There are calls for “at least a million more Britons” to be put on antidepressants. This is odd because Britain’s National Health Service already “prescribed a record number of antidepressants” in 2016.
That represented “a massive 108.5% increase on the 31 [million] antidepressants which pharmacies dispensed in 2006.” In the States, one estimate is that 12% are already on these drugs.
Still, the clarion for ever more drugs was signaled after the results from a new statistical analysis were announced.
The study was “Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis.” It was led by Andrea Cipriani and published in The Lancet.
Do antidepressants alleviate or ameliorate the suffering caused by acute major depressive disorder? In some cases, the analysis says the answer appears to be yes. Which means that in some cases, the answer appears to be no. This is another way of saying that antidepressants don’t always work, or do not work for all people all of the time.
And that means that, at least for some, placebos are as “effective” as the active chemicals in antidepressants. The authors admit “Depressive symptoms tend to spontaneously improve over time and this phenomenon contributes to the high percentage of placebo responders in antidepressant trials.”
Placebos, it should go without saying, do not carry any risk of side effects. Actual drugs do; about which, more in a moment.
Caution Over the Results
Now this was not an original study, but a re-look at old studies called a “meta-analysis.” As a statistician, I only often half-jokingly say that meta-analyses are conducted to “prove” what individual studies could not. If the results from individual researches were clear and robust, meta-analyses would hardly be needed. On the other hand, a meta-analysis can provide a vantage individual studies cannot. The limitations of the method must be kept in mind.
Only studies that treated acute depression were examined here. What about side-effects? Cipriani cautioned “that some of the adverse effects of antidepressants occur over a prolonged period, meaning that positive results need to be taken with great caution, because the trials in this network meta-analysis were of short duration.”
The result of the meta-analysis indicate antidepressant effectiveness is not strong, classed as medium to small effect sizes. The authors warn “Given the modest effect sizes, non-response to antidepressants will occur.” Meaning not all who are given drugs will react to them.
Now the study’s reported statistical measures are highly specialized and take definite meaning only inside a mathematical system. The details are too technical to go into, but naive use of reported measures can exaggerate effectiveness.
If you’re not taking so many pills you can’t see straight, click here to read the rest.
If only there were some sort of book, exploring what a drugged populace would look like and how it might be controlled. https://en.wikipedia.org/wiki/Brave_New_World
The difference between us and the Satanists, er excuse me, Leftists – we see 1984, Atlas Shrugged and Brave New World as dire warnings. They see them as instruction manuals.
One of the crimes committed by THX1138 was Drug Evasion
Matt, thanks for this commentary as psychiatry is being exposed more and more as harmful, ineffective and unscientific. For example: http://www.mayohomeopathy.ie/index.php/psychiatry-not-science/
Also, there is a bias now in psychiatric medicine to treating the mind reductively as nothing more than biomarkers or neural circuits: http://www.mayohomeopathy.ie/index.php/mind-brain-split-psychiatry/
The first humane psychiatrist was Samuel Hahnemann, overlooked by medical history because he did not distinguish between mind and body, but saw mental symptoms as a continuation of earlier physical symptoms: http://www.mayohomeopathy.ie/index.php/psychiatry-homeopathy-care-management/
Reading Briggs (twice) I came away with the following:
– Medication (depressants) vs. anti-depressants [that is the balance/the issue]
– Sometimes they work, sometimes not
– and a general theme that doctors are pushing anti-depressants
In other words, an either/or sort of outlook regarding use of this type of medication for the treatment indicated.
The press report perspective was explicit in parsing things much further:
– 80 percent stop using an initial trial a month too soon — well before the patient sees benefits
— So “more” use means “more” in a very qualified way (‘use them correctly’, like finish all your antibiotics, which most now understand why and adhere to the prescription)
– Also, the stigma against addressing mental health issues is alive & well there
— Doctors as a result avoid addressing a diagnosed and treatable condition
— I.E. the known under-treated population is significant
– Med effectiveness is better than placebo in all cases — however, not all medications work equally well (and, some of the “brand” names are more ineffective than others)
– Prescription of such meds is a short-term treatment, or should be — to avoid chemical dependency (“reliant on medication” was the UK-English presentation)
— Gen’l Practitioners should be offering talk therapy as the long-term solution
— which is not pushing more medications
One can suppose why some readers will only see the most general theme — that drug use is rising; while others will see that medicine is reaching & benefiting more people.
There’s a “tell” in the presentation. Read the various reports — the basic statements — at the most basic level where specific subject matter is removed; for example as:
“Do[es] [THE TREATMENT] alleviate or ameliorate the suffering caused by [THE CONDITION]? In some cases, the analysis says the answer appears to be yes. Which means that in some cases, the answer appears to be no.”
