Friday, 7 January 2011

Antidepressants Still Don't Work In Mild Depression

A new paper has added to the growing ranks of studies finding that antidepressant drugs don't work in people with milder forms of depression: Efficacy of antidepressants and benzodiazepines in minor depression.


It's in the British Journal of Psychiatry and it's a meta-analysis of 6 randomized controlled trials on three different drugs. Antidepressants were no better than placebo in patients with "minor depressive disorder", which is like the better-known Major Depressive Disorder but... well, not as major, because you only need to have 2 symptoms instead of 5 from this list.

They also wanted to find out whether benzodiazepines (like Valium) worked in these people, but there just weren't any good studies out there.

The results look solid, and they fit with the fact that antidepressants don't work in people diagnosed with "major" depression, but who fall at the "milder" end of that range, something which several recent studies have shown. Neuroskeptic readers will, if they've been paying attention, find this entirely unsurprising.

But in fact, it's not just not news, it's positively ancient. 50 years ago, at the dawn of the antidepressant era, it was commonly said that most antidepressants don't work in everyone with "depression", they work best in people with endogenous depression, and less well, or not at all, in those with "neurotic" or "reactive" depressions (see, e.g. 1, 2, 3, but the literature goes back even further).

"Endogenous" is not strictly the same as "severe", however, in practice, these two concepts have never really been clearly seperated, and they're largely equivalent today, because the leading measure of "severity", the Hamilton Scale, measures symptoms, and arguably these symptoms are mostly (though not entirely) the symptoms of the old concept of endogenous depression. The Hamilton Scale was formulated in 1960 when modern concepts of "minor depressive disorder" and "major depressive disorder" were unknown.

Why then are we only now working out that antidepressants only work in some people? There's one obvious answer: Prozac, which arrived in 1987. Before Prozac, antidepressants were serious stuff. They could easily kill you in overdose, and they had a lot of side effects. Many of them even meant that you couldn't eat cheese. As a result, they weren't used lightly.

Prozac and the other SSRIs changed the game completely. They're much less toxic, the side effects are milder, and you can eat as much cheese as you want. So it's very easy to prescribe an SSRI - maybe it won't work, but it can't hurt, so why not try it...?

As a result, I think, the concept of "depression" broadened. Before Prozac, depression was inherently serious, because the treatments were serious. After Prozac, it didn't have to be. Drug company marketing no doubt helped this process along, but marketing has to have something to work with. Over the past 25 years, terms like "endogenous", "neurotic" etc. largely disappeared from the literature, replaced by the single construct of "Major Depression".

For nearly 1,000 years, the great scientific and philosophical work of the ancient Greeks and Romans were lost to Europeans. Only when Christian scholars rediscovered them in the libraries of the Islamic world did Europe begin to remember what it had forgotten. We call those the Dark Ages. Will the past 25 years be remembered as psychiatry's Dark Age?

ResearchBlogging.orgBarbui, C., Cipriani, A., Patel, V., Ayuso-Mateos, J., & van Ommeren, M. (2011). Efficacy of antidepressants and benzodiazepines in minor depression: systematic review and meta-analysis The British Journal of Psychiatry, 198 (1), 11-16 DOI: 10.1192/bjp.bp.109.076448

37 comments:

Jayarava said...

Add to the mix that they started prescribing SSRIs for things like chronic migraine, anxiety, eating disorders, OCD, ADD...

Some time back there was a suggestion that anti-depressants might work by stimulating brain cell growth (this was in mice I think). Did anything become of that? I thought it was interesting in that it helped explain why side-effects appear within 20 minutes but the anti-depressant effect takes weeks. It is the strangest thing, isn't it?

Neuroskeptic said...

Well there's evidence that SSRIs work in stuff other than depression, like OCD. Thats a seperate issue.

but whether it would work in "minor ocd" is doubtful.

IMO the real issue is not that they only work in severe depression, but rather they only work in people with clear illness not mild "symptom"s which are probably normal emotions...

Retriever said...

