[English]
Hvor stor er effekten? Hva er
bivirkningene? Hvordan påvirkes selvmordsrisiko?
Kapitel 7 i Brinkmann S, Petersen A (red.). Diagnoser: perspektiver, kritik og diskussion. Aarhus:
Forfatterne og Klim; 2015: http://www.deadlymedicines.dk/overdiagnostik-og-overbehandling-i-psykiatrien/
OVERDIAGNOSTIK OG OVERBEHANDLING I PSYKIATRIEN: http://www.deadlymedicines.dk/wp-content/uploads/2015/09/Diagnoser_kap-7.pdf
Side 168:
Har antidepressiva nogen effekt på depression?
I runde tal viser de randomiserede forsøg, at omkring 50%
af patienterne får det bedre på et antidepressivum og 40% på placebo.
Effekten hos de 40% kaldes ofte for en placeboeffekt, men det er det
ikke. Mange af patienterne ville have fået det bedre, selvom man ikke
havde givet dem nogen som helst behandling, idet de fleste depressioner
går over af sig selv efter nogle uger. Når såvel læger som patienter “har
erfaring for”, at behandlingen virker, må vi derfor sige, at vi ikke kan
bruge den “erfaring” til noget, da vi jo ikke ved, hvordan det ville være
gået uden behandling.
Forskellen på 10% betyder, at der kun er én patient, der får gavn
af behandlingen, når man behandler ti patienter. Den reelle effekt er
imidlertid meget mindre, hvis den overhovedet eksisterer. Forsøgene har
nemlig ikke været ordentligt blindet. Antidepressiv medicin har markante
bivirkninger, og mange patienter og deres læger vil derfor vide, om det
blindede lægemiddel indeholder aktivt stof eller placebo. En systematisk
gennemgang af 21 forsøg ved en række forskellige sygdomme, der havde
både en blindet og en ikke-blindet observatør, fandt, at behandlingseffekten
blev overvurderet med 36% i gennemsnit (målt som odds ratio),
når den ikke-blindede observatør vurderede effekten (Hróbjartsson et al.
2012). De fleste forsøg havde anvendt subjektive effektmål, og effekten
af antidepressiva vurderes også på meget subjektive skalaer (fx Hamilton-skalaen).
Hvis vi antager, at blindingen er brudt for alle patienterne
i forsøgene med antidepressiva, og justerer for den overvurdering af effekten,
tabet af blinding forårsager, finder vi, at antidepressiva ikke har
nogen effekt (odds ratio 1,02) (Gøtzsche 2015a).
Blindingen brydes sikkert ikke for alle patienterne, men man skal kun
fejlklassificere 5% af patienterne med hensyn til, om de har haft effekt eller
ej, før den tilsyneladende effekt af antidepressiva forsvinder (idet 50%
med effekt på aktivt stof bliver til 45%, og 40% på placebo også bliver til 45%)
Side 177:
Hjerneskader
Situationen er den, at medicinen holder patienterne fastlåst i patientrollen
og ændrer deres personlighed (Gøtzsche 2015a; Healy 2004; Kessing
et al. 2005; Whitaker 2013), så de ikke lærer at håndtere livets udfordringer.
Desværre er opfattelsen hos de toneangivende psykiatere stik modsat.
De siger, at det er vigtigt at tage antipsykotika og antidepressiva, fordi
ubehandlet skizofreni (Lægemiddelindustriforeningen 2013) og depression
(Videbech & Dalsgaard 2014) kan give hjerneskader. Jeg anser dette
for at være et lige så ubehageligt eksempel på magtmisbrug, misinformation
og overtalelse som skrønen om den kemiske ubalance.
Drag Info Madinamerica.com: Antidepressants as a treatment for depression https://www.madinamerica.com/drug-info-antidepressants/
Irving Kirsch et al. 2002: The Emperor's New Drugs: An Analysis of Antidepressant Medication Data Submitted to the U.S. Food and Drug Administration. “The proportion of the drug response duplicated by placebo was significantly greater with observed cases (OC) data than with last observation carried forward (LOCF) data. If drug and placebo effects are additive, the pharmacological effects of antidepressants are clinically negligible.”
