Thanks for this article I completely agree.

I agree completely with you. I came across a similar article back when I was still very much in the back hole. It almost convinced me not to keep that appointment with the psychiatrist. I’m so glad I did; I feel much better today.

Just as a side note, I’m one of those people who need more than one medication to stay stable – three, to be exact. A mood stabilizer (Lithium, anti psychotic (Zyprexa) and anti-depressant (Paxil).

Two things, though.

I thought you were on one antidepressant and a mood stabilizer, not two antidepressants. Don’t confuse the two, they are different.

It is impossible to have both depression and bipolar. This is because depression is a symptom of bipolar disorder – often, an extremely vital symptom – and is therefore simply a part of the bp for you. Go ask any qualified psychologist or psychiatrist if the two are diagnosed at the same time and most, if not all, will say “no”. You do not have bipolar and depression: you have bipolar disorder. Please stop listing them separately, it gets on my nerves every time.

Read more here: http://psychcentral.com/lib/2007/can-a-person-be-diagnosed-with-simultaneous-depression-and-bipolar-disorder/

Thanks, Erika. I appreciate your insight and I understand what you say. My official diagnoses now, for insurance purposes, are dysthymia and bipolar II – hypomania. However, four years ago, when I slid into a very deep clinical depression, I was diagnosed with depression. Subsequently I was diagnosed with bipolar II. Of course, I self-diagnosed my alcoholism.

Obviously, I am not a psychologist/psychiatrist. Three times in my life I have experienced very deep, clinical depressions. My other episodes have been less severe and my mania has not exceeded the range for hypomania – so they tell me.

I take two antidepressants and one mood stabilizer. I am going in for a check-up on Monday and I will definitely get some clarification on this.

Thanks again.

I think the statement is very misleading. But on the other hand, I was a critic of antidepressants. But after pride, being in the hosiptal, and a attempt to take pills. I need help!! I can say the antidepressants work for me. I still have my days when I feel lonely and I want to give up. But the next day is not as bad. When I was not taking medication, I would sleep all day and cry all day for the whole weekend. One day at a time. But for me, they work.

Mood disorders and medication is like drinking. Everyone is effected differently. What works for some doesn’t work the same for others.

I can also add those expensive Tic Tacs saved my life. My thinking is clear and I can remember a lot better. I am not working on getting out of a verbally abusive relationship. This is not condusive with someone with depression. But for now I am making changes. Ive asked my employer for a hardship transfer to another state, to be closer with my family. Im not sure how that will go. But you know what all I can do is be honest. I’m not ashamed anymore. I got help.

I meant to say I am working on getting out of a verbally abusive relationship.

I agree as well two anti-depressants and a mood stabalizer and my life is worth living.

Prior I wanted nothing more than to end my life. I still get down, and yes suicide still crosses my mind. However the lows are not as low or as long. And as far as my dark thinking, I am able to redirect the negative energy into more creative outlets.

By no means are these drugs a cure, but at least they help me stay more balanced than not.

I tried tic tac’s but no dice, they did not help in the least .

Fresh breath?

The Newsweek piece clearly stated two facts:

a. SSRI drugs have a statistically significant ameliorative and positive effect on those with severe depression

b. About 13% of the depressed population has severe depression.

Science Daily maintains that about 5% of the entire American population deals with depression of all kinds.

http://www.sciencedaily.com/releases/2008/12/081203092440.htm

Do the simple math: 300 million Americans, 5% with persistent depression. That’s 15 million Americans. 13% of those with severe depression? That’s nearly 2 million people in America alone for whom SSRI anti-depressants would most likely help.

Let me first say that I am glad you are getting help and that it is a significant benefit for your daily functioning and mood. And the same for the others who have posted here – that you all have been helped. I am happy for all of you. Truly.

Newsweek says that anti-depressants categorically don’t work; you say (or imply) that they do work. You are both partially right; you are both partially wrong. Newsweek omits those, like yourself, who are helped. You omit those that are not helped.

Permit me to offer another view. In many cases (a third?) they don’t work. No combination, no dosage, no substitute of one brand for another. They don’t work. Not maybe, not a little, not at all. They simply don’t work.

Science doesn’t know what causes depression. They don’t know what depression is. If they had a clue they would have a higher rate of success. A prescription that is helpful about two-thirds of the time is hardly a successful therapy. It’s a best-guess approach despite being represented by the professionals as effective.

