ScienMag: Usual antidepressants may not work in patients with chronic illness

[Sasha]

Ignore the article's actual title: this is interesting.

DALLAS – Nov. 6, 2017 – Scientists are finding more evidence that commonly prescribed antidepressants aren't effective in people battling both depression and a chronic medical disease, raising a critical question of whether doctors should enact widespread changes in how they treat millions of depressed Americans.

A new study published in the Journal of the American Medical Association found depressed patients with chronic kidney disease did not benefit from a common antidepressant. The finding follows other research that indicates traditional antidepressants are also ineffective in depressed people with chronic conditions such as asthma and congestive heart failure.

Read the rest at: https://scienmag.com/depressed-with-a-chronic-disease-consider-alternative-therapies/

 

[adreno]

The alternatives might not be that much greater:

He also notes a range of other therapies that have proven effective for patients who don't respond to initial treatments. These include ketamine, electroconvulsive therapy, neuromodulation with magnetic stimulation, psychotherapy, and exercise.

 

[Sasha]

The alternatives might not be that much greater:

Very true - but I think that's what's most interesting is the recognition that the usual stuff doesn't work.

 

[Adrian]

I thought there was evidence around certain anti-depressants being good for chronic pain. But I guess this is looking at just depression.

I thought there were some suggestions that anti-depressants may work better for pain than depression. Something to do with slowing/blocking signals in the brain.

 

[Squeezy]

@adreno some of those alternatives don't look so bad to me. People look at these things from the viewpoint of a non-Majorly Depressed person, and/or with pre-conceived, One Flew Over The Cukoos Nest notions.

Research has shown that half an hour of walking daily is MORE effective than pills. If the depressed person can get out of bed.

In the case of antidepressants possibly being ineffective in diabetes, as mentioned in the article, walking would be fantastic. For any illness, probably, except for ours, if the patient is fit enough for a half hour walk a day, that should be promoted.

I thought there was evidence around certain anti-depressants being good for chronic pain. But I guess this is looking at just depression.

I thought there were some suggestions that anti-depressants may work better for pain than depression. Something to do with slowing/blocking signals in the brain.

They are definitely prescribed for pain, where there is no hint of depression. My daughter takes a low dose of the tricyclic amitryptyline for Fibromyalgia pain. A couple of friends take Effexor (venlafxine) for Fibro too. It's an SSNRI.

It stops serotonin and norepinephrine from being taken out of circulation too soon. The effect is, they all feel considerable pain relief, and not many side effects at their low doses.

 

[Hoopoe]

What is depression supposed to be anyway, it mostly seems like a label applied to all sorts of problems that share a reduction in vitality as common symptom.

 

[hixxy]

Effexor (venlafxine)

This shit causes the most extreme withdrawal syndrome of any antidepressant and is called side effexor for a reason. I was on it for a couple of years pre-ME and I would never touch it again. I've taken other anti-depressants too and as far as negatives go this one is in a league of its own.

I would never recommend it to anyone.

 

[Squeezy]

side effexor

I'm so sorry you had such a miserable time with it.

That's a fantastic name. Nearly as good as Dopamax for Topomax, (because it slows down your thinking, and word-retrieval issues - epilepsy drug I take for migraines and pain). I take it anyway, because the pros outweigh the cons.

The other drugs for Fibromyalgia have nearly as bad withdrawal effects! And far worse side effects when you're taking them...

Drugs are NOT as easy as doctors often make them out to be, and lack of information given about getting off them is a huge issue.

I hope you're doing well now, Hixxy.

 

[Squeezy]

@strategist if you ever have a grey screen come down over your eyes for days on end, lose enjoyment in almost everything, don't want to eat/eat too much, see no future, feel everyone would be better off if you were dead... Then you're depressed.

That's not just "lack of vitality."

But are pills handed out too easily, when they're not appropriate? Not everyone is depressed. Some are transiently miserable. Some are stressed and need a good game of squash once a week.

What's in it for UK doctors to over prescribe?

 

[hixxy]

@Squeezy It's when you try to come off it that the shit hits the fan.

