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  1. Beenthere2Hippie
    A couple of months ago, a study on the efficacy of antidepressants for children and adolescents was published in The Lancet. A flurry of headlines from major news outlets followed: “Most Antidepressants Aren’t Effective for Children, New Study Finds” (Wall Street Journal); “Most antidepressants ineffective in teens, study finds” (CBS News); “Study: Most antidepressants don’t work for young patients” (Business Insider). You get the picture.

    The media is ever-hungry for the latest exposé of the pharmaceutical-medical industry. (And The Influence is certainly] no exception.) But when it comes to antidepressants, do claims that they’re at best placebos, at worst dangerous, hold any weight?

    Dr. Peter Kramer is a psychiatrist who made a name for himself by exploring the ethical and philosophical dimensions of using antidepressants to change personality in his 1993 book Listening to Prozac, a New York Times bestseller. Now he’s back with a new book, in which he argues that antidepressants get unjustly picked on, and in fact work “ordinarily well” (the book’s title). Media claims about the recent Lancet study, he says, were entirely wrong.

    Kramer is a practicing psychiatrist, a faculty member at Brown Medical School, and the author of six other books. Ordinarily Well: The Case for Antidepressants has clearly struck a nerve, garnering three separate reviews in The New York Times alone.

    It’s important to note the evidence that he is no Big Pharma shill. In 2008, as he recounts in Ordinarily Well, the British Medical Journal (BMJ) named him as one of 100 or so “independent medical experts” who did not take money from pharmaceutical companies. He was one of only six psychiatrists on the list.

    Speaking with Kramer on the phone, I got the impression of a man both passionate about his subject and ever so slightly frustrated with a climate that he perceives as hostile towards Western medicine, and psychiatry in particular. Still, it was great to talk to a psychiatrist that I didn’t have to pay. Dr. Kramer gave me the inside scoop on the best antidepressants, why depression is like tuberculosis, and the meaning of “the trout in the water.”

    Sarah Beller: So, what was going on with that Lancet study?

    Peter Kramer: The study found that Prozac [generic name: fluoxetine] did have an effect size that was statistically significant [compared to placebo]. It’s as good as the effect size for adults. The study tested something like 10 antidepressants, and it’s not that there was no effect picked up at all for the others. If you test 10 of anything, some will be higher and some will be lower.

    The prevailing theory is that depression makes it harder for the brain to make new cells and new connections, and antidepressants seem to restore that capacity. You find it with lithium and ECT, too—lots of remedies for depression seem to “unstick the brain.”

    Children and adolescents do that so well already—they are making new cells and new connections all the time—so it’s sort of hard to know if that mechanism is working for them. We don’t have as good a theoretical basis for prescribing for them … I don’t really work with children or younger adolescents, but what you want for your child is the same as what you want for an adult—a really good expert. Despite the average result [in his new book, Kramer writes: “My impression is that antidepressants work unreliably in children and carry serious risks”], you’ll try these things if the child is really suffering, not achieving developmental milestones.

    Why do you think people are so distrustful of anti-depressants in general?

    That’s one topic of Against Depression [his 2005 book]. There’s such a long history of seeing melancholy as being somehow informative—a sign of sensitivity, a sign of discernment, an illness of superiority—the way at certain points tuberculosis was seen as a sign of refinement. There’s a reluctance to see it in medical terms. Some of it has to do more generally with medical psychiatry and reluctance to see phenomena that have psychological symptoms as syndromal and diagnosable. There’s a distrust of medication for things of the mind.

    Then, under the heading of stigma, psychiatrists are not that well respected or trusted, in comparison to other doctors. Antidepressants are being used longer and longer and there is unease about seeing depression as something like diabetes where you might need to be in treatment indefinitely.

    What pushed you over the line to the place of writing this book?

    The idea of anti-depressants as glorified placebos came to the forefront in the last five or 10 years in the media. I started noticing that my patients, even people who owed so much of their lives to anti-depressants, were asking, “Am I just responding to this because I believe it? Is this just a placebo effect?”

