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Should I take antidepressants?

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In MotherJones magazine which I was quoting it states “Psychiatrists and other mental-health professionals (I am a practicing therapist) know that any given antidepressant has only about a 50 percent chance of working with any given person. But what most people — patients and clinicians alike — don’t know is that in more than half of the 47 trials used by the Food and Drug Administration to approve the six leading antidepressants on the market, the drugs failed to outperform sugar pills, and in the trials that were successful, the advantage of drugs over placebo was slight. As it would hardly help drug sales, pharmaceutical companies don’t publish unsuccessful trials.’

Most important is that people take their own advice. 

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Is Mother Jones a reputable source of info? Why not look at the original sources such as NICE in the UK and the equivalent in the USA?  You say people ‘should take their own advice’. I in general take the advice of experts.

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3 hours ago, Handy said:

In MotherJones magazine which I was quoting it states “Psychiatrists and other mental-health professionals (I am a practicing therapist) know that any given antidepressant has only about a 50 percent chance of working with any given person. But what most people — patients and clinicians alike — don’t know is that in more than half of the 47 trials used by the Food and Drug Administration to approve the six leading antidepressants on the market, the drugs failed to outperform sugar pills, and in the trials that were successful, the advantage of drugs over placebo was slight. As it would hardly help drug sales, pharmaceutical companies don’t publish unsuccessful trials.’

You reference an article which you don't provide information to, merely a quote, which itself doesn't provide specific information about ITS sources.  That is not useful information.  It proves nothing.  Anyone can post a quote.  Anyone can write a percentage and make a claim.  For example:

"In Dragon Slayer weekly magazine it states "Monster hunters and other warrior professionals (I am a practicing barbarian) know that any given magic weapon has only about a 50% chance of killing dragons.  But what most people - adventurers and peasants alike - don't know is that in more than half the 47 monsters hunts used by the Royal Dragon Hunting Academy to prove the six most effective magic dragon killing weapons on the market, the weapons failed to outperform a common broadsword, and in the trials that were successful, the advantage of magic weapons over common broadsword was slight.  As it would hardly help weapons sales, smiths don't publish unsuccessful trials."

I have no more reason to believe your quote than my own, obviously fictitious quote.  Anyone can write what you or I wrote.  If you are going to make a claim that runs counter to widely accepted belief, you need to back it up with concrete evidence and sound logical reasoning.  Where are the actual studies this information supposedly comes from?  How old are they?  What have more recent studies shown?  How many?

Further, you would have us believe in massive conspiracies rather than the more common, boring explanation, that the drugs work and are more effective than placebo.  If that were not the case, why not just sell us sugar pills?  if these companies have the power to cause multiple government arounds the world to ignore the scientific results, it should be trivial for them to approve labeling simple sugar pills as "real" medication and selling that, for a far greater profit.  The logic of the supposed scam doesn't even hold up to simple, reasoned, scrutiny.

Further, to back up my view (and the consensus view of both mental health professionals and mental health organizations around the world, here's the name of a very recent meta-study which reviewed dozens of other studies to examine the effectiveness of SSRIs for treating major depressive disorder:
"Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis"
You can do a search for that and read the entire thing for yourself.  You don't have to believe what I say, you can go straight to the source.

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4 hours ago, Angst said:

You say people ‘should take their own advice’. I in general take the advice of experts.

indeed!  People are generally poorly informed on most topics, not because they are stupid or anything, just because there is so much to know out there!  While its important not to just trust an authority without question, it is also important not to overestimate ones own knowledge or a laymans knowledge in an area compared to an expert.  OCD sufferers should well be aware of how easy it can be for an individual to misjudge things like risk, its at the core of our condition after all.

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19 hours ago, Carooba Manooba said:

I agree most people believe antidepressants are effective.

Except its not a matter of belief, its a matter of proof.  The majority of people can be wrong on objective topics.  For example, the majority of people could believe the earth is flat (thankfully they don't), but that doesn't mean its flat.  We have the evidence to prove its not.  Likewise we have the evidence to show that SSRIs are effective.  Not perfect, true, but more affective than a placebo? Absolutely.
 

19 hours ago, Carooba Manooba said:

Absolutely. However, Irving Kirsch is not someone you would ever say doesn't have the evidence to back it up.  His book "The Emperor's New Drugs – Exploding the Antidepressant Myth"  is based on much detailed analysis.

