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More fallout from Peter Kramer's defense of antidepressants in NYTimes


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The comments keep on coming. For the most part, critics are negative about Peter Kramer's In Defense of Antidepressants, published on the cover of the NYTimes July 9 Sunday Review, and find Marcia Angell's two-part NY Review of Books piece, The Epidemic of Mental Illness: Why? and The Illusions of Psychiatry, more convincing.

 

First, Robert Whitaker soundly debunked Kramer's article on his Psychology Today blog.

 

See the Surviving Antidepressants discussion topic here.

 

Other articles have followed, see below.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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The Antidepressant Controversy: What Does it Mean For You?

By Charles H. Elliott, Ph.D. PsychCentral

 

You’ve read about the ongoing controversy over the effectiveness of antidepressant medications. Luminary psychologists such as Dr. Robert DeRubeis and Dr. Irving Kirsch have made persuasive arguments supporting the idea that most, if not all, of the effectiveness of antidepressant medication appears to be due to the so-called placebo effect.

 

In other words, their analysis of studies has led them to conclude that when patients improve on antidepressant medication, that most of that improvement is readily chalked up to the expectations of improvement that come when people take a pill they believe will improve their symptoms.

 

In this week’s New York Times, Dr. Peter Kramer (clinical professor of psychiatry at Brown University and author of Listening to Prozac) presented arguments that antidepressant medications do exert effects over and above that obtained from placebos (i.e., sugar pills) alone. ....I suspect for many patients, antidepressant medications do little more than placebos; whereas for some, there is likely to be efficacy above and beyond that of sugar pills.

 

Regardless of the ultimate outcome of this debate, many people wonder whether they should take antidepressant medications if they have depression or obsessive compulsive disorder (OCD). And a large percentage of professionals recommend them to their patients. They reason that numerous studies have demonstrated similar improvements for antidepressant medications and psychotherapy for these problems. And then they make the logical conclusion that providing both psychotherapy and medication will result in even better outcomes.

 

However, precious little data suggests that combining psychotherapy and medication improves outcomes for most people. Granted, there is scattered evidence that the combination improves outcomes for a small percentage of patients, but it’s difficult to determine for whom that will the case and the additional bump from a combined approach is generally disappointingly small. So if you’re someone with depression or OCD, what does all of this mean?

 

Obviously, I can’t tell you what’s best for your problem and your case. However, you just might consider trying psychotherapy first if you’re depressed or have OCD. Psychotherapy usually works just as well as medication and even confers some protective value against relapses. Given that medications sometimes have serious side effects, consider seeing how you do without them for a while. On the other hand, if your progress is painfully slow or nonexistent, or if your distress is utterly overwhelming, by all means consider trying both approaches. You may be someone who will benefit.

 

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Are Antidepressants Just Placebos with Side Effects?

By John Horgan Jul 12, 2011 Scientific American blog

 

I have first-hand experience of the devastation of depression, in myself and those close to me. Although I have been tempted to try antidepressants, I've never done so. Of course, like everyone reading this column, I know many people who have been treated with antidepressants--not surprisingly, because according to a 2005 survey, one in 10 Americans are now under such treatment. Some people I know have greatly benefited from their treatment. Others never find adequate relief, or they experience annoying side effects--such as mania, insomnia, emotional flatness or loss of libido--so they keep trying different drugs, often in combination with psychotherapy. One chronically depressed friend has tried, unsuccessfully, to stop taking his medications, but he experienced a surge of depression worse than the one that led him to seek treatment. He accepts that he will probably need to take antidepressants for the rest of his life.

 

We all, to greater or lesser degrees, have this kind of personal perspective on antidepressants. But what does research on these drugs tell us about their efficacy? The long-smoldering debate over this question has flared up again recently, with two medical heavyweights staking out opposite positions. In a New York Times essay, "In Defense of Antidepressants," Peter Kramer, a professor of psychiatry at Brown, insists that antidepressants "work—ordinarily well, on a par with other medications doctors prescribe."

