Antidepressants fail to cure the symptoms of major depression in half of all patients

Discussion in 'Politics' started by ZZZzzzzzzz, Mar 23, 2006.

  1. Drugs Cure Depression In Half of Patients

    Doctors Have Mixed Reactions To Study Findings

    By Shankar Vedantam
    Washington Post Staff Writer
    Thursday, March 23, 2006; A01

    Antidepressants fail to cure the symptoms of major depression in half of all patients with the disease even if they receive the best possible care, according to a definitive government study released yesterday.

    Significant numbers of patients continue to experience symptoms such as sadness, low energy and hopelessness after intensive treatment, even as about an equal number report an end to such problems -- a result that quickly lent itself to interpretations that the glass was either half empty or half full.

    The $35 million taxpayer-funded study was the largest trial of its kind ever conducted. It provided what industry-sponsored trials have rarely captured: Rather than merely ask whether patients are getting better, the study asked what patients most care about -- whether depression can be made to disappear altogether.

    The study has been eagerly awaited by physicians, patients and the pharmaceutical industry. According to government statistics, depression afflicts 15 million Americans a year. About 189 million prescriptions for antidepressants were written last year, and the disease costs the nation $83 billion annually because of treatment costs, lost productivity, absenteeism and suicide.

    David Rubinow, a professor and the chairman of the psychiatry department at the University of North Carolina at Chapel Hill, said the results are an "illuminating and disconcerting" window into the affliction that is thought to fuel many of the 30,000 suicides committed each year in the United States.

    Although the study showed that patients who do not respond well to one drug could be helped by another, the results are "discouraging for several reasons," Rubinow said in an editorial published in the New England Journal of Medicine, which also published the study.

    It is troubling that large numbers of patients continued to have problems, he said. Additionally, he noted that the drugs used in the study -- Celexa, Wellbutrin, Zoloft and Effexor -- work in very different ways yet had roughly equal effectiveness when it came to treating depression. This suggests that the underlying brain mechanisms of depression are far more complicated than simple notions of a single chemical imbalance.

    Thomas Insel, director of the National Institute of Mental Health, which funded the study, emphasized that patients should seek -- and stick with -- treatment. "The glass is half full from our perspective," he said. But "the glass is half empty in that we need to come up with better treatments in the future."

    The study is immediately relevant to physicians because it tracked a large number of patients with the kind of complications and chronic problems that are usually excluded from pharmaceutical industry trials. About one in three patients had seen their depression symptoms go away after an initial round of treatment, a result known as remission. About half achieved that goal after a new round of treatment involving either a new medication or an additional drug, the research found.

    Although patients recruited to pharmaceutical industry trials are usually carefully screened to ensure they do not have other psychiatric or medical conditions, those in the government-funded study often suffered from multiple physical and mental problems -- typical of patients whom doctors routinely see.

    At the same time, the researchers acknowledged, the care provided in the study was exceptional. Intensive monitoring and careful evaluation was provided to all patients. Such services are available today in perhaps one in 10 medical practices. If the patients in this study had received the kind of care that patients receive on average, the researchers said, the remission rate probably would have been significantly lower -- perhaps even in the single digits.

    "People who entered into this trial received a level of care which is quite different than many patients receive when they see a primary-care doc or even a psychiatrist," Insel said as he described what clinical facilities should aim for in terms of care. "This involved a depression-care specialist who made sure there was very careful monitoring of side effects and a relentless effort to optimize the dose. It is not like writing a prescription for penicillin and coming back in four to six weeks."

    The study also employed standardized assessment tests that looked more deeply at patients' conditions than the routine conversations about their health that are generally employed in clinical care. Such attention allowed problems to rise to the surface that may otherwise be missed, and kept patients from becoming discouraged about treatment.

    Augustus John Rush, a psychiatrist at the University of Texas Southwestern Medical Center in Dallas, who helped organize the study known as the Sequenced Treatment Alternatives to Relieve Depression, said the results are positive, given the many complications that often accompany depression.

    "A 50 percent remission rate is extraordinarily good, given the nature of these disorders," he said. "These individuals have had an average of 16 years of depression. Two-thirds have other concomitant psychiatric conditions and two-thirds have concomitant general medical problems. All of these reduce the chances of remission."

    Although the study has continued to offer treatment for even longer periods, those results are not yet available. Rush said that with chronic problems, most of the benefit is usually seen in the first couple of rounds of treatment, since the remaining patients are those with the most intractable problems.

    Psychiatric drugs have been at the center of growing controversy for nearly two years -- including concerns that antidepressants may increase the risk of suicidal behavior among some children and worries that drugs used to treat attention deficit hyperactivity disorder are overused. Still, researchers and clinicians say they are far more worried about untreated mental illness than any overuse of medications.
  2. Rearden Metal has been posting the same conclusions for years as recently reached by these scientists. Yet, when he found his own 'superior' treatment, ZZZzzzzzzz ridiculed him. Now, seeing the post above, I cannot help but notice the irony.

