Placebos as effective as anti-depressants

Since 2001, over 90,000 cyclist's have joined Cycling Forums to discuss topics from general cycling to equipment, training, racing and travel or vacation destinations (especially in europe during the tour de france). We also feature an great deals in our online store, 100's of articles, classifieds and product reviews.

http://groups.msn.com/psychbusters Decoding Psychiatric Propaganda

* * *

Jagged little pills

Robin Harvey TORONTO STAR

7 June 2003

Treating depression is an inexact balance of art and science.

Since you can't study live brains to see how any treatment really works, tackling the disease is
somewhat like nailing jelly to the wall, says a leading expert.

Add that to the fact that more than half of depressive episodes eventually go away without
treatment, and it's even harder to understand the disease, says Dr. Robert Cooke, of the mood
disorders clinic at the Centre for Addiction and Mental Health in Toronto.

The resulting reality is that each day, millions of North Americans take pills to fight depression
even though no one really knows exactly how they work.

"The brain is incredibly complicated (and) the mind is incredibly complicated," Cooke says. "There
are still no simple answers or magic cures. We have treatments worked out on a trial-and-error basis
and they are imperfect."

A mainstay of treatment has been antidepressant medication. But the earliest pills developed in the
1950s had significant side effects and could be highly toxic. By the late 1980s, with the advent of
the new "designer" antidepressants, doctors thought they'd found a better answer.

The new drugs specifically target and change levels of the brain's chemical messengers —
neurotransmitters. They were touted as "cleaner" drugs with fewer side effects and less toxic if
taken in overdose.

They became so popular that sales of the drug Prozac — the first of the new class — hit
$2.81 billion (U.S.) worldwide in 1998, and it became the fourth pharmaceutical product ever to
eclipse $2.5 billion (U.S.) in global sales.

In Canada, from 1993 until 2002 the number of prescriptions for this class of drugs increased 768
per cent to 13.8 million, according to IMS Health Canada, a medical research firm.

Yet today, though millions of people are prescribed the new class of drugs, the new pills have not
lived up to initial expectations.

"We need a major breakthrough in medications," Cooke says. "Most (used today) are copycats of older
ones changed somewhat so they have fewer side effects. But the fact is, when it comes to
effectiveness, the new drugs are no more effective than the ones we used in 1950s."

There is no doubt that changing neurotransmitter levels can affect mood, easing depression and mood
swings, Cooke says.

Toronto's Glenn Hardcastle who has had bouts of depression all his adult life says he could never
have fought the "molasses on the mind" without medication.

"It would be cruel to expect people to talk their way out when they are really down," he says. "For
me, it was just not possible."

And Phil Upshall, spokesperson for the Mood Disorders Society of Canada, says the drugs help people
out of their immediate crises so they can engage in talk therapy. Upshall, who has bipolar disorder,
says medication was key to his getting his life back on track.

Though people on the medicine paint a glowing portrait of the drugs' benefits, the scientific
evidence is not as clear-cut.

Studies show antidepressants help only 20 per cent of people who take them. That's based on
controlled, double-blind trials which show that although 60 per cent of people respond to
antidepressants, 40 per cent respond to a sugar pill, Cooke says.

But Dr. Barry Martin, another expert at the centre who runs its electro-convulsive therapy service,
says that picture is incomplete because it only deals with patients who report improvement.

If you look at the number of people who completely recover on medication and compare it to people
who take a sugar pill who report the same recovery, both are equally effective — about 40 per
cent, he says.

However, Dr. Anthony Levitt, psychiatrist-in-chief at Sunnybrook and Women's Health Sciences Centre,
says neither statistic is relevant. He says if you just look at depressed people left on waiting
lists who are not involved in any studies, only 20 per cent improve on their own.

Besides the hazy picture of the drugs' effectiveness, other problems have emerged over the past 15
years as the newer medications have grown more popular.

Their side effects can be significant. The major ones are weight gain,

Up to 30 per cent of patients using the neurotransmitter reuptake

inability to have an orgasm, impotence or delayed orgasm. Hardcastle

sleeplessness and frequent urination as side effects in his search for a suitable medication.

Another concern has been the reports of physical withdrawal when people stop taking antidepressants
— a problem Cooke says was "really underestimated."

