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At the turn of the 20th century, buying medicine was a risky business. Medicine shows traveled the country, entertaining crowds and hawking pills and potions of dubious origins, known as "patent medicines." Even the medicines sold in apothecary shops had not been shown to work well or be safe.
The establishment of the Food and Drug Administration and the development of its standards in the course of the 20th century were supposed to put an end to that kind of uncertainty. Now, Americans justifiably believe that their medicines should be safe and effective. In fact, the law calls for the FDA to determine that before it approves any new drug.
How well does this work? A new analysis suggests that modern antidepressants are no better than inactive placebo pills for alleviating mild to moderate depression (Journal of the American Medical Association, Jan. 6, 2010). Yet over 100 million prescriptions are written each year for drugs to ease the blues.
According to the meta-analysis published in JAMA, people with severe depression clearly benefit more from antidepressants than from placebo. The authors conclude, "...efforts should be made to clarify to clinicians and prospective patients that whereas ADM [antidepressant medication] can have a substantial effect with more severe depressions, there is little evidence to suggest that they produce specific pharmacological benefit for the majority of patients with less severe acute depressions."
Popular antidepressants like Effexor, Lexapro, Paxil or Prozac can cause side effects, however, even in people who may not be getting significant benefit. Moreover, some of these medicines can be difficult to stop, producing withdrawal symptoms such as dizziness, nausea, sweating, chills, loss of appetite or sensations like an electrical shock.
This is not the first study to throw doubt on the value of antidepressants for mild or moderate depression. In 2008, Irving Kirsch, MD, and his colleagues reported that highly successful antidepressants such as Celexa, Effexor, Paxil, Prozac, Serzone and Zoloft hardly worked better than placebos in clinical trials (PLoS Medicine, Feb., 2008). The authors concluded, "the overall effect of new-generation antidepressant medications is below recommended criteria for clinical significance."
Even before that, a huge government-funded study (STAR*D) revealed that the effectiveness of antidepressant medications was disappointing (New England Journal of Medicine, March 23, 2006). Only one in four patients responded favorably to the first medication prescribed.
Some people really get great benefit from antidepressants. Those who are especially depressed seem to benefit the most.
For the vast majority of people with mild to moderate depression, non-drug approaches such as exercise, talking therapy or controlled light exposure may be helpful. You can learn more about a variety of approaches in our new Guide to Dealing with Depression.
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Many cases of depression are caused by endocrine problems, most commonly hypothyroidism. The widespread use of the TSH as the primary screening and treatment monitoring tool for hypothyroid patients is a huge disservice to us all.
I became depressed about 16 years ago and my TSH was tested and found to be "normal" so I was put on Prozac. I developed many other health problems in addition to the depression including menstrual problems that finally ended in a hysterectomy, high cholesterol, autonomic nervous system dysfunction, gastric problems and fibromyalgia. My TSH was tested several times and was always "in range" and my thyroid was passed over each time.
When I discovered my mother had a probable hypothyroidism, I finally did some research and found that additional testing was necessary to properly evaluate my own thyroid. When I requested free T3 and free T4 tests I found my levels were extremely low and thyroid hormone replacement was needed. I’m still not completely optimized on my hormone replacement because the damage was significant from so many years of being undiagnosed hypo; my adrenals were fatigued from trying to compensate for the under-producing thyroid and I also developed a thyroid hormone resistance which will require T3 therapy to reverse.
So please look beyond the TSH if you are suffering from depression! Since the TSH has become the "gold standard" for screening and treatment monitoring many have suffered needlessly… with huge profits to the drug companies that make antidepressants, statins, NSAIDS, weight-loss drugs and a whole host of other medications to treat the results of untreated or under treated hypothyroidism.
Many people who are hypothyroid end up being prescribed antidepressants with little or no improvement in their depression. Until the underlying cause of their problem is found, they will only get sicker.
I do not use any antidepressant, they go against me,in many ways... BUT I am on anti-anxiety (ativan). I keep asking for what to do, not to rely so much on ativan! Thank you.
I was similarly hypothyroid for several years but diagnosed with depression and also high cholesterol. My TSH was only just within the "normal range". I was given Wellbutrin for the depression but it made me feel so terrible that I discontinued it after 4 weeks. I was also prescribed a typical cholesterol-lowering drug, but I never took this because I saw the side effects that my father was experiencing with his cholesterol-lowering drug.
Finally, when I reported extreme dryness and thirstiness, an alert General Practicing doctor suggested that my TSH was lower than she would like to see at my age of 50 and she prescribed Syntroid. My symptoms disappeared and I found myself laughing for probably the first time in 5 years. The pain and inflammation from my arthritic joints was also "magically" reduced. (I understand a normal thyroid level facilitates clearing of inflammation.)
This was about 4 years ago. Now I am noticing a return of some of these symptoms, in spite of an acceptable TSH level, so I am going to have my T3 level tested. If I understand the Graedon's handout on thyroid disorders correctly, I may need the natural thyroid hormone with T3 and T4.
