View Full Version : Placebo effect of anti-depressants


clovislorax
07-10-12, 12:09 AM
I'm wondering if anyone saw the recent 60 Minutes piece on placebo effects of anti-depressants. I was intrigued by what Dr. Kirsch had to say so I got his book from the library and read it through. (The Emperor's New Drugs).

He makes a very compelling argument that almost all (if not all) of the beneficial effects of SSRIs are placebo effect. Which isn't to say that the meds aren't effective. Placebo can be very effective.

Anyway, I'd been taking an anti-depressant for about ten years and have been taking Adderal for the past two years. It's become clear to me that my depression really was worsened by my untreated ADD. I decided to wean myself off of the SSRI about three months ago and I haven't noticed a difference.

I'm not recommending that others do this. It's something that you'd want to discuss with your doctor. However, I'm glad that I educated myself on this issue and have been able to decrease my med regimen without negative consequence.

Chicchick
07-10-12, 07:31 PM
I have to say I disagree, but I do see that side of the argument.

With mild depression, I think placebo and lifestyle changes might be enough, but coming from someone with moderate to severe depression, placebo is certainly not enough to help most people that are depressed. Having been on various SSRIs since age 7 or 8, when I went on Wellbutrin I was expecting NOTHING, I think due to the place I'm in mentally I expected it to not work if anything. To my disbelief, it actually helped after taking maybe 6 other meds with no positive effect or just side effects. I also don't think that medication is enough. I think the person needs to have a desire to want to get better, and make lifestyle changes as well. It is still something I am struggling with badly, but I credit Wellbutrin (and later Adderall) with my life. Without it I don't know if I'd still be here right now.

Just because a med isn't immediate doesn't mean it's placebo. Just medications like Adderall, Ritalin, or Xanax have much more immediate effects, which makes them more prone to be habit forming.

But I'm very happy to hear you have been able to get off of your antidepressant successfully! congrats and I hope you continue with your positive recovery! :)

Fuzzy12
07-10-12, 07:42 PM
I'm glad you are doing so well.

I guess, it's possible that anti depressants can have a placebo effect since anything can.

When I started taking anti depressants, I didn't really expect them to really help and I didn't anticipate the side effects. I could feel a noticable change within a few days. The side effects in particular felt very, very physical. I could almost feel my brain being rewired. I definitely didn't expect that, especially not so soon.

I think that anti depressants cause a very real chemical reaction rather than just a psychological one.

I think, most things, at least in large enough quantities, we put in our body affect its working in some way though the extent of the effect can vary. Some medicines might be helped by the placebo effect, and sometimes they might not work as expected but they do impact on us.

Abi
07-10-12, 07:43 PM
Numerous double-blind controlled studies have shown that most if not all anti-deps. on the market have a statistically significant difference in efficacy when compared to placebo.

Most tricyclic and SxRI antidepressants are effective for about 60% of the population.

In a trial and error process of consecutively trying different antidepressants, less than 7% of the population will see no positive effects after trying 3 different antidepressants consecutively.

clovislorax
07-11-12, 09:37 AM
Numerous double-blind controlled studies have shown that most if not all anti-deps. on the market have a statistically significant difference in efficacy when compared to placebo.

Most tricyclic and SxRI antidepressants are effective for about 60% of the population.

In a trial and error process of consecutively trying different antidepressants, less than 7% of the population will see no positive effects after trying 3 different antidepressants consecutively.

I didn't go much into Dr. Kirsch's research in my first post, but I think it's probably a good idea for me to explain further. I know that his position isn't a popular one and that a lot of people have benefitted from anti-depressants. It would be normal for people to dismiss what he has to say on this topic.

Dr. Kirsch is not an expert on anti-depressants. He is, however, the top of his field in placebo research. After doing his research he was given a professorship at Harvard. He went into the research expecting to find good outcomes for anti-depressants. He had every reason to believe that anti-depressants were effective, but he found a different story when he looked into it further.

The research supporting anti-depressants has all been done by the drug companies. Any research done by a company that has the primary motivation of financial profit should be looked at closely.

