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Can we talk about Prozac?

My shrink recently prescribed it, but I haven't started taking it. I'm apprehensive about it, and want to hear others' experiences.

And I'm not interested in hearing over-the-top, tinhat bullshit about how antidepressants are terrible, don't work, or how people who take them are weak-minded, etc. So kindly start your own thread with that shit.

So, who's actually taken it? What were the side effects? Did it help?

by Anonymousreply 14511/22/2012

I took it for a number of years. I still don't know if it worked. I think my depression was always more situational than chemical but it didn't make me worse anyway. You have to be vigilant because I've heard some people get suicidal. Make sure you have a good (MD) who you can talk to about your concerns.

by Anonymousreply 111/08/2012

Shrinks need to be kept on a tight leash, OP. YOU have to suggest medications to them. I tried Prozac for anxiety and it was ineffective although I didn't know that at the time. I regret wasting my time with it and its' side effects. I now take Seroquel and Xanax which works for me.

by Anonymousreply 211/08/2012

I've been on several SSRIs already, and really don't want to take another one. They all cause anorgasmia for me, and I can't stand it. Plus, they are hell to get off of.

I was on Wellbutrin for a while, but aside from suppressing my appetite and making me horny as hell (both good things), I was never sure if it did much.

by Anonymousreply 311/08/2012

I still haven't started taking it, and I'm not sure I'm going to. I've been trying to taper off Luvox for months now, and finally decided to just stop about a week ago.

I FEEL LIKE SHIT.

Lightheaded, sleepy, no energy, extremely agitated, and I feel like I can hardly draw a breath half the time. This shit is as awful to get off of as Zoloft was. And this motherfucking shrink wants to put me on another SSRI? I don't think so.

by Anonymousreply 411/12/2012

Why don't they give you loratab for depression? I take one and I'm always in a good mood...

by Anonymousreply 511/12/2012

OP? I'm on nefazodone(used to be Serzone), which is NOT an SSRI, and I love it. It's best for people who have problems sleeping, because it virtually knocks you out at night. I've been on it for about 12 years with no problems.

by Anonymousreply 611/12/2012

r6, wasn't serzone was taken off market due to liver toxicity risks?

OP i haven't taken prozac but know at least 2 people who have. One woman killed herself -- her parents think that though she was depressed the drug kind of wigged her out. we'll never know. this was when it was pretty new, around 1989.

The guy i know who took it said it worked ok but he also had trouble with inability to orgasm. He was depressed because he didn't have a BF but the drug made him more self conscious.

OP do you know why your depressed? Prozac may or may not help you deal with whatever it is.

by Anonymousreply 711/12/2012

There's one class of drugs that interacts badly with SSRIs, might be Serzone. In any case, a switch might require a lengthy waiting period.

by Anonymousreply 811/12/2012

Well, if you're worried about having trouble getting off of Prozac, that shouldn't be a concern. It has the longest half-life of any of the SSRIs so stopping taking it is not often a problem. In fact, it's often cross-tapered with other SSRIs when people are getting off of them.

by Anonymousreply 911/12/2012

My 86 yr old mother with cancer was on Prozac for a long time, and it really helped her. However, once she ran out and didn't tell anyone (maybe didn't notice) and the side effect of stopping suddenly was an attack that we thought was a stroke. After a night in the ER she was better and we figured out what had caused it. Totally confused, grasping for words, etc.

So be careful to taper off if you do try it!

by Anonymousreply 1011/12/2012

wow r10 that's scary. Could they say for sure the sudden stopping of prozac triggered the stroke? At that age stroke isn't uncommon.

by Anonymousreply 1111/12/2012

I just started Celexa. Anybody on that?

by Anonymousreply 1211/12/2012

Again, Pozac is by far the easiest SSRI to come off of. The half-life is so long that your body basically naturally tapers off of it if you stop taking it even abruptly (not that I would suggest that). I suspect r10's mother had something like a panic attack.

by Anonymousreply 1311/12/2012

R12 I took celexa briefly. It did nnothing for me.

by Anonymousreply 1411/12/2012

Took Prozac and it did nothing for my major depressive disorder. Zoloft was amazing though.

by Anonymousreply 1511/12/2012

It wasn't actually a stroke, we just were afraid it was. She didn't have, for example, any loss of movement on one side of her face. But she was totally out of it.

Anyway, the doctor confirmed that the sudden abandonment of prozac was the cause. She was always very sensitive to meds, so perhaps her case was unusual, but I think you can find those symptoms in the literature on prozac.

It did make for a scary Christmas!

by Anonymousreply 1611/12/2012

R12 - I took Celexa for about a year. It's the only SSRI I've ever taken, so I can't compare it to anything else. I took it mainly for anxiety. It did help take a bit of the edge off. I kind of felt it just made me feel 'ho-hum' most of the time. It was like, "what, a burning child? Oh, that's nice. I just won a million dollars? Oh, that's nice." My emotions and emotional response just sort of flatlined. What I learned about coming off Celexa, though, is that a bit of anxiety isn't a bad thing, and it's also nice to feel a bit of emotion once in awhile. I think you have to gauge how much you really need it. Some people need it more than others. If you're going to take something, then don't expect it to completely be the answer to your problems - take it, but also look for tangible ways to make yourself happy. If you're coming off any SSRI, never quit cold turkey - you'll more than likely go through hell with sweats, brain zaps and sleeplessness. I quit cold turkey and wouldn't recommend it to anyone.

by Anonymousreply 1711/12/2012

There's a book called Prozac Nation or something and it deals with the issue of Prozac poop-out. Sometimes it stops working and can send people into a tailspin. Isn't it made from the seratonin in rat's brains? Re: psychiatrists-most people that go into to this field are crazy themselves and are just trying to figure themselves out. They're playing guessing games with your medications. Finding a stable personality in a psychiatrist is rare. Most of them are damaged souls with a God complex. Never forget this when you are seeking their care and always go with your gut instinct because the reality of it all is, quite simply, THEY are crazy themselves and/or playing big pharma games at your expense.

by Anonymousreply 1811/12/2012

I've been taking 10 mg of Prozac (fluoxetine), off and on, for about 11 years now.

I was prescribed it after some PTSD anxiety related to an incredibly awful and at one point seizure-inducing migraine that had sent me to the emergency room when I was 19 and had just started taking birth control pills.

When I first went on the drug (at the time it was marketed as Serafem, but I later learned it was just Prozac at mark-up price) I found myself become something of a social butterfly for the first time in my life when I had been a very brooding, loner sort of girl for much of my life to that point. I felt more confident and talkative and open to things, but at the same time I found it kind of hard to cry and lost some of my sex drive for a while. This isn't the case though now.

When I had an insurance change post-college I went off the Prozac for a couple of years but decided to start taking it again after having a random panic attack during a night of drinking where I decided to go to the E.R. to get checked out. I was prescribed Ativan to use as-needed in addition to going back to the regular Prozac dosage but I haven't really needed the Ativan and haven't had any anxiety episodes since going back on Prozac, even with adding huge stress to my life in quitting my job and going to law school.

So far I've stayed on the same 10 mg dose the entire time I've been on Prozac and while I think I might benefit from an increased dosage, it hasn't been imperative that I go up in the amount.

by Anonymousreply 1911/12/2012

Perhaps you haven't gone up on your dose R19, but just try getting off of it.

They ARE terrible, they don't work, etc., etc., simply because they don't address the cause of depression -- all they do is RECYCLE what little serotonin you may have left.

by Anonymousreply 2011/12/2012

Prozac helped me . I took it for 4 months. No side effects.

by Anonymousreply 2111/12/2012

I took it and it did help, but gave me disturbing dreams. I ended up switching to welbutrin.

by Anonymousreply 2211/12/2012

I took it from 1996 until 2011. Was fine taking it but wanted to get off of meds. Twice I tried cold turkey. Big mistake, I ended up in the mental ward with a psychotic break on a 5150. I finally took 2 years and weaned off veerrrry slowly. Now I take vitamins and herbs that help my mood. Theanine-L being the main one.

