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.

Cognitive-behavioral strategies to manage my OCD

This post is directed toward those with obsessive-compulsive disorder (OCD). I developed OCD during my last year of high school, and it became a serious disorder during college (combined with tics). At the time, I didn't try to get treatment, and I had no idea that I even had OCD. In my mid-twenties, I began seeing a psychiatrist, and started on a drug called Anafranil, which helped a lot. I was on Anafranil for 10 years, with 2 of those years combined with Zoloft. I combined the medication with my own cognitive-behavioral strategy. I found that existing psychological treatments (e.g. exposure therapy) didn't work very well for me. After 10 years of Anafranil along with my own strategies, I no longer needed medication. My OCD remained sub-clinical, i.e. although I still had an obsessive-compulsive personality, it no longer impacted my functioning. This was 3 years before I started investigating the link between my OCD/tics and the Earth's magnetic field (which I present in my harrymagnet.com website).

My symptoms were mainly obsessions about philosophical issues. I also had checking and cleaning compulsions. The compulsions weren't as bad as the obsessions. During my early and mid-twenties, virtually any reading or writing could trigger obsessions and tics, which would last for days. I believe that the obsessions derived from my extreme interpretation of the Ayn Rand/Objectivist philosophy. I'll expand upon this connection at another time.

My strategies to deal with the OCD involved refraining from mental suppression and mental forcing. Mental suppression is the willful cutting off of thoughts, images, and feelings as they arise from the stream of consciousness. Mental forcing is the willful forcing of thoughts, images, and feelings that would otherwise have not come from the stream of consciousness. Both of these behaviors are self-stimulatory, addictive, and destabilizing. Daniel Wegner's book White Bears and Other Unwanted Thoughts is a good source on the futility of trying to suppress thoughts.

To avoid these behaviors, you need to distinguish between mental forcing/suppression, which are internal behaviors, and triggers, which are external behaviors and stimuli. I believe that people with OCD should avoid triggers. Triggers are basically anything that can set off an obsessive/compulsive state. They involve an interaction with the person and his environment (as opposed to a strictly internal thing like mental suppression). As I stated earlier, before I started with medication almost any reading or writing served as triggers for me. Triggers include being in an unclean or disordered environment, and any kind of change or stress. Medication helped reduce the number of triggers, and also the severity and duration of the dysfunctional state that ensued. That's why I support the use of medication to control OCD.

Exposure therapy says that OCD is an anxiety disorder (based on the DSM categorization), and just as exposing anxious people to things they fear helps them (e.g. exposing people with claustrophobia to a confined space), exposing people with OCD will help them overcome their obsessions and compulsions.

There are several problems with the theory behind exposure therapy for OCD. One problem is that OCD isn't really an anxiety disorder. It's usually treated by antidepressants. If it was a true anxiety disorder, it would be treated by anti-anxiety meds like Xanax or Valium. The other problem is that obsessions and compulsions are addictive, self-stimulatory behaviors. One doesn't treat addictive behaviors by exposing the addict to things that can trigger the addiction. For example, one doesn't treat alcoholism by exposing the alcoholic to wine or liquor.

I don't know why some people and therapists claim that exposure therapy is effective for OCD. Perhaps some people with true anxiety are misdiagnosed with OCD. Perhaps others are helped in the short term by exposure therapy, only to have different obsessions and compulsions replace the ones that they were exposed to. Others likely relapse.

I hope the above strategies help some people with OCD. Feedback is welcome.