The drugs do work: antidepressants are effective, study shows

Link to whole paper : http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(17)32802-7.pdf

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

Summary

Background
Major depressive disorder is one of the most common, burdensome, and costly psychiatric disorders worldwide in adults. Pharmacological and non-pharmacological treatments are available; however, because of inadequate resources, antidepressants are used more frequently than psychological interventions. Prescription of these agents should be informed by the best available evidence. Therefore, we aimed to update and expand our previous work to compare and rank antidepressants for the acute treatment of adults with unipolar major depressive disorder.

Methods
We did a systematic review and network meta-analysis. We searched Cochrane Central Register of Controlled Trials, CINAHL, Embase, LILACS database, MEDLINE, MEDLINE In-Process, PsycINFO, the websites of regulatory agencies, and international registers for published and unpublished, double blind, randomised controlled trials from their inception to Jan 8, 2016. We included placebo-controlled and head-to-head trials of 21 antidepressants used for the acute treatment of adults (≥18 years old and of both sexes) with major depressive disorder diagnosed according to standard operationalised criteria. We excluded quasi-randomised trials and trials that were incomplete or included 20% or more of participants with bipolar disorder, psychotic depression, or treatment-resistant depression; or patients with a serious concomitant medical illness. We extracted data following a predefined hierarchy. In network meta-analysis, we used group-level data. We assessed the studies’ risk of bias in accordance to the Cochrane Handbook for Systematic Reviews of Interventions, and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. Primary outcomes were efficacy (response rate) and acceptability (treatment discontinuations due to any cause). We estimated summary odds ratios (ORs) using pairwise and network meta-analysis with random effects. This study is registered with PROSPERO, number CRD42012002291.

Findings
We identified 28 552 citations and of these included 522 trials comprising 116 477 participants. In terms of efficacy, all antidepressants were more effective than placebo, with ORs ranging between 2·13 (95% credible interval [CrI] 1·89–2·41) for amitriptyline and 1·37 (1·16–1·63) for reboxetine. For acceptability, only agomelatine (OR 0·84, 95% CrI 0·72–0·97) and fluoxetine (0·88, 0·80–0·96) were associated with fewer dropouts than placebo, whereas clomipramine was worse than placebo (1·30, 1·01–1·68). When all trials were considered, differences in ORs between antidepressants ranged from 1·15 to 1·55 for efficacy and from 0·64 to 0·83 for acceptability, with wide CrIs on most of the comparative analyses. In head-to-head studies, agomelatine, amitriptyline, escitalopram, mirtazapine,
paroxetine, venlafaxine, and vortioxetine were more effective than other antidepressants (range of ORs 1·19–1·96), whereas fluoxetine, fluvoxamine, reboxetine, and trazodone were the least efficacious drugs (0·51–0·84). For acceptability, agomelatine, citalopram, escitalopram, fluoxetine, sertraline, and vortioxetine were more tolerable than other antidepressants (range of ORs 0·43–0·77), whereas amitriptyline, clomipramine, duloxetine, fluvoxamine, reboxetine, trazodone, and venlafaxine had the highest dropout rates (1·30–2·32). 46 (9%) of 522 trials were rated as high risk of bias, 380 (73%) trials as moderate, and 96 (18%) as low; and the certainty of evidence was moderate
to very low.

Interpretation
All antidepressants were more efficacious than placebo in adults with major depressive disorder. Smaller differences between active drugs were found when placebo-controlled trials were included in the analysis, whereas there was more variability in efficacy and acceptability in head-to-head trials. These results should serve evidence-based practice and inform patients, physicians, guideline developers, and policy makers on the relative merits of the different antidepressants.

Funding
National Institute for Health Research Oxford Health Biomedical Research Centre and the Japan Society for the Promotion of Science.

Link to whole paper : http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(17)32802-7.pdf

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What can I say? My cynicism knows no bounds...

