Maybe you should read this source a little more carefully. Nothing in here said SSRIs weren't effective nor that psychotherapy was as good.
From your citation:
No overall difference in efficacy between cognitive behaviour therapy and tricyclic antidepressants was found using individual patient data (i.e. mega-analysis) of a subgroup of outpatients with moderate to severe major depression from four randomized controlled trials but patient numbers were small (DeRubeis et al., 1999). Thase et al. (1997) in a mega-analysis of six studies found equal efficacy for combined drug–psychotherapy compared with psychotherapy in mild to moderately depressed patients but a poorer response to psychotherapy alone in moderate to severely depressed patients. Again, patient numbers were small and some treatments and combinations were not represented. Evidence is lacking about the efficacy of specific psychotherapies in severely ill hospitalized patients (Persons et al., 1996; Thase and Friedman, 1999); in these patients cognitive deficits may be expected to impair ability to engage with psychological treatment (Murphy et al., 1998)
Tricyclics are not SSRIs though a couple of them have SRI activity. Tricyclics are mostly Noradrenaline reuptake inhibitors. The studies were small and only outpatients are referred to in this assessment of the available data.
From your citation:
Early or non-persistent improvement in depressive symptoms may be due to placebo response (IIb) Early abrupt improvement (before completion of 2 weeks treatment) is seen in patients on both placebo and antidepressant drug treatment and is less likely to be sustained than gradual improvement or later responses on drug treatment. This suggests that non-persistence of improvement or relapse in the first few weeks of treatment are due to loss of a placebo effect (Quitkin et al., 1984, 1987).
In other words, true drug response begins after 2 weeks of treatment and is sustained. If your patient improves rapidly but then relapses, the drugs were likely not working in the first place. This does not say SSRIs are only eliciting a placebo effect.
ChristineR said:
And here's a well-known, somewhat controversial, non-technical article which discusses a review of anti-depressants and how the authors interpreted the data to show the drugs weren't astonishingly effective.
Psychology Today article
Fisher and Greenberg have written extensively on the psychiatric pharmaceutical industry and certainly has some good points worth considering. But their work has a declared bias, and isn't the bottom line on
all psychiatric drug therapies.
ChristineR said:
Googling around I found tons of articles, but not one that really gives the summary I was looking for. But here's one called
Clinical trials of antidepressant medications are giving meaningless results which will link you to a whole bunch of articles discussing how the data can be intepreted so that anti-depressants (especially SSRIs) can be considered to be no better than placebo. Most experts think this interpretation is going too far, but no one doubts that drug companies are interpreting the data too positively.
From your citation's abstract:
...Antidepressant treatment of depression in the under-18s has been thought to be justified because clinical trials show that it works so well in over-18s. But is that a reasonable assessment of the evidence?...
Here's a caution about expanding conclusions without verifying the applicability. How does that discount the study results on the population that was looked at? And the
review that does claim antidepressants are only a little better than placebo is not available without a paid subscription. You can see from its abstract that it looked at the material provided the FDA for approval of particular drugs. This article did not look at the effectiveness of SSRIs in general. The
next article cited in your citation looked at St John's Wort which has not had strong evidence supporting its effectiveness and again, isn't an SSRI, nor is it a particularly active drug in general. The other outcome which wasn't a goal of the study was the effect of sertraline which is an SSRI. The study concluded:
...the efficacy of sertraline was demonstrated on the secondary CGI-I measure, resulting on average in much improvement, hypericum had no efficacy on any measure. Although not designed to compare sertraline with hypericum, the study showed superiority of sertraline on the CGI-I. Responders who entered continuation treatment maintained their improvement equally in each treatment group.
ChristineR said:
There are two basic problems that I see. One is that the drugs have side effects, so that everyone knows if they are on a drug or a placebo, and this leads to "the amplified placebo effect"--a stronger placebo effect in people who have correctly guessed that they are on the drug. The other is what I mentioned above, that the drug companies are likely to count things like "sleeping more soundly" as an improvement when in fact the depressed person may simply consider it an unimportant side effect.
And here is the basic problem I see in your conclusions. You misunderstand what you are reading and expand your bias against psych drugs beyond what the literature you are reading actually supports.
There is good reason to prescribe medications with caution, to take meds with caution, to not over-interpret research results, to be aware of drug company bias and marketing techniques that seem to have less and less ethical limitations every day and to look at non-drug therapies when there is evidence they may be effective.
OTOH, scientific research into brain processes is beginning to reveal just what is going on in mental disorders and offer means of correcting the underlying basis of the disorders. There is no reason to treat brain dysfunction differently than we treat other organ disorders despite the fact that has been done extensively in the past. From being possessed by demons to be ruined by your mother's incompetence, the science of mental illness has had some historical hurdles to get over to reach new roots in evidence based medicine. SSRIs are one of the best understood pharmacological interventions in mental illness. Nothing offered in this thread supports the conclusion SSRIs merely have placebo effects.