 

Kramer's article seeks to rebut a wave of negative coverage of antidepressants, most notably a two-part essay in The New York Review of Books (which can be found here and here) by Marcia Angell , former editor of The New England Journal of Medicine and now a lecturer in social medicine at Harvard. Angell cites research suggesting that antidepressants—including both selective serotonin reuptake inhibitors (SSRIs) and other medications—may not be any more effective than placebos for treating most forms of depression.

 

Angell highlights a meta-analysis, carried out by the psychologist Irving Kirsch, of trials of a half dozen popular antidepressants submitted by drug companies to the U.S. Food and Drug Administration.....

 

Angell quotes from Kirsch's new book The Emperor's New Drugs (Basic Books), in which he states that "the relatively small difference between drugs and placebos might not be a real drug effect at all. Instead, it might be an enhanced placebo effect." This "startling" claim, Angell adds, "flies in the face of widely accepted medical opinion, but Kirsch reaches it in a careful, logical way. Psychiatrists who use antidepressants—and that's most of them—and patients who take them might insist that they know from clinical experience that the drugs work. But anecdotes are known to be a treacherous way to evaluate medical treatments."

 

So how does Kramer begin his defense of antidepressants? With an anecdote—about a friend who benefited from antidepressants after suffering from a stroke. This rhetorical strategy should not be surprising, since Kramer's 1993 bestseller Listening to Prozac (Penguin), which contributed to the surge in popularity of Prozac and other SSRIs, relied heavily on anecdotal evidence rather than clinical data. Kramer told story after story of patients transformed by Prozac. He suggested that SSRIs might be ushering in an era of "cosmetic psychopharmacology" in which patients are not only cured of disorders but become "better than well."

 

The Brave New World envisioned by Kramer was always a complete fantasy. When he wrote his book in the early 1990s, studies by Eli Lilly , Prozac's manufacturer, showed that it was no more effective than older antidepressants, such as tricyclic drugs, or psychotherapy without drugs. Although Prozac was touted for its relatively mild side effects, it causes sexual dysfunction in as many as three out of four consumers. Kramer relegated a discussion of Prozac's sexual side effects to the fine print, literally, in his book's endnotes. His Times essay doesn't provide any better data for antidepressants than Listening to Prozac did. Kramer delves into an arcane discussion of how difficult it is to distinguish genuine drug benefits from placebo effects, but he does not really grapple with the claim of Angell and Kirsch that antidepressants may be active placebos.

 

Kramer does not mention, for example, a recent analysis of STAR*D (Sequenced Treatment Alternatives to Relieve Depression), which has been called "the largest antidepressant effectiveness trial ever conducted." According to a group of four researchers, STAR*D data show that "antidepressants are only marginally efficacious compared to placebos," and even this modest benefit might be inflated by "profound publication bias." The authors recommend "a reappraisal of the current recommended standard of care of depression."

 

Angell agrees. She thinks that the surge in antidepressant prescriptions over the past two decades stems less from the drugs' efficacy than from the marketing muscle of the pharmaceutical industry, which she says "influences psychiatrists to prescribe psychoactive drugs even for categories of patients in whom the drugs have not been found safe and effective."

 

....She also urges that we "stop thinking of psychoactive drugs as the best, and often the only, treatment for mental illness or emotional distress.... More research is needed to study alternatives to psychoactive drugs," including exercise and psychotherapy (although of course studies of psychotherapy reveal that it may also work by harnessing the placebo effect).

 

Given what science is telling us about antidepressants, Angell's recommendations seem wise to me. I sometimes suspect that psychiatric drugs work, to the extent that they do, simply by making people feel different. The suffering person interprets this difference as an improvement, in the same way that someone who is in a rut may feel better by traveling to another country. But does that mean that any psychoactive drug—Caffeine? Beer? Antihistamines? Psilocybin?—can in principle produce the same benefits as an SSRI, as Angell and Kirsch seem to suggest? Even for a skeptic like me, that seems hard to believe. We clearly need more research not only on alternatives to antidepressants (yoga, meditation, jogging, reading groups, journal-writing) but also on the drugs themselves, to understand why some people benefit so much from them while others don't. But more research will be helpful only if the results are reported—as all medical data should be but too often aren't—with absolute candor and transparency.

