Anti-depressants and the placebo effect

I’m disappointed, as a regular reader of DBS, that so little research and editing went into this piece before it was published.

You state that ADHD needs to be treated with depressants? Really? That’s kind of a careless assumption to make, especially when so much data exists about a disorder. Here’s a basic link, just to help you learn more:

http://www.webmd.com/add-adhd/tc/attention-deficit-hyperactivity-disorder-adhd-medications

Hopefully, before you write other pieces, you’ll take the time to research and read what you’ve written before you publish it.

“Another point is that TCAs are also used to treat ADHD. You should treat ADHD with depressants, and yet TCAs – anti-depressants – are used to treat depression. I question any group of drugs used as depressants and anti-depressants at the same time.”

You might want to question your editing/writing skills first.

Hi, firstly may I point out that I have studied this for quite some time being a student of psychology, so suggesting I need to further research when I have undoubtedly done far more research than yourself is a bit redundent. But I’m not here to insult your research or brag about mine, so I am sorry if it came across like that.

Lots of things are lost in the editing process, with no fault of Andi’s of course. This isn’t Andi’s field of work so he wouldn’t see the difference that a different structure for the words would make. So please don’t insult his editing skills as he is a far superior editor than you or I. All complaints should be aimed at me and I will quote what I originally wrote.

I’ll start with Mi’s problems first. I’ll admit straight away that ADHD is not my prefered field of work. I tend to work on depression, schizophrenia and eating disorders (anorexia/bulimia nervosa). However, from those I have talked to in Britain (so treament may be different in America) they were on depressants for their ADHD/ADD. What I originally wrote was:

“You treat ADHD with depressants, and yet TCAs are used to treat depression. I question any group of drugs that can be depressants and anti-depressants at the same time.”

I did not state you should treat ADHD with depressants, I said you do. That does not mean it is the only treatment.

As for E. Doe, thank you for taking the time to write such a well-thought out piece. See the first problem is that you are talking about experience, this is the downfall of any homeopath or new age healer. They talk about their own experiences. People tend to remember the evidence that supports their claim and forget the evidence that refutes it. So please look at private research, I’ll come back to why it should be private and not drug company funded research later.

E. Doe, you underestimate the placebo effect. It is truly beautiful and can be incredibly effective. Theodor Kocher performed hundreds of incredibly intricate and dangerous neck surgeries with the only sedative being little more than a placebo. Blackwell (1972) gave students one or two, blue or pink sugar pills before a “boring” lecture, telling them they would either be a stimulant or sedative. Those who took the pink pills showed signs of being more active, whereas those taking the blue pills became lethargic and in some cases fell asleep. Two pills also worked better than one. But this isn’t exactly as grand a scale as anti-deppresants, so let’s step it up a notch. There’s plenty of procedures that have been tested out without actually doing anything. For example pacemakers have been plaed into people not turned on. Admitadly it hasn’t had as good a succes rate as when pacemakers are turned on, but yet their heartbeat becomes more regulated. There’s been fake keyhole surgery, where all they’ve done is open up and seal back up again, yet patients show that the “surgery” has worked. Montgomery and Kirsch (1996) told students that they were taking part in a trial on a new anaesthetic called trivaricaine. This substance was incredibly potent, stinking awfully of medicine, it had to applied with rubber gloves on. A little bit was put on the fingers of the students and pressure was applied. The students didn’t feel the pressure. Was it because of the trivaricaine? Yes, however trivaricaine is a placebo consisting of rosemary oil, water and another substance I can not remember for the life of me. None of which are pain killers. All this shows that the placebo effect should not be underestimated. It is a highly powerful psychological effect.

As for side-effects, you’d be incredibly surprised. There is something called the nocebo effect, which is similar to the placebo effect except when someone takes it there is negative effects. However those symptoms you pointed out are symptoms of depression. So a drug that is supposed to treat depression has the side-effects of depression? I know supposedly that not all anti-deppresants work as well for each person, however it is quite possible that there is something behind the procedure of trying each drug, as if eventually they’ll find the cure. The bigger the facade behing a placebo the better it works. However I can not prove this it is little more than a hypothesis that should be tested. Imagine this, you go the doctors with say swine flu (let’s be topical) and they give you medication. They say this drug will work except all its side-effects are symptoms of swine-flu. Wouldn’t you be a bit dis-concerned by the legitimcay of this drug?

