The drugs do work: antidepressants are effective, study shows

A review from a cardiologist of the meta-analysis posted in the original post in this thread :

Fawning Coverage of New Antidepressants Review Masks Key Caveats

A recent review and meta-analysis of 522 randomised trials, including about 117,000 participants suffering from depression, has concluded that all antidepressants are better than a dummy tablet.
Click to expand...

While numerous studies were included, the analysis and review itself seem to be mathematical and unidimensional. The number of patients in these studies is too small and the follow-up too brief to make a convincing argument about effectiveness. It is well known that antidepressant pills take as long as a month to kick in, that dropout rates are high (as much as 400% more than placebo), while their efficacy as compared to placebo is marginal in clinical terms.
Click to expand...

As a cardiologist, I am concerned that amitriptyline, a tricyclic antidepressant developed in the 1950s, has emerged as the most effective antidepressant compared to placebo. Amitriptyline is notorious for triggering sustained ventricular tachycardia. This is a potentially lethal rhythm disturbance that can kill if not treated immediately. Almost every heart patient whose heart has been weakened (by a previous heart attack, hypertension, valvular pathology, etc.) is susceptible to it.
Click to expand...
 
Just heard this on the news:
"
The Royal College of Psychiatrists challenged over burying of inconvenient antidepressant data

The following letter was sent, by email, at 2.26pm today:

To: Professor Wendy Burn, President – Royal College of Psychiatrists;
Professor David Baldwin, Chair, Psychopharmacology Committee – Royal College of
Psychiatrists.

February 28, 2018

Dear Professors Burn and Baldwin

On 24.2.2018 The Times published a letter signed by you, in your capacities as President, and Chair of the Psychopharmacology Committee, of the Royal College of Psychiatrists (RCP). In that letter you made the following claim: ‘We know that in the vast majority of patients, any unpleasant symptoms experienced on discontinuing antidepressants have resolved within two weeks of stopping treatment’

We believe that statement is not evidence-based, is incorrect and has misled the public on an important matter of public safety."

the rest here:
http://cepuk.org/2018/03/01/royal-c...ged-burying-inconvenient-antidepressant-data/
 
Another article
Royal College of Psychiatrists leaders accused of 'dangerous' and 'misleading' comments on antidepressant withdraw
Marion Brown, a psychotherapist from Helensburgh who has been petitioning the Scottish Parliament to improve the support available to patients harmed by dependence on prescription pills including antidepressants, said professors' letter was "absolutely shocking". Her petition has been backed by organisations including the BMA.

She added: "The Royal College of Psychiatrists either have no idea of the problems these drugs, and antidepressants in particular, are causing, or they do know and they're trying to not know - a wilful blindness."

The letter of complaint, submitted by Dr John Read, a professor of clinical psychology at the University of East London, is signed by another 29 psychiatrists, academics and patients who have suffered years of withdrawal symptoms after coming off antidepressants
Click to expand...
http://www.heraldscotland.com/news/...ments_on_antidepressant_withdrawal/?ref=fbshr

And Sir Simon himself, with his incomparable condescending tone:

I saw several tweets of people complaining of being classified as having "medically unexplained symptoms" when trying to withdraw from antidepressants.
What a convenient dust bin to avoid taking any responsabilty at any time...
 
"
The Horrific Effects of Not Being Believed

By most accounts Jose Mario Bergolio is a remarkable person. It came as a shock to his fans then a few months ago when he visiting Chile he came out against victims of child abuse. The issue centered on one bishop whom survivors of abuse fingered as complicit with what had happened. JMB obviously liked the man and took the position he was innocent until proven guilty.

When it comes to us, you have to believe in us but for us to believe in you we need proof.

This is the same dynamic as found in establishment (Royal College of Psychiatrists, APA, WPA and other physician organizations) responses to Drug Wrecks such as antidepressant dependence. The plural of anecdotes is not data, they say. We have the data, all you have is anecdotes.

When power is at play, those with power are innocent until proven guilty, those without it are guilty until proven innocent. It has been ever thus.

What the Chile case and the Antidepressant Withdrawal Saga bring out is the horrific consequences of not being believed."