Please note, according to the full paper, they were looking for outcomes after just 8 weeks of treatment. When I have been put on anti-depressants I have always been told that they take at least 6 weeks to work. And if I have then seen a doctor and said "These don't work" I've been told to continue taking them because they may need a few more weeks to work.

 

Personally I can't recommend this book highly enough:

 

yes I'm afriad that knowing what i do about the SMC & about such 'meta analyses' (eg cochrane) I am skeptical to say the least. I mean i dont know if they work or not, but i dont trust this one little bit. I'll be happy to be proven wrong, but just the reports in the press that so many more people should be on them & that big pharma funding makes no difference to outcome.... yeah right.

 

If you're not high 100% of the time, you're abnormal and need antidepressants. Also, if you have any unexplained physical symptoms such as GI issues or remarkably poor stamina then you're probably also depressed, because depression works in mysterious ways. Signed, the pharma industry.

Edit: sure enough, articles are already out saying that "Patients and GPs must not be squeamish about treating mental health problems with drugs" https://www.thetimes.co.uk/article/more-people-should-get-pills-to-beat-depression-sv5vhczss

What is omitted here is that there is also a relentless push to promote the view that all sorts of physical symptoms are really due to a hidden mental health issue.

 

Those couple of documentaries on the flip sides of SSRIs and David Healy prolifically blogging perhaps denting market share?

For some these drugs are lifelines, for others a living hell.

 

Can you remember more details? I would be interested.

 

http://news.bbc.co.uk/1/hi/programmes/panorama/5346938.stm

 

"We assessed the studies' risk of bias in accordance to the Cochrane Handbook for Systematic Reviews of Interventions."

"Depressive symptoms tend to spontaneously improve over time and this phenomenon contributes to the high percentage of placebo responders in antidepressant trials."

"Another possible explanation could be a bias in conduct, analysis, or reporting of head-to-head trials, driven by commercial interests.27 In our analyses, funding by industry was not associated with substantial differences in terms of response or dropout rates. However, non-industry funded trials were few and many trials did not report or disclose any funding."

"However, many trials did not report adequate information about randomisation and allocation concealment, which restricts the interpretation of these results."

"We did not cover important clinical issues that might inform treatment decision making in routine clinical practice (eg, specific adverse events, withdrawal symptoms, or combination with non-pharmacological treatments). Additionally, because of the paucity of information reported in the original studies, we were not able to quantify some outcomes, such as global functioning.

It should also be noted 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."

eta: it's not as cut and dry as the media make it out to be

 

I watched this story about anti-depressants on 60 Minutes a few years ago.

https://www.youtube.com/watch?v=BDAf8GtUr7Q

 

Antidepressants may raise death risk by a third
Sept 2017
A new study suggests that common antidepressants may pose a serious risk to health; they drastically raise the risk of mortality

The first author of the study - which is published in the journal Psychotherapy and Psychosomatics - is Marta Maslej, from McMaster University, and the lead investigator is Paul Andrews, who is an associate professor at McMaster University.
Prof. Andrews and his team conducted a meta-analysis of existing research from various medical databases, looking for a link between mortality and antidepressant use. The analysis comprised 16 studies, summing up approximately 375,000 participants.

The researchers pulled out data on cardiovascular diseases, cardiovascular risk, and the class of antidepressants. They looked at SSRIs, tricyclic antidepressants, and others."
"The analysis found that in the general population, those taking antidepressants had a 33 percent higher risk of dying prematurely than people who were not taking the drugs. Additionally, antidepressant users were 14 percent more likely to have an adverse cardiovascular event, such as a stroke or a heart attack. "

https://www.medicalnewstoday.com/articles/319462.php

eta:
"Death and serious outcomes resulting from overdose or poisoning from drugs used to treat depression more than doubled during the last decade and a half, found a recent study, with amitriptyline topping the list. Fatal cases overall increased by 32%, and amitriptyline accounted for approximately 2 of 5 deaths from antidepressants, the results showed."
https://www.psychiatryadvisor.com/d...y-and-mortality-in-depression/article/640096/

