Article on antidepressants - Times UK

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http://www.thetimes.co.uk/tto/health/mental-health/article2562303.ece
Do antidepressants works?

Some interesting parts.
The allegations about these medicines are many and varied: first, that nobody really knows how SSRIs work in the brain; second, that the drugs were licensed on the basis of flawed or unrepresentative clinical trials; third, that if they work at all it is mostly because of the placebo effect; and, finally, that they are marketed aggressively to people who don’t really need them.
His first finding was that about 40 per cent of studies were never published. That means they were never sent to a peerreviewed academic journal. Overwhelmingly, the unpublished studies showed the drugs to be marginally effective or useless. This is known as “publication bias”, when scientists publish work that backs up their theories but quietly bury studies that don’t. Companies will often run the trials again, say with specific patient groups (eg, under-40s, or those with only severe depression), or using different criteria to gauge improvement, until the data looks prettier. This is the (not entirely unfounded) basis for the allegation that drug companies get their products licensed on the grounds of unrepresentative data.
His view is not that they have no effect (in fact, he urges people to carry on taking them); it is, instead, that antidepressants pep up the psyche, rather than restore a chemical imbalance. The reason you feel better after taking antidepressants is mostly because you expect to feel better. He suggests that doctors should be trying other interventions to shoo away the “black dog”, such as counselling or cognitive behavioural therapy, which don’t have a long list of side-effects.
Dr Ted Kaptchuk from Harvard Medical School, who carried out the survey, said that self-reported conditions such as chronic fatigue, arthritis, headache, insomnia and depression are more responsive to placebo treatments than other conditions: “All illnesses have this [psychosocial] component to some extent, but [placebo] is more likely to change outcomes in an illness that is primarily about the patient’s experience.”
In modern medicine, prescribing a placebo does not square with the hallowed principle of fully informed consent, because only an uninformed or semi-informed patient will benefit from it. Placebo is essentially about deception, so it is a question of degree, says Dr David Shaw, lecturer in medical ethics at the University of Glasgow: “There might, under certain circumstances for some medical conditions, be a place for semiinformed consent.
 
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Just thought I would throw a question out there.

Placebo response is low in CFS.
The Placebo response is not dependent on whether you have low or high seratonin levels.

Times article - Do antidepressants works?
All illnesses have this [psychosocial] component to some extent, but [placebo] is more likely to change outcomes in an illness that is primarily about the patients experience.
Doesn't this challenge Wessely's idea, that the low placebo response in CFS is due to patient expectations?

The Placebo Response in the Treatment of Chronic Fatigue Syndrome: A Systematic Review and Meta-Analysis HYONG JIN CHO, MD, MATTHEW HOTOPF, PHD, AND SIMON WESSELY, MD
Why might the placebo response have been lower than expected in CFS compared with other medical conditions? First, the low placebo response could be a result of low expectation of CFS patients in relation to the interventions in general, because CFS is widely understood to be difficult to treat (27). Our finding that the type of intervention had an effect on placebo response concords with this explanation the treatments we anticipated would lead to the lowest expec- tations of recovery in sufferers also had the lowest placebo responses. Second, the frequently observed lack of a shared belief system between CFS patients and medical professionals could be an explanation for the finding. The therapeutic rela- tionship between patients and clinicians seems to be one of the determinants of the placebo effect (105).
and what of the further papers that the FINE trail investigators want to do?

Further papers will examine exercise capacity and illness beliefs as potential mediators of the effects of pragmatic rehabilitation. We will also be reporting on predictors or moderators of treatment response
 
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Thanks for this. While I think studies are good and necessary, in my opinion they do not necessarily indicate how a single individual will do. In my case, Zoloft was HUGE, GOLD, AWESOME, SAVED MY LIFE, and I'll be forever grateful. I tried everything else, diet, supplements, anti-oxidants, heck, even hyperbaric oxygen. Nothing comes even close to Zoloft's effect on me. What would have happened to me if Zoloft had not been released and marketed?
 

Jenny

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Hi Karin

I've heard good reports of Zoloft too. Could you say a bit more about how it helped you?

Jenny
 

dannybex

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Zoloft had the exact opposite effect when i tried it 4-5 years back. Made me extremely weak, could hardly stand up for more than 5 minutes, gave me RLS, and drove me close to suicide.
 