"The New York Times recently ran an article on Antidepressant Dependence and Withdrawal. This was dissed by British College of Psychiatrist figures from Wendy Burn to Simon Wessely."

full article (quite short) here:
https://davidhealy.org/the-horrific-effects-of-not-being-believed/
 
Yup, big pharma galore:
Declaration of interests

ACi is supported by the National Institute for Health Research (NIHR) Oxford Cognitive Health Clinical Research Facility. TAF has received lecture fees from Eli Lilly, Janssen, Meiji, Mitsubishi-Tanabe,
Merck Sharp & Dohme, and P zer; consultancy fees from Takeda Science Foundation; and research support from Mochida and Mitsubishi-Tanabe. SL has received honoraria for consulting from

LB Pharma, Lundbeck, Otsuka, TEVA, Geodon Richter, Recordati,
LTS Lohmann, and Boehringer Ingelheim; and for lectures from Janssen, Lilly, Lundbeck, Otsuka, Sano Aventis, and Servier. NT has received lecture fees from Otsuka and Meiji. YH has received lecture fees from Yoshitomi. JRG is an NIHR Senior Investigator. All other authors declare no competing interests.
Click to expand...
 
As you were!
Antidepressants Work for Major Depression! Not so Fast

Written in Medscape by Nassir Ghaemi, MD, MPH, Professor of Psychiatry, Tufts Medical Center, Tufts University School of Medicine; Lecturer in Psychiatry, Harvard Medical School, Boston, Massachusetts; Director, Translational Medicine-Neuroscience, Novartis Institutes for Biomedical Research, Cambridge, Massachusetts.

"The latest attempt to trick ourselves into believing that the past few decades of prescribing antidepressants has been an effective strategy comes from one of the most prestigious medical journals, The Lancet. The published meta-analysis' basic finding—since repeated all over the press—is that antidepressants work because they are all better than placebo. What they don't tell you is that they are hardly any better than placebo, and that the only drugs with clinically meaningful benefits are the ones that are used rarely today, the older tricyclic agents."

In the final paragraph he questions the validity of the Major Depressive Disorder concept itself:
"This conclusion puts aside the more important issue of the scientific validity of the MDD concept itself, which the authors ignore completely. Our profession seems devoted to believing that antidepressants "work." They don't, at least not for "MDD"."

He also says, " ... one has to go to page 142 of the appendix [in the Lancet] to find the real result of all this effort: This meta-analysis confirms the results of prior meta-analyses which found that antidepressants have small overall effects in "MDD" and do not provide major clinical benefit in general."

Why wasn't that rather critical bit of statistical info, showing that the effects of antidepressants are clinically meaningless, included in the body of the article?!

https://www.medscape.com/viewarticl...t_wir&uac=69945CY&spon=17&impID=1661939&faf=1
 
Last edited:
oldtimer said:
As you were!
Antidepressants Work for Major Depression! Not so Fast

Written in Medscape by Nassir Ghaemi, MD, MPH, Professor of Psychiatry, Tufts Medical Center, Tufts University School of Medicine; Lecturer in Psychiatry, Harvard Medical School, Boston, Massachusetts; Director, Translational Medicine-Neuroscience, Novartis Institutes for Biomedical Research, Cambridge, Massachusetts.

"The latest attempt to trick ourselves into believing that the past few decades of prescribing antidepressants has been an effective strategy comes from one of the most prestigious medical journals, The Lancet. The published meta-analysis' basic finding—since repeated all over the press—is that antidepressants work because they are all better than placebo. What they don't tell you is that they are hardly any better than placebo, and that the only drugs with clinically meaningful benefits are the ones that are used rarely today, the older tricyclic agents."

In the final paragraph he questions the validity of the Major Depressive Disorder concept itself:
"This conclusion puts aside the more important issue of the scientific validity of the MDD concept itself, which the authors ignore completely. Our profession seems devoted to believing that antidepressants "work." They don't, at least not for "MDD"."

He also says, " ... one has to go to page 142 of the appendix [in the Lancet] to find the real result of all this effort: This meta-analysis confirms the results of prior meta-analyses which found that antidepressants have small overall effects in "MDD" and do not provide major clinical benefit in general."

Why wasn't that rather critical bit of statistical info, showing that the effects of antidepressants are clinically meaningless, included in the body of the article?!

https://www.medscape.com/viewarticl...t_wir&uac=69945CY&spon=17&impID=1661939&faf=1
Click to expand...

There is a Vox article i was planning on starting a thread on that comes the the same conclusion, been saving it till i can give it cognitive energy

Edit: I'll post it now and do replies later

Edit 2: Posted
https://www.s4me.info/threads/we-need-new-kinds-of-antidepressants-in-addition-to-pills.4777/
 
Last edited:
Happen to be reading this older 2018 study, great to see that there's already a S4ME thread for it.

