Do Some Antidepressants Even Work?
In 1997, the FDA allowed companies to advertise prescription drugs on TV and in popular magazines. As a result, we got to see old men talk about their erection problems and sales of new drugs went through the ceiling, especially drugs for depression and emotional matters. But do these drugs really work?
Independent researchers--those whose work isn't funded by drug companies--have found that much, and in some cases, "virtually all" of the benefit of popular antidepressant medications is from the placebo effect. In other words, you think it's going to work, your healthcare provider tells you it's going to work, and the drug companies spend millions of advertising dollars to create the fiction that it will magically work. So you take it, and sure enough it starts to work because you expect it to work--in the short term, anyway.
Study after study have shown that many of today's antidepressants don't work any better than sugar pills. For instance, studies on Paxil showed it didn't work any better than sugar pills in seven trials. Finally, the company that makes it managed to choreograph two successful trials and the drug was finally approved by the FDA.
The Biggest Problems
The researchers we trust to police our medications often receive large consulting fees, stock options, special funding and paid vacations from the drug manufacturers. Perhaps this is why their findings often show better results than the findings of independent researchers who are not on the corporate dole.
Unfortunately, we usually don't hear about studies which find that drugs don't work or are potentially harmful. For instance, there were nine studies that showed how a widely prescribed antidepressant tripled the risk of suicidal thoughts and suicide attempts in young people, yet none of these were ever published.
Another problem is how drugs are tested on only a few hundred people for a couple of months before being released for public consumption. There is seldom any data on the long term effect of taking these drugs, yet physicians keep their patients on them indefinitely.
And finally, there's the extreme influence that the pharmaceutical industry sometimes has on the way that medical students are taught to reason and think. This ties in well with the need of HMOs for their doctors to come up with quick fixes during the fifteen minutes they are allotted to see each patient. But good luck finding a quick fix for something as difficult and complex as depression.
Antidepressants and Sex
While plenty of top-notch scientists question how much of a biological impact many of today's antidepressants have on depression, people who take the drugs often find that they have a very definite biological impact on their sexuality. The two biggest complaints are delayed orgasm and decreased sex drive which begin after the patients start taking the antidepressants. The problem of delayed orgasm is so great that a drug company that makes one of today's more popular antidepressants is trying to have it approved for use by men with premature ejaculation.
If physicians were being straightforward with what we know about antidepressants, they would warn their patients of the following when prescribing SSRI antidepressants to people with minor to moderate depressions:
1. There is at least a 50% chance that a sugar pill will have a similar impact on depression as the pricey antidepressant you are about to start taking.
2. Studies that have compared the effectiveness of exercise vs. antidepressants on minor to moderate depression have shown some surprising results. It appears that 30 minutes a day of exercise relieves symptoms of depression for many people as much as antidepressants do in the short term, and for a number of people who were studied, better in the long term. Plus, exercise doesn't have the side effects of taking pills and it doesn't artificially change your brain's chemistry.
3. While antidepressants may help take the edge off of some people's depression, they can also take the edge off of feelings in general--good and bad.
4. Based upon reports from many patients who are taking antidepressants, there is a good possibility that the antidepressant will impact your enjoyment of sex, either by delaying your ability to have an orgasm, by decreasing your sexual drive, or both. Be sure to talk to your doctor about these if they arise, especially if you aren't able to squeeze an orgasm out after ten hours of banging away.
5. Some researchers are concerned that antidepressants might be changing the chemical balance in the brain that is necessary for having loving feelings for your partner. Of course, you might simply be waking up to the fact that your relationship isn't particularly rewarding or a good one, or your new lack-of-loving-feelings might be an emotional side effect of the medication you are taking. This is something you may need to sort out.
6. Even if the antidepressant do help with your depression, they are not going to be a magic answer. You will still need to make significant, lasting changes in the way you cope and deal with life.
Clinicians should also have their patients read the following conclusion about antidepressants from two of the country's finest psychologists, Drs. Carol Tavris and Carol Wade:
"Consumers must think critically about the benefits and limitations of medication for psychological problems. Drugs for mental disorders are neither totally miraculous nor totally worthless. Their effectiveness depends on why the individual is taking them, how severe the problem is, and whether the person learns how to function better and cope with the problem."
