Anti-depressants' 'little effect'
 |  Anti-depressant prescription rates have soared  |
A University of Hull team concluded the drugs actively help only a small group of the most severely depressed.
Marjorie Wallace, head of the mental health charity Sane, said that if these results were confirmed they could be "very disturbing".
But the makers of Prozac and Seroxat, two of the commonest anti-depressants, said they disagreed with the findings.
A spokesman for GlaxoSmithKline, which makes Seroxat, said the study only looked at a "small subset of the total data available".
Reviewed data
And Eli Lilly, which makes Prozac, said that "extensive scientific and medical experience has demonstrated it is an effective anti-depressant".
University of Hull
Alan Johnson, the Health Secretary, has announced that 3,600 therapists are to be trained during the next three years in England to increase patient access to talking therapies, which ministers see as a better alternative to drugs.
Patients are strongly advised not to stop taking their medication without first consulting a doctor.
The researchers accept many people believe the drugs do work for them, but argue that could be a placebo effect - people feel better simply because they are taking a medication which they think will help them.
In total, the Hull team, who published their findings in the journal PLoS Medicine, reviewed data on 47 clinical trials.
They reviewed published clinical trial data, and unpublished data secured under Freedom of Information legislation.
They focused on drugs which work by increasing levels of the mood controlling chemical serotonin in the brain.
These included fluoxetine (Prozac) and paroxetine (Seroxat), from the class known as Selective Serotonin Reuptake Inhibitors (SSRIs), alongside another similar drug called venlafaxine (Efexor) - all commonly prescribed in the UK.
The number of prescriptions for anti-depressants hit a record high of more than 31 million in England in 2006 - even though official guidance stresses they should not be a first line treatment for mild depression.
There were 16.2m prescriptions for SSRIs alone.
The researchers found that the drugs did have a positive impact on people with mild depression - but the effect was no bigger than that achieved by giving patients a sugar-coated "dummy" pill.
People with severe symptoms appeared to gain more clear-cut benefit - but this might be more down to the fact that they were less likely to respond to the placebo pill, rather than to respond positively to the drugs.
Lead researcher Professor Irving Kirsch said: "The difference in improvement between patients taking placebos and patients taking anti-depressants is not very great.
"This means that depressed people can improve without chemical treatments.
"Given these results, there seems little reason to prescribe anti-depressant medication to any but the most severely depressed patients, unless alternative treatments have failed to provide a benefit."
Professor Kirsch said the findings called into question the current system of reporting drug trials.
Reviewing guidance
Dr Tim Kendall, deputy director of the Royal College of Psychiatrists Research Unit, has published research concluding that drug companies tend only to publish research which shows their products in a good light.
Association of the British Pharmaceutical Industry
He said the Hull findings undermined confidence in the ability to draw meaningful conclusions about the merit of drugs based on published data alone.
He called for drug companies to be forced to publish all their data.
The National Institute for Health and Clinical Excellence (NICE) is currently reviewing its guidance on the use of antidepressants.
Marjorie Wallace of Sane commented: "If these results were upheld in further studies, they would be very disturbing.
"The newer anti-depressants were the great hope for the future.... These findings could remove what has been seen as a vital choice for thousands in treating what can be a life-threatening condition."
Dr Andrew McCulloch, of the Mental Health Foundation, said: "We have become vastly over-reliant on antidepressants when there is a range of alternatives.
"Talking therapies, exercise referral and other treatments are effective for depression.
"It is a problem that needs a variety of approaches matched to the individual patient."
Dr Richard Tiner, of the Association of the British Pharmaceutical Industry, said there was no doubt that there was a "considerable placebo effect" from anti-depressants when treating people with mild to moderate symptoms.
But he said no medicine would get a licence without demonstrating it was better than a placebo.
Dr Tiner said: "These medicines have been licensed by a number of regulatory authorities around the world, who looking at all the evidence, have determined that they do work better than placebo."
