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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by pegasus on February 3, 2010, at 12:46:49
There's a new cover story in the current Newsweek that essentially reports that research shows that 75% of the effectiveness of antidepressants (all of them) can be attributed to the placebo effect. They also argue that the remaining 25% could well be due to placebo effect, after people in the drug trials that are given the real drug start experiencing side effects, and so begin to more strongly believe that they will experience the real benefits of the drug.
Here's a link: http://www.newsweek.com/id/232781
What do you all think of this? It just doesn't seem right to me. I've been on Paxil for years, and it has changed my life. When I forget to take my pills, after a few days, I really feel a difference. It's that difference that often reminds me that I've been forgetting my pills. When I've tried to go off of it, my husband says he totally notices a difference in my ability to cope even after a couple of months. When I tried Prozac I felt nothing.
Could this all be placebo effect? And if so, what would you make of that? My immediate thought is that, whatever it is, I like it and I receive great benefit from it.
peg
Posted by inanimate peanut on February 3, 2010, at 15:50:59
In reply to newsweek: antidepressants all placebo effect, posted by pegasus on February 3, 2010, at 12:46:49
I've always said that I don't care if my meds are placebo effect or not-- as long as they trick my brain into thinking they're working, that's all that matters to me. That said, I don't think they're all placebo effect.
Posted by Phillipa on February 3, 2010, at 16:41:34
In reply to Re: newsweek: antidepressants all placebo effect, posted by inanimate peanut on February 3, 2010, at 15:50:59
Maybe for some where a med really isn't needed but if needed and works take the med and ignore study. Now how's that? Phillipa
Posted by morganator on February 4, 2010, at 1:47:00
In reply to Re: newsweek: antidepressants all placebo effect, posted by inanimate peanut on February 3, 2010, at 15:50:59
Medications really DO something and they DO work often absent of any placebo. It's one stupid study. I'm sure there are plenty of holes in it.
Posted by gman22 on February 4, 2010, at 8:27:14
In reply to Re: newsweek: antidepressants all placebo effect, posted by morganator on February 4, 2010, at 1:47:00
I think that this is a phenomenon due to over diagnosis of depression. People go to their GP complaining of almost anything and the Dr. will say they are "depressed". All kinds of ailments from tiredness, headaches, body aches, to vague symptoms of unhappiness in your job or relationship.
I've had true depression and it is way different than what people mean when they say "Oh he/she is just depressed today".
So logically, an antidepressant cannot work if the illness is not depression.
The results for "severe depression" and studies using tricyclics or MAOIs are much more promising.
As a matter of fact these classes of drugs were discovered by accident, meaning that there could be no placebo effect (since the drug was given for other reasons than depression)
Posted by polarbear206 on February 4, 2010, at 10:47:17
In reply to Re: newsweek: antidepressants all placebo effect, posted by gman22 on February 4, 2010, at 8:27:14
> I think that this is a phenomenon due to over diagnosis of depression. People go to their GP complaining of almost anything and the Dr. will say they are "depressed". All kinds of ailments from tiredness, headaches, body aches, to vague symptoms of unhappiness in your job or relationship.
> I've had true depression and it is way different than what people mean when they say "Oh he/she is just depressed today".
> So logically, an antidepressant cannot work if the illness is not depression.
> The results for "severe depression" and studies using tricyclics or MAOIs are much more promising.
> As a matter of fact these classes of drugs were discovered by accident, meaning that there could be no placebo effect (since the drug was given for other reasons than depression)
>Ditto gman. And Primary physicians handy these drugs out like candy. This makes me so mad!!!!!
Posted by bleauberry on February 4, 2010, at 18:30:59
In reply to newsweek: antidepressants all placebo effect, posted by pegasus on February 3, 2010, at 12:46:49
When reading any article on any topic, you really have to read it. You have to look at not just what they said, but what they didn't say. If that makes any sense.
This article was so full of bias and flaw it was almost nauseating.