I am 70 and developed depression when I was 25. At this age, all I have been taking, including prozac, seroquel etc. have not worked very well. As you age the meds tend to give out and must be changed to something stronger. We have finally discovered the right combination and abilify was the one that completed my cocktail. Sometimes it takes two or three or more to finally feel human again. Thanks for your column. sheila
People should be very, very cautious if a doctor prescribes an antidepressant. That medication can be dangerous and even deadly. On Jan. 21, 2005 my youngest son (who was 33 years old and married with 2 children) committed suicide while taking Prozac. I did not know before he died that Prozac could cause suicidal behavior. I researched the drug later and found out about that deadly side effect.
In my opinion the drug companies should be forced to put a black box warning about the drug causing suicidal thoughts. My son's suicide was the most traumatic emotional evident that I have ever experienced. Only my Christian faith and pastoral counseling helped my wife and I to survive the tragedy emotionally.
Prozac, even at a very low dose, caused me to break out in a hive-like rash. I felt worse instead of better. I've tried many anti-deps over the years but can never cope with the various side effects (some are really disturbing.) Anyhow, the more I read, the less I want to take that path. If only it were as easy as taking a pill. But for me, it just isn't.
St John's Wort is an herb that works well for mild depression. Of course there have been no studies on that - the drug companies make sure none are done.
XyZ,
There HAVE been studies on St. John's Wort, but maybe you haven't heard about them. These small studies showed that St. John's Wort was as effective as Zoloft and Prozac.
You are correct in one way: there is no large drug company promoting its use or investigating its side-effects.
There is no FDA monitoring its manufacture or ensuring its safety, efficacy or purity. Not that the FDA is perfect in doing this.
St. John's Wort, like other drugs, has its risks and benefits, its side-effects and drug interactions.
See Cochrane Review for this adn other alternative medication reviews http://www.cochrane.org/reviews/en/ab000448.html
There is a LOT of research on St. John's Wort! There have been entire books written about it since there is so much research. I used to take it along with one prescription antidepressant, but when I developed a side effect that was probably caused by a combination of the two, I followed my doctor's advice to drop the St. John's Wort and take a 2nd prescription antidepressant. I'm sorry I did that; I miss the sense of well-being it gave me.
Now I'm in the process of gradually tapering one prescription and replacing it with SAMe. When I finish that, I plan to taper off on the other one and (carefully, of course) replace it with St. John's Wort. My doctor does not love this plan but I keep her fully aware of it. Most doctors are still not aware of the research.
TLC,
Take what works for you, but have they shown that St. John's Wort and SAMe are safer or more effective than the prescription products? Please let me know where I can look to find data supporting either of these medications over SSRI's.
Keep in mind a physician takes on a lot of liability in recommending patients take non-FDA approved drugs. I spoke with a surgeon and he pays $ 70,000 dollars a year just in insurance. If you were a doctor would recommend these drugs?
The problem is that most insurance will cover a pill, but not therapy.
Tired of headline medicine? Does this article make sense to you? What do you think is the truth? Please look beyond the headlines--are we sheep or rational human beings with a brain in our heads?
http://www.nytimes.com/2010/01/12/health/12mind.html?ref=health
Last week, The Journal of the American Medical Association published a study questioning the effectiveness of antidepressant drugs. The drugs are useful in cases of severe depression, it said. But for most patients, those with mild to moderate cases, the most commonly used antidepressants are generally no better than a placebo...
Rational Medicine,
Thank you for having me actually read the article and not just telling me what to think. It's nice to get a more complete picture.
I have been suffering from hypothyroidism and severe depression, I am on Levoxil and Cymbalta, I am living a fairly normal life, besides of gaining excessive weight for no reason at all. I used to cry all the time; I tried many anti-depressants, since I started taking the Cymbalta I am happier than before,I am functioning but still with anger issues. Is this part of the Thyroid or a side effect of the medication? I have also tried many diets and to no avail. Please help!
Rosa J.C.,
The weight gain may be because of your thyroid. I'd have your levels checked. Usually Cymbalta does not cause weight gain, but it's not impossible.
Are you seeing and Endocrinologist or just your family MD? I found that an Endo is way more in tune with symptoms. Get checked for "insulin resistance." My endo solved exactly the same issues. Also, an endo can tell if the levoxil is actually being absorbed properly. That is why they are a "specialist." I love my cymbalta, also good for pain control...Good luck.
Thanks for your website. I hope there will be more people to stand up and educate more people about the untold story of anti-depressants. I came to this site after watching a documentary directed by Steven P Miller. I hope I have the first name correct. The documentary is called, "Generation RX". I am a victim of anti depressants and anti anxiety medications prescribed to for the last 12 years.
When I told my doctor that Paxil made me feel numb to the world, he quickly prescribed prozac and many others through the years. I am now on Effexor XR and now I have many illnesses such as Bi Polar ll and fibromyalgia. My goal now is to get off all prescription medicines. The only downfall of learning the truth about what these drug companies are doing is that now my brain will never be the same again. Will I ever be like the person I was before the drugs?
Time will only tell.