Note: This is an editorial
Antidepressants – what’s going on?
One out of ten Americans are currently on antidepressants. That’s just the beginning. More than 25% of college students at some schools are on them.
Everyone is being given them for all sorts of reasons. Are they really that effective or safe? Maybe. That said, there is a horrible secret.
We don’t know how antidepressants work. We don’t know if they are safe for long term use. And finally, we don’t know how well they work, and for what reasons they should be prescribed.
There’s too much money at risk for the big drug companies to bother to answer these questions.
After all, antidepressants are ideal money-makers, $80 billion annually. They have to be taken daily for months if not years, and it can be impossible to tell if they’re working. And they have serious side effects, like possibly doubling your risk of committing suicide.
Everything we know about antidepressants comes from medical studies. But the studies are really screwed up.
First, who runs the studies? The drug companies. What do they have at stake?
Good results mean that they make hundreds of millions of dollars. Bad results mean they’ve wasted years of research and development. What do you think happens?
Positive results in the studies are inflated on average 32%. One analysis of 74 trials covering 12,500 patients showed that 36 studies gave negative results – and a shocking 11 of those were reported as being positive! And if the negative studies can’t be spun positive, then we simply don’t hear about them.
Studies on antidepressant safety and efficacy are 94% positive – but if negative studies were published, they’d only be 51% positive. The difference between what we hear and what is actually going is especially big for new drugs like Remeron.
The less time spent testing the drug means the less chance of picking up annoying side effects and saves operating costs. Because of that, most studies don’t track long term use, and some studies last only a month.
That’s right. Despite antidepressants being taken for months if not years, most research into them only goes on for a month or two, ignoring long term risks.
Extremely limited research
Millions of people take antidepressants. By contrast, the studies which confirm their efficacy and safety study at most a thousand patients.
The initial studies for Prozac that approved its use had only a few hundred patients complete the study.
Some quick math. 30 million people have taken Prozac. Now imagine there’s a serious side effect that occurs in 1/10,000 of the people who use it, and was missed in the initial studies. That’s 3,000 people.
Antidepressants aren’t benign drugs, far from it. They can cause thoughts of suicide in up to 4% of children, anger and violence in adults, alongside more mundane issues like nausea, restlessness and sexual dysfunction.
The Serotonin Hypothesis – a myth?
We don’t know how the medications work. The Serotonin Hypothesis – that reduced levels of serotonin in the brain cause depression – is inaccurate and lacks scientific basis.
Lowering the level of serotonin in the brain doesn’t cause depression. Increasing its levels directly doesn’t do much, either. And if low levels of serotonin were to blame for depression, antidepressants wouldn’t take several weeks to work – they would work within days because that’s how fast they raise levels.
To cap it off, antidepressants that don’t target serotonin – like Wellbutrin – work at about the same rate as those that do. Clearly the serotonin hypothesis is a vast over simplification that’s convenient for the drug companies.
Use in bipolar?
Antidepressants are very heavily used in patients with bipolar disorder. Unfortunately, the data seems to be at best only moderately in support of such use, and there are no antidepressants approved for use in Bipolar (July 2008).
The STEP-BD, Systemic Treatment Enhancement Program for Bipolar Disorder, a study run by the National Institute of Mental Health, seems to show that antidepressants are only as effective as placebo for bipolar depression.
And while antidepressants aren’t much better than placebo for bipolar patients, they may exacerbate mood cycling.
Use for depression
A similar major study of antidepressant efficacy for regular depression, STAR*D, showed similarly lackluster results.
STAR*D’s data is open to interpretation, but at the least indicates that antidepressants are not as effective as thought. About only 50% of patients experienced improvement initially, and over a year span efficacy was only about 25%.
For the vast majority of uses, antidepressants may work only as well as placebo, or a sugar pill. Placebos, after all, show about the same 25% efficacy. Due to the psychological nature of depression, the placebo effect absolutely must be monitored for.
Antidepressants do help some people, and do save lives. A black-box warning in 2003 which sharply reduced their use may be linked to a significant increase in teen suicides.
But they are also huge money makers with highly inflated efficacy rates, and should not be as heavily prescribed as they are. In many populations, they are no more effective than placebo, but unlike placebo have significant side effects.
Their use in Bipolar patients should be carefully examined.
You might like:
Why antidepressants are not antidepressants: STEP-BD, STAR*D, and the return of neurotic depression
Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials?
Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature
The Shocking Truth – Boston Magazine