Against Depression, a Sugar Pill Is Hard to Beat

Washington Post ^ | May 7, 2002 | Shankar Vedantam

[liberallarry]

After thousands of studies, hundreds of millions of prescriptions and tens of billions of dollars in sales, two things are certain about pills that treat depression: Antidepressants like Prozac, Paxil and Zoloft work. And so do sugar pills.

[Al B.]

BTW, the study that started this entire thread only had seventeen people in it.

'Scuse me?  I don't think so.  Read the article again.  The study that was the basis of this article was the giant FDA database analysis done by Khan, Leventhal et al. 

"A new analysis has found that in the majority of trials conducted by drug companies in recent decades, sugar pills have done as well as -- or better than -- antidepressants. Companies have had to conduct numerous trials to get two that show a positive result, which is the Food and Drug Administration's minimum for approval. .
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The average participant in an eight-week trial spends about 20 hours being examined by top experts and highly trained caregivers, said Seattle psychiatrist Arif Khan, who studied the placebo effect in trials submitted to the FDA."

The Lilly-funded Mayberg study that you're referring to is the small-scale neuroimaging study that was commented on later in the article.¹

BTW, this FDA database analysis has been reported in at least 3 other places in some of the most respected journals in the field.^2,3,4  It wasn't funded by the drug companies and analyzed the results of the entire FDA clinical trial database for antidepressants over a 12-year period, covering 45 phase II and phase III trials with 8,731 participants.  In addition to Dr. Khan, the other 4 people who worked on this came from such scientology hotbeds as Brown Univ., Duke Univ., and Tufts.

This rare glimpse at the FDA's own closely-kept clinical trial data is revealing in that, despite the best efforts of the researchers to put a happy face on it, the data speaks for itself.  Of the 8,731 participants in the various trials, 41% improved on new antidepressants (SSRIs), 42% improved on older antidepressants, and 31% improved on placebo.  What's remarkable about this is that despite the drug companies best efforts to screen subjects through carefully selected inclusion/exclusion criteria and use of dubious scientific techniques like placebo washout, (1) SSRIs were no better than older antidepressants, (2) the lowly placebo hung right in there and (3) 60%-70% of the subjects showed no significant improvement at all no matter what they were taking.  From these numbers one might be tempted to ask whether there even IS such a thing as an antidepressant.

The psych drug industry has a great gig going, but you need to be more careful with what you represent here.

1.  See my post #55 on this thread for a citation.

2.  Khan, A. et al., "Symptom reduction and suicide risk in patients treated with placebo in antidepressant clinical trials," Archives of General Psychiatry (April, 2000), 57:311.

3.  Bower, B., "Placebos for depression attract scrutiny," Science News (April 29, 2000), p. 278.

4.  Khan, A., Leventhal, R., et al., "Severity of depression and response to antidepressants and placebo: An analysis of the Food and Drug Administration Database," Journal of Clinical Psychopharmacology (May, 2002), 22(1): 40-45.

[185JHP]

Thanks and FReegards.

[Razz Barry]

If diethylstilbestrol (DES) can cause cancer in the granddaughters of those who took it, what will we see in the offspring of the Ritalin and Prozac kids?

Tell me, as someone who is greatly interested by the DES story, where I could read more about your claims.

Sorry for the slow reply. I'm not here, at this computer, weekends.

If you still want the article (it's about six pages) you'll have to do a search of "Science News-Modus Operandi of Diethylstilbestrol". For some reason I can't create a link. More information, about DES, can be found doing a search with "DES and Miscarriages" and "Diethylstilbestrol and cancer".

[WilliamWallace1999]

First, most psychiatrists do little or no therapy. Second, any psychiatrist worth his salt can have a thriving practice in short order regardless of how many antidepressants are written by primary care physicians. You want to be the big cynic, you're going to need to know a little more about the real world and entertain a few less half-formed theories.

Since I have been the Medical Director of a 55 doctor group for over 6 years, I think I can speak with authority on the subject. What makes you so erudite on this topic?

[null and void]

Just a thought: Having something meaningful to do can lift depression. Would participating in a study to help develop drugs to treat depression be a meaningful thing to do?

[a history buff]

This is what I found:

http://www.yourlawyer.com/practice/overview.htm?topic=DES%20Diethylstilbestrol

[D-fendr]

I'm clinically depressed.

Every time I go to a clinic, I get depressed.

[GOP_1900AD]

I miss the 1950s mentality. I miss the 1250s mentality even more. I am not kidding, I do. Take a step back and think about it. Look at the world TODAY and think REALLY HARD about it!

[weegee]

"Layoffs will continue until morale improves."

[Amore]

In a lot of ways, I'd like to go back to the 1950's myself. But, still, I'll stick with my earlier posts on this thread. As for 1250, no way!, for many reasons, one of which is that I enjoy modern conveniences way too much.

[kms61]

With all due respect, my grandmother was as devout a Christian as you'll find. And she suffered from depression. Antidepressants worked for her when nothing else would. It's a physical disease that can be very treatable.

[Amore]

Nice, simple, logical post you've made. Too bad so many on this oft-wonderful site refuse to accept it.

[Anamensis]

Did you ever read SUGAR BLUES? I've cut down a lot too.

[Sam Cree]

I haven't read Sugar Blues. How was it?

[Anamensis]

Sugar Blues is pretty interesting. It was written some 30 years ago but is still in print, just one guy's story about ditching sugar completely and the difference it made in his health. There is also a lot of history on the cultivation of sugar (which was of less interest to me). Overall, very interesting story.