How effective are SSRIs? Not as good as you think!

A new study looking at the effectiveness of common antidepressant drugs has found them lacking. Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration was coauthored internationally, analyzing study data submitted to the FDA including previously unpublished data obtained under Freedom of Information rules. This makes it the first meta-analysis of an unbiased range of research on the efficacy of 3 common SSRI (selective serotonin re-uptake inhibitor) drugs: Prozac, Efexor and Aropax .

The findings of the new study do not paint the same optimistic picture as the companies producing these drugs would like us to believe and through statistical analysis concluded that those people who were severely depressed did not respond as well to the medication as previously reported. In fact the study concluded:

“Meta-analyses of antidepressant medications have reported only modest benefits over placebo treatment, and when unpublished trial data are included, the benefit falls below accepted criteria for clinical significance.“

This study also highlights an ongoing issue with predominantly pharmaceutical industry funded research – the non-inclusion of all trials when the drug is submitted for approval (eg: to the FDA in the USA) and in cases such as this where there is post-market research, reassessment of efficacy once the drug has been approved. This is a problem that has dogged medical research for years.

The meta-analysis looked only at drug efficacy, not adverse reactions or other issues that many patients have with taking SSRIs.

Herbal alternatives to SSRI’s: St Johns wort – suitable if not on other medications including ‘the pill’ and other hormonal drugs. Most studies have found it works as well as SSRI’s and with fewer side effects. Lavender and hops are also popular alternatives.

A lifestyle and spiritual approach to wellbeing is covered in the show on raising our spirits.

While you are here, don’t forget to offer a comment on the happiness thread.


Update: The Independent featured a particularly good response.

Mental Health - getting the care you need

The Federal Government has announced a $3.2 million initiative to ‘educate’ GPs in referral options concerning mental health. The subtext is that 8 months down the track since the Medicare subsidised consultations with psychologists were introduced, the service is proving to be too popular and costly. The popularity of the rebate is interesting considering there has been little publicity, or even encouragement, for this GP referral service since it’s introduction at the beginning of the year.

Although the re-education scheme, in the hope that cheaper mental health services such as consulting a social worker or occupational therapist will be offered in preference, was only announced yesterday - I have for some time had a significant number of clients complain about the difficulty they have had in convincing their GP that they would benefit from seeing a psychologist. One woman was told by her regular doctor that she would need to come back for a long consultation for assessment before she would decide whether seeing a psychologist was justifiable. While this extra consulting may be considered a hidden drain on Medicare, the issue is that the patients often find it confronting to ask for help over mental health issues and this just makes it less likely they will get the help they need. Some doctors however, have given the referral without hesitation.

But equally of concern is the ongoing habit of the majority of GPs to prescribe popular antidepressant drugs at the first sign of depression in a client, without offering a referral of any kind for emotional help. Anecdotally, as reported to me by my clients – this is the most common course of action occurring in Melbourne General Practices.

Although drug therapy may be the cheapest option to the government, in common mental health issues such as exogenous depression it is not often the most effective course of action. In the notoriously underfunded health sector of mental health - $3.2 million could go a long way in appropriately, therapeutically assisting a vast number of patients.

Sometimes finding a psychologist can take a little time to get one who you feel comfortable with – this is no different from finding a good match with a doctor, naturopath or any other health practitioner. But you do have a right to demand the referral, in order to make this service affordable. If you are unhappy with the way you have been treated in this area, consider contacting the Health Services Commissioner in your State.

Links

Victorian Government Mental Health Services index

Health Services Commissioner

The Australian Psychological Society

The Victorian Psychologists Association

Victorian Psychologists Registration Board: find a qualified psychologist in your area
PADA: Panic, Anxiety, Depression Assistance

What did you want to do when you grew up?

With a clinic in the heart of the city, it’s not unusual that I have many clients who are unhappy with various aspects of their working lives. Workloads are too high, expectations unrealistic and time to have a fulfilling life inside and outside of work has become greatly diminished.

