I hope you have been able to see the new PBS special. It is doing very well and has helped raise a lot of money for PBS in just its first week of airing. I am thrilled, because it helps get our message out to the general public and raises money for PBS, one of my favorite venues for lifelong learning.
Now comes a large study from England that basically says antidepressants are no better than sugar pills. How does the study below have any validity. I have been a psychiatrist for a long time, now more than 25 years. I know antidepressants work when prescribed properly. But I also know that I can help people heal with natural supplements, exercise and psychotherapuetic interventions.
Most doctors prescribe antidepressants as if depression was a single or simple disorder. Our brain imaging research says it is at least 7 different disorders and giving everyone the same treatment invites failure and often making people worse. We need to tailor the treatment to indivual brains, not vague diagnostic categories. Enjoy the article.
LONDON (AFP) “” Best-selling anti-depressants like Prozac and Seroxat are barely more effective than placebos in treating most people with depression, a study led by a British university said Tuesday.
The research, which analysed 47 clinical trials, breaks new ground by incorporating data not previously released by drug companies which researchers obtained under US freedom of information laws.
Its findings prompted some academics and mental health campaigners to question whether people with mild and moderate depression should be prescribed drugs like Prozac, which has been taken by 40 million people worldwide.
“The difference in improvement between patients taking placebos and patients taking anti-depressants is not very great,” said Professor Irving Kirsch of Hull University, in northern England, who led the team.
“This means that depressed people can improve without chemical treatments.
“Given these results, there seems little reason to prescribe antidepressant medication to any but the most severely depressed patients unless alternative treatments have failed to provide a benefit.”
The study, published in the journal PLoS (Public Library of Science) Medicine, looked at Prozac, Seroxat, Effexor and Serzone and found the drugs were only better than a placebo for some people with severe depression.
Kirsch’s team said it was one of the most thorough probes into the impact of new generation anti-depressants or selective serotonin reuptake inhibitors (SSRIs).
But drug companies strongly questioned the findings.
A spokesman for Eli Lilly, which makes Prozac, said that “extensive scientific and medical experience” had shown it is “an effective anti-depressant.”
And GlaxoSmithKline, which makes Seroxat, said the study had not acknowledged the “very positive benefits” of the drugs.
“Their conclusions are at odds with what has been seen in actual clinical practice,” a spokesman said.
“It is widely recognised by experts in the field that studies in depression are challenging and very difficult to conduct.”
One leading academic who has studied why drug companies only publish some of their data on new drugs said in the wake of the findings they should be obliged to provide full details.
Doctor Tim Kendall, deputy director of Britain’s Royal College of Psychiatrists research unit, said the study was “fantastically important.”
“I think it’s too dangerous to allow drug companies — where profit is a key factor — to be able to withhold data which shows that a drug is ineffective or harmful,” he said.
Alison Cobb, of British mental health charity Mind, hailed the findings as “a serious challenge to the predominance of drugs in treating depression.”
“Anti-depressants do help many people but by no means all and some people experience severe side-effects with them,” she said.
“Nine out of 10 GPs (general practitioners) say they’ve been forced to dish out drugs because they don’t have proper access to ‘talking treatments’ such as cognitive behavioural therapy, which are recommended as the first-line treatment for mild to moderate depression.”
Another mental health charity, Sane, warned the findings “could remove what has been seen as a vital choice for thousands,” adding people should not stop taking their drugs immediately.
As the study was published, the British government published details of a 170-million-pound (225-million-euro, 335-million dollar) programme to improve access to counselling and therapy for people with depression.
Officials say this should see 900,000 more people receiving such treatments over the next three years.
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Thank you for this article, Dr. Amen. I would be interested in obtaining it to examine how and with whom the study was conducted. This is a very bold statement to make without solid back up. I work in the field of education, and I would challenge the statement that antidepressants are no better than sugar pills. This is very over generalized.
