Monday, February 1, 2010

Antidepressants Are No Better Than Placebo

Newsweek’s cover story reinforces what researchers concluded in a recent article in JAMA—that for the vast majority of patients, antidepressants are no better than placebo. In fact, antidepressants are worse than placebo, because they have side effects. Only for patients with more severe forms of depression do these pills have any significant benefit.

Considering that 2008 antidepressant sales in the U.S. were $9.6 billion, it seems that if one wants to control spiraling health care costs, substituting sugar pills for antidepressants would be effective. If anything, we’re going in the opposite direction. Antidepressant users doubled in the 10 years from 1996 to 2005. Aggressive marketing by Big Pharma to both doctors and customers has expanded antidepressant use, even while the evidence of their effectiveness has been seriously questioned. As the Newsweek article states, “antidepressants are basically expensive Tic Tacs.”

Antidepressants are also used to control OCD. I feel that my OCD/tic disorder was helped by Anafranil, an older antidepressant. While this benefit could be due to the placebo effect, I doubt it. I think that from a biological perspective OCD is more similar to severe depression than to anxiety disorders, with which it is classified by the current DSM. Both OCD and severe depression are helped by antidepressants.

The distinction between antidepressant effectiveness in severe and light/moderate depression reinforces my view that a more individualized/case-by-case approach is needed for psychiatric disorders. As Dr. Klitzman says in a separate Newsweek article, paraphrasing Tolstoy, “every unhappy individual is unhappy in his or her own way.” It’s possible that light/moderate depression is a reaction to negative life events, while serious depression, OCD, and bipolar disorder are something completely different.

My human magnetoreception hypothesis connects these serious disorders with the Earth’s magnetic field. Since magnetoreception is dependent on childhood experience, i.e. where and when someone grew up, each of these magnetoreceptive people needs to be tested and evaluated individually. While the same drug may work in many people, the location of their magnetic home will vary based on their childhood experience. Also, their sleeping behavior and environment is likely different, so recommendations on changing this behavior and environment need to be tailored to the individual circumstances. This is similar to psychotherapy, in that therapy needs to be cognizant of the individual’s background, interests, intelligence, and personality.

In conclusion, we need to stop prescribing antidepressants to people for whom they have no benefit over placebo. For those with more serious disorders like severe depression, OCD, and bipolar disorder, antidepressants and other medications are useful. In the future, if my human magnetoreception hypothesis is confirmed, there will likely be more effective treatments that combine behavioral changes and futuristic devices.

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