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.

[Lucius Cornelius Sulla]

In other words, in three out of five Prozac trials the placebo was either equal to or more "effective" than Prozac.

What about the other 1000 odd studies that were performed on Prozac?

[Lucius Cornelius Sulla]

You didn't read the article at all, did you?

Read every word. I have also spent 6 years of my life as a professional analyst of clinical data, including 6 months at Eli Lilly, the manufacturer of Prozac. (I am a consultant, and do not work for a single company for long periods). I have been in charge of assembling the data for NDA submissions, and have produced numerous reports for the FDA.

I am also well aware that Prozac is a particular target of the Scientologists, who are the primary producer of anti-psychiatric drug propaganda. Their position is that psychiatric drugs do not work, that those who take them should instead pay thousands of dollars to Scientology, so that they may be 'cleared'.

That is to say the the primary opponents of psychiatric drugs are a well-financed, fanatic, conspiratorial group of charlatans, quacks, and con-men. I do not know if you are associated with these nut-cases, but you are fighting their battles.

[Dianna]

Your suspicion is wrong. The penicillin would wipe out the infections in a way the placebo never could. It's a proven drug - not through personal anecdotes, but through the same research that prozac can't seem to pass

Knee-jerk? We are looking at a group of runny noses and doing NO other diagnosis. Penicillin could only work in 1/3 of the cases. The placebo could look effective for all groups. If one gets away from the allergen while taking the placebo, it seems to work. If a cold has run it's course and one is taking a placebo, it could be seen to work. And many infections will clear up entirely on their own.

[Dianna]

Sticking with the parallel you suggested, would you feel the same about a new cold medicine if they couldn't seem to prove it's efficacy in trials, and had no idea how or if it worked? Drug companies could advertise it as a cure, and they should be allowed to market this nonsense? Why do we make an exception when we move from physical illness to mental illness? Because the mentally ill are easier to con?

Like....zinc tablets, vitamin C? Not prescription, but touted all over the place. People with colds are easier to fool?

Let's go back to penicillin. If you had a 1000 sick people, and 900 would not be helped by penicillin, would you withhold it from everyone? These meds DID help SOME people, even in this study.

[Dianna]

The research doesn't indicate that the drugs give that person any more relief than sugar pills. If we don't know what it does, how is it that we could know it won't cause lasting damage?

You certainly have a point. If we could make everyone feel better by giving them m&m's, I'd go for that in an instant. But they won't work for everyone, and some people will die from depression. Some families are very negatively affected by depression. That is why I said that the circumstances must be taken into account. People must evaluate the risks.

[Dianna]

So did these people improve because of a placebo effect, or because of the drugs? The truth is, you don't know, and they don't know, and the drug companies are pretty sure it's the former. But your friends feel better, and that's good. It's too bad they had to pay $$$$$$$ for candy to feel better.

Know what? To a depressed person, it really doesn't matter. Getting their lives back is worth not being able to answer this question.

[philman_36]

I thank God that at least so far our government gives us the right to make our own decisions on the matter.
Sorry for nitpicking, but...
You are not free to make your own decision in this matter and I find it absurd that you would think so. If that were so you wouldn't need a prescription from an M.D. to get the medication and your only "decision" is to follow, or not to follow, the M.D.'s advice after he gives you the prescription. Further, the FDA (the government) has to approve a drug before it can even be sold, again removing "us" from having to make any "decisions". The decisions are all made for us.
And prescription drugs aren't sold over the counter like some other drugs are. They aren't called controlled substances for nothing.

You just go on, though, believing that "our government gives us the right to make our own decisions on the matter. IMO "we" are given very little choice in the right to make our own decisions on any number of matters. "Our government" is always doing what is "best for the people of America", and they vocalize that frequently, whether it is or isn't. What matters is that those making the rules for the rest of "us" believe it is "best for the people of America".

[Dianna]

I wish you well in dealing with your son. I hope you find the real cause of his problems, and get him a serious cure.

Thank you. But I believe the "real cause" of his problems is a brain disorder. I had hoped to circumvent that by teaching him to better control it. He hasn't given me that option.

Why do I think it is a brain disorder? Because his profile of symptoms is very similar to psychological/social difficulties associated with Tourette's Syndrome and Autism. He exhibits anxious behaviors similar to behaviors I exhibited as a child which he could not have known about (ie adding numbers on digital clocks, with some totals being "good" and others being "bad"), so suspect there MAY be a genetic influence (influence, not cause).

And because he was barely 3 years old when we were made aware of his anxiety. He had/has a loving mom and dad and had a strong network of friends and adults. No abuse of any kind (he was young enough that I could be certain of this). No trauma. Atypical behavior for a well loved child.