I thoroughly enjoyed, and once again learned from your PBS special. I try to direct many people to your website in hopes of increasing awareness of the fact that mental health is equally as important as physical health. I believe many people are suffering due to a lack of awareness and recognition of this issue.
Thanks Again,
Jennie Polson
I am the only one of four in our family who does not have ADD and struggle with depression. I have been extremely frustrated with the “one size fits all” treatment and experimentation’s my husband and children have been given as I almost helplessly watched them try in vain to live up to their exceptional potentials. It’s so difficult to observe the low self esteem developing, and to have to witness their own frustration levels. I have long believed treatment needs to be specifically tailored and fine tuned to each of their individual needs. It’s obvious that the conclusions of this study were made by people who haven’t been personally touched by or educated about depression. You don’t need to be a doctor to realize depressed people shouldn’t all be treated the same way. It’s like saying each child in a family should be raised exactly the same way and is no more true. After 12 years of trial and error treatment I am flying my 20 year old daughter to California for a scan, and intend to bring my son and hopefully my resistant husband in too. I believe the more information a doctor has, the better. The SPECT scan is a fantastic diagnostic tool, and offers more hope than I’ve felt in years. My prayer is that these clinics continue to grow and expand so the rest of the nation and even the world can get the individualized treatment that each person deserves to have. I’m not a doctor, but family experience, common sense and Dr. Amen’s books tell me this is finally a real break through in treatment for these disorders.
I am the only one of four in our family who does not have ADD and struggle with depression. We have been extremely frustrated with the “one size fits all” treatment and experimentation’s my husband and children have been given. Treatment needs to be specifically tailored and fine tuned to individual needs. It’s obvious that the conclusions of this study were made by people who haven’t been personally touched by or educated about depression. It’s like saying each child in a family should be raised exactly the same way and is no more true. I’m not a doctor, but family experience, common sense and the information from Dr. Amen’s books have convinced me that SPECT imaging should be routinely used as one of several diagnostic tools because it demonstrates distinct brain function and gives added information that doctor’s or researchers should have to draw conclusions and to provide optimal patient care.
Thank you for this article, Dr. Amen. I would be interested in obtaining it to examine how and with whom the study was conducted. This is a very bold statement to make without solid back up. I work in the field of education, and I would challenge the statement that antidepressants are no better than sugar pills. This is very over generalized.
I thoroughly enjoyed, and once again learned from your PBS special. I try to direct many people to your website in hopes of increasing awareness of the fact that mental health is equally as important as physical health. I believe many people are suffering due to a lack of awareness and recognition of this issue.
Thanks Again,
Jennie Polson
Dr. Amen,
I think the conclusions are somewhat skewed. As a researcher who has conducted over 70 randomized placebo controlled trials on antidepressants, I am very cognizant of the incredible placebo response. After all each of my volunteers spends three hours at their initial visit and generally 1 hour weekly for the next 8 weeks. Many patients are thus getting extrodinary intesen care that is unlike private practice. Therefore many trials fail. The antidepressants are not panaceas.
The best advice to a patient is to look at their family history as this will give them some indication as to whether they would respond and also at their own history of med response.. before bedcommid disillusioned.
My son and I both have ADHD with anxiety ( and Post Traumatic Stress Syndrom). We are both on Cymbalta (Mfg: Lilly). My son is on a stimulant as well. I benefit greatly from stimulants but I can’t take them due to insomnia. (I have been on Lunesta this past year.) Without medication we can not function. We are receiving psychotherapy by a trusted counselor that we also attend church with. We are in the process of seeking the care of pyschiatrists as the pediatrician and family practitionor do not have the time or expertise to deal with these issues. My point is that you need both
counling and meds. You can’t just take a pill and make it go away. No amount of counseling will resotre chemical imbalance. I am pediactric nurse I see kids with ADHD every day, they are noticably different than other kids. My heart goes out to all of you who struggle. I am greatful to know there is someone such as Dr. Amer to do research and proactive treament. I hope it become more common place and affordable to the average person.
