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Antidepressants & Placeboes 

People who take antidepressants often say they feel better, but some researchers claim that's the placebo effect. If so, aren't drug companies abusing depressed people by getting them to buy pricey, useless drugs? On the other hand, if antidepressants make you feel better, is the feeling lasting, and are they addictive? -ssdfssasdva asdfascaasa

So your question is, are antidepressants bad because they don't work, or bad because they do? We can eliminate a few possibilities right off the bat. For starters, if I'm in the antidepressant business, I'm not about to sell a product that permanently cheers people up. What I want is something they need on a regular basis, like a nice glass of wine. But I take it you're more interested in pills.

First some statistics:

• One in nine Americans over age 12 takes antidepressants, including one in four women between 40 and 59. Since the early 1990s antidepressant use has increased 400 percent across all age groups. Nobody's going to tell me life has become 400 percent more depressing.

• One American in 12 takes antidepressants despite having no symptoms.

• Less than a third have had a checkup with a mental health professional in the last year, and one in seven has been on antidepressants for more than a decade.

• Nearly three quarters of all antidepressant prescriptions are written without any diagnosis of a psychiatric problem. Primary-care physicians are much more likely to prescribe these drugs than specialists-one in 11 visits to a primary-care physician results in a new prescription or refill. In nearly 80 percent of these office visits where there's no psychiatric diagnosis, there's also no specific complaint.

Summing up, a common attitude in the medical community is basically take your Prozac and don't come back. Nearly a quarter of respondents to a 2008 survey cited the chance they'd get put on unwanted meds as a reason they might not tell their doc they felt depressed.

We're now prepared to grapple with the possibility that all those mother's little helpers don't help. Here's what we find:

• A review of 177 studies involving more than 24,000 depressed patients found placebos alleviated symptoms in 38 percent, while antidepressants reduced them in 46 percent. Psychotherapy alone reduced symptoms in 47 percent. Best of all was combining antidepressants and psychotherapy, with 52 percent success.

• A review of 96 studies from 1980-2005 concluded the placebo effect was responsible for 68 percent of improvement seen in patients taking antidepressants. Another review said 84 percent.

• Some research says there's no benefit. A European study of "active placebos" (where the placebo mimicked the drug's side effects) found no difference between placebos and antidepressants.

So why are antidepressants prescribed so often? We find a clue in a review of 35 antidepressant clinical trials submitted to the FDA. The review found that, on average, antidepressants didn't meet the criteria for "clinical significance" except for one group: the extremely depressed.

We further note that: (1) the U.S. population is aging, and elderly patients require more medical attention, among other things for depression; and (2) the percentage of primary-care physicians has dropped significantly. In 1950 about half of doctors were in primary care; now it's barely over 30 percent.

The upshot is that primary-care doctors have higher patient loads and less time to spend per patient. Since everyone nowadays expects the doctor to do something, and since antidepressants evidently work for the extremely depressed and make many others feel better if only through the power of suggestion, the default response is to prescribe drugs-next patient, please.

The situation is likely to get worse. The number of primary-care physicians entering the field between now and 2020 isn't expected to keep up with demand. How all this will play out in the face of rising costs and the Affordable Care Act remains to be seen, but for a lot of people pills might be all they ever get.

 

 

 

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Cecil Adams

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