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    Antidepressants Under Attack
    Michael D Yapko, PhD posted:
    Antidepressants are the most popularly prescribed class of drugs in the United States. Is that because of good science--- or good marketing? Reading the posts here on WebMD by some, the hopefulness for a drug solution is a common theme. Recently, however,a flurry of books and articles have directly challenged antidepressants, suggesting they pose little benefit beyond placebo.

    Just 2 weeks ago, a new review called "Efficacy and Effectiveness of Antidepressants " by H. Pigott et al. was published in Psychotherapy and Psychosomatics. It involved four meta-analyses of efficacy trials submitted to the FDA and suggested that ADMs are only "marginally efficacious" compared with placebo, showing "a sustained benefit only 2.7% above placebo."

    The Emperor's New Drugs: Exploding the Antidepressant Myth, by Irving Kirsch, Ph.D., is a new book providing a detailed accounting of the huge controversy he sparked by suing to obtain the hidden data about antidepressant medications. Kirsch created an uproar when he added back in the negative data the drug companies had hidden from view while shamelessly promoting drugs they knew were little better than placebos. Kirsch was interviewed by Newsweek magazine in the February 8th issue (see the lead article "The Depressing News About Antidepressants " by Sharon Begley). This was the first time the general public was alerted to the issues raised by Kirsch and many others who also revealed the misdeeds of BigPharm.

    When so many people rely on these medications, experts don't take it lightly to raise questions about them. No one who devotes their career to studying depression and who wants to help people seeks to undermine a potential solution. But, it has become increasingly apparent over the years that the promise of antidepressants has become a marketing tool more than a genuinely effective treatment. Just taking medications is not likely to be enough of an intervention for most people. The importance of learning specific skills known to reduce - and even prevent - depression is more apparent than ever and will be the subject of future blogs.

    It is vitally important to be realistic about what medications can and cannot do in helping people overcome depression. When you hear about new research like this, does it affect your views about antidepressants?

    Take the Poll

    Do the new data emerging that show the antidepressants may not be as effective as people have been led to believe change your views about these drugs?
    • No, not at all
    • Yes it does
    • No opinion
    View Poll Results
    DDDGuy509 responded:
    This is somewhat discouraging news to me. I read an very interesting article in Consumer Reports Magaizine a few months back where they asked people dealing with depression/anxiety meds how well they thought they were doing with meds/therapy help, and the biggest majority said they benefitted by both meds and counseling. They "rated" a number of anti-depressants with people who took them and if they helped people and by how much. The majoirty opinion was that meds did help the people and counseling did as well.

    I know I am on my 3rd week on Elavil and I think I am starting to feel better. Its a battle though, but I am trying my very best and am also talking with a Therapist. But still, this is somewhat discouraging news to me.
    wylee21 responded:
    This type of article only reinforces the nagging feeling
    I already had that antidepressants are little more than placebos.
    It's so frustrating that we can do heart transplants,
    and eye surgery, and other miraculous medical procedures,
    but so far, there's basically nothing for those of us
    stuck in the black hole of depression.
    susiemargaret responded:
    hello --

    i was appalled when i read the newsweek article, because i have plenty of experience on/off depressants, and on/off different antidepressants, and

    -- i know for certain that i would be dead if it were not for antidepressants, and

    -- it makes me afraid that people who might benefit from them will not even try them.

    -- susie margaret
    what good is gold, or silver too, if your heart's not good and true -- hank williams, sr.
    chez1 replied to susiemargaret's response:
    I am with you susiemargaret, although meds are not always perfect and have some awful side effects, they have saved many lives. Research is without paving the way for the future but sadly the results often show biased views of the researchers.
    Without the help of medication and a good dr I think I would not be here now to post on this thread.

    JustAnotherGirl83 replied to chez1's response:
    There will always be people for and against the use of antidepressants. As far as studies go I am sure we are all aware that a person can get any sort of results they want if they try hard enough. Statistics can be manipulated to show whatever the researcher would like (one of the few things I remember from the two useless statistics classes I had to take while at University, lol). It appears that you, sir, are not one who favors the use of antidepressant medication, possible because you do not believe it is a chemical imbalance so much as it is environmentally influenced (in my honest, albeit limited, opinion I believe it can be one or the other but more often than not is a combination of the two as well as several other added factors). That seems like a very narrow point of view, if I am to speak honestly. For myself I would love to again be 'properly medicated' (lack of insurance and financial problems necessitated that I stop taking my meds). I cannot adequately describe the great difference it made or the Normalcy it brought, a Normalcy that I thought had been lost to me. I was very thankful for them.
    susiemargaret replied to JustAnotherGirl83's response:
    hello, J --

    here are some resources for finding free/low-cost meds --

    -- ask your prescribing dr or your family dr for samples;

    -- ask a pharmacist if s/he knows of local/state/national programs for getting free/low-cost meds;

    -- ask a pharmacist if any of the meds you are taking have generic equivalents, which are much less expensive than brand-name ones; many discount stores (target, wal-mart, etc.) and grocery store pharmacies dispense generic meds at $4/month;

    -- look at the labels on your current meds, get the manufacturer's name for each, then apply to each manufacturer's patient assistance program;

    -- check out the listings from these websites -- , , , , and ;

    -- check out the website for the national conference of state legislatures, which lists prescription assistance programs by state (subsidy programs, table 1, and discount programs, table 2, each can be reached by a link within the text); the page with the listings requires a little maneuvering but is well worth the effort -- ;

    -- check out these websites to determine your eligibility for various govt assistance programs -- , and ;

    -- check out the NIH website for links to possible sources of financial assistance, ;

    -- call your city, county, or state dept of health and dept of family services (or something that sounds equivalent), and ask if there are state or local programs for prescription assistance;

    -- go to the website for your state government, e.g., , and click on every social services link you can find; and

    -- ask around at food banks, shelters, united way and other charitable organizations, the YMCA/YWCA, and similar places about local programs thru churches, fraternal organizations, etc.

    if any of these links do not work or are too hard to navigate, please let me know so that i can correct them or drop them from my list. thanks.