Notice it began with the word "suggests". And of course that word we so rapidly gloss over, "may". Notice that the studies used to form the opinion of this article were not identified so that readers could scrutenize them themselves. Notice how data for the opinion was "cherry-picked".
And of course right at the beginning it was glaringly obvious what the whole thing was about...a treatment resistant friend must mean ADs don't work.
I could spend all night tearing this article to shreds sentence by sentence. Very easy to do. The article is scientific garbage.
Newsweek itself as a whole is a very biased and unreliable source of information. They do not take a rounded whole-picture stance on anything. They have an agenda and cherrypick whatever data they need to make their story, banking on the assumption that you the reader are as stupid as they think you are and that you will buy whatever they say hook-line-and-sinker.
In the real world, outside of this author's frustrated fantasy world, most of us here have seen and/or experienced what benefits meds can do. You all are much smarter than this author. You know the real story and you don't even need any clinical studies or third-party research to do it.
I would suggest that author go to revolutionhealth.com and askapatient.com to see what REAL people say about their ADs. It's all there...the good, the bad, and the ugly. He'll be happy to see the reported failures. It'll make his day. He will quickly gloss over and ignore the astounding cases of remission and miracles. In general, any AD in the real world helps people in a meaningful way beyond placebo effect, because the average rating of meds is in the mid 3's on a 1 to 5 scale. There are some failures scoring 1, some 2's, but also a bunch of 4's and 5's where the drugs obviously worked really good.
Anyway, this author is a joke. Newsweek in general is not to be relied on for anything more than entertainment. Certainly don't go to them for facts.
I do extend empathy and sympathy to his friend. He has obviously been working with the wrong doctors and not trying the right meds. Or not getting a thorough diagnosis of other unsuspected phsycial problems. Something. In any case, I feel sorry for him and wish him better days ahead. His treatment providers up to this point have obviously not been very skilled.
Posted by Phillipa on February 4, 2010, at 19:20:29
In reply to Re: newsweek: antidepressants all placebo effect, posted by bleauberry on February 4, 2010, at 18:30:59
I just really read the article and have to agree with most of it as ad's don't work for me and have been to many pdocs. The l0mg of paxil had me laid out in a hammock for three months til could function again. My brain adapted to it. Only reason was given an ad was they thyroid went. Until that time tiny doses of benzos worked just fine and beet to unwind at night for sleep. I functioned and was nationally certified in psych nursing. I often wondered why some patients constantly admitted could cry through the assessment and then join other patients and laugh and have fun. Seems to me they really weren't depressed. This is excluding bipolar, schizophrenia and more to me biologically based illnesses. Depression to me is too broad a scope of meanings. Phillipa
Posted by topcatclr on February 4, 2010, at 23:30:28
In reply to Re: newsweek: antidepressants all placebo effect, posted by bleauberry on February 4, 2010, at 18:30:59
Oh God, another article stating Meds don't work. Clearly this was written as a personal commentary with an agenda! I don't care what they think, I cannot function without them! This seems to be an extension of previous theories stating antidepressants only work in severely depressed people. This tells me that doctors give them to too many people who should not be on them, nothing more. I actually believe this is true. They probably only work in people who have a true, chemical problem! Makes total sense to me, and does not need to be over analyzed. What would insulin due to a healthy person?
Posted by bulldog2 on February 5, 2010, at 15:36:21
In reply to Re: newsweek: antidepressants all placebo effect » bleauberry, posted by Phillipa on February 4, 2010, at 19:20:29
> I just really read the article and have to agree with most of it as ad's don't work for me and have been to many pdocs. The l0mg of paxil had me laid out in a hammock for three months til could function again. My brain adapted to it. Only reason was given an ad was they thyroid went. Until that time tiny doses of benzos worked just fine and beet to unwind at night for sleep. I functioned and was nationally certified in psych nursing. I often wondered why some patients constantly admitted could cry through the assessment and then join other patients and laugh and have fun. Seems to me they really weren't depressed. This is excluding bipolar, schizophrenia and more to me biologically based illnesses. Depression to me is too broad a scope of meanings. Phillipa
Again you are using yourself to prove a point. If they don't work for you that only means they don't work for you.
