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Prozac is not a placebo. July 7, 2006 6:44 PM   Subscribe

Prozac is not a placebo. There's no way to say this in the thread without it being a derail, but the comment is counterproductive and assfaced in its wrongness, so I'm going to call it out here.
posted by bingo to Etiquette/Policy at 6:44 PM (59 comments total)

I'm not trying to start a fight about whether prozac is objectively good or bad. I was on it for a while, during which time it probably saved my life, but I'm not on it now, and don't really want to be. Some people have tried it and hated it. Some people have sued the manufacturer, claiming harmful side effects. We could (and have) argue for months about what it does and whether or not one should choose to use it. But it does NOT do nothing, and the flippant suggestion that it does nothing to someone asking an honest question that uses prozac as a comparator is agressively stupid.
posted by bingo at 6:47 PM on July 7, 2006


Stating in a calm, clear manner that you disagree with OmieWise's assertion would be fine. This thread, however, will do nothing.
posted by cortex at 6:50 PM on July 7, 2006


cortex, you are objectively wrong on both counts. However, since arguing about the worthiness of this discussion would be even more of a pointless derail, I'm not motivated to engage that argument.
posted by bingo at 6:58 PM on July 7, 2006


How is cortex objectively wrong? My feeling from omiewise's point was that he maybe knew something, had read studies, could have cited some stuff. Nothing wrong with asking him how he knew what he knew, we see it in AskMe all the time.
posted by jessamyn (staff) at 7:03 PM on July 7, 2006


Prozac is not a placebo. Aspirin is not a placebo. Though nor are lifestyle issues, such as diet or levels of physical activity. Omniwise made a claim that was deliberately provocative.
posted by econous at 7:06 PM on July 7, 2006


jessamyn, the thread was not about prozac, not really. I had nothing to say in answer to the question itself. So I could have made a comment just to argue with omiewise. Do you really think it would have ended there? He would have argued back, and we'd end up ruining the thread that should really about fish oil.
posted by bingo at 7:09 PM on July 7, 2006


Well I'm certainly not trying to argue with anyone, but it seemed to me like one of the questions was "Is fish oil as good as prozac?" I know we sometimes play "hey you're all winners!" in AskMe threads, but we do try to keep stuff that's on-topic if at all possible.
posted by jessamyn (staff) at 7:13 PM on July 7, 2006


You think he said something incorrect. You state that you think it's incorrect, and why. You don't call names. OmieWise responds either in a constructive manner (provides citations for his claims), in an unconstructive manner (in which case you simply do not re-engage), or not at all. The thread doesn't get ruined!

The principle of not diluting threads with conspicuous side arguments is good, and I appreciate that you're trying to observe that here, but I think you're being too conservative in this case. And I simply do not see what good you expect to come of this thread.

Do you believe there is a site-wide belief in OmieWise's position that needs to be addressed independent of the one thread in which it has any apparent context?
posted by cortex at 7:15 PM on July 7, 2006




Counterproductive, maybe, but can you please explain how the comment is "assfaced"? I'd like to hear the argument here.
posted by xmutex at 7:26 PM on July 7, 2006


Do you believe there is a site-wide belief in OmieWise's position that needs to be addressed independent of the one thread in which it has any apparent context?

I do think that there's a tendency to post throwaway provocative comments that are could obviously lead to a derail if engaged, and are therefore fairly safe as long as they are not the emphasis of the comment itself.

amro, that's true, and perhaps I should have merely started another thread in which we can argue about whether or not prozac is a placebo. Wait...that's what I did, or meant to do anyway.

xmutex: I don't know, really. When I read it, the visual that came to me was that of an ass attempting to speak. It was a sort of ass, with a face.
posted by bingo at 7:32 PM on July 7, 2006


bingo, calm down, and read Omiewise's comment again. He neither claimed that Prozac did nothing nor that Prozac was itself a placebo. He claimed that "the studies showing efficacy for prozac don't show all that much efficacy beyond placebo effect." Which, it turns out, is true. His comment was neither flippant nor assfaced.
posted by monju_bosatsu at 7:42 PM on July 7, 2006


perhaps I should have merely started another thread in which we can argue about whether or not prozac is a placebo. Wait...that's what I did, or meant to do anyway.

So... You meant to start a thread to call a user out on a comment that the user didn't make?
posted by amro at 7:45 PM on July 7, 2006


So... You meant to start a thread to call a user out on a comment that the user didn't make?

