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Re: Do antidepressants really work?

Posted by Althea8869 on April 4, 2004, at 10:39:34

In reply to Do antidepressants really work?, posted by lexman on March 29, 2004, at 20:23:39

Ive seen this question many times and I think most have answered it pretty accurately, but I thought, 'its sunday morning and i'll throw my two, maybe three cents in'.

Two things we know for sure, 1) Depression is an illness(disease) and is characterized by particular neurological and physical symptoms which can be measured using a number of different methods, one of the most scientific is Proton Emmission Tomography (PET). Brain scans of depressed people (both endogenous and exogenous) show a clear differentiation from those not suffering. 2) We also know that certain medications over a period of several weeks will have a marked affect on the results of those brain scans - returning them to a more 'normal' state, if you will.

While this is good news, it must be pointed out that 1) The placebo effect must not be underestimated - the very act of thinking that a medication is going to work for you can often cause improvement - and not just in the short term as others have suggested. I have told the story before of patients in a trial of a cancer drug losing all their hair, despite, as it turned out, being given the placebo. They truly believed they would lose their hair and so they did. It didnt matter that they were taking sugar pills. 2) There is now an abundance of clinical evidence to show that psychotherapy alone results in precisely the same changes to PET scans that medication shows. (Not all medications, but many) Moreover, psychotherapy alone has been linked to longer term remission rates - no 'poop out'. This is why we are always advised that the best solution is both medication and psychotherapy in combination. 3) Its important to remember that the people that are most often used in the clinical trials that determine efficacy have an exogenous form of depression, typically short term. In other words they select the people MOST likely to respond to the medication - which across most medications shows ~35-50% some improvement and 25-35% significant improvement - and these results are for their 'taylor made' group. Said differently, these are not real world results. Typically you should divide those numbers in half for 'real world' application - and those numbers divided in half, surprise, surprise, are roughly the equivalent of the 'placebo' response group in most trials.

While it may seem that the picture is fairly bleak for medications, in reality its not that bad, actually its pretty good. The reason being that 1) There are so many different meds out there now (all of which have different chemical structures and most of which work by different mechanisms), and so many different forms of depression, that the probability of an individual responding to one of them is actually quite high - on the order of about 70%+. Its just a question of finding the correct match. This is why we constantly tell each other to go back to the doc and ask for something different. In fact there is a great deal of work being done now to better understand who will respond to what. This should improve initial response rates in the very near future. 2) We also know that combinations of meds can be complementary - something unthinkable just ten years ago. 3) The US government is starting to take this disease far more seriously than it ever did in the past - that translates into research dollars 4) Most importantly, thanks to advances in medical technology, our understanding of the human brain and its many functions, neurochemicals, interactions etc, has increased a thousand fold in just the last few years. The NE/SE/DO model of depression is now just one of many. There are leading edge psychopharmacologists that believe the next wave of medications will use a completely different model and target a completely different set of neurotransmitters - most of these meds dont have names right now, but they are being developed as we speak. 5) Finally, and best of all, there are sites like this one that allow sufferers to learn more about medications and the particulars of their conditions, similarities etc, as well as to form friendships and inspire in each of us a sense of helping others - which always makes me feel a little better. One truth is that an educated patient has a far greater chance for success than an uneducated one. This is true regardless of the condition. Kudoz to Dr Bob - i think he underestimates the true potential of a board like this. Bob if you ever need any financial assistance to keep this going, dont ever hesitate to ask.

I guess what this all distills down to is that, 'yes' antidepressants do work, but until we know more about neurochemistry and can better diagnose different kinds of depressive states, it will continue to be a trial and error process. For some a positive response may come quickly, for others, like me, it may take many years to find the right med or combination that works. Just dont give up, and always convey your experiences to others in formats like this. And dont ever forget about excersize/nutrition. In concert with the right meds, it can increase the level of improvement dramatically.

Anyway, take care and enjoy your sunday. I know that writing this has already put me in a good mood.




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