Prozac: No better than placebo?

A major new meta-analysis, as reported in The Guardian, makes exactly that claim. The full study, published in the Public Library of Science, is here. And, it’s not just Prozac; another major selective serotonin reuptake inhibitor antidepressant, Paxil, get the same critical nyet, as do two serotonin-norepinephrine reuptake inhibitor antidepressant:

The review breaks new ground because Kirsch and his colleagues have obtained for the first time what they believe is a full set of trial data for four antidepressants.

They requested the full data under freedom of information rules from the Food and Drug Administration, which licenses medicines in the US and requires all data when it makes a decision.

The pattern they saw from the trial results of fluoxetine (Prozac), paroxetine (Seroxat) [Paxil in the U.S.], venlafaxine (Effexor) and nefazodone (Serzone) was consistent.

“Using complete data sets (including unpublished data) and a substantially larger data set of this type than has been previously reported, we find the overall effect of new-generation antidepressant medication is below recommended criteria for clinical significance,” they write.

I think the conclusion is somewhat overstated, and meta-analysis research in general is sometimes overhyped; nonetheless, is this anywhere near bogus? I think the research probably is pretty solid.

In any case, Big Pharma is HUGELY worried and wasted no time to attack.

In adults, however, the depression-beating benefits were thought to outweigh the risks. Since its launch in the US in 1988, some 40 million people have taken Prozac, earning tens of billions of dollars for the manufacturer, Eli Lilly. Although the patent lapsed in 2001, fluoxetine continues to make the company money — it is now the active ingredient in Sarafem, a pill sold by Lilly for premenstrual syndrome.

Eli Lilly was defiant last night. “Extensive scientific and medical experience has demonstrated that fluoxetine is an effective antidepressant,” it said in a statement. “Since its discovery in 1972, fluoxetine has become one of the world's most-studied medicines. Lilly is proud of the difference fluoxetine has made to millions of people living with depression.”

A spokesman for GlaxoSmithKline, which makes Seroxat, said the authors had failed to acknowledge the “very positive” benefits of the treatment and their conclusions were “at odds with what has been seen in actual clinical practice.”

Hey, if you can remarket an antidepressant as another drug, as Lilly did by rebranding Prozac as a pre-menstrual issues drug after its patent expired, you’re going to be dollar-sensitive.

That said, as someone currently on citalopram (generic Celexa), and having run through comments on a post on this on Political Animal, I have a few thoughts.

First, if antidepressants did work BECAUSE they were placebos, why wouldn’t the placebo effect work with the first antidepressant? Why do so many people, unfortunately, try three or four before finding the right one for them?

Second, claiming a “spontaneous remission” for depression, saying that means we can and should go back to pre-drug days, is not just naïve but dangerous. Like a physical illness such as MS that goes into “remission” but then flares up again, depression can do the same.

Finally, we know too little, still, about brain chemistry to know exactly how antidepressants work. Therefore, claiming we know they don’t work is premature, even if that does prove to be the case 20-30 years from now.

Death, death of relationship hopes mean lots of acting out the past week

My mom died two weeks ago yesterday. Emotions over her seem to have punctured me deeply enough to force a more emotional, conscious awareness that a female friend of mine is, not now nor in the foreseeable future, going to be anything more than “just friends.” I like her enough, and she’s attractive enough, that I really want her, and I’m definitely kind of depressed it isn’t going to happen.

So, between the two, I’ve got a shitload of emotions I’ve been trying to stuff… and online porn surfing has been the method of stuffing.

Is lust an emotion?

Would you call lust an “emotion” or a “drive”? In either case, would “revulsion” be its best opposite?

Gurus, authoritarianism and recovery groups — not just an AA phenomenon

For years, beyond its religious emphasis, a major complaint many people have had about Alcoholics Anonymous (and NA), is the idea of “sponsorship.” While the idea of a mentor to help in one’s sobriety, especially if truly voluntarily chosen, may be an idea of worth, in reality, especially with it being a quasi-requirement of AA/NA, it is easily abused.

Predatory-minded sponsors can easily become controlling and manipulative to minds in the midst of trying to clear themselves of the fog of alcohol and/or drugs. Or, people who aren’t official sponsors can do some of this. The predatory nature can come in with sexual manipulation, establishing a power base in a local support group for the sponsor, and more.

Even outside the official sponsorship idea, gurus can set themselves up with new insights on the best way to get clean/sober, etc. And not just inside individual groups.

