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Anti-depressants and ADHD meds worse than no medication for most patients

Seriously.  I’ve suspected this for years, here’s the hardcore evidence.

Honestly, if you’re depressed the best treatment for everything short of the most severe depression is exercise.  If you don’t want to exercise, get a puppy.  Having someone who is always happy to see you and who needs you is what most people need.

And with luck, going on walks with the puppy will get you started on exercise.  Double win.

Americans in particular, and westerners in general are horrendously overmedicated.   In part I suspect this is simply because American lives, for all the material splendor, suck.  Working 9-5+ overtime + 2 hour commute, always knowing that if you lose your job you’ll lose everything, eating (too much) manufactured food denatured of proper nutrients while not getting enough exercise puts people under constant stress.  Added to that is the strong pressure to act “normal” and to never be seen to be sad or anxious or moody.  Act in unexpected and socially unacceptable ways and pretty soon that job you need, no matter how good you are at it, starts becoming insecure.

So people medicate.  Heavily.  It’s the only way they can get through their lives.  Anti-depressants are more addictive than opiates.  More addictive that cocaine.

But hey, that’s a good business to be in.  For pharma.  Get people hooked on your legal drugs, make the cheap natural stuff (pot and opiates and coca leaves rather than cocaine) illegal, and clean up.

(Some quotes after the jump)

And yet many studies have shown that antidepressants can treat depression, especially in severe cases.

In severe cases, you do see that people benefit from antidepressants, and that shows up consistently. But you still have to raise the question, even in that severe group: What happens to those medicated patients in the long term, compared to what happened in previous times? One thing that surprised me, looking at the epidemiological literature from the pre-antidepressant era, is that even severely depressed, hospitalized patients could with time expect to get well, and most did. Today, however, there’s a high incidence of patients on long-term drug therapy that become chronically ill.

What about stimulants used to treat ADHD. How effective are they?

These stimulants alter behavior in a way that teachers can appreciate. They subdue finger-tapping and disruptive symptoms. But in the 1990s, the National Institute of Mental Health started looking to see if things like Ritalin were benefiting kids with ADHD, and to this day they have no evidence that this drug treatment improves long-term functioning in any domain — the ADHD symptoms, lower delinquency rates, better performance at school, et cetera. Then the NIMH studied whether these drugs provide a long-term benefit, and they found that after three years, being on medication is actually a marker of deterioration. Some patients’ growth has been stunted, their ADHD symptoms have worsened. William Pelham, from the State University of New York at Buffalo and one of the principal investigators in that study, said, “We need to confess to parents that we’ve found no benefit.” None. And we think that with drugs, the benefits should outweigh the risks.

….(On Schizophrenia) If it suddenly announces to the public that a long-term NIMH-funded study found that the 15-year recovery rate for schizophrenia patients was 40 percent for those off meds and 5 percent for those on meds, then that story begins to fall apart. By not reporting the results, psychiatry maintains the image of its drugs in the public mind, and the value of psychiatrists in today’s therapy marketplace.


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  1. puppies are absolutely wonderful, but a lot of work. i usually suggest to people that they adopt a young adult dog from the pound, talk about somebody who needs you!

    our drug-making and testing system is downright criminal.

  2. The talking cure is the one I recommend. It unspools those poisonous feedback loops, opens and stimulates what was closed and dying. Yup, talk it out. You might think of it as verbal and ideational exercise. Oh, and cats help too.

  3. DancingOpossum

    No, talking about it just keeps the focus on you and allows for more depression-inducing navel-gazing. And getting a puppy? Well, only if you really want to be a pet owner, and a responsible one at that. An adult puppy (or cat) from a shelter is a much better choice, but don’t put the onus of your happiness on some poor creature who’ll end up neglected or back in the shelter because you changed your mind later.

