Study: Antidepressants, Placebos Near Equally Effective

Commonly Prescribed Antidepressants Had ‘Negligible’ Effect on Patients With Mild, Moderate, Even Severe Depression

By JOE TUZZO and LEE FERRAN

Jan. 6, 2010 —

 A new analysis found that commonly prescribed antidepressants had little effect on people with cases of mild to severe depression compared to those treated with placebos.

 The analysis, published in the Journal of the American Medical Assocation, combined the findings of six different previous studies of two commonly prescribed treatments — paroxetine, similar to common Paxil, Prosac and Zoloft, and imipramine, an older antidepressant drug.

 ”The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial,” the study concluded.

 The findings do not mean that the drugs or the placebos were frivolous for most users, “Good Morning America” chief medical editor Dr. Richard Besser said today. Rather, both the antidepressants and the placebos had a positive effect on the patients.

 ”You hear that headline and you think, ‘Oh, my God, there is nothing out there that works for depression,” Besser said. “The study actually found the exact opposite; that both placebo and medications were extremely effective at treating mild to moderate depression. What you can’t tell from this study is what else is going on. Were these individuals getting what is most effective, which is talk therapy?”

 The analysis included a pool of 434 patients from the antidepressant group and 284 patients in the placebo group.

 Dr. Gary Kennedy, a professor of psychiatry and behavioral science at Montefiore Medical Center, Albert Einstein College of Medicine, said that analysis seemed logical, but was cautious of its conclusions.

 ”The finding that more severe depression is more likely to respond to antidepressant medication seems sound,” Kennedy said. “But only six studies were used to generate the conclusion, and three of those studies used an antidepressant that few practicing physicians would prescribe nowadays.

 ”However… This is a major line of enquiry at present and offers the hope that we can prevent severe depression if we could identify the trajectory from minor to major depression,” he said.

 The Value of Therapy and Social Support

One criticism of the study is that by simply participating in the trial, the patients are getting a secondary form of therapy that is not measured: talk therapy.

 ”The most effective thing for mild to moderate depression is being in a therapeutic relationship where they can talk through their problems with someone who is really skilled,” Besser said. “What they found in [the study], and you can’t really tell from this, is that it didn’t really matter the drug. You were getting better if you had this and that should give people hope with mild to moderate depression.”

 Harold Koenig, a professor of psychiatry and behavior sciences at Duke University Medical Center, said the study coordinators are often extremely kind and encouraging of participants to make sure they comply with the study.

 ”This is basically providing supportive therapy, and supportive therapy is very effective in mild to moderate depressions,” Koenig said.

 Several experts told “Good Morning America” that antidepressants are often prescribed to those with mild to moderate depression when proper therapy or interpersonal support is lacking.

 ”Consumers should understand that with mild or moderate depression, the ideal treatment must include talk therapy, ideally either cognitive-behavioral or interpersonal psychotherapy,” said Dr. Ken Robbins, clinical professor of Psychiatry at the University of Wisconsin in Madison. “In addition, if antidepressants are to be used, it is best if they are prescribed by someone who has training and experience in the most up-to-date use of these medications.”

 Copyright © 2010 ABC News Internet Ventures

What is your conflict style?

So are you a flighter or fighter?  Problems or challenges come our way and we often find ourselves falling into one camp or the other.  During the middle of the conflict we wish that we were the other style.  Or worse yet, the problem involves the other style.  We all have over learned behaviors of flighting or fighting.  I

The flighter – A conflict ensues and you feel a knot in your stomach, a dry throat, a quivering voice and start to shut down while looking for the nearest exit.   The flighter negotiates with herself that the problem isn’t that important so you will let it go or it is important but you will figure out some other way to deal with the issue or you will just agree with this person to avoid any waves.  After the interaction, while alone, you come up with many great comebacks and responses and wish you could have uttered these during the discussion.  You wonder why people are so selfish and don’t think about or see your needs.

Common myths and fears of the flighter:

• You are a conflict phobic
• You believe that people who love each other should never fight or argue
• You believe anger, conflict and disagreements should be avoided at all costs
• There is nothing that can be gained in conflict and you will be hurt in the process
• You have to meet everyone else’s needs
• You feel like you have to get along with everyone

The Fighter – You just can’t believe what people do and say sometimes.  If you don’t let others know how you feel they might take advantage of you.  They shouldn’t disagree with you as you know the answer on this issue!  People often make you frustrated.  You give people a piece of your mind when they deserve it.  You know what you want and insist on it, even if it means having to get angry.  You will keep addressing the problem until people pay attention.

Common myths and fears of the fighter:

• You have strong ideas and beliefs about how things should be
• You are acutely aware of how others should behave and can see right and wrong behaviors
• When others respond in a way that is different than your beliefs, you quickly address the situation
• You like to be in control of situations and will apply pressure to gain more control
• You believe that you are innocent and others are to blame
• You wish people would think, feel and behave the way you expect

 Become Emotionally Intelligent

Take a look at the effects of both styles.  Are you a flighter, fighter or both?  What physical symptoms do you experience when you are flighting or fighting?  Do these styles lead to other negative emotions (i.e., anxiety, being down on oneself or depression)?  Do you find resolution to your conflict with others?

Being in touch with your feelings will help you improve the way you address conflict.  For each style it is critical to identify your emotions, express them in an assertive way and negotiate conflicting needs.  Describe what you are feeling.  State your needs into words that are clear and request specific change.  Determine how you value relationships and people.  Often being a flighter or a fighter diminishes your own self respect or the self respect of others. 

Managing your Style

Learn new methods of dealing with conflict.  Remember that practice makes perfect.  That is why it is so important to develop a plan with identified strategies and have someone coach you through the steps. 

 Flighter

• Identify your needs.  What do you want in specific behavioral change?  First articulate your need to yourself, then to the other person. 
• Address the fearful thoughts that keep you frozen.  Your thoughts can scare you into aversive strategies.  Write down your fear and the evidence for and against.   Write down a plan including skills and resources if your feared scenario comes true.
• Address your physiology by creating states of relaxation which can include doing mindfulness training, progressive relaxation, deep breathing or explore some of the energy therapies. 
• Address your behavior by being proactive in starting the conversation about the problem and setting a structure for the conversation. 
• Practice writing down scripts and scenarios of the conversation and practice this prior to the conversation.  Better yet practice it with someone.  Keep the notes present when addressing the problem.  If you get to anxious take a time out and come back to the problem once you have calmed yourself. 

 Fighter

• Describe the behaviors that anger you.
• Identify your automatic destructive thoughts.  These beliefs are often evidenced by should statements.  Monitor your thoughts to see if they are righteously indignant, blaming the other person and criticizing. 
• Practice expressing how you feel without “you” statements.  Also, remove criticism from your statements.  This creates defensiveness in others.
• Notice your tone of voice and when it raises try to bring it back to a normal state.
• State what you want to happen and what you are willing to do.
• Notice when you are escalated and take a break to reduce the intensity.
• Find the understandable part of what the other person is saying

There is not a quick fix, yet there is a way out using effective approaches.  It is often easy to read books about what to do when we are calm, yet this advice is often difficult to replicate when we are faced with a conflict.  We often just want to stop encountering people that trigger this response or we want to flip a switch and respond differently.  Rather than getting lost in these fantasies, try taking a new direction in addressing conflict.