149
however, are big sellers--among the best-selling medicines in the world, with
such names as Prozac, Serzone, Wellbutrin, Zoloft, Remeron, Celexa, Effexor,
Lovox, Paxil, and others—all similar in chemical composition. The total sales
world-wide are about 20 billion dollars per year. In 2002 alone about 11
million prescriptions were written just for children and teens in the US. Let’s
think about why is it difficult to honestly know the effectiveness of anti-
depressants (or any other treatment).
People come to see doctors and therapists because they are feeling badly,
often their discomfort has gotten gradually worse, and they are seeking help
at the height of their depression. If so, the chances are (for a variety of
reasons) that the problem will later get better rather than staying awful or
getting worse. This amelioration process is observed so often when scientists
re-assess unusually high or extreme conditions; this going back towards
normal (for you) is called “regression to the mean.” So, you see a doctor with
a bad cold, an aching back, a tension headache, etc., and soon in the natural
course of things you begin to feel better (closer to average for you).
There is another process that also makes it hard to evaluate the effectiveness
of a treatment method—the suggestion or placebo effect. It is well known that
a sugar pill can help many people feel better (if the doctor suggests it is very
effective medicine and will take care of the problem in a couple of days or
weeks). If such a suggestion is made or just implied when actual medication
is given, then the placebo effect and the drug effects combine together and
both may be working. To prove the effectiveness of a drug (or any treatment)
the amount of improvement shown to be due to the drug alone has to be
significantly greater than the placebo effect by itself. Note: according to
testimony given in the fall of 2004 to the Congressional Energy and
Commerce Committee, about half of all studies of anti-depressants
have not shown in adults that the SSRI drugs are significantly more
effective than a placebo alone. Even worse, insignificant results were
found in two thirds of the studies in which children were given anti-
depressants and compared to children given a placebo. This is not well
understood by the general public. Please note that these research findings
certainly do not prove that anti-depressants are entirely ineffective (in fact,
half the studies may suggest anti-depressants yield some benefits), but these
results cast considerable doubt on the effectiveness of the drugs. Psychiatrists
know the effectiveness of anti-depressants is limited; they commonly point
out that anti-depressants do not help about 1/3 of their depressed patients.
In addition to these difficulties interpreting the results of research, more
recently there is a new and very disturbing possible problem with using anti-
depressants, especially with children and teens. Over several years, there
have been occasional clinical reports of suicide and violence associated with
taking anti-depressants. For instance, it was reported that Eric Harris, one of
the suicidal shooters in Columbine High School, had been taking an anti-
depressant (Luvox). Parents have described the sudden, out-of control suicide
of a college student after taking a regular dose of anti-depressants
(
prescribing anti-depressants to children and teenagers in late 2003 (a year
before the US considered such action). Even more alarming, Shankar
Vedantam of the Washington Post reported on September 10, 2004, that
testimony was given at a congressional meeting that two internal FDA
