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Kirsch: SSRI's = Placebo

post #1 of 19
Thread Starter 
I apologize if this has been posted/discussed. If it has been, please direct me to the right thread.

http://discovermagazine.com/2008/oct...y-worth-taking

Has anybody heard about this? I have PPD and was taking fluoxetine until two factors got me to stop. First, Kirsch's research made me raise an eyebrow. And second, my insurance company jacking up my copay to $35.00.....for a $%#%#$ generic drug! $35.00 for a month's worth of a placebo? FWIW, I was responding to the medication. Any thoughts?

Any thoughts?
post #2 of 19
This was the cover story on Newsweek in the beginning of February this year as well- http://www.newsweek.com/id/232781
Although I've been reading it from various sources for a few years now. I believe Robert Whittaker touched on it in "Mad in America" and it looks like he'll cover the topic more in depth in his new book "Anatomy of an Epidemic"

I stopped taking meds two years ago, for the same reasons you cite- the research makes me nervous, and I had insurance issues at the time. I did think I was responding at the time that I quit. Insurance is no longer an issue for me, but I've chosen to stay off the meds. Generally the data shows that they are only effective for the most severely depressed patients. And then there are other worrying studies- I read one showing that macaque monkeys when given a common antipsychotic loss brain mass over time. http://www.nature.com/npp/journal/v3...0710a.html#abs
And I've seen numerous references to a World Health Organization study that showed people with serious mental illness in third world countries have better outcomes and prognosis than developed countries, although I can't find the link at the moment. The other thing that worries me is that noone knows exactly how the drugs work- the theory is that they act on brain chemicals, but no one has ever proven that for sure- and no one has ever proven that a chemical imbalance in the brain is diagnostic of mental illness.

I would say, for me, it was the right decision to go off them. I'm still sick, but I also feel better in some ways, without the drugs in my system. I have friends who really believe in psychiatric meds and take theirs daily. I think its a really personal decision. I would look at the data and decide what you are comfortable with. Also be sure to look into alternatives- therapy can be helpful, some people use various vitamins, exercise, acupuncture etc etc.
post #3 of 19
With all due respect, you cannot base your decisions to take antidepressants on one or two articles.

Talk to a medical professional.
post #4 of 19
Yeah, I don't buy this. Meds helped me out of a pretty bad time in my life, and I truly believe they work. I think one or two articles should not be enough to sway a person one way or another. Talk to your doctor, preferably a pdoc that specializes in PPD, and a therapist who does, also... read books like Shoshanna Bennet's books, Daniel Amen's, etc... and then decide. Meds DO work. And they can be a life saver for so many.
post #5 of 19
Thread Starter 
Helpful information, Oubliette8. Thank you!

Quote:
Originally Posted by goodygumdrops View Post
With all due respect, you cannot base your decisions to take antidepressants on one or two articles.

Talk to a medical professional.
And with all do respect from my end, did you actually read the meta-analysis, (let alone the first URL that I provided)? Before you get dismissive, this is not just “one or two articles.” This is rigorously conducted research with salient implications.

Also, medical professionals don't have time to keep up on the latest research, including Kirsch's. So the ask-your-doctor platitude shouldn’t apply in this case.


Quote:
Originally Posted by mom0810 View Post
Yeah, I don't buy this. Meds helped me out of a pretty bad time in my life, and I truly believe they work. I think one or two articles should not be enough to sway a person one way or another. Talk to your doctor, preferably a pdoc that specializes in PPD, and a therapist who does, also... read books like Shoshanna Bennet's books, Daniel Amen's, etc... and then decide. Meds DO work. And they can be a life saver for so many.
Yes, they work. Via the Placebo Effect. And if Kirsch’s research holds any weight, they can legitimately help for extremely severe cases. I do have a care team and intend on addressing this with them. But I’ll be super cautious if they're quick to dismiss it or come up with excuses. I’m not saying that Kirsch’s research it valid; I need to read more. But come on. Let’s take a less dogmatic and more rigorous, open-minded, and intellectually honest look at the matter!
post #6 of 19
I'm not buying it. I'm not severely depressed, and it took 4 tries to find an SSRI that worked, and if I try to wean off too quickly the withdrawls are unpleasant for sure.
post #7 of 19
I may not take the time to find sources but...I too was/am skeptical of meds. A lot of studies show that they don't seem work much better than placebo for garden variety depression. From what I understand (there was an NPR show about it recently) meds work especially well for depression caused by specific events; like PPD and PTSD.