In April, Health Canada warned doctors that "withdrawal reactions or discontinuation symptoms" occur
with all the newer antidepressant drugs. It "may be misdiagnosed, leading to inappropriate
treatment."

Cooke says people who stop antidepressants don't crave them for a high. But they can experience
nausea and diarrhea. They may also have nightmares and can get a disturbing feeling like electrical
sparks shooting through parts of their body, he says.

Bonnie North says she went through "agonizing withdrawal" when she tried to stop an
antidepressant in 2001.

She had been on the treatment for three years to fend off depression after childbirth.

North suffered headaches, extreme nausea, vomiting and diarrhea. Most maddening, she says, was a
constant sense of an electrical "zap" in her head that lasted for months. She has launched a lawsuit
against the drug manufacturer.

The manufacturer will not comment on the court case but says its drug is safe and causes no severe
withdrawal symptoms if discontinued properly under a doctor's supervision.

North also worries because there have been no studies of long-term side effects.

People like herself, who are put on the drugs for years, are "guinea pigs" she says.

Most of the pre-market studies of the drugs before they were approved for sale lasted six weeks. But
many patients stay on the drugs much longer. That's because, unless the drugs are taken for a year,
a patient is likely to have a relapse, Cooke says.

He acknowledges that information about long-term side effects is not available. But since the drugs
are monitored after they hit the market, serious adverse reactions would be reported, he says.

* * *

http://groups.msn.com/psychbusters Decoding Psychiatric Propaganda

"Theta" <theta@btinternet.com> wrote in message
news:18e81488.0306281043.7657e8de@posting.google.com...
> http://groups.msn.com/psychbusters Decoding Psychiatric Propaganda
>
> * * *
>
> Jagged little pills
>
> Robin Harvey TORONTO STAR
>
> 7 June 2003
(snip)

> Studies show antidepressants help only 20 per cent of people who take them. That's based on
> controlled, double-blind trials which show that although 60 per cent of people respond to
> antidepressants, 40 per cent respond to a sugar pill, Cooke says.

I am appalled at the scientific ignorance inherent in such simplistic statements.

Subjects receiving placebo pills in antidepressant trials are *not* untreated.

From http://www.psychiatrictimes.com/p000429.html, written by Dr. Khan.

"The less-than-impressive results in these and other studies also calls to mind the fact that
patients assigned to placebo treatment in clinical trials are not "getting nothing." The capsule
they receive is pharmacologically inert but hardly inert with respect to its symbolic value and its
power as a conditioned stimulus. In addition, placebo-treated patients receive all of the commonly
employed treatment techniques: a thorough evaluation; an explanation for their distress; an expert
healer; a plausible treatment; expectation of improvement; a healer's commitment, enthusiasm and
positive regard; and an opportunity to verbalize their distress. "

He goes on to include a very important warning about the interpretation of his findings. Note
particularly the concluding statement.

"A cautionary note is indicated about the generalization of these data to the clinical management of
depressed patients. The less-than-impressive difference between drug and placebo in this and other
studies of clinical trials does not speak directly to the effectiveness of antidepressants in
clinical practice. Participants in antidepressant clinical trials are a highly select group and are
not representative of the general population of depressed patients. They are not actively suicidal,
they are almost always outpatients who are moderately rather than severely or mildly depressed, and
they are free of comorbid physical or psychiatric illness. They are likely to have a higher placebo
response rate than more severely ill depressed patients. "

"Furthermore, the primary aim of these studies is not to assess the optimal effect of
antidepressants, but rather to rapidly assess efficacy of new drugs so they can be brought to the
market. Therefore, dose, duration and diagnosis in clinical trials are not necessarily ideally
suited to identify the optimal effects of antidepressants. Accordingly, clinical trials may identify
the lower bound of the effect size compared to placebo. "

In article <18e81488.0306281043.7657e8de@posting.google.com>, Theta says...

Great research. My research team at Independent Research Laboratories came to the same conclusions
after exhaustive testing. Our material was published in the Old England Journal of Medicine and the
Journal of Ancient Medical Astronauts (JAMA).

Carry on and keep us posted about further developments!!

