Antidepressants = placebo effect

Check this out on 60 minutes. Quite jaw-dropping really and makes me wonder what the hell really does work!

http://www.cbsnews.com/video/watch/?id=7399362n&tag=cbsnewsMainColumnArea.8

Scott

This is certainly controversial. This is my two cents regarding this information. I don’t 100% agree with this Dr. I do believe that Anti-Depressants affect our brain chemistry to some degree, how much? No one really knows. I don’t completely disagree with him either, as he pointed out placebo’s work. The mind is a very powerful thing. So if we believe the medication is working and it helps then placebo effect is just fine. What concerns me is how many people are experiencing placebo effect and then hear this kind of information and then the placebo effect is no longer effective for them. Does that make sense?

Also, Harvard Dr.'s, John’s Hopkins Dr,'s, Duke Dr.'s etc. as we all WELL know, can be, and often times are wrong. Only God know’s what’s really going on in our brains.

If you think and Antidepressant is working for you it IS. One way or another (which is pretty much what this Dr. is saying).

Maybe anti-depressants help MAV and not depression. That’s my hope :slight_smile:

I guess they are still relatively new in the history of meds so a lot is to be seen with how they really work and big pharma has a lot of pull these days to convince us of how effective they really are!

This guy concludes that antidepressants do work better than placebos for severe depression. It’s the mild to moderate cases where he found no difference. It makes sense to try non-medication approaches first (exercise, increasing socializing, enjoyable activities, talk therapy, etc) before jumping into antidepressant therapy if you have mild to moderate depression.

:shock: I watched this through to the end and all the drs. on there were agreeing that the anti depressents only worked for severe depression and only minimally on mild to moderate depression. My GP has just given me nortriptyline and says it is used in low amounts for migraine and a lot higher amounts to treat depression. If anti depressents dont affect mood etc. why did those people commit suicide whilst on the SSRIs? and why did amitryptiline in very small dose make me really depressed for a week until I came off it? I just feel really confused now. I wonder how this fits in with the findings of the neurogenesis and low serotonin where they are saying that low serotonin is not the cause of depression (see my post in “The Lounge”). And why is it that anti depressents can actually make people more depressed? This raises so many questions?

Christine

Christine, people who are severely depressed are often suicidal but LACK THE ENERGY to carry it out. Picture someone who barely cares for their own hygiene, who stays in pajamas most of the time, etc - they are so lethargic that even when they think about killing themselves, they can’t summon up the energy to follow through. Just like when they think about brushing their teeth or putting on clothes for the day - not enough energy. But when they start on an antidepressant, they start to improve, they start to rev up a bit. They don’t become “undepressed” all at once - they start progressing upward, in terms of mood and energy level and activities of daily living. They start brushing their teeth, getting dressed - and if they had thought about suicide, they start to have energy enough to gather the things they need to carry it out. They’re still severely depressed, but not at the bottom of the tank like they were - they’re starting to emerge, having risen just above the bottom, but still in a very bad place. That’s why severely depressed people need very close monitoring when they’re in treatment.

These meds don’t usually make people depressed. A small percentage of people get what’s called a “paradoxical” reaction (where a medication causes more of the problem it’s supposed to treat) - that may be what you had. Some people who take anti-anxiety medications become more anxious when they take them. Not a lot of people, but it happens.

Scott,

Interesting topic. I had the reverse placebo effect happen to me. When I ended up in the hospital because of my dizziness, I was so down and out and scared that I’d never be able to walk again. They loaded me up with valium in there and it did not make a difference at all. I was so worried that I’d never be able to walk again that even the valium made no difference. Once I realized what was going on and nothing seriously was wrong with me, things like alcohol (which I think is somewhat like a benzo) made my symptoms disappear! So I think the fact that I was so distraught at the time, even the valium didn’t help me any, but I know if I were to take it now, I’d be nearly symptomless.

Greg

It’s a tough one to get my head around. Every time I’ve tried to come off an SSRI permanently my head goes into a migraine meltdown about 5-6 weeks after I am on no drug. This has occurred like clockwork at least 5 times over the years.

So does it apply to migraine as well? Probably does if we took a wide sample of studies on this (for which there are few on SSRIs and migraine).

I’d like to see what happens if someone switched my drugs for an exact sugar pill replicate without me knowing. I would bet the farm that I’d fall apart but … maybe I’m wrong.

Pretty hard to dispute the evidence presented by 60 minutes. It’s pretty obvious that all of us underestimate the placebo effect.

