Comments on: Treating Depression: Is there a placebo effect?
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- The research reported in the 60 Minutes segment on the effects of placebos vs. antidepressants would more than likely have been performed using statistical analysis based on data from all subjects grouped together under each condition. In other words, improvements in mood following medication or placebo for each individual would have been combined with all other individual data in each condition prior to statistical analysis.
It is possible, therefore, that overall results did not represent the actual data of ANY ONE particular subject in the study. There are patients who respond with highly clinically significant improvement following treatment with antidepressants. There are patients who have no response whatsoever. Some respond with only mild success. Antidepressants have NEVER been regarded as "one size fits all".
When research with clinical topics such as depression bases conclusions on comparisons of subjects exposed to different variables, these conclusions are usually derived from data combining all individual results. The results of exposure to one variable vs. another on any one subject is therefore lost. In other words, it is possible that for a minority of subjects the medication was far more effective than a placebo. In that case, data would have been masked as a result of combining and averaging with the other subjects.
Treatment of depression is a process, not only in psychotherapy, but also when medication is used. The physician attempts to match patient characteristics with a particular drug. Subsequent changes are evaluated, and one of the following events occurs: it is continued without change, it is discontinued, dosage is manipulated, another drug is added, or the drug is changed to another one. This process could continue for years, since patients' needs change, drug effectiveness often changes over time, and potentially more effective drugs become available. In view of this ongoing process, It would be difficult, if not impossible, to evaluate the results of medication over a short period of time.
The conclusions of the study have the potential to discourage depressed persons from seeking medical treatment and to decrease the confidence that existing patients have in treatment. The "60 Minutes"segment represents irresponsible and potentially dangerous reporting. - Reply to this comment
- I felt I had to say something about techniques that I felt as a patient. Ascendin is well know. It can make you euphoric. This level when you add other anti-psychotic medication can make people very absent. Driving impairment. But I heard, or realize, the new base medications can have other leveling effects. A patient may suffer an embarrassing moment on these prescriptions. Old advice on Downs Syndrome patients was the need to have Special Ability persons be responsible in state to the affects. It seems cruel to me to make promises.
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- Shame on 60 Minutes.
There are studies in which possibility of "placebo effect" was eliminated, such as patients who experienced NO IMPROVEMENT with first drug/drug combo, NO IMPROVEMENT with second drug/drug combo, & experienced VAST IMPROVEMENT with third drug/drug combo.
Is Kirsch going to claim patients play placebo games?? - Reply to this comment
- I WATCHED THIS EPISODE LAST NIGHT AND WAS ASTONISHED BY THE COMMENTS MADE BY THIS CLINICAL PSYCHOLOGIST. DOES HE HAVE HIS DOCTORATE? I AM A FAMILY PHYSICIAN OF MORE THAN 24 YEARS AND TOTALLY DISAGREE WITH HIM. DEPRESSION IS A MEDICAL ILLNESS LIKE ANY OTHER DISEASE AND MUST BE TREATED AS SUCH. WHAT HE SAID WILL HAVE A NEGATIVE EFFECT ON THE PUBLIC. SOME WILL STOP THEIR MEDICATIONS AND SOME WILL NEVER GO TO THE DOCTOR TO GET MEDICATION. HE MADE IT SOUND LIKE DEPRESSION IS SOMETHING THAT PEOPLE CAN CONTROL WITHOUT MEDICATION. SOMETIMES THIS IS TRUE AND COGNITIVE THERAPY AND PSYCHOTHERAOY WORK WELL BUT NOT ALWAYS. I ONCE HAD A PATIENT THAT SAID HE WOULD RATHER HAVE CANCER THAN DEPRESSION BECAUSE PEOPLE ARE MORE ACCEPTING OF THAT DIAGNOSIS AND MORE IS UNDERSTOOD ABOUT CANCER THAN THE BRAIN CHEMISTRY. THAT PATIENT COMMITTED SUICIDE BY HANGING HIMSELF IN THE BASEMENT OF HIS HOME AND WAS FOUND BY HIS WIFE. I WOULD LIKE ONE DAY TO BE INTERVIEWED ON 60 MINUTES TO TELL MY TRUE STORIES ABOUT REAL PATIENTS WITH MENTAL ILLNESS. IF ONLY WE ALL SAW IT AS A MEDICAL ILLNESS AND IT WERE TREATED APPROPRIATELY THERE WOULD BE LESS MURDERING AND RAPING ON THE STREETS. I THOUGHT THAT CONGRESSWOMAN GABBY GIFFORD WOULD HAVE GOTTEN MORE INVOLVED WITH MENTAL ILLNESS AND CHANGED THE LAWS SO WE COULD MORE EASILY COMMITT THESE MENTALLY ILL PEOPLE FOR THEIR SAKE AND THE PUBLIC SAKE. I WOULD LIKE TO TAKE THIS CHALLENGE TO CHANGE THE LAWS. I HOPE YOU GIVE ME THE OPPORTUNITY TO SPEAK ONE DAY ON 60 MINUTES. THANK YOU FOR READING MY COMMENTS. DR. BONNIE LEVIN
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- Want to see Big Pharma in action? Just read the glowing posts of the benefits of these harmful drugs. Look close at the wording; these are paid, professional writers.