Yes, anti-depressants have been shown to be more effective than placebo in multiple double-blind studies. Double-blind studies are the standard in medical research. However, a more in depth look at placebo effect and efficacy is appropriate.
1) Most of the people in these studies know after a few weeks if they're receiving a placebo or not. The anti-depressants have side effects and the placebos do not. When people know they are getting the "real" medication the medication becomes more effective. Repeated research has shown that medications are more effective if the patient "knows" they're getting the actual medication. Interestingly, many medications are more effective when there are more side effects. Receiving an injection actually has a tremendous placebo effect. I guess our mind tells us that if we're going through some kind of pain then it must be treating the condition that they tell us it's treating. The drug companies could give a placebo that has similar side effects as the anti-depressant if they wanted a more accurate outcome, but they don't.
2) The difference between placebo and anti-depressant treatment is significant. "Significant" is a scientific term. It doesn't mean the same as "meaningful". The difference between placebo and the anti-depressants are significant, but they're not large. And, it's up to debate on whether or not there would be any difference if a better placebo were used.
3) Many studies have been published on anti-depressants. However, it's disturbing to find out how many studies have been published from the same data set. Drug companies will take successful data and then have multiple authors publish different parts of the research. It makes it look like the research has been verified many times by multiple people. When we read a news story on a particular topic we know that just because we read it from several sources it doesn't mean that the event happened more than one time. However, if a study is published in multiple journal articles we more easily believe that there were actually more studies completed.
4) The whole "serotonin" theory is still theory. There isn't evidence to back it up and the original research that the theory was first based on has been found to be inaccurate.

A couple other things to consider regarding Dr. Kirsch's data review.
1) 60 Minutes doesn't tend to do "sensationalist" stories. They have a reputation to keep up so they do their homework first (usually, at least).
2) Much more relevant than that point: England's national healthcare system has reviewed this research and they've totally revamped their treatment of depression. Cases of mild and moderate depression are treated first with exercise and Cognitive Behavioral Therapy. Cog B shows the same benefits of anti-depressants over time and costs less money in the long run. And the individual isn't stuck taking anti-depressants for many years.

I don't really expect anyone to believe what I've shared on this topic as this is an emotional issue. I imagine that most people will make up their minds on this before they look at any of the evidence. I was discussing the 60 Minutes show with a friend who is a LCSW. She turned off the show about two minutes into it. She already had her mind made up so she didn't want to hear what was being presented. I read the book with an open mind...and I'm a firm believer in science. I'm always willing to change my mind on a topic if there is adequate evidence to support an alternate view point.

I'm not advocating that people stop taking their anti-depressants. It's not just because something is mostly (or all) placebo effect that it's not effective treatment. If it works it works. No reason to stop. But, for me, I'd rather not take a medication if I don't need it.

Chicchick
07-12-12, 04:46 PM
The research supporting anti-depressants has all been done by the drug companies. Any research done by a company that has the primary motivation of financial profit should be looked at closely.

Yes, anti-depressants have been shown to be more effective than placebo in multiple double-blind studies. Double-blind studies are the standard in medical research. However, a more in depth look at placebo effect and efficacy is appropriate.
1) Most of the people in these studies know after a few weeks if they're receiving a placebo or not. The anti-depressants have side effects and the placebos do not. When people know they are getting the "real" medication the medication becomes more effective. Repeated research has shown that medications are more effective if the patient "knows" they're getting the actual medication. Interestingly, many medications are more effective when there are more side effects. Receiving an injection actually has a tremendous placebo effect. I guess our mind tells us that if we're going through some kind of pain then it must be treating the condition that they tell us it's treating. The drug companies could give a placebo that has similar side effects as the anti-depressant if they wanted a more accurate outcome, but they don't.
2) The difference between placebo and anti-depressant treatment is significant. "Significant" is a scientific term. It doesn't mean the same as "meaningful". The difference between placebo and the anti-depressants are significant, but they're not large. And, it's up to debate on whether or not there would be any difference if a better placebo were used.
3) Many studies have been published on anti-depressants. However, it's disturbing to find out how many studies have been published from the same data set. Drug companies will take successful data and then have multiple authors publish different parts of the research. It makes it look like the research has been verified many times by multiple people. When we read a news story on a particular topic we know that just because we read it from several sources it doesn't mean that the event happened more than one time. However, if a study is published in multiple journal articles we more easily believe that there were actually more studies completed.
4) The whole "serotonin" theory is still theory. There isn't evidence to back it up and the original research that the theory was first based on has been found to be inaccurate.

A couple other things to consider regarding Dr. Kirsch's data review.
1) 60 Minutes doesn't tend to do "sensationalist" stories. They have a reputation to keep up so they do their homework first (usually, at least).
2) Much more relevant than that point: England's national healthcare system has reviewed this research and they've totally revamped their treatment of depression. Cases of mild and moderate depression are treated first with exercise and Cognitive Behavioral Therapy. Cog B shows the same benefits of anti-depressants over time and costs less money in the long run. And the individual isn't stuck taking anti-depressants for many years.

