In the book Inventing mental disorders, several sometimes recommended in this blog, González Pardo and Pérez Álvarez provided by the fact that by 1980 depression was a rare disorder, affecting 50 to 100 people per million, while estimates of the decade just passed The are around 100,000 people per million. If we believe (and we believe because, given the existing evidence seems indeed a matter of faith), as they say from certain sectors of the profession, we are facing a brain disease caused by imbalances in neurotransmission, we should ask what happened in the human brain in these three decades that where before there was a depression, now has 1000. We will respond, no doubt, that what happens is that previously underdiagnosed. That is, as before (in 1980, in the seventeenth century, ie relatively recently that at least one of the authors of the blog remember that year) we had 999 people undiagnosed depression per 1000 patients we have today, , which received no treatment while now they are benefit from it. This would lead to the conclusion that people were much more unhappy or even commit suicide in 1980 than in 2010 but does not seem to have data to suggest such a thing (OK, we admit that the Madrid scene, Moran and jokes could be Naranjito depressive equivalents, but even so, the accounts do not we go ...).
And these figures are more striking when we consider that it is in the 80's when they start to market the new (and expensive ) antidepressants, with the paradigmatic example of Prozac. In medicine we have seen the advent of antibiotics causes a reduction in morbidity and mortality due to infectious processes. Or how the emergence and development of antiretrovirals have been achieved dramatically increased life expectancy in HIV patients. Or how the development of TB drugs TB became a very rare disease. It turns out that the emergence of new (and expensive ) antidepressants, presumably effective and well tolerated ( and, if we did not mention, expensive ) not only fail to reduce the number of depression, but they 1000-fold increase ... We must recognize that depression, a disease for biological neurochemistry nature, behaves more like a sales index powered to infinity for greater glory and benefit of some lucky company (" and why we think of that this comparison ?).
And after these comments, we would dwell on the question of the effectiveness of antidepressants to prescribe (and so many people take). Today, we believe, there remains an unwritten rule of "maybe something help." And because we also note we have used: "a recent match, but I send the antidepressant because maybe something help," you have been kicked out of gigs, but I send the antidepressant because maybe some help " "Their parents have separated, but send him the antidepressant because maybe something help" ... For every difficulty vital, prescribe (and recognize the plural) any antidepressant, often underestimating bothersome side effects such as dizziness, drowsiness, tremors, nausea, sexual dysfunction than common ... And also underestimating side effects very rare but very serious, such as serotonin syndrome ...
Not to mention how we create the role of sick people suffering from difficulties in life that no pill will fix that, instead of having to take up the pieces and find their own resources and support in your environment, leaving our consultations with the message that do not have to work, that his family has to put up if you want to spend all day doing nothing and that has to expect little calm, without taking any decision until a few weeks, the pill will encourage ... And if not encouraged, we will send another ... And if not encouraged, they are changed by two and add lamotrigine ... And if not encouraged and we like him we put aripiprazole, which is also cheaper and safe ... And if we do not like, then we say that you are a hysterical and seeking refuge in psychiatry, but do not remove any of the drugs ...
perhaps exaggerated, but the real base is so real ...
Because if antidepressants in question effectively cured all that we call depression , and also no significant side effects, it would be wonderful (we would take ourselves without hesitation). But what if it turned out are not effective in most of what we call depression but they do have side effects? And not to mention today that price ...
psychiatrists will say that Multiple studies have demonstrated the effectiveness of antidepressants (and please nobody tell us not to believe in the studies but has drug tested and will work, as if there were no placebo effect or bias observer, which seems to be listening to the nearby lava swearing that your detergent cleaner and he knows because he has proven ).
A study published in the New England Journal of Medicine found that in 74 studies registered with the FDA about the effectiveness of various antidepressants, 31% (including 3449 participants) did not were published. 37 studies were published with positive results for the drug tested and with only one positive result was not published. By contrast, studies with negative or questionable results, 3 were published, 22 were not published and 11 were published so that in the opinion of the authors, induced to perceive a positive outcome. In the published literature, 94% of the trials were positive, while the FDA analysis showed only 51% of positive results. Separate meta-analysis of data from the FDA and publications show that the increase in effect size ranged from 11% to 69% for each drug individually, with 32% for total.
magazine PLoS Medicine published a meta-analysis in 2008 to study the relationship between initial severity of depression and the effectiveness of antidepressant medication, based on data provided by the FDA for clinical trials provided by the pharmaceutical industry to gain approval for the indication antidepressant fluoxetine, venlafaxine, nefazodone and paroxetine. The data came from both published and unpublished studies. The meta-analysis included 5 clinical trials with fluoxetine, 6 with venlafaxine, nefazodone and 16 8 with paroxetine, which accounted for a total of 5,133 patients, of whom 3,292 were randomly assigned to receive medication and 1,841 to placebo. The authors analyzed the data, concluded that there was no statistically significant difference in antidepressant response between placebo groups and groups with any of the four antidepressants studied. All groups improved, but no statistically significant difference between active and placebo, except in the most severe cases of major depression, which itself showed an effect that antidepressants placed slightly ahead.
A meta-analysis published in the British Journal of Psychiatry concludes that the studies analyzed show that it is unlikely that there is a significant clinical benefit for antidepressants versus placebo in patients with minor depression.
An article in the British Medical Journal includes a meta-analysis published and unpublished studies of reboxetine. The conclusion is that an antidepressant reboxetine is ineffective and potentially harmful, saying the evidence (correct translation of evidences ) published are affected by publication bias.
A study published in the Journal of the Canadian Medical Association on paroxetine, analyzing published and unpublished studies of treatment of depression in adults, concluded that in moderate to severe major depression, paroxetine was not superior to placebo in terms of effectiveness.
there any other work in the same line but we think it's enough for today. We do not want staff or depressed depress us (lest someone would prescribe an antidepressant because maybe something help ...).
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