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

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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

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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.

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

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.

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.