I don't really expect anyone to believe what I've shared on this topic as this is an emotional issue. I imagine that most people will make up their minds on this before they look at any of the evidence. I was discussing the 60 Minutes show with a friend who is a LCSW. She turned off the show about two minutes into it. She already had her mind made up so she didn't want to hear what was being presented. I read the book with an open mind...and I'm a firm believer in science. I'm always willing to change my mind on a topic if there is adequate evidence to support an alternate view point.

I'm not advocating that people stop taking their anti-depressants. It's not just because something is mostly (or all) placebo effect that it's not effective treatment. If it works it works. No reason to stop. But, for me, I'd rather not take a medication if I don't need it.

I have watched a few documentaries on this subject, and I do agree that drug companies will publish studies that make their drug look FAR more superior than it actually is. I've felt that with my experiences (im biased, of course) SSRIs seem to feel more like a placebo than a NDRI like wellbutrin or even a SNRI like Effexor. The effects are far more noticeable.

There are without a doubt some shady things going on in the drug companies with their published studies.. but the number of people anti-depressants have helped is so large, their benefits ("placebo" or not) are undeniable. For mild depression, CBT and exercise are a far better choice than a medication. But when something is severe enough, sometimes meds and CBT need to be combined. Doctors should be more conservative when giving out antidepressants though, that I agree with.

hollywood
07-16-12, 04:33 PM
I guess I will admit that I have been pretty depressed at my work. It's the worst subset of feelings both mentally and physically ever. It makes you feel like your constantly tired , you can never think. Thats the trick depression plays on your head. Its terrible and if you have it even the work inflicted type you should really do anything to eliminate it. I agree there are things you can do to make it better but you may indeed need meds. In my opinion all the ssri's helped a little but left me useless without drive and created alot of fatigue. Basically they s u ck for me. The snri's flat out work and fast. You can feel the difference immediately on the big guns ( cymbalta and effexor) I think cymbalta is the best but I never really took effexor that long because the side effects really were alot worse.

Lunacie
07-16-12, 04:52 PM
I have to say I disagree, but I do see that side of the argument.

With mild depression, I think placebo and lifestyle changes might be enough, but coming from someone with moderate to severe depression, placebo is certainly not enough to help most people that are depressed. Having been on various SSRIs since age 7 or 8, when I went on Wellbutrin I was expecting NOTHING, I think due to the place I'm in mentally I expected it to not work if anything. To my disbelief, it actually helped after taking maybe 6 other meds with no positive effect or just side effects. I also don't think that medication is enough. I think the person needs to have a desire to want to get better, and make lifestyle changes as well. It is still something I am struggling with badly, but I credit Wellbutrin (and later Adderall) with my life. Without it I don't know if I'd still be here right now.

Just because a med isn't immediate doesn't mean it's placebo. Just medications like Adderall, Ritalin, or Xanax have much more immediate effects, which makes them more prone to be habit forming.

But I'm very happy to hear you have been able to get off of your antidepressant successfully! congrats and I hope you continue with your positive recovery! :)

Having a link in the OP would have been helpful. Here's what I could find on
the Leslie Stahl interview with Dr. Kirsch.

http://www.cbsnews.com/1770-5_162-0.html?query=antidepressant+placebo&tag=srch&searchtype=cbsSearch (http://www.cbsnews.com/1770-5_162-0.html?query=antidepressant+placebo&tag=srch&searchtype=cbsSearch)

It seems that Dr. Kirsch is actually saying is similar to what you've written
here, that for severe depression there is no question that anti-depressants
are helpful, but that for mild and even moderate depression, The Placebo
Effect works just as well.

I take an anti-depressant (generic Zoloft), but it's more to treat my anxiety
than my depression. When the anxiety is not burning me out every minute
of the day, I don't seem to get as depressed.

Lunacie
07-16-12, 04:54 PM
Quoting this to add spaces between paragraphs. I cannot read it as it was posted.

I didn't go much into Dr. Kirsch's research in my first post, but I think it's probably a good idea for me to explain further. I know that his position isn't a popular one and that a lot of people have benefitted from anti-depressants. It would be normal for people to dismiss what he has to say on this topic.