Also you stated many years ago luvox worked very well for you. Have you forgotten that?
They have worked for many people in here and not worked for some. Go to askaptient.com and you will see how they really work.
Using yourself (one person) is not a scientific test of wether these meds work or not. Also knowing a few people is not scientific. Many in the real world will also tell you they benefitted from the meds.
Posted by topcatclr on February 5, 2010, at 23:13:52
In reply to Re: newsweek: antidepressants all placebo effect, posted by bulldog2 on February 5, 2010, at 15:36:21
Ya'
cracks me up when 1 persons experience means a drug does or doesn't work! These lame threads drive me crazy!
Posted by livingdeath on February 6, 2010, at 0:04:35
In reply to Re: newsweek: antidepressants all placebo effect, posted by bleauberry on February 4, 2010, at 18:30:59
"You know the real story and you don't even need any clinical studies or third-party research to do it. "
Spoken like a true believer. I have no doubt this person benefits from the placebo effect.
Posted by Dr. Bob on February 6, 2010, at 1:44:59
In reply to Re: newsweek: antidepressants all placebo effect, posted by livingdeath on February 6, 2010, at 0:04:35
> I have no doubt this person benefits from the placebo effect.
Please don't jump to conclusions about others or post anything that could lead them to feel accused or put down.
But please don't take this personally, either, this doesn't mean I don't like you or think you're a bad person, and I'm sorry if this hurts you.
Bleauberry, I'm also sorry if you felt hurt.
More information about posting policies and tips on alternative ways to express yourself, including a link to a nice post by Dinah on I-statements, are in the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
http://www.dr-bob.org/babble/faq.html#enforceFollow-ups regarding these issues should be redirected to Psycho-Babble Administration. They, as well as replies to the above post, should of course themselves be civil.
Thanks,
Bob
Posted by livingdeath on February 6, 2010, at 18:21:37
In reply to Re: newsweek: antidepressants all placebo effect » bleauberry, posted by Phillipa on February 4, 2010, at 19:20:29
Here's an NEJM article on this topic, from about a year ago.
Posted by djmmm on February 7, 2010, at 8:13:24
In reply to newsweek: antidepressants all placebo effect, posted by pegasus on February 3, 2010, at 12:46:49
Fascinating. I think most people are afraid to address the concept of placebo. I mean, what would happen if we knew the human brain had the capacity to heal itself, with simple intention, or belief? If we are given a placebo, and it works, we are forced to think outside the box. Maybe we should look at this article from a different perspective. How amazing is it, that placebo's work for some people. What is going on, within our minds, that allows this to happen? We should all be encouraged by research like this, because it forces us to acknowledge that we may have more control over our illnesses than the various pharmaceutical companies want us to have.
Posted by Cherry Carver on February 7, 2010, at 11:32:49
In reply to newsweek: antidepressants all placebo effect, posted by pegasus on February 3, 2010, at 12:46:49
I just read the Newsweek article--thank you for the link! Here's what I think:
First, I really don't like the high-and-mighty tone of Sharon Begley, the person who wrote the article. In all likelihood, she has never been a victim of depression or mental illness. She seems to feel disdain for anyone who requires medication, and wishes to disabuse us all of the notion that drugs can help alleviate depression. Aside from a shallow review of a few classes of drugs, she really doesn't know the bigger picture: that there ARE other drugs besides tricyclics, SSRIs, and NSRIs.
While none of those worked for me (most of them made me sick), it's not helpful for Begley to dismiss all antidepressants out of hand. I take Klonopin, a benzodiazepine, to control panic disorder. Unless I missed something, Begley doesn't discuss that class of drugs. Long before Prozac, there was Valium. It's still a very popular drug, and definitely not a sugar pill by any stretch of the imagination.
It's true that a lot of these newer antidepressants are prescribed too freely by family doctors who don't know enough about mental illness or pharmacology to be handing out prescriptions to clinically-depressed patients. However, in many cases these drugs have helped enough people to validate their efficacy. We are all wired differently. For instance, Cymbalta made me throw up all day after one dose, but other people say it gets them out of bed in the morning without pain.