Not to be cranky, but all the meds are inadequate. I've had relatives whose lives have been brought back from the brink by the right ones, but they're still "not exactly gruntled". We watch the Big Pharm ads on TV and snicker...

Extended psychodynamic Psychotherapy is still the best we've got for certain conditions, but individuals of average means can't afford it and insurers don't want to pay for it, because they rightly recognize the range of quality in providers from charlatans to gifted clinicians.

In families with clusters of chronic, severe disorders, the only family members who tend to function, stay employed, etc. are those who have got good psychotherapy. Tho sceptics will say that they are just the worried well whining about taking care of the sicker family members who get sectioned and have episodes year after year? Significantly, the sicker ones refuse therapy, lack insight, and exemplify that trope of "insanity is doing the same thing, expecting different results" I've always liked Jamison's description of why she needed both meds and therapy.

The outcome based research that seeks to limit care is flawed because humans are individuals. CBT for six sessions for depression only works for the naive and easily bullied. It comes back. It can be useful in group therapy as an adjunct, and in encouraging lifestyle improvements.

Sorry to rant. I'm not anti-med. When one sees them bring a suicidal person back, one is profoundly grateful. But I am a little surprised you didn't mention psychotherapy...Of course, I am an American and we Americans are all narcissistic, self-indulgent and extravagant...:)
Other things that help the "mildly" depressed (it doesn't feel mild, it's just not the "classic" depression):

--religious faith, belonging to a warm and loving church, church suppers and discussion groups, particularly one that expects you to volunteer and do something to help others. (teaching Sunday school is good)
--getting outside in nature (cubicle life sucks)
--sunshine every day (no sunblock as this prevents Vitamin D absorption
--going away on holiday (escape horrible family, get more sun, escape cubicle)
--getting a dog (my kid, who was severely disturbed when young, got out of the hospital and ran to hug the family golden and said "You are the best psychiatrist ever...)

Anonymous said...

Psychiatry hasn't changed much in 50 years. Our "new" and "revolutionary" treatments are no more efficacious than the old treatments. All we have done is provide our patients with a greater range of side effect profiles to choose from.

Anonymous said...

The evidence that the so-called antidepressants 'work' in severe major depression isn't great either is it, though, despite your implied assumption that it is? As i recall, that meta-analysis of papers submitted to the FDA - whether then published or not - found only a small average effect that was barely significant, and only because the placebo control became less effective. And even then most of the studies are only for six months or whatever to satisfy the regulators, hardly evidence of a life change.

You also imply that SSRI's don't have severe side-effects which of course they can have. In fact even trying to come off them can cause a range of serious adverse effects http://apt.rcpsych.org/cgi/content/full/13/6/447 Just because the psych-pharma complex covered them up or didn't investigate them, doesn't mean you should talk as if they don't exist as well.

And as for wanting to return to the distinction between exogenous and endogenous depression, as per the former FDA chairman who posted here a while back...I mean it's hard to imagine a more over-simplistic and neuroscientifically dubious distinction, like declaring that half of people are nurture and half are nature. Or half are mind and half are brain, that's not science it's fantasy. It's also an unfounded assumption that genetic/brain disposition means more severe prolonged depression, whereas reaction to the environment means less severe and prolonged. Nonsense.

Sorry but I think this is a sloppy sheepy post that betrays very neuro-unskeptical prejudices.

Caz said...

... IMO the real issue is not that they only work in severe depression, but rather they only work in people with clear illness not mild "symptom"s which are probably normal emotions..."

From what you've written, are the real issues a bit bigger:

- they haven't reviewed the tool for assessing depression in all this time? Really?! (*rolls eyes*)

- anything deemed vaguely 'not normal' is medicated (as deemed by the patient or the doctor - doesn't matter which)

- with placebos continuing to show stunning efficacy, including for patients told that they are taking a placebo ... well, pharma's & doctors are tossing pills about in full knowledge that someone, somewhere will feel better or a bit special for a little while, and most of the time no harm will come of it.

Of course, sugar pills and a bit of hand holding would be cheaper for society as a whole and for the individuals.

Michelle Greene said...