 

[Esther12]

What is depression supposed to be anyway, it mostly seems like a label applied to all sorts of problems that share a reduction in vitality as common symptom.

Considering the way 'depression' as a diagnosis is often given, it wouldn't surprise me if most of those with chronic health problems who were scored as having depression had very different problems to healthy people who were scored as having depression.

 

[ukxmrv]

@strategist

What's in it for UK doctors to over prescribe?

I don't know why they over prescribe but they do in the case of my extended family and that is at different GP surgeries

Given that depression doesn't have a physical test they are erring on the side of over diagnosing and not even using the paper questionnaires. Family members who are under stress or just plain miserable are being prescribed them. Must be happening to others.

Some of the extended family go on to discover that they have other diseases that cause their symptoms.

My local ME group members often say that they are prescribed AD's either as a way of treating pain, treating sleep problems or even because the GP believes that ME is depression. I've lost count of the times over the decades GP's have tried to get me to take them and sometimes succeeded.

 

[Squeezy]

I think even doctors forget that our patterns of thinking are affected by deficiencies in the chemicals that power, and constitute, our brains, even while they're prescribing pills that focus on just a couple of neurotransmitters!

B12 deficiency can present as depression - I've read a psychiatrist describe how a couple of decades ago they would try B12 supplementation in hospital and it was frequently effective!

I think everyone should have a full work up for the most likely deficiencies and given the opportunity to treat them before taking the pills, unless desperately depressed.

Some of the extended family go on to discover that they have other diseases that cause their symptoms.

A friend of mine thought she was having panic attacks, and was expecting a diagnosis of bipolar illness. She was hugely relieved to find her palpitations and extreme mood swings were in fact due to hypoglycaemia from undiagnosed Type 2 Diabetes.

It took long, scary weeks to get correctly diagnosed as she is slim, and doesn't fit their image for that condition.

Just like with ME, maybe we should search for another physical reason for depressive symptoms before starting medication? If the patient can bear their psychological distress?

 

[healthforall]

What is depression supposed to be anyway, it mostly seems like a label applied to all sorts of problems that share a reduction in vitality as common symptom.

It is possible for people to feel like crap,to feel like the world is a very dark place and they can't go on because of interactions of hormones and the brain or some other biochemical or neurochemical reason.

A few years ago I realized that I felt like what I described for a few hours every month on the eve of getting my period.After realizing it I don't take it very seriously although it has morphed into some sort of social phobia whereby I find myself worrying that I said something I shouldn't have or I missed a cue in a social interaction (nothing more major than eg an interaction with a cashier in a supermarket) and I have to rethink what I did earlier that day(assuming that I actually went out that day)in order to reassure myself that I didn't do anything that might have upset anyone in any imaginable way.I was surprised that social phobia could have a neurochemical component.

I had read that dopamine rises in the middle and at the end of the menstrual cycle so the rise or the drop in dopamine could expain certain things.Some women get severe depression after childbirth. Hormones rise during pregnancy. Maybe the drop in testosterone in men at middle age could cause depression and make them look for younger women so that they can compensate for having less testosterone.

I agree that most psychiatrists can not be relied upon to make the distinction between clinical depression and transient situations of feeling miserably as Squeezy said or situations that might require therapy because of dysfunctions that were caused in childhood such as being rejected by a parent or other issues that can affect a person.

Something else that I would like to mention another possible explanation for the unsuitability of antidepressants for ME/CFS sufferers could be because antidepressants like most other medications can affect negatively liver function.

Hepatotoxicity caused my medications is an important issue for me I think that it is at the root of my CFS but I think that it has been swept under the carpet for decades now and doctors tend to overlook it and not inform the patients one reason because they don't like to acknowledge that sometimes they cause harm to patients and the other reason it has been downplayed is that more reliable tests to diagnose liver damage could result in medications not being approved by the FDA(it is written on the FDA site that liver injury is the biggest obstacle in medications getting approval).

