Note" RCT = Randomized Controlled Trial
Authors of treatment guidelines seem to take for granted that the chemical substance causes the specific effect of antidepressants and that this is more important than the context in which it is prescribed.
In fact, the difference in symptom reduction between patients given added support and those given a sparse contact is greater than the difference typically reported between patients given antidepressants and those given placebo in RCTs. ... The psychosocial interventions given in RCTs thus seem to have a greater effect than antidepressants per se. ... Most of the effect is dependent on the amount of support given during the trial." "Successful doctors get better result with support plus placebo than unsuccessful doctors get with support plus antidepressants ...Again, it seems that it is not the antidepressants per se that have effect but rather the doctor’s skill and the quality of the alliance between doctor and patient.
Available evidence supports a psychological model of therapeutic action when it comes to antidepressant medication, and there is not much support for the pharmaceutical model. Although evidence in some areas is sparse, we think that the burden of proof rests on those who continue to hold onto the pharmaceutical model of therapeutic action.
"When looking at treatment with antidepressants from a perspective building more on the common factors model and Wampold’s contextual model all treatments with antidepressants that in general follow the treatments tested in RCTs would be accepted as having a scientific support."
Contextual model and psychological model are synonymous in this article.
In clinical practice, the strong support for the psychological model of antidepressant treatment makes it necessary for doctors to change focus. Instead of focusing mostly on the pharmacological details of treatment, focus should be on creating a context that provides the best opportunities for symptom reduction. This means allowing enough time with the patient, at least every other week. It also means paying attention to how the patient experiences the doctor and the relationship. The goal would be for the individual doctor to be seen as someone who understands the patient’s dilemmas and to create a good therapeutic alliance.
When patients don't improve: " Since relationship factors are mostly responsible for the effects of antidepressant treatment, the first step to take should be to attend to the therapeutic alliance."
In the United States, physician prescribing of antidepressants for depression is increasing while referrals for psychotherapy are decreasing. This is the reverse of what might be expected since there is limited and minimal evidence that antidepressants are effective with adults and children. Psychotherapy appears to be effective and more effective for both adults and children than antidepressants.
These findings suggest that there is a significant gap between science and treatment of depression in America. Current guidelines and recommendations for the treatment of depression in the United States should be revised in light of research findings internationally.
use of anti-inflammatory pain medications, such as ibuprofen, aspirin and naproxen, reduced the “effectiveness” of the most widely used type of antidepressants.
In brief, one way SSRIs are supposed to work is by enhancing the flow of serotonin, an effect that would be felt immediately upon taking them. However, it is well recognized that an additional mechanism is in play, as for many it takes several weeks or longer before their mood seems to improve. This latter effect is due to the SSRI medication progressively accumulating in glial cells, inducing a highly inflammatory toxic response, and triggering the release of BDNF. Now you can understand why taking anti-inflammatory drugs would interfere with SSRI function.
A person who is depressed is lacking BDNF. This means their credit cards for BDNF have been maxed out trying to cope with the stress in their life. In essence, SSRI antidepressants are like getting a new BDNF credit card from a loan shark. The interest rates are astronomically high, i.e., the loan is given in the form of excitotoxic brain cell injury. Talk about robbing Peter to pay Paul. This is a very short term remedy, at best.
All SSRI studies but one showed an increased risk of female cancer. Additionally, this April 2011 study also evaluated the financial ties of study authors to the companies that make antidepressants. Shockingly, none of the 15 researchers with financial ties to the industry found any risk for breast/ovarian cancer in the studies they conducted, whereas 43 percent of the researchers without industry ties found clear evidence of cancer risk