Hi Dr. Amen,
Thank you for calling attention to this study. SSRI drugs are not as effective as was originally thought, and there are potential risks as well as significant side effects. I agree that depression can be successfully treated, however, and we do not have to say to those suffering from significant depression that drugs are useless. Your innovative method of studying brain metabolism with SPECT scanning and then tailoring treatment accordingly, makes good sense, although now that PET scans are available, and as I understand it, more sensitive, why not incorporate these studies as well?
I have been on an SSRI antidepressant, venlafaxine, for several years, and feeling that it is not giving me any benefit, and carries significant side effects, I’ve asked my physician to help me come off the drug. Due to drug side effects from withdrawal symptoms, I’ve had to wean off it very very slowly–I have a form of muscular dystrophy known as amp deaminase deficiency–and withdrawal effects from venlafaxine seem to make symptoms of my muscular dystrophy disorder worse–muscle aches and pains, weakness, feeling of profound fatigue. I am now, over about a three month period, almost weaned off, from 300 mg/day to taking 25 mg a day, but because the drug at the 25 mg level is not long acting, I have split it in half, and take a half tablet twice a day. The next step, finally, is to discontinue the drug completely.
Why am I writing about this in detail? Because I think most physicians are not aware that withdrawal symptoms from venlafaxine or Effexor can be quite significant. You don’t have to believe me: check the PDR. Also, the form of MD that I have is very common–and many people have mild forms of this disorder without being aware of it. From what I have read, it is the most common form of MD, and often “asymptomatic.” I have put this in parentheses, because “subclinical” symptoms in my experience, may be symptomatic, but simply not considered significant enough by a patient to be reported to his or her physician.
best regards,
Rachel
There is another aspect of SSRI medication that seems to also be overlooked. My son has ADHD, and OCD. If it were not for Zoloft he would never get past his obsessions. I agree with Beth’s comment, it is frustrating as you get involved with a new Doctor and they start at the very top of the treatment formulary in an experiment to find what works. In many ways I wish I had access and Dr. Amen’s clinics over the years as means to better pin point treatment instead of literaly wasting years trying one drug after another.
Thank you Dr. Amen for making you research accessable in book form.
-Lee
I am very much interested in knowing a bit more about SPECT, can you please give me more nformation about children around 12 years old with ADD, are they easily to drop into depression? Please thank you for your information and advise.
My family struggles with depressesion, ADHD, ADD, insomnia, etc.
If only there was free medical care or low cost or that the Amen Clinic
accepted health insurance plans.
We need help and need it fast!
It has been well-established in the research literature that cognitive-behavior therapy can be effective in reducing the symptoms of mild to moderate depression without medical intervention. Severe depression is best treated with both medication and therapy. However, there is no way for a prescribing physician to know which anti-depressant will work for any particular patient, unless the patient has already tried other anti-depressants. As a mental health counselor my experience is that physicians understand the difficulty of prescribing the correct medication for any particular patient . It is a complex, sometimes lengthy process, fraught with financial considerations, potential side effects and patient non-compliance. In truth, every prescription begins an experiment with an “N” of one. That said, clinical studies have documented significant improvement in patients who take anti-depressants, and my patients report positive effects as well, and these positive effects are obvious to me. The British study referred to was a meta-analysis of studies that included both reported and unreported studies of only a handful of anti-depressants studied by pharmaceutical companies. The intent of the British study was to include negative as well as positive results from these studies for the general population to evaluate. However, reading and understanding the journal article requires a very sophisticated understanding of statistical research, beyond the average layman. In addition, the interpretation of the results can be challenged. While the pharmaceutical industry is a for-profit industry, that doesn’t mean it doesn’t provide effective medical treatment for depression and other mental disorders. Certainly today we have many more medical options for treating various mental health conditions, thanks to the efforts of both public and private entities. It would be foolish to abandon the progress we have made in treating mental health disorders just because anti-depressants don’t work all the time for all of the patients. That would be like giving up chemotherapy for cancer patients because some of them still die from the cancer. One last thought, which for me as a mental health practitioner is of utmost importance: untreated depression is still the number ONE cause of suicide!
