37. SSRI Antidepressants Are No Better Than Placebo, Says JAMA
Off SSRI Anti-Depressant Drugs
Left Image: Sad Face Icon, courtesy of Tango Desktop Project and Wikimedia
A study published in JAMA on Jan 5, 2010 reported
that SSRI antidepressants are no better than placebo for most cases of
depression.(1) The authors reviewed 30 years of data and concluded that:
"the benefit of antidepressant medication
compared with placebo may be minimal or nonexistent in patients with mild or
this is old news, and reminds me of the famous scene in 1942 film, Casablanca
starring Humphrey Bogart and Ingrid Bergman where the game is always
rigged. When Rick asks, “why is the casino being closed down”? The French Captain replies with the famous
line: " I am Shocked, Shocked ... to
find gambling here....Here are your winnings... Oh thank you." You must see the video clip on You Tube. (12)
than Placebo for Severe Depression
I should add that the study found SSRI
antidepressants work better than placebo for severe depression. This is not surprising, since virtually any
psycho-stimulant can be found useful for the most severely depressed
Depression Really a Medical Disease?
Medically speaking, the term "Depression"
is a vague constellation of feelings and symptoms scored by a questionnaire
called the Hamilton Depression Score.
There are a number of handy on-line tools for taking the Hamilton
Depression Score Questionnaire. For the
short 17-item version of the Hamilton questionnaire, scores can range from 0 to
54. Hamilton scores between 0 and 6 are
normal. Scores between 7 and 17 indicate
mild depression, scores between 18 and 24 indicate moderate depression, and
scores over 24 indicate severe depression.
According to the Jan 5 JAMA study, if the Hamilton score is less than
24, then placebo is just as effective as SSRI antidepressant drugs. That means the SSRI drug is as effective as a
sugar pill called a placebo.
Depression Score Questions (short version):
you sad, hopeless, helpless, worthless?
Feeling of Guilt
you have feelings of guilt, or self reproach?
you have Suicide ideas, gestures or attempts?
you have difficulty falling asleep, staying asleep?
Work and Activities
you have thoughts and feelings of fatigue or weakness? related to
activities, or decreased or stopped
activities or working because of present illness?
you have Slowness of thought and speech; Do you have difficulty
concentrating; slow movements?
you have Fidgeting, Playing with
hands, hair, etc, Moving about, can't
sit still. Hand ringing, nail biting,
hair-pulling, biting of lips etc?
you have tension and irritability, Worrying,
Apprehension, Fears expressed?
you have dry mouth, wind, indigestion, diarrhea, cramps, belching. -
Cardio-vascular : palpitations, headaches. hyperventilation, sighing. Urinary
frequency - Sweating?
SOMATIC SYMPTOMS: GASTROINTESTINAL
you have loss of appetite, require laxatives or medication for bowels, or
medication for gastro-intestinal symptoms?
SOMATIC SYMPTOMS: GENERAL
you have Heaviness in limbs, back or head? Backaches, headache, muscle aches.
Loss of energy and fatigability?
you have loss of libido, menstrual disturbances?
you have preoccupation with your
LOSS OF WEIGHT
you have weight loss from depression?
or denies being depressed ?
Overlapping Symptoms- Is it Really Depression?
As is obvious, many of these feelings or symptoms
are somewhat subjective and rather vague, so depression scoring is not an exact
science and can be manipulated according to the agenda of the research or
questioner. As you can see, many of these Hamilton symptoms overlap with real
medical diseases. For example,
inflammatory bowel disease patients would score positive for the GI symptoms
even though they may not be clinically "depressed". Somatic symptoms of fatigue and muscle pain
may overlap with fibromyalgia and hypothyroid symptoms. Slowness of thought and speech could overlap
with a low thyroid condition or a neurological disorder such as B12
deficiency. Patients in chronic severe
pain contemplating suicide may not necessarily indicate clinical
"depression". Obviously, these
patients need pain relief rather than an SSRI antidepressant.
Imbalance Symptoms Overlap with Many of the Hamilton Symptoms
Many women with hormonal imbalance related to
pre-menopause or post menopausal
transitions will have mood disorders and symptoms which overlap with many of
the symptoms on the Hamilton Depression Score.
For example, estrogen deficiency is a well known cause of anxiety, a
symptom listed on Hamilton Depression Score.
However, it would be a mistake to treat a woman with estrogen deficiency
with an SSRI antidepressant.
The syndrome Premenstrual Dysphoric Disorder is
commonly treated by mainstream physicians with SSRI antidepressants. (39) This is an error, and a practice that should
be halted. These patients would be best
served by treating them with progesterone, the hormone missing in this
disorder. With the Jan 5, 2010 JAMA
article, we now have evidence that Premenstrual Dysphoric Disorder and other
common forms of hormonal imbalance are poorly served by SSRI
antidepressants. Using SSRI's is simply
the wrong way. The benefit of SSRI antidepressants for this group is the same
as the benefit from placebo. Rather than give them SSRI antidepressants, this
group of women with PMS, estrogen deficiency or progesterone deficiency should
be properly evaluated, and then treated with bioidentical hormones to address
their underlying problem. We have noted
considerable success using cyclic natural progesterone in this group of women
with PMS and other hormonal imbalances.
In my opinion, natural progesterone is a far better form of treatment
with none of the adverse side effects associated with SSRI antidepressants.
Side Effects of Antidepressants - Placebos Have NONE
When SSRI antidepressants are found equally effective
compared to placebo, the next question relates to adverse side effects. By definition, placebos have no adverse side
effects. However, this is not true for
SSRI antidepressants which have the following adverse effects: Sexual dysfunction, weight gain and sleep
disturbance are the most troubling adverse effects of SSRI anti-depressant
therapy.(42-44) The most common side effects associated with SSRI
antidepressants are nausea, headache, nervousness, insomnia and sexual
dysfunction. When I examine these
patients in my office, they usually demonstrate dilated pupils and hyperactive
reflexes. The long term SSRI users may
have irreversible neurological changes, and many are simply “burned out” from
chronic over-stimulation of the nervous system.
Antidepressants and Suicide Risk
Another troubling adverse effect of SSRI
antidepressants is increased suicide first reported by Teicher in 1990.(40) According to David Healy’s book, “Let Them
Eat Prozac”, the original clinical trial data was manipulated by moving the
suicide cases from the treatment arm over to the placebo arm of the study.(41) This manipulated data was then submitted to
the FDA who conveniently looked the other way.
This disturbing information was presented at a Cornell University Mar
25, 2009 talk by David Healy which can be seen on a You Tube video.(42)
Army and Military Suicide from SSRIs Antidepressant Use
Another striking finding is the unprecedented
increased suicide rate in the military with widespread use of SSRI's and other
psycho active drugs in the Army. Again
this is a rather sad commentary, and another nail in the coffin for SSRI drugs
as more harmful than helpful.(34-36)
For references and links, see my web site: www.bioidenticalhormones101.com
References for Chapter 37. SSRI
Antidepressants No Better Than Placebo Says JAMA
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Online Hamilton Depression Score. 17- item
version of Questionnaire
On-Line Hamilton rating scale for depression 17 questions
online HMD questionaire - quick score for depression - adjusted for
online HMD questionaire - quick score for depression - classic printable
Casablanca is a 1942 film - Captain Louis Renault. I am shocked — shocked— to
find that gambling is going on in here!
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Author: Dr Dach
Jeffrey Dach MD