A new mega-analysis has found in favour of SSRIs. Time to give people who take them a break, writes Mark Brown, former editor of mental health magazine One in Four, in the Guardian. Read on:
British society just cannot get comfortable with the reality of medication for depression. Despite widespread use, they still attract disapproval. New research appears to strike a decisive blow against widely publicised claims that antidepressant medications such as Prozac, a selective serotonin reuptake inhibitor (SSRI) are no better than sugar pills for people with depression.
Elias Eriksson, professor of pharmacology at the University of Gothenburg and one of the authors of the new paper, said: “I think, once and for all, we’ve answered the SSRI question. SSRIs work. They may not work for every patient, but they work for most patients. And it’s a pity if their use is discouraged because of newspaper reports.”
Newspaper reports, well-meaning advice, punditry of all sorts. At some deep level, we seem to want people to be wrong for choosing to take antidepressants. Every now and then columnists circle like vultures over each new story about how doctors hand out antidepressants “like sweeties”, or that side-effects might turn you into a monster, or that the drugs don’t in fact work at all. Some 64.7m items of antidepressants were dispensed in England in 2016. Surely, people ask, you should try everything else first? Have you thought about jogging? Eating kale? Not being in poverty or danger or not having a history of terrible things being done to you?
In 2008 Irving Kirsch and colleagues published a meta-analysis of published and unpublished trials of SSRIs that found overall a clinically significant difference between placebo and actual drug conditions only when people’s depression was severe. Kirsch and colleagues suggested those more depressed patients were less likely to respond to the placebo pills, meaning there was a bigger than normal advantage in that category for the actual antidepressants. Kirsch wasn’t saying that SSRIs weren’t doing anything, just that they weren’t doing very much and should be the final, not the first, option.
People went wild for this finding. The Guardian reported the story under the headline “Prozac, used by 40m people, does not work, say scientists”. Kirsch took up the offer to expand the article into a book, finally published as The Emperor’s New Drugs: Exploding the Antidepressant Myth.
We are invested in the idea of a grand conspiracy … an industry dampening human responses to reality for profit
Part of Kirsch’s thinking was that side-effects enhance the expectation of improvement by making the patient realise that he or she is not on a placebo, paradoxically ramping up the placebo effect. The new paper, a mega-analysis of patient-level trial data for two different SSRIs, found that contrary to Kirsch’s findings, there was a clinically significant positive difference in people’s mood when they were given the SSRI rather than a placebo, regardless of whether they experienced early side-effects or not. In other words, they controlled for confounding variables, and still found that medication was having an effect.
Kirsch does not accept the conclusions of the new paper, stating: “What one ought to do is look at side-effect profile and health risks and then use the safest of the alternative treatments available. And that’s certainly not an SSRI.”
Arguments against depression medication always hinge on the way that somehow, somewhere, someone in the journey from laboratory to blister pack is being duped. We are invested in the idea of a grand conspiracy to medicate us; a rapacious and shadowy industry dampening human responses to reality for profit.
The popular imagination mashes together half-remembered stories of tranquillisers being prescribed to women unhappy with family life; scandals about addictive sleeping tablets; late-night viewings of One Flew Over the Cuckoo’s Nest and a general feeling that there is something not quite right about taking tablets that are intended to affect what happens in your brain.
People like findings that challenge “the powers that be”. But when you’re depressed, it’s the status quo of feeling hopeless, helpless and worthless you want to challenge. Few people want to take SSRIs for the hell of it; and since there’s absolutely no “high” associated with them, there’s little incentive to carry on if they’re not actually helping you function. And depression is an emergency.
The illness does not benefit from a “keep calm and carry on” approach. As anyone who has taken antidepressants and found they feel less depressed will tell you, it can be the difference between life and a kind of living death. If that’s what being manipulated Big Pharma feels like, I can think of worse things.
British society just cannot get comfortable with the reality of medication for depression. Despite widespread use, they still attract disapproval. New research appears to strike a decisive blow against widely publicised claims that antidepressant medications such as Prozac, a selective serotonin reuptake inhibitor (SSRI) are no better than sugar pills for people with depression.
Elias Eriksson, professor of pharmacology at the University of Gothenburg and one of the authors of the new paper, said: “I think, once and for all, we’ve answered the SSRI question. SSRIs work. They may not work for every patient, but they work for most patients. And it’s a pity if their use is discouraged because of newspaper reports.”
Newspaper reports, well-meaning advice, punditry of all sorts. At some deep level, we seem to want people to be wrong for choosing to take antidepressants. Every now and then columnists circle like vultures over each new story about how doctors hand out antidepressants “like sweeties”, or that side-effects might turn you into a monster, or that the drugs don’t in fact work at all. Some 64.7m items of antidepressants were dispensed in England in 2016. Surely, people ask, you should try everything else first? Have you thought about jogging? Eating kale? Not being in poverty or danger or not having a history of terrible things being done to you?
In 2008 Irving Kirsch and colleagues published a meta-analysis of published and unpublished trials of SSRIs that found overall a clinically significant difference between placebo and actual drug conditions only when people’s depression was severe. Kirsch and colleagues suggested those more depressed patients were less likely to respond to the placebo pills, meaning there was a bigger than normal advantage in that category for the actual antidepressants. Kirsch wasn’t saying that SSRIs weren’t doing anything, just that they weren’t doing very much and should be the final, not the first, option.
People went wild for this finding. The Guardian reported the story under the headline “Prozac, used by 40m people, does not work, say scientists”. Kirsch took up the offer to expand the article into a book, finally published as The Emperor’s New Drugs: Exploding the Antidepressant Myth.
We are invested in the idea of a grand conspiracy … an industry dampening human responses to reality for profit
Part of Kirsch’s thinking was that side-effects enhance the expectation of improvement by making the patient realise that he or she is not on a placebo, paradoxically ramping up the placebo effect. The new paper, a mega-analysis of patient-level trial data for two different SSRIs, found that contrary to Kirsch’s findings, there was a clinically significant positive difference in people’s mood when they were given the SSRI rather than a placebo, regardless of whether they experienced early side-effects or not. In other words, they controlled for confounding variables, and still found that medication was having an effect.
 |
| ‘Arguments against depression medication always hinge on the way that somehow, somewhere, someone in the journey from laboratory to blister pack is being duped.’ Photograph: Don McPhee for the Guardian |
Kirsch does not accept the conclusions of the new paper, stating: “What one ought to do is look at side-effect profile and health risks and then use the safest of the alternative treatments available. And that’s certainly not an SSRI.”
Arguments against depression medication always hinge on the way that somehow, somewhere, someone in the journey from laboratory to blister pack is being duped. We are invested in the idea of a grand conspiracy to medicate us; a rapacious and shadowy industry dampening human responses to reality for profit.
The popular imagination mashes together half-remembered stories of tranquillisers being prescribed to women unhappy with family life; scandals about addictive sleeping tablets; late-night viewings of One Flew Over the Cuckoo’s Nest and a general feeling that there is something not quite right about taking tablets that are intended to affect what happens in your brain.
People like findings that challenge “the powers that be”. But when you’re depressed, it’s the status quo of feeling hopeless, helpless and worthless you want to challenge. Few people want to take SSRIs for the hell of it; and since there’s absolutely no “high” associated with them, there’s little incentive to carry on if they’re not actually helping you function. And depression is an emergency.
The illness does not benefit from a “keep calm and carry on” approach. As anyone who has taken antidepressants and found they feel less depressed will tell you, it can be the difference between life and a kind of living death. If that’s what being manipulated Big Pharma feels like, I can think of worse things.
No comments:
Post a Comment