[Make it Lady (OP)]

Antidepressants have been given a bad press recently. They are saying a placebo is just as good. Has anyone had experience of over prescription of these drugs? Do you think this report is correct?

[iko]

Hi M.i.Lady,

this should be the scientific report (meta-analysis!) you refer to, I suppose.
The whole thing seems to be restricted to a group of "new antidepressants":

http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050045

Initial Severity and Antidepressant Benefits: A Meta-Analysis
of Data Submitted to the Food and Drug Administration

Irving Kirsch, Brett J. Deacon, Tania B. Huedo-Medina, Alan Scoboria, Thomas J. Moore, Blair T. Johnson

PLoS Medicine, Feb 2008,5(2),e45.

...
What Do These Findings Mean?

These findings suggest that, compared with placebo, the new-generation antidepressants do not produce clinically significant improvements in depression in patients who initially have moderate or even very severe depression, but show significant effects only in the most severely depressed patients. The findings also show that the effect for these patients seems to be due to decreased responsiveness to placebo, rather than increased responsiveness to medication. Given these results, the researchers conclude that there is little reason to prescribe new-generation antidepressant medications to any but the most severely depressed patients unless alternative treatments have been ineffective. In addition, the finding that extremely depressed patients are less responsive to placebo than less severely depressed patients but have similar responses to antidepressants is a potentially important insight into how patients with depression respond to antidepressants and placebos that should be investigated further.


...

The discussion is open, but let me remind that we must be careful: those data have to be confirmed in such a crucial field like psychiatric pharmacology.  Antidepressants work and give dependence sometime: consequently, any stop-and-go in these treatments could be more dangerous than the treatment itself.
Mental illness is a too much serious issue and suicidal behaviour is a reality.
Patients should be given straight forward indications, these 'news' create chaos instead.

ikoD

http://mountcope.files.wordpress.com/2007/05/depression.jpg

[that mad man]

I think it is a bit alarmist in saying that 31 million prescriptions was given out in 2006 for anti depressant drugs alone without giving out much other needed background data.

Depression can last months and no data is given on how many were repeat prescriptions from the same people in that year only that there was 31 million prescriptions. The maximum prescription dose, I think is normally for 2 weeks but can be for a max of 1 month and then goes under review.

It would be nice if more money was spent on tackling the reasons why some of us are depressed in the first place. Drugs are not the only way but can help some, improving living conditions and employment also help but this also means extra spending to improve those conditions.

I moved from the 15th floor of a dilapidated and run down hi-rise block to the top floor (only 3 floors) of a newly renovated small block of flats and I now have neighbours that I talk to.

Life for me has improved dramatically!


Unfortunately for some though, the stress of work and the stress in trying to pay off the mortgage causes havoc.

The why? we are depressed in the first place seems to be missing in all of this.

[JimBob]

Also missing is any biochemistry. It has been known for a long time that certain mineral waters help with certain types of depression. We have our own example here in Texas. It was know as "Crazy Woman Well" originally. It has a clinically significant amount of Lithium in it.

http://home.flash.net/~duus/mineralwells.htm

[Make it Lady (OP)]

I went bonkers due to lack of sleep when I was 18. I think the usual hormone imbalances caused me to only be able to sleep from about 2am to 12noon. Because I had to go to school I wasn't getting much sleep and started to become paranoid and very depressed. All my thoughts were beyond gloomy. this went on for about 4 months. The insomnia lifted and so did the depression but in the 4 months I lost all my friends and lost all track of my A=levels as I had no energy to even read or write at times. My Mum wouldn't dream of taking me to the Doctors because she hated the thought of me going on antidepressants. I often wonder if they would have helped or hindered.
About 10 years ago a GP tried to put me on Prozac for extreme PMT. This time I resisted even though the systems were severe:
1) paranoia
2) A feeling like my nerve endings were so close to my skin that I could have happily flaid myself.
3) suicidal thoughts.

I solved all this with a change of contraception. I now have the marina coil and no periods so no PMT hurray!!!

What annoys me is how quickly the Doctor wanted to prescribe the antidepressants without looking at other methods first.
   

[another_someone]

What annoys me is how quickly the Doctor wanted to prescribe the antidepressants without looking at other methods first.

The trouble is that doctors in this country see patients in 10 minute slots - that is not a lot of time to explore lots of alternative possibilities.

By the time you have explained your symptoms (while being acutely aware that the clock is ticking, so no deviation or hesitation allowed), and allowing for the doctor to write out a prescription for whatever it is that ails you, it allows very little time between to discuss or think about whether this or that is a better possibility.