    Then a friend of mine had a stroke, a kind for which antidepressants are sometimes given to make the recovery more robust. Even though it’s not really related to depression, the neurologist had held back on prescribing antidepressants in this case because of the general drumbeat of doubt about antidepressants.

    I thought this was really extraordinary. Here we have one of the few things you can do that is easy and almost instantaneous to help recovery from a stroke. My jaw dropped to think this remedy was being thrown away based on a what I thought was a cultural, rather than a scientific response.

    [Thanks to Kramer’s urging, the patient’s physician put him on a course of antidepressants. Soon, Kramer’s friend had regained movement and speech.]

    And that was before I myself had really looked at the research to see what the flaws were. And it’s really bad. After having written the book, and speaking to readers, it seemed that I even underplayed it. When you see some of what’s wrong with some of these studies, there’s been an enormous amount of tolerance for flawed research by health and medicine professionals.

    What’s an example of this egregiousness?

    There’s one that Donald Klein called “the trout in the milk.” The phrase comes from when dairy farmers went on strike in 1849, and deliverymen were accused of watering down the milk. The saying originates because if you find a trout in the milk, it may be circumstantial evidence, but you can be pretty sure someone has watered it down.

    In 1998, Irving Kirsch conducted a meta-analysis of different drug trials. He argued that studies that showed that antidepressants worked were probably due to the fact that the placebos [in the control groups] weren’t strong enough [to convince people they were on real medications]. He wanted to find studies that used placebos—non-antidepressant medications—with active side effects. So he used a study of medications, like a thyroid hormone and lithium, that had been used to augment antidepressants in people who hadn’t responded to antidepressants alone…But most people did respond to the combination of the two. If you divide the data that way, you end up having people who are actually on anti-depressants [plus the non-antidepressant “catalyst” medication] in the “placebo” group! That was the trout in the milk—if there are anti-depressants in the placebo group, you can be pretty sure the author of the study is up to something.

    This author used that same study in three or four other papers. He has a new paper in 2016—almost 20 years later—based on the same misunderstanding of the study.

    How has the reception of Ordinarily Well been so far, compared to Listening to Prozac?

    Listening to Prozac was a cultural phenomenon. It hit the public at the right moment. This book is much more narrowly focused, so it hasn’t been that same type of response. But I have to say, when I wrote this book, I was really worried about bad reviews. There’s such willingness to oppose medicine on any basis. I’ve been just gratified that it hasn’t been the case. Even when people don’t agree, they’ve been very respectful. I’ve been worrying about how much I’ve had to go into technical issues—I had to be absolutely technical about what the evidence does and doesn’t say. But it’s full of narrative illustrations. It’s less a defense of anti-depressants than a defense of psychiatry as a humane undertaking.

    How do you as a psychiatrist choose what anti-depressant to prescribe first? Are there ones that are your go-tos?

    Every doctor has an opinion, and we don’t really know that one is better than the other. I do give a little rationale in the book for using one kind of anti-depressant for people who seem more slowed down and another for those who seem more agitated. But I think it’s very hard to name medicines.

    Andrea Cipriani [the author of the Lancet article] has tried to rank order the anti-depressants in terms of their efficacy. For adolescents, Prozac came out the best by far, and Lexapro and Zoloft came out the best for adults. Those are all SSRIs. There’s certainly a case to be made too for non-SSRIS, like Effexor, and Wellbutrin certainly has its uses. Those five—Prozac, Lexapro, Zoloft, Effexor, Wellbutrin—at least some of those would probably make the list for any doctor. Prozac is probably not in the top for adults though.

    Have you ever been on anti-depressants?

    No.

    I find your chapter on the end-stage depression you witnessed in Boston 20 years ago really interesting. You write: “But if I am honest, there are reasons, beyond the numbers, that I would find it hard to believe that antidepressants do not work. Among them is an apparent decrease in the end-of-the-line depression that was familiar in my medical school years.”