I found this paper illuminating in understanding why SSRIs fail the mildly-to-moderately depressed. Essentially, the effect of the SSRI was constant (and small) over all levels of depression, but the severely depressed patients had less of a placebo effect than the others, making a larger difference between treatment and control groups.

Anonymous said...

I agree with Anon's post to the effect that the evidence for efficacy of antidepressants in severe depression, while statistically slightly significant, is not all that much to write home about.

Neuroskeptic said...

Anon 12:23 - i'll reply in more detail later but - no doubt the subtyping of depression is inadaquate. But that's better than nothing surely? To divide all Christians into Catholics, Orthodox or Protestants is very simplistic but better than nothing. At the very least you must admit that there are *some* subtypes or dimensions or whatever even if you don't like mine.

Szwagier said...

It's all very complicated. Over the past 25 years, I've been treated with SSRIs and tricyclics for major depression, with the tricyclics being more effective.

I've been told that my depression is not endogenous, but then how do they know?

Anonymous said...

Reply to NS:

The real equivalent would probably be splitting all religions into either diehard fundamentalism vs fairweather liberalism, and incorporating an assumption into it that the former are inbred while the latter are understandable

Peter Jones said...

Consider the factory that makes playing cards. They produce ten thousand of each card, every day in fifty two batches for a deck of fifty two playing card. Then a machine takes one from each batch makes one deck, gives them to another machine to shuffle them. A third machine puts them in a box, seals the box and sends it for the sale. Somebody decides that if he buys many decks of cards from the market and carefully write the order of incidence of each card in the deck, after a while he can find a pattern for the occurrence of cards in the deck. Well, he has every right for that haunch. Shuffling is done by machines. Those machines follow mechanical rules and it seems likely to find their pattern. In the next stage he announces that he has found the pattern. Then you ask him what about those cards in your drawer? Do they also follow the pattern? He says:" no, they are only fifty percent of the cards, but I assure you investigation of my colleagues and mine are on the way to extend the pattern to cover all the cases." No, the story is not finished yet. He believes every time that people shuffle the cards, after certain amount of shuffling, cards return to the original factory-shuffling pattern. He only needs some more time, some more deck of cards, some more assistances, and some more computers. He can create works, papers. He publishes patterns and statistical manuals to help his colleagues around the world to put every new deck of cards in one of the many categories that are instructed in the manual. Creation of new patterns are most welcome if done by the “pattern-experts” who have been trained under his instructions of “pattern-o-logy.” If you ask them they always are just about to solve the problem. Of course, of course the problem has a solution. Isn't it? This is something partially I can remember written by chemist Irving Langmuir written in Physics Today around 1990. You can find the link to the original at the "copyrights page" of this website. I used to teach all that to my students after explaining details of Semmelweis' discovery. Langmuir quotes such story with reference to one of his university colleagues. I expanded that quoted story in this way. You might not believe that such a trivial example might exist. There is a “house” in astrology that recently has been created based on the study of pattern of lives of “celebrities” and the details of time and place of their birth.
source: http://messiahpsychoanalyst.org/Documents/MathematicsPhilosophy.html

Anonymous said...

Top 10 legal drugs linked to reports of violent behaviour:
http://healthland.time.com/2011/01/07/top-ten-legal-drugs-linked-to-violence/

9) Venlafaxine (Efexor), an SNRI 'antidepressant'
8)Fluvoxamine (Luvox), an SSRI 'antidepressant'

3)Paroxetine (Paxil) An SSRI 'antidepressant'

2) Fluoxetine (Prozac) The first well-known SSRI 'antidepressant'


I personally was given Prozac at age 19 and in the immediately following weeks I became more verbally aggressive and then one night in a state of desperation that I couldn't control as I normally would I set fire to my student dorm room, an act that could have killed dozens of people.

Serious stuff.

Anonymous said...

oh & 10)Desvenlafaxine (Pristiq) an SNRI 'antidepressant'

veri said...

