4 ms·

AFTER FIFTY YEARS, billions of dollars of intensive marketing campaigns, and tens of billions of dollars of profits for pharmaceutical companies, it is still fa

by htk 7y ago

AFTER FIFTY YEARS, billions of dollars of intensive marketing campaigns, and tens of billions of dollars of profits for pharmaceutical companies, it is still far from clear that antidepressant drugs are any more effective than placebo. The only group of people who have demonstrably benefited from the widespread use of antidepressants are pharmaceutical executives and investors. I don't think this is accurate or helpful, and I hope people who benefit from medication don't stop taking them after reading things like this.

rjkennedy98 7y ago
> I don't think this is accurate Yes it is accurate. It is very accurate. The garbage studies routinely dumped on us by Big Pharma have been continually debunked, reversed, and retracted after the raw data comes out (often in lawsuits). Nevermind the complete absence of long-term studies or any studies that reflect the actually usage of these drugs in the real world.
- wbronitsky 7y ago
  Here we go, actual data about SSRIs vs the placebo effect: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/ It would be super cool if we all took the time to cite data that back up our assertions instead of just insisting that our ideas are correct.
  - nitrogen 7y ago
    I'll quote the lede from the abstract so people know what they are clicking on: Instead of curing depression, popular antidepressants may induce a biological vulnerability making people more likely to become depressed in the future. Nobody currently taking antidepressants should stop them without very careful planning and consideration of whether they should and how, but the same very strong consideration should be given before starting them for long term use, too (with a professional ideally, which I am not).
    - mcguire 7y ago
      On the other hand, from the end of the article, "My colleagues and I have conducted a meta-analysis of various treatments for depression, including antidepressants, psychotherapy, the combination of psychotherapy and antidepressants, and “alternative” treatments, which included acupuncture and physical exercise (Khan, Faucett, Lichtenberg, Kirsch, & Brown, 2012). We found no significant differences between these treatments or within different types of psychotherapy." So the first thing you should know about the treatment of depression: Nothing works very well.
    - wbronitsky 7y ago
      I'm not agreeing or disagreeing with anyone here. I'm merely asserting that we should use facts to back up our arguments.
- Pfhreak 7y ago
  > We identified 28 552 citations and of these included 522 trials comprising 116 477 participants. In terms of efficacy, all antidepressants were more effective than placebo. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6... I dunno, studies seem to suggest otherwise. I think it's terribly irresponsible to be telling people not to take medications that can help them.
  - rjkennedy98 7y ago
    You don't know. My brother is a doctor who writes papers on meta-analysis. The Cipriani paper is trash. The actual effect size is LESS than in the paper posted in this thread (Kirch et al) which was featured on 60 minutes about the placebo effect. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6597641/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6597641/
papreclip 7y ago
it is accurate. i don't know if it's helpful to the antidepressant drug user, though. placebos work better than nothing, but not if you know they're placebos
- jyrkesh 7y ago
  Actually, the crazy thing about placebos is that they work (albeit not as well), even if you know they're placebos. https://www.health.harvard.edu/blog/placebo-can-work-even-know-placebo-201607079926 https://www.health.harvard.edu/blog/placebo-can-work-even-kn...
PragmaticPulp 7y ago
It's partially accurate, but it's mostly misinterpreted. "No better than placebo" sounds like the drugs don't work at all, but that's not true. Placebo is unreasonably effective at treating depression, and strangely enough placebo is getting more effective over time: https://www.psychologytoday.com/us/blog/straight-talk/201803/the-curious-case-the-growing-placebo-effect https://www.psychologytoday.com/us/blog/straight-talk/201803... Take a look at the response chart for placebo vs. SSRI some time and it will become very clear. Placebo treatment is literally so effective that it's difficult for actual antidepressants to significantly separate from placebo. That doesn't mean they work, though. So why don't we just give everyone placebo? Ignoring the moral issues, active treatments are still superior to placebo and the results tend to last much longer than placebo. And for the most severely depressed patients, active treatments perform much better than placebo. The placebo effect cuts both ways. If someone goes into an SSRI trial convinced that SSRIs are a garbage conspiracy pushed by Big Pharma after reading anti-psychiatry posts on the internet, they are much less likely to see depression remission.
htk 7y ago
Why I don’t believe it’s accurate: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