This doctor isn't doing this research at Nebraska Teachers School. He's from Harvard. The biggest con in America is Big Pharma. They write the papers that a Dr, signs to get the fake information published in medical journals, they have moved testing from the medical schools to private testing companies to allow the disposal of the documented side effects.
Next time you are in Starbucks and you are watching a well dressed salesperson making an $80 purchase, ask them about the morning party they are throwing. At a fancy lunch place and see a $300 order of catered food picked up? Yep....it's a drug salesperson, on their way to bribe a customer.
If there anything that needs to be stopped in the business of medicine and heath care, it's these type companies who prey upon the human condition and then bill insurance companies an outrageous fee for the latest blockbuster.
The entire business, from the doctors to the pill pushers is just one more Mafia like business that is allowed to flourish, generally aided by their enablers in Congress.
So interesting...once the Mafia was essentially broken, look what happened. Banks, mortgage companies, Big Pharma, Big oil and more have taken their place. 10,000 Al Capones could equal the destruction these businesses have brought upon the American public - Reply to this comment
- If a placebo were as effective as an anti-depressant, then how would you explain why an individual often tries several anti-depressants before the one that is effective---that actually turns a life around? There will always be people whose conditions improve even when they take a placebo.
To quote from the transcript:
"Kirsch: If they were mildly or moderately depressed, you don't see any real difference at all. The only place where you get a clinically meaningful difference is at these very extreme levels of depression."
How can a medication be effective ONLY at extreme levels of an illness, while theorizing that it's no better than a placebo at the less serious levels? If the mechanism of action is not actually known, then how could one put forth that it works only at certain levels of a condition? - Reply to this comment
- Question: Has Dr. Kirshner ever suffered from depression? It is easy to look at data and intepret it into something that makes for a good book. However, like most things, it's seem purely subjective.
If Dr. Kirshner wants to review some data, take a look at these numbers: 90% OF PEOPLE IN THE U.S. WHO COMMIT SUICIDE SUFFER FROM A UNTREATED MENTAL ILLNESS. In the U.S. Suicide is the second leading cause of death among college students, the third leading cause of death among 15-24 year olds. More people die from suicide than homicide; suicide ranks 11, homicide 13.
Personally, until I started taking medication - I was unable to function normally and at many times in my life had suicidal thoughts. I have an excellent psychiatrist who monitors the medication closely and combines with therapy. If I miss one or more medications for a week, there is a significant different in the way that I feel.
...And even more interesting, there is a significant family history of depression on my mother's side of family. I also have nothing in my life to be depressed about. I have a loving husband and family, a comfortable home and very little stress. Can you explain why then doctor why without my medication, I want to drive off a bridge?
So like many of the others on this string of comments, your theory on paper may look good, it may get people talking, but in reality, but you are hurting the people who could really benefit, like me and others here. - Reply to this comment
- I agree with the Doctor. There are many effective ways to defeat depression, panic and anxiety naturally. We just don't often hear about them. No one thought I could do it but I've overcome my diagnosis of Bipolar I using a few simple methods, and am now off therapeutic doses of medications entirely. I just take a simple sub-therapeutic dose of the mineral Lithium and have decreased it to the point of a trace mineral with no-side effects (and have added the potential benefit of increased brain cell tissue).
Yes, drugs can be helpful when we need them to become balanced, but we must not count on them therapeutic stregnth for any legnth of time as they can have debilitating effects in the long run. Often our brain chemistry becomes compromised through environmental factors and nutritional deficiencies among other factors (many out of our direct control). We also need to retrain our thinking. This is where Recovery International becomes an invaluable tool (www.reoveryinternational.org).
Educate yourself! Recovery International, nutritional changes and detoxification (as well as a handful of other helpful natural methods) healed my depression, axiety, panic, hallucinations, agoraphobia and other symptoms including detachment from reality. They are gone: www.beauty-and-body.com/stress-relief - Reply to this comment
- Dr. Kirsch's study proved that the placebo effect is alive and well. What it did not prove is that the 4 out of 5 [let's say for simplification] who took the meds would feel just as well on a placebo. This is the problem with news coverage of scientific data. One does not prove the other; it is a logical fallacy. You would have to take the 4 out of 5 on meds and run a separate study. Dr. Kirsch's theory was to prove the placebo effect; it was not to show that these meds are routinely prescribed and ineffective.
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- Dr. Kirsch: I find your theorizing depressing. For over 15 years I have battled depression, my psychiatrists searching for the most effective pharmaceutical "cocktail" to keep me here on this earth. Yes, many SSRI's didn't work, was it because only 2 of 12 drug trials found them effective? We are talking about an organ that is illusive, the brain, and mostly capable of subjective study only. Try listening to your patients who may be relapsing after 2 years. And please, define mild, moderate and severe depression for all of the viewers. I, for one, am a product of good medication management combined with other therapies. I have stopped the medications and have relapsed in weeks to a month.
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