I thought they didn't ban meds during the Dark Ages. While the Arabs continued with the knowledge quest, the Jews, Hindis, Cordova etc. practitioners + medicines were still around. Combining endogenous, exogenous, parsimony to whatever sounds lucrative, but at least there is an option to be cautious if need be. On the same token even if distinctions were strict protocol, as long as the medicine is available the practitioner will likely prescribe than not prescribe. I guess it’s a case of coming up with better drugs targeted for each distinction, or better holistic practices.

Enlightened Medicine Found in Dark Ages

Retriever, thanks for the tips :) church is probably why I haven't had the need to see a counsellor or take mental meds.

Brother Peter, that's really exquisite. Forgive my ignorance but I was under the impression humans don't tend to make mechanical decisions.

Anon, that's disturbing. Please go away you're scaring me.

pj said...

Blogged briefly on this paper here.

Basically I'm saying that:
a) I'd concentrate on HRSD scores rather than response rates (I go into some reasons for that here)
b) There simply isn't much evidence to decide either way on efficacy at this stage
c) The effect sizes found are actually no smaller than seen in some antidepressant medications that are widely used (i.e. lamotrigine) and larger than would be expected by data from studies in more severe depression.

Paul said...

Certainly from my experience, I wouldn't say lamotrigine was a widely used antidepressant. Indeed, within the four years of working within the field, I've never once seen it prescribed for unipolar depression.

pj said...

Widely used in bipolar depression was my point. You could always read my post about lamotrigine to see what I was talking about.

Paul said...

I could; but I shan't.

Thanks for the tip though.

Caz said...

The failure of meds to do what they claim, or to do anything at all, will, eventually, be demonstrable through science, not self reporting. It won't put an end to the multi billion dollar pharma gravy train, but maybe they'll at least start trying to develop meds that work, and do so without creating harm.

EVestG, the diagnostic technique developed at Monash University is a total game changer, which will not only improve and save lives by providing fast and accurate diagnosis or mental and neurological illnesses, but will also provide fast and accurate feedback on whether or not a prescribed drug is working ... or just a sugar pill illusion.

I doubt that the pharma's have yet contemplated how radical this is, how the many frauds of mental health diagnosis and treatments are going to unravel. Ditto those doctors who hold themselves up to be experts in the field.

jgs said...

Caz: Re eVestG, there remain no publications (beyond engineering conference abstracts) as to its efficacy. I find it rather unlikely that the diagnosis of complex (and inherently variable) disorders of mental health can be reduced to a disorder specific auditory evoked potential. I'd love to be proven wrong!

In relation to the general thread, there is a small body of literature examining the effects of SSRIs on healthy people in placebo controlled designs. Although there are methodological issues, the few robust long term studies do suggest small but significant improvements in depression relevant domains, such as mood, emotional processing and decreased aggression. They also indicate areas for concurrent CBT to increase effects. I've just finished a PhD exactly on this topic and hope to publish soon.

Caz said...

Diagnostic specificity for EVestG is around 90%, I think (running purely on memory there) ... it's remarkably high.

Anonymous said...

Re. RJ,

Neither of you are citing sources for your claims.

Re. SSRI's in non-depressed individuals, this review found simply that SSRIs had a few relatively small stimulating effects
http://www.ncbi.nlm.nih.gov/pubmed/15842547

And there's the ongoing controversy around induction of suicidality or hostility/violence, including possibly in healthy volunteers in drug trials http://www.medicalnewstoday.com/articles/51685.php

And just the fact that SSRI's now have to be labelled as causing in some people "'anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania"

And by the way an initial study indicated that at least one SSRI induced abnormal sperm DNA fragmentation in more than 40% of healthy volunteers http://www.medscape.com/viewarticle/704701

Anonymous said...

sorry that was in response to "jgs"

pacificpsych said...

Problem is, as a psychiatrist you're forced to prescribe antidepressants even though you know they're mostly useless. Patients demand it, and the system sees it as incomprehensible to NOT prescribe antidepressants to anyone who utters the word "depressed" or "suicidal".