If you are one of those people that finds the idea of drug-based mental health treatment problematic (e.g. a Scientologist opposing ADHD treatments as Tom Cruise made [in]famous) Briggs presentation will certainly strike a chord with you.
But if you’re objective or more accommodating, you’ll see right thru the bias– you’ll note you can substitute something mundane such as “poor vision” for THE CONDITION and “glasses” or “contact lens” for THE TREATMENT … and essentially the exact same presentation works. Except, when you read how the number of treatments (glasses/contact lens) being imposed rises you do not perceive some ominous trend, you instead recognize the obvious — that people living with an adverse condition, often without even realizing it, are getting treatment previously unavailable. And, obviously, the stigma about admitting to poor vision is orders of magnitude less than admitting one has a mental health condition warranting treatment (even to only one’s physician — though when eye-glasses first came out they were homely and many avoided them as well).
All of which begs a question: Why do some people viscerally oppose some types of medical interventions that really do work?
Ken thank you for your as always, impressively diligent proper look at the article.
Your question begged is very important and the answers in part involve people receiving bad information about the subject and definitely a lot of emotional responses that are based on that bad information. It’s not surprising that medicine that affects the brain would be shied away from. Quite a normal kind of reaction on spec. The same types go out and pickle their brains though, without a thought for side effect or contraindication or anything so fancy. You rightly point out the scientologists.
Anti-depressants are not a silver bullet. They are part of an array of intervention. Talking therapies or CBT which is more practical and pragmatic. If alcohol is involved in the mix then some like Citalopram interact and can cause violent behaviour.
Alcoholism, not just quantity drinking but where alcohol is used to self medicate, is a classic example of what men, in particular, don’t mind admitting rather than admitting they’re depressed.
Placebo is present in every medicine which also begs a question. Which has been answered by pain science. That the brain I like to call it the body, contains very strong pain killers stronger than heroine and of different types which it self-administers when needs arise.
If you think there is no danger or the converse, this affects the mind and therefore the body’s own drug supply.
People can understand adrenaline junkies or gym junkies deriving benefit from the effects of their activities but the same kind of dampening and excitation happens in situations where sudden danger, stress or chronic situations obtain to affect the body’s ability to untangle itself into a state compatible with feeling well. Mentally or physically. The two go together.
Any stressor which persist for long enough will induce depression. Sometimes a stressor is unknown or subconscious. Sometimes unavoidable.
In treatment of chronic pain, If you have just seen a practitioner who explains your condition and gives you hope you will likely notice an immediate improvement in symptoms. This can be in fact a sign, not of something worthless but of something rather more important in the case of depression. There are times when the symptoms do subside and the trick or the puzzle is to make that happen more of the time. Placebo is telling something important about chronic conditions. Something profound.
Hope is the word nobody likes to use because it sounds religious, and it is.
Briggs asks an important question but faintly. There are indeed other measures to take than prescribing more anti-depressants but like all new medicines they are a cure all when they first come out then they’re the devil’s work, then they’re appropriately used and prescribed by well informed Dr’s. You can’t legislate al the time for the lazy or disinterested medical Dr. They will always be with us. Some Dr’s want to prescribe anti-depressants just because patients start crying in consultation. Many many do and this is no measure of depression. Sadness is not depression. Depression is real though. A Pitt with deep sides. Antidepressants can be a ladder but you’ve got to pull yourself up by dealing with or understanding any of the causes as far as is possible.
Interestingly a man who was undergoing hormone treatment for prostate cancer said the side effects were depression. He said he could suddenly sympathise with women and the hormones were female hormones. He developed breast tissue which was very upsetting for him of course but the depression meant he required SSRI’s for that. He explained that no more would e view women the same way with their weepiness and consider them weak.
There’s nothing like first hand experience to show someone the light.
Just caught a glimpse of a ‘discussion’ elsewhere on this topic.
Acute depressive episodes normally last about 24 48 hours maximum.
These are of the natural history that people can distract or wait out presuming they are looked after or supported by family or health professionals. There is no need for prescription of antidepressants in such cases because the symptoms do not last long enough.
Single depressive episodes, however, are described in medical notes as such because that is what they are. They appear commonly in the past medical history of patients. Yet reactionaries get excited about it. Asking ‘how can this be?’
The same way as autism, asthma, diabetes and cancer, are diagnosed more readily.
The same way “there has been an increase in tropical storms.”
There’s no epidemic. There is recognition and treatment. Just as there is treatment for arthritis of different sorts which were previously not available. Any statistician knows this fallacy in reporting alarm about a condition.
Conditions may be over or under reported and time will sort this apparent rapidly changing ‘trend’.