Take it at your own risk. If you're truly miserable, take it. But expect to be on it a long time unless you're willing to wean off it very very slowly. Weaning off for me meant electrical "snaps" in the head, migranes, nervousness, more anxiety, malaise, pretty much the entire withdrawal symptom list. I was miserable but determined to get off it.

Years back my doctor said to expect to be on meds for the rest of my life, I'm not. And I'm doing fine now too.

by Anonymousreply 2311/12/2012

good for you, r23. I think it's terrible for docs to tell patients they need to be on meds for a lifetime. Having been on the marketing side of pharma, i know that idea is coming from pharma salespeople. It's not coming from medical research.

by Anonymousreply 2411/12/2012

Meh. Made me feel sort of blank, I didn't feel too much. No tears but no real laughs or joy either, felt a bit numb. I had problems with delayed ejaculation. My MD said it was helpful for anxiety too but I didn't necessarily find that be true, at least in my case. I found the old tricyclics much better for anxiety (and sleeping) but didn't want the weight gain, dry mouth and dizziness.

I'm on Wellbutrin now, I have loads of energy and no sexual side effects. Drugs work different for people, Prozac might be right for you even if it wasn't right for me.

by Anonymousreply 2511/12/2012

Fuck you. Try more!

by Anonymousreply 2611/12/2012

Even if you refuse to believe it and all of the expert studies that have been done, it does not change the fact that Prozac has very little - if any effect on depression.

I don't understand why people insist on putting something in their body that has no effect on what they are taking it for - and in fact could damage your health.

Americans have, for several decades now, fallen for the huge marketing campaign that the drug companies have conducted on the public to see this worthless drug.

They keep creating successors to it to maintain profits when generics come into the market.

People don't want to believe in climate change, do believe that the earth is 9,000 years old and Jesus rode dinosaurs. This is the same sort of insanity.

by Anonymousreply 2711/12/2012

R27 I FUCK YOUR ASS BOY

by Anonymousreply 2811/12/2012

r27 I thought prozac was one of the few that did show efficacy at slightly higher rates than placebo.

by Anonymousreply 2911/12/2012

gay ass. BIG ASS

by Anonymousreply 3011/12/2012

Prozac, Zoloft, Paxil and Celexa are all SSRIs, but they are completely different molecules and have different secondary neurotransmission effects on various receptors. This is why some people respond to one or another very differently, even though they all share the serotonin reuptake inhibition effect.

In general, patients with a high mixed anxiety-depression state, or obsessional qualities, will respond best to an SSRI. People who have severe depression with melancholic features may respond better to Cymbalta or Effexor XR, although many psychiatrists will try an SSRI first. Wellbutrin is hit or miss and often a third choice.

No one should be wasting time with a third trial of an SSRI if you have been on it for at least six to eight weeks at an effective dose. In fact, most patients will respond within two weeks if it's going to work at all.

And yes, antidepressants do not work for everyone, but they are usually very effective in severe depression with anxiety.

by Anonymousreply 3111/12/2012

Slightly higher for some people, not all, just a very small percentage. The drug industry was found to have concealed their own tests showing that the drug had no benefits, but they got leaked. It's been a multi-billion dollar scam on the public. Somebody should go to prison for it. It's bigger than Madoff. Unfortunately, the big drug companies completely control Washington politicians through their contributions and lobbyists.

by Anonymousreply 3211/12/2012

My sister has done very well for years on Prozac. It did nothing for me except give my major panic attacks.

Zoloft has worked great for me though.

by Anonymousreply 3311/12/2012

60 Minutes exposed the fraud of anti-depressants in February of this year. here's a link below and an excerpt:

"The medical community is at war - battling over the scientific research and writings of a psychologist named Irving Kirsch. The fight is about antidepressants, and Kirsch's questioning of whether they work.

Kirsch's views are of vital interest to the 17 million Americans who take the drugs, including children as young as six and to the pharmaceutical industry that brings in $11.3 billion a year selling them.

Irving Kirsch is the associate director of the Placebo Studies Program at Harvard Medical School, and he says that his research challenges the very effectiveness of antidepressants.

Irving Kirsch: The difference between the effect of a placebo and the effect of an antidepressant is minimal for most people.

Lesley Stahl: So you're saying if they took a sugar pill, they'd have the same effect?

Irving Kirsch: They'd have almost as large an effect and whatever difference there would be would be clinically insignificant.

Stahl: But people are getting better taking antidepressants. I know them.

Kirsch: Oh, yes.

Stahl: We all know them.

Kirsch: People get better when they take the drug. But it's not the chemical ingredients of the drug that are making them better. It's largely the placebo effect.

Irving Kirsch's specialty has been the study of the placebo effect: the taking of a dummy pill without any medication in it that creates an expectation of healing that is so powerful, symptoms are actually alleviated.

[Kirsch: This is the placebo response...]

Kirsch, who's been studying placebos for 36 years, says "sugar pills" can work miracles.

Kirsch: Placebos are great for treating a number of disorders: irritable bowel syndrome, repetitive strain injuries, ulcers, Parkinson's disease.

Even traumatic knee pain. In this clinical trial some patients with osteoarthritis underwent knee surgery. While others had their knees merely opened and then sewn right back up.

Kirsch: And here's what happened. In terms of walking and climbing, the people who got the placebo actually did better--

Stahl: Come on.....

by Anonymousreply 3411/12/2012

more:

Kirsch: --than the people who got the real surgery.

Stahl: No.

Kirsch: And that lasted for a year. At two years after surgery, there was no difference at all between the real surgery and the sham surgery.

Stahl: Is it all in your head or--

Kirsch: Well, it's not all in your head because the placebos can also affect your body. So if you take a placebo tranquilizer, you're likely to have a lowering of blood pressure and pulse rate. Placebos can decrease pain. And we know that's not all in the mind also because we can track that using neuro-imaging in the brain as well.

He says the doctors who prescribe the pills become part of the placebo effect.

Kirsch: A clinician who cares, who takes the time, who listens to you, who asks questions about your condition and pays attention to what you say, that's the kind of care that can help facilitate a placebo effect.

He says he got into researching the effect of antidepressants by accident.

Kirsch: I was interested in evaluating the size of the placebo effect. I really didn't even care about the drug effect because everybody, including me, knew it worked. I used to refer patients to get prescriptions. I didn't change the focus of my work onto looking at the drug effect until I saw the data from our first analysis.

What he saw was that it almost didn't matter what kind of pill doctors gave patients.

Kirsch: We even looked at drugs that are not considered antidepressants: tranquilizers, barbiturates. And do you know what? They had the same effect as the antidepressants.

Stahl: Come on.

Kirsch: Really.

Kirsch was so surprised by his initial findings, he decided to do a second study - using data not only from the drug companies' clinical trials that had been published in medical journals.

This time he got data that weren't published but had been submitted to the FDA, which he got through the Freedom of Information Act.

Kirsch: These are the studies that showed no benefit of the antidepressant over the placebo. What they did is they took the more successful studies, they published most of them. They took their unsuccessful studies and they didn't publish them.

Stahl: So when you did your study, you put all the trials together?

Kirsch: That's right.

Stahl: You're looking at patients who took the real drug and patients who took the placebo.

Kirsch: Yes.

Stahl: Did they get equally better, or did the ones who took the pills get even a little better?

Kirsch: If they were mildly or moderately depressed, you don't see any real difference at all. The only place where you get a clinically meaningful difference is at these very extreme levels of depression.

Stahl: Now look, psychiatrists say the drug works.

Kirsch: Right.

Stahl: The drug companies and their scientists say the drug works. Maybe you're wrong.

Kirsch: Maybe. I'd add to that, by the way, patients say the drugs--

Stahl: Patients say the drug works.

by Anonymousreply 3511/12/2012

Kirsch: --work. And, for the patients and the psychiatrists, it's clear why they would say the drug works. They take the drug; they get better. Our data show that as well.

Stahl: You're just saying why they get better.

Kirsch: That's right. And the reason they get better is not because of the chemicals in the drug. The difference between drug and placebo is very, very small; and in half the studies non-existent.