Sir Arthur

>http://groups.msn.com/psychbusters Decoding Psychiatric Propaganda
>
>* * *
>
>Jagged little pills
>
>Robin Harvey TORONTO STAR
>
>7 June 2003
>
>Treating depression is an inexact balance of art and science.
>
>Since you can't study live brains to see how any treatment really works, tackling the disease is
>somewhat like nailing jelly to the wall, says a leading expert.
>
>Add that to the fact that more than half of depressive episodes eventually go away without
>treatment, and it's even harder to understand the disease, says Dr. Robert Cooke, of the mood
>disorders clinic at the Centre for Addiction and Mental Health in Toronto.
>
>The resulting reality is that each day, millions of North Americans take pills to fight depression
>even though no one really knows exactly how they work.
>
>"The brain is incredibly complicated (and) the mind is incredibly complicated," Cooke says. "There
>are still no simple answers or magic cures. We have treatments worked out on a trial-and-error
>basis and they are imperfect."
>
>A mainstay of treatment has been antidepressant medication. But the earliest pills developed in the
>1950s had significant side effects and could be highly toxic. By the late 1980s, with the advent of
>the new "designer" antidepressants, doctors thought they'd found a better answer.
>
>The new drugs specifically target and change levels of the brain's chemical messengers —
>neurotransmitters. They were touted as "cleaner" drugs with fewer side effects and less toxic if
>taken in overdose.
>
>They became so popular that sales of the drug Prozac — the first of the new class — hit
>$2.81 billion (U.S.) worldwide in 1998, and it became the fourth pharmaceutical product ever to
>eclipse $2.5 billion (U.S.) in global sales.
>
>In Canada, from 1993 until 2002 the number of prescriptions for this class of drugs increased 768
>per cent to 13.8 million, according to IMS Health Canada, a medical research firm.
>
>Yet today, though millions of people are prescribed the new class of drugs, the new pills have not
>lived up to initial expectations.
>
>"We need a major breakthrough in medications," Cooke says. "Most (used today) are copycats of older
>ones changed somewhat so they have fewer side effects. But the fact is, when it comes to
>effectiveness, the new drugs are no more effective than the ones we used in 1950s."
>
>There is no doubt that changing neurotransmitter levels can affect mood, easing depression and mood
>swings, Cooke says.
>
>Toronto's Glenn Hardcastle who has had bouts of depression all his adult life says he could never
>have fought the "molasses on the mind" without medication.
>
>"It would be cruel to expect people to talk their way out when they are really down," he says. "For
>me, it was just not possible."
>
>And Phil Upshall, spokesperson for the Mood Disorders Society of Canada, says the drugs help people
>out of their immediate crises so they can engage in talk therapy. Upshall, who has bipolar
>disorder, says medication was key to his getting his life back on track.
>
>Though people on the medicine paint a glowing portrait of the drugs' benefits, the scientific
>evidence is not as clear-cut.
>
>Studies show antidepressants help only 20 per cent of people who take them. That's based on
>controlled, double-blind trials which show that although 60 per cent of people respond to
>antidepressants, 40 per cent respond to a sugar pill, Cooke says.
>
>But Dr. Barry Martin, another expert at the centre who runs its electro-convulsive therapy service,
>says that picture is incomplete because it only deals with patients who report improvement.
>
>If you look at the number of people who completely recover on medication and compare it to people
>who take a sugar pill who report the same recovery, both are equally effective — about 40 per
>cent, he says.
>
>However, Dr. Anthony Levitt, psychiatrist-in-chief at Sunnybrook and Women's Health Sciences
>Centre, says neither statistic is relevant. He says if you just look at depressed people left on
>waiting lists who are not involved in any studies, only 20 per cent improve on their own.
>
>Besides the hazy picture of the drugs' effectiveness, other problems have emerged over the past 15
>years as the newer medications have grown more popular.
>
>Their side effects can be significant. The major ones are weight gain,