 

 

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Is Medication Always The Answer To Mental Illness?

By Richard Zwolinski, LMHC, CASAC PsychCentral

 

A recent NY Times article, In Defense of Antidepressants, is one of several passionate articles about psychiatric medications, for and against. I stand firmly in the middle.

 

Not the wishy-washy swampy middle, but the place where scientific evidence, common sense, and holistic viewpoints all merge.

 

Correctly prescribed and correctly used psychiatric medications do help people. They can literally save lives. So, in what kinds of cases of mental illness (depression, anxiety, bi-polar disorder, schizophrenia, etc.) might  psychiatric medications be helpful or even necessary?

 

It depends largely on the skill and medical philosophy of the prescribing professional. Still, most psychiatrists generally agree that:

 

Psychiatric medication may be helpful or necessary in cases where the individual is a danger to himself or others. That doesn’t mean we can rely on the medication to protect the individual (or others), from harm—it means that the medication is a useful piece of a comprehensive treatment plan.

 

Psychiatric medication may be helpful or necessary in cases where the patient’s symptoms interfere with their ability to benefit from psychotherapy. This doesn’t mean other approaches cannot be used in tandem with medication or even tried instead of medication. These other approaches might include the aforementioned psychotherapy, stress/anxiety management techniques, guided visualization, relaxation techniques, meditation, breathing exercises, nutrition, and so on.

 

Psychiatric medication may be helpful or necessary in cases where the symptoms of depression or anxiety or other mental illnesses cause the patient to experience chronic or intolerable suffering and pain.

 

Psychiatric medication may be helpful or necessary in cases where the symptoms of mental illness interfere with important aspects of a person’s life. For example, someone with bi-polar disorder might be able to hold a job while on medication.

 

However, if we take a big-picture holistic approach to the treatment of mental illness and addiction, too,we see that these illnesses are mental, physical and spiritual diseases—and that medication isn’t always the answer.

 

In the course of over twenty five years in the field, I can say that I have seen more than a few cases that simply broke the predicted mold.

 

At the anecdotal level…

 

I’ve seen cases where people with clinical depression and anxiety made sustained improvement after reframing their experiences by examining big-picture issues ala Viktor Frankel (Man’s Search for Meaning) or through the lens of belief in God and prayer.

 

I’ve seen cases where schizophrenia symptoms were lessened by radical changes in diet and exercise, including the complete elimination of some common foods.  I myself have encouraged that people with mental illness or in recovery from addiction to improve their diets and try eliminating sugar, gluten, and common allergens.

 

In fact, I believe that whether you are on medication or not, it might also be helpful to take various supplements to support your physical and mental health, such as fish oil or flax seed oil or other sources of Omega 3s, a multivitamin, calcium-magnesium, and so on. Naturally, if you are on medication, you must check with your doctor and make sure there are no potential interactions between the supplements and the medications.

 

Last Friday I met with someone I’ve known for nearly seven years (he’s not my patient but a friend). He was diagnosed with a pervasive anxiety disorder and depression several years ago and has attempted extraordinarily violent suicides, twice. He has been on major psychotropic medications since before I met him.

 

I hadn’t seen him in a couple months when he stopped me on the street. I didn’t recognize him. He was smiling. His flat affect was gone. His eyes were bright and clear, his skin was positively glowing. He looked ten years younger and he even told a couple jokes. Though he had some symptoms of his mental illness, the symptoms were so mild as to be unnoticeable unless you knew what to look for.

 

He told me that he felt the drugs were not helping him and so he decided, along with his nervous but supportive psychiatrist, to titrate off them. During this period which lasted a few months, he found an MD who was also a naturopath recommended vitamins, minerals, and even herbal supplements. He changed his diet and began an exercise regimen which involved walking quite a distance each day to a hospital. There he began to do volunteer work with patients which helped him gain a sense of meaning and accomplishment.

 

....

Do I recommend everyone do as my friend did? No way. Do I recognize that medication isn’t always the answer? Yes.

 

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Is There Now A National Debate Over Antidepressants?