Kirsch and his studies have triggered a furious counterattack - mainly from psychiatrists, who are lining up to defend the use of antidepressants like Dr. Michael Thase, a professor of psychiatry at the University of Pennsylvania School of Medicine, who has been a consultant to many of the drug companies.

Stahl: Irving Kirsch says that depressants are no better than placebo for the vast majority of people with depression, the vast majority. Do you agree with that?

Michael Thase: No, no. I don't agree. I think you're confusing, or he's confusing, the results of studies versus what goes on in practice.

He says that Kirsch's statistical analysis overlooks the benefits to individual patients.

[Thase with patient: Have a seat.]

And while he agrees there's a substantial placebo effect -

[Thase: Have you been keeping track of your depression scores?]

Especially for the mildly depressed, using a different methodology, he finds that the drugs help 14 percent of those moderately depressed, and even more for those severely depressed.

Thase: Our own work indicates pretty convincingly that this is a large and meaningful effect for a subset of the patients in these studies.

Stahl: But even by your own numbers more people, maybe twice as many people, are having a placebo effect than are actually being helped by the drug.

Thase: That's correct.

Stahl: In the moderate range?

Thase: That's correct.

Stahl: And this isn't troubling to you?

Thase: I wish our antidepressants were stronger. I hope we have better ones in the future. But that 14 percent advantage over and above the placebo is for a condition that afflicts millions of people, that represents hundreds of thousands of people who are better parents, who are better workers, who are happier and who are less likely to take their life.

Since the introduction of Prozac in the 1980s, prescriptions for these drugs have soared 400 percent -

[Commercial: I used to be happy, I remember being happy...]

-- with the drug companies having spent billions over the years advertising them.

Stahl: I don't know about you, but I'm seeing more women running through daisy fields after looking morose than ever before.

Dr. Walter Brown: Absolutely. There's a lot of hype out there.

by Anonymousreply 3611/12/2012

Dr. Walter Brown is a clinical professor of psychiatry at Brown University's Medical School. He has co-authored two studies that largely corroborate Kirsch's findings.

Brown: The number of antidepressant prescriptions over the last decade has increased and most troublesome, the biggest increase is in the mildly depressed, who are the ones who are least likely to benefit from them.

He says they're getting virtually no benefit from the chemical in the pill. Like most experts, he says these drugs do work for the severely depressed, but he questions the widely held theory that depression is caused by a deficiency in the brain chemical called serotonin, which most of these pills target.

Brown: The experts in the field now believe that that theory is a gross oversimplification and probably is not correct.

Stahl: And the whole idea of antidepressants is built around this theory?

Brown: Yes, it is.

To approve any drug, the Food and Drug Administration merely requires that companies show their pill is more effective than a placebo in two clinical trials - even if many other drug trials failed.

Brown: The FDA for antidepressants has a fairly low bar. A new drug can be no better than placebo in 10 trials, but if two trials show it to be better, it gets approved.

Stahl: Does that make sense to you?

Brown: That's not the way I would do it if I were the king. But I'm not.

Dr. Tom Laughren, director of the FDA's division of psychiatry products, defends the approval process.

Stahl: We're told you discard the negatives. Is that not right?

Tom Laughren: We consider everything that we have. We look at those trials individually--

Stahl: But how are you knowing that the two positives deserve bigger strength in the decision?

Laughren: Getting that finding of a positive study by chance, if there isn't really an effect, is very low. I mean, that's basic statistics and that's the way clinical trials are interpreted. A separate question is whether or not the effect that you're seeing is clinically relevant.

Stahl: Okay. Is it clinically relevant?

Laughren: The data that we have shows that the drugs are effective.

Stahl: But what about the degree of effectiveness?

Laughren: I think we all agree that the changes that you see in the short-term trials, the difference between improvement in drug and placebo is rather small.

Stahl: It's a moderate difference.

Laughren: It's a small, it's a modest difference.

It's so modest - that in Great Britain the National Health Service decided to dramatically revamp the way these drugs are prescribed. It did so after commissioning its own review of clinical trials.

Tim Kendall: We came to the conclusion that for mild to moderate depression, these drugs probably weren't worth having.

Stahl: At all.

Kendall: Not really.

by Anonymousreply 3711/12/2012

Dr. Tim Kendall, a practicing psychiatrist and co-director of the commission that did the review says that like Irving Kirsch - they were surprised by what they found in the drug companies' unpublished data.

Kendall: With the published evidence, it significantly overestimated the effectiveness of these drugs and it underestimated the side effects.

Stahl: The FDA would say that some of these unpublished studies are unpublished because there were flaws in the way the trials were conducted.

Kendall: This is a multibillion dollar industry. I doubt that they are spending $10 million per trial to come up with a poor methodology. What characterizes the unpublished is that they're negative. Now I don't think it's that their method is somehow wrong; it's that their outcome is not suitable from the company's point of view.

Because of the review, new public health guidelines were issued. Now drugs are given only to the severely depressed as the first line of treatment. For those with mild to moderate depression, the British government is spending nearly half a billion dollars training an army of talk therapists.

[Instructor: If you wanna go a little faster, you can.]

Physical exercise is another treatment prescribed for the mildly depressed.

Kendall: By the end of 10 weeks, you get just as good a change in their depression scores, as you do at the end of 10 or 12 weeks with an antidepressant.

None of the drug companies we spoke to was willing to go on camera, but Eli Lilly told us in an email that drug trials show antidepressants work better than placebos over the long term and that "numerous studies have shown that patients on placebos are more likely to relapse" back into depression. The industry's trade association, PhRMA, wrote us: "antidepressants have been shown to be tremendously effective."

But if Irving Kirsch has his way, the drug companies will have to completely rethink their $11.3 billion business.

Stahl: You're throwing a bomb into this. This is huge what you're saying.

Kirsch: I know that. The problem is that you can get the same benefit without drugs. I think more are beginning to agree. And I think things have begun to change.

Everyone in this story says that if you're depressed, you should see your doctor, and if you're already on these powerful drugs, you shouldn't stop taking them on your own.

by Anonymousreply 3811/12/2012

The problem with Irving Kirsch, et. al, is their conclusions are based on meta-analysis of numerous trials of various antidepressants that were not "apples to apples" comparisons. Some were shorter, some were longer, some had inadequate controls, some may not have blinded, some were not dose-optimized, etc.

It is not a secret that most pharma drug trials for antidepressants are too short and the pool of patients is unreliable. As more and more people have entered treatment in the last twenty years, it is more difficult to assemble a group of truly depressed patients that may respond to the drug. Instead, the testing centers recruit people who are mildly to moderately depressed, which responds strongly to the care provided, the clinical setting and the passage of time. As a result, these study patients are not representative of the average outpatient seen in a psychiatrist's office.

There is no question that some people do not respond to antidepressants, while others only partially respond. But many people who are properly diagnosed by a psychiatrist do get better over time, especially if combined with effective psychotherapy.

There are a lot of axes being ground in this debate and the nuances of what is being said is difficult for the general public to understand. It's not a black or white conclusion.

by Anonymousreply 3911/12/2012

I cry.

by Anonymousreply 4011/12/2012

I guess I'll go by what 60 Minutes said.

by Anonymousreply 4111/12/2012

[quote]There are a lot of axes being ground in this debate and the nuances of what is being said is difficult for the general public to understand. It's not a black or white conclusion.

Yes, but ... We should be erring on the side of caution, and science, and protecting people from drugs that are neither safe nor effective. In justifying the status quo you seem to be arguing that we should continue to err on the side of maintaining market share.

Apart from the clinical implications are the financial ones: the billions spent (much of it tax money) on drugs that might be no more effective than placebo.

Or maybe it's the financial ones that drive the clinical ones. That seems to be the case now.

by Anonymousreply 4211/12/2012

Erring on the side of caution should be followed by every clinican, whether an MD or not, R42. Whether we use drugs, psychotherapy or some combination thereof, none is a cure-all for depression.

The fact remains these drugs can be very effective, even life-saving, when appropriately prescribed after reaching a reasonable diagnosis. To paint them as "placebos" or "ineffective" is inaccurate and smacks of axe-grinding when there are 50 years of research showing antidepressants do work.

