Jelly Belly French Vanilla – the New SSRI?

April 7th, 2010. By AbiK

I just took the Hamilton Depression Rating Scale (HDRS or HAM-D) test. Yes, I administered it to myself, which is not really legit. And I was popping jelly beans (full disclosure: Jelly Belly original mix that wasn’t comped) in my mouth while clicking thru the answers. I scored a three. Which, apparently is within the “normal” range—or as I’m made aware of by my test source (Journal of Neurology, Neurosurgery and Psychiatry) “in clinical remission” had I been previously and officially depressed. For comparison, a score of 8-13 is “mild depression”; 14-18 is “moderate depression”; 19-22 is “severe depression” and a score of 23 or more is “very severe depression”.

Did I mention I was popping jelly beans? aka mommy’s little sugar pills?

So who knows—maybe I was just on a sugar rush and otherwise would’ve scored a four. Be that as it may, it got me thinking.

See, I took the test—and popped the J-beans—while reading an article, “The Serotonin Skeptic” by Carlin Flora in the spring 2010 issue of Discover Presents The Brain. The gist of the article is that, perhaps, antidepressant drugs like Prozac and Effexor—those classified as SSRIs or SNRIs—don’t help with depression any more than sugar pills (ie, placebos).

Now you see where this is going.

The article is an interview of psychologist, Irving Kirsch, who has written a book, The Emperor’s New Drugs. Kirsch believes, based on a meta-analysis he conducted of unpublished clinical trials, that psychoactive drugs are not any better than placebos (sugar pills) at treating mild to moderate depression.

In fact, Kirsch has a post over at the Huffington Post where he states the results of his meta-analysis showed:

…that 75% of the antidepressant effect was also produced by placebos—sugar pills with no active ingredients that are used to control the effects of hope and expectation in clinical trials. In other words, most of the improvement seen in patients given antidepressants was a placebo effect.

Seventy-five percent is a pretty big number—particularly when you factor in how many prescriptions are written each year in the US for anti-depressants. Kirsch states in the HuffPo post that anti-depressants account for 15% of all prescriptions in the US.

In addition to the meta-analysis, Kirsch reviewed the data that pharmaceutical companies had submitted to the FDA—the clinical trial data—which he obtained via the Freedom of Information Act. Upon that review, Kirsch states,

What we found was even more shocking that what our 1998 study had shown. The difference between drug and placebo was even smaller in the data sent to the FDA than it was in the published literature. More than half of the clinical trials sponsored by the pharmaceutical companies showed no significant difference at all between drug and placebo. What they did find was differences in side effects, like nausea and sexual dysfunction, produced by antidepressants; and the FDA later determined that SSRIs, the most common type of antidepressants, actually increases the risk of suicide for children, adolescents and young adults.

Needless to say, there are supporters and detractors of Kirsch’s work. But it does raise some questions given the amount of side effects—and potentially dangerous ones—associated with SSRI anti-depressants. Additionally, it’s fairly common knowledge that many patients have to try prescription after prescription till they find the “right” anti-depressant. And many still then reject any anti-depressant prescription after not being able to find one that’s a good fit—or one in which the benefits far outweigh the side effects or risks.

Given the conflicting and contradictory information “out there” on antidepressants–their efficacy, their safety—I’m not sure how I’d feel if I were ever prescribed one. Though given that I’ve scored a three (with or without my own little sugar pill effect) —and the fact that I’ve probably always been a three—maybe it’s a bridge I won’t have to cross someday. I’m hoping so.

Tags: Antidepressants, Irving Kirsch, SSRI, SSRIs

This was posted on Wednesday, April 7th, 2010 at 3:05 pm and is filed under Drugs/Medical . Feel free to respond, or trackback. Read our comments policy.