There is a lot of misinformation about antidepressants on the internet.
Richard J. Metzner, M.D.
Clinical Professor
Semel Institute for Neuroscience and Human Behavior at UCLA
Founder, DepressionConsultant.info
Some of it comes from well-meaning patients who assume their own unfortunate treatment experiences can be generalized to everyone. Others have different reasons, perhaps also well-intended. Life Extension®, a company that sells vitamins and nutritional supplements, seems to believe that its products are better than antidepressants for relieving depression.
A brief blog entitled “Why Antidepressants Don’t Work” by a diet doctor named Michael A. Smith, M.D., appeared on Life Extension’s website March 1, 2012. The piece, received favorably by many who were directed to it on sites like Twitter, contained misleading factual errors starting with the inaccurate title. Antidepressants do work when used correctly. I'm confronting this misinformation for the sake of depressed people who need to know the truth, not to denigrate Life Extension or to convey any opposition to the use of vitamins and supplements when useful. On the contrary, my first research at Johns Hopkins Medical School involved studying the critical role of vitamin B6 in serotonin metabolism, and I've seen many times with patients how nutritional deficiencies can contribute to medical and psychiatric problems.
INCORRECT INFORMATION ABOUT ANTIDEPRESSANT EFFECTIVENESS:
The blog wrongly stated that: “Less than 50% of patients prescribed antidepressants actually get better.” and cited a news report in Nature as its source. What the Nature report actually said was that: "roughly one-third of people with depression ... do not respond to current therapies," referencing a nationwide U.S. study showing that the majority (67%) of depressed patients achieved remission after receiving one or more antidepressant therapies.
INCORRECT INFORMATION ABOUT ANTIDEPRESSANT FUNCTION:
The piece went on to say that “antidepressants for the most part work by preventing the removal of one neurotransmitter from the brain — serotonin, the ‘feel-good’ neurotransmitter.” Actually, only five of the more than two dozen antidepressants in current use are SSRI’s (selective serotonin reuptake inhibitors). Others modify norepinephrine and dopamine neurotransmission with or without affecting serotonin. Personalized antidepressant treatment pays attention to those differences and helps improve treatment results by matching patients to the right medications.
INCORRECT INFORMATION ABOUT ANTIDEPRESSANT MECHANISMS:
Finally, the website asserted that “the most popular class of antidepressants does not increase serotonin production. The drugs only prevent its removal from the synaptic cleft...simply preventing its removal doesn’t address the deficiency.” The facts? Studies measuring serotonin metabolism in the brain show very clearly that SSRIs do increase serotonin levels initially, after which they are kept in balance by natural feedback mechanisms.
The blog ends by listing some vitamins and supplements which it declares to be the best way to treat depression. A more balanced article might have said that regular exercise and good nutrition are important components of a depression treatment program, but that without antidepressants or other types of professional treatment there will be little hope for the millions of people who suffer from depression each year and the 15% who die from suicide.
Ernest Hemingway once said: “Every man should have a built-in automatic crap detector operating inside him.” Perhaps Life Extension knows of supplements which could stimulate compelling gastrointestinal disturbances in people before they release misinformation into cyberspace.
LIFE EXTENSION'S RESPONSE ON TWITTER THREE HOURS AFTER WE POSTED THE ABOVE ARTICLE:
Copyright 2012, Scaled Psychiatric Systems, Inc. All rights reserved.
Richard J. Metzner, M.D.
Clinical Professor
Semel Institute for Neuroscience and Human Behavior at UCLA
Founder, DepressionConsultant.info
There is a lot of misinformation about antidepressants on the internet. Some of it comes from well-meaning patients who assume their own unfortunate treatment experiences can be generalized to everyone. Others have different reasons, perhaps also well-intended. Life Extension®, a company that sells vitamins and nutritional supplements, seems to believe that its products are better than antidepressants for relieving depression.
A brief blog entitled “Why Antidepressants Don’t Work” by a diet doctor named Michael A. Smith, M.D., appeared on Life Extension’s website March 1, 2012. The piece, received favorably by many who were directed to it on sites like Twitter, contained misleading factual errors starting with the inaccurate title. Antidepressants do work when used correctly. I'm confronting this misinformation for the sake of depressed people who need to know the truth, not to denigrate Life Extension or to convey any opposition to the use of vitamins and supplements when useful. On the contrary, my first research at Johns Hopkins Medical School involved studying the critical role of vitamin B6 in serotonin metabolism, and I've seen many times with patients how nutritional deficiencies can contribute to medical and psychiatric problems.
