Life
Wisdom.
I'm Psychetruth corespondent, Corrina Rachel and I'm joined today by doctor
Colin Ross.
An author and practicing psychiatrist in Dallas, TX.
Thank you so much for joining me today. Well thank you for having me.
So today I wanna ask a burning question, do anti-depressants
really work?
For somebody who is experiencing depression, what would you want them to
know about anti-depressants before they started them. Well that's an excellent and an
important question
and the scientific facts are very different
from what you often hear from your doctor and from what's generally known
in the culture.
We're taught, we psychiatrist that anti- depressants are powerful and effective
and that
it's really a life-saving intervention and that you're not doing your job as a
psychiatrist if you don't offer a depressed person a medication. That's the basic
teaching and on the side we're taught that
depression is probably some kind of brain disease
and is due to low serotonin levels
or maybe another
brain chemical called noradrenaline
and that's just kind of accepted in our culture. That
the doctors and scientists know that it's a low serotonin problem.
It's just a disease. It doesn't have that much to do with
your personality or what you've been through in life.
And you take a medication.
It's just like taking an antibiotic. It's gonna work,
not 100%, but a big percentage of the time.
But that whole picture
is not scientifically true. In fact that whole picture is completely disproven by
the existing science.
So you wouldn't recommend then
that somebody start? Well the question's a little bit more complicated
because your in the world of practical reality.
So for instance when I worked in an anxiety disorders clinic in Canada, it was
mostly people with panic attacks coming in. So I'd do an assessment and the
two options we have here are we have certain medications or we have cognitive
therapy,
which has got a whole evidence-based showing that it works for panic attacks, not
all the time but reasonably well.
One person would go "I'm not crazy. I don't need medication."
Then the next person would say there's nothing wrong with me I don't need therapy,
I'll take the medication. So people would have completely opposite viewpoints on
medication versus therapy
and the bottom line is
some people are just not going to do therapy.
They're not interested, there's no way or they can afford it or they don't have
time...there's a million different reasons. So if the person is not going to do any
kind of therapy, it's either nothing or medication.
In an ideal situation when you've got time, when you've got insurance or you
could afford to pay for therapy, I'd say the number one way to go is therapy and there
is actually data supporting that. That long-term if you're depressed and you
take antidepressants you're gonna do better with cognitive therapy
and on one analysis in terms of cost
it looks like of course just to take a prescription is cheaper than seeing a
therapist week after week after week, but once you get out to about nine months
the cognitive therapy is usually ten or twenty sessions for depression but the
antidepressant you keep taking taking taking taking.
Around about nine months the cost of the antidepressant catches up with the cost
of therapy and then it keeps getting greater and greater and greater. So from
an insurance company point of view
it's not true that drugs are cheaper.
When we look at the evidence on how well do these medications work... So we've got
the old antidepressants and the new anti-depressants and the main group of
new ones is the SSRIs,
which is selective serotonin re-uptake inhibitors, so they're called SSRIs.
that's prozac, zoloft, and things like that.
When you look at all the studies that are done by the drug companies including the
ones they've suppressed and not published, when you get those all
together
the basic scientific fact is
there's virtually no difference between drug and placebo.
People with depression, on average their depression scores dropped the same
amount. The difference is tiny
and you wouldn't be able to tell the difference yourself if you
were on placebo and you were on antidepressant and you had the average drop in depression score
or the average drop in
score for placebo there's no way you could internally subjectively tell the
difference.
So does that mean drugs don't work? No because there's another group in the
research, which is called the waiting list control. That's where you
don't get drug or placebo or anything and you just wait until we call you in a
few months when a slot opens up. Now those people do worse than the placebo and
drug groups.
So both drug and placebo are clearly better than doing nothing. Both
in fact work
but the drug doesn't work better than the placebo.
