DEPRESSION GUIDELINES AND RECOMMENDATIONS
CAN YOU TRUST THEM?
Antidepressants Do Work, And Many More People Should Take Them: Major International Study" The headline of a Newsweek story run on 2/22/18. Especially interesting considering the January 28, 2010 issue of the same magazine carried the headline "Why Antidepressants Are No Better Than Placebos"
"Antidepressants really do work, and should be prescribed to millions more people, if you believe today’s newspaper headlines. The reality is more nuanced, as we still don’t know that these drugs will help most people with less severe depression. The positive press has been triggered by a study out this week that found these medicines do relieve depression, contradicting previous claims they are little better than a placebo." From the February 22 issue of New Scientist (Almost Every Antidepressant Headline You’ll Read Today is Wrong)
The first thing I noticed about the timing of this study was that mere days after it was published, the AAP (American Academy of Pediatricians) issued new guidelines calling for universal screening of children for Depression as well as increased government funding to do so. What do I think of most "MEDICAL GUIDELINES"? Dig into them and you'll usually find serious and numerous financial COI (I showed you this just a few weeks ago concerning antivirals -- HERE). NPR picked up the story, with the publication of Allison Aubrey's February 26 article, Pediatricians Call For Universal Depression Screening For Teens.
"Only about 50 percent of adolescents with depression get diagnosed before reaching adulthood. And as many as 2 in 3 depressed teens don't get the care that could help them. 'What we're endorsing is that everyone, 12 and up, be screened ... at least once a year, Zuckerbrot says. Zuckerbrot helped write the guidelines...."
And here's the rub. Despite everything you've been told or heard on TV from when you were a tot, more or earlier screening is rarely if ever better. In fact, it leads to a potentially deadly phenomenon that the medical community refers to as "OVERDIAGNOSIS & OVERTREATMENT" (Dr. Ionnidis is big on this). And with what we already know about the way that antidepressant meds work in kids; what the heck would these docs do anyway? Are you really going to prescribe these children antidepressants?
If you Google "antidepressant medication side effects children" you'll find some interesting material. But to get there, you'll have to wade past the first several pages of propaganda from outlets like WebMD, Mayo, our own government, and their media accomplices first. It's critical for you to be aware that only about 1% of drug side effects are ever reported to agencies that actually count them (HERE), which makes most drugs appear far safer than they really are. And secondly, despite what I am going to show you momentarily, the numbers of kids already taking these drugs is off the charts.
According to CCHR International (Number of Children & Adolescents Taking Psychiatric Drugs in the U.S.), there are nearly 2.2 million children under the age of 17 on antidepressants. Throw in anti-anxiety meds, ADHD DRUGS, and antipsychotics, and the number of children on psych meds is an astounding 8.4 million, or over 11% of all children. And here's the real kick in the teeth --- research shows that these drugs don't work well on kids in the first place. Case in point, an Oxford study by a team of twenty researchers, and also published in the Lancet (June of 2016 --- Comparative Efficacy and Tolerability of Antidepressants for Major Depressive Disorder in Children and Adolescents: A Network Meta-Analysis). Writing for the medical daily, STAT (Most Antidepressants Don't Work on Kids and Teens), journalist Karen Weintraub explained the study thusly....
"The new paper, a so-called meta-analysis, looked at 34 previously conducted studies. Those studies included more than 5,200 children and teens who took one of 14 antidepressants or a placebo..... The vast majority of antidepressants given to kids and teens are ineffective and potentially dangerous, according to a new study in The Lancet. Of 14 regularly prescribed drugs, only one — Prozac — proved effective enough to justify giving to children and teens, the researchers found. If medications are given at all, Prozac should be the drug of choice, the study concluded. 'No one should be on any other antidepressant, and I think it’s doubtful that people should be on Prozac, as well,' said Dr. Jon Jureidini, a child psychiatrist at the Robinson Research Institute at the University of Adelaide in Australia, who wrote a commentary that ran with the study. 'The case for Prozac is quite weak.'"