[JimBob]

The reason insomnia is present is a problem with the hypothalamus/ It does not release at a the end of the day, normal sleep time, hormones that increases the production of gamma-amino-buteric acid. This neuroactive chemical is only present in the nervous system. It  produces the suppression of the nervous system necessary for the onset of sleep.

Gabapentin is often given to induce the production of this. Sleeping pills over the long term usually increase depression because they also suppress GABA.

I was reading about the treatment of bi-polar disorder as a grand nephew has recently been diagnosed with this. It is amazing what i found, There are NO long term studies of the effects of the medications usually given for bi-polar control. This is absolutely ridiculous. 

"Mental Illness" or nervous system disorders as I prefer, are still stigmatized and it is evidence in th treatment of any of them, although great advances have been made in the treatment of schizophrenia. But they don't know why the chemicals work.

This scares me no end. We are still in a privative stage. I have looked up all of the medications I take - I am older and on more than most - and in the vast majority of the cases the package insert for the drug contains a statement that "the precise mechanism of action is unknown."

My, my, how comforting.

[DoctorBeaver]

Following on from Iko's post, here is an article from http://www.guardian.co.uk

The big pharmaceutical companies are to be 'shamed' into handing over their secret data on the effects of antidepressant medications, amid growing concern that the 'sunshine pills' may not work as well as originally promised.

A [British] government minister has taken the unprecedented step of calling on the drugs companies to give the data to the body that will review the current depression guidelines, the National Institute for Health and Clinical Excellence (Nice). Ivan Lewis, the minister with responsibility for mental health, said that 'a failure to do so would leave the inevitable impression they had something to hide'.

Nice, the body that looks at the effectiveness of all treatments and recommends to the NHS how they should be used, is embarking on a fresh look at the antidepressants known as selective serotonin reuptake inhibitors, or SSRIs. Its most recent guidance was published four years ago. However, the organisation has no legal right to see unpublished data and can only request it from a company, which might refuse to give it if the findings were negative.

Backed by the government, Nice is now set publicly to ask for all the data, which would leave the companies facing huge criticism if they did not hand it over. The toughening stance towards the companies follows the publication last week of a major review that examined all available data on the drugs, including trials that had not been published.

It showed that antidepressants taken by millions of people worldwide did not appear to work well - unless they were being given to the most severely depressed patients. They found that when patients on the drugs were compared with those who were taking a placebo they showed similar rates of improvement.

The number of prescriptions for antidepressants hit a record high of more than 31 million in England in 2006, with more than four million people thought to be on them. Even though official guidance stresses they should not be a first-line treatment for mild depression, they are still being routinely prescribed.

Lewis said: 'I have no doubt that medication can and does help some people with mental health problems. Equally a major expansion of psychological therapies that Alan Johnson [the Health Secretary] announced last week reinforces the need for an end to the "prescription not therapy" culture which has characterised our mental health system.

'I would call on any company in possession of any relevant evidence to make it available to Nice. The failure to do so would leave the inevitable impression that they have something to hide.'

Dr Tim Kendall, head of the National Collaborating Centre for Mental Health, said it had proved impossible to get access to unpublished trials in the past. 'We know that there have been thousands of trials since the drugs were licensed. We would like to use the data and recrunch it using our own methods and do a proper analysis.'

In 2005, the Labour manifesto included a promise to make it mandatory for companies to hand over published data, but under EU law Britain is unable to force foreign companies to do so.

Lewis said: 'I have no doubt that medication can and does help some people with mental health problems. Equally a major expansion of psychological therapies that Alan Johnson [the Health Secretary] announced last week reinforces the need for an end to the "prescription not therapy" culture which has characterised our mental health system.

This is a view I have long held - that many, if not most, doctors are too quick to prescribe medication.

[Karen W.]

I would like to say on behalf of the antidepressants I have been taking... Thank you...

The last two years of my life have brought me some very difficult punches and I have

been in the worst places I have been in a very very long time... endless crying which

still happens but better now since medication.. depression like I would never wish on

anyone with terrible horrible thoughts running rampid in my head and feeling like my

life just spun out of control and I could not get back on.. to slow things down and

cope with my feelings or anything else... It has been reeking hell with my illness ..