Those are the scientific facts, but the way things are set up right now you
can't go to a doctor and tell the doctor i'd like to get a placebo please
because nobody ever asks that question plus the doctors have all these ethical
problems about how it's deceptive to give somebody a placebo
without telling them, so they won't do it in secret.
And if they did and the person found out they could probably sue them.
There is actually research where people are told well what we're going to do is give you a placebo,
the dummy pill, a sugar pill that has nothing and but we found that this is
quite helpful and that the placebo response stays the same.
There's also studies where
you'll see TV ads for Abilify which can be added to an
antidepressant to kind of boost the effect of the anti-depressant and those are on TV quite
regularly. There's also research showing
that if you're depressed and you're given a
placebo,
you respond a certain percentage of the time. When you add on another placebo
that the person thinks is the second drug, it basically bumps the depression down
as much as Abilify bumps down your depression when you're taking
an SSRI.
There's no question scientifically that these drugs are indistinguishable from
placebo and from each other in terms of how well they work,
but since you can't go get placebo in our culture, and you can go get anti-depressants
they will work some of the time for some people
and for some people they won't work at all.
The kicker is then what about the side effects? There's a lot of side
effects which includes your sex drive just goes to zero,
nightmares, agitation, feeling restless, keyed up, and when you stop these
anti-deprssants you can get a noticeable withdrawal syndrome.
Not all the time that a lot of time.
Since psychiatrists really don't want to recognize that these drugs are addictive
and cause withdrawal they call this discontinuation syndrome to make it
sound kinda softer and nicer but it's clear that
a lot of people have serious withdrawal from these drugs. So are the side-effects
really worth it?
Well maybe if you're one of the people who is a very good placebo responder
you take the antidepressant, you feel better and you're one of the people that has
minimal side effects. Your insurance company pays for it.
In a way you could live with that, but
the whole culture is kind of kidding itself. These drugs in fact do not work
better than placebo and in fact they have alot of side effects, which could include being aggitated
suicidal, homicidal, delirious, more than a placebo will cause. That is also proven
scientifically.
In terms of the chemical imbalance idea where you have a chemical imbalances,
you have low serotonin. These drugs boost up your serotonin. Doctors say this over and over
and over. It's in the drug ads. There's actually an antidepressant that's on the
market in europe that
was first developed in france that's called a selective serotonin
re-uptake enhancer,
So it's an SSRE.
Instead of boosting serotonin it actually boosts the re-uptake. So it sucks the serotonin
out of the synapses back into the nerve so it reduces the serotonin level
but it's equally as effective as the ones that boost the serotonin level.
And we have lots and lots and lots of research showing
psychiatrists can't find any consistent problem in the serotonin system at all.
It's just a marketing method
and
that's not surprising because why would we think the antidepressants are working
through serotonin if they don't work any better than placebo?
We don't really need the serotonin effect at all and that's proven by if
you have a drug thatboosts up serotonin, it doesn't work any better than
one that blocks serotonin down.
So you're saying that the message that's conveyed in TV commercials that's
conveyed to people and then even their doctor may tell them is actually not backed
by the scientific evidence?
Well let's look at another class of TV commercial. That is what I'm saying. So I've
learned from watching tv ads that depression is a medical disease that has
certain symptoms that is thought to be due to imbalance of serotonin
and you should talk your doctor about these effective medications.
That's what i've learned from TV ads, but is not scientifically true.
Here's something else I have learned from tv ads, if you're a guy and you really
really really wanna date supermodels, the number one thing you gotta do is
drink beer
'cause supermodels just love guys that drink beer, clearly proven by beer ads on TV.
It's all proposterous. We know that first of all the super models that are
drinking the beer are not drinking a whole lot of beer because they are so thin and
they're not impressed by guys who are throwing up at the beer party. It's
complete nonsense.
It's not any more objectively scientifically true what you see
in a anti-depressant ad.