    Do something that takes you out of yourself, that’s the ticket. Get outside in nature: Take a walk, plant and grow something in the dirt (my own sure cure for the blues), go dancing, go to a museum, go for a walk — there’s that exercise thing again. Force yourself to do it –that’s one trick that psychologists have learned works, actually–in doing something you don’t “feel like” doing, you atctually start to feel like doing it! Salespeople are trained to smile while they’re talking on the phone, even if they’re in a grumpy mood, because it actually does make them more cheerful. In religious terms, “Acts done without faith may restore faith.” Just try it. It really does work.

    And yeah, everyday life in the U.S., for most people, is appallingly bad and it’s no wonder we’re all narcotized to within an inch of our lives.

  4. I think his conclusions are the sensible ones: that the drugs have some uses, but that they are overused. Also, I think a sensible study would have to look at the use of caffeine day-to-day–I wonder how many people can get through their workdays without coffee, tea, coca-cola and so on.

    BTW, I don’t think most of our food is “denatured of proper nutrients.” It is processed so as to encourage overeating, but that is a different problem. The most common unhealthy diet in the USA involves too much food, not too little.

  5. I was hyperactive as a small child and ‘medicated’ with ritalin. My case was rather severe though, so it’s more understandable than being ‘disruptive’ in school, whatever the hell that means. (As a 2 year old I was sleeping about two hours a night and there was concern about the strain on my heart, which is rather more than finger tapping).

    As an adult I had some stff that they tried and utterly failed to treat with antidepressants.

    Ironically, I’m on a very early and primitive one now for digestive issues. It doesn’t work, for anyone, on depression, but it works like a charm for some people with otherwise untreatable digestive ailments, including me. Nobody knows why; my doctor told me it’s also used successfully off-label for phantom limb syndrome and a few other really oddball ailments.

    These drugs are extremely complicated, and their functioning very poorly understood. I can say from personal experience that they have very powerful effects, and often not the ones intended. They can permanently change you too, long after you’ve stopped taking them.

    The end of the interview with the author really does sum it up; with any drug/treatment, we should always try to be sparing. Medical intervention of any kind always has a price, and if better outcomes can be obtained without it, then that’s what you should pursue. Conversely, there are times when you have to use drugs, and we shouldn’t stigmatize people for needing them. Which we do, even more with psychiatric drugs, but with anything. It’s part of our American cultural madness; we have a perpetual war on drugs side by side with an industry pushing drugs on every citizen they can get their tentacles on.

    So I suppose what we really need is some therapy for our entire messed up society. Anyone have any ideas on how to put the country on a couch?

  6. Ian Welsh

    One of my favorite studies was of mildly neurotic types. One third were given talk therapy, one third left alone (control group), one third given a puppy.

    The only group which showed overall improvement was the puppy group. Love and activity works. Of course, there is always a risk to such for the puppy, but companionship/love/need are a big deal. Lately (highly trained) companion dogs have been found to make a huge difference to PTSD victims (I certainly wouldn’t give such people puppies). Part of it is the training, but a big part of it is that they have to care for the dogs even as the dogs care for them. Someone /needs/ them who also loves them, so they get out and they do things.

    The data on exercise is fairly extraordinary. If you can keep it up consistently for 3 to 6 months it is very successful at dealing with all but the most severe depression, helps drug addicts, deals with ADHD, improves concentration, improves learning, fights off alzheimers, blah, blah, blah. In fact, in general I’d say about the best thing anyone whose body can take it can do is exercise.

    Get some sun at the same time, if possible. Funny how the old things (good diet, exercise, sunshine, love) keep proving just how powerful they are.

    There is also some reason to believe that even real depression has its advantages, and that it is a stage many people go through, as it forces you to go over and over and over certain issues. That can be bad, it also has its uses. And a certain amount of depressive tendencies correlate very strongly with creative ability.

  7. Exercise has helped me with my digestion too. Not my mental state, but I like being crazy.

    On the other hand, Ian, I hate dogs with a passion that burns brighter than ten thousand blue-hot stars. So puppy therapy wouldn’t work for me.

  8. Marks

    I would suggest that this is a North American or western problem more than especially an American problem. A problem nonetheless but it does no good to heap it on Americans.

