Wednesday, March 5

Maybe I should have been taking a placebo?

Wasn't that a kick in the head to read an article and discover that I might as well have been taking a placebo to treat my depression? It's another kick in the head to have learned that I may have been bipolar and not just depressed.

Getting back to the medications, I've been on and off antidepressants for years. I have taken just about all of them: Triavil, Tofranil, Norpramin, Prozac, Paxil, Zoloft, Cymbalta and Wellbutrin. None of them worked long term. Now I realize that that is partly due to the fact that the manic issue wasn't being addressed. Not only that, there is this:

Only Severely Depressed Benefit From Antidepressants: Study

Published: 03/01/08

TUESDAY, Feb. 26 (HealthDay News) -- While popular antidepressants such as Prozac are widely prescribed for people with varying degrees of depression, the drugs are only effective for those with the most severe depression, a new study suggests.

"Although patients get better when they take antidepressants, they also get better when they take a placebo, and the difference in improvement is not very great," lead researcher Irving Kirsch, a professor of psychology at the University of Hull in Great Britain, said in a prepared statement. "This means that depressed people can improve without chemical treatments," he added.

In the study, Kirsch and his colleagues collected data on 35 clinical trials of antidepressant drugs whose results had been submitted to the U.S. Food and Drug Administration. The antidepressants included in the trials were fluoxetine (Prozac), venlafaxine (Effexor), nefazodone (Serzone), and paroxetine (Seroxat/Paxil).

An analysis of the data showed that patients taking antidepressants fared no better than patients receiving a placebo. This appeared to be the case whether the patients were mildly or moderately depressed.

The drugs only seemed to benefit a small group of patients -- those with the severest depression when the study began.

Based on these results, there appears to be little reason to prescribe these antidepressants to anyone but the most severely depressed patients, the study authors concluded.

The findings were published online Feb. 25 in the journal PLoS Medicine.

Dr. Nada Stotland, president-elect of the American Psychiatric Association, said she wasn't surprised that the study found that not every antidepressant works for every patient. Many people who are depressed don't respond to the first antidepressant they try. It can take up to an average of three different antidepressants until one works for a particular patient, she said.

"Medication helps some, but not all, people with depression," Stotland said in a prepared statement. "For people with mild to moderate depression, psychotherapy can work as well as medication. Studies have shown that between 70 and 80 percent of people can and do get better with a combination of treatment approaches, which will often include individual therapy, family therapy and/or medication.

"Therefore, testing any single antidepressant on a group of depressed individuals will show that many of them do not improve," Stotland added. "There is a small group of depressed individuals who do not respond to any antidepressant."

The new study highlights the fact that treatment for depression needs to be tailored to an individual, and that the most effective treatment will often include multiple approaches, Stotland said. The study results also suggest that more long-term follow-up trials are needed to determine which patients are most likely to benefit from specific therapies.

"Some of the most exciting research in progress at the present time concerns our attempt to match the antidepressant to the patient from the outset; we may be able to perform laboratory tests or identify clinical factors that let us know in advance which antidepressant will work for each person," Stotland said. "That will be an enormous advance for the millions of people suffering from this very painful and potentially disabling disease."

In a prepared statement released late Tuesday, Pharmaceutical Research and Manufacturers of America (PhRMA) Senior Vice President Ken Johnson said, "It is true that pharmaceutical products, such as antidepressants, can result in a differential response among different patients. It is for this reason that a variety of therapeutic options is important in health care -- so that each patient can receive the most effective treatment for his or her needs.

"Because of this, America's pharmaceutical research companies are dedicated to continuing their research into and development of potential new medicines to treat depression as well as the other disease that affect patients worldwide."

Er, what? And just what is severe depression anyway? I know that I have had and still have major clinical depressive episodes. Is that considered severe? I've also been told I have dysthmia, a chronic "mild" form of depression--one that I live with everyday until I'm hit with a major episode. I also have atypical depression, meaning that I can laugh even though I'm sad and I gain weight instead of losing it.

I found a pretty good description of clinical depression:
Major depression is also known as clinical depression, unipolar depression, and major depressive disorder. People who experience major depression feel persistently sad. They do not take pleasure in activities that were once enjoyable. Other physical and mental problems often experienced include sleep problems, loss of appetite, inability to concentrate, memory problems, and aches and pains. People who suffer from this condition often feel worthless, helpless, and hopeless about their ability to fix things. They often welcome sleep and experience their waking life as a living nightmare. No matter how hard they try to snap out of it, they feel as though they are falling into an abyss with nothing to hold on to.

But what is severe depression? I had to look a while but finally found it.

Severe depression is
The number of symptoms well exceeds the minimum for diagnosis, and they markedly interfere with patient's work, social or personal functioning.

Is that me? I'm not sure ... I'm atypical, you see. ;) I really would like to believe that I didn't spend all that money all these years on medicine that was about as helpful as placebos. I tell myself: this study involved Paxil, Prozac, Effexor and Serzone...and I took only two of these four. Maybe all the others work.

I'm just going to keep telling myself that.

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