Hard News: The drugs don't (always) work
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The Herald is getting a bit of a roasting in its Your Views section already. I think there are people talking about Press Council complaints.
I, for one, have quietly emailed the journalist to suggest he ask his sub-editors to change the headline at least. Given it doesn't hold true to his story or the study, it seems particularly cavalier when dealing with mental health topics (not that people suffering depression aren't just as likely to see through it, but for anyone skim-reading to get that impression is not exactly a positive thing in what remains a somewhat contentious area)
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The data were obtained under America's Freedom of Information Act, and include both published and unpublished trials. This has the effect of removing "publication bias": where only the published research is examined.
You'd really want to know if there was a difference between the published and unpublished trials here.
Sometimes there are reasons why research isn't published, often that reason is that "it's crap".
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I, for one, have quietly emailed the journalist to suggest he ask his sub-editors to change the headline at least. Given it doesn't hold true to his story or the study, it seems particularly cavalier when dealing with mental health topics...
It's not just the Herald - I spotted the story earlier this morning on the Guardian...
Prozac, used by 40m people, does not work say scientists
...and a quick Google News search reveals many more.
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It strikes me that another weakness in this study -- probably a reflection of the vintage of the trials -- is that it does not consider at all the use of SSRIs to ease anxiety disorders, only clinical depression.
It may be that it would require a completely different trial . Often new effects from the trials can cause the new studies.
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Prozac, used by 40m people, does not work say scientists
I know in an intelligent audience like this people won't see everything in black and white and absolutes, but I'll say this anyway - the truth is that Prozac __doesn't__ work for everyone. That's why there's a whole range of SSRIs. Prozac didn't work for me because all it made me feel like was numb and completely emotionless. Meanwhile Citalapram makes me feel like me. You don't always get the right drug (or counsellor) straight off the bat, unfortunately.
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Sometimes there are reasons why research isn't published, often that reason is that "it's crap".
Sometimes Kyle. And then...
Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy
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Hi, first time poster here... SSRIs helped me deal with post natal depression 4 years ago. And they really worked like magic - it felt like an immediate correction to a chemical imbalance, even though I wasn't taking a high dose. When I saw the headline in the Herald today I immediately thought "like hell they don't". Thanks for the interesting discussion on this and the thorough research behind it. Kia kaha to those battling depression/mental illness in all its forms.
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"For a really interesting, and disturbing, look at the implications of over subscribing anti-depressants watch Anthropologist Helen Fisher talk about the chemistry of love."
www.ted.com/index.php/talks/view/id/16
Thanks, Cushla, the Helen Fisher clip is excellent. The notion that fiddling with serotonin levels also affects dopamine levels (suppresses it) and therefore interferes in human ability to bond, is a concern. Would that make us less empathic? Unable to form meaningful romantic commitments or even have raunchy casual sex?
My GP reckons it can take quite a bit of experimenting to find the right SSRI, at the right dose, for a patient. I suspect that they don't actually stop the black thoughts, but loosen your attachment to them. As a depressive myself, from a likewise family, it's been instructive to me to live with my 17 yr old son, who is a total optimist and naturally sunny person. As Cushla says, I'm convinced it's all in the brain chemistry and somehow, that chemical pathway gets carried on genetically. My son got his chemistry set from the paternal end of the gene pool, I reckon!
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shitty and utterly powerless you feel at the very notion of choking down medication
taking Prozac, for example, for years is something I find deeply unattractive
Isn't this because society not only stigmatises mental illness, but also the use of chemicals, legal and illegal, to alter mood?
All things being equal, there is nothing wrong with taking an SSRI every day. Any more than there is me taking an ACE inhibitor each day to suppress hypertension.
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I've commented before on Allan Bell's research into scientific accuracy in journalism, but I guess it's worth repeating here.
Bell (1989) sent copies of articles on global warming back to the sources quoted and asked them to comment on any inaccuracies. Bell (1991) summarises the results of that study:
"Sources rated 29% of stories absolutely accurate, and 55% slightly inaccurate, with 16% in the higher inaccuracy levels [...] Scientific/ technical inaccuracies were present in about a third of stories οΎ‘ technical terms misused, wrong figures given, scientific facts confused. Non-scientific inaccuracies (such as mis-spelled names, misnamed organisations and wrong dates) also occurred in about a third of the stories, as did misquotations. About a quarter of stories had significant omissions or exaggerations."