 

July 18, 2011 wbur Boston By Carey Goldberg

 

Tell me if I’m exaggerating. But I think it’s now fair to say that there’s a rising national debate — at least judging by some of the premiere media outlets — over the value of antidepressants.

 

Just to update you on the latest posts and ripostes: Dr. Marcia Angell, former editor of the New England Journal of Medicine, wrote a provocative two-part series in The New York Review of Books on three recent books that call into question the current drug-heavy style of psychiatry. Then Dr. Peter Kramer, of “Listening to Prozac” fame, responded in defense of antidepressants in The New York Times on Sunday, July 10.

 

Now the latest gleanings from Twitter: There’s a petition afoot to get the Times to run a response to Peter Kramer’s piece. The response is by Bob Whitaker, author of “Anatomy of an Epidemic,” who challenges current practices of prescribing psychiatric drugs. (CommonHealth wrote about him here.) As of this morning, the petition had nearly 400 signatures.

 

Here’s Bob responding on Psychology Today’s blog. He challenges Peter’s arguments in his usual data-driven way, and concludes:

 

As I noted in Anatomy of An Epidemic, the real problem we have in this field of medicine is that academic psychiatry hasn’t been honest in what it tells the public about psychiatric medications. If the medications are to be used wisely, and in an evidence-based manner, we need to have an honest discussion about what science is telling us about the drugs. But on Sunday, in this essay “In Defense of Antidepressants,” the American public has been treated to yet another dose of misinformation.

 

http://commonhealth.wbur.org/2011/07/antidepressant-debate/

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Robert Whitaker was interviewed today on PRI WNYC radio.

 

Big pharma's role in mental illness

 

Listen to audio for full report.

 

....

For almost 40 years, conventional wisdom has been that mental illness is caused by a chemical imbalance in the brain. "Serotonin" is a household word, along with Prozac, Zyprexa and Zoloft. But recently, there's been a vigorous debate within the medical community over whether that line of thinking is accurate.

 

This summer Marcia Angell, a physician, senior lecturer at Harvard, and former editor-in-chief of The New England Journal of Medicine, wrote in the New York Review of Books that the chemical imbalance model of mental illness may be ineffective at best, and harmful at worst. In her article, Angell talked about medical journalist Robert Whitaker's book "Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America."

 

Whitaker researched years of drug trials and determined that pharmaceutical companies play an enormous role in deciding what causes mental illness, who qualifies as mentally ill, and how those illnesses should be treated. "In 1987, which is when Prozac comes to market, there were 1.25 million people on disability in the United State due to mental illness," he told The Takeaway. "Today, there's 4 million."

....

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Jerry A. Coyne, Ph.D, an evolutionary biologist and author of Why Evolution is True, refutes Peter Kramer's article on his blog at https://whyevolutionistrue.wordpress.com/2011/07/12/peter-kramer-defends-antidepressants/:

 

Peter Kramer defends antidepressants

 

Peter Kramer is an American psychiatrist specializing in depression, and author of the best-selling book Listening to Prozac. In a long op-ed piece in Sunday’s New York Times “In defense of antidepressants,” Kramer argues that recent attacks in the press on the efficacy of antidepressants (particularly Marcia Angell’s scathing two-part critique....), are misguided and may be inimical to the treatment of depression. (I’ve discussed my take on Angell’s review on this website.) Kramer’s thesis is this:

 

Antidepressants work — ordinarily well, on a par with other medications doctors prescribe. Yes, certain researchers have questioned their efficacy in particular areas — sometimes, I believe, on the basis of shaky data. And yet, the notion that they aren’t effective in general is influencing treatment.

I’ve been working my way through the books Angell reviewed, particularly Irving Kirsch’s The Emperor’s New Drugs: Exploding the Antidepressant Myth, to see how much of Angell’s critique was accurate (I’ve also been looking at the primary literature on antidepressants). I don’t claim to have anywhere near Kramer or Angell’s knowledge about antidepressants, and so take this analysis of Kramer’s article in the same way I read Angell’s critique: as one seen through the eyes of a scientist who has a better-than-average knowledge of the literature on depression and antidepressants.