Hmm. On further reflection, yeah, I guess that is kind of what I did.
posted by bingo at 7:57 PM on July 7, 2006


Looking back over the thread now that I've calmed down a bit, I guess that whether or not omiewise was being provocative or sly is arguable. He said something offhand that went against something I obviously have strong feelings about and a lot of experience with. I have been on so many different antidepressants and such, and have dealt with so many other people who have, that there could be a story on the front page of the WSJ tomorrow morning announcing that prozac has actually been sugar all along, and I wouldn't believe it, even if the manufacturer stood behind the story. But hey, we all have our own experiences and perspectives, and maybe omiewise's only experience with prozac has been reading the studies he referred to. I felt I had to say something, and 'I have a great deal of non-scientific evidence indicating that prozac is not a placebo' was (I felt) only going to derail the AskMe thread, so I expressed my frustration here.
posted by bingo at 8:06 PM on July 7, 2006


Go tell an OCD sufferer that prozac or paxil is no better than placebo; watch them laugh in your face 3 3 3 times.
posted by 517 at 8:17 PM on July 7, 2006


So I could have made a comment just to argue with omiewise.

No, asking for clarification of an answer that strikes you as wrong (even if it wasn't, as in this case) is perfectly fine. Why on earth did you think otherwise?
posted by mediareport at 8:30 PM on July 7, 2006


bingo, if I were there with you I'd congratulate you on your self control, that AskMe thing is the only place not to piss in. Then I'd prescribe you Venlafaxine. It's like Prozac only less fake.
posted by econous at 8:39 PM on July 7, 2006


Prozac IS NOT a placebo, but over a population study it does not perform much better than a placebo on average. Meaning that for some the benefits of the drug may be from either the drug, or the expectation that the drug will provide benefits. I don't know/think trials are run to see if side effects correlate with placebo use. The drug will have some effect on all takes whether or not that is the intended beneficial effect is a matter of individuality and expectation.

breath in
breath out
find the happy place.
posted by edgeways at 8:40 PM on July 7, 2006


breath in
breath out
find the happy place.

Or take a pill.

In the two threads a single link to a motherjones article has been provided as evidence of the barely significant nature of treatment by Prozac where indicated. Omniwise may have access to periodicals or journals that mortals don't, nevertheless links to abstracts would be enlightening. The more incredible the claim, the better the evidence has need to be.
posted by econous at 8:55 PM on July 7, 2006

Go tell an OCD sufferer that prozac or paxil is no better than placebo; watch them laugh in your face 3 3 3 times.
I don't believe anyone's stated that fluoxetine is no better than a placebo for the treatment of OCD. OmieWise's statement specifically concerned depression, and he's absolutely correct on the basis of the available evidence.

While we're here, and I'm soapboxing, I'd like to reiterate for the hard-of-thinking that the plural of "anecdote" is not "data". Whatever your personal experiences, and however authoritative you believe them to be, they are scientifically meaningless unless subjected to peer-reviewed experimentation.
posted by scrump at 9:00 PM on July 7, 2006


Lovely if you could provide a couple of links to available evidence. Scrump. Nice if it were current too.
posted by econous at 9:09 PM on July 7, 2006


There was a scientific paper linked from the blue about ... probably a year back--that said that, if I remember correctly, in every study conducted placeboes were just as effective at "curing" (curbing) depression as Prozac and other SSRIs.
posted by dobbs at 9:24 PM on July 7, 2006


econous, seriously: do your own PubMed or Google Scholar searches.

You also appear to be conflating OmieWise's statement into "Prozac works no better than placebo for all sufferers of depression". That's not what he said, and it's not what I'm saying.

There is a statistically significant portion of the depressive population for whom fluoxetine is no more effective than placebo treatment.

Since you're on this kick, though, I'll quote (PDF) Lilly's own research on Prozac versus placebo in depressed adolescents for you:
In summary, 40 adolescent patients with major depressive disorder were randomized in a double-blind, parallel study to evaluate the efficacy and safety of fluoxetine compared with placebo. On the basis of baseline to endpoint improvement in HAMD17 and HAMD21, CGI-Improvement, Raskin Total, and Covi Anxiety Scale Total scores, fluoxetine was no more effective than placebo in alleviating symptoms of depression in adolescents.
posted by scrump at 9:27 PM on July 7, 2006


the plural of "anecdote" is not "data".

Yeah, I've always liked that one.

