Today’s science headlines include a new study about the weakness of SSRIs (such as Prozac and Paxil) relative to placebos for the treatment of depression. While kudos go to the researchers for investigating this question, doubts about the SSRIs have been around for a long time.
Ten years ago, Kaspar and others were already reporting essentially the same findings as the current study: that SSRIs seem somewhat effective in severe cases of depression, but evidence for their efficacy in mild or moderate cases are questionable, especially when compared with placebo. Given the side effects of the SSRIs, including REM sleep suppression and sexual dysfunction (affecting 30-70 percent of patients), the wisdom of prescribing SSRIs for anything but the most severe cases of depression seems inappropriate.
Needless to say, the pharmaceutical giants who make tons of money on these drugs are not too happy with this latest report. According to Reuters, a spokesperson for Paxil maker GlaxoSmithKline argued that the data reported today are “at odds with what has been seen in actual clinical practice.” Now this should be scary to anyone who understands anything about placebo effects and experimental design. The whole point of doing double-blind studies is to avoid the kinds of bias that are typically seen in the “clinical practice,” where both health care provider and patient know that medication is being used. GSK is apparently telling us to disregard the controlled, empirical data in favor of some anecdotal observations. Not good.
Personally, I like the results of studies that investigate the effects of aerobic exercise on mood–no side effects there!
11 Comments
rnadams · February 27, 2008 at 6:43 pm
If this research is correct, it’s troublesome to think about how many people have been prescribed SSRIs and for how long. It seems amazing that the information is just starting to surface. And if placebos are just as effective for mild cases, what does this say about psychiatrists who are hastily prescribing away medication for patients they may have been able to help with therapy? I say it looks bad.
love2run · February 27, 2008 at 11:09 pm
I have to agree with the Holistic health side of this and against the medication aspect. I feel like each and every one of us needs to be more in tune with our bodies, minds, and spirits, and by putting these sorts of drugs inside of us just to get an immediate affect is not going to help us out in the long run. Wheras exercise, acupunture, yoga, breathing techniques, overall body awareness, and being able to communicate what is really going on inside our brains will lead us to hopefully no other side effect that could potentially harm our biological capabilities. It may be a longer and more emotionally painful experience because the person is being forced to deal with whatever is making them depressed or anxious, but it will only serve them and their bodies better in the end–that is the hope anyway.
stclark · February 28, 2008 at 3:47 pm
It’s about time we saw more of this research. I’d like to see this data published in magazines like Cosmo to get the word out to all the women who are the biggest targets of the pharmaceuto-nazis pushing their wares on us! I’m so tired of seeing ads and commercials for pills that will fix everything for us. Not every bout of depression faced should be treated as a seratonin-based issue. Sometimes we are facing real issues in our lives that need to be addressed through support groups, lifestyle changes, or cognitive therapy. I want people to be healthy and happy, but sometimes our health problems are more than a chemical snaffu to be fixed with a tablet. It’s time that holistic care got more press because people need to be treated as whole people. A healthy diet, regular exercise, relazation/meditation, counseling, social networks, …these medicines have only good side effects!
stclark · February 28, 2008 at 3:52 pm
Addendum to above comment : In light of my earlier post, I feel I should mention that some depression may NEED medical intervention. Bipolar disorder for instance is often helped a lot by drugs. Certainly if it’s a choice between prozac and suicide, choose the drug! Severe depression is nothing to be minimized or shrugged off. Though I am not a fan of the drug companies, I would never tell a desperate person not to seek help or follow their psychiatrist’s advice. It goes without saying that if a person feels they need help and cannot do it on their own, then they should not hesitate to contact a professional. Research be darned…..
biopsych · February 28, 2008 at 6:43 pm
Unfortunately many people do not do their research and are easily persuaded by advertisements claiming to provide the quick solution. I do not think that doctors should be over prescribing SSRIs given their questionable effectiveness. However, I also think that it is up to each individual to be an advocate for themselves and to do their homework.
trubio · February 28, 2008 at 6:44 pm
I truly believe that many times medicine is just a band-aid that doctors and pharmaceutical companies slap on in an effort to rid someone of a problem. In actuality, I believe that medications are more harm than good as the cause of the problem is left un-dealt with, the symptoms are masked, and the side effects produce short and/or long term effects in the mean time. I know that some people may desperately need medication to at least stablilize themselves while they attempt to get to the bottom of the problem, but I think we need to stop looking at medication as a fix-all, end-all solution and more of a temporary fix. I too, agree that regular exercise may be just as effective or even more so than an SSRI.
Laura Freberg · February 29, 2008 at 2:12 pm
Thanks to all of you for these thoughtful comments. Part of the problem is that SSRIs still beat placebos in most studies in the treatment of “severe” depression. I am not a clinician, but I can imagine that it is difficult to decide what is “severe” versus moderate or mild. Given the possibility that someone could sue you if you failed to take their depression seriously enough, my guess is that the safer course of action for physicians is to prescribe the medication.
Swedish55 · March 2, 2008 at 11:53 pm
Overall, it is up to you to know what it is you are putting into your body. It is also important to understand the dynamics between doctors, pharmaceutical companies, and laws. Just because your doctor prescribes you something, doesn’t mean that you NEED it, or that you couldn’t make natural changes in your life to help with the problem. I feel like these days people trust their doctors more then they should, they don’t do enough research on their own, and they always want the easy answer, such as taking a pill. I think the less that you need to chemically change or alter your body the better. But in this world of instant gratification and quick fixes, I don’t think people are as careful as they should be with their bodies.
aoneil · March 5, 2008 at 2:35 pm
I am a firm believer that clinicians should prescribe medication only after all other options have failed. This is partly due to past experience with seeing people on SRRIs and the negative side effects when they stop taking them. Tragically, one of my good friends mother’s committed suicide a few years back after she stopped taking her anti-depressant medications.
It seems that often clinicians are too quick to make a diagnosis, and medications in the US are all around over prescribed. Many drugs have dangerous unknown side effects, yet will only be tested for a few weeks before being approved by the FDA to go on the market.
ccallag · March 12, 2008 at 10:27 am
My opinion on this topic is that I believe medication should not be used unless it is a severe case. I personally don’t like taking medications, especially on a regular basis. I think it is interesting to see that the SSRIs are working only benefitting those in a severe case. I believe there are alternate methods to medicating one’s problems. Especially methods that are free of charge!
hvitullo · May 5, 2008 at 11:21 pm
I don’t think that there is ever going to be a drug that everyone is on board with. People are always going to be asking questions, doing studies, and researching it. But, that is the reason we have many effective drugs today because those people asked the right questions. Questions about SSRIs have been around for ages. But, the truth of the matter is that they do work for some people. If someone going through depression is aware of the possible side effects, then why not let them try it out and see if it helps. Unless you have been through the depths of depression, you do not know what these people are willing to do to be relieved of it. The side effects start to look “not so bad” compared to everything else.
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