The idea they cause dangerous side effects is pure nonsense. Any drug can cause unusual side effects, but the vast majority of patients take them with minimal to no side effects. That said, patients must be carefully monitored and given proper follow-up and they shouldn't be handed out like candy.

by Anonymousreply 4311/12/2012

Prozac is amazing.

For me, I had TERRIBLE generalized anxiety that made me feel depressed.

I couldn't get on a plane, I worried endlessly - it sucked.

Prozac really helped.

And if you're a woman, and get PMS, it helps with that too.

by Anonymousreply 4411/12/2012

r43 have you read the side effects described here? Brain zaps?

Nobody disputes that they work. The issue is: Do they work better than placebo? The more we learn about the studies whose results the drug companies discarded the more it looks like the answer is: They don't work better than placebo in a clinically significant way.

There's no ax grinding here. You conveniently leave out the multibillion dollar interests that don't want any of us to pay any attention to the man behind the curtain. That is a huge part of the equation.

by Anonymousreply 4511/12/2012

Brain zaps are not a serious side effect and are the result of patients stopping the drug cold turkey or weaning off too quickly. The withdrawal syndrome is easily managed by prescribing Prozac for two weeks and allowing a natural taper of the serotonin reuptake effect.

The drugs are meant to be prescribed to people experiencing severe depression that interferes with their functioning, not mild to moderate depression, which often responds to placebo. Not everyone who is depressed needs medication and psychotherapy is very important.

by Anonymousreply 4611/12/2012

But they are prescribing these drugs to people with mild to moderate depression, R46.

by Anonymousreply 4711/12/2012

Primary care physicians are doing most of the overprescribing, not psychiatrists. There are not enough psychiatrists to treat mild to moderate depression and most don't want to.

Internists are not trained adequately nor do they have the time to treat mental illness. That's why we have social workers and psychologists.

by Anonymousreply 4811/12/2012

I was prescribed Prozac for OCD, and eventually worked up to a 100mg/day dose. Effective for my OCD, but I never felt a natural emotion for the 3 years I was on it

by Anonymousreply 4911/12/2012

I also had it for OCD in the 90s .At that time it was the only thing that worked with me

by Anonymousreply 5011/13/2012

Brain zaps are not a serious side effect? WTF?

I'm pretty sure 'brain zaps' aren't listed as a possible side effect even though it seems like a significant percentage of people experience them.

r46, do you work for a drug company?

by Anonymousreply 5111/13/2012

[quote]The drugs are meant to be prescribed to people experiencing severe depression that interferes with their functioning, not mild to moderate depression

This is simply not true. 'Meant' by whom? Certainly not the drug companies.

Have you seen the zoloft ads with the bouncing bubble? They are clearly targeting people with mild or dysthymic depression. ALL the drug ads do this. They want the largest market possible.

by Anonymousreply 5211/13/2012

The drugs work for people under appropriate circumstances.

An individual should be self-educated about their treatment as well as working with a provider whom they trust.

One size does not fit all in these cases.

I wonder about the person who (incessantly) tries to make this so.

by Anonymousreply 5311/13/2012

This thread is a perfect example of what is fucked up about health care in this country. It will never get fixed as long as people can get away with billing worthless treatments to insurance companies. If people had to pay for it themselves it would stop.

America believes popping a pill can solve any problem. We are a placebo nation.

by Anonymousreply 5411/13/2012

[quote]The drugs work for people under appropriate circumstances.

That is not in dispute, r53. That they do work,for some people, in some circumstances, is something everyone agrees on.

The issue is: Do they work better than placebo? The more we learn the more it appears they don't.

If these drugs can't stand up to scientific scrutiny though, they have no business being sold (and they are not cheap). That is the issue.

A lot of us (gay people) are/have been diagnosed with depression (me included) and we deserve better.

by Anonymousreply 5511/13/2012

R55, you are confusing what is measured as a statistical signal in a controlled study versus clinical practice in the real world. The conclusion that antidepressants are no better than a placebo is valid in many cases for the newer drugs in various trials. The question is why.

In the real world of practice, there is absolutely no doubt among most clinicians, both medical and non-medical, that the drugs work. Do they work for everyone? Do they do what the marketing reps promise all the time? No. But that is true of any drug.

To make a statement that antidepressants do not stand up to scientific scrutiny because of poorly designed studies that fail to show sufficient power over placebo is intellectually dishonest and ridiculous.

by Anonymousreply 5611/13/2012

"In the real world of practice" where "there is absolutely no doubt" ... how many patients were given placebo and also improved? And were fully convinced it was the pill that did it?

That's the key question.

What is "intellectually dishonest" and "ridiculous" is telling people they have a chemical imbalance and they "need" to be on medication, maybe for life.

No doctor can say what chemicals in the brain are "imbalanced". No doctor can say "You have a deficiency of substance X in your brain. If you had X% more, you'd be fine. This medication will give you that X%".

That's the pretense. That's what they want depressed people to believe. There's only one problem: It's a marketing statement. It's has no scientific basis at all; it's just a theory.

Until the science catches up with the pill marketing, the chemical imbalance message is what is intellectually dishonest and ridiculous.

by Anonymousreply 5711/13/2012

Apprehensive about anti-anxiety drugs too?

by Anonymousreply 5811/13/2012

Who says patients have a chemical imbalance? I've never heard of a psychiatrist telling anyone that. An honest statement is a particular drug may relieve symptoms and help someone function better. No is claiming any psychiatric medication is a cure.

There are some people who have a high risk of relapse and poor functioning over the long-term that should remain on medication for life. This is a very small percentage of most patients. Standard practice with depression is six to nine months at an effective dose for a first episode, then wean off.

Most people who choose to stay on the drug have a long history of anxiety and depression that interferred with their ability to function at times. If the drug is helping them stay well and is not causing any serious side effects, it may be a wise decision for these folks to stay on the medication.

It sounds like you have an axe to grind based on your personal experience with depression or another condition. There are many reasons people become depressed and not all of those reasons are solved by taking a pill.

by Anonymousreply 5911/13/2012

The mechanism of anti-anxiety drugs is much better understood. They also test clearly better than placebo. Problem is most are addictive.

by Anonymousreply 6011/13/2012

The mechanism of antidepressants has been understood since the mid-50s. The newer drugs act on the same neurotransmitters the old tricyclics did, but with less action on numerous other receptors that caused most of the side effects with the old drugs. This is why they are not more effective, just much more easier to tolerate.

What is not known is how exactly the effect on receptors translates to antidepressant action. There are lots of theories, but none have been proven. Depression is a complex set of symptoms that can encompass many conditions and psychological states, making it harder to define than simple anxiety.

by Anonymousreply 6111/13/2012

r59, what 'axe to grind'? Ad hominem remarks don't solve anything. I'm saying stick to the science and what we know about the placebo effect, and you're saying i have an axe to grind.

If you haven't heard the 'chemical imbalance' idea then you're not paying attention. It is the major metaphor used to sell drugs (and hopefully make lifelong customers).

The only 'axe to grind' i have is against fraud. I've been on the marketing side of big pharma and see how powerful they are and how ruthlessly they pursue market share. I think DTC drug ads should be illegal but that's another story.

The other 'axe' is that we (gay) people deal with a lot of hostility and hatred and THIS is what makes most of us depressed. Not a chemical imbalance.

by Anonymousreply 6211/13/2012

I took Prozac for a while. It really didn't do anything for me, except give me headaches and I couldn't get erect. Also, it kinda made me jittery. I got dizzy spells when I'd forget to drop one, too. Oh yeah, it also gave me EXTREME DIARRHEA all the time, which, as you might imagine screwed up my sex life!

There are reports that it and other drugs like it cause brain cancer.

Be careful. Just smoke weed when you're upset or feeling like you want to kill.

by Anonymousreply 6311/13/2012

AMEN r-62 you nailed it.

by Anonymousreply 6411/13/2012

The bottom line is some people benefit tremendously from antidepressants, while others do fine without it. One size doesn't fit all.