I'm not about to debate psychopharmacology — but as long as we're trading pet peeves, how about the knee-jerk insistence that people demonstrate scientific claims with hyperlinks, as if anything worthwhile or authoritative must have been published on the Internet. I yearn for the days when "I saw it on the Internet" was an automatic indictment, not some validation of legitimacy.
posted by cribcage at 9:31 PM on July 7, 2006


In the two threads a single link to a motherjones article has been provided as evidence of the barely significant nature of treatment by Prozac where indicated.

On top of the data scrump cites, did you actually read the motherjones article? The evidence isn't the article itself, but rather the comprehensive review of the studies and FDA files discussed in the article.
posted by monju_bosatsu at 9:31 PM on July 7, 2006


Dear scrump,

Since it would appear from that statement that the only thinking you do is reading, I'll take my advice on thinking from someone else.

All the best,

517
posted by 517 at 9:33 PM on July 7, 2006


The problem is that placebos are very effective at curing depression.
posted by delmoi at 9:41 PM on July 7, 2006


I just saw this--I would have responded sooner if you'd sent me an email, bingo.

It wasn't a provocative comment, unintentional or otherwise. The comment was apropos in a thread which was about, in part, how fish oil works. If it works, it works in part through placebo effect.

I'm at home, on dial-up, so it would be onerous for me to track down references right now, but they're abundant. If you've got fast internet, surf on over to the British Medical Journal, they've done a pretty good job of being honest about the efficacy of SSRIs. Make no mistake, SSRIs work for some people some of the time, but overall they aren't that much better than placebo. That doesn't mean that they don't work--placebos too work. I'm all for anything that helps people in mental distress get better.

Incidentally, the notion that people who've been helped by SSRIs are exempt from providing evidence beyond their own anecdote(s) strikes me as wrong. I can almost guarantee that I've seen more depressed people try more treatments than most people on Metafilter since it's my job. Talking about the limited efficacy of anti-depressants isn't a nefarious crusade of mine designed to elevate people through suffering. (And you won't find comments of mine suggesting that people not take meds or arguing that people who say they were helped weren't "really" helped.) On the contrary, my interest is in helping depressed people get better however they can, and medications are an important part of that. But, their use and their effectiveness are consistently overstated, not least because the studies have been pretty rigged (severe exclusion of difficult patients as well as noted placebo repsponders), and the advertising budgets of pharmaceutical companies are quite high. Questioning that conventional "wisdom" may seem provocative, but to me largely seems like a way to broaden the discussion of how people with mental distress can get better.
posted by OmieWise at 9:46 PM on July 7, 2006 [1 favorite]

Since it would appear from that statement that the only thinking you do is reading, I'll take my advice on thinking from someone else.
To which statement of mine, exactly, are you responding, 517?
posted by scrump at 9:47 PM on July 7, 2006

as long as we're trading pet peeves, how about the knee-jerk insistence that people demonstrate scientific claims with hyperlinks, as if anything worthwhile or authoritative must have been published on the Internet.
I can only speak for myself, but I generally only request hyperlinks when the hyperlinks are interfaces to reference collections like the NIH. Google Scholar, if I am not mistaken, generally contains reference materials that can be found in reference libraries.

You will never, and I say this with full confidence, see me asking for references from Some Guy With A Website.
posted by scrump at 9:53 PM on July 7, 2006


exactly.
posted by 517 at 10:08 PM on July 7, 2006


Scrump for the benefit of discussion:

OmniWise said in part: "Well, many many things work about as well as prozac for treating depression, since the studies showing efficacy for prozac don't show all that much efficacy beyond placebo effect."

OK, so we might now agree that his/her claim was baldfaced? No studies mentioned.. just the claim. And no sub groups, where does the 'not all' sufferers become relevant? What have I conflated.
posted by econous at 10:13 PM on July 7, 2006


I'm sorry, 517, but if there's some sort of deep truth to be gleaned from what you're saying, I'm not seeing it.

If you were making a joke, I didn't get it, and I assumed you were serious. If you're making another one now, I'm not getting that one either, and I'm assuming you're an ass.