SSRI’s are used purely as anti-deppresants in anxiety disorders, deppresion and personality disorders. Well… They can also be used to treat premature ejaculation, but that’s a different matter.

“Also, there is no such thing as a psychological disorder in the mental, but not physical sense. All cognitive function is a result of the physical properties of the brain.” Be careful, the neuron hypothesis is little more than a hypothesis. However, my inference was that depression is not caused by low levels of serotonin, noradrenaline and dopamine, but that these low-levels are caused by depression. Whereas the monoamine hypothesis would suggest the opposite.

The genetics theory is little more than a theory as well. Oh yes there appears to be a heavy link, however there is plenty of other theories as well. I’ll admit that a 79% concordance rate of bi-polar depression between monozygotic (identical) twins is impressive. However there is plenty of other factors that can easily explain this. There is plenty of cognitive theories as well as biological theories out there. Social learning theory for example would easily suggest why children pick up depression from their parents as they see their parents getting attention from it. Behavioural theory could also suggest why MZ twins get deppresion together more than DZ (dizygotic/non-identical) twins, because MZ twins get treated more similar. Genetic theory alone is not evidence for low-levels of the three neurotransmitters causing depression. Also, genes have not been identified for depression, genetics has been suggested. No one has pointed at a gene and said “that causes deppression”.

There’s something called “recession to the mean”. This is a mathematical principle that eventually everything will return to it’s mean. For example you may have heard of the Sports Weekly curse (it may be given some other name, it may be some other publication. I’m not American, I do not know), this suggests that once a player or sportsmen has been on the issue of sports weekly they will become a lot worse. Now people levae this down to some curse or other. However what it actually is is recession to the mean. To be on the cover of Sports weekly you need to have a better than average week in your respective sport, luck if you will. However, eventually you will fall back to where your mean is. Do you follow? Now this also applies to medication. If you have a cold and take medication (which does not work for a cold) you will eventually become better, attributing it to the medication. When in reality you would have become better without the medication. Which could also apply to anti-deppresants. Once you are diagnosed you will certainly be treated better, so symptoms may alleviate with or without drugs. However again, this is only a theory, I can not prove it.

As I mentioned earlier you should consider private research rather than medically endorsed research. This is due to something called the file-drawer phenomenon. This phenomenon is that where research is just filed away, left un-published. And in the case of medicine it tends to be because researchers are made to sign a non-disclosure agreement, meaning they can not talk about the research, nor publish it. You’ll also find that the media won’t mention when things do not work, they want it to work, it sells better. A few years ago there was this hysteria in Britain that Omega-3 fish oil has been shown to increase intelligence reported by the media. However there had been no research published on he point at that point, it was all based on a hypothesis on on-going research. But did this stop the media from reporting that it had been proven? Did it hell! Yet a year later when the research was concluded, and no link had been found, the media didn’t report this.

Now I’m not suggesting all medicine doesn’t work, I’m not one of those people. No. Most medicine does work. You’ll find me arguing with anyone whom suggests we should stop taking all medicines.

Now you may be thinking, well if this does all turn out to be little more than a placebo, then surely it’s better to let people take them if they work? Well no. Because then it makes people more easily fooled when it comes to evenmore serious matters (not that depression isn’t serious).

E. Doe, I am very sorry to hear about your depression. It is always awful to hear about such a thing. And I hope in time that your symptoms do subside.

Also, please may I point out that we here are supposed to be intellectuals, reducing this to little more than insulting people’s writting/editing skills is childish and something we tend to see from others. Critique what I write, but not how I write or how Andi edits, this is a low way of trying to disregard someone’s work. And I am truly astounded that a skeptic would do this. I did expect better.

On a lighter note, thank you for reading. I really did not expect to write so much in response. I hope that clears a few things up. And if you reply, please stand by for a response, I may take awhile

I’m concerned about a few things in this particular article, particularly because I was pointed to it by a relative currently on medication for bipolar disorder. I have some serious questions, and I really would appreciate any response.

The use of the word “cure” at the beginning of the article. Are anti-depressants supposed to “cure” depression?

“No, honestly, urine.” I fail to see why you use this particular rhetorical device to question the usefulness of studying urine samples as part of a diagnosis. Or are you arguing that it’s not?

There are dozens of articles on PubMed alone dealing with the possible mechanisms for the efficacy of anti-depressants; a number of the experiments described deal with the behaviors and responses of animals in various trials. Are you suggesting that these effects can be explained by the placebo effect in animals?

Is there evidence-based research regarding a psychological mechanism for the changes in the amounts of neuro-chemicals? Efforts to disprove the current theory, even if they are compelling, aren’t evidence for this alternative theory. I would be very interested in evidence that points to alternatives, psychological or otherwise.

“…assuming one little tablet can cure such a complex thing as a psychological disorder.” This, of course, assumes that the problem is, in fact, a psychological rather than a physiological disorder. My relative’s doctors believe this to be a physiological condition, and it has taken years to find a treatment that seems to be effective. While that case is completely anecdotal and should not be accepted as evidence in and of itself, are you suggesting that my relative ignore the advice of the medical doctors? Again, I ask this in all seriousness, and I appreciate your responses.

Great article. Drugs aren’t needed at all ever by anyone, is my only qualifier.

Gary is correct, the problem is, as with any topic any author writes about on here people may have an emotional attachment to the idea. I am sure at some time you have all banded in all guns blazing with someone about how religion is false, or psychics are liars or any other topi, only to find they get emtionally distraught about the subject. When I wrote this article myself I did consider that both my Mother, Aunty, and other relatives are on anti-depressants themselves. So I’m not emotionally detached from what I wrote. It has as much a mark on my life as it does yours. It’s a kin to spending your life devoted to God, believeing in his exsistence, worshipping him and going to church every Sunday, only to find out he does not exist. You may find it hard to accept any of this, you may never accept this, but the facts are there for you to consider. An to dismay them with a glance is something I’d expect from a religious person. Not a crtitical thinker or skeptic.

CJ, thank you for taking the time to write such a very thoughtful comment and set of questions, you have certainly thought about this, and I am more than happy to answer any question you pose.

You are correct, the word “cure” is a deceiving word. The original idea of any medication is that it will help the problem and eventually you will be able to come off it. This is also the case with anti-depressants. People are supposed to come off them eventually. However new problems arise from taking a drug every day for years on end, you become addicted. This itself causes a lot of problems.

I am sorry CJ for the mis-communication. There is no problem with urine studies. It is a fantastic way to show that those with depression have abnormal levels of the monoamine neurotransmitters.

Animals and anti-depressants are a problematic area. As I have previously mentioned when humans have artificially low-levels of the three neurotransmitters produced there is no ill-effect. People do not become depressed. However, when non-human animals have artificially low-levels of the three created they do show signs of what appears to be depression. Obviously this arrises problems as to why do animals react differently, and then does this mean it is makes it very hard to generalise non-human animal studies to humans?

There is plenty of research into other theories for depression. Behaviourism, social learning theory and so on. But just like any psychological theory they all contain gaps, un-explainable facts. I would not suggest for the life of me that any theory for depression is correct, far from it. Psychologists are still to get it right, and maybe they never will. I could start a debte on the questionable existence of depression in one single entity due to it being a banding together of symptoms that should be considered as different disorders… However that’s another debate for another day.

CJ, I am sorry to hear about your relative, I truly am. When I write this maintain the idea in your head that I am not your relatives doctor and I have not gained a doctorate of yet. My words should not be taken as gospel, your relative should make their own choice of whether they should take medication, as with any psychological condition. If your relative is already taking medication then it would be a hinderence, as much as I consider these as nothing less than placebos, they are undeniably addictive drugs, and stopping taking addictive drugs is incredibly dangerous.

Again, thank you for reading.

Well… It’s interesting. Placebo or not this sort of thing happens often. Obviously there has been a change. There’s varying theories as to why you may not see a change… But obviously without thorough investigation nothing can be determined.

“I did not state you should treat ADHD with depressants, I said you do. That does not mean it is the only treatment.”
 
No, you do not treat ADHD with depressants.  ADHD is treated almost entirely with stimulants.  It is sometimes treated with other drugs, but never depressants.  The idea of treating ADHD with a depressant is frankly ridiculous, as that would make the problem worse.  It’d be similar to treating someone with hemophilia with an anti-clotting agent.  It boggles my mind to see how anyone could make such a ridiculous statement and still claim to have any knowledge about the subject.