Antidepressants do work when appropriately prescribed with a correct diagnosis. They do not work on personality disorders, life problems or past unresolved drama.

by Anonymousreply 6511/13/2012

r65, the bottom line is some people benefit tremendously from antidepressants -- in roughly the same proportion that people benefit from placebo.

This is a question that deserves more rigourous research and testing instead of "one size doesn't fit all" bromides defending the status quo.

by Anonymousreply 6611/13/2012

Besides the fact they are worthless for the reason people take them, another problem is the millions of people who are pissing anti-depressants into the water table.

In most major cities and high population areas of the country you've got them in your system from the water you drink. This is true of birth control hormones as well.

Pharma is more dangerous to America than terrorism.

by Anonymousreply 6711/13/2012

I'm on Celexa, and it's really turned my life around. I know longer dread every challenge.

On the minus side, if I want to have an orgasm, I have to set aside most of the afternoon to achieve it.

by Anonymousreply 6811/13/2012

I have been transformed, no problems anymore, I feel so free and optimistic about everything. Everyone likes me now. I lost weight, I feel smarter and more focused. Even the pains I used to have in my legs have vanished. I have had not sex problems, I get as much as I want from hot men. All this happened a few days after I started taking Celexa. Pay whatever it costs, forget any rumors of side effects - it's a miracle!

by Anonymousreply 6911/13/2012

Lisle Von Rhuman has written some excellent articles on Celexa and its life prolonging effects.

by Anonymousreply 7011/13/2012

Prozac made me feel worse, but it's about finding the right med if you feel meds are right for you. I take paroxetine, and have done for over ten years. Everyone is different, but for me, it makes me able to cope- I deal with plenty of crap and that's fine. The meds stop me from being crippled. I do the rest.

by Anonymousreply 7111/13/2012

You should try smoking opium, tried and true and works miracles, all your problems will vanish.

by Anonymousreply 7211/13/2012

The reason placebo rates are high in the trials for newer antidepressants is the pool of patients are not severely depressed. They also exclude many other comorbid conditions, especially anxiety or OCD, in order to assemble a "pure" sample of depressed people.

Since the vast majority of patients who present have anxiety mixed with major depression, is it any wonder these results do not correspond to what happens in clinical practice? They also exclude "suicidal" patients, which means the vast majority of people suffering from melancholic, severe depression are not in the studies.

It's not a big mystery or conspiracy.

by Anonymousreply 7311/13/2012

Oxy is even better and it's easy to get. Celebs swear by it. It's cheaper than Celexa and can get it almost anywhere these days.

by Anonymousreply 7411/13/2012

R-73 is right, don't believe any of those scientific studies, there are plenty more that are out there that say the opposite. It's like climate change - that's another hoax on the public. Thousands of scientists stand behind Effexor, too.

by Anonymousreply 7511/13/2012

As somebody posted earlier, why not try pot? There are no side effects, it's natural and it works. Bill Maher commented on this last week. Pot will make you relaxed and happy.

by Anonymousreply 7611/13/2012

It causes some people to lose weight. It's one of the older ones, so it has been tested for a long time. Zoloft is another old one but I've never heard of it making anyone lose weight. All are addictive, so you have to come off them slowly.

by Anonymousreply 7711/13/2012

[quote] it's natural and it works

Many of the most deadly substances are 'natural'. Invalid qualifier!

by Anonymousreply 7811/13/2012

Zoloft rounded out my figure and I lost my pubic hair.

by Anonymousreply 7911/13/2012

With the exception of Wellbutrin, all the antidepressants cause weight gain over time. Some people do better on one versus another, but they all have the potential to do it.

Paxil is generally the worst, followed by Lexapro/Celexa. Zoloft tends to be neutral, while Prozac may cause slight weight loss. But everyone is different and your experience could be the opposite.

by Anonymousreply 8011/13/2012

I say, use them all. I make a cocktail of a mixture Of Lexapro, Zoloft and Wellbutrin every morning to which I add St. John's Wort and loads of Omega three. You can't have too much of it. The more you take the more happiness you get. The world will be wonderful once more!

by Anonymousreply 8111/13/2012

I take mine six times a day, every three hours. I find if I stop the depression returns immediately, within minutes. Thank god for Celexa, I have the demon of depression at bay! You just have to figure out what works for you, I don't think there is any one way.

by Anonymousreply 8311/13/2012

LOL, R81!

by Anonymousreply 8411/13/2012

[quote]Since the vast majority of patients who present have anxiety mixed with major depression, is it any wonder these results do not correspond to what happens in clinical practice?

How do you know the results don't correspond to what is seen in clinical practice?

Unless you are giving some patients placebo -- which would be highly unethical -- you have no way of knowing which patients are getting better from the drug vs the placebo effect.

All you know is the drugs seem highly successful because everyone says they feel better on them.

Please stop deliberately confusing the issues.

by Anonymousreply 8511/13/2012

[quote]All you know is the drugs seem highly successful because everyone says they feel better on them.

Except for when they don't.

And then they try another drug, and they do.

The drugs can be effective beyond placebo. This is a fact, whether you choose to believe it or not.

by Anonymousreply 8611/13/2012

r81 i hope you're joking but now the drug companies are selling people the idea that if your antidepressant doesn't work, maybe you should take an anti-psychotic (Abilify) as a 'boost'.

If brain zaps were a drag, wait until you get tardive dyskinesia.

Advertising drugs to consumers should be illegal, like it is in Canada.

by Anonymousreply 8711/13/2012

[quote]The drugs can be effective beyond placebo. This is a fact, whether you choose to believe it or not.

they 'can be', but it's not what the studies suggest, when you include the studies the drug companies didn't want anyone to ever see, and only were uncovered only because of a FOIA request.

A fact, because you said so.

Nothing you have said contradicts the idea that most of the benefit from antidepressants may in fact be due to the placebo effect.

Why you find this so threatening is an interesting mystery.

by Anonymousreply 8811/13/2012

The studies are six to eight weeks in duration for most trials, which is far too short to show anything but a response, whether from the drug or placebo. Very few patients will recover from an episode of severe depression bedore six months.

Studies are flawed and not some holy grail of indisputable results.

by Anonymousreply 8911/13/2012

I hardly find it threatening, R88.

You, on the other hand, seem obsessed.

Is anyone forcing you to take a drug against your will. Perhaps in the past?

by Anonymousreply 9011/13/2012

Interesting you resort to another ad hominem, implying I was drugged against my will in my past, ie mentally ill. Sorry to disappoint, in your cruel attempt at humor, but I've never been drugged against my will.

You still avoid addressing my main point: Nothing you have said contradicts the idea that most of the benefit from antidepressants may in fact be due to the placebo effect.

by Anonymousreply 9111/13/2012

R91 I believe you are confusing posters.

In any case, placebo affect can be used to challenge the efficacy of any drug on the planet. Your hyper-focus is irrelevant and misplaced. You're certainly not helping OP (remember him?). Re-read his post. This is not about you.

Get some sleep.

by Anonymousreply 9211/13/2012

[quote]placebo affect can be used to challenge the efficacy of any drug on the planet

And when they do, and drugs are deemed no better than placebo, they can no longer be marketed as 'drugs'.

Still resorting to ad hominems, still avoiding the main point: Nothing you have said contradicts the idea that most of the benefit from antidepressants may in fact be due to the placebo effect.

This has everything to do with OP's original post.

by Anonymousreply 9311/13/2012

And yet Prozac continues to be marketed as a drug....How's that for contradiction?

And no, OP specifically asked that tinhats start their own thread and yet here you are. Another contradiction!

by Anonymousreply 9411/13/2012

Intool Elavis, Prozac and ceexa at different times one of them caused me to have the most amazing sleep disturbances. I forgot which one, but I was on it for years and years.

by Anonymousreply 9511/13/2012

I say, pick the studies that support your position and ignore the others. What's science anyway - it's all subject to interpretation.

Pharma employs tens of thousands of people in the USA, it's an important industry, important to our economy.

If the drugs are worthless, who cares, if people like taking them, let them. It's all about freedom and Pharma keeps the USA economy going. Chow down on the Effexor and Celexa, boys! You are creating American jobs.

by Anonymousreply 9611/14/2012

I did a six month course of Prozac in 2003. I was having suicidal thoughts at the time and I felt like it did give me the space to make some sense of what was making me depressed (hated my job and where I was living). The side effects did suck though - really tough to get and sustain a boner and I gained about 20 pounds.