>
>Up to 30 per cent of patients using the neurotransmitter reuptake

>inability to have an orgasm, impotence or delayed orgasm. Hardcastle

>sleeplessness and frequent urination as side effects in his search for a suitable medication.
>
>Another concern has been the reports of physical withdrawal when people stop taking antidepressants
>— a problem Cooke says was "really underestimated."
>
>In April, Health Canada warned doctors that "withdrawal reactions or discontinuation symptoms"
>occur with all the newer antidepressant drugs. It "may be misdiagnosed, leading to inappropriate
>treatment."
>
>Cooke says people who stop antidepressants don't crave them for a high. But they can experience
>nausea and diarrhea. They may also have nightmares and can get a disturbing feeling like electrical
>sparks shooting through parts of their body, he says.
>
>Bonnie North says she went through "agonizing withdrawal" when she tried to stop an
>antidepressant in 2001.
>
>She had been on the treatment for three years to fend off depression after childbirth.
>
>North suffered headaches, extreme nausea, vomiting and diarrhea. Most maddening, she says, was a
>constant sense of an electrical "zap" in her head that lasted for months. She has launched a
>lawsuit against the drug manufacturer.
>
>The manufacturer will not comment on the court case but says its drug is safe and causes no severe
>withdrawal symptoms if discontinued properly under a doctor's supervision.
>
>North also worries because there have been no studies of long-term side effects.
>
>People like herself, who are put on the drugs for years, are "guinea pigs" she says.
>
>Most of the pre-market studies of the drugs before they were approved for sale lasted six weeks.
>But many patients stay on the drugs much longer. That's because, unless the drugs are taken for a
>year, a patient is likely to have a relapse, Cooke says.
>
>He acknowledges that information about long-term side effects is not available. But since the drugs
>are monitored after they hit the market, serious adverse reactions would be reported, he says.
>
>* * *
>
>http://groups.msn.com/psychbusters Decoding Psychiatric Propaganda

although there is some bias in drug company findings at times, I find this to be a tad outrageous. I
have seen how well patients respond to antidepressants, even when other modes of therapy are
incorporated. These medications are extremely helpful in the long term treatment of patients who
suffer from depression. Although a multi modality approach is often best, many of the other modes
work much better if the patient is receiving appropriate antidepressants. Its clear to any clinician
how effective these medications are.

I'm afraid the original poster (who's sig includes the site "Psychbusters", by the way) is sorely
mistaken, and obviously has some sort of axe to grind.

As a family practice physician, I find depression and anxiety to be the easiest of medical
conditions to treat, and that's entirely because we have so many wonderfully effective medications
available.

I would guess that the efficacy of antidepressants and placebos may approach similar efficacy in
mild cases of depression. there are a lot of non-specific variables in treatment to consider. For
example, going to a doctor for help, admitting to a problem, committing to change it and believing
in a treatment regimen (as well as all of the concurrent things one might do to improve
oneself-exercise, therapy, relaxation, dietary change, support groups, support from family, etc) all
have a tremendous effect. I would guess that antidepressants are highly effective, but the
previously mentioned variabes account for a great deal symptomatic improvement and in mild cases of
depression may contribute enough to cloud the effects of antidepressants.

"Wayne Alan Simon" <ariess@bellsouth.net> wrote in message
news:9xtLa.10650$j31.3103@fe02.atl2.webusenet.com...
> although there is some bias in drug company findings at times, I find this to be a tad outrageous.
> I have seen how well patients respond to antidepressants, even when other modes of therapy are
> incorporated. These medications are extremely helpful in the long term treatment of patients
who
> suffer from depression. Although a multi modality approach is often best, many of the other modes
> work much better if the patient is receiving appropriate antidepressants. Its clear to any
> clinician how effective
these
> medications are.

In fact, some folk can't be treated by other modalities until they have some drug treatment. I've
heard the drug treatment described as a milk crate to help you struggle out of the ditch.

On Sun, 29 Jun 2003 00:18:40 GMT, Sir Arthur C. B. E. Wholeflaffers
A.S.A. <nospam@newsranger.com> wrote:

*In article <18e81488.0306281043.7657e8de@posting.google.com>, Theta says... * *Great research. My
research team at Independent Research Laboratories *came to the same conclusions after exhaustive
testing. Our material *was published in the Old England Journal of Medicine *and the Journal of
Ancient Medical Astronauts (JAMA). * *Carry on and keep us posted about further developments!! *
*Sir Arthur * <snip crap>

Flappy! You are still loose and not on your meds. Your research team, HA! Court ordered medication
for several years is not the same thing as exhaustive testing. You crack me up, Flappy. Thank god
you have a computer to keep track of all the conspiracies you see, otherwise it might actually
require you to use some brain power.
--------------------------------------------------
AT. Dickie Skepticult member in good standing #394-00596-438 Poking kooks with a pointy stick
--------------------------------------------------
"The important thing is not to stop questioning. Curiosity has its own reason for existing."
B. Einstein