Jeffrey R. Vittengl 2017: Poorer Long-Term Outcomes among Persons with Major Depressive Disorder Treated with Medication. “The presence of major depressive disorder (MDD) and receipt of mental health treatment predicted greater depressive symptoms 9 years later”. The FDA’s “Major Depressive Disorder: Developing Drugs for Treatment Guidance for Industry” states the following: “Antidepressants in established classes (e.g., SSRIs, SNRIs) typically need studies of 6 to 8 weeks duration to demonstrate efficacy.”
Hengartner M.P · Angst J.· Rössler W.2018: Antidepressant Use Prospectively Relates to a Poorer Long-Term Outcome of Depression: Results from a Prospective Community Cohort Study over 30 Years. https://www.karger.com/Article/Abstract/488802
Hengartner et al. 2019: ‘Newer-generation
antidepressants and suicide risk in randomized controlled trials: A
re-analysis of the FDA database’
New
study: antidepressants significantly raise the risk of suicide in the
treatment of depression for adults:
“Earlier analysis of
this data did not reveal the increased risk because the method used
was incorrect.
Previously, calculations were based on ‘person
exposure years’ (PEY) rather than the number of patients receiving
treatment...
Suicide attempts and suicides combined was about 2.5
times higher”.
“Our findings thus conflict with the work by
Khan et al. [5], who based their effect estimates on PEY rather than
the number of patients.
When hazards are not constant over time,
PEY is inappropriate [10] and may obscure a true adverse drug effect”
Hengartner et al. 2019: Reply to the Letter to the Editor: “Newer-Generation Antidepressants and Suicide Risk: Thoughts on Hengartner and Plöderl’s Re-Analysis”: To demonstrate that misreported suicides can substantially bias the results, we show in Table 1 that the suicide risk accord-ing to a Bayesian random-effects meta-analysis (the method rec-ommended by Ren et al. [6]) of the uncorrected data table was OR = 2.49, 0.82–45.32 (note the discrepancy to Hayes et al. [1]).
Ny studie sår fornyet tvil om medisiner mot depresjon
Forskningen på antidepressiva har så store
metodeproblemer at vi ikke kan stole på resultatene, ifølge en ny
analyse. Anerkjent professor er uenig.
Systematisk skjevhet,
utvalg av positive resultater, mangelfull rapportering av
bivirkninger. Det er noen av problemene i studiene av medisiner mot
depresjon.
Metodeproblemene er så store at vi ikke vet om
medisinene
virker.
https://forskning.no/angst-depresjon-medisiner/ny-studie-sar-fornyet-tvil-om-medisiner-mot-depresjon/1359079
How common and severe are six withdrawal effects from,
and addiction to, antidepressants? The experiences of a large
international sample of patients
Author JohnRead
https://doi.org/10.1016/j.addbeh.2019.106157
•Over half (55%) of people who had tried to come off
or reduce antidepressants report some degree of difficulty coming
off, with 27% ticking ‘very difficult’
•61% report
‘withdrawal effects’, with 44% of these describing the effects as
‘severe’
•40% report ‘addiction’, with 39% of these
describing their addiction as ‘severe’
•‘Anxiety/panic’
(66%) and ‘Irritability (62%) are particularly common.
•Less
than 1% had been told anything about withdrawal effects or
dependence.