If I had it to do over again I would have spoken up about the sexual side effects and asked to try something different.

by Anonymousreply 9711/14/2012

"My shrink recently prescribed it, but I haven't started taking it. I'm apprehensive about it."

Oh, the irony...

by Anonymousreply 9811/14/2012

I read an interesting article on "The Witch Doctor Effect" of ritual and placebo. Prozac and these family of drugs were discussed as a mass-hysteria event where millions were brainwashed by the media and advertising to use them even though they were useless.

The article also discussed "Restless Leg Syndrome" and how the millions spent on TV ads convinced hundreds of thousands of people had it and they really started manifesting the symptoms.

If we followed the Canadian example and banned drug advertising all this would stop. We would save billions a year on drugs and be healthier.

by Anonymousreply 9911/14/2012

How ridiculous, R99. No one is brainwashed and taking antidepressants is not like popping Xanax or Valium. There is no immediate relief or euphoria and the side effects are difficult in the first few weeks.

If they were so useless, then why do the SSRIs remain the most prescribed antidepressants? Because everyone is getting high on them?

by Anonymousreply 10011/14/2012

r-100 you really don't believe the drug companies are brainwashing you with these ads?

by Anonymousreply 10111/14/2012

[quote]If they were so useless, then why do the SSRIs remain the most prescribed antidepressants? Because everyone is getting high on them?

Because a lot of people are depressed, and the government approved them to treat depression.

It's not a difficult equation.

by Anonymousreply 10211/14/2012

Right, R102. So everyone is popping them like robots and putting up with various side effects because they don't work, right?

These anti-psychiatry arguments are nonsense.

by Anonymousreply 10311/14/2012

It saved my life. I am happy to be alive and productive today not because I just took prozac, but because it gave me enough sense of well-being and control that I was able to go into therapy and make real progress.

I know many think it's garbage, but for some of us, it worked.

by Anonymousreply 10411/14/2012

what anti-psychiatry arguments r103?

And just to beat a dead horse: For many people the pills do work. Whether they work better than placebo is the question.

The real nonsense is that people keep refuting the above statement with: "Well I know they work, because they worked for me. I'm proof the pills work, they're not useless."

There seems to be a basic misunderstanding of the placebo effect. Also a basic misunderstanding of why drugs are tested and why we have an FDA.

by Anonymousreply 10511/14/2012

I am currently taking paroxetine/paxil and have used prozac, zoloft, and wellbutrin in the past. Paxil is by far my favourite: I was feeling so good at one point that I thought I was cured of my depression (big mistake trying to go off it). I also have mild OCD and paxil helps best with obsessive thoughts imo.

by Anonymousreply 10611/14/2012

It's worked very well for my anxiety. After a couple years for depression, not so much.

by Anonymousreply 10711/14/2012

Excellent points, R-105. Thanks for the posting you are a rational voice in this thread. I hope people will listen to what you have to say.

My partner has been on these drugs for the 19 years we have been together. He saw the 60 Minutes report and now he's saying he wants to stop because he no longer believes in them. I was very surprised.

by Anonymousreply 10811/14/2012

R108, I hope you encourage your partner to discuss this decision with his doctor and to commit to a very slow weaning process if he does decide to stop. It is very important not to stop antidepressants suddenly or too quickly, especially after 19 years of continuous treatment.

Sometimes people stay on the medication for fear of "rocking the boat". The only way to know for sure if you still need them is to wean off, but it must be done slowly under medical supervision.

by Anonymousreply 10911/14/2012

Thank you for the kind words, his dad was a doctor and he has good care.

by Anonymousreply 11011/14/2012

thanks for the compliment r108.

FWIW it helped me a lot to realize that being depressed is a healthy reaction if you're gay. 'Healthy' meaning there's nothing wrong with your brain that needs 'fixing'. It sucks feeling down about yourself, but the solution is to not internalize all the constant negativity you face.

good luck to you and your partner.

by Anonymousreply 11111/14/2012

"Feeling down about yourself" is not the same as being clinically depressed. Depression is a distinct condition. It has criteria. It is not always treated with medication. In some cases medication is extremely effective (beyond placebo). Studies show a combination of medication and psychotherapy being the most effective course of treatment. Often psychotherapy is effective without medication.

by Anonymousreply 11211/15/2012

{quote]"Feeling down about yourself" is not the same as being clinically depressed.

Neither are they mutually exclusive. Depression as a 'distinct condition' doesn't mean that someone's external circumstances don't play a role. Psychiatrists/psychotherapists all seemed trained to focus on parents as one's most formative influences. They seem to downplay the influence of culture and other social factors.

by Anonymousreply 11311/15/2012

[quote]They seem to downplay the influence of culture and other social factors.

This is completely ludicrous. Where do you get your information? Are you posting from the 1950s?

The days of single-focused pscyhodynamic therapy have long passed. Most therapists today practice at least some form of Cognitive Behavioral Therapy which includes examination of culture and social factors--any or all factors which might contribute to negative thinking. Any therapist who would not address societal stigma and its influence on feelings and behavior would not be worth his salt.

by Anonymousreply 11411/15/2012

I took prozac as my first antidepressant and it worked well but I gained ten pounds pretty quickly and the sexual side effects were not so fun.

I later switched to a combo of effexor and wellbutrin which I didn't like so much. I really didn't like effexor as I always really felt like I was on something. For a while I took wellbutrin alone which always felt rather speedy.

Effexor is also the worst to come off of. I tapered very slowly and it was still a bitch.

I've been on lexapro for years since and it's been great. Sexual side effects are minimum at first and they subsided.

by Anonymousreply 11511/15/2012

r114, your points would be better made without the ad hominem remarks. (I'm the person you made fun of by presuming i'd been drugged against my will in an institution. Classy.)

I should have said "in my experience" therapists tend to want to zero in on parents, because that's how they seem to be trained. I've had good experience with CBT but the woman i saw also downplayed anti-gay influences, probably because she was not gay herself and just had no idea.

by Anonymousreply 11611/15/2012

First of all R116, this is the DL--you have to expect a certain level of snark (but I never used the word "institution"--a Freudian slip, perhaps?. Also, you have been addressed by other posters besides myself.

Secondly, I think my points have been aptly made. Again, I'm really not trying to convince you, personally, of anything. OP asked for information, and others on this thread benefit from objective information. Sharing personal experience is fine---making sweeping generalizations is irresponsible and can be dangerous for those in need of help.

by Anonymousreply 11711/15/2012

You didn't have to use the word r117, when you 'joked' that i was drugged against my will. I know there are no sacred cows here, but making fun of mental illness on a thread about depression speaks volumes about you.

OP to answer your original question: good friend was on prozac for years, switched to something else due to sexual side effects. He also said when he would complain it didn't seem to be working, they'd just up the dose.

by Anonymousreply 11811/15/2012

Which is standard practice. He chose to get off Prozac due to side effects and switch to another drug, which may not work as well. Getting the right dose is part of the process to see if the medication has been optimized before dropping it and trying something else.

Antidepressant treatment is trial and error for most patients. Unfortunately, there is no way to know in advance which drug is going to work with the least amount of side effects. Sometimes a drug is effective at relieving symptoms, but the side effects are burdensome. At that point, a decision has to be made based on risk/benefit and whether to try something else.

There is no perfect solution, but again, that doesn't mean the drugs don't work for people for whom they are appropriately prescribed.

by Anonymousreply 11911/15/2012

R118 I joked about you, not mental illness. Again, delicate flowers have no place on the DL.

Thank you R119, for that succinct and appropriate post.

by Anonymousreply 12011/15/2012

I talked about Celexa in a previous post...Here are some other things.

I tried Prozac and Wellbutrin in previous years...I disliked both of them.

It seemed counter-productive at first to take Celexa for anxiety, since anxiety is one of the side effects, at least at first. Once that faded, it's been working great.

I've lost weight on it, although that could be because I'm not drinking.