The popular slogan is to ‘find our passion’ and all else will follow. It is a cliché but I for one am proof of the riches that come when you take a giant leap of faith. I went from a government job in another country to starting my journey in naturopathy in Melbourne - all in the course of a fortnight, 20 years ago. Like in all good urban fables – I woke from sleep with a deep sense of ‘knowing’ what I needed to do with my life and where I had to go to make it happen. Later when I had the time to backtrack through what had been brewing for the previous 2 years, the leap from a political science degree, to becoming a naturopath made total sense. What helped me connect the dots was perhaps ”one inspired thought” that had been nurtured with some time to dream. But more than that, it was believing in the thought and running with it all the way to the travel agent.

I admit, now 2 decades on from that monumental life change, ensconced in a very comfortable life complete with my own business and a mortgage – I wonder if I had a similar epiphany today, would I find the bravery needed to turn my world upside down completely? I believe I would. Even without a complicated life, not all of us find the courage to believe in our dreams and take a risk. Despite the 'baggage', there are times when we need to harness our inner resources in order to find fulfillment. If we continue to ignore them, sometimes the consequences can be deadly

In recent years I watched a close friend go from the top of his game to near bankruptcy. Ten years on from co-founding a small company, it had grown into a very successful business with 100 employees. As a trade-off for the long trips overseas that he loathed, he and his partner got to play on some of the world’s best golf courses. His family were well and happy. They’d just made a lifestyle choice to move to a new, inner-city apartment and were enjoying the cosmopolitan life. One day on his pre-work walk along the river he sketched out a plan to make the company more sustainable without him, to cut down his hours and spend more time doing what he loved. The dream was attainable and I felt very excited for him.

The next time I saw him he was depressed, medicated and working 7 days a week. Fear had got in the way of putting his plan into action. He’d stopped enjoying days on the green and hid in the office. The original partner had left the company and 2 younger men had replaced him. They were moving the business in another direction, expanding in areas they professed expertise in which was different from his own. While this could have been an opportunity to restructure his role, he’d gone with the energy of the new partners and was left feeling old and tired. Fluctuations in the value of the dollar had put pressure on their cash flow, as most of their stock was sourced from overseas. The new ventures were not performing as they’d expected and all was not well at home. The transition from a man on the brink of exciting change and one heading deeper into despair was remarkable. It was as if he’d opened the door to his dreams and slammed it shut. Within a couple of years the new ventures had bled the company dry, the young investors had passed all the blame to him and scarpered, he’d had an unhappy affair and left his marriage. The business folded, the apartment sold and his world at 50 was the absolute opposite of what he imagined 5 years earlier. While he was devastated by the company's failure, he began to slowly get his life back. It’s early days but one year on he’s been off antidepressants for some time, gone back to university and more often than not, seems to be happy. At times he feels guilty to be enjoying his new life so much.

Frequently I see examples of ill health or negative consequences from not following our dreams. Sometimes our secret desires conflict with those of the other people in our life, or we are just too fearful to rock our comfort zone. Often it’s not the job that makes us unhappy, it is our how we react to the work and our approach to living. There comes a moment when we can choose to no longer be a victim of either a successful or a thwarted career, and begin to take responsibility for our happiness in and out of work.

Where to start:

A career consultant might help you change your focus but if you are not allowing yourself to access the bigger picture, a move sideways will not satisfy for long. A more holistic view of work/life change is presented in Barbara Sher’s classic "I Could Do Anything If Only I Knew What It Was”. She has gone on to write further inspiring books but I’d recommend this one as the place to start.

Careershifters.org is a UK based careers coaching site with some great articles and ideas. The founder, Richard Alderson, describes the project as a “dedicated online community for career changers”. It’s well worth a look.

”The Artist’s Way” by Julia Cameron is both an inspirational and practical process to access the artist that resides within us. Even if you think this is not you, start doing her “morning pages” – 3 pages of free writing the old fashioned way with pen and paper every morning – and see what comes up for you.

Lastly, it is very difficult to access our hopes and dreams if we don’t take some time out from the everyday routine. Try traveling to work by a different route, getting away from your desk every lunchtime and making time each day to read, write, observe and walk. Ask people who you admire what makes them happy? Find role models who have achieved work/life balance. Write about what you wanted to do when you grew up.

Guess what? You’re a grown up now!

