Antidepressants Over the Medium and Long Term: Little to No Evidence

John McManamy Health Guide September 30, 2013
  • Last month, in two posts - Antidepressants: the Evidence and Antidepressants Over the Short Term - we examined the scientific evidence for treating depression with antidepressants. I principally relied on three major clinical treatment guidelines that were published over 2009-2010.    These...

13 Comments
  • Tabby
    Nov. 05, 2013

    For nearly 30 years, I was diagnosed as Recurring Major Depressive by both psychiatrists, therapists, and primary physicians.  Each gave me one anti-depressant after another anti-depressant that NEVER assisted me and instead left me lethargic, apathetic, suicidal, or just off my rocker crazy... never mind the eyes burning, face swelling, heart racing,...

    RHMLucky777

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    For nearly 30 years, I was diagnosed as Recurring Major Depressive by both psychiatrists, therapists, and primary physicians.  Each gave me one anti-depressant after another anti-depressant that NEVER assisted me and instead left me lethargic, apathetic, suicidal, or just off my rocker crazy... never mind the eyes burning, face swelling, heart racing, nerves zinging adverse reactions to many of them.

     

    Then, in 2005, I was diagnosed with my very first diagnosis of Bipolar and in 2006, I was confirmed by supposedly a leading Bipolar psychiatrist...

     

    since, I've had primarily diagnosed Bipolar with a few Recurring MDD thrown in by others.

     

    Some of the psych docs (who diagnosed me with Bipolar) insisted on anti-depressants, whereas others tell me "no no, those with Bipolar are not to have anti-depressants.".

     

    I refuse to take any, anti-depressant.  They can insist... I'll smile... take the prescription home and throw it in a drawer.

     

    I know what anti-depressants do, to me... NOTHING but trouble, if any thing.

     

    BTW:  I've found it most interesting, over recent years, that suddenly more and more folks taking anti-depressants are NOW also getting anti-psychotics added to "boost" the anti-depressant.  

     

    Or, maybe it's that some folks just have Bipolar and can't handle anti-depressants and so the anti-psychotic is used to tamper and dampen down any potential "mania"?  rather than just not prescribing the AD. 

     

    I've said it before and I'll say it again:  IN MY OPINION, because there is still NO diagnostic medical/chemical/brain scan tool to actually diagnose any mental illness or how best to treat any mental illness...

     

    the meds out there, developed (yes, developed in a lab), to assist those with mental illness.... are ONLY FOR THE symptoms WE report as having or the behaviors that we have while going through the symptoms we report

     

    and what bothers me most is that some psychiatrists say Bipolar, some say MDD, some say schizoaffective, some say Bipolar again... and then some say MDD again... and now you can have BOTH Bipolar and MDD

     

    but meds... meds are everywhere and are crossed over for everything

     

    if you are anxious - a pill

    if you are nervous - a pill

    if you are down - a pill

    if you are up - a pill

    if we claim we "see" something - a pill

    if we just can't get to sleep - a pill

    if we just can't stay asleep - a pill

    if we sleep too much - a pill

    if we feel "squirrely" - a pill (maybe 2)

    if our head hurts - a pill

    if our chest hurts - a pill

    if we see spots in our vision - I'll bet there is a pill

    if we feel nauseated - a pill

    if our hair starts to thin - a pill

    if we suddenly feel top of the world - 2 or 3 pills

     

    and even while we take our pills, to cure or alleviate the ills we tell... damn it all if we still feel anxious, nervous, up and down, can't sleep - sleep too much, head hurts, feel squirrely, chest hurts, see spots and other things, feel nauseated, hair thins to near invisible and we have moments of being on top of the world

     

    even while taking the pills...

     

    and yet, even I... will break down and seek a psych med... while I still feel the ill, I wish to relieve

     

    I'm not anti-med or anti-psychiatry... I just want effective, prudent, concise and consensus thought, respectful med therapy... and not anything and everything thrown at me to see what might stick, a bit

     

     

    • jon
      jon
      Nov. 06, 2013

      tabby, i've heard a psychiatrist say that they sometimes have problems giving an exact diagnosis ,for some patients, because patients might report different symptoms at each appointment, it can be subjective, so drs might end up having to treat symptoms. i see you are very frustrated trying many medications. if you have been given a diagnosis of bipolar disorder,...

      RHMLucky777

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      tabby, i've heard a psychiatrist say that they sometimes have problems giving an exact diagnosis ,for some patients, because patients might report different symptoms at each appointment, it can be subjective, so drs might end up having to treat symptoms. i see you are very frustrated trying many medications. if you have been given a diagnosis of bipolar disorder, maybe you could ask your dr if you could be on just one medication. lamictal is used as a mood stabilizer. it's worth having a discussion with him and see if he is happy with that medication.

      do you have a therapist?  a psychologist can assess you and give you a diagnosis. therapy will help to seperate any emotional issues ,if you have them,from medical ones. it can be very helpful because each session is about an hour so the therapist has a lot more time to interact with you. if you do have a therapist and you are still having all those frustrations,try another therapist for awhile to see if you get better results.i know it's very hard to be suffering and dealing with medication issues at the same time.