It improves my creativity, and it's never turned me into a zombie.

My main worry: Is this something I'm going to have to take for the rest of my life?

by Anonymousreply 12111/15/2012

R-121 You don't need it. They don't work. Don't fall for the fraud being put on you by the drug companies. Note the important line:

"little or no benefit over placebo (inactive pills) in less serious cases"

Now you don't have to believe this - it's a free country - but it is TRUE.

************************* From WebMD: How effective are antidepressants? That's a question that many people with depression have asked -- and research suggests that the answers aren't simple.

It's a question that's relevant to millions. About one in 10 Americans takes an antidepressant, now the most commonly prescribed type of drug in the U.S., according to research published in 2009 in the Archives of General Psychiatry. Much of the surge has happened in the past two decades. From 1996 to 2005, the rate of antidepressant use rose from 5.84% to 10.12%.

But a report recently published in The Journal of the American Medical Association showed that the drugs work best for very severe cases of depression and have little or no benefit over placebo (inactive pills) in less serious cases.

That report isn't the last word on the topic, but it got plenty of media attention. So much, in fact, that many psychiatrists became concerned that people would misunderstand the findings and possibly dismiss crucial treatment.

But the controversy also creates an opening to get a reality check about the popular drugs' advantages and limitations, experts tell WebMD.

Here's what those experts said -- and the four questions they recommend you consider when deciding if an antidepressant is right for you.

by Anonymousreply 12211/15/2012

DON"T DO IT! STOP!

From Scientific American

Question: Are antidepressants effective or ineffective?

Answer: Yes!

In my view, both these statements are true: Antidepressants do work. And antidepressants don’t work. Not to put too fine a Clintonian point on it, but determining whether antidepressants work depends on the definition of the word “work.”

A controversial article just published in the prestigious Journal of the American Medical Association concluded that antidepressants are no more effective than placebos for most depressed patients. Jay Fournier and his colleagues at the University of Pennsylvania aggregated individual patient data from six high-quality clinical trials and found that the superiority of antidepressants over placebo is clinically significant only for patients who are very severely depressed. For patients with mild, moderate, and even severe depression, placebos work nearly as well as antidepressants.

There have been at least four other review articles published in the last eight years that have come to similar conclusions about the limited clinical efficacy of antidepressants, and one of the study authors, psychologist Irving Kirsch, has recently published a book on the topic, provocatively entitled The Emperor’s New Drugs: Exploding the Antidepressant Myth. The recent review articles questioning the clinical efficacy of antidepressants run counter to the received wisdom in the psychiatric community that antidepressants are highly effective. Indeed, it wasn’t so long ago that psychiatrist Peter Kramer wrote in his best-selling book Listening to Prozac that this miracle drug made patients “better than well.” Prozac was a Rock Star. Its extraordinary success even led to a photograph of the green and white capsule on the cover of Newsweek Magazine in 1990.

The essential facts about antidepressant efficacy are not in dispute. In double-blind, randomized controlled trials – meaning that patients are randomly assigned to receive either drug or placebo, and neither patient nor clinician knows who gets what – antidepressants show a small but statistically significant advantage over placebos. The debate is over the interpretation of these findings, and it revolves around the distinction between clinical significance and statistical significance.

Statistical significance means that an effect is probably not due to chance and is therefore likely to be reliable. But statistical significance says nothing about the magnitude of the effect or its practical implications. Clinical significance indicates the degree to which an effect translates to a meaningful improvement in symptoms for patients. Although the superiority of antidepressants over placebos has been shown to be statistically significant, the observed differences are not clinically significant. In fact, the average difference between drug and placebo is approximately two points on a depression scale that ranges from 0 to 52. This difference does not exceed the commonly accepted standard for a minimally significant clinical improvement of a 3 point improvement on the depression scale.

But what of the testimonials from patients and their doctors reporting dramatic relief of symptoms in response to antidepressants? Such reports really aren’t in conflict with the data from randomized controlled trials. In clinical trials, patients treated with antidepressants do show substantial improvement from baseline. However, the clinical trial data also show that patients treated with placebos improve about 75% as much as patients treated with antidepressants, suggesting that only a quarter of the improvement shown by patients treated with antidepressants is actually attributable to the specific effect of the drugs. The rest of the improvement is a placebo response. In clinical practice, of course, there is no placebo group, and therefore patients and their doctors are likely to attribute all symptom improvement to the medication.

by Anonymousreply 12311/15/2012

MORE

The following is an excerpt from The Emperor's New Drugs: Exploding the Antidepressant Myth by Irving Kirsch, Ph.D. Available from Basic Books , a member of the Perseus Books Group. Copyright © 2011.

Like most people, I used to think that antidepressants worked. As a clinical psychologist, I referred depressed psychotherapy clients to psychiatric colleagues for the prescription of medication, believing that it might help. Sometimes the antidepressant seemed to work; sometimes it did not. When it did work, I assumed it was the active ingredient in the antidepressant that was helping my clients cope with their psychological condition.

According to drug companies, more than 80 percent of depressed patients can be treated successfully by antidepressants. Claims like this made these medications one of the most widely prescribed class of prescription drugs in the world, with global sales that make it a $19-billion-a-year industry. Newspaper and magazine articles heralded antidepressants as miracle drugs that had changed the lives of millions of people. Depression, we were told, is an illness – a disease of the brain that can be cured by medication. I was not so sure that depression was really an illness, but I did believe that the drugs worked and that they could be a helpful adjunct to psychotherapy for very severely depressed clients. That is why I referred these clients to psychiatrists who could prescribe antidepressants that the clients could take while continuing in psychotherapy to work on the psychological issues that had made them depressed.

But was it really the drug they were taking that made my clients feel better? Perhaps I should have suspected that the improvement they reported might not have been a drug effect. People obtain considerable benefits from many medications, but they also can experience symptom improvement just by knowing they are being treated. This is called the placebo effect. As a researcher at the University of Connecticut, I had been studying placebo effects for many years. I was well aware of the power of belief to alleviate depression, and I understood that this was an important part of any treatment, be it psychological or pharmacological. But I also believed that antidepressant drugs added something substantial over and beyond the placebo effect.

As I wrote in my first book, "comparisons of anti-depressive medication with placebo pills indicate that the former has a greater effect . . . the existing data suggest a pharmacologically specific effect of imipramine on depression." As a researcher, I trusted the data as it had been presented in the published literature. I believed that antidepressants like imipramine were highly effective drugs, and I referred to this as "the established superiority of imipramine over placebo treatment."

When I began my research, I was not particularly interested in investigating the effects of antidepressants. But I was definitely interested in investigating placebo effects wherever I could find them, and it seemed to me that depression was a perfect place to look. Why did I expect to find a large placebo effect in the treatment of depression? If you ask depressed people to tell you what the most depressing thing in their lives is, many answer that it is their depression. Clinical depression is a debilitating condition.

People with severe depression feel unbearably sad and anxious, at times to the point of considering suicide as a way to relieve the burden. They may be racked with feelings of worthlessness and guilt. Many suffer from insomnia, whereas others sleep too much and find it difficult to get out of bed in the morning. Some have difficulty concentrating and have lost interest in all of the activities that previously brought pleasure and meaning into their lives. Worst of all, they feel hopeless about ever recovering from this terrible state, and this sense of hopelessness may lead them to feel that life is not worth living.

by Anonymousreply 12411/15/2012

In short, depression is depressing. John Teasdale, a leading researcher on depression at Oxford and Cambridge universities, labelled this phenomenon "depression about depression" and claimed that effective treatments for depression work – at least in part – by altering the sense of hopelessness that comes from being depressed about one’s own depression.

Whereas hopelessness is a central feature of depression, hope lies at the core of the placebo effect. Placebos instill hope in patients by promising them relief from their distress. Genuine medical treatments also instill hope, and this is the placebo component of their effectiveness. When the promise of relief instills hope, it counters a fundamental attribute of depression. Indeed, it is difficult to imagine any treatment successfully treating depression without reducing the sense of hopelessness that depressed people feel. Conversely, any treatment that reduces hopelessness must also assuage depression. So a convincing placebo ought to relieve depression.