If that's what you want, go for it. Otherwise, it might be a good idea to explain, unless you want me to think you're an ass. If we keep this up, heck, there's no limit to the possibilities!
posted by scrump at 10:15 PM on July 7, 2006


econous, OmieWise has already adequately answered your claims on his own.
posted by scrump at 10:17 PM on July 7, 2006


Abstracts from reliable sources are available to the public for free, no need for an institutional subscriber account. The Internet, like a newspaper or library can be a crappy source. On that scrump we can agree.
posted by econous at 10:18 PM on July 7, 2006


Ah.. yes I shall read that then scrump. Cheers.
posted by econous at 10:22 PM on July 7, 2006


I think you've already won the pedantic ass award in this thread, scrump. I don't see any reason to challenge you for it. To staunch your curiosity, my original comment was a joke. It was a sentence that could mean two entirely different things, if you think about it rather than just read it.
posted by 517 at 10:29 PM on July 7, 2006


YAY I WIN DO I GET A TROPHY OR WHAT

Man, this trophy sucks.
posted by scrump at 10:42 PM on July 7, 2006


See. Because reading? It's not what thinking people do. Thinking people think. Reading is for non-thinkers. And anyone who says otherwise is a pedant. Because the internet is made of tubes. And there's an enormous amount—an—an enormous amount of material.

An enormous amount.

It's Friday night! Christ!
posted by cortex at 10:44 PM on July 7, 2006


Well I read the comment scrump, has no relationship on my point. Nice statement though. "Works for some not for others, on average: a bit."
posted by econous at 11:12 PM on July 7, 2006


Is it the summer that brings out all of the metatalk posts?
posted by Pacheco at 12:20 AM on July 8, 2006


It's the dampness. Kind of like fungus.
posted by Kirth Gerson at 4:05 AM on July 8, 2006


xmutex: I don't know, really. When I read it, the visual that came to me was that of an ass attempting to speak. It was a sort of ass, with a face.

someone hasn't been taking his prozac.
posted by quonsar at 5:09 AM on July 8, 2006



posted by StrasbourgSecaucus at 5:26 AM on July 8, 2006


My understanding based on my reading of the literature is that a big reason Prozac and other antidepressents are little better than placebo in broad trials is because placebo is so effective in treating modest or occasional depression; In other words, most people get better on their own, so giving them an anti-depressent isn't going to be significantly more effective than giving them pills filled with sugar, St. John's Wort, basil, grape nuts, or really anything else.

However, in studies targetting folks with serious or very persistent depression, my understanding is that SSRIs and other anti-depressents do prove to be of significant benefit when compared to placebo.
posted by Justinian at 5:33 AM on July 8, 2006


delmoi : "The problem is that placebos are very effective at curing depression."

Justinian : "My understanding based on my reading of the literature is that a big reason Prozac and other antidepressents are little better than placebo in broad trials is because placebo is so effective in treating modest or occasional depression"

I'm reading the initial comment the same way. It isn't saying that Prozac is a placebo. And it's not saying "Prozac is weak, no stronger than a placebo." It's saying "Prozac works. Placebos work. They work roughly equally, with Prozac working slightly, but only slightly, more."
posted by Bugbread at 6:46 AM on July 8, 2006


*sprays fish oil all over the thread*
posted by matteo at 7:41 AM on July 8, 2006


*licks thread, feels normal for the first time in decades*
posted by PinkStainlessTail at 8:18 AM on July 8, 2006


*swallows thread, remembers peeing in boss's coffee.*
posted by shmegegge at 10:18 AM on July 8, 2006


Placebos are powerful remedies for brain-related diseases. Their effects at the level of the neurotransmitter are well documented.

Some of us who work in the field feel that so-called "ethical" restrictions on administration of placebo are terribly misguided. To be clear, placebo is not equivalent to "nothing;" placebos have potent effects.
posted by ikkyu2 at 11:42 AM on July 8, 2006


OmieWise, thank you for your thoughtful and very civil response.

bugbread and Justinian make a good point above, although that's not the same argument that I was taking issue with.

I do not think that my own experience is the same as peer-reviewed scientific data, but I have ingested a variety of prescribed mind-altering substances, sometimes without reading up on them in advance, and they each have their own "feel" for lack of a better word. Prozac, Luvox, L-Tryptophan, Wellbutrin, and others all have valid antidepressant properties in my experience, and the fact that they felt so different from each other is one reason that I don't think that I was feeling a placebo in any case. Of course, I could have been making up the separate properties, or just one of them, etc.
posted by bingo at 6:15 PM on July 8, 2006


Not aimed at anyone in particular, and ikkyu2 clearly knows this already, but a lot of people seem to have a misunderstanding of what a placebo effect is. A placebo effect doesn't mean nothing happened, and if someone is given a placebo and then gets better it doesn't mean nothing was wrong in the first place.