Put Another Way
There are different types of depression. Some are appropriate to your life situation and are a necessary part of dealing with sad or difficult events. Some are a sign that your decisions in life have not been good ones, and that you need to make significant changes in the way you deal with your life, your job, and/or people. Other kinds of depression have a strong genetic loading to them and can get progressively worse; treatment might require a combination of therapy, pills, and sometimes hospitalization.
No matter what kind of depression you are having, crawling out of a depression can be a long and difficult process. Pills can sometimes help with the anxiety, panic or deadness, but they might only be a short term fix and can bring their own significant side effects.
In sorting through feelings, you can often find hidden triggers to your depression. But don't expect there to be just one or two things to fix and bam--life will be good. If you are in a whopper of a depression, it probably means you need to make serious changes in your life and in your approach to people and things.
Unless you have the kind of depression that results from strong genetic loading, there aren't any pills that can make these changes for you. Pills might help some people, but they are just a start.
As for those depressions that are super strong and inherited, even if you can find a mix of pills that helps, it still often requires a tremendous amount of psychological work and change to stabilize yourself over the long haul. This can be a very good thing, but it won't just happen from taking pills.
Reader Rant
"You did nothing but bash antidepressants. I feel you were too one-sided. My fiance's father is bipolar and my fiance suffers from a form of depression. Antidepressants, therapy and loving acceptance from a man has cast out the darkness from her life. The truth of the matter is, sex is not everything, even though I have to try harder to get her to come (sometimes, not always, sometimes she's quicker than normal by a lot. Explain that, smartass). That being said, perhaps you could go into more depth. Which drugs have less sexual side effects etc?"
Lumping a bipolar disorder in with the kind of depression that most people have who take SSRI antidepressants is like comparing a penis that is four inches long to one that is eight inches long. A bipolar disorder is the hideously wicked step-child of garden-variety depression, which can be bad enough on its own. With a bi-polar disorder, one tends to find a genetic trail that's long and wide. Not so with most kinds of depression that people are popping Prozac and Zoloft for. Also, if my past experience in working with patients who have bipolar depression is any indicator, it tends to get more difficult to deal with rather than less as a person gets older. It can be a horribly difficult emotional cross to bear for both the patient and his or her family.
That said, I would wonder if your fiance's depression is the "garden-variety" type--whatever that might mean, or if she is struggling with something she may have inherited from her father.
If we are talking a "garden-variety" type of depression, I can assure you that for many people, a good experience with a therapist and a new boyfriend are MORE than enough to help her climb out of it. If we are talking about something with a strong genetic loading, then it is far beyond the capacity of anyone on the Internet to analyze what drugs are good or not. This is something she needs to discuss with her prescribing physician.
I am a 20-year-old female in my first sexual relationship. Being in love is wonderful -- and so is fooling around!... I do object to one section on your website: the feature on antidepressants. I have been taking Lexapro, an SSRI, for almost a year now, and it has helped immensely. To say that nearly every study confirms that antidepressants are no more effective than placebos is misleading and dangerous. While medication is not for everyone, and should be supplemented with therapy, it is foolish to claim that antidepressants do virtually nothing....
Your claim that depression is "a necessary part of dealing with sad or difficult events" is downplaying a serious mental illness. When I was thirteen and my father committed suicide (no doubt a sad and difficult life event), I was sad for many weeks. I was not clinically depressed. When I suffered from bulimia throughout high school and left my friends and family for my first semester at college, I was not sad -- I was clinically depressed. Medication helped pull me out of the dark hole that is depression. Perhaps if I had taken a sugar pill every day I would have felt a little better. I seriously doubt, however, that any placebo could make me feel as I do now -- content, not anxious, and happy with my life.
When your father commits suicide and you suffer from bulimia, these are serious and sad events that might indicate a bit more is going on than a minor to moderate depression. Most people who are taking SSRIs don't have this kind of history. On the other hand, you might reach a point where you want to experiment with pulling back on the SSRIs--but that would be a matter for you and your therapist or healthcare provider to work out or work on.
This site is neither produced nor supervised by physicians or pharmacists. We occassionally make mistakes. This information is meant to help inform but not be medical advice. Use your health-care provider as a final source on all matters, especially on those regarding drugs.