Except I would say he doesn't have the evidence to back up his claims.  For example his book ignored the results of double blind placebo controlled studies, studies which are THE standard for scientific research and unequivocally show his claims to be false.  Further, if SSRIs (and other antidepressants) were merely exhibiting a placebo effect, then other drugs studied for treatment of depression would have shown a similar result, but this was not the case.  Finally, the statistical values he has chosen for his analysis were arbitrary.  Did he do an analysis? Yes.  But was that analysis based on sound logic, meaningful results, and included all relevant evidence? No, it did not.  If his theory was correct the evidence would be simple to gather, a double blind, placebo controlled study (or preferably multiple) would bear that out, you would see no statistically significant difference in outcome.   Yet the opposite is true, multiple studies confirm it.

If a person chooses not to take drugs for their condition I fully support that choice, for any number of reasons.
If a person chooses not to believe that SSRIs or other drugs are effective for treatment of conditions like OCD, that also is their choice.
If they want to debate the current scientific evidence and consensus, they should also have that right.

But this forum is not the place to do the third one.  OCD-UK and the forum follow NICE guidelines, which accept the scientific consensus and evidence on the effectiveness of SSRIs (and of course CBT).  When a person visits these forums seeking advice, that is the framework in which it is meant to be provided.  Raising contrarian theories here isn't appropriate because it results in side tracking from the main post (like is happening right now).  I base that not on my own particular views (though I obviously agree) but with the posted guidelines of the forum and my personal experience from reading other threads.  Obviously if Ashley or another mod steps in to correct a mistake I've made, I would accept that, but I am fairly confident on this one.

So not only do I believe Handy is factually in correct, I also believe that its not appropriate to be sidetracking threads raising that issue.  And I share a part of the blame for engaging the argument to the extent I have, so I'll try to make this my final post on the topic and suggest we return the thread back to the OP and their original question.

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I understand and agree with your totally serious point - but I have to say this properly made me chuckle! 

3 hours ago, dksea said:


"In Dragon Slayer weekly magazine it states "Monster hunters and other warrior professionals (I am a practicing barbarian) know that any given magic weapon has only about a 50% chance of killing dragons.  But what most people - adventurers and peasants alike - don't know is that in more than half the 47 monsters hunts used by the Royal Dragon Hunting Academy to prove the six most effective magic dragon killing weapons on the market, the weapons failed to outperform a common broadsword, and in the trials that were successful, the advantage of magic weapons over common broadsword was slight.  As it would hardly help weapons sales, smiths don't publish unsuccessful trials."

 

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3 hours ago, dksea said:

 I'll try to make this my final post on the topic and suggest we return the thread back to the OP and their original question.

We'll agree to disagree ,and move on.

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13 hours ago, Handy said:

In MotherJones magazine which I was quoting it states “Psychiatrists and other mental-health professionals (I am a practicing therapist) know that any given antidepressant has only about a 50 percent chance of working with any given person. But what most people — patients and clinicians alike — don’t know is that in more than half of the 47 trials used by the Food and Drug Administration to approve the six leading antidepressants on the market, the drugs failed to outperform sugar pills, and in the trials that were successful, the advantage of drugs over placebo was slight. As it would hardly help drug sales, pharmaceutical companies don’t publish unsuccessful trials.’

Most important is that people take their own advice. 

In this country we do.  It's called The National Institute for Health and Care Excellence (NICE) which evaluates all the evidence and makes recommendations for the treatment of mental health problems based on that global evidence. And for the most part, NICE generally get it right. 

Handy is right though, in the past pharmaceutical companies didn’t always publish unsuccessful trials and I have heard that too about DBS trials for depression, some disturbing things happening there, but this is not the place to debate that.

Hopefully NICE will remain independent and focus on the evidence.

 

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On 12/07/2019 at 05:31, Handy said:

more than half of the 47 trials used by the Food and Drug Administration to approve the six leading antidepressants on the market, the drugs failed to outperform sugar pills, and in the trials that were successful, the advantage of drugs over placebo was slight.

It is an interesting point. However, there are obviously many, many factors to consider when assessing what this quote actually means (in terms of the research). There are an enormous number of potential methodological issues, potential limitations with the research design, and from the quote you gave - we know nothing about the statistical findings, etc. if the article contains an academic reference to a strong journal - please post it. 

From an academic perspective, generalized summaries that are not published in peer-reviewed academic journals (it is worth checking how well placed the journal is too) have to be read with extra caution. 

Edited by DC82

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