Antidepressants and effectiveness

Recently there have been many articles explaining why antidepressants don't really work. On several occasions I've tried to explain how these articles were a misunderstanding of the research. This New York Times article (see below) a pretty good job at explaining this, so I'm presenting it here. I think this is an important article because the same rationale applies to all of the research that has been in the press about ADHD medications, anxiety medications and so on.  The big drug companies are not to be fully trusted, however, neither are the writers of all the anti-medication nonsense you read on the web. Almost all of that is supported not by "big pharma" but instead by "big natural health food blah blah."  Here's the link to this excellent article:

http://www.nytimes.com/2011/07/10/opinion/sunday/10antidepressants.html

The article points out that in the depression studies often subjects are included who don't really have depression. Well sooner or later, when filling out a form about their symptoms they report that they don't have depression. That's good, they never did, so at least these individuals didn't develop depression from simply taking part in the study. There are also problems with people participating who are after free care, or in some cases payments offered for participation in the trials. You often see ads for these studies on college campuses and elsewhere. After the study is over these people return to their original level of depression, whatever that might have been. The effect isn't a result of the medication or placebo as much as an artefact of the recruitment process to find people to participate. And who, today, would even volunteer to take a new, untried medication when so many cheap and generic medications are available?

In the most recent study of the effects of antidepressants by Dr. DeRubeis (this is the one every newspaper and health food/herbal medicine web page tells us that antidepressants are only as effective or less effective than placebos, we see some odd statistics that just don't support that claim. The overall result, that for healthier patients the medications are less effective - fell shy of statistical significance. The study looked at weak treatment, and intentionally maximized placebo effect. Still this paper ended up the talk of the town.

Another excellent article on how publications don't give us a really good view of things comes from the web page Science-Based Medicine. You can find that article here: Do Antidepressants Work? The Effect of Publication Bias

This article (which you really need to print out and read with an underliner!) should make you cautious about what you read. Statistics can be used to prove almost anything....to those who don't understand statistics. It's very difficult for the lay person to know what is right and what is wrong or misleading. As usual, I suggest that you ask your medical doctor...not your neighbour, brother, sister or something you've read on the internet that trashes medications or some other treatment and ....just by chance....is on a page covered with ads for "alternative treatments."

The Science Based Medicine article on AntiDepressants ends with this:
"At this time it is premature to conclude that modern antidepressant medications do not work. There is sufficient evidence for efficacy to continue to use medication as part of the overall treatment approach to depression. The current consensus is that therapy is also a critical component of the long term treatment of depression, and therefore looking at the use of medications in isolation may not reflect their actual clinical use. Multiple studies have now shown that combination treatment (medications and therapy) are better than either alone. There is also evidence that medication treatment is more successful when multiple agents are tried in order to find the optimal treatment. These so-called “real world” treatments are not well reflected in the pre-approval trials considered in this analysis."


My advice, print out articles that bring up concerns, put them in your pocket, and take them with you to doctor.  This goes for any medicine, medication, treatment or intervention your considering.