    • John McManamy
      Health Guide
      Nov. 07, 2013

      Hey, Jon. We love your input here, but here's a guideline we need to keep in mind: We cross people's personal boundaries when we start singling them out for unsolicited advice. This puts other people in the very uncomfortable position of feeling they have to defend themselves.

       

      We are the experts in our own personal experiences and how things work or...

      RHMLucky777

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      Hey, Jon. We love your input here, but here's a guideline we need to keep in mind: We cross people's personal boundaries when we start singling them out for unsolicited advice. This puts other people in the very uncomfortable position of feeling they have to defend themselves.

       

      We are the experts in our own personal experiences and how things work or don't work for us. We are not experts in other people's lives. Let's assume these people know what they are doing. 

       

      Sometimes, people will ask a question along the lines of: "Has anyone experienced this?" or "Does anyone know about that?" or "Does anyone have an opinion on such and such?" In these cases, by all means, please feel free to jump in, but again - speak from your own experience.

       

      Also, feel free to take issue with anything I may write. I have my mind changed many times by readers, and I am very grateful for this. I may not have time to answer every comment, but I read them all and consider them very carefully.

       

      We are all here, learning from each other, and to do that - first and foremost people need to feel safe here. I'm sure you understand this. 

       

      Again, we value your input here. 

    • jon
      jon
      Nov. 08, 2013

      ok, thank you for explaining.

  • Anonymous
    jon
    Nov. 04, 2013

    john-have you read any of the books by psychiatrist dr. peter breggin?

    it's very interesting,and gives the same information that my own dr. gave me,

    and, it's very much like you wrote. most antidepressants are no better than sugar pills. i started getting interested in that information after someone i know said she thought her son was being used as a lab rat...

    RHMLucky777

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    john-have you read any of the books by psychiatrist dr. peter breggin?

    it's very interesting,and gives the same information that my own dr. gave me,

    and, it's very much like you wrote. most antidepressants are no better than sugar pills. i started getting interested in that information after someone i know said she thought her son was being used as a lab rat by his psychiatrist. i checked dollars for docs and was shocked at how much money(reported) he was getting. drugs are a product that is sold for profet and the drug companies have given us a mantra -" we have a chemical imbalance". and "mental illness is like diabetes", . psychiatrists are md's but they never do any medical tests to show us that. they just sit in the chair and write scripts because,of course...we have a problem with our serotonin etc.

    - sadly,most psychiatrists are either greatly influenced or bought by drug companies. anyone can find thousands of reports on that subject if they open their eyes and try a good therapist before they try 'medication'.

    they even pay for textbooks for med students.

    http://www.vaccinetruth.org/pharmaceutical_companies.htm

    http://projects.propublica.org/docdollars/

    http://www.dailyfinance.com/2011/09/09/is-your-doctor-on-big-pharmas-payroll/

    http://stlouis.cbslocal.com/2013/03/22/drug-money-how-pharmaceuticals-earn-a-doctors-endorsement/

    • Crystal
      Nov. 04, 2013
      Jon, there is pessimisium all over your post. You may actually scare some people away with your opinions. Some people actually need an antidepressant or another kind of med. I would not compare antidepressants to a sugar pill at all. Really??? We are told by scientist that some of these mental illnesses are due to a chemical imbalance. Pharma did not make this...
      RHMLucky777
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      Jon, there is pessimisium all over your post. You may actually scare some people away with your opinions. Some people actually need an antidepressant or another kind of med. I would not compare antidepressants to a sugar pill at all. Really??? We are told by scientist that some of these mental illnesses are due to a chemical imbalance. Pharma did not make this up. There are more people than you think that try therapy before meds. And many that go to therapy on meds. I'm sorry you are so sour with pscychiatrists but it is not a majority who are just out for money. Maybe in the state I live in we just happened to have good pscychiatrists, although I think it's more wide spread than you do. I am very lucky to have a great one as are many members of our bipolar group. The most important thing in my opinion about having a mental illness is you have got to be you own ADVOCATE and be informed and research your mental illness and do what you can, when you can, to help yourself. Then you not only help yourself by your knowledge but you have power too. You hired the therapist and or pscychiatrist you can fire them just the same if they are not living up to your expectations. You see, you have the power. At that point you know what's going on with you, you are protecting yourself, you are not letting anyone take advantage of you and your in the drivers seat.
    • John McManamy
      Health Guide
      Nov. 05, 2013

      Hey, Crystal. I see where Jon is coming from, but I think you will find my reply to Jon also validates what you say here. :)

    • jon
      jon
      Nov. 05, 2013

       i agree with many of your comments. i had said 'most' antidepressants,not all.  however, i can see that was easy to miss, so if i have upset anyone, i sincerely apologize and ask that people discuss all their medication with their dr. because people respond differently towards antidepressants and drs can and do have success with them. i have taken...

      RHMLucky777

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       i agree with many of your comments. i had said 'most' antidepressants,not all.  however, i can see that was easy to miss, so if i have upset anyone, i sincerely apologize and ask that people discuss all their medication with their dr. because people respond differently towards antidepressants and drs can and do have success with them. i have taken an antidepressant that i feel has been helpful and each psychiatrist has their own viewpoint concerning that group of medications.  