My husband (then finance) did much research before he flew me from Georgia to California to see Dr. Amen. I was having panic attacks, unable to concentrate, self medicating with alcohol and severely depressed. Because my blood pressure was so high, I could not find a single doctor to prescribe the medications that I so desperately needed.
I had my SPECT scans done in the Fairfield Clinic, back when it was the only one in existence. I was fortunate to spend some time directly with Dr. Amen. After my scans were completed, I was put on the correct medications and my life totally changed. I was treated for Bipolar, ADHD and Panic attacks. With minor adjustments, I am still on the same medications after approximately 10 years. My blood pressure went down. My husband and I are very happily married for almost 8 years.
If I had not had the SPECT scans, I doubt that I would be alive today. I had my suicide planned, had already given away most of my belongings. Because my husband saw something, worth saving, he took me to see Dr. Amen and his Clinic. I will be forever grateful to Dr. Amen’s amazing research and to my husband finding his Clinic.
Don’t tell ME that antidepressants are sugar pills!
Linda Benschop
30 years on antidepressants. 1970’s Imipramine – if I missed a dose I would become depressed aproximately 36 hours after last dose. 1990’s – This didn’t happen with Prozac. I later found out that Prozac has a much longer half-life. Everytime I have tried to go off antidepressants I have become depressed and gone back on them. I read that certain forms of depression run in families as alcoholism in the men and depression in the women. This is true for my mother’s side. My husband once said ” Hmmm, Jenny on Prozac or Jenny off Prozac? I pick on Prozac then I have a wife.” Off antidepressants everything is too much. Lights are too bright, sounds too loud, expectations impossible. I automatically think of suicide. Mentally and physically I slow down. On antidepressants I am like the person I was in my high school years. Fun, competent, loving and alive. I’m grateful to drug researchers, companies and physicians.
Anti-D’s for me have been moderate at best. They’re great at first to get you over the hump, but the side affects are a bit tough to deal with and manage. The only Anti-D I take now is Wellbutrin, which is pretty good and helps with the Nor-Addrenaline or something like that, either way it helps me stay relatively organized.
If you would like to discuss this further in a thoughtful, well organized forum, please click my name above and sign up and lets talk.
I come from a family with a lot of alcoholism and depression. Fortunately, I am not an addict, but I too have suffered from depression. I have had a lot of therapy and I attend alanon regularly, but I continue to take Prozac and Seldane. Although I only reguire small doses, I find I function much better with the meds. Most important, I do not have to struggle with the depression! I agree that the best option would be the brain scan, but I can not afford it and Kaiser will not pay for it.
That’s Europe for you. Why are GP’s prescribing psychotropic drugs in the first place?
I have been on several SSRI’S and MAOI’S, and I am very discouraged by the ” One Size Fits All approach and its ruining my happiness and I really need advise.
So, does all this about anti-depression meds mean I could just stop, save some money, and stop seeing the shrink?
I just wanted to say that the drug manufacturers are unwilling to release information regarding how many people have committed suicide while taking their for of an SSRI anti-depressant or have died or suffered in other ways from the severe side effects from this type of anti-depressant. I was placed on the “Great Prozac”, when it was first marketed, instead of the typical tricyclic antidepressant of which I had used with success so many times before the SSRIs were available. I recall waiting at a train track one night on my way home from work waiting for the train to come so I could pull in front of it and end my miserable existence. Thank God I thought of my young daughter and come to my senses and went on home. The next day I was at my PCP’s office waiting to be prescribed the same tricyclic antidepressant I had used previously and warning my Doctor of the danger in taking Prozac.
I myself have never been on meds. Yet , my son was prescribed 3 different types. They did not manage his depression. Excercise, sunlight, supplements, revealed everday improvement.