    It seems to me that the nature of depression has changed—I’m talking about depression not accompanied by psychosis. On the wards in good hospitals where the diagnosis was presumably good—you would see people thin, no energy, repeating depressive sentiments whenever you spoke to them. Just suffering. Nowadays, anyone integrated into the medical system, there’s a chance they would be treated with medication [antidepressants] before they got to that stage. It’s been such an interest of mine—I thought, where are these people? I asked young medical residents and they said they’re really not seeing many of them. Lots of illnesses change form and frequency, so it’s not really knowable—it’s very hard to study—but I think some of it is due to the fact that we’re less reluctant to prescribe.


    By Sarah Bellar - The Influence/Aug. 15, 2016
    http://theinfluence.org/do-anti-dep...listening-to-prozac-is-back-with-the-answers/
    Art: bad art inc
    Newshawk Crew

    Author Bio

    Beenthere2Hippie
    BT2H is a retired news editor and writer from the NYC area who, for health reasons, retired to a southern US state early, and where BT2H continues to write and to post drug-related news to DF.

Comments

  1. LazyMonkey
    There is much arrogance in parents who want to shape the personality of their son, a psychiatrist pretend to do it without ever experiencing or even manifacturing or specifically studying the drug he admnister for this purpouse (parents can beat you at worst).

    I'm not talking about dr. Kramer becouse he is in the elitè side and knew really well what he was doing, forcing his dumb cosmetic psychopharmacology theorie.

    Antidepressant for childrens? What a mad scientist could dare to diagnose that meaningless major depression stygma with such a little patient story?
    They do more harm than good at such age?
    Yeah, thanks to all the studies who proved it... it was hard to believe.
  2. aemetha
    That's not what the article says at all. The article clearly says that if children are struggling significantly it may well be appropriate to prescribe antidepressants.

    Major depression isn't meaningless. It is a crippling disorder suffered by millions of people. It could be considered a potentially fatal disorder because of the suicide risk, not to mention the other medical complications arrived at through neglect contributed to by depression.

    The studies don't prove they do more harm than good. They just show there is no statistical improvement over placebo on the whole, that doesn't mean there are no cases where children and adolescents can't benefit from antidepressants. If a child is struggling significantly, do you instead advocate doing nothing and letting them suffer? That way leads to life long problems, and in some cases death.
  3. noddygirl
    All the antidepressants I've ever been prescribed did not work for me. In fact I have never met anyone who said antidepressants worked for them either. I think the medical science behind depression, depression drugs and a lot of other mental health issues is still in the Stone Age. What I dont understand is if we are now l that so many of the depressed people in the world are deficient in endorphins and not actually serotonin...then why are we still being prescribed so called "antidepressants" that work on serotonin & why is there not a medication being developed right now that helps an individual to produce more endorphins?? And not only when he exercises, but all the time, so he or she can have a more normal, healthier, happier brain that is not endorphin deficient. It seems so obvious to me.
  4. aemetha
    Noddygirl, there is. It's called ALKS5461 and there are a number of threads mentioning it in the antidepressants forum and others. If suboxone didn't help with your depression then it is unlikely to help either because it is a combination of suboxone and samidorphan. Suboxone is a kappa and mu receptor agonist, and samidorphan is a mu receptor antagonist, the proposed net result is selective agonism of the kappa receptor providing the antidepressant properties of opioids, without the high and dependence associated with mu receptor agonism.

    Serotonin based antidepressants work for many cases of depression and this has been shown statistically, this is in fact what the independent psychiatrist in the article is arguing. You're right that it is more complex than just serotonin. There are more neurotransmitters involved in depression, or in fact any brain process than just serotonin and opioids definitely seem to play some role as shown in studies showing their efficacy in treating treatment resistant depression. Treatment resistant may in fact be a misnomer, depression may in some cases be a serotonin deficiency, and in others an opioid or other neurotransmitter deficiency. The term depression probably does not adequately describe the condition as well as deficiency of a specific neurotransmitter might, rather it describes the symptom instead of the cause.
  5. perro-salchicha614
    There are a couple of things going on here--disillusionment with Big Pharma (not unfounded), and the fact that people are unable to do anything to reduce the influence it has on our lawmakers. So the media, being the opportunistic vultures they are, capitalize on this by writing click-bait articles that play into people's concern for their children's well-being.