Dr. Kirsch is not an expert on anti-depressants. He is, however, the top of his field in placebo research. After doing his research he was given a professorship at Harvard. He went into the research expecting to find good outcomes for anti-depressants. He had every reason to believe that anti-depressants were effective, but he found a different story when he looked into it further.

The research supporting anti-depressants has all been done by the drug companies. Any research done by a company that has the primary motivation of financial profit should be looked at closely.

Yes, anti-depressants have been shown to be more effective than placebo in multiple double-blind studies. Double-blind studies are the standard in medical research. However, a more in depth look at placebo effect and efficacy is appropriate.

1) Most of the people in these studies know after a few weeks if they're receiving a placebo or not. The anti-depressants have side effects and the placebos do not. When people know they are getting the "real" medication the medication becomes more effective. Repeated research has shown that medications are more effective if the patient "knows" they're getting the actual medication.

Interestingly, many medications are more effective when there are more side effects. Receiving an injection actually has a tremendous placebo effect. I guess our mind tells us that if we're going through some kind of pain then it must be treating the condition that they tell us it's treating. The drug companies could give a placebo that has similar side effects as the anti-depressant if they wanted a more accurate outcome, but they don't.

2) The difference between placebo and anti-depressant treatment is significant. "Significant" is a scientific term. It doesn't mean the same as "meaningful". The difference between placebo and the anti-depressants are significant, but they're not large. And, it's up to debate on whether or not there would be any difference if a better placebo were used.

3) Many studies have been published on anti-depressants. However, it's disturbing to find out how many studies have been published from the same data set. Drug companies will take successful data and then have multiple authors publish different parts of the research. It makes it look like the research has been verified many times by multiple people.

When we read a news story on a particular topic we know that just because we read it from several sources it doesn't mean that the event happened more than one time. However, if a study is published in multiple journal articles we more easily believe that there were actually more studies completed.

4) The whole "serotonin" theory is still theory. There isn't evidence to back it up and the original research that the theory was first based on has been found to be inaccurate.

A couple other things to consider regarding Dr. Kirsch's data review.

1) 60 Minutes doesn't tend to do "sensationalist" stories. They have a reputation to keep up so they do their homework first (usually, at least).

2) Much more relevant than that point: England's national healthcare system has reviewed this research and they've totally revamped their treatment of depression. Cases of mild and moderate depression are treated first with exercise and Cognitive Behavioral Therapy. Cog B shows the same benefits of anti-depressants over time and costs less money in the long run. And the individual isn't stuck taking anti-depressants for many years.

I don't really expect anyone to believe what I've shared on this topic as this is an emotional issue. I imagine that most people will make up their minds on this before they look at any of the evidence. I was discussing the 60 Minutes show with a friend who is a LCSW. She turned off the show about two minutes into it. She already had her mind made up so she didn't want to hear what was being presented. I read the book with an open mind...and I'm a firm believer in science. I'm always willing to change my mind on a topic if there is adequate evidence to support an alternate view point.

I'm not advocating that people stop taking their anti-depressants. It's not just because something is mostly (or all) placebo effect that it's not effective treatment. If it works it works. No reason to stop. But, for me, I'd rather not take a medication if I don't need it.

I didn't get the impression Dr. Kirsch was saying that
antidepressants are "mostly (or all) placebo effect."

I think it may be difficult for a psychiatrist to tell whether
the patient has mild, moderate or severe depression. An
antidepressant may be a good treatment to trial. But if
it's not helping, then taper off it.

sarahsweets
07-16-12, 06:13 PM
I wasnt able to read the full interview...but while drug companies fund such studies that promote their drugs, I find it hard to belive that all ssri's or snri's are a placebo effect due to manipulation of big pharma. Its great to feel like you have figured out that big pharma has duped you again, but many many people have turned their lives around due to these drugs. Maybe in mild cases these drugs arent applicable, and maybe they are over prescribed and maybe they are prescribed due to kick backs, but the life changing,life saving capabilities of these drugs shouldnt be overlooked. I would be dead without them.

clovislorax
08-08-12, 10:22 AM
[quote=Lunacie;1334334]Quoting this to add spaces between paragraphs. I cannot read it as it was posted.



I didn't get the impression Dr. Kirsch was saying that
antidepressants are "mostly (or all) placebo effect."

quote]

I don't believe that he said that it in his interview, but he was pretty clear about it in the book.

Lunacie
08-08-12, 10:36 AM
I don't believe that he said that it in his interview, but he was pretty clear about it in the book.

I do not agree.

Wish I could find a placebo that would make my migraine headache vanish. :rolleyes: