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Anti-Depressant Medication & The Placebo Effect

medication_bottleNo better way to kick off a new research website than with controversial research.  Let’s start first with the concept of a “placebo effect.”  The placebo effect is very common in most forms of healthcare.  When people who are ill (mentally or physically) believe that they will get better – guess what – they do.  These are real changes though the placebo effect may wear off over time. 

The placebo effect is so powerful that the new gold standard in psychological and medical research is to have a placebo group instead of having a simple control group that does not receive the treatment.  For example, when a manufacture tests a new anxiety drug, they might give the real drug to one group (called the “experimental group”) and, for example, give a sugar pill to another group (“placebo group”).  Believe or not the placebo group often reports meaningful improvements despite getting a sugar pill.  The same concept applies to psychological treatments and research. In fact, simply going to psychotherapy, even if no real therapy is conducted, will likely result in a treatment gains. Belief is a powerful force!

The Food & Drug Administration (FDA) regulates and approves medications that are available to the public. Antidepressants are group of psychotropic drugs used to treat, as the name implies, depression.  This is next statement is strictly an opinion: I am skeptical of the benefits of anti-depressants.  I cannot tell you how many people I have worked with in a clinical setting that are on anti-depressants and still depressed. Aside from this bias, anti-depressants come with side effects, physiological dependence (your body physically relies on them and will through withdrawal symptoms without them), and tolerance (you need more of the drug to get the same effect).  Pharmaceutical companies must submit a certain number of studies to the FDA that demonstrate that their drug actually works and does so in a reasonably safe manner.  But there’s a catch…. while pharmaceutical companies must submit all studies for a particular drug including the studies that demonstrate that it does NOT work, the FDA only counts the studies that show positive results.

Researchers in the article* discussed today were resourceful. They used the Freedom of Information Act to obtain all studies submitted to the FDA for 4 new generation (“SSRIs”) anti-depressants.   A statistical technique called a meta-analysis was used to analyze the data.  A meta-analysis combines data from studies to derive an “effect size.”  The results were astounding: the antidepressant medications used in the analysis were no better than the placebo effect, except for the most severely depressed patients.  Keep in mind that a meta-analysis is not a “cause and effect” experiment so you cannot say that “this causes that.” Nevertheless, this a very important finding.  You can download the free research article here.

This is a perfect topic to remind folks to read the disclaimer on this blog.  You need to speak with your prescribing physician before EVER making changes to your prescribed medications.  It is dangerous and ill advised not too.  Physicians may not be aware of this study so take the article with you if you choose to visit him or her.

References

*Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration. Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, et al. PLoS Medicine Vol. 5, No. 2, e45 doi:10.1371/journal.pmed.0050045

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