    I'm not a fan of psychiatric medications in general, but aemetha is right when he says that parents of depressed children have to do something. I am the result of untreated childhood depression. I began to suffer from depression when I was about 8 years old, anxiety at around 10, and I developed an eating disorder not long after. My parents didn't seek treatment for me because they didn't take my issues seriously, even though there was every indication that they should have. I have no doubt that the fact that these issues were left to fester for so many years has done irreversible damage to my health.

    The chronic malnutrition due to the eating disorder (which had/has a *lot* to do with my anxiety) no doubt stunted my physical growth (I'm tiny compared to most American women), and it has probably affected my brain chemistry in ways that are irreversible as well. I'm on anti-depressants now, and I've been trying therapy, but if feels like it's too little too late.

    Not every child whose depression goes untreated will grow up to be an addict, but I did. I have no doubt that the fact that my issues were left to fester for years and years is a major factor in the lack of success I'm having with conventional treatments and why I feel the need to self-medicate with opiates. Anti-depressants aren't ideal for kids, but they're sure as hell better than the alternative. Trust me.
  6. LazyMonkey
    growing is a significant struggle by itself, altering the neurochemistry of such a plastic mind may only result on an impaired and misfunctional brain.

    could you link any studies that prove the existence of any organic cause of the so called "major depression", as far as i know there are only evidences of enviroment or stress leading to a chemical umbalance.
    you are talking about medical complications like patients abusing their prescription drugs or organic problems caused by long term teapies right? that's the biggest statistical harm of depression.

    sure most of those are driven by people that aren't searching for any answer but just trying to produce evidences for their assumptions...
    there are already plenty of studies around the permant damages caused by antidepressant and their efficacy being comparable to placebos, there is no need for new insights on the subject. what we could need is safer medications or just a better world
    doing nothing you are already doing a lot, it has been pointed out already that most antidepressants raise the suicide risk, expecially during long term terapies and abruptions/terapy switches

    i must say that your signature says more than anything else...
  7. aemetha
    If the child is struggling the neurochemistry of the brain is already impaired or misfunctional. By your argument here the worst that can be achieved is the status quo, and the best is an improvement.


    Everything psychological is biological, this is not disputable, it is clearly evident in the brain. Everything we think and feel is caused by biological functions in the brain. There is no requirement for an "organic cause" for a disorder to be real, only an abnormal function.

    I'm talking about drug abuse yes, that's just one. There is also lack of exercise arrived at through a lack of motivation, which leads to obesity and anxiety and exacerbates the condition. There is as perro has already mentioned eating disorders which can as she also mentioned cause stunted growth, amongst other problems, including but not limited to death. There is lack of social interaction which again leads to anxiety disorders, and exacerbates the depression.

    This first part just sounds like paranoia. I'm not suggesting antidepressants should be given to every child, nor is that suggested in the article. What is suggested is that if a child is significantly struggling it might be appropriate to give them antidepressants. Your argument that antidepressants increase the suicide risk may well be borne out in some situations, but we're talking about a situation with an already elevated suicide risk. Are you claiming the suicide rate of treated depression is higher than for untreated depression? I would very much like to see statistics on that, but I would make the logical assumption that the longer depression is untreated the higher the statistical probability of a suicide attempt is. We've already had one member recount how they could have potentially benefited from antidepressants as a child, and the serious consequences of "doing nothing" as you advocate.

    I'm not sure what if anything I've posted in this thread constitutes hypocrisy, but if we are devolving into insults I would suggest you get a dictionary and look up the definition of the word before attempting to use it in an argument. I would respectfully ask that you refrain from such behaviour however, it is not a requirement that we agree on this topic, but we can disagree in a mature way.
  8. LazyMonkey
    Again "struggling" means nothing and congratz for such a nazi statement.
    I'm struggling right now trying to get your point, it will help me next time i'll interact with another very different being. Or does it mean i'm impaired in my brain?

