There are millions of Americans who suffer with horrible, debilitating depression and millions who take antidepressants daily.
Antidepressants have been available since the 1950s. Still, unbelievably, few studies have focused directly on how the pills affect people with milder symptoms.
"After all these years -- and all those prescriptions -- you'd think we'd know everything there is to know about how antidepressants affect the people who take them," writes Alix Spiegel on National Public Radio's blog.
MOST DEPRESSION IS MILD TO MODERATE
In fact, almost 70 percent of depressed people on medication have moderate to mild symptoms. Why haven't we studied these folks?
"Because drug companies fund the vast majority of clinical trials, and obviously drug companies are interested in having their clinical trials show the efficacy of their antidepressant medications," Brett Deacon, a psychologist at the University Wyoming told NPR's All Things Considered.
A recent study finds that, for people with mild to moderate depression, taking an antidepressant is no better than swallowing a placebo. Pharmaceuticals versus sugar pills and sugar wins.
AN ETHICAL CONUNDRUM
This presents us with an ethical conundrum.
How about doing right by the patients involved in research, the ethical obligation toward those who are randomly assigned to get a placebo?
Will the pharmaceutical manufacturers admit to the public that their drugs are only helpful for severe depression? Don't bet on it.
Will physicians stop prescribing the drugs and increase prescribing placebos ?
Who makes all the profit from placebos? The pharmacies or manufacturers? Numerous other studies have found that patients believe a medicine's value is evidenced by its cost. A drug that is cheap doesn't work nearly as well as an expensive drug, most of us think. The same applies to placebos.
Do the pharmacies or manufacturers split the profits from sugar pills with the prescribing doctors?
And the big one -- Is lying to a patient ethical -- Telling her that you're prescribing a real drug and withholding the fact that it's really a placebo?
Will any of the above-mentioned tell us the truth?
Of course, the rules of randomized research trials is that a drug must work better than a placebo.
It may seem contradictory, but the data suggests that patients who have mild depression do feel better when they take antidepressants. Huh? Well, they also feel better when they take placebos. Ain't science great?
The more severe the depression becomes, the benefits of the active drug increases more than the benefits of the placebo.
The study, which appears in this week's Journal of the American Medical Association (JAMA), looks at two drugs: paroxetine, sold as Paxil by GlazoSmithKline, and an older drug called imipramine. A previous study published in 2008 looks at a larger range of antidepressants and had similar findings. The new study, however, is the first to analyze responses from hundreds of people being treated for more moderate symptoms -- which represents most people who seek care.
A team of researchers, led by Jay C. Fournier and Robert J. DeRubeis from the University of Pennsylvania, included psychologists -- who prefer psychotherapy, or talk therapy -- and physicians -- who favor consultation with drug makers. Using government grants, the team performed the new analysis, evaluating six large drug trials, with 728 men and women -- half with severe depression and half with moderate symptoms.
LITTLE EVIDENCE DRUGS HELP
"The message for patients with mild to moderate depression," Dr. DeRubeis said, as reported by The New York Times, "is, 'Look, medications are always an option, but there's little evidence that they add to other efforts to shake the depression -- whether it's exercise, seeing the doctors, reading about the disorder or going for psychotherapy.' "
Research over the last approx. 60 years, since antidepressants were first introduced, has linked antidepressants with suicidal thoughts, birth defects and a life-threatening neurological disorder. Other studies have also shown antidepressant drugs can impair male fertility and female libido and interfere with a breast cancer drug, reports Bloomberg.com.
THE LITTLE BLACK BOX
"In 2004, the U.S. Food and Drug Administration began requiring a black box, the most serious type of warning for prescription drugs, to be added to labeling of all antidepressants to warn about the increased risk of suicidal thoughts and behavior in children and adolescents being treated with the medications," says Bloomberg.
Wait-a-minute -- When someone is depressed, the worst possible scenario is suicide, so we give them drugs that could cause suicide. Or, better yet, we take folks who only have mild to moderate depression, who never have suicidal ideation, and push them to the brink they would never have reached without the drugs.
I've got it! Let's print a little black box on the packaging that contains the drug. And another thing, don't think that the prescribing doctor will always tell you about the possible side effects. Most doctors seem to believe that when they specifically warn patients about a drug's potential side effects then our weak little minds will be influenced and we'll get the side effects. Of course, it is the doctors who think they've got every disease they study while in medical school.
If it weren't for money and greed, patients might get nothing but placebos. And our powerful and easily influenced minds would heal us. Just saying ...
by Sharon McEachern