Patients who've "been on everything" and say that "nothing works" are not open to suggestions such as "it would help you feel better to find something to do", no matter how carefully and supportively phrased. All they want is a pill. Period. People get very angry at you if they feel you're "denying" them a pill, even if you offer in their place empathy, compassion, a real discussion of their situation and a plan that covers all aspects of their life. No pill = angry patient. And in today's world, that means a complaint to the authorities.

Best to avoid such things, either by avoiding the system altogether, or, if you must work in an employed position, by caving in, nodding and prescribing.

The Shrink said...

This paper is congruent with the emerging picture, illustrated nicely within JAMA last year, that antidepressants work as well as placebo in mild and moderate depression.

I'd agree with your contention that depression gets better, in spite of rather than because of medication, most of the time.

The confounding factor in practice is therefore folk present with low mood, are given Drug X, two months on are improving, so the doctor and patient believe the drug's helpful for their depression. Emerging studies of the last 2 years evidence that placebo has identical efficacy and less side effects.

Increasingly I struggle to reason how antidepressants can be routine practice in Primary Care if they've only a place to play in severe depression.

If considering the evidence and care pathways, where severe depression sits in Secondary Care, then shouldn't antidepressants only be considered, initiated, titrated and evaluated within specialist mental health services?

Anonymous said...

"98% of respondents visiting their GP for mental health problems were prescribed medication, despite the fact that less than one in five had specifically asked for it.

More than half of respondents felt they had not been given enough choice."

http://news.bbc.co.uk/1/hi/health/1842102.stm

pj said...

Anon: choice is fine but that article seems to be arguing for things like aromatherapy to be on the NHS, which is just silly, and, if patients want that, they can pay for it themselves. The 98% figure seems absurdly high, certainly I never prescribed like that in my brief sojourn in general practice. But, as that article intimates, alternatives like psychotherapy or even counselling are not readily available. The alternative to medication for a GP is usually just GP support (regular appointments, relaxation advice, signing off work, pointing towards self-directed CBT like therapy).

Shrink: I do think it is disingenuous to say that antidepressants have no effect in mild or moderate depression. The limited data from this study suggests that there may be an effect but that this is going to be small (around 1 point on the HRSD). The limited data for more moderate depression from other studies such as Fournier et al suggests that there may be an effect but this is likely to be less than the NICE 3 point threshold, and for more severe depression studies including the Kirsch et al data suggest that there looks to be a fairly robust statistically significant effect around or above the NICE 3 point threshold.
I think we can all tell when someone has very mild or minor depression, the difficult question comes when we try to characterise patients we see in clinic as being 'moderate' or 'severe' - as has been talked about here before there is both disagreement about both the arbitrary NICE threshold for 'clinical significance' and also as to what exactly different HRSD score cut-offs mean in practice (such as whether 'severe' on the APA/NICE boundaries is actually 'moderate' to most clinicians). The methods GPs have available to assess severity other than their clinical acumen such as the PHQ-9 are, I think most would agree, not up to the job. So the question is how severe are most depressed patients presenting to general practice, how small an effect is still worth prescribing antidepressants for, how severe actually is the patient presenting, and should a patient with severe but uncomplicated (i.e. not psychotic, no significant suicide risk) depression be managed in primary care?

I'll leave the first few questions but I would say that I believe a GP can adequately manage an uncomplicated but severe depression in the first instance, starting an SSRI and referring for psychological therapy.

A Bitter Pill said...

Great article! Just goes to show that people will still buy if they want to believe something will work even in the face of contrary evidence.

Anonymous said...

pj, 98% doesn't sound absurdly high to me when considering that antidepressant prescribing by GPs has been termed an 'automatism' and when you look at how the rates have skyrocketed.

That BBC report wasn't exactly arguing for alternatives, it was quoting a then government minister (as I recall) saying that patients were arguing for it for themselves.

Regarding aromatherapy, I'm not 'naturally' into all stuff like that but I also think your dismissal of it and of patients who want it, is quite unscientific of you. I mean, firstly, if nothing else, these drug trials show that placebo interventions DO have a scientifically demonstrable therapeutical effect.

