Antidepressant drug statistics turn out to be depressing

June 6, 2009 by  
Filed under Medical Research & Studies

My views on antidepressants are that they be necessary for some people, at some time, but that natural methods and therapy work just as well. Now it seems, I have support from Stephen Wisniewski, a professor at the University of Pittsburgh, who set up a study of data compiled in a massive, government-funded review of more than 40 psychiatric facilities. Known as the ‘Sequenced Treatment Alternatives to Relieve Depression’, it’s catchy title reveals that antidepressants are only effective in a small percentage of patients and then only within a very narrow spectrum of conditions.However, most patients have multiple issues and it appears the majority (around 60 percent) are not benefiting from being given antidepressants. What is as troubling is the fact that the ‘great results’ given out by the pharmaceutical companies have been carefully selected so that patients in their particular drug’s trial are only those within the spectrum that the drug can help – in other words it seems they exclude the multiple issue patients. When Wisniewski did a comparison of patients in drug trials, against those whose data was in the Sequenced Treatment research it appeared that only 22 percent of the people he studied would have been eligible for the drug trial. Hardly a representative sample of the general population who suffer from depression.

Depression can be debilitating and destructive and I am all in favour of doing what works, but a preliminary step of seeking help from counselling, hypnotherapy, cognitive behaviour and herbs such as Rhodiola and St John’s Wort would seem like a good first step.

Heart disease and depression link

Being diagnosed with coronary heart disease can be frightening and stressful, however optimistic the prognosis. It can be a time to revaluate lifestyle, relationships and work and can place enormous pressure on the individual and their family, affecting all aspects of life – including mental health. Now, the American Heart Association has recommended that coronary patients should also be screened early and regularly for depression. They have spoken out because of the growing body of evidence that shows a link between depression in cardiac patients and a poorer long-term outlook.

Many studies have now shown that major depression is associated with worse prognosis in patients with coronary disease. What has also now been confirmed is that more severe depression is associated with the patient having earlier and more severe cardiac events.

In many cases, depression can often be treated with exercise, counselling, good nutrition and cognitive-behavioural therapy. American Psychiatric Association suggests that two questions can identify patients who may need further follow up and treatment. The doctor should ask: ‘Over the past two weeks, how often have you been bothered by the following two symptoms?

1. Little interest or pleasure in doing things

2. Feeling down, depressed, or hopeless

If the answer to either question is yes, they have been bothered by those symptoms then the follow up questions are: ‘how often have you been bothered in the past two weeks by:

1. Trouble falling asleep, staying asleep, or sleeping too much

2. Feeling tired or having little energy

3. Poor appetite or overeating

4. Feeling bad about yourself, that you are a failure, or that you have let yourself or your family down

5. Trouble concentrating on things such as reading the newspaper or watching television

6. Moving or speaking so slowly that other people could have noticed or being so fidgety or restless that you have been moving around a lot more than usual

7. Thinking that you would be better off dead or that you want to hurt yourself in some way.

This is not a definitive way to define depression, but it is a useful tool to evaluate how someone is coping after having a coronary and can help you decide whether or not help is needed.

Often used strategies for patients who have coronary disease and depression are antidepressant drugs, cognitive behavioural therapy, and physical activity, such as aerobic exercise. Diet can also play a part, and most nutritionists would recommend a diet that excluded sugar, caffeine and alcohol.

St John’s Wort – Does it work?

Get ready – this is the rant! As someone who has been writing about health for 20 years, I thought I had become anaesthetised to the ‘false information’ syndrome that seems to accompany most natural medicines. Linus Pauling is a fine example. He was one of the first scientists to work in the fields of quantum chemistry, molecular biology and orthomolecular medicine, was awarded two Nobel Prizes in different fields which you would have thought was enough qualification for anyone. However, his research into the benefits of vitamin C on health were systematically rubbished for years, and now a natural supplement that has been proven to help thousands cope with depression is getting similarly clobbered.