https://www.sciencedirect.com/science/article/abs/pii/S0306460319309001?via%3Dihub
Forskere konkluderer: «Lykkepiller» virker ikke mot
depresjon
Stor gjennomgang av forskning tyder på at
SSRI-medisiner mot depresjon gjør mer skade enn nytte. Men hvorfor
opplever da noen at de hjelper? Marie Barse JOURNALIST, VIDENSKAB.DK
PUBLISERT Lørdag 18. februar 2017 –
04:00
https://forskning.no/depresjon/forskere-konkluderer-lykkepiller-virker-ikke-mot-depresjon/364440
James Davies et al. 2019: Clinical guidelines on
antidepressant withdrawal urgently need updating
Letters
Antidepressant withdrawal
Clinical guidelines on antidepressant
withdrawal urgently need updating
BMJ 2019; 365 doi:
https://doi.org/10.1136/bmj.l2238 (Published 20 May 2019)
Cite
this as: BMJ
2019;365:l2238
https://www.bmj.com/content/365/bmj.l2238utm_source=twitter&utm_medium=hootsuite&utm_term=&utm_content=&utm_campaign=editors
Susan McPherson et al. 2019: Long-term outcomes of
trials in the National Institute for Health and Care Excellence
depression guideline:
“The forthcoming National Institute for
Health and Care Excellence depression guideline reviews short-term
outcomes for long-term depression. We present effect sizes for
long-term outcomes in trials that report these data. Psychological
therapies become more effective, whereas antidepressants become less
effective over the long
term.”
https://www.researchgate.net/publication/335693982_Long-term_outcomes_of_trials_in_the_National_Institute_for_Health_and_Care_Excellence_depression_guideline
Campaigning forces Royal College of Psychiatrists to change its position on antidepressant withdrawal by CEP Admin on 30/05/2019
Ny studie sår fornyet tvil om medisiner mot
depresjon.
Forskningen på antidepressiva har så store
metodeproblemer at vi ikke kan stole på resultatene, ifølge en ny
analyse. Anerkjent professor er uenig.
Marie Barse JOURNALIST,
VIDENSKAB.DK PUBLISERT Fredag 19. juli 2019 –
04:30
https://forskning.no/angst-depresjon-medisiner/ny-studie-sar-fornyet-tvil-om-medisiner-mot-depresjon/1359079
Anti-depressants CAN ruin lives: Major U-turn as psychiatrists say millions of patients MUST be warned over severe side effects. By BEN SPENCER MEDICAL CORRESPONDENT FOR THE DAILY MAIL PUBLISHED: 22:00 BST, 29 May 2019
-For years side effects of withdrawing from antidepressants were branded 'mild'
-But the Royal College of Psychiatrists has now changed its position to 'severe'
-UK prescribes more antidepressants than any other Western country
Keller
et al. 2001 «Study
329» (Wikipedia)
der en re-analysis
av rådata korrigerte den opprinnelige
konklusjonen.
In conclusion, the findings of this (original) study
provide evidence of the efficacy and safety of Paxil in the treatment
of adolescent depression.
The reanalyses concluded that "[t]he
efficacy of paroxetine and imipramine was not statistically or
clinically significantly different from placebo for any prespecified
primary or secondary efficacy outcome," and that there were
"clinically significant increases in ... suicidal ideation and
behaviour and other serious adverse events in the paroxetine group
and cardiovascular problems in the imipramine group."
Maß, R,. Backhaus, K., Lohrer, K., Szelies, M., & Unkelbach, B. K. (2023). No benefit of antidepressants in inpatient treatment of depression. A longitudinal, quasi experimental field study. Psychopharmacology. https://doi.org/10.1007/s00213-023-06417-4
Winfried Rief, John M. Kelley, Yvonne Nestoriuc, 2023. Placebo and nocebo effects in depression: Implications for treatment and clinical trial designs. “ Although antidepressants show statistically greater efficacy compared to placebos, the effect sizes are small, and the specific effect of these drugs provides only a small clinical benefit to patients.Placebo responses in double-blind trials are about 80% as large as the response to antidepressants.” https://doi.org/10.1093/med/9780197645444.003.0016
Jahanna Moncrieff et al. 2022: The serotonin theory of
depression: a systematic umbrella review of the evidence
The main
areas of serotonin research provide no consistent evidence of there
being an association between serotonin and depression, and no support
for the hypothesis that depression is caused by lowered serotonin
activity or
concentrations.https://www.nature.com/articles/s41380-022-01661-0
Inner Compass Initiative. Strømmet direkte 1. sep. 2022: Moving Beyond Myth: A Postmortem Analysis of Chemical Imbalances and Antidepressants Efficacy. https://www.youtube.com/watch?v=5pGkjBnrPe8