Let's say someone is experiencing significant pain. If that person's body can be made to produce pain-dampening endorphins, that pain will be at least somewhat relieved. You can give that person a narcotic and it will relieve their pain. Or you can give them a placebo. And if they believe they are receiving medication, their body will produce endorphins which bind to the opiod receptors... just like morphine. And their pain is relieved.

Again, if you give someone who is expecting treatment a placebo, their pain is relieved through much the same mechanism as if you give them an opiate. This is not difficult to confirm; You hook someone up to a device that causes pain. You demonstrate it, and they agree it hurts. You run a couple trials where you give them a narcotic and the device doesn't cause pain. Then you substitute a placebo (saline, etc) for the narcotic without telling the subject and... the device doesn't cause pain.

But wait! Perhaps it never hurt in the first place, and they only said it hurt because they expected it to do so. You can test this by, instead of giving them a placebo, give them a solution with an opioid antagonist. And lo and behold, the patient reports pain again!

So the patient reported no pain despite having been given no opiates... and then reported pain again when given an opiate antagonist despite having been given no opiates! The placebo made their bodies produce their own natural painkillers.

Cool. And it shows that deriding something as a "placebo" is ridiculous. Placebos make people feel better. They work.
posted by Justinian at 6:46 PM on July 8, 2006


Well as someone on an antidepressant (due to a non interesting medical condition) and therefore being Ms Anecdotal - when discussing this with various doctors the one thing they have all said is that you have to take some of these studies with a grain of salt in that there are so many and varied reasons for depression amongst the subjects used in some of the studies, not to mention the gender differences that come up, that it's hard to make sweeping statements based on them. Unless of course they are very specific in their subject group - for example, people of a certain age range with depression post-cancer treatment, or something of that sort. I was under the impression that Prozac wasn't prescribed as often as previously - I know that my doctors have been skeptical of it in the past, and it was never offered to me. I'll not even get into how much fun (sarcasm) it is trying to track down whether certain studies have been successfully replicated. When that sort of thing isn't your day job, that is.

Oh and anyone who would take medical advice from any area of the net, even AskMe, without having links to several resources with which to better judge such information - well, let's just say that sounds like a bad idea. Honestly bingo, you should have commented in that thread and asked for clarification. And a polite request for a link never hurts - usually others pop in and post something even if the original commenter doesn't. I often get more information out of the links in the comments than the original post.
posted by batgrlHG at 12:02 AM on July 9, 2006


In OmieWise's case, the degree to which he's speaking authoritatively is also the degree to which we should be skeptical because of professional bias. There's really no avoiding the simple reality that you've got to make an effort to research and evaluate such claims on your own.
posted by Ethereal Bligh at 12:49 AM on July 9, 2006


bingo : "I have ingested a variety of prescribed mind-altering substances, sometimes without reading up on them in advance, and they each have their own 'feel' for lack of a better word. Prozac, Luvox, L-Tryptophan, Wellbutrin, and others all have valid antidepressant properties in my experience, and the fact that they felt so different from each other is one reason that I don't think that I was feeling a placebo in any case."

Well, also keep in mind that what's being described is the overall effect across a sample group. So, purely hypothetically, and simplified so that you can understand what I'm getting at, imagine:

Two groups of people.
Each group contains:
1 person on which placebos don't work at all, but in which actual medications do.
1 person on which medications don't work (or don't work much), but on which placebos do.
2 people on which they work equally.

Give group one a placebo. Give group two a medication.

The results would be:
Group 1:
Person 1: No effect.
Person 2: Improvement
Person 3: Improvement
Person 4: Improvement

Group 2:
Person 1: Improvement
Person 2: No effect.
Person 3: Improvement
Person 4: Improvement

So what would the overall statistics show? That a placebo works 75% of the time, and that medication works 75% of the time, hence they work equally well.

But what if you're Person 1? Would you have the experience that placebos and medication work equally well? No. You'd see there as being a tremendous difference. However, that wouldn't change the fact that, overall, they work equally well.

I'm not saying that's the case here, but just that there are possible situations where there is no contradiction between: "Overall, medications are no more effective than placebos" and "My experience with medication is that it's much more effective than a placebo".
posted by Bugbread at 6:03 AM on July 9, 2006


personally, prozac saved me from a severe depression. the change was from black to white. no kidding!
posted by brandz at 9:05 AM on July 9, 2006




Make sure that the grain of salt you take with your studies is proper natural salt. Table salt is bad for you.
posted by flabdablet at 5:05 PM on July 9, 2006


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