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(01-02-2015 11:49 AM)monster Wrote:  

This isn't true. I 100% agree that antidepressants are over-prescribed, but in patients where they work they are effective. I also agree that prescribing antidepressants without lifestyle modifications (exercise, healthy diet, CBT) is often useless, again they are remarkably effective for some people.

It's often a catch-22 with depression: people who are depressed simply cannot make the necessary lifestyle changes (exercise, health diet, etc) because serious depression sucks every motivation and positive thought out of them. So there's no easy solution because in cases of major depression saying "man up" just doesn't work because of the fucked up neural pathways.

Also, I'd add that St Johns Wort/5HTP/L-Dopa and other OTC supplements sometimes are just as effective if not more than the Big Pharma antidepressants. But it all comes down to the individual: although we're all the same biologically, we don't respond to all the same things when it comes down to these neurotransmitter details

Please don't miscontrue what I'm saying: exercise is probably the most effective antidepressant out there but medication & supplements have value too.

I'm afraid we just don't agree, except on the exercise part. Correlation is not equal to causation. I could take 100 depressed patients, and tell them to wear a purple colored magic copper bracelet that cures depression...and guess what? 2 months later some of them would be cured!!!

My information comes from a peer reviewed article, "Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy" published in New England Journal of Medicine in 2008, in which a researcher used the Freedom of Information Act to get access to the unpublished failed studies conducted by big pharma and then combined the data from those with the data from all published studies, to get a meta statistical picture of whether or not they actually worked. It turns out that the results trumpeted in paid ads were from cherry picked studies.

Furthermore, all this talk of pathways, and how SSRIs etc "balance" your levels of dopamine and seratonin, are theories with no scientific substantiation.
Their mechanism of action is essentially unknown.
The regulation of our mood and emotions is a highly complex process involving both absolute and relative levels of various chemicals, where the number of variables far exceeds any real understanding of them.

http://www.nejm.org/doi/full/10.1056/NEJMsa065779

Quote:

BACKGROUND
Evidence-based medicine is valuable to the extent that the evidence base is complete and unbiased. Selective publication of clinical trials — and the outcomes within those trials — can lead to unrealistic estimates of drug effectiveness and alter the apparent risk–benefit ratio.
Full Text of Background...
METHODS
We obtained reviews from the Food and Drug Administration (FDA) for studies of 12 antidepressant agents involving 12,564 patients. We conducted a systematic literature search to identify matching publications. For trials that were reported in the literature, we compared the published outcomes with the FDA outcomes. We also compared the effect size derived from the published reports with the effect size derived from the entire FDA data set.
Full Text of Methods...
RESULTS
Among 74 FDA-registered studies, 31%, accounting for 3449 study participants, were not published. Whether and how the studies were published were associated with the study outcome. A total of 37 studies viewed by the FDA as having positive results were published; 1 study viewed as positive was not published. Studies viewed by the FDA as having negative or questionable results were, with 3 exceptions, either not published (22 studies) or published in a way that, in our opinion, conveyed a positive outcome (11 studies). According to the published literature, it appeared that 94% of the trials conducted were positive. By contrast, the FDA analysis showed that 51% were positive. Separate meta-analyses of the FDA and journal data sets showed that the increase in effect size ranged from 11 to 69% for individual drugs and was 32% overall.
Full Text of Results...
CONCLUSIONS
We cannot determine whether the bias observed resulted from a failure to submit manuscripts on the part of authors and sponsors, from decisions by journal editors and reviewers not to publish, or both. Selective reporting of clinical trial results may have adverse consequences for researchers, study participants, health care professionals, and patients.