INCORRECT INFORMATION ABOUT ANTIDEPRESSANT EFFECTIVENESS:
The blog wrongly stated that: “Less than 50% of patients prescribed antidepressants actually get better.” and cited a news report in Nature as its source. What the Nature report actually said was that: "roughly one-third of people with depression ... do not respond to current therapies," referencing a nationwide U.S. study showing that the majority (67%) of depressed patients achieved remission after receiving one or more antidepressant therapies.
INCORRECT INFORMATION ABOUT ANTIDEPRESSANT FUNCTION:
The piece went on to say that “antidepressants for the most part work by preventing the removal of one neurotransmitter from the brain — serotonin, the ‘feel-good’ neurotransmitter.” Actually, only five of the more than two dozen antidepressants in current use are SSRI’s (selective serotonin reuptake inhibitors). Others modify norepinephrine and dopamine neurotransmission with or without affecting serotonin. Personalized antidepressant treatment pays attention to those differences and helps improve treatment results by matching patients to the right medications.
INCORRECT INFORMATION ABOUT ANTIDEPRESSANT MECHANISMS:
Finally, the website asserted that “the most popular class of antidepressants does not increase serotonin production. The drugs only prevent its removal from the synaptic cleft...simply preventing its removal doesn’t address the deficiency.” The facts? Studies measuring serotonin metabolism in the brain show very clearly that SSRIs do increase serotonin levels initially, after which they are kept in balance by natural feedback mechanisms.
The blog ends by listing some vitamins and supplements which it declares to be the best way to treat depression. A more balanced article might have said that regular exercise and good nutrition are important components of a depression treatment program, but that without antidepressants or other types of professional treatment there will be little hope for the millions of people who suffer from depression each year and the 15% who die from suicide.
Ernest Hemingway once said: “Every man should have a built-in automatic crap detector operating inside him.” Perhaps Life Extension knows of supplements which could stimulate compelling gastrointestinal disturbances in people before they release misinformation into cyberspace.
LIFE EXTENSION'S RESPONSE ON TWITTER THREE HOURS AFTER WE POSTED THE ABOVE ARTICLE:
Richard J. Metzner, M.D.
Clinical Professor
Semel Institute for Neuroscience and Human Behavior at UCLA
Founder, DepressionConsultant.com
Thank you for visiting this website. Perhaps you are here because you or someone you know has problems with depression or has been prescribed medication to treat depression. Maybe you are just interested in seeing what is available here. In any case, feel free to explore.
I created this website and the TTDI Depression Consultant app because I know that there is a better way to treat depression than many people are receiving. Thousands of patients I've treated and fellow professionals with whom I've spoken would agree. People all over the world are now beginning to use the individualized methods I talk about on this website. That's good news, because the usual one-size-fits-all cookbook approach doesn't work most of the time and has made the word "antidepressant" a joke in too many people's minds.
Depression is anything but a joke. I know because I’ve battled it myself. It runs in my family, and I've seen what it can do up close and personal. That's part of why I decided to devote my professional life to finding a better way to treat it. My personal experiences with treatment in the beginning were not great, so I am very sympathetic to anyone who questions the value of therapy or medications. What I've learned, however, is that those treatments can be very valuable when professionals pay careful attention to what patients need.
Here's a good rule to follow:
DON'T ACCEPT TREATMENT FROM ANYONE WHO TREATS YOU THE SAME WAY AS EVERY OTHER PATIENT.
Just ask the professional this: "How are you going to decide what I need?
If the answer is something like "Let's figure out together what your particular situation calls for," you are much more likely to be treated effectively.
This website is devoted to talking to both non-professionals and professionals about individualizing treatment, but not always in the same places. The TTDI app is designed to help patients get optimal treatment for their depression and other mood disorders under the care of their health professionals.
Welcome to DepressionConsultant.info.
Copyright 2012, Scaled Psychiatric Systems, Inc. All rights reserved.
Richard J. Metzner, M.D.
Clinical Professor
Semel Institute for Neuroscience and Human Behavior at UCLA
Founder, DepressionConsultant.info
Thank you for visiting this website. Perhaps you are here because you treat depression or have a professional interest in the topic. Maybe you are just interested in seeing what is available here. In any case, feel free to explore.