    Stop defining brain anomalies in such a gross way, for what i know, still little is know about brain mechanics... let's not talk about brain development.
    Do you know the mechanism of action that make an antidepressant a good guide for healthy grow? For what populations? Struggling ones?
    Yeah, lt's keep it generic.

    Unlike you, i don't dare to know the best potential brain functionality an individual could achieve
    but i surely didn't mention that a "struggling" (starting to like this word) child would be always the same.
    You want to tell there is no development for some unless they get dosed?
    Link me a reliable study about a successfull child rehab with antidepressant please, i wanna see how high that fueled star went...

    Yeah, i'm claming it. They just work rarely during emergency phase mainly becouse they sedate you and your willing (to die).
    From Recurrent vital depressions. Van Scheyen, J. Psychiatry, Neurologia, Neurochirugia 76 (1973):93-112:
    "more systematic long-term antidepressant medication, with or without ECT, exerts a paradoxical effect on the recurrent nature of the vital depression"

    Don't grasp the air in such a pathetic manner, he didn't used them during childwood.
    We don't know nothing...

    I didn't call you "idiot" or something, but i really feel every word you write is laced by hypocrysy or just plain fear.
  9. aemetha
    I use the word struggling because it's not a yes no situation, every person is different and every person reacts differently to differing stimuli and different medications. Struggling is a broad term that covers the context I am attempting to convey. I was not aware it was derived from the Nazi party or their politics and history of human rights abuses, and I apologise if you've somehow misconstrued it that way. I'm not sure how you would prefer I defined it?

    My point isn't that antidepressants make brains grow in a healthy way, my point is that in the cases I am suggesting the brain is already growing in an unhealthy way and doing something may be better than doing nothing in these cases.

    I'm sorry, but I really don't understand what you are asking here? I never claimed that children wouldn't develop unless they were administered antidepressants. What do you mean by a reliable child rehab? Do you mean a successful treatment of depression? What on earth is a "fueled star"?

    Okay, fair enough. Good reference, here are some of my own.

    http://www.psychiatryadvisor.com/mo...icacy-of-ssri-antidepressants/article/417102/

    http://www.news-medical.net/health/Efficacy-of-SSRIs-for-Depression.aspx

    http://www.nimh.nih.gov/about/director/2011/antidepressants-a-complicated-picture.shtml

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/

    I could provide more, but those are just the first ones that popped up on google search.

    Well that's not true, we do know that in this particular case the untreated childhood disorders extended into adult life and continues to affect her life negatively.

    Again, nothing I have said is hypocritical. I have nothing to be afraid of here. I would again respectfully ask that you refrain from insults and invective, it's not required or desired.
  10. LazyMonkey
    I was not relating to the struggling term but to this statement
    There are many reasons for such a broad attitude like you said, not just a impaired brain.
    We don't know the precise mechanic by witch antidepressants work and still it's right to administer it to such a broad spectrum using just functional assessment as a key test?

    Cases of natural remittance with time are common for many form of young depression and usually antidepressant supplementation work just for a while taking away symptoms. Never heard of a successfull complete remit.

    Yeah, i meant a successfull child treatment of depression with a control follow-up study to attest efficacy of antidepressant over placebo.
    A fueled start is the drugged "abnormal" child, he usually don't become a healthy man.

    "Do antidepressants increase the risk of mania and bipolar disorder in people with depression? A retrospective electronic case register cohort study" R Patel et al. ‎2015


    I replyed
    I meant cognitive development and then issues development.
    It's quite clear, i was referring to spontaneuos remittance or some change of the numerous external stimuli that shaped his biological (i have to agree with the statement "Everything psychological is biological") equilibrium out of the track.
    Like a violent daddy... i know many who managed to become wonderful functional people after a long depressing childwood becouse of a shitty family.
    They were showing all the symptoms of severe depression.
    You are not forced to just watch or dose, you could try to understand their situation and to improve some aspect of their life. But it's time and money demanding... Better to just dose and see.
    The mechanism of action by wich antidepressants work is still not know, see the power of randomness.
    I just think it's better waiting when you don't know what's happening.

