4 ms·

Antidepressants are not associated with improved quality of life in the long run

FollowingTheDao 5y ago
Original Study: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0265928 https://journals.plos.org/plosone/article?id=10.1371/journal...
ncmncm 5y ago
You can tell without even reading it that something is deeply wrong with their methods.
octokatt 5y ago
> The study was not able to separately analyze any subtypes or varying severities of depression. The authors say that future studies should investigate the use of non-pharmacological depression interventions used in combination with antidepressants. > The authors add: "Although we still need our patients with depression to continue using their antidepressant medications, long-term studies evaluating the actual impact for pharmacological and non-pharmacological interventions on these patients' quality of life is needed. With that being said, the role of cognitive and behavioral interventions on the long term-management of depression needs to be further evaluated in an efforts to improve the ultimate goal of care for these patients; improving their overall quality of life." This was not a fantastically designed, rigorous study. I would be interested to see if this is enough to follow-up with a better study, though, as anti-depressants tend to be barely better than placebo [1], with a lot of ugly side effects. *IMPORTANT NOTE*: If you are currently on antidepressants or any mental health medication and they're working for you, do not let this article or comment section influence you to go off meds without talking to your doctor. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/
- NoPie 5y ago
  I would definitely emphasise the same – do not take the conclusions of this study as a proof to stop antidepressants. First of all, be careful of single studies that may be biased. In this case I don't even know if life in Saudi Arabia might have some specific features that are not applicable in western countries. And generally long-term studies do not have a good track record. For example, many studies about long term effect of certain diet on health outcomes have disappointed.
  - FollowingTheDao 5y ago
    Until studies take genetics into account there will be no progress.
    - ncmncm 5y ago
      Until we have means to objectively distinguish between many different pathologies all labeled as "depression", other than by what medication they respond to, there will be no progress. And, all RCTs purporting to show no effect will remain worth less than the paper they are printed on. And, claims based on these RCTs will be, at best, ignorant; at worst, dishonest. If you have read this and continue repeating such claims, you have moved to the "dishonest" column.
  - biomcgary 5y ago
    US data, not Saudi. From the article: the researchers used data from the 2005-2015 United States' Medical Expenditures Panel Survey (MEPS), a large longitudinal study that tracks the health services that Americans use. Incredibly low resolution study.
derbOac 5y ago
This is an important study but I think has to be interpreted carefully. They verify an effect on depression symptoms but don't find an effect on overall rated quality of life. It would have to be replicated but is broadly consistent with some findings that psychiatric treatment effects don't always have the boundaries you'd think they would. It would be important to understand what differs between the depression measures and QoL and what of that is being moved by the antidepressants.
braingravy 5y ago
Fascinating, but not incredibly surprising considering that many commonly prescribed antidepressant drugs fail to beat a placebo. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592645/pdf/wps0014-0294.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592645/pdf/wps... (Compare the black bar under ‘antidepressants’ to the placebo bar.) This isn’t to say you shouldn’t take antidepressants if you have MDD; it’s worth a shot. However, it should make us curious as intelligent consumers of research of what the actual remediation of depressive symptoms is caused by(in both placebo and AD groups). Personally, I’d say it’s likely that the individual is the one making a difference in recovery from MDD, not the chemical. All that said, this post is absolutely not meant to shame antidepressant use: Depression is a potentially life threatening illness. I’m very happy for those who have over come it and I am not against antidepressant use in any way. It’s the best we’ve got (and they works quite well in conjunction with therapy btw! Far above placebo). But from a scientific perspective, it’s experimentally unclear if antidepressant drugs are anywhere near as efficacious as major pharmaceutical companies (with major financial incentives) say they are. It’s worth noting this is being currently debated in the field. There does seem to be a somewhat consistent effect of AD drugs performing slightly above placebo (see study linked above). However, it’s not clear if that effect is due to recognizable side effects that antidepressants have (allowing participants to ‘unblind’ themselves), or if antidepressants are indeed slightly more effective than a place I. Due to the nature of the illness, it’s been assumed that it’s worth it to keep prescribing these drugs to those who suffer from depression. Edit: If you are dealing with depression, please seek help. Doing so will improve your life, and the lives of those around you. Life is too short to suffer without help.
- Perenti 5y ago
  I live with depression, and have taken SSRI and SNRI medication for about 30 years. It took a very long time to find the drug and dosage and dosing regime that works for me. I still get way down, but not _too_ dark and since going on current meds 3 years ago have had no issues with suicidal ideation. Depression is a complex set of problems, and it is in my experience unreasonable to expect a "complete cure in a box" when dealing with Major Depression. In my case there is little doubt that my current SNRI is life extending. To be honest, I sometimes think that maybe pointing out how weak the evidence is for AD meds in general may dissuade some people from trying them - and they may work, as may a placebo. I really appreciate the way you worded this, it's really rare to find a balanced and informed opinion like you have shared.
hammock 5y ago
Anyone ought to look up the NNT (number needed to treat) for any of the most common SSRIs
Perenti 5y ago
I feel I must point out that people who have been on antidepressants for a long time are not dead by their own hands yet. So the question becomes "Depressed people live longer on antidepressants. How do we make their lives suck less?".
- FollowingTheDao 5y ago
  You are forgetting about the number of people who die after taking antidepressants. https://www.bmj.com/content/358/bmj.j3697/rr-4 https://www.bmj.com/content/358/bmj.j3697/rr-4