I have read that the cost of developing a medication is at least a billion dollars.Who would fund research that could make it very hard for pharmaceutical companies to get approval for new drugs?Which researcher would consider putting a proposal for research that might get him blacklisted and end his career?

 

[TigerLilea]

I thought there was evidence around certain anti-depressants being good for chronic pain. But I guess this is looking at just depression.

I thought there were some suggestions that anti-depressants may work better for pain than depression. Something to do with slowing/blocking signals in the brain.

Amitriptyline is one of those antidepressants. I know three people who are using it for pain and to help with their sleep.

 

[Mij]

I take low dose antidepressant for sleep.

I think it also depends on dosage. The dose I take for sleep is so small, not even close to the dosage recommended for depression.

Apparently some anti-depressants work well for menopause too.

 

[Webdog]

It's probably worth mentioning the recently revised CDC website, which now states (emphasis mine):

Depression, Stress, and Anxiety

Adjusting to a chronic, debilitating illness sometimes leads to other problems, including depression, stress, and anxiety. Many patients with ME/CFS develop depression during their illness. When present, depression or anxiety should be treated. Although treating depression or anxiety can be helpful, it is not a cure for ME/CFS.

Some people with ME/CFS might benefit from antidepressants and anti-anxiety medications. However, doctors should use caution in prescribing these medications. Some drugs used to treat depression have other effects that might worsen other ME/CFS symptoms and cause side effects. When healthcare providers are concerned about patient’s psychological condition, they may recommend seeing a mental health professional.

https://www.cdc.gov/me-cfs/treatment/index.html

 

[Woolie]

What is depression supposed to be anyway, it mostly seems like a label applied to all sorts of problems that share a reduction in vitality as common symptom.

Yea. Before we talk about how to treat it, let's talk about what we mean by it and how we decide if someone's got it (spoiler: all that is a super big mess).

@strategist if you ever have a grey screen come down over your eyes for days on end, lose enjoyment in almost everything, don't want to eat/eat too much, see no future, feel everyone would be better off if you were dead... Then you're depressed.

Yes, genuine depression is real - and awful - but the diagnostic category has become way too broad.

Honestly, its hard not to be scornful of this article. If you're depressed because you're ill, then it seems fairly obvious that the best way to remedy the depression is to address the symptoms of the illness. And that's even assuming they're correct about the depression part to start with.

See also this thread I started on a study showing that, in people with inflammation, anti-inflammatory drugs are better at reducing depression inventory scores than antidepressants: https://www.s4me.info/index.php?thr...eatment-resistant-depression.1027/#post-17457

I know tricyclics are supposed to be good at pain management, but I've never heard of anyone who has actually put this to the test in a placebo-controlled trial.

 

[Wonko]

From my somewhat limited experience at least one tricyclic, amitriptyline, is not particularly effective at controlling severe pain (TN) on it's own, no matter how much is taken.

They may have an effect on less severe pain, simply because of the sedative effect.

However when used in combination with what was, if memory serves, a beta blocker (atenolol) then even 25mg of ami was extremely effective.

 

[Arnie Pye]

What's in it for UK doctors to over prescribe?

What is in it for UK doctors you ask? £1712 per new diagnosis of depression.

This is worked out as follows :

The number of QOF (Quality and Outcomes Framework) points they get for each new diagnosis of depression is shown in this link under the heading of Depression :

http://www.nhsemployers.org/~/media...and outcomes framework summary of changes.pdf

They get 10 points for each new diagnosis of depression. They only get paid if they reach a certain threshold i.e. a certain number of new diagnoses, and do appropriate follow up. Or at least that is my understanding.

This link : http://www.nhsemployers.org/your-wo...ework/the-2017-18-menu-of-qof-recommendations

gives the value of each point :

The value of a QOF point will increase by £6.02 or 3.6 per cent from £165.18 in 2016/17 to £171.20 in 2017/18.

So, if a new diagnosis of depression gets 10 points, and each point is worth £171.20, then each new diagnosis is worth £1712.

For more info on QOF : https://en.wikipedia.org/wiki/Quality_and_Outcomes_Framework