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".
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They reviewed published clinical trial data, and unpublished data secured under Freedom of Information legislation.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.
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.
Below is the translated text of a petition made by Chinese artists and writers in response to their government's position on Tibet. I think they're pretty brave to stand up in this way, and I post it here to honor that move on their part. I walked in two anti-war protests, wrote as many letters as I could, but my protests that the War in Iraq was fake, there were no WMD's, no connection to 9/11, fell on deaf ears. But then I didn't have to fear that police would show up at my door and kick my **s. If you're curious about the Tibetan situation, there are some pretty cool clips on youtube showing monks and people marching in the streets of Tibet, and for some interviews, check the panel next to this for clips from my documentary on the subject.
March 22, 2008
Twelve Suggestions for Dealing with the
Tibetan Situation by Some Chinese Intellectuals
1. At present the one-sided propaganda of the official Chinese media is having the effect of stirring up inter-ethnic animosity and aggravating an already tense situation. This is extremely detrimental to the long-term goal of safeguarding national unity. We call for such propaganda to be stopped.
2. We support the Dalai Lama’s appeal for peace, and hope that the ethnic conflict can be dealt with according to the principles of goodwill, peace, and non-violence. We condemn any violent act against innocent people, strongly urge the Chinese government to stop the violent suppression, and appeal to the Tibetan people likewise not to engage in violent activities.
3. The Chinese government claims that “there is sufficient evidence to prove this incident was organized, premeditated, and meticulously orchestrated by the Dalai clique." We hope that the government will show proof of this. In order to change the international community’s negative view and distrustful attitude, we also suggest that the government invite the United Nation’s Commission on Human Rights to carry out an independent investigation of the evidence, the course of the incident, the number of casualties, etc.
4. In our opinion, such Cultural-Revolution-like language as “the Dalai Lama is a jackal in Buddhist monk’s robes and an evil spirit with a human face and the heart of a beast ” used by the Chinese Communist Party leadership in the Tibet Autonomous Region is of no help in easing the situation, nor is it beneficial to the Chinese government’s image. As the Chinese government is committed to integrating into the international community, we maintain that it should display a style of governing that conforms to the standards of modern civilization.
We note that on the very day when the violence erupted in Lhasa (March 14), the leaders of the Tibet Autonomous Region declared that “there is sufficient evidence to prove this incident was organized, premeditated, and meticulously orchestrated by the Dalai clique.” This shows that the authorities in Tibet knew in advance that the riot would occur, yet did nothing effective to prevent the incident from happening or escalating. If there was a dereliction of duty, a serious investigation must be carried out to determine this and deal with it accordingly.
If in the end it cannot be proved that this was an organized, premeditated, and meticulously orchestrated event but was instead a “popular revolt” triggered by events, then the authorities should pursue those responsible for inciting the popular revolt and concocting false information to deceive the Central Government and the people; they should also seriously reflect on what can be learned from this event so as to avoid taking the same course in the future.
We strongly demand that the authorities not subject every Tibetan to political investigation or revenge. The trials of those who have been arrested must be carried out according to judicial procedures that are open, just, and transparent so as to ensure that all parties are satisfied.
We urge the Chinese government to allow credible national and international media to go into Tibetan areas to conduct independent interviews and news reports. In our view, the current news blockade cannot gain credit with the Chinese people or the international community, and is harmful to the credibility of the Chinese government. If the government grasps the true situation, it need not fear challenges. Only by adopting an open attitude can we turn around the international community’s distrust of our government.
We appeal to the Chinese people and overseas Chinese to be calm and tolerant, and to reflect deeply on what is happening. Adopting a posture of aggressive nationalism will only invite antipathy from the international community and harm China’s international image.
The disturbances in Tibet in the 1980s were limited to Lhasa, whereas this time they have spread to many Tibetan areas. This deterioration indicates that there are serious mistakes in the work that has been done with regard to Tibet. The relevant government departments must conscientiously reflect upon this matter, examine their failures, and fundamentally change the failed nationality policies.
In order to prevent similar incidents from happening in future, the government must abide by the freedom of religious belief and the freedom of speech explicitly enshrined in the Chinese Constitution, thereby allowing the Tibetan people fully to express their grievances and hopes, and permitting citizens of all nationalities freely to criticize and make suggestions regarding the government’s nationality policies.
We hold that we must eliminate animosity and bring about national reconciliation, not continue to increase divisions between nationalities. A country that wishes to avoid the partition of its territory must first avoid divisions among its nationalities. Therefore, we appeal to the leaders of our country to hold direct dialogue with the Dalai Lama. We hope that the Chinese and Tibetan people will do away with the misunderstandings between them, develop their interactions with each other, and achieve unity. Government departments as much as popular organizations and religious figures should make great efforts toward this goal.
Wang Lixiong (Beijing, Writer)
Liu Xiaobo (Beijing, Freelance Writer)
Zhang Zuhua (Beijing, scholar of constitutionalism)
Sha Yexin (Shanghai, writer, Chinese Muslim)
Yu Haocheng (Beijing, jurist)
Ding Zilin (Beijing, professor)
Jiang peikun (Beijing, professor)
Yu Jie (Beijing, writer)
Sun Wenguang (Shangdong, professor)
Ran Yunfei (Sichuan, editor, Tujia nationality)
Pu Zhiqiang (Beijing, lawyer)
Teng Biao (Beijing, Layer and scholar)
Liao Yiwu ()Sichuan, writer)
Wang Qisheng (Beijing, scholar)
Zhang Xianling (Beijing, engineer)
Xu Jue (Beijing, research fellow)
Li Jun (Gansu, photographer)
Gao Yu (Beijing, journalist)
Wang Debang (Beijing, freelance writer)
Zhao Dagong (Shenzhen, freelance writer)
Jiang Danwen (Shanghai, writer)
Liu Yi (Gansu, painter)
Xu Hui (Beijing, writer)
Wang Tiancheng (Beijing, scholar)
Wen kejian (Hangzhou, freelance)
Li Hai (Beijing, freelance writer)
Tian Yongde (Inner Mongolia, folk human rights activists)
Zan Aizong (Hangzhou, journalist)
Liu Yiming (Hubei, freelance writer)
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