    You are so fast getting to conclusions... We don't know if a course of antidepressant could have solved his problems.
    I could use myself as a strugglin child and tell you i'm fine now (i really was, some tought i was autistic).
    It's meaningless.
  11. Beenthere2Hippie
    I think you each made valid and interesting points on differing views pertaining to the "jury's still out" debate on the value of anti-depressive medications being used to treat young children and teens suffering depression. And I thank you both for making the thread more valuable and more interesting to the our DF community than the article alone would be.

    But, alas, I think it's time you two agree to disagree on your individual points of view so that we can keep the thread on track and not head it further into off thread-subjects and personal territory. Of course you can continue the discussion via dm...
  12. aemetha
    I am beginning to think we are arguing at cross purposes, and if my original statements were unclear I apologise for that.

    I would like to clarify, I am not advocating the use of antidepressants in children or young teens in all cases of depression, or even in many cases. I am certainly not advocating their use as a replacement for a healthy developmental environment or a therapy based approach. The only thing I am advocating is that antidepressants should not be taken off the table in situations where other approaches have failed, and where there is a real risk of impaired cognitive development and/or life long mental illness from the childhood condition.

    As Beenthere2Hippie suggests, I am happy to agree to disagree at this point, ultimately this is a decision for parents to make, ideally with the information they need to make the best possible informed decision. Hopefully this discussion will help some of them to weigh the risks and benefits as they see them.

    LazyMonkey, thank you for the tone of your last post, I understand it's a sensitive subject, but a civil discourse allows for a more productive discussion.
  13. monkeyspanker
    Whoa! Very interesting discussion :thumbsup:

    My story, it has been posted before but, I will say it again, bare with me...thanks!

    In 1971 I was 9 years old and had ADHD before they even knew what that was, I acted out, was disruptive in class, could not sit still..."You, yes, you behind the bike shed, stand still with it!" ~Pink Floyd, The Wall, Bless them!

    My teachers spoke with my parents and wanted to put me in special ed, I tested at 149 in the IQ tests at that time, my vocabulary was off the charts, math skills in the toilet.

    My folks took me to a doctor and he prescribed 10mg of Dexadrine twice daily, it calmed me down and as far as the teacher was concerned, made me easier to have in class...WTF?? Yea, I was calm, my mind was racing full throttle, speed shuts me down, I hate it. Opiates and 'shrooms make me very happy and content. I can take oxycodone and clean my entire house, dance listening to my wonderful music, speed makes me want to crawl into a hole...or have sex, which is why I got sucked into meth years ago, it was fun until I realized what it would ultimately do to me.

    Everyone's chemistry is different but, I strongly, very strongly, hope that the medical community understands that most of these drugs do Not belong in a young persons body.

    I'm sure many of you have read some of my posts where I 'Fly off the handle', part of that is my passionate emotions on subjects that I hold dear and near to me, the other is a complete disconnect of right and wrong behaviour in a social setting. While it is very easy to point a finger and say That Shit did this to me...I do think that it messed me up a little bit. You can't change who you Really are deep down inside, you can screw a young persons life up and that can carry on into adult life. I think/feel/know that happened to me.

    I have a lot more to say on this subject, I'm wore out now, be back later

    :vibes:
    M~
  14. LazyMonkey
    I didn't want to personal attack you Aemetha, i don't even know you.
    Antidepressant are a hot topic for me since they destroyed many weird and dangerous personalities i loved and most of the time i get harsh when debating about these drugs.
    I can't avoid it...
    Next time i'll try to be less bitter.

    I'll stop here, as experimental data is still mostly inconclusive and we'll just keep telling the same points.
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