Original Study: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0265928 https://journals.plos.org/plosone/article?id=10.1371/journal...

ncmncm 5y ago

You can tell without even reading it that something is deeply wrong with their methods.

octokatt 5y ago

> The study was not able to separately analyze any subtypes or varying severities of depression. The authors say that future studies should investigate the use of non-pharmacological depression interventions used in combination with antidepressants. > The authors add: "Although we still need our patients with depression to continue using their antidepressant medications, long-term studies evaluating the actual impact for pharmacological and non-pharmacological interventions on these patients' quality of life is needed. With that being said, the role of cognitive and behavioral interventions on the long term-management of depression needs to be further evaluated in an efforts to improve the ultimate goal of care for these patients; improving their overall quality of life." This was not a fantastically designed, rigorous study. I would be interested to see if this is enough to follow-up with a better study, though, as anti-depressants tend to be barely better than placebo [1], with a lot of ugly side effects. *IMPORTANT NOTE*: If you are currently on antidepressants or any mental health medication and they're working for you, do not let this article or comment section influence you to go off meds without talking to your doctor. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/

NoPie 5y ago
I would definitely emphasise the same – do not take the conclusions of this study as a proof to stop antidepressants. First of all, be careful of single studies that may be biased. In this case I don't even know if life in Saudi Arabia might have some specific features that are not applicable in western countries. And generally long-term studies do not have a good track record. For example, many studies about long term effect of certain diet on health outcomes have disappointed.
- FollowingTheDao 5y ago
  Until studies take genetics into account there will be no progress.
  - ncmncm 5y ago
    Until we have means to objectively distinguish between many different pathologies all labeled as "depression", other than by what medication they respond to, there will be no progress. And, all RCTs purporting to show no effect will remain worth less than the paper they are printed on. And, claims based on these RCTs will be, at best, ignorant; at worst, dishonest. If you have read this and continue repeating such claims, you have moved to the "dishonest" column.
- biomcgary 5y ago
  US data, not Saudi. From the article: the researchers used data from the 2005-2015 United States' Medical Expenditures Panel Survey (MEPS), a large longitudinal study that tracks the health services that Americans use. Incredibly low resolution study.

derbOac 5y ago

This is an important study but I think has to be interpreted carefully. They verify an effect on depression symptoms but don't find an effect on overall rated quality of life. It would have to be replicated but is broadly consistent with some findings that psychiatric treatment effects don't always have the boundaries you'd think they would. It would be important to understand what differs between the depression measures and QoL and what of that is being moved by the antidepressants.

braingravy 5y ago

Fascinating, but not incredibly surprising considering that many commonly prescribed antidepressant drugs fail to beat a placebo. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592645/pdf/wps0014-0294.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592645/pdf/wps... (Compare the black bar under ‘antidepressants’ to the placebo bar.) This isn’t to say you shouldn’t take antidepressants if you have MDD; it’s worth a shot. However, it should make us curious as intelligent consumers of research of what the actual remediation of depressive symptoms is caused by(in both placebo and AD groups). Personally, I’d say it’s likely that the individual is the one making a difference in recovery from MDD, not the chemical. All that said, this post is absolutely not meant to shame antidepressant use: Depression is a potentially life threatening illness. I’m very happy for those who have over come it and I am not against antidepressant use in any way. It’s the best we’ve got (and they works quite well in conjunction with therapy btw! Far above placebo). But from a scientific perspective, it’s experimentally unclear if antidepressant drugs are anywhere near as efficacious as major pharmaceutical companies (with major financial incentives) say they are. It’s worth noting this is being currently debated in the field. There does seem to be a somewhat consistent effect of AD drugs performing slightly above placebo (see study linked above). However, it’s not clear if that effect is due to recognizable side effects that antidepressants have (allowing participants to ‘unblind’ themselves), or if antidepressants are indeed slightly more effective than a place I. Due to the nature of the illness, it’s been assumed that it’s worth it to keep prescribing these drugs to those who suffer from depression. Edit: If you are dealing with depression, please seek help. Doing so will improve your life, and the lives of those around you. Life is too short to suffer without help.

Perenti 5y ago
I live with depression, and have taken SSRI and SNRI medication for about 30 years. It took a very long time to find the drug and dosage and dosing regime that works for me. I still get way down, but not _too_ dark and since going on current meds 3 years ago have had no issues with suicidal ideation. Depression is a complex set of problems, and it is in my experience unreasonable to expect a "complete cure in a box" when dealing with Major Depression. In my case there is little doubt that my current SNRI is life extending. To be honest, I sometimes think that maybe pointing out how weak the evidence is for AD meds in general may dissuade some people from trying them - and they may work, as may a placebo. I really appreciate the way you worded this, it's really rare to find a balanced and informed opinion like you have shared.

hammock 5y ago

Anyone ought to look up the NNT (number needed to treat) for any of the most common SSRIs

Perenti 5y ago

I feel I must point out that people who have been on antidepressants for a long time are not dead by their own hands yet. So the question becomes "Depressed people live longer on antidepressants. How do we make their lives suck less?".

FollowingTheDao 5y ago
You are forgetting about the number of people who die after taking antidepressants. https://www.bmj.com/content/358/bmj.j3697/rr-4 https://www.bmj.com/content/358/bmj.j3697/rr-4