Let me be the first to call, "Bullshit!"

In the interests of full disclosure, I do take antidepressants. I am not thrilled with the side effects I've experienced, but I am more than satisfied overall. That said -

I'm reading the paper now, and will post a detailed critique here (and possibly on my blog). For now, I'll just say that there is some truly spectacular cherry picking going on, and that's before I've gotten into the numbers.

I agree. Multiple studies have shown that the effects of these drugs are minimal at best for a large majority of patients, but they can be a lifesaver for many people. Plus, the drugs have some really great off-label uses for other diseases and conditions like insomnia, smoking cessation, and premenstrual syndrome.

I take sertraline and it has improved my life greatly. When I was depressed, I felt fatigued all of the time. I cried for no reason. My anxiety levels were through the roof, and I couldn't cope with even the smallest crisis. I was a terrible employee, wife, mother, and student when I was like that.

And seriously, there are tons of drugs with warnings for use in the elderly. Just because a drug has a Black Box warning on it, doesn't mean that the drug is bad. Lots of drugs have Black Box warnings over complications that have only happened with the drug a handful of times.

I'm on the other end. I've gone through dozens of antidepressants over the years because of side effects. The drugs didn't hep as much as time did, but they have been a dogsend for others I know. The newer ones do seem to work better for me.


Disclaimer: Anecdotes do not equal data.

x2. Accepting that anti-depressants can make a real difference for many people, it is not a solution for all and can in fact do damage.

Notice anything missing here?

http://www.frontiersin.org/Evolutionary ... 00117/full

Actually, I don't. I might be missing something bloody obvious, but to me that looks like a standard way to report author affiliations in a research paper.

I disagree it's bullshit or 2x bullshit.

One of my volunteer endeavours is to work with enlisted folks recently discharged after multiple deployments to Iraq/Afghanistan. The single thing that helps the healing is exercise because it actually works with no adverse side effects (Mayo Clinic)

The pharmaceuticals I've seen prescribed have all been both ineffective and damaging.

OK. There are a lot of little problems with this study, most of which are not worth getting into in great detail, at least yet. (Although, for the record, I'd like to point out that "not quite statistically significant" is like "not quite pregnant". It's either significant, or it's not.)

For those who wish to play along at home, the paper itself can be found here:
http://www.frontiersin.org/Evolutionary ... 00117/full

Instead of getting into major nit-picking (and, believe me, there are quite a few nits to pick with this paper), I'm just going to look at two things: the listing of costs and benefits, and the method used to assess effectiveness of anti-depressants.

If you look at their Table 2, you'll find a list of effects of anti-depressants. The list is rather heavily stacked toward showing costs and minimizing benefits. For example, under the "Mood" heading, each class of SSRI has a separate listing for relapse after discontinuation. "Reduce Depressive Symptoms" has a single line for all classes of drug (and is identified as neither a pro nor a con, an issue I'll get to momentarily). If you look at the section for "Gastrointestinal Effects", you'll note that each possible side effect has its own line, with each listed as a con. If you look back up to "Mood", you'll note that "Reduce Depressive Symptoms" is a single entry, and absolutely no attempt is made to look at the range of symptoms.

The assessment of the effectiveness of anti-depressants is even more problematic, particularly since it's the basis for their rather strongly worded conclusion:


Their basis for this statement is a study that did a comprehensive meta-analysis of all of the data received by the FDA, published or unpublished. That study found that anti-depressants provided, on average, only a 1.8 point improvement in depressive symptoms when measured on a particular scale, when compared with the effectiveness of placebos. The threshold used to determine clinical significance is a three-point improvement. Therefore, they conclude that anti-depressants do not provide a clinically significant improvement compared with placebo.

What they don't mention is just how much improvement placebos generate. The placebo effect on depression is enormous. Placebos are quite effective in anti-depressant treatment. Every study used in the analysis demonstrated at least a three point improvement with placebo use, and many demonstrated 9-10 point improvements. The 1-2 point performacne improvement over placebo is not an improvement from baseline; it's a further improvement beyond the clinically significant effect that placebos have. And, although not "clinically significant", the 1-2 point improvement over placebo is very clearly statistically significant. Basically, placebos typically generate a 7-8 point improvement, and antidepressants a 9-10 point difference.