(Bell, Allan (1991) The language of news media. Oxford: Blackwell. p217)More generally, the accuracy of journalism suffers whenever journalists stray from their comfort zone. In other research, Bell got similar results (an average of one serious factual error per story) for stories set in unfamiliar cultural contexts.
Bell points out that the errors introduced are not random.
All journalism has a number of observable biases towards maximising news value.
This shows up as exaggerations of: negativity, relevance to audience, unexpectedness, novelty, suddenness of event, eliteness (fame, talent, power, credibility) of principals and sources, simplicity of story, and conformity of story to some expected "script" or pattern, amongst other factors.Such exaggerations are most likely to occur in the lead paragraph, where journalists try to concentrate the most news value; and in the headline, where journalists and/or editors try to find an angle on the story displaying its news value to greatest effect.
The rest of the story may actually be accurate.
There may be (and usually, is) no intent to mislead or deceive the reader.
Unfortunately, the nett effect is to mislead the reader -- because readers are more influenced by the headlines and leads than by the more nuanced reporting that may follow.
In this case, the choice of the angle "they don't work" is entirely predictable, as it maximises negativity, unexpectedness, and relevance.
It's also an error.
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Isn't this because society not only stigmatises mental illness, but also the use of chemicals, legal and illegal, to alter mood?
Exactly, because it's a weak thing to do, and you should just get-the-fuck over it.
I love love love the John Kirwan ads. They really speak to me, and apparently they're speaking to a whole lot of other NZers, especially men, because they're so real and relateable, and he's a fricking All Black, a god amongst men and even he needs help, and that's okay. I think they're pretty much the most helpful public service announcement I've ever seen.
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Lots of people here, who say or imply "the drug had a great effect on me, so the research must be wrong", are missing an important point: how do you know you were not being given a sugar pill?
Note that the research says (for all but perhaps the severest cases) a placebo was as effective as the drug. And, by definition, a placebo is something you're given and you believe it to be the actual drug.
So the fact that what you were being prescribed worked for you (which I do not doubt) doesn't show that the research is wrong.
Having said that, the coverage leaves much (clarity) to be desired!
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Er, Steve, respectfully: Fuck off. I wasn't given a sugar pill and I have never taken part in any trial and I know it worked (and works) for me.
I can go off meds for up to six months at a time but when I start not coping I can go back on them to mediate the extremes. They help me live my life when stress pushes me over the edge.
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Russell: Hope the TVNZ7 launch went well (somehow I had a notion that it was next week!).
I have had a not-completely-satisfactory exchange of messages with Freeview and they hinted that the Freeview/MySky incompatibility problem will be solved 'later this year'. Do you have any more info/insights on this? -
Re the placebo thing: placebos really do work. They produce results. They are not the same as no treatment.
(To be facetious, perhaps the medical profession are cursing at being found out, and will now have to find something else to give people...)
So I agree with Steve R - personal accounts of "it worked for me" aren't proof, because placebos can and do have significant effects on people.
Having said that, I'm getting the sense from my reading is that it's all way more complicated than the headline story. Eg, SSRIs as a class are in some doubt; yet individual SSRIs do something. So maybe they work, but not for the reasons that have previously been advanced. And we know that people vary enormously in their responses. And maybe "depression" isn't actually one disease, but several with different causes but similar symptoms.
Given that complexity "Anti-depressants don't work" seems like a very irresponsible headline, one that isn't even supported by the story underneath it.
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i) Perhaps a bit left field, but much of the angst around this issue has not been helped by the modern marketing of prescription drugs in the wider population.
ii) Steve I would urge you to stop and ponder the dilemma for the medical profession of figuring out who can and cannot have a real drug as opposed to a placebo or indeed who would be qualified to make such a determination.
iii) Some people would argue that there comes a point where brains, thoughts and chemicals become the same thing.
iv) Spare a thought for the poor buggers who go against big pharma with research. I know one at the moment who is pretty unhappy. These people as you can imagine really don't care who they insult.
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Oh and super post thanks RB.
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I can go off meds for up to six months at a time but when I start not coping I can go back on them to mediate the extremes. They help me live my life when stress pushes me over the edge.
Respectfully too, I think you said alot. The stress, edge,extremes, not coping are all personal experiences and whether you self medicate or take prescriptions, one will often find something that will work.I guess it should be each to their own. I do find it interesting that children are taking drugs(of any sort) rather young, and I am sure society pressure can influence. I find it sad that those kids are missing out on the real life experiences (through suppression of "bad behaviour") which in the long run could help them to grow.But, different strokes etc, and do the kids on meds now, end up being the adults on ssri's?