I created this website and the TTDI Depression Consultant app because I know that there is a better way to treat depression than I was taught and is now being taught in many places. Thousands of patients and colleagues with whom I've spent time would agree. People all over the world are now beginning to use the individualized methods I talk about on this website. That's good news, because the usual one-size-fits-all cookbook approach doesn't work most of the time and has made the word "antidepressant" a joke in too many people's minds.
Depression is anything but a joke. I know because I’ve battled it myself. It runs in my family, and I've seen what it can do up close and personal. That's part of why I decided to devote my professional life to finding a better way to treat it. My personal experiences with treatment in the beginning were not great, so I am very sympathetic to anyone who questions the value of therapy or medications. What I've learned, however, is that those treatments can be very valuable when we professionals pay careful attention to what our patients need.
Our message to patients should be: "Let's figure out together what your particular situation calls for." There are many places on this website devoted to the details of how to do just that.
Other parts of the website are aimed at patients. We have, for example, extensive information about antidepressants, but we've divided it into separate sections, just because the facts needed by non-professionals are quite different from those needed by us.
Many of the articles are professionally-oriented, though educated non-professionals may learn from them as well. I hope you will take advantage of all the TTDI app.
Welcome to DepressionConsultant.info.
Copyright 2012, Scaled Psychiatric Systems, Inc. All rights reserved.
Have you heard that serotonin has been unfriended by a lot of people? It was inevitable, of course. Like all idealized love objects, serotonin was headed for heartbreak.
Richard J. Metzner, M.D.
Clinical Professor
Semel Institute for Neuroscience and Human Behavior at UCLA
Founder, DepressionConsultant.info
BACKGROUND
It started with Prozac, the media's first serotonin MILF (Medication I'd Love To Feature), but time can be cruel to aging molecules. Those of us who started prescribing Prozac the year it came out (1987) remember how rapidly it became the cultural phenomenon we were all "listening to." We also remember that, as good as it was, it was never even close to being a universal panacea. We knew that when we listened to patients rather than the hype about the medication, we could hear differences between people who responded to selective serotonin reuptake inhibitors (SSRIs) like Prozac and those who responded better to noradrenergic or non-selective antidepressants like the tricyclics and monoamine oxidase inhibitors. For that reason we knew that the serotonin theory of depression was as incomplete as the norepinephrine or dopamine theories of depression. We still know that these neurotransmitters matter, because the most widely used medications that alleviate depression are the ones that involve them, but we also know that they aren't the whole story.
1. Can clinicians improve antidepressant remission rates with better treatment algorithms?
Richard Metzner, M.D. & Andrew P. Ho, M.D.
SUMMARY:
According to the STAR*D ("Sequenced Treatment Alternatives to Relieve Depression") study group nearly 7 in 10 Major Depressive Disorder patients fail to remit after first-step antidepressant treatment, with few predictors to guide second-step choices. We contrast those findings with the more positive results we obtained in a 33 month study of depressed patients treated in 80 naturalistic primary care and psychiatric settings throughout the United States. Participating clinicians volunteered to receive guidance from an online program called the TTDI ("Targeted Treatment Depression Inventory"), which suggested antidepressants on the basis of patient responses to a 17 item printed questionnaire. The TTDI program was accessed successfully 1,164 times. A sample of 117 patients repeated the TTDI questionnaire between 10 days and 6 months after initial evaluation. Of those 61 were first-step patients. After a mean of 5.7 weeks, they evidenced a 59% remission rate on the TTDI (convergent validity between TTDI and both Hamilton Depression Rating Scale and Zung Self Rating Depression Scale: p<.01). TTDI score improvements were also highly significant (p< .001; paired t tests). Despite the high remission rate achieved by weighing combinations of TTDI responses in recommending antidepressants, analysis of those items using logistic regression did not demonstrate significant predictive value for any of them alone. The conclusions of this study were limited by the fact that that most of the patients were treated without follow-up TTDI testing. Nonetheless, the fact that the TTDI algorithm helped produce a 59% remission rate in a first-step sample without demonstrating predictive value for any specific item, suggests that researchers may need to find other statistical methods to evaluate predictors of antidepressant effectiveness.
- American Psychiatric Association Scientific Meeting presentation No. 54, San Francisco, CA 2009.
2. A Symptom-Guided System for Improving Antidepressant Outcomes: An Observational Study (PDF). (Full text HTML)
Richard Metzner, M.D. & Andrew P. Ho, M.D.
Why hasn't this report been published in a journal?