I have had OCD since I was an adolescent. I took Prozac in 1997 for approximately 9 months; therefore, I am fully aware that its contents provide something more than a placebo. It made me numb I couldn’t cry, and before the Prozac I was able to find emotion and tears quite simply. Prozac does work for the right individuals that have the right chemistry just like many other medications. I also attended the AMEN Clinic in Feb 2008 and though I feel that Dr. Amen is obviously well versed and educated in the field of Psychiatry I do not feel that the brain SPECT scan is all that beneficial, at least this is my personal experience. I was told by one of their licensed psychiatrists that my scan shows very little activity in the area where the OCD would be. I was very discouraged, as I have had this for the majority of my life, and I was really hoping for some assistance in helping me to best systematically treat it. I am already in therapy and have been for some time now. The scan did not match the evaluation report that I was given, it clearly states in the ” Psychiatric/Conclusions” from my verbal comments that I have Obsessive Compulsive Disorder. So, I was clearly disheartened by this, as I was told about this establishment by someone whom I admire and respect a great deal, they also expected it to be really helpful and were discouraged as well. And It was not inexpensive, which is not an issue when you are really looking for help in assistance/healing such a problematic issue. They also offer these scans at various other locations, one being UCLA. However, I cannot see it being any different there… I wish you all the best of heath in Body, Mind and Spirit. J
Livingodslight@aol.com
For 19 years now, starting with anti-anxiety drugs, the older trycyclic medications, the full range of SSRI’s, and other types of anti-depressants, in addition to a 6 month disastrous trial with Dexedrine. I’ve had to give up on the doctors for help. Not that I would recommend the same to others in need of help, because it was better than nothing.
I have reduced my dosage of Effexor to one third of what it was,and learned all I can about diet, supplements ,exercise, and have started talking therapy. It has been way more effective, but I’m doing most of it trial and error.
I just wish that the drug companies could loosen their grip on the medical system so that it could evolve with the new discoveries such as Amen Clinics is working on, so that I wouldn’t be doing this hit and miss method of maintaining my mental health.
As a therapist of several decades, I can’t agree more. Pills as the only answer are far from a good solution. Moreover, they ignore that the side effects, such as sexual dysfunction, can be just as depressing as the original condition. In addition, ignoring good things like nutrition, exercise, the effects of too little sunlight and so on imply human beings are little more than biochemical machines needing to be tweaked, adjusted, and fine tuned. Obviously, this is not true.
I do have a question for Dr. Amen. I am wondering why, if 95% of the serotonin is in the enteric brain, why there have been no scan studies done with regard to the effect of depression, and antidepressants, there? I ask as my research as a personality theorist over the past twelve years shows a significant psychological component of personality stems from the physiological properties of the enteric brain. This research in fact further supports the need for good nutrition and exercise, and for that psychotherapy alone is not the whole answer either.
Enjoying your site.
Warmly,
Steven Paglierani
What is the next step? More long-term studies? Increase funding for counselors to get education and open clinics? I see this as speculation, not a solution.
I recently saw Dr Amens PBS show and on it he talked about the negative impacts on longterm Zoloft users. I bought the book “Change Your Brain Change Your Life” and I can’t find info. regarding that. Would you please let me know where I can find such info.?
I have been on prozac pretty much since it came out. the few times I got offit for some reason, such as not having insurance or thinking I would be OK I slipped into a dpression that I was not able to get out of without the medicine. All I can say is it has helped me remain on an even keel despite tjings that used to haunt me.