    - Spydertrader
  3. A clinical trial conducted at Harvard Medical School in 1995 demonstrated that <b>seven out of ten</b> treatment-refractory major depression patients could be successfully treated with an opioid called Buprenorphine, even after dozens of other (non-opioid) medications had failed to provide these patients with any measure of relief. Some of these patients even endured electroshock therapy, which didn't help either.

    Watch TV for a couple hours and you'll probably see quite a few antidepressant commercials. The cruel joke is that every single one of those commercials is just pitching yet another serotonin/dopamine/norepinephrine re-uptake inhibitor product. If your depression results from an endogenous opioid deficiency, none of those products can help you.
  4. Personal stories or hard scientific data- I'm not sure which would be more effective in altering your thinking for the I'll provide both:


    Note: Suboxone & Subutex, aka 'sub', is the U.S. brand name for buprenorphine.

    Posted by leeglegle: Finally, I found a Sub doc and my addiction instantly disappeared AS DID MY DEPRESSION! I still take 10 mgs/day of Suboxone and will for the rest of my life. It is my "insulin". The disappearance of depression was even more significant for me than was the relief from addiction. I had been an addict for 7-8 yrs., but a depressive for thirty or more years.

    Posted by Jake:

    I had depression for years. I could quit drugs and go through the withdrawal, but it was the depression that would eventually get the best of me and draw me back into addiction. I was self medicating with opiates to fight my depression. Once I began Buprenorphine my depression vanished. I was down to 2mg for a while with still no depression and its been a couple months since I stopped Suboxone and still no depression. Its almost like whatever wasn’t working before was fixed by the Suboxone.

    Posted by gwen : i started bupe in june and have noticed that it is also helping my depression (connected to my addiction to Oxys). i had been prescribed different anti-depressants off and on over the years, but nothing worked as well as the bupe is working.

    Posted by spanky: I was on prozac for about 4 years prior to starting on Bupe for anixity and mild depression.Since I started on Bupe however I have been able to discontinue the prozac without any troubles.I feel wonderful and like you will most likely be on it for awhile if not forever.The book you're writting is a wonderful thing ,maybe it will open the eyes of those in power to make this drug more available for the many who still suffer.I can honestly say that if not for the Bupe I'd be either using again or dead by my own hand cause I honestly couldn't stand the misery I was dealing with.By the grace of God I found this forum and this drug and I and my life are so much better for it.

    Posted by natasha: Anyway, my reason for posting is to let you know that I, too, had major depression and that I was self-medicating for years with hydrocodone. That is until I finally got on suboxone. That was in March of 2004. I am still taking 8 mgs. every morning. I also take Effexor 150 mg. This seems to be the magic combo for me. I am happy and enjoying life. Can't begin to describe the "before" for you, but I'm sure you can imagine. Every time I tried to get off the opiates, I just got soooo depressed, didn't want to live, and just didn't know why. I had been on antidepressants before, but nothing worked as well as the two meds together.

    Posted by connieZ: This past September I went to rehab for my third time they gave me suboxen. Within minutes I felt normal I could'nt believe it no more depression what a miracle. I left detox and immediately felt like s***. A friend of mine told about a doc who prescribed suboxen I got an appointment immediately. I started taking the suboxen and again felt normal it's been two months now and have never felt better.

    Posted by SomeDayBFree: My first experience with Suboxone began in May 2004 and the relief I received from nearly life long resistant depression was simply miraculous. I was at my best taking 4mg per day. That was better than at 6mg and better than at 2mg. Unfortunately, due to my own internally placed pressures, I opted to stop taking it and began a slow wean and finally ceased in March 2005. The depression returned fairly quickly(no surprise...) and I relapsed a few weeks later. This relapse was relatively short, but "hard and heavy." Much more so (nearly 3 times more) than my previous 3 or so years of abuse. When I returned to Sub in early November, my intent was to do a short detox only - then I found this site along with significantly more data on the drug than I had been able to find previously. I also learned that a significant number of other people as well, were finding relief from serious depression by using Suboxone.

    Posted by rac1210:
    I am amazed the level of intelligence at this forum. I read the post by others at these sites and realize how many people have suffered due to the ignorance and arrogance of the medical community. I read years ago a study done in England that showed Buprenorphine to be effective in treating depression and now I am convinced that there is clearly a place for this drug in not only dealing with opioid dependency but also refractory depression. The proof is in the pudding...look at the folks on this site who have suffered for years with depression ultimately leading ot opioid addiction and all its negative consequences and then suddenly started Sub and now are functioning, happy, productive individuals who have regained the joy of living.