Make up your own mind

This morning I was writing a piece about how the 'official' messages we get about food inform our choices even when they fly in the face of common sense. One aspect of this being the impact of corporate sponsorship on some of our professional associations and other authorities we look to for unbiased, nutritional advice. While taking a break I picked up yesterdays “Age” and came across one of those vox pop style bites, this time asking leaders in appropriate professions whether “We should ban junk food such as McDonalds?” There smiling at me was the pretty face of Alison Graham, spokeswoman for the Dieticians Association of Australia. If you represented the peak orthodox organization for nutrition what message would you give about not just junk food, but McDonalds in particular? Her response did not surprise me. In a piece of perfect spin she was quoted as saying, “It’s wonderful that we have such a diverse food supply in Australia, so we can’t take choice away from people. Fast food is more than deep fried fatty foods: it can be quick and convenient and it’s here to stay, but they’re not all bad choices – salads, sushi and wraps can all be healthy”.

Once more, the take home message is that fast, or junk, food can actually be healthy. Let’s ignore the direct issue of the deep fried, empty caloried most popular choices and shift the focus to something innocuous like sushi, which I could be wrong, but don’t believe is actually on the multinational in question’s menu. What is more it is one step away from saying it is UnAustralian if we banned fast food. Choice is important! The positive spin on the fast food industry would seem curious from a member of the Dieticians Association if you didn’t realise that although McDonalds are not direct sponsors of the Association, unlike the industries providing the meat and cheese for their burgers, but have donated generously by way of things like purchasing a stall at their annual conference. The quote obtained from the Association could not have been better written if a lobbyist for McDonalds had dictated it.

While many of us do not directly consult a member of the DAA to teach us about food choices, other than by well-placed media quotes their influence is reaches wider than we would imagine. Recently I spoke to a final year Medical Student at the country’s leading medical. We chatted about the course and how they were assessed. I asked directly about nutritional training and she happily informed me they had a whole semester on it now. “Fantastic a whole semester on how to eat!” No, I was informed, it was actually about digestion and a little nutrition got tagged on the end. “How then do you teach your patients about healthy food choices?” I enquired. To which she responded about the handing over of pamphlets from the Heart Foundation (the organization that McDonalds has now paid at least $330,000 a year for the privilege of a few of their well placed ‘ticks’) and the DAA. “Or”, she added “I’d send them to a dietician or nutritionist”. “I’m curious”, I asked, “what is the difference between the two?” She admitted to not know, but would refer them anyway.

This did not engender me with hope as to the future of orthodox nutritional advice. Does the sponsorship of the DAA, by Nestle (a leading manufacturer of infant formula and controversial for it’s work in the developing world) indirectly influence advice given to a breastfeeding mother? Would a registered dietician ever cite the many studies that repeatedly prove that milk or even high calcium intake does not reduces the risk of fractures nor prevent osteoporosis, when Dairy Australia is a generous sponsor of the Association? Would they point out the biggest study to date, observing 120,000 woman for more than 10 years, not only disproved the dairy-healthy bones link but went further to show the more milk you drank the higher your chances of developing ovarian cancer? Not mentioning a study in one thing, but actively promoting contradictory advice is another.

While individuals of a profession may not speak for every member, using high profile doctors to advertise a product sends a much more universal message. Although that toothpaste ad doesn’t show us the face of the dentist, the milk commercial with high profile GP, Cindy Pan more than trades on her reputation, using her as the face of all doctors. In a nifty and possibly subliminal twist it goes even further by using a Chinese woman it neatly subverts the contradictory message that the majority of Asians are lactose intolerant. We should all drink milk, Cindy the doctor, media personality and Asian tells us it will give us strong bones, so it must be true!

Recently I went shopping with my 80 year old father. He has only had to acquaint himself with the supermarket in recent years and is a good consumer, taking time to read labels and pour over information about food ingredients. Diligently he grabbed the low fat, high calcium milk, the “lite” potato chips and chose a frozen dinner based on the Heart Foundation Tick. When I tried to point out a similar meal that had better ingredients he refused due to its tick-less packaging. I stayed silent on the irony of someone who has a classic lactose allergy choosing a milk that has higher lactose than its full fat counterparts. As for the chips, why bother mentioning the “lite” actually referred to the flavour and well, if you cant have clogged arteries in your ninth decade of life, when can you?