Are you joking? Is this from some kind of perverted SNL skit? PROZAC? Really? Let's look briefly at why you need to take results of antidepressant studies like this one with a grain of salt. For instance, if we go back one decade, to the January 2008 issue of the New England Journal of Medicine, a published meta-analysis called Selective Publication of Antidepressant Trials and its Influence on Apparent Efficacy, showed something completely different.
After looking at 74 studies of over 12,500 people (the authors stated that a third of these studies involving 3,500 people had never been published --- something known in the industry as "INVISIBLE & ABANDONED" --- the study's lead author had to obtain the hidden studies via court orders and the FOIA), the authors determined that, "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." In other words, industry was inflating efficacy by almost 100%. Not surprisingly the authors ended their study with these words. "Selective reporting of clinical trial results may have adverse consequences for researchers, study participants, health care professionals, and patients." "Selective reporting" is great ---- it's why I continue to hold the world record for consecutively-made free throws (HERE). Bear in mind that in this massive study, the placebos were 82% as effective as the drugs themselves. Gulp!
One year later in 2009, researchers at Northwestern University in Chicago published a study in JAMA (it was from a presentation given at Neuroscience 2009), showing that antidepressants don't work for the majority of those who take them, and particularly not in those with less severe cases of Depression. That pillar of truth and virtue (WebMD) published an article about the study called Can Antidepressants Work for Me?, which raised some interesting questions. Katherine Kam wrote....
"How effective are antidepressants? It's a question that's relevant to millions. About one in 10 Americans takes an antidepressant, now the most commonly prescribed type of drug in the U.S., according to research published in 2009 in the Archives of General Psychiatry. The report published in JAMA isn't new research -- it's a pooled analysis of data from six previously published studies."
This article is chocked full of excuses for why antidepressants were shown to be so ineffective in in the JAMA study. Excuses for this, excuses for that, people are misunderstanding the findings, the report is limited, etc, etc, etc. But it was tough to make enough excuses to whitewash the study published less than a year later, in 2010. Once again, JAMA (Antidepressant Drug effects and Depression Severity: A Patient-Level Meta-Analysis) showed exactly how effective (or ineffective as the case may be) antidepressants really are for the majority of people on them. "The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms, and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms." How many people who were prescribed antidepressants met "severity" criteria? "It is likely that a sizable proportion of depressed individuals who start antidepressant medications in the community evidence severity levels well below this value. In fact, a recent survey of depressed treatment-seeking outpatients found that 71% of the 503 patients assessed had HRSD scores less than 22 [the threshold for being considered "severe"]."
In 2014, Dr. Irving Kirsch, Associate Director of Placebo Studies and a lecturer in medicine at the Harvard Medical School and Beth Israel Deaconess Medical Center, published a truly amazing paper in the European journal, Zeitschrift für Psychologie (Antidepressants and the Placebo Effect). My opinion is that if you are on antidepressants, or considering going on antidepressants, read this study in its entirety as it's relatively short and easy to understand. Here are some cherry-picked highlights. And as you read this, be sure to grasp the fact that the fact that half of the studies on antidepressants that he looked at had been buried (invisible & abandoned), and that this was not an accident (after all, THE FDA is Big Pharma). "The failure to mention the unsuccessful trials was not merely an oversight; it reflects a carefully decided FDA policy dating back for decades."
"Antidepressants are supposed to work by fixing a chemical imbalance, specifically, a lack of serotonin in the brain. Indeed, their supposed effectiveness is the primary evidence for the chemical imbalance theory. But analyses of the published data and the unpublished data that were hidden by drug companies reveals that most (if not all) of the benefits are due to the placebo effect. Some antidepressants increase serotonin levels, some decrease it, and some have no effect at all on serotonin. Nevertheless, they all show the same therapeutic benefit. Even the small statistical difference between antidepressants and placebos may be an enhanced placebo effect (we found once again that 82% of the drug response was duplicated by placebo). The serotonin theory is as close as any theory in the history of science to having been proved wrong. Instead of curing depression, popular antidepressants may induce a biological vulnerability making people more likely to become depressed in the future."