Scott

Having had panic disorder for 30 years I know anti-depressants kept me from going to the nut house. There is no placebo effect about it. In the 80s I took Ami even though it included side effects I put up with them as there wasn’t a choice. I had Prozac in the early 90’s until it just stopped working at one point and changed to Paxil. The results didn’t happen right away…it took time. I have changes when I have skipped a dose (and didn’t realize it until later so no mind game there). I’ve not had depression so can’t speak to that. I’ve seen many demented patients of mine that have no idea what they are taking have improvement in their depression and it is certain they aren’t having a placebo effect.

Scott

Your body is used to being on that drug so when you go off it, your head go,s into over drive.
That’s precisely why l am cautious to start anything in the first place. Does there ever come a time to say enough drugs? In other words when is there an end insight? For me it just seems like a temporary fix, which is very reasonable when your desperate and very unwell and interferes with your everyday life, but if you can get out of not taking anything and trying everything else first then at least you can say everything has been tried. But what l worry about is that too many people rely on these drugs as a quick fix without trying all things thoroughly. I know you have tried everything, but have you tried to stay of the meds for longer than 5-6 weeks to see if you head settles?
Could it be a rebound effect? Does it mean you have to stay on the meds forever?
:smiley:
Sue

Hi Sue

I don’t believe the meds are a temporary fix; rather, they stop a migraine brain – a brain which is genetically predisposed to being a diva as Carolyn Bernstein puts it – from going nuts. As an analogy, I don’t think this differs a whole lot from diabetes. A person with type 2 diabetes (assuming they’re on a good diet and not overweight which has not reversed the problem) will need a medication to increase their insulin sensitivity … or if really advanced, insulin injections. You could not say that was a temporary fix. It’s a necessary fix. For some of us with really nasty genetically-programmed migraine brains I think the same holds. You can do the best you can with lifestyle and eating well, sleeping well etc, but for a large chunk of us, the symptoms will not go until a medicines intervention happens. Some lucky ones go on meds for a while then come off and are good for a year (rare) only to see the whole thing come roaring back again.

You are correct though that for many, they should first try a migraine lifestyle first to see if that gives sufficient control. If not then it’s meds.

At the 5-6 week mark visual vertigo goes off the charts for me, my head hurts like crazy and I stop being able to function properly – namely at work. So, unfortunately, it’s not an option at this point. I haven’t seen anything to indicate that I would feel any better if I tried to white knuckle it after 6 weeks. The opposite has played out where I spiral downward. It’s a bummer.

S

I agree Scott. The meds are not a temporary fix and are absolutely necessary if lifestyle changes, trigger elimination, diet etc do not bring the Migraine brain under some sort of control.

It’s just a shame so many of us waste a ton of time and money on all these ‘natural’ remedies, which quite frankly, dont even poke a hole.

All I know is, I would be a vegetable if it weren’t for meds. I dont care if I have to stay on them for life, I’m not going back there. :expressionless:

With depression and migraine, severity is key. Many of us couldn’t function without medication - I was to the point where I was starting to question if I should be getting behind the wheel of a car, since I was sometimes having tunnel vision auras when I’d have my worst dizzy spells. Fortunately, I never had one while driving - but what if?

Many people in the mental health field wish that some conditions like clinically significant depression could be renamed so that there would be a lot less stigma and a lot less confusion: watching a sad TV show and reacting to that is not the same as the chemical imbalance that occurs in what is now called major depressive disorder. Some have suggested “negativity disorder” because some people don’t even report feeling “depressed” at all - some say they feel “empty,” some say they just don’t care about anything, men especially can become very irritable - there’s a range of negative mood changes that may or may not include feeling depressed, accompanied by an impact on social or occupational functioning.

Lots of brain disorders respond to diet and lifestyle changes, so it makes sense to look at diet, sleep, stress management, work/life balance, etc. no matter what severity your condition. These things may be sufficient for mild cases, and may augment the effect of medication in more severe cases; I believe in and continue to work on these things.

But I’d have been a mess without my Topamax. :shock:

— Begin quote from “maryalice”

But I’d have been a mess without my Topamax. :shock:

— End quote

I love pills. Love, love, love them. Brain candy. :shock:

— Begin quote from “Muppo”

I love pills. Love, love, love them. Brain candy. :shock:

— End quote

I’m with you, better living through chemistry :lol:

Muppo- not everyone is as affected as you and we are all different. For me vitamin B2 works somewhat, well enough to get me through the bad days. So l wouldn’t discount natural remedies altogether. My neuro suggested l take the B2 and it helped me. Not to say it will help everyone else out there, but at least l think it’s wise to try the natural remedies first and other treatments before meds.
Some people are either that bad they need the meds instantly, or just can,t be bothered enought try a few, or simply just don,t trust they will work. For you the natural remedies didn’t work, but how do you know for others it won,t work?

