Wisdom.

I'm Psychetruth correspondent, 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 apsychiatrist

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 thet wo 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 havetime...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 youd on'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 a lot of side effects, which could include being agitated

suicidal, homicidal, delirious, more than a placebo will cause.

That is also provenscientifically.

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 that boosts 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 preposterous. 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.