Do Antidepressants Work? Maybe Not.

Not_A_Hat_Person, RN · Apr 3, 2016

The studies I've seen concluded that talk therapy plus antidepressants worked better than either one by itself.

Score 1 for the psych med stigma.

elkpark · Apr 3, 2016

This information has been floating around for many years. A few years ago, Newsweek did a big cover story on the question. It's v. hard to get evidence of antidepressants working significantly better than placebos. Of course, part of the problem is that the placebo effect is extremely strong in depression.

I consider this psychiatry's big, dirty secret. We've got half the country taking these medications, and it's not clear that they're doing anything more for people than M&Ms would (if only we could convince the public that M&Ms treat depression!)

CrunchRN, ADN, RN · Apr 3, 2016

Cognitive therapy actually gets to the problem. Drugs have their place temporarily, but do nothing to fix the underlying issues.

umbdude, MSN, APRN · Apr 3, 2016

There's also a recent study claiming that "talk therapy" is not as effective as people think when publication bias is considered.

A key thing to note from your link is that those 4 antidepressants did prove to have clinically significant effect for those with the most severe depression (compared to placebo).

Then people might want to ask why then are so many people with mild/moderate depression on antidepressant. Frankly I think a chunk of people on antidepressants are prescribed by primary care providers, not specific psych-trained clinicians. They probably should've referred patients to psychotherapy before handing out pills (but many people simply aren't patient enough to follow through psychotherapy).

Those SSRIs/SNRIs also get prescribed for other reasons. Finally, the study includes only 4 (maybe 6) drugs, and I think it's a bit misleading as it implies that all antidepressants. Calling antidepressant a "myth" seems be a little unfair and might keep away those who can really benefit from these drugs.

TheNurseStudentMom · Apr 3, 2016

Not everyone has time for therapy. I miss 2 hours of work for each 1 hour appointment, and that's assuming my appointment is at 8am. I have to make up the hours the same day, or use PTO. I get 6 hours of PTO a pay period. I get paid twice a month. Depending upon how the appointments work with my pay period, that's either 4 or 6 hours of PTO per check, granted it's usually 4. Since I'm a single mom, I usually don't make up the time the same day or I wouldn't get home until after 7pm. I put both meds and therapy off as long as I could (about 4 years). My primary care IS psych trained. I went to therapy twice, but ended up in the hole for PTO, which also has to be used for other appointments for both myself and my daughters. I just cannot afford to miss work like that.

Farawyn · Apr 3, 2016

Following.

ixchel · Apr 3, 2016

"89% of depressed patients are not receiving a clinically significant benefit from the antidepressants that are prescribed for them" Antidepressants and the Placebo Effect

What I have read in the past is that antidepressants show little to no benefit in those with mild to moderate depression. Severe depression shows significant improvement with antidepressant usage. I think that information *may* have been limited to SSRIs. I'll have to dig for it. It may have been on medscape.

pixierose, BSN, RN · Apr 3, 2016

M&M's can be used as a complementary therapy, no? I wonder if there would be a difference in colors: "For anxiety, eat 5 blue M&Ms daily," For depression, eat 5 red M&Ms bid." Voila - placebo effect (and delicious).

Following ... this article has been out for a little while with some controversy. From what I understand, it is limited with SSRIs/SNRIs; I don't believe a placebo effect has been noted in studies with other antidepressants (or if there has even been studies with other antidepressants). Will try to look later on. Thus, I would agree the title of the article is misleading as it implies all antidepressants.

Julius Seizure · Apr 3, 2016

If M&Ms were the placebo, and I was in the placebo group, there's a strong risk that I would OD and mess up the study.

thekid · Apr 3, 2016

If you really want to dive in to a can of worms, look up Dr. Peter Breggin's work. Or MAD in America. It's at the very least an interesting topic.

I have observed antidepressants cause more harm than good to patients, and I have also observed antidepressants serving as a temporary rescue action to help jump start a patient again .

What bothers me the most is observing the prescribing provider switch a few medications at the same time and not follow up for six weeks. IMO, unless a patient is having severe adverse reactions necessitating a "wash out" , one med should be altered at a time and evaluated. I've witnessed way too much polypharmacy in psych .

And any change in medication should be closely monitored, at the very least by phone contact, between provider and patient. A patient can slide downhill quick .

When I worked in psy case management, I would create a simple daily log for my members, each day they had to write a brief summary , listing medications and dosages, times, diet, sleep and amount of stress, and any symptoms. It gave them a sense of involvement (and perspective) into their own medication management. And it was a great tool to present to the provider when it was time to follow up.

joe a. · Apr 4, 2016

If you really want to dive in to a can of worms, look up Dr. Peter Breggin's work. Or MAD in America. It's at the very least an interesting topic.
I have observed antidepressants cause more harm than good to patients, and I have also observed antidepressants serving as a temporary rescue action to help jump start a patient again .
What bothers me the most is observing the prescribing provider switch a few medications at the same time and not follow up for six weeks. IMO, unless a patient is having severe adverse reactions necessitating a "wash out" , one med should be altered at a time and evaluated. I've witnessed way too much polypharmacy in psych .
And any change in medication should be closely monitored, at the very least by phone contact, between provider and patient. A patient can slide downhill quick .
When I worked in psy case management, I would create a simple daily log for my members, each day they had to write a brief summary , listing medications and dosages, times, diet, sleep and amount of stress, and any symptoms. It gave them a sense of involvement (and perspective) into their own medication management. And it was a great tool to present to the provider when it was time to follow up.

Here's the deal. We do whatever works. Tricyclics, MAO inhibitors, serotonin uptake inhibitors, lithium salts. Our endocrine systems are taxed by environmental poisen and stress hormones are like male urethras, they don't know if they're coming or going. I like the writings of my good friend Dr. John Gray. His Mars/Venus work has opened us up to taking the reins and coming up with our own answers for our woes. Gender brain chemistry is controlable. That is to say, you ultimately control the release of oxyticin, serotonin, testosterone, and other hormones through interaction with the environment.

I can give you a list of 100 ,things to do that will increase your oxytocin and his testosterone, and you won't spend one red cent.

John Gray doesn't pay me fir promoting his ideas. He pays me with knowledge. The man is amazing. Only Harry Potter has outsold John's books.