Blogs by MidAmerica Nazarene University staff and faculty.
ANTIDEPRESSANTS: EFFICACIOUS OR NOT?
It’s been 60 years since the original serendipity. A drug with potential to alleviate tuberculosis was found to improve depressive moods symptoms instead. In short time, whatever gains were seen in elevating mood was countered by a sustained hypertension that soon became life threatening. But the race was on to find a psychotropic drug selective for depression. Tricyclic antidepressants and selective serotonin reuptake inhibitors have been and are currently used to treat a large chunk of the population in the US. More than 1 in 10 Americans take one or more antidepressant medications.
In 2010, 3 books were written uniformly challenging the usage of this #1 medication. Clinical psychologists Irving Kirsch’s book: The Emperor’s New Drugs—Exploding the Antidepressant Myth; journalist Robert Whitaker’s book: Anatomy of an Epidemic—Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness; and psychiatrist Daniel Carlat’s book: Unhinged: The Trouble With Psychiatry—A Doctor’s Revelations About a Profession in Crisis, all from different perspectives seriously challenging the efficaciousness of these drugs. A major premise in these books recognizes it is time to lay to rest the old and now discredited theory of chemical imbalances that began this pursuit in the first place. Kirsch argues that at least 100 studies have over the last few years have failed to support the idea that when the critical neurotransmitters ( norepinephrine and serotonin) have been artificially depleted in normal people, depression becomes the expected consequence. Furthermore, when the expected imbalance is corrected with medication, advantageous therapeutic effects are not seen for at least 3 to 4 weeks following if seen at all.
Is the advent of antidepressant medications over or should a more incipient variable be considered? A treatise written by Anita Slomski and covered by Brain in the News, May 2012 (www. dana.org) suggests the latter. She points out that a large per-cent of studies on this issue are sponsored by pharmaceuticals and contain scientific methodological errors. 1. Subject pools are generally small and consequently a few positive or negative results skew the conclusions. 2. Subjects selected for trial participation generally have mild to moderate depressive ratings and are rarely the garden variety patients who often have accompanying symptoms of drug or alcohol abuse, anxiety disorders, or personality disorders. 3. Patients in these trials often show the methodological confound called the “Hawthorn Effect”. That is, those on a placebo also want to “please” the investigators and report they are getting better.
The best index for an accurate evaluation of this issue was seen in a 2008 study (STAR*D: Sequenced Treatment Alternatives to Relieve Depression). This non-pharmaceutically based investigation was a $35 million venture using 4000 depressed patients and 10 different drugs. It incorporated 4 rounds of selected therapy. Phase 1 utilized a single antidepressant. After 13 weeks on the selected drug, 1/3 of the patients showed full remission of symptoms and for the other 2/3 an additional 10% to 15% reported improvements. Phase 2 allowed the non-responsive patients to switch to another antidepressant medication or continue on with the original plus an additional drug. They also were allowed to switch to psychotherapy with or without drugs. When medication was switched, a consequential 25% became symptom free. When an additional drug was added about 1/3 found remission of symptoms. Phase 3 involved patients still unresponsive. They were given the option of a drug specific to another neurotransmitter or added on to the original a non-conventional drug such as lithium. Depending on their selection, 12% to 20% became symptom free. Patients in phase 4 were taken off all antidepressant meds and given treatments utilized when all drug treatments failed.
In all, STAR*D patients showed 50% symptom-free results after 2 phases and 70% after 3. Peter Kramer, clinical professor of psychiatry at Brown University and author of the book: Listening to Prozac, stated when referring to depression: “medications for mental illness are as effective a medication doctors use for other indications. Doctors treating hypertension, for example, often need to switch or supplement medications. The use of antidepressants is comparable”.