Very interesting. So we can take with a grain of salt just about anything
we see in a tv commercial and obviously when we see a
Dorito's commercial or whatever we kind of know that
you know that isn't really true, but it's interesting that you know even in
what is often kind of purported to be very medical and very scientific is
really not so much. This is just their marketing. Right instead of some good
looking guy driving a car fast down the road it's a guy who's got a lab coat on
and seems like some sort of professional or doctor. It's all marketing.
So you spoke a minute ago about side-effects and you mentioned
the sexual health side-effects in a previous video that we did awhile back.
We kind of touched on that subject and one of the comments that was left on that
video was that this is completely true. I was on anti-depressants for all these
years and actually even now that i've been off of anti-depressants for several
years
he was still experiencing the same negative sexual health side-effects.
Now that's something that I've heard of and I was actually on a radio show with a
guy who's kind of an expert in that who has seen dozens and dozens and dozens of
people.
So the idea is first of all these drugs don't have that many side effects. Don't
worry about it. Well it turns out they do have a lot of side-effects.
Especially the SSRIs, dropping your sex drive down to nothing.
But as soon as you stop you know pretty soon
the side effects will go away and you'll be back to normal as far as your sex life is
concerned.
Now we're starting to see
there's people where it doesn't come back
for months and months and months and months
and then of course the psychiatrist will say that's 'cause they're depressed.
Low sex drive is a symptom of depression
but I'll bet you a lot of times it's a side effect of the drug.
Just like when we go back twenty years with the anti-psychotics
there's a lot of people with tardive dyskinesia
which is these twitching, grimacing kinda movements
just caused by anti-psychotic medications and when you stop the meds the side-effect
gets worse and it last for years, the rest of your life.
So we know within
my professional practice lifetime that's there are psych meds that have
severe side effects that can last your whole life. That's not unheard of.
That's admitted to and recognized by everybody.
Now we're starting to see maybe some of these SSRIs have long long long
lasting sexual side effects.
Of course drug companies don't want to hear about that. Psychiatrists are by and large not wanting to hear
about that. It's
absolutely realistically possible.
So
what would you suggest
to somebody who has
received
a mental health diagnosis or who's feeling depressed or maybe they're watching those
commercials and thinking, man I need to ask my doctor. What would you recommend? First of all
depression is a very real problem. We haven't proven that it's a
medical disease. We know anti-depressants don't work that well but it is a very real
and serious problem.
And we know a number of things that can be helpful, exercise. It's hard to get to
sleep in your so depressed you can't sleep, but good exercise, good diet, good
social relationships, and good support, all those normal things that are good in
life, good nutrition, good diet.
In terms of treatment
I, number one would say cognitive therapy is well
proven to be effective. There's several other schools of therapy. So basically therapy .
To take a look at what's happened in your life that's making you feel this
way and what's happened in your life that's making you think this way about yourself
and you can work your way out of that.
Antidepressants
you know they're just here to stay in our culture for at least awhile. People
are going to get them from their doctors. Their doctors are going to tell them this is the
way to go. I just wouldn't invest all my time and energy in meds.
I'd look into
healthy lifestyle emotionally, personally, psychologically, and psychotherapy.
Interesting and it's
neat that you point out you know and looking at someone who's depressed you
really do have to look at their history and look at what they've been through
and we've talked in several videos about trauma especially childhood trauma even
sexual abuse and how those things play in.
So that's definitely an important consideration for anybody in that
situation. Right now lots of people have been depressed and never been sexually abused
but if you have been sexually abused it clearly at least doubles your risk of
depression.
So it's interesting that you would recommend those things because
Psychetruth's channel is kind of founded on trying to give people alternatives of
ways that they can improve their lives or handle depression
and that's exactly what you'll find on our channel information about exercise
workout videos nutrition all of these different things.
So
it's actually very helpful to hear from your perspective that those
things really can be helpful for people.
Right and I think that's why you and I are doing these interviews together
'cause what my view of the world fits with the Psychetruth view.
Well thank you so much for joining me today I really appreciate it! And thank
you for joining me.
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