The side effects are real and can be annoying. After I felt better I decided to stop taking Zoloft because of the side effects which for me were: sleepiness, excessive sleeping, slightly fuzzy thinking and emotional flatness. I am convinced that Zoloft saved me from insanity, my PPD was THAT bad. As I've had over a year to reflect on the experience I have realized that the side effects that got so annoying where the exact "effects" I needed when I had PPD. I could not sleep, I had intense and racing thoughts and just felt mentally/emotionally hyped up and overactive. Even if the Zoloft didn't work on my depression per se, the side effects were just what I needed. I feel like the Zoloft slowed me down physically and mentally and that was just what my mind and body needed-a break.

So if your depression is the blah, can't-get-out-of bed variety, I can see that SSRIs might not work better than placebo. BUT I have seen too many otherwise mentally/emotionally healthy women become anxious isomniacs after pregnancy and then find amazing relief from Zoloft to discount it. It was my skepticism that kept me from seeking medical help sooner, I wish I had.

My rambling point is: would it be possible to focus on SSRIs and PPD, and find research on exactly that? In my research, experience and the experience of others PPD and regular depression are very very different.

Just my two cents...
post #8 of 19
I do not buy the nonsense about the placebo effect AT ALL. Having taken zoloft at two points in my life, I know the effect it had and it was NOT a placebo effect at all. The others around me noticed an effect before I did. That would not be placebo. Serotonin DOES rise in the brain when ssris are taken. NOT placebo. I just think this is a justification for someone who is already not liking the idea of meds.
post #9 of 19
Thread Starter 
Quote:
Originally Posted by mom0810 View Post
I do not buy the nonsense about the placebo effect AT ALL. Having taken zoloft at two points in my life, I know the effect it had and it was NOT a placebo effect at all. The others around me noticed an effect before I did. That would not be placebo. Serotonin DOES rise in the brain when ssris are taken. NOT placebo. I just think this is a justification for someone who is already not liking the idea of meds.
I looked at my last post to you and realize that I sounded pretty abrupt and dismissive of your own experience. Many apologies. Blame it on my PPD!

And FWIW, I’ve been on fluoxetine for the past seven years—nothing but positive results and zero side effects. I'm definitely experiencing the hell that is PPD and just like to keep an open mind…

Quote:
Originally Posted by azgirl View Post
My rambling point is: would it be possible to focus on SSRIs and PPD, and find research on exactly that? In my research, experience and the experience of others PPD and regular depression are very very different.

Just my two cents...
This is a sensible idea. Thanks.
post #10 of 19
There are detectable and measurable changes in the brain when a patient is taking ssri's. Please check out Dr. Daniel Amen's books and look at the SPECT scans of patient's brains *before* meds and *after* meds. The changes exist. They would not exist if the ssri was having only a "placebo" effect. The scans show activity in the brain where there was none before. That's a detectable PHYSICAL change. Not a placebo.
post #11 of 19
I have not read Amen's books, but my understanding is that the placebo effect can cause physical change. The body can be self-regulating and I would think that it would be possible that the brain could make changes in response to a placebo. Why not? Did he specifically compare brain scans of patients given a placebo with those given the real thing?
post #12 of 19
There would not be withdrawal effects from a placebo effect. Ssri's are well known to cause withdrawal (discontinuation) symptoms. So no, I do not and will not buy that they have a placebo effect.

I took them for mild to moderate depression/anxiety and they helped me immensely. And again, others noticed the change before I did. If it were a placebo effect, I would think I would notice the change in myself at least at the same time as others or before. So again, based on the research and my own personal experience, and the opinions and knowledge of professionals that I trust... no, I do not believe it is a placebo effect.

I think it's dangerous to assert that, especially in a forum for mothers with PPD, because if someone is already worried about taking meds, and then thinks or is told that they really don't do anything, anyway... I just think that is a dangerous thing to do in a PPD forum. It may prevent someone who NEEDS help from seeking it. That's all.
post #13 of 19
Hey Mommies! I thought I might jump in. I have a 3 year old and we are expecting #2 in Dec.