 

Nevertheless, I found Kramer’s piece, well, depressing: scattered, lacking cohesion, hard to follow, and even a bit misleading. He’s not all gung-ho on antidepressants, but anyone who reads his editorial should also read Kirsch’s book, for Kramer makes several arguments that were already addressed by Kirsch, and neglects some of Kirsch’s important points, like the difference between “active” and “inert” placebos.

 

Here are what I see as Kramer’s main arguments:

 

  • Some studies show that antidepressants work. He quotes an article which appears to come from Lancet Neurology (Chollet et al. 2011 10:123-130) showing that fluoxetine (the generic name for Prozac) helped significantly improve motor function in French stroke patients.

I have read the original study, which was done in a double-blind trial with placebos, and involved 118 patients. All patients were also given psychotherapy. The study did indeed show a significant drug-induced improvement in motor function over the three months of the study. My quibbles with this analysis are threefold:

 

1. It did not measure long-term improvement.

 

2. It did not test whether or not the drug (an SSRI, or “selective serotonin reuptake inhibitor”) had any effect on mental functions, so we don’t know whether its effects—and I don’t deny it had them—involved alleviating depression, making the patients thereby more responsive to treatment, or acting more directly on motor function itself (after all, SSRIs affect neurotransmitters). Thus, the reader might be misled when Kramer follows the description of this study with the statement, “Antidepressants are good at treating post-stroke depression and good at preventing it.” That may be the result of other studies (he doesn’t mention any), but certainly not from the one he describes. It’s also possible that the recovery of motor function itself (and not the drug’s effect on the brain) is what makes the patients less depressed.

 

3. The placebos were probably not “active” placebos, i.e., those placebos that have side effects, but rather “inert” placebos—those with no side effects, like sugar pills. I suspect that the placebos in this study weren’t active simply because they are not described as active.

 

Kirsch has made the important point that the “effects” of antidepressants in double-blind trials (which are much smaller than most people assume, often neither statistically nor clinically significant) might well stem from patients’ perception that they are indeed taking the real drug because they experience the common side effects of antidepressants. Inert placebos have no side effects. In other words, when a patient perceives side effects, he concludes that he’s getting a drug that might be efficacious, and improves via an “enhanced placebo effect.”

 

....

 

Kramer also cites another study which, he claims, shows that “elderly female cardiac patients who had emergency operations and were given antidepressants experienced less depression, shorter hospital stays, and fewer deaths in the hospital.” I’ve read that study (Hata et al. Surgery Today 41: pp. 791-794), and as far as I can see, it used no placebos at all. Here’s the relevant line from the methods:

 

We divided the patients into two groups: group I consisted of 58 patients who had undergone surgery from January 2006 and were prophylactically prescribed 10 mg paroxetine as an SSRI from the first or second postoperative day; group II comprised 59 previous patients who had undergone surgery before December 2005 and had not been administered an SSRI after surgery.

The word “placebo” does not appear in the report, either.

 

If no placebos were given, not even inert ones (and we already know that inert placebos themselves improve depression far more than no drug at all, with the drug effect being substantially smaller than the placebo effect), then one can’t conclude anything from this study about the effects of the drug. It could all be placebo effect.

 

It can’t be emphasized strongly enough that double-blind trials (preferably with active placebos) are far better than plain clinical observation in determining whether a drug is efficacious, for the effects of placebos on alleviating depression are strong and well documented. If a doctor gives a patient an antidepressant and she improves, we have no idea whether she’s responding to the drug, to perceiving the drug’s side effects that makes her think it’s “working”, or simply to the fact that she’s being treated by a professional and taking a pill. The testimony of doctors that their patients “appear to improve” when they take an antidepressant are worthless—and by “worthless” I mean they don’t say anything about whether the drug per se is alleviating depression. It’s clear that many doctors do see their patients improve when given antidepressants. And lots of people taking antidepressants have reported improvement (many on my previous thread). Those patients might have felt just as much better had they been taking placeobs.

 

Given the side effects of antidepressants, and any possible long-term effects on the brain, doctors might start treatment by giving patients placebos, which will often cause big improvement. Unfortunately, I don’t think doctors are allowed to prescribe placebos—and you’d have to hide that fact from the patient, which could be considered unethical.

