Hard News: The drugs don't (always) work
93 Responses
First ←Older Page 1 2 3 4 Newer→ Last
-
Good point Emma. I know people with thyroid problems (underactive). Symptoms include depression, tiredness, and possible collapse. Just treating this with anti-depressants is dangerous. Still, this issue does not detract from Russell and others' main points.
(As an aside, I am pretty convinced that thyroid check ups should be much more standard than they are.)
-
Sue,
ok we are all intelligent and lovely here so i hope we can stay this way during a discussion around which is is for some a deeply personal issue.
there is a difference between feeling depressed and experiencing full blown depression
for those of you who have not experienced depression, (and by that i do not mean a bad day/week/month) can you maybe show a little compassion for those of us who constantly feel stigmatised by society for not being normal.
and onwardyes there are instances of over medication, or medication when someone is experiencing situation depression and not a clinical form of depression.
some of that is becuase the patient cannot afford to take time out from their job/life or cannot afford therapy, so doctors do what they can.
-
ii) Steve I would urge you to stop and ponder the dilemma for the medical profession of figuring out who can and cannot have a real drug as opposed to a placebo or indeed who would be qualified to make such a determination.
And the moral issue. If doctors were to find that a placebo was as effective as the drugs that they were handing out, then what does that say about what they've been doing for umpteen years, and indeed the medical profession and prescription drugs?
And if depression is the only instance where that's true (or the only major one), then what does it say about the 'depression medical drug industry' that has built up over the past few decades.
If I was a GP I could see a whole heap of "Holy crap that's big" issues in front of me, and I'd sure want scientists (and the media) to be absolutely confident about what they're saying.
downers for your chihuahua anyone?
Seriously, if you get one of those stupid little pretend dogs, it's not the dog that needs help.
-
The NZ media's coverage of medical/health issues, reports & etc is usually pretty patchy, but the Herald's story this morning really infuriated me. Couldn't the reporter have managed to interview at least one person on SSRIs to see what they thought or, um, actually experienced?
I think that most people who have genuinelly suffered from clinical depression - as opposed to a bit of a blue patch - benefit from SSRIs. I think the problems are that a) most people don't understand what real depression is & b) SSRIs are totally over-perscribed.
I know several people who are on SSRIs who shouldn't be: they never struck me as clinically depresssed, and the drugs have made no real difference to either them or their lives. I also know people who have prescriptions for SSRI who, effectively, use them as a recreational drug - not because they need them. Surely that points to over-prescription?
Personally, my life was probably saved by aropax. Yet I resisted going on to it for as long as possible - preferring to self medicate. It took the combined persuasive efforts of everyone close to me + my doctor and my psychologist to convince me that I had no other choice if I wanted to function again.
I combined the SSRIs with cognitive behavioural therapy (as reccommended). After that first horrendous & scary three weeks, my life changed for the better. Now, I feel like I'm a real, functioning person again.
I think that if anyone who would genuinelly benefit from SSRIs is put off by the Herald's report of that study it is outrageous, and the paper should take some responsibility. Which, of course, would never happen.
-
I think we could go a long way with reducing the prison pop if a few kept taking their meds and a bit more diagnosis & therapy was avalible.
-
What the research says is that, because the drug turns out to be no better than a placebo (for all but the most extreme cases), the fact the pill works for someone does not tell them whether it contains the drug or is a placebo. That's all.
Yes. But you also have to look at what the research actually is, and consider its limitations too.
Direct-to-consumer advertising a la the US, implying that this pill will solve your problems and make you happy, is crazy. It's extremely like that a lot of people who don't need these drugs are getting them.
But what's being analysed here are trials conducted in advance of any real-world clinical experience with these drugs, over a much shorter treatment period than would be considered useful now.
And, as i said, this isn't entirely new analysis: the core of it is a decade old, and it continues to be debated. It's just the reporting that (in the Guardian headline's words) "scientists say" that SSRIs "don't work" that is deeply flawed.
The real story is that the drug companies cherry-picked their clinical trials.
-
As usual, Ben "Bad Science" Goldacre strikes a badly-needed note of clarity.
-
I wish I could get the placebo effect more often, it sounds quite wicked.