They don’t work and implying that Newsweek has it completely wrong is having it completely wrong yourself.

As someone who’s been treated (with and without medications) for a depression that saw me trying to suicide, I think I should elaborate on the usage of drugs for mental health conditions.

The problem with medications for any purpose lies in that every single person has a slightly different chemical composition when compared to everyone else. This is why drugs have side effects.

Another problem with using only drugs for any condition (mental health related or otherwise) is that the drugs don’t treat the underlying cause. they just rip the flower off the weed and don’t deal with the roots of the weed, so as soon as you come off the drugs, you’re going to get that weed back and it will probably come back with a massive vengeance.

This isn’t to say that the drugs don’t have a place. They’re useful for helping a person stay (relatively) stable until further help can be found and obtained, but they should not be used on their own to treat mental health conditions.

I could go into how doctors are pressured by the big pharma companies to prescribe as many of their drugs as possible but that’s a whole other subject.

And for all the times that psychiatric medicines help, there are an almost equal number when they don’t, and untrained family doctors hand them out like they WERE Tic-tacs, without regard to their side-effects and potential interactions with other aspects of the patient’s brain chemistry. The blunt truth is that antidepressants and anti-anxiety medications handed out by doctors who are NOT specialists nearly killed me. Yes I was severely depressed. Yes I wanted to get better. So yes I took the pills. The first pill did nothing whatsoever. The second shot my hidden anxiety into orbit. The third (meant to treat the anxiety) removed all remaining inhibitions keeping me from expressing my deathwish… so the hospital gave me a fourth and STILL not knowing any better I took it and in two weeks it made me manic. It took several YEARS for my brain chemistry to settle back to a semi-normal state, under a psychiatrist’s care but without further medication. If I’d just had access to a therapist in the beginning I could have sorted out my personal crisis without getting on the medication merry-go-round in the first place.

Interesting discussion. My take (as someone who has been dysthymic most of my life, with at least 5 major depressive episodes — and counting –).

I do believe that depression is a multifaceted issue and there is not one right answer. There are two main categories of depression — exogenous/situational depression (caused by the environment — a death, divorce, life stressors) which typically resolves itself, and endogenous (internal — caused by a chemical imbalance that is not necessarily related to external factors). I also think there can be depression that starts as exogenous that becomes endogenous (perhaps for those predisposed to depression).

I have a family history of anxiety/depression. I was raised in a narcissistic family system (i.e. very dysfunctional) and was sexually abused by two relatives. The family history predisposed me to depression, the environment provided the conditions necessary to create a chemical imbalance, and my environment did not provide me with healthy/positive/successful strategies for dealing with these issues (nor did I have any family support to help).

These factors coalesced into the person I am today. For a long time, I did not seek help (because that was not acceptable to my family). At some point, I realized I could not continue as I was and I sought therapy. Therapy helped me work through many of the traumatic issues of my childhood and helped me identify coping strategies that would help me deal with life more successfully. However, my therapist did not suggest medication. Looking back, I recognize he should have. My issues were NOT only based on my dysfunctional family and poor coping strategies — it was also chemical. I recognize this now, because there are times when my life is going just fine and I am hit by an overwhelming, nearly incapacitating depression.

I am on medication now, which has helped tremendously (I am also being treated for hypothyroidism, the symptoms of which very closely mimic depression — get checked for it!). Even with my two anti-depressants, I still deal with clinical depressions, but they are shorter and less incapacitating. I have been considering lately returning to therapy to process issues surrounding my divorce and finding goals for the future.

It is interesting to me that there are studies that show that MOST people will recover from depression without the intervention of therapy. I like to think that with therapy, people recover more quickly and are provided tools that help them deal more effectively with future stress (but that’s just my opinion). I would guess that those who are dealing with situational depression might not benefit from anti-depressant medication and will recover well without it. Those of us with chemical depression are, perhaps, different and require them to keep us functional in the world.

Frankly, there are times when I recognize that I am not fully functional, even with the meds. I definitely recognize the difference between what I am able to accomplish and what many people seem to be able to do (I am talking about basic daily functioning kind of things). I used to think I might be able to get off of the meds eventually, but I am not sure that is possible.