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I find it sad that those kids are missing out on the real life experiences (through suppression of "bad behaviour") which in the long run could help them to grow.
I think you're putting a bit of a value judgement on it there Sofie. Being unable to get out of bed does not help you grow. Having chemical imbalances corrected so that you can do the things that you would normally do, however, does.
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One possible conclusion to draw from the observation that the drugs work better than placebos for the more severely depressed is that mild depression is not the same illness.
(Or, to be provocative, not an illness at all, which would tie in nicely with the notion that drug companies are pathologising normal unhappiness.
The best products, from a drug company's point of view, are not the cure for cancer but treatments for the symptoms of chronic ailments that you will take every day of your life...)
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i'll admit to finding this entire thread very brave new world.
"chemical imbalance?! try levi-chem! the new wonder pill from pzitzer!
pzitzer (R); balancing your chemistry since 1984"
i think 81st might have struck the nubbin of the real issue.
Perhaps a bit left field, but much of the angst around this issue has not been helped by the modern marketing of prescription drugs in the wider population.
the drugs in question do work for lots of people, but the big players are doing their best to medicate absolutely everyone...
downers for your chihuahua anyone?
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Dan S said:
Er, Steve, respectfully: Fuck off. I wasn't given a sugar pill and I have never taken part in any trial and I know it worked (and works) for me.
With all due respect, I did say that I do not doubt it works (for you and everyone else who has said so).
What the research says is that, because the drug turns out to be no better than a placebo (for all but the most extreme cases), the fact the pill works for someone does not tell them whether it contains the drug or is a placebo. That's all.
Of course, you would expect that, unless part of an experiment, you know you are being given a pill containing the drug. So, assuming you were not part of an experiment, if you take the pill and it has an effect then that's evidence the drug does work for you. But that still leaves the fact, on the evidence of this research, that a placebo would work just as well.
So, you can see why the drug companies are upset: the research shows that if doctors had prescribed placebos (which are cheap and needed no development) instead of the drug, in all but the extreme cases, the effects would have been the same. So, a doctor might now (leaving a few small ethical issues aside :-) ) prescribe you a placebo (which you believe actually contains the drug) and the drug companies would lose a lot of money! And you would feel the same benefits.
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I think you're putting a bit of a value judgement on it there Sofie. Being unable to get out of bed does not help you grow. Having chemical imbalances corrected so that you can do the things that you would normally do, however, does.
None whatsoever which is why I said each to their own , different strokes etc.I know many people in all walks of life that have or haven't chosen antidepressants and all cope differently. I know others who self medicate and they cope also. I myself take meds and self medicate but I feel great to be alive and its because I woke up after being brain dead so as I said "each to their own. No judgement : )
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Lots of people here, who say or imply "the drug had a great effect on me, so the research must be wrong", are missing an important point: how do you know you were not being given a sugar pill?
Two weeks of crippling side-effects going on? Six freaking months of being weaned off the super-dose my dr put me on when I pointed out they weren't working? And the intervening time spent feeling like I'd been entirely encased in perspex.
yes there are misdiagnosed people, yes some GPS over prescribe. but , better a few extra prescriptions than a few extra deaths eh.
Except it's not that simple. Some of those misdiagnosed people are actually ILL. Doling out SSRIs to every patient who mentions the word 'tired' stops people getting proper treatment. The problem's not the pills themselves, but how they're being used.
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Emma's point about side effects is a good one. I am, however, quite surprised to read (in Wikipedia, so it must be true):
Placebos are inactive or ineffective treatments or formulations; however a patient may experience either a positive or negative clinical effect while taking one. When a placebo is administered to mimic a previously administered drug, it may also incur the same side effects as the prior authentic drug.
The article goes on to say:
Most of these effects are thought to be psychological in nature or due to other unrelated factors. Not all placebos are equally effective. A placebo that involves ingestion, injection, or incision is often more powerful than a non-invasive technique. Placebos administered by authority figures such as general practitioners and other experts may also be more powerful than when this psychological authority effect is absent.
They are, however, not inert, sham, or inactive in any other manner of speaking; and they may well, in and of themselves, generate considerable change within any given subject, at any given time, under any given circumstances.So, you're not being "tricked" or being made to look "stupid" if a placebo works for you---we're just made that way, which is fascinating, I think.
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