 

  • The studies on mild depression submitted to the FDA by the drug companies were inadequate and flawed.

Kramer pinpoints several flaws: “quick and sloppy trials” (it seems to me, though, that if a drug really works, then “quick and sloppy trials” would be less likely to demonstrate a drug effect), the fact that patients may exaggerate their initial symptoms to get into a drug study, and the fact that some “patients” might not have been depressed at all, and that these of course wouldn’t show a drug effect.

 

Kramer might be right here, but I find this an odd criticism. After all, the studies he’s citing were the ones used by the FDA (American Food and Drug Administration) to show that the drugs worked and to support the drugs’ approval. If those studies were flawed, then we shouldn’t be using those drugs at all!

 

  • Other types of studies—not the traditional “double blind” ones—also show positive effects of antidepressants. Here’s Kramer’s description of one type of study:

One reason the F.D.A. manages to identify useful medicines is that it looks at a range of evidence. It encourages companies to submit “maintenance studies.” In these trials, researchers take patients who are doing well on medication and switch some to dummy pills. If the drugs are acting as placebos, switching should do nothing. In an analysis that looked at maintenance studies for 4,410 patients with a range of severity levels, antidepressants cut the odds of relapse by 70 percent. These results, rarely referenced in the antidepressant-as-placebo literature, hardly suggest that the usefulness of the drugs is all in patients’ heads.

 

Unless those placebos are active placebos, the studies are subject to the caveat that the patient’s perception of side effects, not the effects of the drug itself, is an important part of improvement. If the side effects go away because the placebo is inert, the patient may well relapse because of the absence of side effects. Also, the withdrawal of antidepressants often causes pronounced and distressing physical symptoms which could easily make a patient more depressed.

 

  • The news media uncritically focus on studies showing that antidepressants are ineffective. Kramer says:

As for the news media’s uncritical embrace of debunking studies, my guess, based on regular contact with reporters, is that a number of forces are at work. Misdeeds — from hiding study results to paying off doctors — have made Big Pharma an inviting and, frankly, an appropriate target. (It’s a favorite of Dr. Angell’s.) Antidepressants have something like celebrity status; exposing them makes headlines. . .

 

. . . My own beliefs aside, it is dangerous for the press to hammer away at the theme that antidepressants are placebos. They’re not. To give the impression that they are is to cause needless suffering.

I’m glad Kramer agrees about the nefarious acts committed by Big Pharma with regard to antidepressants. (I’ve mentioned one of them in my earlier piece: drug companies often don’t submit the trials that don’t work to the FDA. They need submit only two “successful” trials of a drug for approval; and to get those they could conduct as many as they wanted—and keep them secret and unpublished— before you come up with the requisite two.). Too, Kirsch notes that drug companies publish the successful studies in medical journals far, far more often than they do the unsuccessful ones, giving physicians who read journals a biased view of the drugs’ efficacy.

 

But I think the news media glom onto this story not just because the drugs have celebrity status, but because so many Americans are taking them (antidepressants are the drugs prescribed most often in the U.S.). If you’re not taking them yourself, I bet you know someone who is. And so any questions about their efficacy will naturally be of interest to many people. And I do think the evidence for their efficacy is thin—certainly thinner than most Americans think. Given the huge placebo effects involved in treating depression, the testimony of clinicians that the drugs “work” on their patients seems to me largely worthless. Certainly most of the effects of antidepressants appear to come from the placebo effect accompanying being given a drug, so it’s not quite kosher for Kramer to assert that “antidepressants are not placebos.”

 

We need to know—and the drug companies and regulatory agencies have not been overly forthcoming about this—whether or not antidepressants work and, just as important, how well and how often they work. That is what the press, and critics like Kirsch, are good for. To say that the press’s digging into the science “causes needless suffering” is not only an unjustified threat, but a red herring—and a dangerous one itself. It was that sort of digging that exposed the problems with the drugs and with Big Pharma.

