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Comparative efficacy and acceptability of 21 antidepressant drugs

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Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#101

Post by hmhrex »

Jugglerofworlds wrote: post #99
hmhrex wrote: post #69

Earlier quoted context omitted.

This is the main reason I stayed away from medication for 12 years. That is until 3 weeks ago. I decided late 2017, after a major depressive episode, that I needed to get help after 12 years of dealing with this depression. I kept thinking that I had a handle on it, and then it coming back weeks, months or years later. I read The Depression Cure ( https://www.amazon.com/Depression-Cure-6-Step-Program-withou... ) abou…

For the more severe anxiety disorders, the proof of efficacy above placebo is much better than what we have for depression. People don't get better by taking placebos for their OCD. For anyone experiencing anxiety problems, I highly recommend finding a competent therapist who knows CBT. For anxiety that constantly interferes with daily life, medication may be appropriate. For me the SSRIs completely wiped out my OCD…

Some people need it because their brains is just plain imbalanced, I get that. For some, that imbalance can be fixed with lots of work, however for some, it can't. I'm _hoping_ to be able to fix mine, but I'm willing to work with a doctor to figure out if that's possible.

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#102

Post by askvictor »

markroseman wrote: post #81
askvictor wrote: post #36

This analysis look at effects over 8 weeks. The first four weeks on antidepressants you're feeling terrible due to onset side effects (on top of your depression). Once that settles, you feel better. But there is no way to tell if you feel objectively better than before the medication started.

Statistically, rating scales typically used in these studies have been validated as showing effect, and clinical interviews can pick up a lot of things. That said, it's normally hard for you to be able to look back eight weeks and subjectively compare how you feel then and now. Usually it's not the person being treated, but those around them (family etc.), who notice the improvements first.

I think you mean objectively not subjectively.

In any case, looking back that 8 weeks and comparing to now, _after you've just been through 4 weeks of hell_, you'll report that you're feeling a lot better, even if you've only returned to the same level you were before starting the meds.

Are there studies that use family/etc as the basis for their data? That would be a lot more valuable, as long as they also include a control.

The studies also need to look a lot longer than 8-12 weeks, partly due to the onset side effects, but also as a lot of depression is caused by a stress event that passes and resolves in a few months. It is interesting that a placebo has a positive effect (not as large as the meds); I wonder if they measured the effect of no treatment at all.

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#103

Post by WalterSear »

Jugglerofworlds wrote: post #99
hmhrex wrote: post #69

Earlier quoted context omitted.

This is the main reason I stayed away from medication for 12 years. That is until 3 weeks ago. I decided late 2017, after a major depressive episode, that I needed to get help after 12 years of dealing with this depression. I kept thinking that I had a handle on it, and then it coming back weeks, months or years later. I read The Depression Cure ( https://www.amazon.com/Depression-Cure-6-Step-Program-withou... ) abou…

For the more severe anxiety disorders, the proof of efficacy above placebo is much better than what we have for depression. People don't get better by taking placebos for their OCD. For anyone experiencing anxiety problems, I highly recommend finding a competent therapist who knows CBT. For anxiety that constantly interferes with daily life, medication may be appropriate. For me the SSRIs completely wiped out my OCD…

> Depression is downright benign compared to how bad the situation can get with other psychiatric disorders.

No - you just have no experience of comparably serious depression.

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#104

Post by WalterSear »

tyu100 wrote: post #55
evincarofautumn wrote: post #25

Earlier quoted context omitted.

Likewise, if storebought doesn’t do the trick, some people (myself and my partner included) have better luck with the recreational variety—mushrooms were the thing that kicked me in the psychological ass and started me on the path to recovery from alcoholism (which was partly self-medicating for anxiety). To be clear, this is absolutely not something I’d recommend lightly. Taking (who knows how strong) mushrooms or L…

This study, along with long-accepted clinical practice and the generic cheapness of most anti-depressants now, and the effectiveness of CBT/therapy if it's available to you, means you should really avoid self-medicating for major depression. Why take risks with your health when there are lots of safe, cheap and efficacious treatments that can be monitored by your doctor?

Because they aren't safe, cheap or efficacious.

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#105

Post by kqr »

markroseman wrote: post #63
kqr wrote: post #39

Earlier quoted context omitted.

"Best" is a complicated concept. Yes, amitriptyline has the greatest efficacy, i.e. response rate in a clinical setting. It may still have poor effectiveness (how well it works in the real world) because it belongs to a class of medications which, if you use them, you have to exclude many types of common foods from your diet. It also has less safety margins in terms of overdosing than many modern alternatives. And th…

Amitriptyline is a tricyclic; it's MAOI's that require a special (low-tyramine) diet.