Although this meta-analysis found an effect, for most antidepressants it was notably small. The paper states:
The random-effects summary SMD for all antidepressants was 0·30 (95% CrI 0·26–0·34
Click to expand...

This is an overview from the supplementary material (page 150). For Prozac (Fluoxetine) the effect is only 0.23 standard deviations. So even if antidepressants work, it seems that on average they only have a small effect.

upload_2025-2-16_21-19-8.png
 
These arguments from the response by Joanna Moncrieff also make sense:
The analysis consists of comparing ‘response’ rates between people on antidepressants and those on placebo. But ‘response’ is an artificial category that has been arbitrarily constructed out of the data actually collected, which consists of scores on depression rating scales, like the commonly used Hamilton rating Scale for Depression (HRSD). Analysing categories inflates differences (3). When the actual scores are compared, differences are trivial, amounting to around 2 points on the HRSD which has a maximum score of 54. These differences are unlikely to be clinically relevant, as I have explained before. Research comparing HRSD scores with scores on a global rating of improvement suggest that such a difference would not even be noticed, and you would need a difference of at least 8 points to register ‘mild improvement’.

Moreover, even these small differences are easily accounted for by the fact that antidepressants produce more or less subtle mental and physical alterations (e.g. nausea, dry mouth, drowsiness and emotional blunting) irrespective of whether or not they treat depression. These alterations enable participants to guess whether they have been allocated to antidepressant or placebo better than would be expected by chance (4). Participants receiving the active drugs may therefore experience amplified placebo effects by virtue of knowing they are taking an active drug rather than an inactive placebo. This may explain why antidepressants that cause the most noticeable alterations, such as amitriptyline, appeared to be the most effective in the recent analysis.
Click to expand...
Challenging the new hype about antidepressants | Joanna Moncrieff
 
Sly Saint said:
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:cake: oh no, can't do that as well

:emoji_circus_tent:
Click to expand...
Wow to that third one down when I read the full article- it’s full of fallacy and straw men

but reading it today - tbf there was no excuse then as PACE had been reanalysed by then - his straw man ‘anyone saying CBt isn’t the best is suggesting a conspiracy theory of a CBT mafia’ looks scarily prescient that he was in the know and just trying to make it sound jokingly like a conspiracy theory

it’s incredibly sophist where he has a whole paragraph trying to suggest anyone who disagrees doesn’t get it's scientifically underpinned but then based his ‘evidence for it being scientific truth’ on ‘eminence’ by saying ‘because in the UK it’s the most serious scientists doing this CBT proof research’... guess who he thinks are 'scientists' for the purposes of this claim?

very strange article where I can’t tell if it’s someone deluded themselves or just happy to go so far to ‘persuade’ others that ‘there's nothing to see here’
 
Last edited:
Cheshire said:
Another article
Royal College of Psychiatrists leaders accused of 'dangerous' and 'misleading' comments on antidepressant withdraw

http://www.heraldscotland.com/news/...ments_on_antidepressant_withdrawal/?ref=fbshr

And Sir Simon himself, with his incomparable condescending tone:

I saw several tweets of people complaining of being classified as having "medically unexplained symptoms" when trying to withdraw from antidepressants.
What a convenient dust bin to avoid taking any responsabilty at any time...
Click to expand...

That issue of wilful blindness (also wilful ignorance, callous indifference) seems to come up a lot for this area

if they aren’t all guilty of it themselves then there is an issue with accepting it in others to the level of it being culture that gets printed in articles without anyone blinking about how it comes across as disdain to patient feedback where it’s inconvenient and a methodological blind spot due to a belief in patient voice being to be ignored

interesting to see it having come up before for other things
 
Could amitriptyline and other trycyclic drugs make a person susceptible to insuline resistance and therefore susceptible to ME/CFS?

In my early 20's I was given those pills as a pacifier between two intake-sessions when I asked for assertiveness therapy. I had to wait 10 weeks or more.
I gained 5 kg in 5 weeks, even though playing volleyball, 2 trainings and a match weekly. After 5 weeks I stopped taking the pills.
Might that be enough to cause insuline resistance?

After that I had weight problems untill I was diagnosed with diabetes II at 61. I lost 15 kg back then and had no weight problem anymore.
Metformin works for diabetes and insuline resistance. I was never tested for insuline resistance.

Can trycyclics do more harm than good?
 
You must log in or register to reply here.
Back
Top Bottom