by htk 7y ago

rjkennedy98 7y ago

> I don't think this is accurate Yes it is accurate. It is very accurate. The garbage studies routinely dumped on us by Big Pharma have been continually debunked, reversed, and retracted after the raw data comes out (often in lawsuits). Nevermind the complete absence of long-term studies or any studies that reflect the actually usage of these drugs in the real world.

wbronitsky 7y ago
Here we go, actual data about SSRIs vs the placebo effect: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/ It would be super cool if we all took the time to cite data that back up our assertions instead of just insisting that our ideas are correct.
- nitrogen 7y ago
  I'll quote the lede from the abstract so people know what they are clicking on: Instead of curing depression, popular antidepressants may induce a biological vulnerability making people more likely to become depressed in the future. Nobody currently taking antidepressants should stop them without very careful planning and consideration of whether they should and how, but the same very strong consideration should be given before starting them for long term use, too (with a professional ideally, which I am not).
  - mcguire 7y ago
    On the other hand, from the end of the article, "My colleagues and I have conducted a meta-analysis of various treatments for depression, including antidepressants, psychotherapy, the combination of psychotherapy and antidepressants, and “alternative” treatments, which included acupuncture and physical exercise (Khan, Faucett, Lichtenberg, Kirsch, & Brown, 2012). We found no significant differences between these treatments or within different types of psychotherapy." So the first thing you should know about the treatment of depression: Nothing works very well.
  - wbronitsky 7y ago
    I'm not agreeing or disagreeing with anyone here. I'm merely asserting that we should use facts to back up our arguments.
Pfhreak 7y ago
> We identified 28 552 citations and of these included 522 trials comprising 116 477 participants. In terms of efficacy, all antidepressants were more effective than placebo. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6... I dunno, studies seem to suggest otherwise. I think it's terribly irresponsible to be telling people not to take medications that can help them.
- rjkennedy98 7y ago
  You don't know. My brother is a doctor who writes papers on meta-analysis. The Cipriani paper is trash. The actual effect size is LESS than in the paper posted in this thread (Kirch et al) which was featured on 60 minutes about the placebo effect. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6597641/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6597641/

papreclip 7y ago

it is accurate. i don't know if it's helpful to the antidepressant drug user, though. placebos work better than nothing, but not if you know they're placebos

jyrkesh 7y ago
Actually, the crazy thing about placebos is that they work (albeit not as well), even if you know they're placebos. https://www.health.harvard.edu/blog/placebo-can-work-even-know-placebo-201607079926 https://www.health.harvard.edu/blog/placebo-can-work-even-kn...

PragmaticPulp 7y ago

It's partially accurate, but it's mostly misinterpreted. "No better than placebo" sounds like the drugs don't work at all, but that's not true. Placebo is unreasonably effective at treating depression, and strangely enough placebo is getting more effective over time: https://www.psychologytoday.com/us/blog/straight-talk/201803/the-curious-case-the-growing-placebo-effect https://www.psychologytoday.com/us/blog/straight-talk/201803... Take a look at the response chart for placebo vs. SSRI some time and it will become very clear. Placebo treatment is literally so effective that it's difficult for actual antidepressants to significantly separate from placebo. That doesn't mean they work, though. So why don't we just give everyone placebo? Ignoring the moral issues, active treatments are still superior to placebo and the results tend to last much longer than placebo. And for the most severely depressed patients, active treatments perform much better than placebo. The placebo effect cuts both ways. If someone goes into an SSRI trial convinced that SSRIs are a garbage conspiracy pushed by Big Pharma after reading anti-psychiatry posts on the internet, they are much less likely to see depression remission.

htk 7y ago

Why I don’t believe it’s accurate: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6...