The name “Clancy” is well known for propagating an entire subset of groups within AA.

Many critics of AA have observed that, sociologically, it’s a place of redemption for people who washed out of their local Lions Club, or something similar.

But, it would seem the problem is related to recovery groups and personalities susceptible to addictions, and not 12-Step models of recovery.

Several examples from the world of “secular recovery” will suffice.

One is Jack Trimpey, founder of Rational Recovery. Trimpey, as though he were the Chief Justice of the Supreme Court of Recovery, has, in essence, declared recovery groups null and void. He has said alcoholics/addicts who continue to go to such groups are, in essence, still weak.

Then, you have Marty Nicolaus, founder of Lifering Secular Recovery, an offshoot of Secular Organizations for Sobriety. LSR ostensibly was founded as a separate recovery organization after a Nicolaus-led lawsuit against SOS over some serious recovery issues, such as “single-substance sobriety,” failed in court.

I’ve talked to enough people in LSR besides Nicolaus to not doubt that SOS needed a fire under it (to which its founder, Jim Christopher didn’t repond), and there were grounds for the lawsuit. However, I’ve also talked enough to people in SOS, and done enough analysis on my own, to know that personality issues, including Nicolaus’ personality, were involved.

And, at the individual meeting level, “control freaks” and other types have popped up in my LSR experience too. This is true for online meetings as well as face-to-face ones.

That said, I reject the idea of “the addictive personality” as many people (often not really addicts) use it. But, to the degree addiction exacerbates personality traits, and less desirable ones in some people, and recovery groups give them a platform to spew this out, this is a worrisome phenomenon.

Binge drinking — long-term aftereffects worse with start at younger ages

A new study shows that binge drinking affects ability to relearn tasks that have to be adjusted; what’s more, it shows that this difficulty, as well as long-term loss of impulse control and related issues, is worse for people who start binging at a younger age.

I AM HUMAN, HEAR ME FEEL

A feeling human,
No emotional cripple;
How could I be that?

If I really were
I couldn’t feel so anxious
Of lacking feeling.

Expressions crippled?
Perhaps; I’ll not deny it.
But feelings still whole.

Yes, my mind emotes;
I am human hear me feel.
I need to believe.

Believe I deserve
To feel the love and anger
And everything else.

Anxiety calls

For the first time in a while, and the first time since moving back to Dallas, I felt like throwing up from anxiety this morning. And, although I did not feel that tired, I definitely did not feel like getting out of bed this morning. I do wonder if I tapered back too much on antidepressants.

I have a couple of emotional issues on my plate, no, ONE emotional issue on my plate, that I'm not dealing with well right now, either.

PLATONISM AS PSYCHOLOGICAL BALM

When I was younger,
I believed in the Platonic ideal.
I especially believed in the ideal of myself;
Perfect, and so, incorporeal.
The Platonic equivalent
Of the Pauline spiritual body.
Why?
Was it a love of Platonic philosophy,
Or rather a Pauline loathing of the physical?
I believe the latter.
Not only had I internalized
Augustinian angst about concupiscence,
I also had been buffeted by childhood slings and arrows.
Bullying by neighborhood acquaintances,
Abuse of various types at home,
Asthma, allergies and other breathing problems,
A bit of a lisp,
Late growth and skinniness.
What shy, quiet, lonely, hurting boy
Wouldn’t harbor Platonic thoughts
As a secret dream of salvation
From the curse and burden of the physical,
Deliverance from a body
That brought nothing but pain?

SSRI Depravity

SSRI deprivation,
Or depravity,
Stabs at my head,
An ice pick to my temple,
Mocking my claims to wholeness.
Modern medicine
Isn’t always so modern.
At times, it seems mental health care
Has advanced but little,
From Paleolithic
To Neolithic,
Maybe Chalcolithic.
The equivalent of Bronze or Iran Age uses
Of tailored treatment
Remain far away,
A PR strategy
From Big Pharma,
A sop to regulators,
To justify
Ever-lessened oversight.

Feeling better

My sister and my best friend both tell me I sound better, on the phone at least, since moving back to Dallas. Another person said the same about me just by sobriety chat room observations online.

I guess I’m more transparent than I might want to admit; sometimes, that’s pretty good. I have cut one of my two antidepressants in half, as I felt lethargic in the mornings, not antsy and sleep-deprived. That was shortly after accepting the job offer to move back here, which I figured had something to do with it.

When my tricyclic runs out, I’ll cut the Celexa in half again a month or so later.