My opinion: The problem is not so much that some of these drugs may have a placebo effect, but that some doctors think one size fits all, and it simply isn't so.
Posted by Deneb on February 7, 2010, at 16:15:20
In reply to Re: newsweek: antidepressants all placebo effect, posted by livingdeath on February 6, 2010, at 0:04:35
Hello Livingdeath!
Welcome to Psycho-Babble! I think the placebo effect is great. Anything that helps is good in my eyes. :-)
Posted by bulldog2 on February 8, 2010, at 14:08:25
In reply to Re: newsweek: antidepressants all placebo effect, posted by Cherry Carver on February 7, 2010, at 11:32:49
> I just read the Newsweek article--thank you for the link! Here's what I think:
>
> First, I really don't like the high-and-mighty tone of Sharon Begley, the person who wrote the article. In all likelihood, she has never been a victim of depression or mental illness. She seems to feel disdain for anyone who requires medication, and wishes to disabuse us all of the notion that drugs can help alleviate depression. Aside from a shallow review of a few classes of drugs, she really doesn't know the bigger picture: that there ARE other drugs besides tricyclics, SSRIs, and NSRIs.
>
> While none of those worked for me (most of them made me sick), it's not helpful for Begley to dismiss all antidepressants out of hand. I take Klonopin, a benzodiazepine, to control panic disorder. Unless I missed something, Begley doesn't discuss that class of drugs. Long before Prozac, there was Valium. It's still a very popular drug, and definitely not a sugar pill by any stretch of the imagination.
>
> It's true that a lot of these newer antidepressants are prescribed too freely by family doctors who don't know enough about mental illness or pharmacology to be handing out prescriptions to clinically-depressed patients. However, in many cases these drugs have helped enough people to validate their efficacy. We are all wired differently. For instance, Cymbalta made me throw up all day after one dose, but other people say it gets them out of bed in the morning without pain.
>
> My opinion: The problem is not so much that some of these drugs may have a placebo effect, but that some doctors think one size fits all, and it simply isn't so.Did they discuss maois (nardil,parnate,marplan)?
Posted by Cherry Carver on February 8, 2010, at 19:14:24
In reply to Re: newsweek: antidepressants all placebo effect, posted by bulldog2 on February 8, 2010, at 14:08:25
Only in passing, on page 1, anyway (mentioning their advent in the 1950s).
> > I just read the Newsweek article--thank you for the link! Here's what I think:
> >
> > First, I really don't like the high-and-mighty tone of Sharon Begley, the person who wrote the article. In all likelihood, she has never been a victim of depression or mental illness. She seems to feel disdain for anyone who requires medication, and wishes to disabuse us all of the notion that drugs can help alleviate depression. Aside from a shallow review of a few classes of drugs, she really doesn't know the bigger picture: that there ARE other drugs besides tricyclics, SSRIs, and NSRIs.
> >
> > While none of those worked for me (most of them made me sick), it's not helpful for Begley to dismiss all antidepressants out of hand. I take Klonopin, a benzodiazepine, to control panic disorder. Unless I missed something, Begley doesn't discuss that class of drugs. Long before Prozac, there was Valium. It's still a very popular drug, and definitely not a sugar pill by any stretch of the imagination.
> >
> > It's true that a lot of these newer antidepressants are prescribed too freely by family doctors who don't know enough about mental illness or pharmacology to be handing out prescriptions to clinically-depressed patients. However, in many cases these drugs have helped enough people to validate their efficacy. We are all wired differently. For instance, Cymbalta made me throw up all day after one dose, but other people say it gets them out of bed in the morning without pain.
> >
> > My opinion: The problem is not so much that some of these drugs may have a placebo effect, but that some doctors think one size fits all, and it simply isn't so.
>
> Did they discuss maois (nardil,parnate,marplan)?