It's also noteworthy that the relative effectiveness of the antidepressants compared with placebo reaches clinical significance in the most depressed patients. The authors of the study take pains to point out that this is not because the antidepressants are producing more improvement in these groups, but because the placebo is less effective. I'm not sure why that's supposed to be a bad thing, but the authors seem to be attempting to portray it as such.

Antidepressants and placebos both show clinically significant improvements in mood. And placebos cannot ethically be prescribed - and even if they could, they would almost by definition lose effectiveness if it were to become widely known that they are being prescribed. Add to that the modest increase in effectiveness of medication over placebo, and prescription of antidepressants looks much more reasonable.

I'm a big, big believer in the effectiveness of exercise for depression. It's been enormously helpful to me, personally. I'd go so far as to say that exercise alone would probably be more effective for me than medication alone. But the medication has still been a big help.

I need my medications. I do exercise as time allows, and it does help. But without my medications, I would be dead. It's that simple. The drugs I take keep me stable enough to function and deal with what life throws at me.

I am also in therapy, which helps quite a bit. Unfortunately, I will probably be one of those people that will need to be on medication for the rest of my life. But if it's what keeps me alive, functioning, and relatively sane, I'm all for it. I'll live with the nausea and weight gain. I would rather be fat and stable than thin and suicidal.

And I have no standing to gainsay anyone else's experiences.

All I can go by is my 9 years experience helping people get over their post combat depression. Uniformly and consistently medication has prevented healing and exercise and group/individual therapy have eliminated the depression.

Your group of patients is obviously clinically different than the average patient with major depressive disorder. Apples to oranges.

I'll put it this way, JT:
Whether the conclusion is right or wrong, the paper itself sucks. Shoddy research, not a good understanding of evolution, extremely questionable interpretation of data presented, and that's without taking the time to look at whether or not the methods of analysis selected were remotely reasonable. That would be my conclusion even if I was inclined to agree with their interpretation of their work.

Highland's point is also well taken. Combat veterans with symptoms of depression may be a very different group overall from the classic civilian major depressive disorder population.

Which goes against existing research.

I'll not argue with anyone's specific experience, but exercise is FAR more effective than medication for treating depression whether you want to admit it or not.

Here.

Here.

Here.

Here.

Here.

Here.

Here.

A follow-up to that study found that exercise’s effects lasted longer than those of antidepressants. Researchers checked in with 133 of the original patients six months after the first study ended. They found that the people who exercised regularly after completing the study, regardless of which treatment they were on originally, were less likely to relapse into depression.

Does it apply to every instance? Hardly. Is there a medical basis for the originally posted article? Absolutely.

C'mon, John, nobody argued for medication instead of or to the exclusion of exercise here.

My husband suffers from severe depression. Depression runs in both sides of his family.
He has been taking anti-depressants and a mood stabilizer for about 8 yrs now. They have made a tremendous difference in his life and our life together.

I told him about this article/thread and he had the following to say:

Quote:

Insomnia's Hubby:
"The improvement in my life is so great. If anti-depressants shorten my life span it's still worth it. I may sacrifice some time at the end, but without anti-depressants I wouldn't make it to the end.

A. I wouldn't make it to the end, I would kill myself long before old age.
B. The quality of my life is so improved now, that dealing with any side effects is worth not having to deal with the effects of severe depression. I used to think about suicide every day. If it wasn't for anti-depressants I would be divorced & then dead.

He also wants to know - did whoever write that article suffer from depression? Do they have any idea what it feels like to suffer from major depression?
(I know it's not relevant, but he got kind of upset - his meds have helped him so much he got kind of offended. Those of you who like to get angry at comments like this - please don't yell at me. I am just the messenger on this one.)


He is right about the divorced part. His depression was causing him to sabotage our relationship. He felt he never deserved to be happy so he tried to make our lives as miserable as possible. He also felt it would be easier to kill himself without me around and tried to make me leave.

Instead of making me leave, he just made me mad and I made him go to therapy (he went to 4 therapists before finding one that could help him), and I talked him into starting his meds. It was a huge struggle, but he did it.