Some years ago I met this Swiss filmmaker in Moscow. She was there with her husband's film at the film festival, and was in mourning because he'd just killed himself. I asked what she thought happened. She said "I don't know - he was happy, ready to come to this festival, and he went to his doctor because he was exhausted, and he gave him some pills and the next thing I know he kills himself." I asked if the pills were Prozac. She said yes.
I told her about another friend, in Italy near my ancestral home town in Cadore. This guy was in his 60's, a happy go lucky fella who didn't have a care in the world. He told his doc he was tired, and needed something to help him sleep. Same story. Started taking Prozac, killed himself.
Most people don't know that Congress had hearings to try and figure out why so many people were killing themselves after taking psychotropic drugs. The results? Zippo. Inconclusive. Hard to prove someone didn't want to kill themselves.
Look at most of the gun shootings in high schools and you'll find psychotropic drugs were involved with the students (Columbine included) Here's the deal as I see it:
We have a fight or flight part of our brain that keeps us on the planet. When you're driving down the street, you don't turn into oncoming traffic because of this modulator in your head. I once did a series of interviews with severely depressed people, one of whom described walking "around the planet, trying to figure out ways to kill himself." This part of his brain was malfunctioning - telling him to kill himself instead of to protect himself.
Apparently, up to 10% of the people who take psychotropic drugs have a 'side effect' which disrupts this mechanism in the brain. So.. they stop having the ability to feel happy or sad, because they're being modulated, and they lose the ability to tell the difference between their inner and outer worlds - if they feel rage, but have no outlet for it, it can translate into 'let's pick up a gun' or 'let's kill ourselves.' Or as I call it "Death by Prozac."
When history looks back on this era, it's going to be the time of the drugs which altered people's psyches. I'm not a fan of Scientology, I firmly believe that it's a fantasy religion created from L. Ron Hubbard's psyche, and has no more roots in reality than Joseph Smith did. (I also believe they probably had similar psychic experiences that influenced them profoundly, but that's a topic for another time). However, the Scientologists, Tom Cruise included, are spot on when they try to point out that psychotropic drugs are bad for you. Where we differ greatly is how to cure depression. I don't think getting clear is the answer, as it's another panacea, and leaves your treatment in someone else's hands. I think the most promising research in the area has been done by Richard Davidson of the Univ of Wisconsin.
(Davidson with HHDL, photo Waisman Center, Univ. of Wisconsin)I recently attended a conference at UCLA, filled with psychiatrists, who had come to hear Davidson talk about his research into the amygdala, the part of the brain that regulates depression and happiness. And basically, as Time magazine noted, he laid out the skills that people can learn to make themselves happier, less depressed, and drug free. The questions from the audience were from doctors concerned about giving teenagers psychotropic drugs. Davidson's work is profound, and I think should be included in every doctor's bag - even pediatricians. Here's an article from Science Daily a few days ago.
The cure is pretty simple. A Tibetan meditation called "Tonglen." (I know it's Tonglen because I asked him after the lecture which specific Tibetan meditation he asked his subjects to use to get the profound results.) I won't describe the meditation here, because in order to learn it requires a certain amount of skill, education, and perhaps a guided teacher. You don't have to study under the Dalai Lama to learn it, however, it would be better if you sought out a teacher of meditation, a yoga class for example, which can teach the breathing meditation to begin. Once you've mastered ten minutes a day, you could graduate to a next level. However, Davidson did tell me that in his version of the Tonglen meditation, he asked his subjects not to meditate on curing the ills of a particular person, but on the society in general. This note will make sense to those of you who know about Tonglen meditation, and for those who might be depressed and want to learn about it, check out Davidson's work, or Tibetan meditation in particular.
Anyways, if you have a loved one who is depressed, or if you're depressed, I'd think it would be worth trying to figure out a natural method to cure it, before risking that you'd be part of the ten percent who die from this drug use. What have you got to lose?
That's a wrap.
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