I want to know. Otherwise what is the point.

You can't imagine people arguing with long term outcomes from psychiatric medications and yet they do. Is the evidence overwhelming and compelling as you say? I speed read Whitaker's book and I did not find that to be the case.

I could write pages and pages addressing that question. I will share some anecdote first with my own profession. I remember starting out as a personal trainer and a massage therapist. I now cringe at a lot of what I said and did 8 years ago. I discovered that much of what I do has no research. So when I went looking I was very disappointed to discover that I had nothing to guide me. What can I do? Well the next best thing is to find out what some of the best amongst my profession are doing. I worked my guts out and paid for and got myself mentors to learn from.

Psychiatry has more research but its not so great when compared with the other medical sciences. Among my clients is a lawyer that actually works with the drug companies, a supreme court judge and a psychiatrist. As a massage therapist I have met a lot of people. When I broach the subject I can see them almost rolling their eyes.

Take Patient A.: he has no family or other support, he has unstable accommodation, he is often in trouble with the law and he has no occupation or education. He then gets diagnosed and put on medication for the first time at age 22. He stays out of trouble with the police, he gets part time employment and part time education and stable housing and his mental state stabilizes. He returns to see his psychiatrist every 6 months for the next 10 years and remains stable. This is not that uncommon, no doubt they need some medication changes and they still experience difficulties, they probably do not like taking medications but would prefer that than the alternative. If medications had a poor outcome like you believe then it would be the reverse and the lawyer, doctor and judge would know that. That's exactly what they would be able to tell me don't you think? They would have increasing numbers of clients as they wreck more lives their workload will just go up and up. More patients to treat and then for the others that never used any medications they just go on with their lives because hey they aren't really mentally ill LOL

I find it amusing that Whitaker comes along in 1998 and 'discovers' what the rest of the mental health community had known for years. We already know about the drug companies faking data and the ghost writing and on and on. Its been documented and most of community is outraged and wants changes; it is a case of Johnny come lately preaching to the converted.

Whitaker is a journalist. He has:
a) never practiced as a mental health professional and therefore has no clinical experience
b) has not conducted any research apart from his book
c) has to my knowledge no personal experience with mental illness

Do you really think a journalist is going to reveal things to experts in mental health? Really? Nobody else knows these things? Whitaker is smarter and has looked at what nobody else has? LOL a lol lol a alol lol.

I agree we need more longitudinal studies and since your interested I will link to one. If you have an open mind (that is if you haven't made up your mind already) and are actually interested in it I am sure you will read it. Maybe governments should fund more longitudinal studies.
http://ajp.psychiatryonline.org/doi/....ajp.157.6.931

If you assert there is overprescribing then first you need to know how much compliance there is with medication. Getting people to take medication in the first place is not that easy. They don't need vital to come in here and discourage them. I could post studies about medication compliance but will leave that for now. Maybe there is over prescribing in America but there is not much here. Governments subsidise our medicines and there is no direct to consumer marketing.

I hear people saying that it is all just placebo, antidepressants do not do anything apart from cause side effects. Then they want to withdraw them from the market? At least restrict them for the most severe cases? Bang! Overnight a black market for psychotropic medications. I would be forced to try to get them illegally because under your standards I would struggle to qualify unless I fake my symptoms or get a psychiatrist to say I am amongst the most severe. Its easy to sit there and criticize but much harder to come up with a solution.

I had depression for 10 years at least before I got an antidepressant. So it is not iatrogenic. I took Prozac until 2002 and then I went medication free. I gave it everything I had with exercise, diet, fish oil, meditation and cognitive behaviour therapy, I had a social group going and full time employment. Looking back I was never free of dysthymia, my mood never stabilized and although I achieved a lot I wrecked a lot of it and by 2010 was back into severe depression. I can't qualify for hospital because I am not planning my end so how do I get help if there is no medications? It is the only thing that has worked for me.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2781031

[lonely-and-sad]

Originally Posted by BudFox

Also i often see people defending SSRIs or other drugs by linking to some published study online. But can a layperson just read some abstract or summary of a study and assume the published conclusion has any legitimacy?

Who ran the study, who really paid for it, what info was omitted, what was distorted, what biases corrupted the process?

I think we need people like Whitaker to dig deeper and make some sense out of the collective data. And if you say Whitaker is no good, then who do we trust?

They lay person probably knows nothing about it and maybe many in the mental health profession do not know much. I have had a lot of advice over the decades from Gp's telling me I need God in my life. I was also advised by GP's to take injections of magnesium and b vitamins at their clinic. When I asked about which published large scale long term rct's there were they did not know what I was talking about lol.

A journo can do some investigative work and publish some books if he wants. BUT he is not telling the top level mental health professionals anything at all that they do not know about. The people within the profession know all about this. They are discussing it, they need to improve things themselves, they do not need a journo to tell them anything. That is just funny.

Theses guys have written a fair bit on it. It would not be hard to find more, they even got hold of and published documents about what the drug companies and the academics were up to with ghost writing. Go find it if you like. There is plenty of examples. IMO they need to fix it within we do not need popular media.

Does post-publication peer review work? - Speaking of Medicine

[BudFox]

You seem intent on trashing Whitaker. Don't shoot the messenger. The book speaks for itself. Not sure what to do with your musings and anecdotes.

Originally Posted by lonely-and-sad

Psychiatry has more research but its not so great when compared with the other medical sciences.

Are you saying psychiatry is a medical science? How so? Yet another thing that Whitaker's book lays out so clearly is how the profession so badly wanted to become a legit medical field, and tried to come up with a biological basis for mental disorders, failed, then simply used PR to sell the idea anyway. Smashing success.

[mrnobody]

Originally Posted by BudFox

You seem intent on trashing Whitaker. Don't shoot the messenger. The book speaks for itself. Not sure what to do with your musings and anecdotes.


Are you saying psychiatry is a medical science? How so? Yet another thing that Whitaker's book lays out so clearly is how the profession so badly wanted to become a legit medical field, and tried to come up with a biological basis for mental disorders, failed, then simply used PR to sell the idea anyway. Smashing success.

Wow just wow. You seem intent on bashing psychiatry and tarring everyone with the same brush and then seem sensitive when the spotlight is turned on Whitaker. I am studying medical science with the intention of entering the mental health field and I have read his book. Do you want to withdraw all psychotropic medications? I will assume you answer is yes since according to you they worsen outcomes.

It looks like the poster above gave up posting studies and tried to talk about clinical experience. Of course you attacked it as anecdote, because when studies don't suit you they are biased or otherwise corrupted, but when they do suit your existing beliefs you point to the evidence. Can't win. Psychiatrists have to study medical science. Is your position that because we are still learning about the brain we are not yet a medical science? At what point would we become one?