       

       

    • John McManamy
      Health Guide
      Nov. 05, 2013

      Hey, Jon. I'm well familiar with Dr Breggin and others. They certainly are correct in pointing out that Pharma and the psychiatric establishment have frequently lied to us - often unconscionably so. They are also correct in pointing out the real and potential harm of antidepressants. They are also spot on in pointing out that the clinical trial evidence in...

      RHMLucky777

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      Hey, Jon. I'm well familiar with Dr Breggin and others. They certainly are correct in pointing out that Pharma and the psychiatric establishment have frequently lied to us - often unconscionably so. They are also correct in pointing out the real and potential harm of antidepressants. They are also spot on in pointing out that the clinical trial evidence in support of antidepressants is very underwhelming.

       

      But there is also a trap taking their arguments at face value. Our clinical trials, essentially, ask the wrong questions, which means we're going to get the wrong answers. A more nuanced reading of the evidence suggests that there is a certain subpopulation that greatly benefits from antidepressants. The catch is we don't know in advance who they are. We're not asking the right questions.

       

      This places a tremendous burden on us - we who experience depression. 

       

       

    • Anonymous
      jon
      Nov. 05, 2013

      thank you john. my frustration stems from people thinking that producers of drugs would never intenionally lie to us (and our drs) because it goes against every moral and ethical principle we hold dear. 

      i may not agree 100% with dr. breggin, but to see him holding firm instead of being in lockstep with most of the profession, got my attention. 

  • jon
    jon
    Oct. 29, 2013

    john, thank you for your post. i hope people will keep curent on information related to their disease and not be lazy.they have a responsiibility to be part of their health team. they should try out a support group (NAMI or DBSA) because learning from others helps them to be a "sucessful patient" (from your other post).  there are many 'professional' (not...

    RHMLucky777

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    john, thank you for your post. i hope people will keep curent on information related to their disease and not be lazy.they have a responsiibility to be part of their health team. they should try out a support group (NAMI or DBSA) because learning from others helps them to be a "sucessful patient" (from your other post).  there are many 'professional' (not wikipedia type) sites to learn from, if they are willing to put in the time. the information helps them ask the right questions at a med check. the dr only has a limited time,so asking a few good questions helps the dr to see you are a committed patient. one small example-  by doing some research, i can ask for a prescription dose to be lowered or a drug to be changed.  people need to talk to their dr. ..please don't take any of this as medical advice.i'm just trying to give 15 years worth of experience.

    john,just as you said, medications like antidepressants might not be helpful and they might be prescribed way too long.

    http://www.cmeinstitute.com/psychlopedia/depression/20apr/sec3/section.asp

    check on your psychiatrist on dollarsfordocs.com

    http://projects.propublica.org/docdollars/

  • Cathryne
    Oct. 06, 2013

    I almost didn't comment on this.  It sounds paternalistic.  No matter how I phrase it.  I had a client who was on meds.  This, of course was some time ago, but I run into him every so often and he does not remember me.  His Psychiatrist was with  a county clinic.  The psychiatrist chaged his meds and added an antidepressant...

    RHMLucky777

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    I almost didn't comment on this.  It sounds paternalistic.  No matter how I phrase it.  I had a client who was on meds.  This, of course was some time ago, but I run into him every so often and he does not remember me.  His Psychiatrist was with  a county clinic.  The psychiatrist chaged his meds and added an antidepressant instead of an add on.  The client had a horrible manic episode and never fully recovered.  His brain sort of rewired itself and he is no longer functional. 

     

    A friend of mine is on Abilify and and SSRI.  He drinks because the SSRI and the add on don't take care of his depression.  Not that alcohol will either, in the long run but for the short term, while he is drunk, he is not depressed. 

     

    For me, when I was on Zoloft before dx'd with bi-polar it did absolutely nothing.  I thnk I had a brief placebo effect from it, but that lasted about 2 months.  Weird, I would just go off it suddenly and with no repercussions.  Chocolate works better.  (Sorry, Dad, - he was a chemist

    for Pfizer)

    • John McManamy
      Health Guide
      Oct. 06, 2013

      Hey, Catheryne. Yep - the right thing to say. The APA Depression Treatment Guideline specifically states that before prescribing an antidepressant bipolar must be ruled out. You don't find too many docs screening for bipolar. Even if they did, bipolar is almost impossible to pick up when the patient is presenting with depression. So there is a large population...

      RHMLucky777

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      Hey, Catheryne. Yep - the right thing to say. The APA Depression Treatment Guideline specifically states that before prescribing an antidepressant bipolar must be ruled out. You don't find too many docs screening for bipolar. Even if they did, bipolar is almost impossible to pick up when the patient is presenting with depression. So there is a large population getting these meds who shouldn't be getting them. And the consequences can be enormous and long lasting. 

       

      Doctors need to exercise far more care in prescribing them and in monitoring the patient's progress.

       

      To readers: An antidepressant may be the right med for you - but you and your doctor need to be on top of the situation.