PLEASE tell me how I can relay this info to my family doctor in a manner that he does not feel insulted, threatened or angry….He is a wonderful man, but has strong beliefs that chemical treatments are a good answer to depression & he is not particularily happy that I have chosen to discontinue using them as a result of the horrible side effects. I have done a lot of reading and research about pharma drugs & have spoken with many people who have suffered by using them. I submitted some of this info in writing to my doctor, stating that I was doing so with respect for his consideration & he does not appear happy with that either. I will not take meds that I know are bad for me, but I don’t know how to work WITH HIM to see better results. PLEASE help. Thx
I’m the wife of a depression sufferer. We have been married for 27 & 1/2 years. He had depression when I met him. It has only gotten worse thru the years. He has tried many, many different kinds of anti-depressants. (Such as: Effexor, Prozac, Wellbutrin, Zoloft, Cymbalta and many more!!!!!). The pills work for awhile. They usually take the “egde” off of things for a shor while. Then, the “norm” kicks back in-they quit working. It’s like his body becomes immune to all of them. I TRULY BELIVE THEY DON’T WORK MUCH BETTER THAN SUGAR PILLS MOST OF THE TIME!!!!
Diane Todd
19878 Hwy. 30
Buhl, Idaho 83316
You might be slipping back into a depression when you stop Prozac because you did not receive effective psychotherapy for depression and/or you are coming down from being addicted to the drug.
Because of my tendency to slide into severe depression, I have been on some kind of SSRI for many years. For the last year or so, I have taken Paxil. Although it worked at first at 20 mg. a day, I was still suffering at times from mild to moderate depression. Now I am taking about 36 mg. of Paxil CR, and that has made a big difference in not only alleviating my depression, but in alleviating the anxiety I didn’t even realize I was suffering from. Yes, there are some side effects, but I’d rather put up with them than try to live with the fear that I am going to slip any day into one of those monstrous, deep depressions. Basically, it’s just a quality of life choice for me…
What “moderation”?
How can I ask Dr. Amen a question directly?
I had sent an email to the clinic closest to me in Reston, VA. I received a form letter in return which did not answer any of my specified questions.
Please advise.
Thank you.
This study sent shockwavtes through Britain when it came out. I’m sure that these medications do work in some circumstances, but as Dr Amen has pointed out, depression is many disorders, rather than one. I have written to him to ask if he knows of anywhere in England that performs brain imaging for the same purposes as his Californian clinics in the UK.
Dr Amen I would love to know what your experience is with people who have had a nervous breakdown. I have a friend who was functioning normally (perhaps pushing himself to do so) and then one day he just quit functioning. There has been little improvement in the months following although he is being treated with high doses of medication for anxiety and depression. This blog entry made me think of him. He does have a history of substance abuse but it’s been over 15 years ago.
I get the whole over prescribe “I’m too busy to really listen to you and figure out the real problem and throw the wrong meds at you.” I am 21 years old and I strugle with deppression. My father has bipolar dissorder. I get it. However, I come up against a lot “you don’t need meds, you’re not really sick, we’re all messed up so just deel, etc.” This is not from docs or informed people. I have taken meds in the past and they have helped where others methods have faled and I have been lucky enough not to have side effects. My dad is another example. He is a different person off his meds (insurence, having to change doctors, ect) Just from growing up with him I’ve seen a drastic change from when he got on medication. There are lots of options. Everyone is different and reacts to treatments differently. I don’t want to throw the baby out with the bathwater in regards to any treatment meds or otherwise. Kind of a side note, what do they mean by sevear depression? Is it clinical depression? Wouldn’t that drasticly affect the studies? Shouldn’t you limit it to clinical depression or limit to some other area to get clearer results?
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Dr Dr. Amen,
I have seen you on tv and have purchased your very informative and most encouraging books. Also, I took your memory test and did fine. However, one question that I am most concerned with that was not on the test is: Do you have trouble remembering simple words that were very familiar to you in the past? Although I find I am getting better, I am concerned about the times I cannot recall familiar simple words during a conversation, (even though I eventually tend to remember them later but sometimes with much effort, like going through the letters of the alphabet for a clue.) Also, more than in the past, I find myself freezing (literally being at a lost for words) while trying to express myself or explain something. Your comments would be most appreciated and very important for me.
Thank you so much,
jeannette