-
Ben, they don't give it to sceptics. Horrible side-effects. Can make you vote NZ First.
-
I just remembered I noticed a glaring instance of good reporting of statistics somewhat recently, so I'll share.
When that new cancer drug was approved recently, TV3 explained the percentage difference it would make with startling clarity. Little diagrams and everything.
Their report on this appears to be online.
-
When I went to see my doctor some years ago, or to be precise, the morning when I sat weeping and couldn't stop, so my husband dragged me in to see our doctor, he didn't give me pills. I was severely stressed at work, and therefore somewhat depressed, but really, only mildly so. After talking to our doctor for a while, he signed me out on a month's stress leave, and ordered me off to a gym.
It worked. But I was stressed, and somewhat depressed, not severely depressed. I have seen severe depression at close hand, and I was nowhere near that. It's important to understand the distinction.
-
I just remembered I noticed a glaring instance of good reporting of health-related statistics somewhat recently, so I'll share.
When that new cancer drug was approved recently, TV3 explained the percentage difference it was supposed to make with startling clarity. Little diagrams and everything.
Their report on the SSRI thing is on Scoop TV (text report on TV3 website).
-
sue:
there is a difference between feeling depressed and experiencing full blown depression
i think that's the main lesson i've taken away from this issue thus far.
-
Ben, they don't give it to sceptics. Horrible side-effects. Can make you vote NZ First.
Damn, I blame my family. Skepticism runs in families too.
-
and in other Health News:
Associate Health Minister Jim Anderton said the short-acting hallucinogenic anaesthetic will be a restricted substance after the classification is approved by Parliament.
(Not a pleasant drug so no-one minds)New Zealand researchers road-tested two of the biggest-selling drugs on 100 couples affected by erectile dysfunction.
They found women preferred Cialis, which can help men achieve erections during arousal for 36 hours, over Viagra, which works for about four hours.
(I haven't tried either yet, so I couldn't possibly comment) -
Thank you Russell.
-
"I wish I could get the placebo effect more often, it sounds quite wicked."
My mate used to sell mixed herbs as dope & his mums laxatives as speed at school. All accounts came back that it was good shit.
-
I'm sure that I've had mixed herbs instead of the real thing before simply because there was no effect. So unfair. There's a real downside to critical thought.
-
While my respect for Ben Goldacre is large his SSRI piece did rather miss the point and the discussion for it on badscience.net was very lively.
Yes, serotonin has complex actions in the brain, but that does not in and of itself mean that SSRIs don't, in part, work via the serotonin pathway. Bear in mind that cells are not inert when it comes to reacting to something and the effect of an SSRI might be to cause the cell to produce more molecules to mop up serotonin, or there may be a feedback loop which lowers serotonin levels.
In addition there are animal studies which show that SSRIs recruit new nerve cells from the stem cell population and it may be the time this takes that underlies the long time period before full effects are seen when on SSRIs.
So yes, it might be good to take simplistic stories the drug companies tell with a grain of salt, but that does not mean the chemical imbalance story is all bollocks, only that it is not simple. Also bear in mind that the mechanism of action is a different question to 'does the drug work'. We had no idea that extract of willow bark has its analgesic and anti-inflammatory effects by modulating prostaglindins when we first started evaluating aspirin. And see the story on Lithium therapy from that perspective too.
-
My mate used to sell mixed herbs as dope & his mums laxatives as speed at school. All accounts came back that it was good shit.
Pun intended, I hope.
-
Yes that was our question. Was it good shit?
Cruel cruel children we were, cruel. -
With laxatives it's important to understand the difference between "Good shit" and "Good to shit".
-
Having been exposed to more of the media coverage, the resident (clinical) psychologist's personal frustration was people describing the recommended alternative as "counselling". John Campbell managed to beat that with "counselling or talk therapy". Both of which I'd guess are less effective than the Prozac.
Honestly. You might as well see a "therapist".
Placebo party anyone?
-
Both of which I'd guess are less effective than the Prozac.
You'd guess that, but certain approaches, eg Cognitive Behavioural Therapy, in fact do seem to as effective as drugs (and even more effective when combined with them).
-
Placebo party anyone?
A friend in need's a friend indeed!
Post your response…
This topic is closed.