In the best Parliamentary tradition, I have to declare an ‘interest’ in the subject as I have been subject to depression since childhood and have tried virtually every form of treatment, both chemical and natural, over the years. St John’s Wort works for many people – but not for everyone, so I am never surprised to read research that shows it hasn’t been effective within certain parameters.

What I am surprised, and horrified, to discover is that the latest round of ‘St John’ bashing has come from a group of medical men who concluded “that the St.John’s Wort herb is useless in treating ADHD in children”.

That it is true I don’t doubt, because what they didn’t disclose at the time was that all the children used in the study were given inactive forms of the herb, where the active ingredients had been oxidized and rendered useless. Even the Journal of American Medicine admitted that:

“The product used in this trial was tested for hypericin and hyperforin content at the end of the trial and contained only 0.13% hypericin and 0.14% hyperforin.”

That constitutes a sub-clinical dose, barely containing any usable St. John’s Wort at all. It is in fact barely one-tenth of one percent of the active chemical constituents in the herb, and any decent supplement typically contain up to five percent hyperforin, or thirty-five times the amount of active ingredient used in this trial. JAMA felt obliged to point out:

“Hyperforin is a very unstable constituent that quickly oxidizes and then becomes inactive, which is likely what happened to the product used in this clinical trial.”

In other words, they admitted that it was an inactive, ineffective, form that had been used.

Even more worrying is the fact that there were only 54 children used in the results of the trial, with 27 receiving a placebo and 27 receiving St. John’s Wort. This is a very small sample size to justify any declaration that it doesn’t work, especially given the fact that it has been safely and effectively used by tens of millions of people around the world in just the last decade or so.

Incredibly, more than 40 percent of the children used in the study had previously also used psychiatric medications, and we already know that such drugs actually cause behavioural disorders, shown by the fact that so many children commit violent acts against themselves and others after taking psychiatric medications.

This trial was set up to fail on so many levels; for example, six children who displayed a large response to the placebo were supposed to have been dropped from the study to isolate the herb’s effects from placebo effects. However, they were ‘accidentally’ randomized and their results put into the final conclusion, which had the effect of distorting the final results in favour of placebo responders, and reducing the numbers who responded positively to the St John’sWort.

Another example of the study’s bias is that young boys are far more susceptible to the kinds of behaviours that are labelled as “ADHD,” compared to young girls, and yet in this study, the placebo group consisted of only about 50% boys while the herb treatment group consisted of nearly 75% boys. In other words, the placebo group was predisposed to a positive outcome simply due to its composition of girls vs. boys, while the herb treatment group was predisposed to a less-than-favourable response.

To say nothing of the sheer cynicism of this research, and trying not to boil over at them using young children to test something for a serious condition that they absolutely had guaranteed in advance would not work, they then sent numerous press releases out that warned parents not to use the herb. Some of the headlines included:

St. John’s Wort Doesn’t Work for ADHD Washington Post

St. John’s wort no better than placebo for ADHD, Bastyr study finds Seattle Times St. John’s wort doesn’t help ADHD, study finds Reuters That would certainly put most parents off, but it is not really so surprising when you know that one of the study’s authors, Dr. Joseph Biederman, secretly took $1.6 million from drug companies while conducting psychotropic drug experiments on children, and is currently on the payroll of several drug pharmacies selling ADHD medications – a fact he did not disclose when publishing the study in the Journal of the American Medical Association. So he was not likely to want to find that St John’s Wort, or any other natural alternatives, had any effect on treating a condition cheaply and without recourse to drugs. The whole point of the study of course was to make natural medicines look bad. I had thought after Linus Pauling’s hard battle to get his views accredited that it might have got a bit easier – but clearly the agenda is still a commercial, rather than a medical one.

In case you were wondering, St. John’s Wort has been clinically proven to be even more effective than antidepressant drugs for treating mild to moderate depression. That is a much better track record than all the SSRI drugs ever invented, whether it works for ADHD I don’t know, but I would want to see much better research before it is so cavalierly dismissed.