Jenny

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Sounds awful dannybex. What dose were you on? The people who report it helps them often take very low doses (eg 12.5 mg) and very slowly work up over a period of months.

What is RLS?

Jenny
 
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I am not surprised to hear that people's experiences can vary so greatly with SSRIs. It seems to be very individual. I tried Lexapro, my doctor saying that patients were calling her to tell her how great it was, and it was horrible for me, even after the first pill, similar to what dannybex is saying about Zoloft.

Zoloft on the other has quasi no negative side effects on me. And I felt an effect after the first pills already, though I understand this is unusual, usually it takes a few weeks. It did take a few weeks for the effect to buil up, but I saw a gigantic effect after the first pills already:

Before: problems thinking, concentrating, brain fogged, bothered by everything, noises, talks, people. Feeling like my whole body is tight and compressed and all my nerves are raw (though no pain, just very unplesant all over). Problems sleeping, waking up with every sounds, adrenaline rushes, sleepy all day long, needing a lot of sleep. Mood swings, exploding and screaming for every little irritation, then very depressed, crying a lot (even outside, how shameful). Daily wish for not waking up the next day. Feeling like a failure, a bad mother.

After, short-term: feeling like the windows in my head have opened and sunlight is shining in, fresh air coming in. Thoughts start flowing, concentration easier. Feeling like my whole body's outer 'shield' (for lack of better word) is growing back, things don't bother me anymore, my body feels warm and pleasant, relaxed, my hands feel warm. My mood is smoothened and I don't explode anymore and don't cry anymore. I don't feel happy but I don't feel horrible. Sleep is more refreshing and I don't need as much.

After, long-term: no more feelings of being a failure or wanting to die. Less fatigue.
 

dannybex

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Sounds awful dannybex. What dose were you on? The people who report it helps them often take very low doses (eg 12.5 mg) and very slowly work up over a period of months.

What is RLS?

Jenny
Good point Jenny...starting with low doses can sometimes help. And like Karin says, we all have different reactions. It's very interesting that her positive reactions were/are almost the EXACT opposite of what I had. In addition to the weakness, etc., I noted above, it made my brain fog much, much worse, and made me a lot colder, instead of warmer. We're all different. :eek:

My problem in general with SSRI's is (like most drugs) that they don't address the cause of the depression. They kind of artificially correct imbalances, but don't actually increase serotonin or other neurotransmitter levels for example...they just recycle what levels you might have -- they don't address why the levels are depleted or what's causing the depletion or imbalance -- at least that's my understanding. :Retro smile:

But depression and other mood issues may have many different causes: B-12 deficiency, folic acid deficiency, and especially vitamin D deficiency. In fact vitamin D def may play a role in a lot of the immune problems we have as well as depression, muscle weakness, joint problems, etc.. Vitamin D has been found to be more effective than light therapy for seasonal depression. There are a ton of studies at http://www.vitamindcouncil.org -- plus a lot of reports/stories via google. Many, many people are finding they're "d" levels are shockingly low. The last time mine was checked it was 34 (or something like that), which is barely in the 'normal' range, and I haven't taken much 'd' since then, so it's probably lower now. Experts suggest it should be closer to 50-75. I gotta get my d levels retested...

The other thing that works for some people is SAM-e -- (and again, there is lots of info on the web) -- it also helps not only mood, but liver, joint, circulation, etc., because it supplies an amino acid (methionine) along with ATP (which is found to be low in CFS), and helps a lot, for me, with both mood and joint issues. But then again, some people cannot tolerate it -- that's what's so frustrating about this disease (and others too) -- but you can find discussions on SAM-e and vitamin d by doing a search on the forums.

Just my two cents. I'm not a doctor at all, and not in good shape either, so take these suggestions with a huge grain of salt.

d.

p.s. RLS = restless leg syndrome. Ironically, SAM-e helps a lot with that too, as does vitamin e. And there's a connection with low iron and RLS...so it's a good idea to have one's ferritin levels checked.
 
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Yes, I forgot: I am on the lowest dose of Zoloft, 50 mg. And I started with only half a pill, 25 mg (half the minimum dose), then I increased after a few months when I had a feeling I needed more.
 