He still has bad times, but things are so much better now. I recently asked him "Who are you, and what did you do with my husband?"
His reply: "Just don't look in the crawlspace, that's where I keep my pod."

I'd say that there's considerable evidence that exercise is an effective treatment for depression. Some of the evidence suggests that it can be as effective as medication. I don't think a strong case can be made - at least at the moment - that it's more effective. As far as I can tell, there have been very few studies that have looked at medication + exercise, rather than pure side by side comparisons. Studies looking at whether exercise can help patients that do not respond to medication, or vice versa, are nonexistent.

But you can't show any of that - or, really, anything else - from the article you cited at the top of the thread. You definitely can't show that antidepressants do more harm than good based on that analysis. They might actually do more harm than good in many cases - it's not at all out of the realm of possibility - but the research done in that article is quite simply so poor that if they happen to be correct it will have little to do with rigorous analysis and lots to do with coincidence.

I just skimmed the paper, but at first glance it didn't distinguish between the worried-well (i.e., people who do not suffer from an ongoing mental illness bur are currently in difficulty) and those who are seriously ill. Second, it seemed it was really talking about SSRI's not the earlier or later antis. Third, it didn't seem to acknowledge that any particular anti-depressant only works on about ~40% of the people who take it which will always make the med to placebo ratio is fairly close, but fail to understand the total picture of what happens when the patient eventually finds to right med/cocktail. Finally, it didn't seem to address the medicalization of "normal" depression which would also wind up with the placebo doing well as people recover from "normal" depression on their own in a fairly reasonable time frame.

I'm bipolar and over the last 30 years have taken anti-depressants when I have wound up seriously depressed and unable to function in even a minimal fashion. It has only happened a handful of times, yet I know that they gave me back my life. I'm off the anti-depressants the minute I can get exercise and various activities back on line, but without them I don't think I would be alive today.

All medication comes with risk and side effects. Those of us suffering from any type of serious illness, know it's a balancing between the risk/side effects of taking a med versus the risk and effect of doing nothing.

The online Frontiers in... series of journals bears examination. The review guidelines are unconventional (which does not mean that they are bad). Solid peer review by competent scientists or scholars is the foundation of academic publishing. PsycINFO does not yet index articles in these journals, although Frontiers in... says that is coming soon. Speed of editorial decisions seems to be an important goal. I have no idea whether this journal is taken as seriously as is one published by the American Psychological Association or an academic publisher.

I've had depression since I was 6 years old. I'm stable enough on medication, if a bit joyless. Its generally a positive thing for me. At least I can function.

Full disclosure (1): I've suffered from depression since the late sixties. I have used and plateaued on a fair number of SSRIs and am currently taking two ADs, Buproprinol and Citalopram. I don't have any expectations of not taking them in my lifetime.

(2) My BH takes two anti-depressants as well, Venlafaxine (Effexor) and $eroquel. In addition to that, she has a maintenance ECT (Electroconvulsive Therapy) every four weeks. Her therapy began in the early nineties. Her psychiatrist is the head of the Psychology Department of the major medical school in Oregon. When it comes to psychiatric care, I will be relying upon his advice over an internet journal that lacks minimal peer review.

Let's put it this way...the antidepressants allow/enable/other psycho-mumbojumbo of the week - me to exercise. If it wasn't for the ADs, I wouldn't feel like going out and doing good stuff for me.

Anecdotal experience is not empirical evidence. Anecdotal experience is useful and valid but is not an adequate way to evaluate the validity of this review.

I need to sleep, but a few quick points first. One study does not create ample evidence. The article is NOT an experimental study; it is a review of selective data. Some portions of the article are barely sourced. Toll makes an excellent point about the source of the article:



I've never come across Frontiers. It is not a recognized psychology journal. That matters very, very much.

I'm not sure what Realist was referring to when he asked what is missing. I see that there isn't a single MD as an author of the article.

I'm not saying that this article doesn't have good or valid things to say. I am saying that an article of this nature should be read carefully and with the understanding that it is not empirical research.

To be continued ... after I have slept. As you can all guess, I has lots to say on the issue.