i apologize if this has been posted already, but i found it very interesting. personally, i've never believed that anti-depressants work very well for depression. i do think that paxil works for anxiety, but that's about it. considering the staggering number of patients on these medications, i think that we should take a hard look at what we're giving people and why. not saying i believe for certian that anti-depressants don't work in most people, but i think we should take a step away from the cupcakes that our friendly pfizer rep brought for us today and take a second look at some objective studies.
antidepressants most likely have little or no effect on the majority of those suffering from slight or non-severe forms of depression, and placebos were often observed to have just as much perceived beneficial affect.
trial end results showed that whatever the drug used, the conclusions were the same -- in cases of severe depression, antidepressants were much more effective than placebos, but on the other hand, the beneficial effects of drug molecules was observed to be minimal, or even nonexistent, in patients treated with drugs adapted to conditions of mild depression, and placebos worked just as well.
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it appears that neither patients or healthcare professionals are aware that most studies which claim to demonstrate the efficiency of various antidepressants only used patients suffering from severe forms of depression, which would spin the study conclusions.
I've always suspected this. What is hard is that the part of treatment that often is effective is difficult to initiate for the patient, and is time consuming, and requires the patient to be active in his/her own treatment plan.
I'm talking about finding a group to participate in some activity with that can be therapeutic, as well as activities that the individual can do that are achievement based but entertaining and of use to that person. Exercise. It's hard to catch someone when symptoms are mild and get them supported early on with this stuff. For many, this is nearly impossible simply due to work and obligations.
Wouldn't it be great if like in the movies, friends would come and sweep you away to some wonderful scenic place for you to lick your wounds for 6 months in luxury after you've been hit in the head by life?
you wouldn't be talking about the first Sex and the City movie, would you?
I think they do work better for some people than for others. The problem is that we know so little about why they work that we aren't able to tailor the med to the patient. Oh, yes, I've sat through presentations by drug reps and academics, tracing the paths of the various neurotransmitters to the various parts of the brain. I STILL maintain we really know next to nothing about how these chemicals really interact electrochemically. It's an exaggeration and unfair, but part of me understands why many of our colleagues think we practice "voodoo medicine."
And I heartily agree that the most effective treatment is meds plus psychotherapy. I stress this to patients. I don't usually see patients with mild depression, since I work inpatient, but if I did I'd probably recommend psychotherapy before meds. Of course the trick is to get insurance to pay for therapy--so much easier for them to pick up the tab for a 15 minute "med check." Which is why the general pracitioners find it easiest to hand out med samples.
I think there IS a strong placebo effect. I hear patients say, after two days, "Oh, that (insert name of antidepressant) must be really starting to work, I feel much better." Now, there's no way the med is working that well, that quickly. What is probably going on is that the person has been taken out of the stressful environment they've been in, and given a lot of listening, a lot of focused and compassionate attention, has met with peers who have also been going through a rough time so they know they're not left on their own, has met with a therapist who has informed them of resources available to them in the community. Of course they feel better, but I doubt it's because of medication.
Still, I'm sure there are people alive and functioning well today for whom antidepressants did and do help, so I don't think we can just discount them. We just need to learn more.
And I heartily agree that the most effective treatment is meds plus psychotherapy. I stress this to patients. I don't usually see patients with mild depression, since I work inpatient, but if I did I'd probably recommend psychotherapy before meds. Of course the trick is to get insurance to pay for therapy--so much easier for them to pick up the tab for a 15 minute "med check." Which is why the general pracitioners find it easiest to hand out med samples.
As previously mentioned by some insightful posters, studies have shown that psychotherapy and further medication plus psychotherapy is exceptionally effective in treating depression. Of course there is the problem of cost - psychotherapy at $100+ a session a week indefinitely is more expensive than a box of pills. Some people don't have that sort of money and some people have no insurance/insurance problems. Then of course there's the tug toward a quick fix. Swallowing a pill is a hell of a lot easier than working your orifice off in therapy for weeks on end.
Simba&NalasMom, LPN
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