Then came 2017. In one of the strangest and most controversial studies I've ever seen -- one that BIG PHARMA tried desperately to spin ---- the July 2017 issue of Molecular Psychiatry (Efficacy of Selective Serotonin Reuptake Inhibitors in the Absence of Side Effects: A Mega-Analysis of Citalopram and Paroxetine in Adult Depression) concluded that the beneficial effects of SSRI ANTI-DEPRESSANTS (the most common type of antidepressants) are mostly in your head --- but not in the way you might think. Think I'm making this up? Listen to some of the popular headlines that swirled around last summer's study.
- "People who take antidepressants may report they effectively relieve symptoms merely because they expect them to do so. That’s the intriguing finding of Swedish researchers who found that believing in the value of such medications influences their benefits." From NewsMax' October 9 article, Do Antidepressants Work Because People Believe They Will?
- "According to the challenged hypothesis, the fact that many people medicating with antidepressants regard themselves as improved may be attributed to a placebo effect, i.e. that someone who expects to be improved by a medication often also feels improved, even if the medicine lacks actual effect. To explain why antidepressants in such trials nevertheless often cause greater symptom relief than placebo, it has been suggested that SSRI-induced side effects will make the patient understand that he or she has not been given placebo, hence enhancing his or her belief of having been given an effective treatment." From the website of the University of Gothenburg --- the university that published said study (A New Study Rebuts the Claim that Antidepressants do Not Work).
- "The fact that antidepressants are only very marginally better than placebos is well-established. In addition, many authors have asserted that even this marginal superiority is an artifact. The reasoning goes like this. In order to prove that a drug is effective, the manufacturer has to prove, not only that it seems to help some people, but that on average it does better than a placebo. This is because placebos do seem to have a beneficial effect, especially in psychiatry." From Phil Hickey's September 7 article in Behaviorism and Mental Health (Pharma Responds: Antidepressants Really Work. Really?). After ripping this study, Hickey points to an investigative piece about the lead author's incredible financial conflicts of interest (COI) by Swedish reporter Janne Larsson called Big Pharma Strikes Back – The Ultimate Antidepressant Study.
Do you get what's going on here? The authors admit that the positive effects of SSRI antidepressants are caused by THE PLACEBO EFFECT. More specifically, they are driven by the portion of the placebo effect caused by the subject realizing he / she had been given the drug and not the placebo because they had...... you guessed it, side effects. Despite these sorts of studies being double-blinded, test subjects realized they were on the drug because they had side effects, and after coming to this realization, got better via the placebo effect. Strange and kind of tough to explain, but if I'm lyin, I'm dyin. Which brings us to the brand new Lancet study I mentioned at the beginning of the post, which says that antidepressants work better than placebo.
One of my favorite headlines written about this study came from Olivia Goldhill of Quartz (Researchers are Still Working to Prove that Antidepressants are More Effective than Placebo). This is exactly what's going on --- proof that the medical community will pull out any and all stops to get a positive headline on this most-prescribed class of drug; antidepressants. Writing for Vox, Johann Hari exposed how bad things really are in this segment of the medical system, with her article, We Need New Ways of Treating Depression. What would make astute reporters question Lancet's findings, while so many from the mainstream press were jumping on the bandwagon and pumping out articles and PRESS RELEASES praising antidepressants? How about the study itself? The study opened up with these sentences.
"Major depressive disorder is one of the most common, burdensome, and costly psychiatric disorders worldwide in adults. Pharmacological and non-pharmacological treatments are available; however, because of inadequate resources, antidepressants are used more frequently than psychological interventions."
Face it; in our insurance-driven medical system, it's always easier and more timely to prescribe rather than do or educate. And it's not this way only for antidepressants. We see the same phenomenon with the plethora of diseases that are intimately linked to POOR DIETS & LACK OF EXERCISE. Unfortunately, it's not a coincidence that GP's have been labeled as "PILL PUSHERS" (which is not always their fault --- HERE).
