"Then it is dark; a night where kings in golden suits ride elephants over the mountains." - John Cheever

Tuesday, February 26, 2008

The drugs don't work

All across the news today that Prozac and some other SSRI's aren't any better than a placebo - I'd be interested to hear people's thoughts on this.

My experiences with these things haven't been particularly good - a feeling of speediness for the first few days followed by same old same old only with increased mental muzziness and anxiety. I *really* didn't like Prozac...

13 comments:

Tom said...

I think it's true that these drugs aren't terribly effective for acute and specific mental health problems. However, for your 'bog standard' mild depression/anxiety, then they do boost serotonin and are very effective in helping people to manage their lives better. Certainly, my experiences of Seroxat have been very good and I think they should put a low dosage in the water, like fluoride.

Colin said...

No, i'm with John. I wasn't a fan of Seroxat, seemed to leave me numb and blank - although was kind of like that anyway. Anxiety wasn't the main issue though. What really helped was talking stuff through with a professional, but the NHS can't provide that for most at short notice, so drugs the other option. I do wonder if I really needed to be on it for my 'bog standard' symptoms, and ever since I've tried to weather the bad patches and just get through them instead. Although age and experience, and knowing how to handle it, help a lot in this regard.

Colin said...

Also, I think the study said that acute cases were where it does help, but that in bog standard cases it had no more effect than placebo. Different strokes for different folks though I guess.

john said...

I guess the thing is that placebo's *do* work to some extent. Though I wonder if they continue work when it's been widely publicised that the pills themselves are no better than placebo (so in effect you are taking the placebo if you catch my drift).

I reckon I'm through with them anyway, they muddy the picture I think.

seumas said...

Well, what a bunch we are :-) I'm currently on Citalopram, and I did actually feel a bit better as soon as I started taking them (before they should have any real effect). I'm not sure it would be totally accurate to call it a placebo effect though: surely part of the better feeling is that you've done something about it (by going to the doc in the first place), rather than just passively accepting what's happening?

Colin said...

That's a good point, I think.

Anyway, it's all perfectly natural and possibly good for you anyway.

Edna said...

Of course in my day, men were men! There was none of this prozac nonsense, men just Got On With It, and if they couldn't then they did the right thing and stepped outside to shoot themselves.

Seems like everybody's a bit loopy these days.

http://garfieldminusgarfield.tumblr.com/

john said...

Comment Of The Century! Pass the revolver...

Tom said...

I've never heard of Citalopram - but I guess it's much like the other SSRIs? I didn't take to prozac at all, but seroxat has always been effective each time I've taken it (3 times) and in each case the improvement began (and was quite marked) about 2 weeks after taking them, and its always felt that it was the drug working rather than any placebo effects.

One thing I've wondered about is that the side-effects of these drugs are quite strong - do you think they manage to recreate this effect for placebo takers? Otherwise it would be pretty obvious you weren't taking a real one.

Interesting that deprssion is thought to have a Darwinian benefit. I can see that, but also think (like the obesity problem) 21st century capitalism is so very different from the environment we are evolutionarily adapted for, that our natural instincts and responses to the modern world can be very problematic.

john said...

The stories always talk about a "sugar pill" as the placebo?

Certainly in my experience when you take these things you know you're on them sure enough.

I agree with you about the 21st century environment not being terribly congruent with the one we're evolutionary adapted for. I remember reading something about the way most people like looking at pastoral landscape scenes being related to the ideal environmental niche of our hunter-gatherer ancestors. Meanwhile our urban world gets more bladerunner-esque by the minute (not to mention the fact that most of us spend the whole day looking at a screen).

Tom said...

Yes, if I was given a sugar pill I think I'd twig pretty quickly that I wasn't on the real stuff.

One thing that struck me (and it makes the point in the BBC article) is that pretty much all mild depression does clear up in the end, just like most illnesses - so if you were comparing results after 18 months or so you wouldn't find that much difference in outcomes. However, I do think that SSRIs can be useful in speeding the process up and (given how incredibly distressing depression/anxiety can be) that's got to be a good thing.

Colin said...

I'm always a bit sceptical about theories like the one about the appeal of pastoral being rooted in our hunter-gatherer origins. That sort of thing's just (informed) speculation really. Poor old early humans are always having their motivations co-opted in order to explain our modern foibles. But I do agree that I, at least, don't feel like I have been naturally selected to thrive in the modern world.

And I am going to go and see Steven Pinker talk about evolutionary psychology at the Douglas Adams Memorial Lecture next week. (Tickets still available - mention the Ecologist mag when you phone up and they're £10.50.)

Tom said...

Although I agree that this hominid-based human nature stuff is open to speculation, it's also a very plausible basis for explaining a lot of otherwise inexplicable (and often disastrous) modern human traits. I can see how depression, stress, obesity, status anxiety, addiction, aesthetics, art all had an ecological/survival function of little practical (and in many cases detrimental) impact on our lives today.