Drugs and Depression
Pet topic. Skip if you're bored already with these critiques of the established world-view; if you're still here, prepare to be surprised.
Pharmaceutical revenues outstrip petroleum revenues by about 50 billion dollars annually. Which means our culture spends more on pills than it does on gasoline and heating. Now, I'd like to think this is because of technical advances in the treatment of conditions for people like Marbella and Ms. Beans. But the real cash cows of the business are the antidepressants. Making people happy is big bucks. Equating dissatisfaction with illness and ascribing it to an "imbalance" in brain chemistry is brilliant marketing; even though the basis of this claim has not been scientifically validated and is more controversial in the field of neurobiology than is popularly recognized. This is not to say that depression doesn't exist or that it can't be a dehabilitating condition; just that the "treatment" proposed is suspect. Here's why.
Taking a look at six most widely prescribed antidepressants, and the studies that support their efficacity, reveals some curious facts. Not the facts you'll hear in the TV ads urging you to "ask you doctor" if this is right for you. But facts that had to be grudgingly extracted with the freedom of information act to examine the data on trials which approved the drugs.
47 trials were performed on Prozac, Zoloft, Paxil, Effexor, Serzone, and Celexa during their approval process. Only 20 of these trials showed *any* measurable benefit of the drugs over placebos. The measurement used was the Hamilton Depression Rating Scale, the most widely used methodology by clinicians to assess a patient's level of depression. In the studies where the drug outperformed the placebo, the difference between the two was remarkably minor. Improvement with the drugs registered an additional 10 points on the Hamilton, and the placebo registered and additional 8, out of a possible 52 points. A 2 point difference on this scale is regarded by psychologists as "clinically meaningless."
So why did the FDA allow these on the market? In a quote from the trials, one deputy states: "It is difficult to judge the clinical significance of this difference," he wrote, but added that this shouldn't be an impediment for bringing Celexa to market because "similar findings for...other recently approved antidepressants have been considered sufficient."
In lay-speak: we allowed others on the market with insignificant results so that's our justification for this one. A bit of circular logic.
But, another factor afoot is, in subsequent trials for other antidepressants, both the placebos and the drugs are showing more affect. Marketing seems to be the key reason; our population is being convinced pills are the answer ---even if they are sugar pills. Ask your doctor what's right for you.
Further Reading
Is it Prozac or Placebo?
Pharmaceutical revenues outstrip petroleum revenues by about 50 billion dollars annually. Which means our culture spends more on pills than it does on gasoline and heating. Now, I'd like to think this is because of technical advances in the treatment of conditions for people like Marbella and Ms. Beans. But the real cash cows of the business are the antidepressants. Making people happy is big bucks. Equating dissatisfaction with illness and ascribing it to an "imbalance" in brain chemistry is brilliant marketing; even though the basis of this claim has not been scientifically validated and is more controversial in the field of neurobiology than is popularly recognized. This is not to say that depression doesn't exist or that it can't be a dehabilitating condition; just that the "treatment" proposed is suspect. Here's why.
Taking a look at six most widely prescribed antidepressants, and the studies that support their efficacity, reveals some curious facts. Not the facts you'll hear in the TV ads urging you to "ask you doctor" if this is right for you. But facts that had to be grudgingly extracted with the freedom of information act to examine the data on trials which approved the drugs.
47 trials were performed on Prozac, Zoloft, Paxil, Effexor, Serzone, and Celexa during their approval process. Only 20 of these trials showed *any* measurable benefit of the drugs over placebos. The measurement used was the Hamilton Depression Rating Scale, the most widely used methodology by clinicians to assess a patient's level of depression. In the studies where the drug outperformed the placebo, the difference between the two was remarkably minor. Improvement with the drugs registered an additional 10 points on the Hamilton, and the placebo registered and additional 8, out of a possible 52 points. A 2 point difference on this scale is regarded by psychologists as "clinically meaningless."
So why did the FDA allow these on the market? In a quote from the trials, one deputy states: "It is difficult to judge the clinical significance of this difference," he wrote, but added that this shouldn't be an impediment for bringing Celexa to market because "similar findings for...other recently approved antidepressants have been considered sufficient."
In lay-speak: we allowed others on the market with insignificant results so that's our justification for this one. A bit of circular logic.
But, another factor afoot is, in subsequent trials for other antidepressants, both the placebos and the drugs are showing more affect. Marketing seems to be the key reason; our population is being convinced pills are the answer ---even if they are sugar pills. Ask your doctor what's right for you.
Further Reading
Is it Prozac or Placebo?
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