We were discussing depression rather than anxiety, but I think the two may have similar causes. I hope the meds will be temporary.

[Dianna]

I think that's alchemy.

As is your right. But for people needing help, I'm glad they get it, in whatever form it may take. Adults can make their own decisions. And I pray that any children who may be involved are cared for by intelligent parents who do their damndest to try everything else first.

[Al B.]

Gee, thanks for trotting out the Scientology smear.

I have no doubt you worked for Eli Lilly.

[Lucius Cornelius Sulla]

I have no doubt you worked for Eli Lilly.

I have never in my life received a paycheck from Eli Lilly. By the way, if you are John Travolta, I could use a lift on your private airliner, next time you fly from Ocala to California. There of course was no Scientology smear, the Scientologists can't be smeared any more than the Taliban can be smeared -- Nothing that can said about them is worse than the truth.

[Al B.]

LOL. Yeah right. You slime-by-association someone who disagrees with your position on psycho drugs, then say there was no smear. You must have worked for Lilly.

[Lucius Cornelius Sulla]

You slime-by-association someone who disagrees with your position on psycho drugs

I gave my professional opinion, and stated the basis on which I had one. What particular education or experience do you have to analyze clinical research data? They fact is that, knowingly or not, you are advancing the interests of a group of conmen --that is the simple truth.

[Al B.]

You neatly ignore the growing number of respected researchers and scientists who are raising serious questions about the safety and efficacy of drugs like Prozac -- including scientists who helped bring Prozac to market -- and then you go right back to it:

They fact is that, knowingly or not, you are advancing the interests of a group of conmen --that is the simple truth.

You're a hoot.

[Amore]

You make some valid points, and I don't dispute them. The only point I was trying to make is that his argument is like a lot of liberals trying to protect those who they perceive as misguided from themselves. I don't need to be protected from myself, I've done countless hours of research on the subject myself. I'd hate to someone like this guy get in control and decide that all these drugs are bogus and should not be available. I am thankful that I can obtain access -- granted, that I have to jump through some hoops to do it. When you've been deeply depressed and had the drugs make a major difference in your life, jumping through a few hoops is a small price to pay.

[Amore]

Thanks for trying to respond to some of the uninformed things said here. I wondered why some were so vehement on the subject, and I did not know that the Scientologists had been propounding the argument watchin has been making. I guess I shouldn't get so upset, just because a few people post nonsense on a message board.

[philman_36]

The only point I was trying to make is that his argument...
Whose argument? The article's author or watchin?
...is like a lot of liberals trying to protect those who they perceive as misguided from themselves.
I was thinking the same thing, but not about either of the two mentioned previously. It sounds like you're describing yourself somewhat, and it is you doing the protecting of others.
I don't need to be protected from myself, (nor do I) I've done countless hours of research on the subject myself. (as have I)
Yet we appear to arrive at two seperate conclusions. I find the issuance and usage of many of the drugs specious at best. Too much subjectivity and nowhere near enough objectivity, except the bottom line, which appears to always be the main object.
I'd hate to someone like this guy get in control and decide that all these drugs are bogus and should not be available.
Again, which guy?
There are already "guys in control" who have decided that some drugs are bogus and shouldn't be available.
...jumping through a few hoops is a small price to pay.
From your reply #71 it would seem that you've been paying a price, which probably isn't all that small after all, and it looks like they saw you coming! You don't seem to have gotten your money's worth.
Whoever said "Talk is cheap" never went to or paid for a "counseling session", did they?

[philman_36]

My apologies...They saw Dianna coming.

[Amore]

I thought it was clear I was speaking of watchin, and -- as I did with watchin -- I highly resent either you or he thinking you know the first thing about me and think that you know better for me than I do. I believe I conceded somewhere above that how drugs work for certain people varies. I also conceded that placebos work for some people. They don't for me, and I explained how I know that's so. I know what does and doesn't work for me. I'm willing to admit the system isn't perfect, but watchin's wide, sweeping generalizations show he has no interest in the truth, only his agenda.

[DallasMike]

Did you happen to read the article, by any chance, or are you so learned and progressive that you can skip such formalities?

Yes, I read the article. Did you read the study? What were the criteria to be accepted for the study -- people just "feeling blue" or people who had been diagnosed with difficult-to-treat clinical depression? Were people with bipolar depression included in the study? And what were the characteristics of the control group?

If you can't answer those things, or if you don't know what I'm talking about (I purposefully avoided technical language as much as I could) then you shouldn't be touting this newspaper article as the end-all in scientific study. For that matter, what are your qualifications as a scientist?