    -- susie margaret
    what good is gold, or silver too, if your heart's not good and true -- hank williams, sr.
    Michael D Yapko, PhD responded:
    I appreciate each of you taking the time to reply to my post. It's true that I'm not a big fan of antidepressants, but neither am I against them or suggesting people shouldn't take them. When people talk about how these medications saved their lives, I believe them. However, each of us needs to be aware that what works for us on an individual basis may not be helpful to others.

    Even though antidepressants have helped some peope, there are problems with them that need to be acknowledged and, hopefully, eventually resolved. Some of those problems will not be possible to resolve, though; addressing the social and psychological factors in depression can't be accomplished with a medication. It's the wrong tool for the job.

    One of the most important concerns I have is that people are led to believe depression is all about a biochemical issue that only the drug will address. As I've stated, there are many contributing factors to depression, many of which are not biological.

    Depression is built on a foundation of passivity; too often, people don't take the steps needed to truly help themselves, believing hopelessly their effort wil be wasted. Just telling someone to take a drug without also advising the importance of actively learning specific skills to help cope and also reduce one's vulnerabilities to depression is what I take issue with. A doctor can unintentionally reinforce passivity by indirectly suggesting to the patient, "you don't need to learn anything new or do anything differently, all you need to do is take the drug on time." This is a likely contributor to depression's higher rate of relapse when all someone does is a take medication compared to when they also enter structured skill-building psychotherapies.

    Antidepressants can help, but there are many other approaches, including physical exercise and skill building psychotherapies, that match and even exceed the success rates of antidepressants. Instead of people believing it's all about drugs and biochemistry, I hope to promote a more multi-dimensional view through my postings.Treating a problem with a huge social component on an individual basis with drugs alone assures the problem will continue to grow, just as it is now.

    Thanks again for your feedback.
    Michael D. Yapko, Ph.D.
    lazydazey replied to Michael D Yapko, PhD's response:
    I totally agree with you, couldn't have put it better myself. Unfortunately, as long as the drug companies keep making obscene profits on some of these medications, nothing will change. Take care.
    snowyowl33 responded:
    Hi Dr. Yapko,

    I would like to ask your permission to copy your two personal posts on Anti Depressant effectiveness to post onto another exchange board here on WebMD (that exchange was created and is moderated by WebMD staff and also has an expert Dr. there)
    I think they could be of assistance and of much interest to many of the people on that board as well. I would of course note that these are your thoughts/posts and credit them to you.
    Some of the moderators here (including Caprice) know me and I hope would vouch for my integrity, in the use of your posts and your knowledge regarding these issues.

    I will not do anything until I have your permission in writing, and should you decline to allow me to use them, I understand completely and thank you for your information regarding AD now information.

    (Caprice, I think your one of the Mods here....) I am not sure if this will comply with the copy write laws on WebMD please tell me if they don't. I think Chrissy's board might be interested in this .... thanks)

    susiemargaret replied to Michael D Yapko, PhD's response:
    hello, dr. yapko --

    i respect your view, of course, but who ever said that taking antidepressants was the whole answer? i don't believe i've ever seen anyone in the webMD communities say that, and i hope i don't ever see anyone in the webMD communities say that, i think it would be irresponsible.

    what i believe -- and i and others have expressed it over and over -- is that antidepressants do help some people think more clearly so that they can address their problems without so much ambient static in the air. i do believe that with some people, biochemistry is a huge part of the problem and that to that extent, all the psychotherapy in the world won't help. but with many others, yes, behavioral or perspective changes are a good goal to work toward, and psychotherapy can help facilitate those.

    i'm afraid that i'm sounding abrupt or intolerant, i hope not. however, because of my own experience, this is something i feel strongly about, and i hope you can understand that.

    -- susie margaret
    what good is gold, or silver too, if your heart's not good and true -- hank williams, sr.
    Nicola78 replied to susiemargaret's response:
    Hi Susie Margaret,

    I'm with you a 100%. I know that when I was really sick, all the cognitive behavioural therapy in the world would not have helped if I had not taken antidepressants.

    I'm also beginning to see that my lack of real coping skills make me more vulnerable to repeated episodes of depression

    The pills seem like an easy answer and, in that sense, they are utterly misleading. My personal truth is that arming myself against depression through the kind of changes in perspective you talk about is my real challenge and solution. I want to eventually wean myself off the drugs. But it's going to take a long time.
    Caprice_WebMD_Staff replied to snowyowl33's response:
    Hi Snowy,

    Since it's all on WebMD, no matter on which board, there wouldn't be any copyright issues involved by posting this on another of our communities.

    However, it might be better, considering this is a good discussion with different viewpoints, to share the web address instead, letting others elsewhere know to come here and read and discuss:

    miserable_sob replied to Caprice_WebMD_Staff's response:
    All it does is confirm the truth about them. They're nothing but poison. And the only people they really help are the owners of the pharmaceutical companies that pedal this poison.
    Michael D Yapko, PhD replied to snowyowl33's response:
    Fine with me. Thanks for asking.
    Dr. Yapko

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