I stand corrected. I was indeed thinking of the wrong class.

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#106

Post by jashpool »

jdietrich wrote: post #34
amputect wrote: post #8

I think that the United States is getting better about dealing with mental health, but we still have a long way to go. This is a little soap-boxy and anecdotal, and I apologize if it's inappropriate here. If I hadn't gotten a prescription for Prozac I probably would have killed myself by now. And I definitely would have destroyed my marriage and most of my important friendships. That's not an over-dramatization, it's…

>If I hadn't gotten a prescription for Prozac I probably would have killed myself by now. The majority of people with depression just get better of their own accord, for no obvious reason. The NNT for most antidepressants is ~7, meaning you need to give them to about seven patients for one patient to see a clinically-significant improvement. The evidence suggests that there's no significant relationship between SSRI…

>The evidence suggests that there's no significant relationship between SSRI use and suicide risk except for young people, for whom SSRIs may actually increase the risk of suicidal behaviours and self-harm.

The paper says: "However, in children and adolescents, there appears to be a bit of increased risk of suicidal ideations and attempts, but not of completed suicides."

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#107

Post by gliese1337 »

aianus wrote: post #49
gliese1337 wrote: post #15

As another person who is on antidepressants, and tried going off them for a while: well, duh. Yeah, I know, anecdotes aren't data, and I'm glad this is being verified by more reliable statistical methods, but this is not news to the many of us who might be dead or worse if someone hadn't said "you are sick--go see a doctor" and if that doctor hadn't said "you need medication--let's see if this works". Without antidep…

> it's amazing what you can do when you actually have enough neurotransmitters in your brain Anything except having an orgasm, in my case.

Well, yeah, there is that. I am somewhat fortunate to be the sort of person who doesn't care too much about that, but it can definitely be a sucky tradeoff for many people.

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#108

Post by nerfhammer »

tachyoff wrote: post #79
jdietrich wrote: post #34

Earlier quoted context omitted.

>If I hadn't gotten a prescription for Prozac I probably would have killed myself by now. The majority of people with depression just get better of their own accord, for no obvious reason. The NNT for most antidepressants is ~7, meaning you need to give them to about seven patients for one patient to see a clinically-significant improvement. The evidence suggests that there's no significant relationship between SSRI…

I agree with all of this, and I can’t help but ask: when did we start ignoring people’s environment and their circumstances? I have tens of thousands of dollars of student loan debt (my monthly payment is basically a mortgage payment) and I’m not particularly satisfied at work. Is it any wonder I find it impossible to get out of bed? Now, I try to be careful because, sure, perhaps the depression was already there and…

This is essentially the learned helplessness theory of depression: https://en.wikipedia.org/wiki/Learned_helplessness

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#109

Post by joveian »

random_throw wrote: post #5

Key bit: "In head-to-head studies, agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine, and vortioxetine were more effective than other antidepressants (range of ORs 1·19–1·96), whereas fluoxetine, fluvoxamine, reboxetine, and trazodone were the least efficacious drugs (0·51–0·84)."

However, agomelatine was not approved in the US due to clinical trials not showing effectiveness (withdrawn by the drug company after phase III), although regular melatonin is super easily available here and I've heard some people say it helps. For a good analysis it is important to get access to unpublished studies submitted to the FDA. I don't have links but I think there are a couple that have done that.

Edit: Looks like they did include some unpublished studies at least.

Re: Comparative efficacy and acceptability of 21 antidepressant drugs

#110

Post by gehwartzen »

icantdrive55 wrote: post #12
tyu100 wrote: post #4

Earlier quoted context omitted.

SSRIs are generally indicated for what's called mild/moderate depression, the most common form, not for the serious conditions that you highlighted. There were some older meta-studies that called into question their general efficacy vs. placebo even for mild/moderate depression but this new meta-study (with the additional previously unpublished data from their initial approval trials) looks like it has finally settle…

I am obviously confused, as usual. I'm not used to reading these studies. I'm looking at the study. I'm looking at the #3 graph under Tables and Functions Tab. It says amitriptyline is the best drug? Isn't that an older drug, or am I misreading the chart?

It's important to remember that these drugs are ranked in term of efficacy vs placebo at reaching a specific outcome threshold (greater than 50% reduction in depressive symptoms). So best in terms of efficacy just means the highest ranked has the best statistical chance of working. It does not mean that it works x% better than another drug (i.e. Drug A reduces symptoms 60% and Drug B only 50%. It also means that the drug ranked #1 might not work for you at all; the "best" for you could be drug ranked #16.

This is basically a ranking to use in when trying drugs to statistically maximize your chance of finding one that works.

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