And in terms of actual chemical effects on the brain, how is it scientific to just blanket denial the olfactory route? According to this Telegraph article from last year, "When the air was breathed in the scent molecules went from the lungs into the blood and were then transmitted to the brain. Brain scans showed the effect on a chemical called GABA on nerve cells was enhanced by the fragrances and helped soothe, relieve anxiety and promote rest. Professor Hanns Hatt said the results published online in the Journal of Biological Chemistry can "be seen as evidence of a scientific basis for aromatherapy" http://www.telegraph.co.uk/science/7881819/Smell-of-jasmine-as-calming-as-valium.html

I knew a guy who, instead of resorting to addictive and damaging benzo's that used be handed out like candy, would calm himself down with a strong dose of essential oil, he was severely depressed/anxious and paranoid and you try telling me he was 'silly' for doing that when I also knew another older mental health patient who had to take handfuls of benzo's everyday because the mental health system had gotten him addicted and adapted to them and even his f'ing eyes would go a weird yellowy colour.

GPs shouldn't be throwing their hands up saying what else have they got, I mean firstly what happened to first do no harm, and secondly there are now plenty of other options, at least in some regions, for counselling or CBT. And in any case GPs are the heart of community NHS they have power and influence and if they're too busy getting little 'information' leaflets and gifts and possibly kickbacks from pharmaceutical reps to actually go out an campaign vigorously against the lack of non-medication options then what kind of victim culture are they endulging themselves in exactly, perhaps they're all too depressed by their massive paychecks or trying to get an even more massive paycheck by running services.

As for the idea that GPs can safely prescribe antidepressants to thsoe they deem moderately to severel depressed, I personally HIGHLY DOUBT that. They have shown time and again that they do'nt have the time to do proper assessments of risk factors - such as the common disposition to hypomania or mania when starting or stopping antidepressants - and a recent report showed that GPs have failed (probably not through their fault but the systems) to even follow patients up properly to check what adverse effects that especially young people might be having, even though they'd been specifically warned about the need to ensure such follow-up checks.

Anonymous said...

http://www.telegraph.co.uk/science/7881819/Smell-of-jasmine-as-calming-as-valium.html

"They tested hundreds of fragrances to determine their effect on GABA receptors in humans and mice and found jasmine increased the GABA effect by more than five times and acted as strongly as sedatives, sleeping pills and relaxants which can cause depression, dizziness, hypotension, muscle weakness and impaired coordination"

"Professor Hanns Hatt said the results published online in the Journal of Biological Chemistry can "be seen as evidence of a scientific basis for aromatherapy"

pj said...

3 points:

1) If jasmine is a potent GABA agonist it will act almost exactly the same as benzodiazepines with the same side-effects, since we deliberately avoid benzodiazepines in depression (except for acute short-term agitation) I'm not sure why finding a potential GABA agonist effect in vitro or in rats is supposed to argue for prescribing somehting wihtout nay clinical trials or evidence of clinical benefit.

2) Other studies have not found any evidence of sedative properties of jasmine

3) I cannot find any trace of the article referred to in that Telegraph story, the only paper in that journal at that date by that author makes no mention of the findings reported in the article in the abstract.

Anonymous said...

3) Is this the abstract you mean: Fragrant Dioxane Derivatives Identify ß1-Subunit-containing GABAA Receptors http://bit.ly/dQbSSY

Are you saying you only read the abstract and it doesn't report the points made about it by the scientist in the Telegraph article, or are you saying you read the full text of the research article? This appears to be the full text http://bit.ly/ibiuaq

Most if's way too chemically technical for me to even try to read but it seems to be reporting a sedative effect via potentiation of hypothalamus B1 GABA pathways related to alertness.

2) Do you mean there's no studies finding evidence of sedative properties of Jasmine, or there are studies which examined it and found no sedative properties? Because this is an interesting study which unlike some previous studies actually found no effect of an essential oil on dental anxiety but actually concludes it might relate in part to the context - i.e. a small waiting room vs a big hectic one. And it also says: http://bit.ly/fMHwfn

"Evidence for the anxiolytic effects of inhalation of pleasant scents like essential oils is provided by studies [long list of citations re animal & human]...The odors of jasmine tea and lavender significantly decrease heart rate, and induce calm and vigorous mood states (Kuroda et al. 2005)" Though also reports some negative findigns re. fragrances and that might be better for moderate than extremes of anxiety.