LOL or my illness has reeked hell with the depression.. seems like a series of

dominoing life events have been the undoing of my soul...my life.. everything I ever

believed has been teetering... have been a complete mess... I am grateful for my little

pill that helps me be a bit less stressed.. It hasn't fixed things but it has taken off

the edge so that I can see a bit better and concentrate better on getting well. I hope

I don't have to use them for a long period of time.. but at this point I needed help

and I could not do it by myself.. I had to seek other help. I do not feel in my case it

has been over used.. I was in a state of shutdown and was not functioning well on my

own.. Overall I don't know much about the pros and cons.. I hated the old meds 25 years

ago.. but this new stuff does not make me feel so bad on a daily basis... I feel I have

control and still have my emotions.. but they are not as spikey as they have been..in

the past months.. calmer you might say... I feel like I can relax a little.. and think

a bit more.

I would be interested in some more facts and studies myself..

[DoctorBeaver]

Karen - no-one has said that medication never works. It certainly does in some cases. The point is that anti-depressants are prescribed willy-nilly without thought as to whether the patient would actually benefit, and in many cases they would not.

[another_someone]

Karen - no-one has said that medication never works. It certainly does in some cases. The point is that anti-depressants are prescribed willy-nilly without thought as to whether the patient would actually benefit, and in many cases they would not.

The reports I have heard is basically that what people are saying is that anti-depressants work no better than a placebo for what is regarded as 'mild depression' (maybe what is regarded as 'mild depression' is a false diagnosis of depression at all), but does work for severe depression.

[paul.fr]

Karen - no-one has said that medication never works. It certainly does in some cases. The point is that anti-depressants are prescribed willy-nilly without thought as to whether the patient would actually benefit, and in many cases they would not.

I suspect letting doctors slap people around the face, whilst telling them to get a grip would work a lot better.

[DoctorBeaver]

I suspect letting doctors slap people around the face, whilst telling them to get a grip would work a lot better.

Funny you should say that. I was talking to a friend of mine this morning who is a counsellor & also happens to be a karate sensei. I said he should punch his counselling clients in the head and tell them to get a grip.  []

[Karen W.]

Karen - no-one has said that medication never works. It certainly does in some cases. The point is that anti-depressants are prescribed willy-nilly without thought as to whether the patient would actually benefit, and in many cases they would not.

No worries, I know nobody said that.. I was just trying to state my experiences  with my meds, and  for the record I have seen them given at the drop of a hat!
I should have said that as far as a placebo effect in my case anyway... I do not see that!  They have helped a great deal... and given my previous condition..I am grateful for them and my being here now.
I see a huge difference, but as George suggests, It may be the difference in mild or severe depression. Mine have been very very severe... to the point of facing being admitted to a facility again,to get help.

I do wonder how many of the folks being treated were at severe levels of depression, and how many were very mild... It has eased mine quite a lot and made it manageable .

I would also like to add that I have had trouble with this before and it took a lot longer then a couple months to recover from it....

[Make it Lady (OP)]

The worst thing you can ever say to someone with depression is 'Smile things could be worse.' That sort of get a grip attitude used to make me go out into the garden and dig a big hole. This was good therapy and stopped me from killing people. I only asked for help when my garden looked like the Grand Canyon.

[Karen W.]

Me too.... People need to be able to ask for help sooner without all the stigma attached.. it is too hard to get out of it when you get so badly depressed that you shut down completely.

 I wonder if there are some more studies that gave more statistics with a little bit more information..

[Make it Lady (OP)]

www.scripeditorblog.blogspot.com
 www.pharmalot.com/2007/09/antidepressant-prescriptions-the-real-trend

Try these.

Scrip is the publication of choice on such matters.

[Karen W.]

Thanks... I will check them out!

[offthestuff]

I wouldn't advise my worst enemy to go on antidepressants! I've been on and off of them for years, all the way back to the Prozac days. The thing is there were times when I thought they helped and made me better. But, usually my life situation had more to do with how I felt than any neuro-chemical state. The problem for me has been the withdrawal symptoms when I do go off of them. It's absolutely horrible. I follow my doctors advise of gradually tapering off, but nothing seems to make the transition easy. This is my warning to all of you who are considering using them. Unless you won't to stay on them for life, then don't start!!

[Jessica H]

The reports I have heard is basically that what people are saying is that anti-depressants work no better than a placebo for what is regarded as 'mild depression' (maybe what is regarded as 'mild depression' is a false diagnosis of depression at all), but does work for severe depression.

I agree!  From personal experience I know that they do definitely work for severe depression.  Antidepressants have totally improved my quality of life.  I have been diagnosed with reccurent major depression and when I tried to go off my meds while pregnant, the depression returned, even though I was in a really great place in my life and really happy about being pregnant. So I strongly beleive there is a biochemical basis for depression and the drugs can work to fix it.

Some people have to try several till they find the one that works best for them.