 

Is that entirely true? I was under the impression amitriptyline was first designed as an antihistamine but was then found to have anti-depressive qualities too...rather by accident. Imo the TCAs are much safer long term be it for sleep or pain and for depression where required. The SSRIs otoh can be very grim..dangerously grim. But individual responses vary. It's probably better to take none of these drugs unless absolutely necessary (and in this vacuum of drugs better designed for whatever purpose..again pain/ sleep/ depression / anxiety) . Roll on individualised medicine whereby the dangers of particular drugs in particular individuals can be assessed ahead of Rx.

 

https://www.msn.com/en-in/health/me...-you-are-suffering-from-depression/ar-AAb8Wfj

"13 hidden signs that tell you are suffering from depression" - see number 12 (MUS) and unlucky 13 (fatigue)

 

Bit of a conundrum looming:
When NICE were singing the praises of CBT:
"
Many mental health groups welcome the shift in emphasis in recent years away from medication towards personalised therapy."
http://www.dailymail.co.uk/health/a...-term-solution-says-leading-psychologist.html

then a shift:

"Another hit to CBT’s reputation came in 2012 from Sweden’s National Board of Health and Welfare, which, after placing CBT at the top of a list of recommended treatments for depression and anxiety, concluded after a two-year trial period that CBT had no noticeable advantage over alternative therapies and that increasing numbers of clients were dropping out of treatment after finding it ineffective. By that time, more than two billion Swedish kronor had been spent in financial incentives to therapists who made CBT their preferred mode of treatment."

https://www.psychotherapynetworker....behavioral-therapy-as-effective-as-clinicians

"Unless we want to consider a world-wide conspiracy of a CBT mafia, we might want to consider the fact that leading serious scientists have concluded that the evidence favors CBT. Indeed, the United Kingdom has advanced the largest dissemination of psychological treatments ever implemented—primarily CBT—in the program called, Improving Access to Psychological Treatments. This program was begun under Prime Minister Tony Blair ."

https://www.psychologytoday.com/blo...itive-behavioral-therapy-proven-effectiveness

"Researchers have found that CBT is roughly half as effective in treating depression as it used to be’

https://www.theguardian.com/lifeand...-cbt-is-falling-out-of-favour-oliver-burkeman

to CBT or not to CBT that is the question, the answer: anti-depressants(?)

just let them eat cake oh no, can't do that as well

 

Amphetamines, anti anxiety drugs, marijuana and even alcohol will relieve depression. Not to mention the scientists who are promoting Ecstasy for PTSD. I can do a study on all of them and prove efficacy, that doesn't prove we have biochemical imbalances causing depression (or that death, divorce or abuse cause them), its a testament to the ability to find ways to "easily" cloak emotional pain.

This is what doctors are now taught to do

Yeah, but people accept it because painful feelings being chased away in an easy to take pill is very appealing.

You can also look into the books by Peter Breggin.

 

It's all over the news in every uk tv channel. Scientists comments that more drugs needs to be used. I don't know what to say.

 

Medicine: You are healthy. All your tests are normal. We don't know why you feel sick. There is nothing we can do for you.

Psychiatry: We know exactly what is wrong with you. Fortunately, it's just a matter of finding the right combination of meds and you will be fine. We promise.

 

A dissenting view:

https://joannamoncrieff.com/2018/02/24/challenging-the-new-hype-about-antidepressants/amp/

Breggin is a little too anti-drugs and pro-psychotherapy for my taste. Both have their place, if used appropriately.

 

I followed a link from NelliePledge's link, then followed some more links to end up here :

http://www.twitlonger.com/show/n_1sqea1l

It is a presentation/speech that a Danish MP wanted to give in the Danish Parliament but for some reason couldn't give it in it's original form. In the end he posted this original version online. He refers to various slides. They are described at the bottom of the page. It's about functional disorders, MUS, bodily distress syndrome, and related subjects.

It is absolutely terrifying.