Sue :smiley:

Hi Sue,

I think what Mupp was referring to (correct me if I’m wrong Mupp) is that apart from the evidence-based vitamins and minerals (B2, CoQ10 and magnesium) most if not all of the others have no effect – and there is no evidence supporting their use either. The evidence for fever few is very weak for example. I know of not one person in 9 years of forum life whose migraine condition was managed successfully from so-called alternative therapies and treatments for more than a few days (acupuncture for example).

There’s absolutely no point in using the word “natural” for vitamins and minerals. It does not in any way guarantee added safety nor does it mean a person will escape side effects. At the end of the day they all have active ingredients and all are medicines that come with potential side effects, more so for a migraineur.

Glad to hear B2 is giving you some good results. According to the science literature it should reduce frequency and intensity of migraine activity in those who get a benefit from it.

Cheers S 8)

— Begin quote from “shezian”

Muppo- not everyone is as affected as you and we are all different. For me vitamin B2 works somewhat, well enough to get me through the bad days. So l wouldn’t discount natural remedies altogether. My neuro suggested l take the B2 and it helped me. Not to say it will help everyone else out there, but at least l think it’s wise to try the natural remedies first and other treatments before meds.
Some people are either that bad they need the meds instantly, or just can,t be bothered enought try a few, or simply just don,t trust they will work. For you the natural remedies didn’t work, but how do you know for others it won,t work?

— End quote

Thanks Scott for your post and yes you’re right. Sue I’m sorry, ‘natural’ is a generalistic term which holds virtually no weight anymore since you can label just about anything as ‘natural’. I have to laugh when I read the igredients list of ‘natural’ products and think ‘since when did so many natural ingredients come with E numbers?’ :shock: Most people on this forum are or have been seriously ill and need serious intervention to help them overcome the trauma of MAV. Natural remedies aren’t going to cut the mustard.

If somone has a distrust that meds - or anything for that matter - will work for them, then that is a shame as it will probably only serve to prolong the agony they’re already in. If you dont have trust, how can you hope to overcome anything? I’m sorry, I dont agree with what you say about the natural angle at all but if you’re getting your life back with B2, which is proven to help Migraine, then great. You are actually taking something that is evidence based to work for migraine. So what is the difference between that and a prescribed med? They’ll either work or they wont and both have ingredients that can cause side effects. The only difference is you can buy one straight off the shelf.

Good luck.

It’s not that l distrust meds it’s just after reading these messages boards l have realised that a lot of people actually struggle to find the pill that suits them, which kind of puts me off trying them. Believe me if l ever get as bad as what l was last year, l will have to take some kind of meds, l just couldn’t,t survive. So l completely understand the reasons why people take them. Luckily for me it’s intermittent. I have an entire box of Valium in my cupboard, l have been very close to taking one on occasion but never have, as l was able to get through it, it’s not to say l won,t next time. You see so many people are very afraid of taking meds, it’s not uncommon at all to have anxiety over taking meds, as the anxiety is already high from MAV, it just makes th prospect of taking the med so much harder, as the frame of mind is all loopy. It’s a difficult thing to understand if you have never had any kind of issue it’s taking meds, but for some of us, it’s frightening to take that first med.

I took a Valium when l flew twice last year and l still fail to understand how this will help my dizziness when it returns. It won,t get rid of the dizziness, it will only make me more relaxed, which is a good thing, but it doesn’t help with the main problem. The Valium actually made me dizzy and depessed as it wore off.

Sue :smiley:

— Begin quote from “shezian”

It’s a difficult thing to understand if you have never had any kind of issue it’s taking meds, but for some of us, it’s frightening to take that first med.

I took a Valium when l flew twice last year and l still fail to understand how this will help my dizziness when it returns. It won,t get rid of the dizziness, it will only make me more relaxed, which is a good thing, but it doesn’t help with the main problem. The Valium actually made me dizzy and depessed as it wore off.
Sue :smiley:

— End quote

That’s a good point about the issue of anxiety and taking meds - I for one truly do not understand it. But I grew up in a home where two granparents were doctors and my parents were born in an age where medicine was considered an absolute godsend (that makes them sound about 150 years old but you get my drift) - they’d seen people with polio, suffered through dental work with little or no anaesthesia etc etc.

I’m the opposite - I’ll tough it out for a while but if things don’t resolve on their own pretty quick smart it’s straight to the medicine cabinet for me! Life’s too short to suffer IMO. And I have been in such utter, awful misery with migraine for days, weeks, months at a stretch that I would have taken ANY medicine if a doctor told me it would help - no side effects could ever compare. My brother once told me to ‘just meditate’ and if he’d been there in person rather than on the phone I would have punched him in the face. :lol:

As for the Valium - when in full throttle the migraine brain is a jangling mess and everything is haywire, which in turn increases anxiety levels. The Valium just calms all of that down.