 

Kramer broaches his own theory of depression, which comes from his 2003 book Against Depression:

 

In 2003, in “Against Depression,” I highlighted research that suggested antidepressants influence mood only indirectly. It may be that the drugs are “permissive,” removing roadblocks to self-healing. That model might predict that in truth the drugs would be more effective in severe disorders. If antidepressants act by usefully perturbing a brain that’s “stuck,” then people who retain some natural resilience would see a lesser benefit.

I haven’t read his book, but his summary above doesn’t make much sense to me. And, at any rate, Kirsch argues (with evidence supporting him) that the effects of antidepressants aren’t really greater in more serious cases, but that the effects of the placebo controls are smaller. That makes the drug-placebo difference (the drug’s “effect”) look larger in cases of more severe depression.

 

In the end, Kramer does take a more judicious stance. He initially treats depressive patients with psychotherapy and says “I am to use drugs sparingly. They have side effects, some of them serious.” Indeed, for the side effects of psychotherapy are nil.

 

I’d recommend reading Kirsch’s book, which is not a tirade but a popular presentation of evidence, with lots of citations and references. You can check the data yourself (and I’ll be continuing to do so). If he’s right, then we almost need to go back to square one in assessing the value of antidepressants. That won’t happen, of course, because those drugs are already approved, Big Pharma makes billions of dollars from them, and doctors see that they “work”. But the placebo effect is powerful, and perhaps something should be done about harnessing that as well. After all, taking placebos, at least inert ones, won’t cause you long-term damage.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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I'd recommend reading Kirsch's book, which is not a tirade but a popular presentation of evidence, with lots of citations and references. You can check the data yourself (and I'll be continuing to do so). If he's right, then we almost need to go back to square one in assessing the value of antidepressants. That won't happen, of course, because those drugs are already approved, Big Pharma makes billions of dollars from them, and doctors see that they "work".

Hallelujah! This is only what I've been saying for years and what people like Robert Whitaker have been lobbying for. All of the skepticism about the safety of ADs (especially long-term), their place in clinical practice, and their usefulness in varying clinical situations (both short-term and long-term) should have been evaluated BEFORE these drugs came to market. And I'm not talking about in a perfect world, either. Just one less corrupt than this country. Psychiatry is well aware of the implications of Kirsch's research and books like ANATOMY, although they'll never admit it (even to their conscious selves): considering the massive corruption that formed the "evidence base" of this new generation of pills, it is now vitally necessary to basically re-evaluate these pills from the ground up and "go back to square one" as Coyne says. Whitaker perhaps is the one doing just that the most: he dug deep into the corruption of psychiatry, realized such widespread corruption threatened to invalidate nearly all the evidence base, and then realized that the FDA and even psychiatry itself couldn't be relied upon to act in the patient's best interest, so he researched alternate therapies like open dialogue and simultaneously called for various flawed studies like the STAR*D trial to be thoroughly investigated, as well as starting his own foundation to conduct unbiased trials on the efficacy and safety of these drugs, which should have been done in the first place. It's become obvious psychiatry will not do such work, for the reasons outlined in the quote above.

 

We the patients and people like Kirsch and Whitaker must all do the work. The cavalry ain't coming.

Been on SSRIs since 1998:

1998-2005: Paxil in varying doses

2005-present: Lexapro.

2006-early '08: Effexor AND Lexapro! Good thing I got off the Effexor rather quickly (within a year).

 

**PSYCHIATRY: TAKE YOUR CHEMICAL IMBALANCE AND CHOKE ON IT!

APA=FUBAR

FDA=SNAFU

NIMH=LMFAO

 

Currently tapering Lexapro ~10% every month:

 

STARTING: 15 mg

11/7/10: 13.5 mg

12/7/10: 12.2 mg

1/6/11: 10.9 mg

2/3/11: 9.8 mg

3/3/11: 8.8 mg

4/1/11: 7.8 mg

4/29/11: 7 mg

5/27/11: 6.4 mg

6/24/11: 5.7 mg

7/22/11: 5 mg

8/18/11: 4.5 mg

9/14/11: 4 mg

10/13/11: 3.6 mg

11/9/11: 3.2 mg

12/7/11: 2.6 mg

1/3/12: 2.1 mg

2/2/12: 1.8 mg

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