"Psychiatric disorders account for 22.8% of the global burden of diseases. The leading cause of this disability is depression, which has substantially increased since 1990, largely driven by population growth and ageing."
While this is certainly true, it's not completely accurate (I'm not buying what they're selling in the last part of this statement). Age is blamed on everything (after all Mrs. Johnson, you aren't as young as you used to be). Here is a common example: A person (HERE) comes into see me because she's had headaches and neck pain her entire life. But since she is now almost 80, her problem is blamed on her age. After all, there's no better / easier scapegoat than birthdays. The reality is, however, that Clinical Depression falls under the same category as do DIABETES, HEART DISEASE, CANCER, ARTHRITIS, and a myriad of others. That's because like these other disease, Depression is caused by inflammation (HERE). Furthermore, runaway inflammation is no longer just an American problem, it's a problem of the Westernized world. And with huge segments of the world becoming increasingly Westernized with each passing day, it's no wonder the problem is growing exponentially around the world.
"There is a long-lasting debate and concern about their efficacy and effectiveness, because short-term benefits are, on average, modest; and because long-term balance of benefits and harms is often understudied."
Why would this be? For one, have you looked at the studies pertaining to how long it takes these drugs to start working? Writing for a November 2017 issue of Very Well Mind (How Long Does It Take for Antidepressants to Work?), Sheryl Ankrom stated, "Studies have generally shown that the full benefits of antidepressant therapy may take as long as 8 to 12 weeks.... For people with severe anticipatory anxiety and agoraphobic avoidance, symptoms may not show significant improvement for 6 months or longer." And here's the rub. They do take a long time to work, but as Dr. Kirsch showed earlier, the longer you are on them, the greater the chances of developing side effects and toxicity (many of which are SEXUAL IN NATURE). Big Pharma set these studies up in order to show the greatest benefit with the least side effects (and then buried the 50% or so that didn't turn out the way they had hoped).
"Overall, 46 (9%) of 522 trials were rated as high risk of bias, 380 (73%) trials as moderate."
This means that only 18% of the studies looked at had low levels of bias. Bias is one of those tricks that allows researchers to prove the moon really is made of green cheese (if the market for green cheese is big enough, prepare for an onslaught of studies). All you have to do is look at my posts on EVIDENCE-BASED MEDICINE to see how true this really is.
"We found that all antidepressants included in the meta-analysis were more efficacious than placebo in adults with major depressive disorder and the summary effect sizes were mostly modest."
What does "modest" mean? For one, it means you don't wear the string bikini to the Sunday School pool party. It also happens to be a nicer way of saying that the study's results kind of sucked. After all, Dr. Kirsch himself admitted that antidepressants were better than placebo --- just not very much better. In fact, he had something interesting to say about this "modest" phenomenon.
"The difference that we found between drug and placebo was very small indeed – small enough to be clinically insignificant. Thus, when published and unpublished data are combined, they fail to show a clinically significant advantage for antidepressant medication over inert placebo. I should mention here the difference between statistical significance and clinical significance. Statistical significance concerns how reliable an effect is. Is it a real effect, or is it just due to chance? Statistical significance does not tell you anything about the size of the effect. Clinical significance, on the other hand, deals with the size of an effect and whether it would make any difference in a person’s life. Imagine, for example, that a study of 500,000 people has shown that smiling increases life expectancy by 5 min. With 500,000 subjects, I can virtually guarantee you that this difference will be statistically significant, but it is clinically meaningless."
By the way, some of the fincancial COI that were mentioned with some of the study's authors included Eli Lilly, Janssen, Meiji, Mitsubishi-Tanabe, Merck Sharp & Dohme, Pfizer, Takeda Science Foundation, Mochida, Mitsubishi-Tanabe, LB Pharma, Lundbeck, Otsuka, TEVA, Geodon Richter, Recordati, LTS Lohmann, Boehringer Ingelheim, SanofiAventi, Servier, and Yoshitomi, among others. Trust this research? Naw. I can't. What I do trust are the results frequently seen when people take their health into their own hands and get serious about removing out-of-control inflammation from their lives (HERE)!