After my last pregnancy, tons of weird things started happening. I was weepy, of course, but nothing worse than the pregnancy. But the really weird part. I was hearing things. Voices, to be specific. And seeing things sometimes. I told my psychiatrist (who is more on the non-interventionist side of the spectrum) and she told me it was totally normal, but rarely talked about. I thought I had post-partum psychosis or something. She asked if they told me to do things, of course, no. It was like I was picking up radio signals of other peoples conversations. Very rarely would they directly address me. This went on until about 6 months post-partum. Very odd. My DH is muslim and he thinks that women who are pregnant or are post-partum are closer to the "spirit world," but Im a non-believer in just about everything. This did make me wonder.

Now, on the topic of using meds. I havent had to take any meds for depression, all though my moods are less than regular, and sometimes Im down right miserable! I feel like its not bad enough to inhibit my survival. My sister, however, has been on meds since she was about 14. On and off, on and off. Finally, 6 months ago she stopped using them. They never really made her feel better and they tended to make her even more violent and extreme. She is like a totally different person right now. I cant believe after basically not having a sister for so many years, I finally have her back. I think some people just dont respond well to brain meds. She is clearly one of them. Now, that being said, she still says shes depressed pretty much every morning and cant think of a single reason why life is worth it. But once she gets out of bed, or someone calls and invites her out... or she has acupuncture, or therapy, or dance class... then she perks up a good bit.

So, I think it really depends on the person... but in my family, not a single person on those medications has gotten better. In fact, most of my family members have gotten worse after extended periods of use and only came out of it because they stopped using them. Its enough to make me never want to use them. Its hard to feel sad all the time! Im so sorry for anyone going through that. Make sure you are not self-sacrificing to the kids too much! Mommy needs to take care of mommy before the babies! I use to forget that and just do everything for my daughter. Now, I need me time! Or I will go crazy!!! I hope everyone dealing with PPD feels better very soon and can find a sense of calm in their life!

Hugs,
L
post #14 of 19
It's well-known that not every med is good for every person. Some of them, like ssri's, will make a person WORSE if they have bipolar depression. Often, more than one med needs to be tried before someone finds the one that will work best for them.

So... not surprising what happened to your sister, PP. I'm happy that she is feeling better and happy that you are feeling better.
post #15 of 19
I think it's also important to distinguish between cases of mild depression and severe cases. The study suggests that for mild depression, meds were no better. But I didn't take meds because of mild depression. I took meds because of severe, debilitating anxiety (as in not sleeping for days on end). The SSRIs made a huge difference in my life.

A good general rule is:
If you're depressed or anxious: Try diet and life style changes. If that doesn't work, talk to a counselor. But if those don't work, then SSRIs are worth a shot.

As someone else said, not every medicine will work for every person -- that's true whether it's cholesterol lowering meds or antibiotics or SSRIs.
post #16 of 19
Lynn, SO well put. Thanks for putting some perspective on this whole thing...
post #17 of 19
Quote:
Originally Posted by mom0810 View Post
There would not be withdrawal effects from a placebo effect. Ssri's are well known to cause withdrawal (discontinuation) symptoms. So no, I do not and will not buy that they have a placebo effect.
Yes, and there are withdrawal symptoms for people who stop taking SSRI's even when the medications aren't working for them. I've been on a few SSRI type drugs in my lifetime and the one that was the least effective for me (Paxil, which didn't work AT ALL) was the hardest to quit, due to the extreme and long-lasting withdrawal.

The fact that discontinuing a drug can cause withdrawal does not in any way prove that the drug is having its intended effects. That's a serious misunderstanding and I would suggest that it is just as dangerous to propose that as a fact on a board for women suffering from PPD, as it may convince some women that they should continue taking a drug that isn't even working for them because quitting causes withdrawal. Some women led to believe that withdrawal symptoms = effective treatment would fail to seek treatments that might actually work for them when they realized quitting the SSRI that wasn't working for them caused horrendous withdrawal.

Withdrawal symptoms do not = effective therapy. They simply = addictive drug.
post #18 of 19
Ssri's are not addictive. Addictive means that MORE of the drug is required to have the desired effect over time. This is not the case. Addictive means that the drug interferes with the person's ability to have a normal life. Not the case with ssri's.

And just because they don't "work" for certain people or have the desired effect does not mean they aren't effective. It means that whichever med that person is on is not the right "cocktail" for them. That's all. It does not mean that ssri's have a placebo effect.
post #19 of 19
I suffer from major depression and post-traumatic stress syndrom and never had any luck whatsoever with the usual antidepressants. The one medication I did take - Opipramol - is too weak according to my psychiatrist to be effective enough on its own. But this med combined with other meds worked wonders.
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