It was with that in mind that one of my postgraduate students, Guy Sapirstein, and I set out to investigate the placebo effect in depression – an investigation that I describe in the first chapter of this book, and that produced the first of a series of surprises that transformed my views about antidepressants and their role in the treatment of depression.

The drug companies claimed – and still maintain – that the effectiveness of antidepressants has been proven in published clinical trials showing that the drugs are substantially better than placebos (dummy pills with no active ingredients at all).

But the data that Sapirstein and I examined told a very different story. Although many depressed patients improve when given medication, so do many who are given a placebo, and the difference between the drug response and the placebo response is not all that great. What the published studies really indicate is that most of the improvement shown by depressed people when they take antidepressants is due to the placebo effect.

Our finding that most of the effects of antidepressants could be explained as a placebo effect was only the first of a number of surprises that changed my views about antidepressants. Following up on this research, I learned that the published clinical trials we had analyzed were not the only studies assessing the effectiveness of antidepressants. I discovered that approximately 40 percent of the clinical trials conducted had been withheld from publication by the drug companies that had sponsored them. By and large, these were studies that had failed to show a significant benefit from taking the actual drug. When we analyzed all of the data – those that had been published and those that had been suppressed – my colleagues and I were led to the inescapable conclusion that antidepressants are little more than active placebos, drugs with very little specific therapeutic benefit, but with serious side effects.

How can this be? Before a new drug is put on the market, it is subjected to rigorous testing. The drug companies sponsor expensive clinical trials, in which some patients are given medication and others are given placebos. The drug is considered effective only if patients given the real drug improve significantly more than patients given the placebos. Reports of these trials are then sent out to medical journals, where they are subjected to rigorous peer review before they are published. They are also sent to regulatory agencies, like the Food and Drug Administration (FDA) in the US, the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK and the European Medicine Agency (EMEA) in the EU. These regulatory agencies carefully review the data on safety and effectiveness, before deciding whether to approve the drugs for marketing. So there must be substantial evidence backing the effectiveness of any medication that has reached the market.

by Anonymousreply 12511/15/2012

And yet I remain convinced that antidepressant drugs are not effective treatments and that the idea of depression as a chemical imbalance in the brain is a myth. When I began to write this book, my claim was more modest. I believed that the clinical effectiveness of antidepressants had not been proven for most of the millions of patients to whom they are prescribed, but I also acknowledged that they might be beneficial to at least a subset of depressed patients. During the process of putting all of the data together, those that I had analyzed over the years and newer data that have just recently seen the light of day, I realized that the situation was even worse than I thought. The belief that antidepressants can cure depression chemically is simply wrong.

Evidence that was known to the pharmaceutical companies and to regulatory agencies was intentionally withheld from prescribing physicians, their patients and even from the National Institute for Health and Clinical Excellence (NICE) when it was drawing up treatment guidelines for the National Health Service (NHS) in the UK.

My colleagues and I obtained some of these hidden data by using the Freedom of Information Act in the US. We analyzed the data and submitted the results for peer review to medical and psychological journals, where they were then published.

Our analyses have become the focus of a national and international debate, in which many doctors have changed their prescribing habits and others have reacted with anger and incredulity. My intention in this book is to present the data in a plain and straightforward way, so that you will be able to decide for yourself whether my conclusions about antidepressants are justified.

The conventional view of depression is that it is caused by a chemical imbalance in the brain. The basis for this idea was the belief that antidepressant drugs were effective treatments. Our analyses showing that most – if not all – of the effects of these medications are really placebo effects challenges this widespread view of depression.

As controversial as my conclusions seem, there has been a growing acceptance of them. NICE has acknowledged the failure of antidepressant treatment to provide clinically meaningful benefits to most depressed patients; the UK government has instituted plans for providing alternative treatments; and neuroscientists have noted the inability of the chemical-imbalance theory to explain depression. We seem to be on the cusp of a revolution in the way we understand and treat depression.

by Anonymousreply 12611/15/2012

hold on, that webMD article says 10% of americans are on an antidepressant?

I had no idea it was that high.

by Anonymousreply 12711/15/2012

Oh, the irony....

by Anonymousreply 12811/15/2012

Did I read 19 billion spent on a worthless drug in a year? YES! I wonder how much of that is in the USA.

Pharma has around a 25% profit margin on everything it sells - that means around $2.4 billion in profits on anti-depressants - A YEAR!

by Anonymousreply 12911/15/2012

[quote]My main worry: Is this something I'm going to have to take for the rest of my life?

Not necessarily, R121.

Be sure to discuss this with your provider.

by Anonymousreply 13011/15/2012

R121 you shouldn't even start, they don't work.

by Anonymousreply 13111/15/2012

What irony?

That 10% of the population is taking drugs that might be ineffective and have side effects?

by Anonymousreply 13211/15/2012

What did I say in the first post?

[quote]And I'm not interested in hearing over-the-top, tinhat bullshit about how antidepressants are terrible, don't work, or how people who take them are weak-minded, etc. So kindly start your own thread with that shit.

by Anonymousreply 13311/15/2012

Why is depression becoming MORE prevalent, despite all the new drugs/treatments on the market? Wouldn't a few decades of available drug treatments lower its rate of incidence?

It almost seems like the treatments create their own market.

Why is the placebo effect getting stronger over time? That's another mystery. One would think it would remain constant.

by Anonymousreply 13411/15/2012

Irving is biased and his conclusions were thoroughly debunked by his peers, many of whom have spent 30 years or more designing and conducting randomized control trials of many different types of psychiatric drugs.

He used arbitrary and unusual trials from the 70s and 80s that were widely thought to be flawed. The effect sizes he assigned to the differences between drug or placebo and the significance of those sizes were widely disputed and not accepted by other researchers and statisticians.

Give it a rest!

by Anonymousreply 13511/15/2012

Ah, a Pharma PR person is in this thread - there is no other explanation. Well, you've been unmasked!

by Anonymousreply 13611/15/2012

R136, please take you're trolling somewhere else. You are exactly the kind of idiot I specifically stated I did not want to hear from.

by Anonymousreply 13711/15/2012

So you are the OP - why did you start this thread? I believe you are a PR flack for pharma in here to get gay men to start trapped into a drug they don't need.

by Anonymousreply 13811/15/2012

OP do you have reasons for why you're depressed? do you have access to a therapist in addition to drugs?

by Anonymousreply 13911/15/2012

I feel so godamn low now

by Anonymousreply 14011/15/2012

[quote] I believe you are a PR flack for pharma in here to get gay men to start trapped into a drug they don't need.

And I believe you are Mrs Patrick Campbell.

by Anonymousreply 14111/15/2012

R136 has a personality disorder that wasn't solved by antidepressants and has created his own world whereas his anger at life is caused by evil pharma and being gay.

Please seek help immediately.

by Anonymousreply 14211/15/2012

r135 your argument is basically: Don't listen to Irving! Nobody likes him!

What do you think of Marcia Angell?

by Anonymousreply 14311/15/2012

Thank you, R142!

by Anonymousreply 14411/17/2012

Here's the fucking truth.

If you feel like absolute shit, if you spend all your time worrying about the bad things in life (people eventually dying, "unloyal friends," job shit, stress, money shit) and very very little time enjoying the day-to-day of life, then you OWE it to YOURSELF and those you LOVE to work at feeling better.

You definitely owe it to at least try Prozac. It has helped thousands of people.

Now it's very true that if you, say, sweated 20 mins a day in a cardio session, you might get a similar effect.

But that is very hard to commence when you feel horrible.

I just think of my life before Prozac and after it.

That feeling of fear -- I was afraid to fly, I'd obsessively call my parents worried something bad was gonna happen to them, I agonized over every work decision - was no way to live.

Since I started Prozac a few years ago, I realized that I love cooking healthy meals and visiting gardens and watching stand-up comedy. I find those activities interesting and fun and rewarding.

If you're reading this and the thought of giving a flying fuck about things like cooking or garden is completely insane to you, and you spend your days wallowing in misery and anxiety, you should try a low dose of Prozac.

by Anonymousreply 14511/22/2012
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