I don’t believe the effect the meds have on me is simply placebo, but if it is I am grateful for it. I know the weight gain that comes with the meds is not placebo, for sure! LOL

justathought

I heard a good discussion of this on some NPR radio show Monday — then lost the station..
It is clear that anti-depressants do help a lot of us. It is also pretty clear that many Drs. may be prescribing them for many reasons other than serious or chronic depression, which can muddy the waters. One comment on the show was that the placebos had an immediate effect. Don’t know about anyone else, but when I finally tried anti-depressant therapy- it took 5-6 weeks before there was a noticable change in mood. And others noticed it before I did. And it has proved helpful in fighting off chronic recurring depression – I doesn’t make me “happy” – it keeps me from falling into epidoes of paralyzed despair.

My own “bone to pick” about articles that seem to downplay the positive effects of some of these chemicals – they may scare people away from treatment.

I was one who had been in psychotherapy-different approaches, different people, as well as exersizing, yoga and trying various dietary approaches, and self-help books up the wazoo…. None of these addressed my depression. All of the understanding of my past, and cognitive approaches (Burns, Seligman)tended to lead me to feel more helpless. Some WERE helpful in developing better habits AFTER my depression was treated with an anti-depressant… but only AFTER I stopped cycling downward.

MAINLY I would hope no one sees these articles, misses the few sentences that acknowledge the utility of drugs for many, and decides that all is hopeless. “justathought” has made a lot of good observations that I agree with, too. I am frankly thankful that we have some tools that can be used to help many of us reclaim major pieces of our lives.

As the author of a recent article on the Begley piece (kindly cited in Dr. Grohol’s recent blog, and available at http://www.psychiatrictimes.com/home/content/article/10168/1520550), I want to support the points made by Ms. Stapleton and also by TPG (whose “math” works out quite close to mine).

Fundamentally, the Begley article tried to juggle two contradictory claims: first, that antidepressants are ineffective and no better than a sugar pill; and second, that antidepressants are significantly better than a sugar pill in very severe depression. Well, you can’t have it both ways!

A sugar pill will not be effective in very severe (“melancholic”) depression, as we know from many placebo studies of the most severe types of depression. Ergo, if antidepressants are effective in those cases, they simply cannot be mere “sugar pills.”

The Begley article also omitted a lot of data from maintenance studies of antidepressants, as I note in my article, and misrepresented what subjects in “placebo” groups actually receive.

Best regards, Ronald Pies MD

[Disclosure statement available on Psychiatric Times website, with link to "Board"]

I did not read the article, but that is very frightening that such an article would be published. When I read something in Newsweek, I assume there is some truth to it. And from the sound of what you wrote, there is no truth and no basis for the author to draw such conclusions. ADs have saved my life and saved the quality of my life with my husband and children. I have enough personal evidence to know that this is not a placebo effect. It makes me wonder what else Newsweek is publishing that is as complete baloney as this article. How disappointing.

Ihope this post goes through because the last one I wrote didn’t.

Dr. Pies, I have repeatedly asked this question on several places to no avail. Is there a direct link to a study that shows the effectiveness of antidepressants over 5 years? In other words, people are prescribed a drug and followed over 5 years.

It seems that if you’re going to claim these drugs are effective, you should easily be able to produce this.

Thanks

If placebos are almost as effective as antidepressants for mildly and moderately and even some severely depressed people – as stated in Begley’s article (she said there was a significant positive drug effect for only “very severe symptoms)– then it seems to me we should be very seriously researching the so called “placebo effect.” About 35 years ago one of my psychology professors proposed this idea to a host of apparently stunned and silent groups of mental health professionals. Seems he was right after all and not a complete crackpot misfit! Too bad nobody listened then… As for those here who still believe in their pills and continue to take them all power to you! Believe in the placebo effect, for it is very strong! And certainly if after long periods of trial and error you find something works, stick to it. If it ain’t broke, don’t fix it! As for the rest of us (myself very much included) who have struggled against the arrogance and deception of some psychiatrists who fired us as patients because we wanted to try other ideas, good luck to us too! Although we probably don’t show up in any statistics at all, we are very likely not immune to the placebo effect either and will probably be positively impacted by Begley’s article because it confirms our long held beliefs. As for those who think Begley’s article is irresponsible, I could not disagree more. In the end (one way or another) the truth comes out and people who call themselves scientists have a duty to search for that truth and communicate it honestly.