1) Interesting that you take essential oils seriously when it comes to evidence of possible adverse effects then, but not evidence of possible benefits. But actually your claim about the side-effects being the same, doesn't seem to take into account that according to the Hatt article the two routes affect GABA via different receptor types. And this informal report of an animal study http://bit.ly/faEJ7Q reports "Side effects of Xanax® are most likely an extension of the pharmacological activity of alprazolam including sleepiness, memory problems and blurred vision in patients. In addition, Xanax® has been known to be habit-forming. Withdrawal symptoms may occur if treatment is discontinued
abruptly. On the contrary, the essential oil has reduced anxiety
in mice without generating side effects in previous reports."

This study seems to be suggesting antidepressant effects of some essential oils via dopamine pathways http://bit.ly/elmCmu


Finally, a 2009 psychiatric review "Aromatherapy Facts and Fictions: A Scientific Analysis..." concludes in the abstract that "From this review, 18 studies meeting stringent empirical criteria were then analyzed in detail and it was found that credible evidence that odors can affect mood, physiology and behavior exists." http://bit.ly/fAlWRn

pj said...

1) I couldn't get the full article but it didn't seem to address the claims made in the news story. Looking at the full paper (thanks) it still doesn't contain any discussion of inhaling the compounds or any effect on whole animals (in vivo) - sniffing a benzodiazepine won't have any effect and that is also a GABA agonist in vitro. It also, in fact, does not mention Jasmine at all, only '[1,3]-dioxane derivatives'.

And you can't claim no side-effects for Jasmine (I note your poster presentation that you think shows essential oils have no side-effects is about neroli oil and a study in gerbils) as it would be inconceivable that it had a GABA agonist activity without side-effects (i.e. either it has no side-effects and doesn't work or it does work but inevitably has side-effects - just like every other drug). Of course, currently, there's no evidence it either (a) gets into the brain, (b) has a GABA agonist activity if it does, (c) has any significant clinical effect in humans (or any side-effects), and (d) even if it was relaxing (and I'm not massively hung up on whether it is or not) it would tell us nothing about whether it helps depression.

2) I was saying previous studies have found no effect.

Anonymous said...

I didn't claim essential oils have no side effects, you stated that they would be the SAME as benzos if they affected GABA pathways in the way that Professor Hatt described to the Telegraph.

I'm not necessarily an aromatherapy advocate I've just been learning about these specific issues since you brought it up. But the ironic thing here is that the blog post we're originally commenting on shows that the scientific clinical evidence isn't necessarily what's driving antidepressant prescribing behaviour anyway, whatever the hardline rhetoric and regardless of who GPs blame for their own actions.

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Anonymous said...

I came here after Googling about antidepressants as a patient and found it very interesting. There are a lot of mixed messages out there about medication. I don't know whether the author is in the uk or the US but it strikes me that in the UK where I am we desperately need more easily accessible alternatives to medication. I have been advised not to try any more by the doc after trying a large number of them over 14 years (they were used in the treatment of anorexia, bulimia, agoraphobia, panic disorder, etc for me so perhaps they are not really well suited to this disorders, as the author notes).

There is definitely an area where people can see little or no relief from antidepressants and mood stabilisers but where a mental disturbance has still taken significant control over their lives. I'd welcome a review into the waiting list for and choice of therapy available on the NHS, and better evaluation of a person's mental state and best course of treatment, as it seems everybody from those with very severe depression and those with - as the author suggests - possibly normal emotions are put together in the same system, which just gets clogged up. Everybody should be offered therapy if they ask for it (probably better than pills in some cases), but perhaps different waiting lists depending on functional damage? I don't know how much funding and research is being put into this but I've long thought more emphasis on therapy rather than meds would be cheaper in the long run since so many of us stay in the system effectively untreated for years/decades.