Posted by Joe Schmoe on February 9, 2010, at 20:01:40
In reply to Re: newsweek: antidepressants all placebo effect » bulldog2, posted by Cherry Carver on February 8, 2010, at 19:14:24
I think the peculiar thing about the idea of ADs being just placebo effect is, why do they take 2-4 weeks to start working?
If it was just belief, wouldn't it work right away?
Does the placebo effect take 2-4 weeks to work in studies relating to drugs for other things like irritable bowel syndrome?
Posted by jedi on February 9, 2010, at 23:27:59
In reply to Re: newsweek: antidepressants all placebo effect, posted by Joe Schmoe on February 9, 2010, at 20:01:40
Of course the placebo effect is real. I've felt it myself when just starting a new medication. But in the case of antidepressants, that is not the true effect. I agree with Joe. An AD response that I have to wait 4 weeks in hell to achieve is not a placebo effect.
Anybody, with serious major depression, who has felt Nardil kick in, knows what I am talking about. It takes time, but when it works, it can be like flipping a switch. This medication has saved my life more than once. Anybody that tells me it is a placebo, better have been in that fetal position on the floor, suffering the unbearable psychic pain that major depression causes.
This is not a game we are all playing. Any illness that is painful enough for a person to consider taking their own life, is right up there with the worse of the purely physical ailments. It takes more than a placebo to break that cycle.
Be Well,
Jedi> I think the peculiar thing about the idea of ADs being just placebo effect is, why do they take 2-4 weeks to start working?
>
> If it was just belief, wouldn't it work right away?
>
> Does the placebo effect take 2-4 weeks to work in studies relating to drugs for other things like irritable bowel syndrome?
Posted by Cherry Carver on February 10, 2010, at 15:19:46
In reply to Re: newsweek: antidepressants all placebo effect, posted by Joe Schmoe on February 9, 2010, at 20:01:40
Bingo! That didn't occur to me when I was reading the article, but you have found the deductive fallacy in Begley's discussion. Good work!
> I think the peculiar thing about the idea of ADs being just placebo effect is, why do they take 2-4 weeks to start working?
>
> If it was just belief, wouldn't it work right away?
>
> Does the placebo effect take 2-4 weeks to work in studies relating to drugs for other things like irritable bowel syndrome?
Posted by Cherry Carver on February 10, 2010, at 15:36:41
In reply to Re: newsweek: antidepressants all placebo effect, posted by jedi on February 9, 2010, at 23:27:59
Very profound statement, Jedi...mental illness is one of the worst diseases in the world because, unless one is drooling and blithering, nobody can see it, and many "sane" people neither understand it nor want to.
I'd rather have cancer than this. Some people wear cancer like a badge--some literally do, with pink ribbons and so forth. Is there a ribbon color for mental illness? I don't think so.
> This is not a game we are all playing. Any illness that is painful enough for a person to consider taking their own life, is right up there with the worse of the purely physical ailments. It takes more than a placebo to break that cycle.
> Be Well,
> Jedi
Posted by Cherry Carver on February 10, 2010, at 15:39:09
In reply to Re: newsweek: antidepressants all placebo effect, posted by jedi on February 9, 2010, at 23:27:59
Forgot to click the "name of previous poster" box on my last post--it's for Jedi.
Posted by linkadge on February 13, 2010, at 8:01:45
In reply to Re: newsweek: antidepressants all placebo effect » Joe Schmoe, posted by Cherry Carver on February 10, 2010, at 15:19:46
> If it was just belief, wouldn't it work right away?
Well, not necessarily. There is something broken in depression. The body is in a disease state. Inflamation, neurotransmitter, neuropeptide imballances, stress hormones out of control..If one does take a placebo and one believes they are taking an active drug - there are real changes in the immune system etc. Just being cared for lowers stress hormones. But acutely lowered stress hormones does not heal somebody immediately. Hope can change things, but it still takes time for healing to take place.
Oh, and it doesn't take 2-4 weeks for the drug to kick in. *Many* people on this board say the opposite - that it started to work immeditely, but pooped out after 2-4 weeks.
Linkadge
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