August59

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With any of the anti-depressants, even the tricyclics. There affects are as unigue as the person taking them. What works for one will be hell for the other and visa versa, but I do think they are a life saver for a lot of people. As well are pure hell as in Dannybex case. This is where the typical doctor instructions are "If this one doesn't work we will try another one", but it is the way they should be done. they tried them on me several years ago and I either got nothing or a zombie like effect. Nothing drastic happened with any of them, but tried about 6 or 7 and nothing came from them that made me want to keep taking them. I was on 80 mg / day of Prozac and it had zero effect. Doctor even asked if I was having any sexual side effects and the truth was nothing had changed cause I was good to go!!!
Just my suggestion is to be patient and go into it knowing you might have to change several times and some experiences might not be good, but the next one could be the real deal or not.
 

Jenny

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My problem in general with SSRI's is (like most drugs) that they don't address the cause of the depression. They kind of artificially correct imbalances, but don't actually increase serotonin or other neurotransmitter levels for example...they just recycle what levels you might have -- they don't address why the levels are depleted or what's causing the depletion or imbalance -- at least that's my understanding. :Retro smile:

But depression and other mood issues may have many different causes: B-12 deficiency, folic acid deficiency, and especially vitamin D deficiency. In fact vitamin D def may play a role in a lot of the immune problems we have as well as depression, muscle weakness, joint problems, etc.. Vitamin D has been found to be more effective than light therapy for seasonal depression. There are a ton of studies at http://www.vitamindcouncil.org -- plus a lot of reports/stories via google. Many, many people are finding they're "d" levels are shockingly low. The last time mine was checked it was 34 (or something like that), which is barely in the 'normal' range, and I haven't taken much 'd' since then, so it's probably lower now. Experts suggest it should be closer to 50-75. I gotta get my d levels retested...

The other thing that works for some people is SAM-e -- (and again, there is lots of info on the web) -- it also helps not only mood, but liver, joint, circulation, etc., because it supplies an amino acid (methionine) along with ATP (which is found to be low in CFS), and helps a lot, for me, with both mood and joint issues. But then again, some people cannot tolerate it -- that's what's so frustrating about this disease (and others too) -- but you can find discussions on SAM-e and vitamin d by doing a search on the forums.

Just my two cents. I'm not a doctor at all, and not in good shape either, so take these suggestions with a huge grain of salt.

d.

p.s. RLS = restless leg syndrome. Ironically, SAM-e helps a lot with that too, as does vitamin e. And there's a connection with low iron and RLS...so it's a good idea to have one's ferritin levels checked.[/QUOTE]

.................................................................................................................................................

All very good points, dannybex. I agree that taking anti-depressants won't address the cause, but it's worth considering that increasing serotonin may have knock on effects that help systemically. And a recent test I had suggested that I was converting tryptophan to a toxic substance and this meant I had less to convert to serotonin, so I've just started 5-HTP.

I thought SAM-e was helping when I took it a year or so ago, but a recent course didn't do anything, and I don't think Vit D3 does much for me either as I've been taking 2,500 mg a day for over 6 months and 1,000 for months before that. Never been able to get my D levels tested.

Jenny
 

taniaaust1

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i tend to get bad reactions from SSRI drugs even with extremely low doses.. i've tried Citalopram (Celexa).. makes me just sleep and non functional, couldnt even make myself a cup of tea on it) and Lovan (Fluoxetine.. prozac) had a different bad reaction (headaches? from it).

i like benzodiazepines eg Xanax (Alprazolam), i use only a quarter of the smallest dose and find that works, ive heard that isnt just used for anxiety in some patients but also as an antidepressant at times and Rivatril / Klonopin (Clonazepam) i found great (till i had a sudden suidial incident and OD on it).

i cant use sedating drugs thou for emotional liability or for sleep. I tried Seroquel (Quetiapine) and Olanzapine (zyprexa) and even at half of the very smallest dose, they have long lasting sleep affects making me loose the next day too. If i cut them back to where they dont go and knock me out for a very long time, they dont then work at all.

A stupid doctor who didnt believe in CFS once put me on Lamotrigine, very bad reaction there too (got hives rash) and went almost psychotic when put on Lamotrigine and Citalopram, i had a near psychotic eposide (strong urges to rip all my partners skin off back).

i've read that many of us with CFS cant tolerate SSRI drugs.