On the effectiveness of antidepressants

Sara Bostock shared with me a comment she left on The Carlat Psychiatry Blog. Given I was pretty dismayed, if not surprised by all the reactions against the report of the study about the lack of effectiveness of antidepressants, I’m pleased to publish Sara’s comments which get to a much deeper issue. Not just do the antidepressants “work,” but are they safe long-term. I’ve seen the unfortunate results of what happens years later myself. It’s imperative that people start to realize that quick fixes are often later regretted.

Sara’s comment:

It was a milestone of sorts to see a study published in a medical journal that claims antidepressants are ineffective. Of course, as an opponent of the use of antidepressants in general, I was delighted to see this, even though I found it surprising because, like others, I am well acquainted with the anecdotes of people who claim the meds are “saving their life.” And these are people who have all forms of depression, not just the most severe. So I was prompted to read the study in full to see what was up. Well, like practically every other medical journal study in psychiatry I’ve ever read and analyzed, I thought the evidence was pretty flaky and vague and the methodology inappropriate to the strength of the data; in general it was just pushing weak data around to come up with something that had poor relevance for real clinical practice. The sophistication of the statistical analysis hardly seemed merited by the quality of the data. And not one example from the clinical details. I’m not surprised there have been a flurry of articles by antidepressant supporters, like Judith Warner (quoting Peter Kramer), Richard Friedman, and Daniel Carlat dissecting the study.

Yes, I admit, as Danny says that “Drugs work” at least in some window of time, but my question is at what price does that “effectiveness” come? I’m not buying it that they should be used just because they “work.” Cocaine would probably work too. I think until we really understand all the things these drugs are really doing to our brain and our body they should be avoided. I don’t think it’s good enough that we see a sad person, give him a pill, and out the other side of some mysterious black box comes someone happier. All very well and good but if we don’t really know what’s going on I think it’s a very risky way to achieve that happiness. It would be fine if things froze at that point but they don’t. The drug continues to wreak changes that are ill understood and, from what I’ve observed, things don’t get better over time. Other subtle (or not so subtle) things start to happen and if someone stops the mood problems from rebound — not relapse — can be worse than ever unless the withdrawal is handled extremely carefully. The drugs may actually lead to someone being crippled by depression for life when they might not otherwise have been.

It almost seems like this article was written to rouse the antidepressant supporters from their slumber and get them riled up and defending that wonderful stimulant effect that makes so many people feel “better than well” until they become so impaired they no longer know “well” from “ill.” It’s time to study what happens when these drugs are used over the long term and also to study withdrawal thoroughly and deeply. That would be a much more effective use of research talent than silly studies like this one.

Yes, thank you, Sara, it is. It’s long overdue in fact.

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