However, the problem I am alluding to is this. Studies of depression have long found that over periods of several months (the amount of time people often try out a new antidepressant) about 1/3 of sufferers get worse, a 1/3 get better and 1/3 stay the same (very roughly). Thus it should make us suspicious of the efficacy of these drugs if practioners tell us (contrary to what we would expect from most theoretical models of how these drugs work) that they have to try many of the antidepressants until they ‘hit’ upon the right one for the patient as this is exactly the observed results we would expect from spontaneous remission plus placebo effects. In other words the confidence many practitioners have in thee drugs at first glance might seem compelling until we notice that it look suspiciously like the sort of inference humans are liable to draw in an attempt to explain what are largely spontaneous or poorly understood events. Especially given that similar claims were made for psychoanalysis until they were ultimately debunked (amusingly this was one of Timothy Leary’s big contributions to psychology).

As far as your remarks about alcohol and opiates it’s certainly true that the abuse of these substances can accentuate and worsen depression. However, one has to be careful about the degree of causality to assign to theses agents given the fact that abuse is often something people do in reaction to their underlying unhappiness. Unsurprisingly those who feel like they have nothing to lose and are in great pain are more likely to turn to various drugs. Conversely successful recovery from drug abuse will (from what I’ve seen) often coincide with some improvement in their underlying psychological problem (whether as the result of intervention by drug abuse professionals, self-reflection or simple time). Certainly none of this denies that the abuse plays a role in worsening the situation but separating out the magnitude of the various effects is very hard.

Also it’s important not to confuse the effects of abusive use, with it’s attendant large dosage fluctuations, from medically supervised use. Despite the bad rap that opiates gets those who are given them for postop pain have very very low rates of resultant addiction and studies of medically controlled uses of either weak (codeine) or partial agonists have suggested anti-depressant activity (though one should be skeptical just as I am here). Just because the major opiates are abused to make depression worse doesn’t mean we should rule out opiate derivatives as potential anti-depressants to replace the ineffective ones on the market today.

Whatever might be true about how many people can be helped there are certainly a clear minority who are afflicted with a long term, treatment resistant severe depression. If these people had terminal cancer or AIDS we would be clamoring for treatments, even experimental treatments that imposed other serious risks. When someone is so depressed their life just isn’t worth living and doesn’t improve for many years we should be making risky dangerous interventions like seeing if prescriptions to opiate compounds or adderall or what not will improve their life even though these would be unthinkable risks for the vaguely depressed normal patient.

This is good news because a Swedish study showed that 52% of the 2006 suicides by women on antidepressants. Since antidepressants work no better than placebos and are less effective than exercise in dealing with depression.

There is a prescription drug epidemic and these are leaders in the list of terribe abuses.

Steve Hayes
http://novusdetox.com