  9. Lex

    I struggled up and down with depression (like most in my family); tried the pills a few times when i felt like i was really losing control, but never saw them as a long term solution to anything.

    The best thing that ever happened to my mental health was falling into horticulture as a trade half a decade ago. I get paid for my fresh air and exercise, and i never lack for either…even in the shittiest of winter weather, i know that i’m better off out there than inside somewhere. And it doesn’t hurt that taking it up as a trade turned a fiddling hobby into a consuming passion.

    Call it plant therapy rather than puppy therapy. Not the same kind of interaction exactly, but i list my preferred companionship as plants, dogs, cats and then humans. You need to be quiet and still, but they talk and they certainly react.

  10. Lori

    I wrestled with depression for years. A trip to the therapist left me bedridden for three days. It was terrible. I was a single mom with no real family other than my son.

    I started walking. I’d just gotten out of a long term, abusive relationship. As I walked, I told myself my story over and over and over again – dozens of times a night. It wasn’t long before I was comfortably covering 10 miles a night and learning to take responsibility for what I did wrong or handled badly in the relationship. After several months had past, I had lost a nice chunk of weight and I was in a much better frame of mind about dating. My new life is completely different than my old one.

  11. scruff

    Everyone I know who takes drugs for depression started doing so because they were unhappy with their lives, and every one of those people end up not changing the things in their lives that they were unhappy with, but rather relying on medication to cope with a bad situation.

    This was always my assessment of the problem: emotions act as a very sophisticated kind of perception, one that deals with perceiving abstract realities based in concepts like “good” and “bad”. To willfully dull one’s own perception of what is “bad” is going to seriously hamper one’s ability (drive) to *change* what is bad into what is good. Of course, this presupposes that an individual would trust their own perceptions of reality before their culture’s socio-behavioral massages, and perhaps that is why my kind of reasoning will never be popular.

    @DancingOpposum; There is dwelling-on-the-problem Talking therapy, and there is working-out-the-problem-and-solutions Talking therapy; both keep the focus on the person, but frankly if that’s where the problem lies then that’s where the focus needs to be.

    This a nice bit of synchronicity; while this post was going up I was being advised to take medication for depression – an idea that grates against every instinct I have – and wondering what the hell I should do.

    More on depression here:

  12. someofparts

    Agree 500% about the dog. I got one last year and all the good stuff about it is true and then some. LOTS of trips to the park. Lots of love for me from the meathead! Plus taking care of someone besides myself is such a nice break from the hamster wheel of my own mind. Count yourselves lucky I don’t upload pictures.

  13. someofparts

    “Don’t let gravity bring you down.
    It’s what keeps us on the ground.
    Holdin’ us together the whole world ’round.
    You couldn’t go up if you didn’t come down.”

    This converstation just reminded me of that song some friend of mine wrote decades ago – a song about depression, as it happens. My friend from back then was very creative, and he thought accepting the blues and working past them was sometimes worthwhile. Didn’t seem to hurt his songwriting.

  14. bluefoot

    This was a timely post. I’ve been sick (colds, flu) off and on all winter and spring, and haven’t been able to exercise or do the things I normally do. I’m frustrated and stir crazy because I can’t burn off stress the way I normally do, nor do most of my non-work activities. My doctor has diagnosed depresssion, thinking that depression is causing me to get sick, and is STRONGLY urging me to take an antidepressant. Somehow I think cause and effect is just a little mixed up in her mind. Why so quick to prescribe, when even on a depression scale test she administered I barely register?

  15. Kia

    I’ve had bouts of (mostly) mild depression on and off, and they have varied in whatever prompted them. I try to abide by the rule that I think comes from the AA people: don’t get too hungry, too angry, too lonely, or too tired. I try to eat well–I really don’t eat much junk food and find it easy to avoid it without trying too hard. One of the characteristics of my depressed-style thinking, which sort of hovers around waiting for a chance to re-establish itself, is not being able to figure out what to do in the next five minutes. This is where it is really great to have a dog. Because even if I noodle the whole afternoon away I still have to walk the dog. The dog is happier if we have an established routine–routine is the sanity of dogs, and it turns out that it helps me too. I can’t talk myself out of getting up and going out. So there’s an hour or two of unavoidable physical activity and I always come back refreshed and feeling like I have another chance at a start. So yeah, dogs.