    Posted by dan sewell : Twenty plus rehabs and institutionalizations....All in the name of addiction. Extended "vacations" at the Gray Bar Inn as a result of "criminal" activity ( I'm a good person, my crimes all drug related, not stealing or violent).Scores of Psychiatrists and counselors. Years in and out of the smoke filled rooms of AA/NA. Attempts to find religion, self help books, new age/ old age philosophies. Every known combination of psychotropic drug known to man.So many failed attempts, when I've had the best intentions of remaining clean. Any of this sound familiar???
    What I've finally come to realize is that my depression drives my addiction, a fact that I have had to force down the throats of those who supposedly know about addiction. Every damn one of them has worked on the premise that everything would be dandy when I stopped using, and then some counseling and a dash of antidepressants to fix me. It just hasn't worked, depression leads me right back to the strong stuff.
    The closest non-addictive drug that has worked is Wellbutrin, but has still paled in comparison to Suboxone.I am only taking 1-2 mg(I say 1-2 because I have to divide an 8mg pill in order to stretch out my limited supply) of Suboxone daily, and even skip days because of it's long lasting effect.Technically I'm (my doc knows Im taking less than prescribed) "detoxing" but figure I'll be coming off the stuff for as long as I can figure out a way to keep a supply.Is this abusing a medication? Am I a criminal? I don't even feel the Sub as much as 90% of the antidepressants I've used in the past. I feel like I can actually function and be a productive member of society--something that has not even been an option for soooo long.


    <b> I could easily provide another hundred such personal testamonials, from a variety of different relevant message boards.</b>

    Good luck to anyone who wishes to convince all of these hundreds of depression patients that they are wrong, and you know better.
  5. Hi! I'm Spydertrader!

    Hee hee hee.....


    I read your comments. That is your take.

    I disagree with your observations and conclusions....

    I continue to believe that RM is a drug addict who is medicating, rather than a person with depression who is seeking a recovery solution.

    Carrying the amount of resentments he lugs around, believing he will die without the drugs he fixes with, the level of drama he displays is not in my opinion a display of "recovery" from the symptoms and or underlying cause of depression.

  6. I think my brother is depressed. If he went to a doctor, could he ask for bupe specifically? ... or does he have to go from doctor to doctor to find one that will prescribe it first...rather than sometime down the line.

  7. Note to those unfamiliar with these boards: LoZZZer is our resident troll, a known sexual sadist with the integrity and credibility of a Nigerian spam letter.
  8. I'd need to talk with him first to make sure bupe is appropriate in the first place. The depression must be congenital, not situational. The laws are complex, the situation is tricky, and there are many other factors as well. I'm not busy tonight. PM me your phone#, and I'll call you...
  9. <b>One by one, scientists and physicians across the globe are rapidly coming around to my point of view:</b>


    Date of publication: 06/29/2006

    <b>"Opiate drugs were first proposed for the treatment of dysphoric
    syndromes, depression and psychoses many years ago. Even so, the usefulness of these compounds in psychiatry is supported by only a small corpus of data. The reasons given for the restrictions placed on opiate use are based on prejudice rather than scientific evidence.
    Buprenorphine, with its unique pharmacological profile, has proved to possess antidepressant, anti-dysphoric and antipsychotic properties in small groups of psychiatric patients. Moreover, it may turn out to be the opiate of choice in subjects affected by lower severity addiction coupled with dysthymic disorders, anxiety disorders and personality disorders."</b>


    Once again, I give you tomorrow’s scientific knowledge- TODAY:

    <b>Type A Depression</b> results from a neurotransmitter deficiency, and can be remedied via the neurotransmitter reuptake inhibitors (Zoloft, Paxil, Welbutrin, Effexor, etc...)

    <b>Type B Depression</b> results from an endogenous opioid (Endorphins, et. al.) deficiency, and can be remedied with opioid medication. Out of these, Buprenorphine is usually the best choice.

    <b>Type C, or Combination Depression</b> results from both neurotransmitter AND endogenous opioid deficiencies. Type C depression patients require neurotransmitter reuptake inhibitors in combination with opioid medication.

    Modern medical orthodoxy recognizes <b>only</b> Type A depression, and remains widely ignorant of the other two varieties. This ignorance results in tens of thousands of suicides per year, while ruining millions of additional lives.

    Fortunately, within a decade or two, my assertions will become common medical knowledge. Suicide rates across the developed world will plummet. While I'll never be personally credited with this revolutionary medical advancement, at least <b>I</b> will always know that my writings played a part in speeding up this process of enlightenment.

  10. Yes, no doubt you will show up with a Russian Slut on each arm as they present you with the Nobel Prize Award for egomania...

    #10     Jul 23, 2006