More doubts about Prozac

[unixronin]

Recently, Prozac and related SSRI antidepressants were dealt a blow when it was made public that Eli Lilly, Glaxo-SmithKline and the other manufacturers of the drugs had failed to disclose data from unfavorable clinical studies that showed patients using SSRIs had an increase as much as four to one in suicide risk.  Now, a new study from Hull University, using the data submitted to the FDA to gain approval for the drugs, has found that for most patients, SSRIs are no more effective than a placebo.

Eli Lilly, of course, defends the drugs' effectiveness; and another researcher, the head of psychopharmacology at Bristol University, says that "if they provide some sort of placebo benefit, this shouldn't be discounted."

Now, the thing that immediately occurs to me is this: If you have the choice between a placebo that is medically inert, and has no side effects that aren't psychosomatic, or a drug that performs no better than the placebo, but has a vicious side-effect profile and may quadruple your likelihood of suicide ... aren't you better off with the placebo?

Clarification:

I should point out that I have not read the studies cited; I have only read summaries.  My intention here was not to discuss the studies per se, but rather to question the idea that it's still a good idea to use a drug with known severe side-effects for it's placebo-like effect if it's (allegedly) no better than a placebo.

Comments

[unix-jedi.livejournal.com]

Placebos have "the placebo effect" or they don't.

But not necessarily for everyone. That's why you have (hopefully) large double-blind studies.

Like treating heart disease or cancer, treatment is complicated and must be tailored to the patient.

My ambivalence comes from seeing people who literally walked into the doctors office and said "I want prozac|zoloft|etc", and the doc said "OK" and wrote the script. No therapy, no examination.

Hell, one friend of mine was on SSRI's in college. Not that she was depressed, she just didn't want to be the ONLY girl in the Sorority not on an antidepressant.

It's well established to be biological problem.

I can't agree with that. I'm speaking more of depression than bipolar (which I have almost no personal experience with), but until we can actually diagnose for it - accurately, and through blind studies, I'll have to remain skeptical.

But I do know that people - such as you - disagree strongly based on their personal experience. And I can't gainsay you - either I'm not affected by the depression, or I deal with it in a different way. That's the problem with problems in the brain. Thus my ambivalence.

[nephthys510.livejournal.com]

I've had a few glasses of wine, so I am not going to be as pithy as I would like, but I feel compelled to reply.

As for your friend and her doctor that settled on Prozac, that's their problem and should not reflect upon those that need and have benefited from pharmacological treatment, nor the manufacturers that they depend upon. This anecdata adds nothing to the debate.

House_pundit speaks to bipolar disorder, I speak for biologic depression. Please don't confuse situational with biological depression. I can't speak for your history, but it seems that if you deal with depression "in a different way" perhaps you deal with situational depression... which can be dealt with more effectively than biological. While it is very difficult to overcome any depression, it's a far sight easier to identify depression that is situational (I lost my SO, my job, and everything is going wrong) than if one can only identify exacerbating circumstances to one's lifelong feelings of worthlessness, apathy, and despair.

I don't trust big pharma any more than I trust that the government has "my" best interests at heart. I do know that I wouldn't be here to reply to you if it weren't for the Wellbutrin I have taken off and on (off by my misdirected choice) for many many years.

[unixronin.livejournal.com]

Wellbutrin is another interesting case, because not even the drug companies have a good working theory about how or why it works.

[laurarey.livejournal.com]

It is interesting. After having tried many varieties of anti-depressants over the last 15 years, I must say it is the only one that has done anything for me.

One of the things I'm researching these days is the link between niacin and nicotine....and wellbutrin and zyban.

[unix-jedi.livejournal.com]

This anecdata adds nothing to the debate.

If we toss anecdotes - (which is fine by me; I use them to point out systematic flaws, not ones with the drugs per se) - then ... we have to toss yours and house_pundit's as well. That was really my complaint - success stories are anecdotal.

That's the problem with this issue - too many people want to toss the anecdotes from the other side, while celebrating the ones from the side they support. That's many things, but scientific isn't one of them.

[unixronin.livejournal.com]

My ambivalence comes from seeing people who literally walked into the doctors office and said "I want prozac|zoloft|etc", and the doc said "OK" and wrote the script. No therapy, no examination.

Well, really, that's not a problem of the medication. That's a problem of the doctor not doing his job.

Hell, one friend of mine was on SSRI's in college. Not that she was depressed, she just didn't want to be the ONLY girl in the Sorority not on an antidepressant.

Ugh. That's sad in several distinct ways.

But I do know that people - such as you - disagree strongly based on their personal experience. And I can't gainsay you - either I'm not affected by the depression, or I deal with it in a different way. That's the problem with problems in the brain. Thus my ambivalence.

The basic factor at work here, I think, is that not all brains are created equal, and not everyone reacts identically to any given medication. It seems they work very well for house_pundit. On the other hand, for me, they're like throwing a monkey wrench into a finely-tuned machine.

[unix-jedi.livejournal.com]

Well, really, that's not a problem of the medication.

Technically?

No, of course not.

But it is a failure of the system that's dispensing those medications, leaving that system's credibility strained when other claims are made.

It's the same issue right now with Ritalyn and Adderol with kids. One of my at-the-time-coworker's kid was sent to the doctor because he couldn't sit still and pay attention during reading. (Math he was great, everything but reading he was stellar.) You can guess where I'm going - Ritalyn within 5 minutes of the doctor walking in the office.

The kid had never even been tested for dyslexia. (Failure on multiple levels, and I hold the parents in particular scorn, especially when at least I and my boss (who had identical symptoms when he was that age - and has dyslexia) insisted that a dyslexia test was well overdue.

Nope. Drugged him up, and he was sitting still, all right.

What percentage of kids have been on "ADD" and "ADHD" drugs now?

Not the fault of Ritalyn, or Adderol at all. I think they have a place. Just as antidepressants and the other mental drugs do. But the brain is the least understood organ we've got. (Even the organs and systems that are "well understood" still have a lot of "Wow. Wonder why THAT's happening" issues.) We're currently mucking around it with damn near the sophistication of tropical witch doctors trying to find cures.

(And like the witch doctors, or "native healers" I suppose is PC now, cures and palliatives (or poisons and other useful compounds) can be discovered and isolated that way. It is a method. But it's not scientific - and it's a nit of mine when non-science tries to take the scientific mantle.)

[unixronin.livejournal.com]

But it is a failure of the system that's dispensing those medications, leaving that system's credibility strained when other claims are made.

Yes. And part of that problem lies with the consumer - the patient. Many doctors will just sigh and write the prescription when a patient walks into their office and demands antibiotics for a common cold, because even though they know it will do no good, they also know that if they say no, the patient will just try another doctor, and keep going until they get their prescription.