    The other thing I found that really helps is to get onboard the learning curve, and there are lots of low-cost low-barrier-to-entry ways to do that. I started going to life drawing sessions at Adult Ed. Anybody could go (even me!), it was cheap, all you needed was some charcoal and newsprint and it was completely absorbing, and it didn’t matter how badly I drew, but I took a lot of heart from seeing my own rapid improvement. One of the features of depression is the sense of something wrong with you, of being set apart, of not being connected to experience in all the interesting ways that other people, you imagine, are allowed to be. While I was drawing I completely lost that feeling, not by talking myself out of it (which is impossible), but by having something else that held my attention, something happier that occupied the space where depression was. And then, too, when you are over the bout of depression the creative activity is not any less fun.

  16. lorac

    Your post seems to trivialize depression, which can be a serious disease and can be debilitating. For many depressed individuals, suicide is an answer to the pain. Sadly, your suggestions to just “buck up” or “get a dog” are heard all to often and indicate a lack of understanding and compassion. For a depressed person, it’s as difficult to “just be happy” as I expect it is for you to “just be depressed”.

    I struggled with chronic depression for many years and acute depressive episodes without ever having it diagnosed or treated. After I started taking anti-depressive medication, I was stunned to discover how “easy” life could be as a “normal’ person. No longer did I break into tears if I missed an exit on the freeway or become even more depressed when I saw a beautiful scene, knew it was beautiful, but couldn’t enjoy it. (And yes, I had dogs, and yes, I had a good job and appeared to the outside world as a normal functioning person. I was very good at hiding my problem.) Fearful of a return to that state, I have stayed on meds for many, many years although more recently I have cut down on the amount taken each day. I manage my disease with more than just meds (e.g., exercise, limiting stresses) but it takes effort and diligence.

    Lumping all depressives together and belittling the battle with a serious disease is not helpful. It’s that kind of attitude that makes it difficult for a depressive to acknowledge her disease and to get treatment. I experience enough discrimination through insurance, the societal pressure and demeaning only adds to the problems.

    I suggest that you educate yourself about the disease and its effects. Try reading William Styron’s “Darkness Visible” or Kathy Cronkite’s “On the Edge of Darkness” for a personal view of depression. You’ll discover (I think) that the reason unmedicated individuals seem OK, is not because their disease goes away, but because they have learned to survive and function in spite of it.

    Although there may be people who take anti-depressives and don’t need them, please be aware that there are many, many who do need them. We also can benefit from your understanding and compassion.

  17. tsisageya

    A few years ago I came across a book by Terrence Real: I Don’t Want to Talk About It: Overcoming the Secret Legacy of Male Depression

    His words caressed me. He didn’t give excuses or blame a woman.

    I need to read it again. He gave me compassion for men.

    I just thought it might apply here.

  18. tsisageya

    …not that anyone here seems to be blaming women. That’s not what I meant.

    Thank you, Ian.

  19. tsisageya

    P.S. I suggest that the reason America is “depressed” is because of the way America was “taken over” in the first place, and what has, since, transpired.

    Funny how no one ever really wants to talk about that except to say, “What does that have to do with ME? I didn’t do it.”

  20. tsisageya

    To talk about depression leads me here:

  21. votermom

    For women who get depressed, ask for a blood test before agreeing to take antidepressants. A lot of times what gets diagnosed as depression is actually either low thyroid function, low blood iron . anemia, or a vitamin deficiency (vit D specially) or a combination of these. Women are the most overworked and undernourished segment of the population, and frequently don’t realize when they are simply exhausted.

  22. tsisageya

    I wholeheartedly agree, VoterMom. Thanks.

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