In article <qvatfvk5m97b7aos5eqh2o9v93ldqgnuu5@4ax.com>, Dr. Dickie says...
>
>On Sun, 29 Jun 2003 00:18:40 GMT, Sir Arthur C. B. E. Wholeflaffers
>A.S.A. <nospam@newsranger.com> wrote:
>
>*In article <18e81488.0306281043.7657e8de@posting.google.com>, Theta says... * *Great research. My
>research team at Independent Research Laboratories *came to the same conclusions after exhaustive
>testing. Our material *was published in the Old England Journal of Medicine *and the Journal of
>Ancient Medical Astronauts (JAMA). * *Carry on and keep us posted about further developments!! *
>*Sir Arthur * <snip crap>
>
>Flappy! You are still loose and not on your meds. Your research team, HA! Court ordered medication
>for several years is not the same thing as exhaustive testing.

First off, you are NOT a real doctor, so your opinion is worthless, by default.

>You crack me up, Flappy. Thank god you have a computer to keep track of all the conspiracies you
>see, otherwise it might actually require you to use some brain power.

I strongly urge you to tell you real doc to increase your medication and take you off the placebos.
In your case it does not work.

>--------------------------------------------------
>Dr. Dickie Skepticult member in good standing #394-00596-438 Poking kooks with a pointy stick
>--------------------------------------------------
>"The important thing is not to stop questioning. Curiosity has its own reason for existing."
>A. Einstein

Sir Arthur C. B. E. Wholeflaffers A.S.A. <nospam@newsranger.com> wrote in
news:d6ALa.5212$cJ5.417@www.newsranger.com:

>
> I strongly urge you to tell you real doc to increase your medication and take you off the
> placebos. In your case it does not work.
>
>

Unfortunately there's no treatment for wanton stupidity and arrogance. (the current U.S.
administration is proof of that). You can't stop people from choosing the low road of egocentricity
and deliberate foolishness, even though everyone else frequently suffers as a result. For your own
peace of mind, I'd suggest relegating such individuals to the Bozo bin.

Byte Me <bytemyb@nana.com> wrote in message news:<Xns93A94FBFEA82bytemybnanacom@142.77.1.194>...
> Sir Arthur C. B. E. Wholeflaffers A.S.A. <nospam@newsranger.com> wrote in
> news:d6ALa.5212$cJ5.417@www.newsranger.com:
>
> >
> > I strongly urge you to tell you real doc to increase your medication and take you off the
> > placebos. In your case it does not work.
> >
> >
>
> Unfortunately there's no treatment for wanton stupidity and arrogance. (the current U.S.
> administration is proof of that). You can't stop people from choosing the low road of
> egocentricity and deliberate foolishness, even though everyone else frequently suffers as a
> result. For your own peace of mind, I'd suggest relegating such individuals to the Bozo bin.

Waton and deliberatly making others stupid and looting money. It is highly depressing that such an
administration is in Power.

Waton! Come here. I need you!

<ss25@mailcity.com> wrote in message news:9cda39b2.0307070411.36ef221f@posting.google.com...
> Byte Me <bytemyb@nana.com> wrote in message
news:<Xns93A94FBFEA82bytemybnanacom@142.77.1.194>...
> > Sir Arthur C. B. E. Wholeflaffers A.S.A. <nospam@newsranger.com> wrote
in
> > news:d6ALa.5212$cJ5.417@www.newsranger.com:
> >
> > >
> > > I strongly urge you to tell you real doc to increase your medication and take you off the
> > > placebos. In your case it does not work.
> > >
> > >
> >
> > Unfortunately there's no treatment for wanton stupidity and arrogance.
(the
> > current U.S. administration is proof of that). You can't stop people
from
> > choosing the low road of egocentricity and deliberate foolishness, even though everyone else
> > frequently suffers as a result. For your own peace
of
> > mind, I'd suggest relegating such individuals to the Bozo bin.
>
> Waton and deliberatly making others stupid and looting money. It is highly depressing that such an
> administration is in Power.