Mythical Monday – misconceptions about antidepressants.

~ kachaiweb

 

Antidepressants don’t do anything. They work as well as a placebo.

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Wait, what, how? I am interested where this misconception comes from. Who installed this myth in the world? The culprit seems to be a meta-study from 2008 when 47 studies were pooled to look for the difference between placebo’s and antidepressants (AD) and their respective outcomes [1]. They found that in mild to moderate depression there was no big difference between the two treatments. For people with more severe symptoms of depression the outcomes for AD were better than the placebo- effect.

In 2011 a different meta-analysis study found that antidepressants were more beneficial in treating mild but long term depression or persistent depressive disorder. This study didn’t convert the opinion about antidepressants.

 

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We need to look deeper into the methodology used in the first study to debunk it.

Methodology is how the study itself  is conducted; they are specific rules in place if you want your conclusion to be valid and significant.

An example of a bad methodology would be:

  • My hypothesis:  People who have headaches lack aspirin receptors in the brain.
  • My observation and testing: People who don’t take aspirin, don’t have this lack in the brain and they don’t have a headache.
  • My conclusion:  Headaches are the result of a lack of aspirin.

Reading this example, do you feel something isn’t quite right with my study?

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The problems in the first study seem to stem from the fact that subjects were selected and treated differently that they would be in real life. Normally researches try to keep all things the same for the two groups of subjects and there is one variable, the thing you want to research. Think about people of all different ages, men and women equally represented, all participants have the same medical condition. When testing new diabetic medicine, would you test that on people without diabetes and conclude that it doesn’t work?

In the first study subjects took AD for a period from 4 to 8 weeks. In real life people take AD much longer than that and doctors can adjust the doses to the need of the patient.

All subjects were given the same medication. In real life doctors and patients look for the best medication for them at that time. Some people have a history with certain medications or have a history of mental illness in the family; all different factors come into play while prescribing the right medication. And still finding that right medication can be a daunting task and doctors don’t find a fit a the first try. So a part of the subjects in the study will not respond to the one AD what doesn’t mean that all the possible AD will not work ever. And sadly that was the conclusion that was being installed into the world.

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When you’re suffering with mental illness, please speak to a certified health professional in the field of psychiatry or psychology. Due to the internet there is a lot of information available but sometimes people who are not qualified to do so, draw conclusions that are just not right. Being right or wrong isn’t even the case here, your health needs to come first. Take care of your mental health and place it in the hands of people you really can trust. Depression can be treated, it can get better there is just not that one miracle cure. Value yourself high enough to get the treatment that is right for you.

 

Resources.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/

Published by kachaiweb

33 thoughts on “Mythical Monday – misconceptions about antidepressants.”

    1. Thanks! I remember that example of aspirin from school 😂 and we should question what is presented to us, I mean, people get so tricky sometimes when only concerned about their message (money)!

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      2. Yes they disclose that in the study itself, so it’s not that hard too have a look. The number of participants is also extremely important but in this case not so. I think 47 for a meta-study is not that bad, 100 would be better but I honestly didn’t look for yet another study for this post. But I’ll have a fabulous study next Monday.

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    2. sometimes it is, my personal thought is I stopped meds and got worse, 6months later a different med and is helping. has side effects i dont like but will live with as I have my brain back.

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    1. Aha! Very good question of course. It depends from study to study but in general they would take standardized test for depression in this case, and after certain amount of time (again the same for all subjects) they will take this test again. There are certain test that are proven to score very well, to measure what they say they measure, symptoms of depression in this case.
      In other studies they ‘just ask’ the subjects which is less reliable of course. Sometimes they can be scored by a psychiatrist too at the start and at the beginning.
      But usually it would be a test, multiple choice, a valid and standardized test. For depression this could be the Beck Depression Inventory. There are others too. Then they interpret the results and hope to find a significant result.

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      1. Ah, okay, I get it. It seems very subjective, though.
        Not long after my stroke, they gave me something called a FES to wear on my leg, to help me walk. It was a very marginal gain and when they timed me walking over just 20m or so, there was not much difference with or without. They used to survey me…on a scale of 1-10, how easy…. I had an idea of what they were looking for so I made up suitably reasonable answers. In truth, over 20m, everything was easy. If they had measured over e.g. 1km, the effect wuld have been far clearer.

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      2. With multiple choice and the tests they use, the tests are designed to rule out ‘socially favorable answers’. That is also why the number of subjects is very important; they need to calculate the answers over a large number of people to even everything out, also drop-outs. Those all things to look for when reading the result of a study. In your case, you’re very right because the number of subjects was 1, you in that moment.

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      4. That is so incredible! Just the reasoning and science behind it. We have 80-90 mV going through the nerve cells. Thank you for the information! I’m going to pass it on to someone who asked me that question once 🙂

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      6. I can imagine that it can work very well for certain people. To get ‘things going again’. I have that too, it’s called anti anxiety medication 😂
        On a completely different note; I see you made adjustments to your site with a very clear message towards receiving awards. Each makes his own choices for his or her blog. I’m happy with one award every 50 followers It can take a while then 🙂

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    2. Hey Josh, you once asked me about the chemistry and electricity in the brain, between the neurons. Today a follower passed me this interesting webpage: “Neurons are electrically active cells.[4] In neurons, information is coded and transmitted as a series of electrical impulses called action potentials, which represent a brief change in cell electric potential of approximately 80–90 mV. Nerve signals are frequency modulated; i.e. the number of action potentials that occur in a unit of time is proportional to the intensity of the transmitted signal. Typical action potential frequency is between 4 and 12 Hz.”
      https://en.wikipedia.org/wiki/Functional_electrical_stimulation

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  7. Research is such a potentially biased thing isnt it. As others have said, who is funding, what sort of University or research facility is undertaking the research. Do they have programed bias. are those involved in the research being paid?

    I was never keen to go on medications. When I was so unwell it was the only avenue that might see me keep living I had t try it. I felt better, took myself off them a year later, sank 6months later, and took to getting to totally withdrawn not showering, eating highly processed foods, no exercise. great gp left to become a psychiatrist. lost. New GP new med my choice sort of, and so thankful she did. I have my brain back. I dont like some of the side effects but will put up with them. Yet many others have found this medication horrible for them. You could easily skew a research program by finding folk who only have positive out comes. The questions you ask,etc.

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    1. Medications need to be really personalized, a lot of trial and error is sometimes needed. Like you said, a working alliance with your health care provider can change your view.
      I don’t see medication as a cure but more as a tool. For me, a needed one, sometimes you need a little help to make you able to tackle the things that are thrown at you. I think the process of stopping your meds is really natural, you can learn like that what is really helpful for you and what not.
      Sometimes meds stop working too and you need to switch.
      Reading research results is a special skill and sadly some people draw wrong conclusions and spread misinformation.
      Thank you very much for commenting!

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  9. That’s an excellent point, that real-world doctors who prescribe anti-depressant medication do so after examining the individual and determining what will fit their needs best (at least I hope they do!). Mental health treatment is a very individual thing. There are some who might be able to use affirmations and other inner work to manage their symptoms, but for others, medication is totally necessary and helpful. The biggest problem with studies about whether anti-depressants and other medications more helpful than placebos or the same as them is the idea that we can make a blanket statement about anything that has to interact with the human brain and mind.

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    1. I agree 100%. Some statements can be made about mental health but we need to be careful and keep understanding that the individual situation (intern or extern) is unique to the person.
      I really love your comment as it fits my next post on Monday about the future of antidepressants. I think you’re going to like it. 🙂

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