Thursday, March 29, 2012

Is “Prozac” just “Placebo” misspelled?

A few facts:
In 2010 the top 5 antidepressants were prescribed 115 million times in the USA.

Antidepressants have side effects, the most common being weight gain, sexual dysfunction, and upset stomach. The most severe being suicidal thoughts and fatal birth defects.

Conclusion: These are not benign medications.

About me – I did not read just one article about antidepressants and then write a blog post about it. I have researched this topic. I have read many articles, and read the Newsweek article including the drug companies responses. I have read studies sponsored by drug companies as well as those with no “Pharm” funding whatsoever.

I wrote before about the publication bias in antidepressant research.
If we look at EVERY published and unpublished study submitted to the FDA for a set of antidepressants and compare the drug response with placebo response, guess what we find?

I'll give you a's depressing.

Everyone in the studies took a "depression rating test" before and after the drug trial.
If patients on Prozac said they got got better by 10 points, those on Placebo got by 8 points. Yes, Placebo had 80% of the effect.

You want the exact numbers?
There is a scale for rating depression called HAM-D which has been used since 1960 for pretty much all antidepressant trials. The higher you score, the more depressed you are.

0-7 = No Depression

8-13 = Mild Depression

14-18 = Moderate Depression

19-22 = Severe depression

>23 = Very Severe Depression

So you take the test before the drug trial. Then you get either an antidepressant or placebo and take it for a few weeks. Then you take the test again. How much lower your score is = your improvement.

Average improvement on antidepressants: 9.6 points (that would move you 1-2 levels up on the scale, like from severe to mild, and from moderate to mild or none.)

So that’s some real improvement

Average improvement on Placebo = 7.8

So the medication works better than placebo – but not much. How do we tell if that difference matters? Does a difference of 1.8 points matter?  If you do a statistical analysis – YEP, it’s significant.

If you do a clinical analysis (do the patients notice any real difference?) – NOPE, it's insignificant.

It turns out that to be clinically significant the drug needs to be at least 3 points better than the placebo. (So says the National Institute for Clinical Excellence)


Americans are taking drugs for depression and their depression is getting better. If they were getting a sugar pill (but thought it was the drug) they’d do just about as well.

So you tell me - Knowing the side effects and the costs – is it worth it?


Anonymous said...

I was on Prozac for about 18 months, if I remember right. I had severe insomnia, and possibly some other hallmark signs of depression. It didn't really seem to get better or worse with the medication (so I'm not sure why I continued on it--wishful thinking, I guess). One day, despite all the urgent warnings to the contrary, I discontinued its use. And I felt exactly the same. I'm sure glad my insurance covered the majority of the prescription! Ambien did help with getting me some sleep, but that's another story...

LeeAnn Prescott said...

If I did not have an antidepressant, I would be dead by now. I would have killed myself and on this...I am being serious. i hate dark rooms and I hate anything that reminds me of the days which remind me of those dark days.

Simple Citizen said...

LeaAnn - Wow, I had no idea.

That's the reason we don't stop prescribing these drugs even though we know how strong the Placebo effect is. I prescribe an SSRI probably 6 times per week. They work, especially in combination with other drugs.
It still amazes me how almost no drug really works the way we think it does.
While I hope the things I write are educational and useful - in the end the only thing that matters is whether or not individuals feel their life is better.

Anonymous said...

I don't know what it's worth but I'm on vitamin supplements formulated for anxiety, and they actually seem to be helping much more than anything else I've ever taken. I don't know if your research goes over into the world of nutrition, but I've been surprised at how real the difference is.
-Charlotte Goga

Cathy Harward said...

Matt, I see what you are saying, and I too have wondered if the medications I take really do any good. However, even if it is just a placebo my nutty brain believes it, and so that matters. I have been where LeeAnn was a couple of times, and I do not ever want to go there again (stress brings on my darkest hours.) I do not fear the dark, because I know the Light, but it was only because of my knowledge of Him and the love for and of my family,that I didn't choose the easy way out. I am grateful for the medications I take-even if they really don't work. My mind thinks they do and it gives me one more coping method. So Charlotte, if your supplements work for you, would you share the names and amounts you take? I would be interested.

Anonymous said...

Until my doctor can prescribe me a sugar pill and my mind fully believes it's an antidepressant (so pretty much never), I suppose I'll have to continue dealing with the cost and side effects.

Geraldine Galvan said...

No, it's not worth it.
Not to mention the adverse effects that it had caused: miscarried, given birth to children who suffer from birth defects, or suffered negative side effects themselves.
Additionally, hundreds of birth defect lawsuits are now being filed because of the adverse effects that this drug brought to it's users.