Chitchat Excellent article on depression suffered by a doctor.

[mojito]

https://news.tfionline.com/post/173319329722/how-to-be-happy-in-todays-crazy-world-3-secrets

How To Be Happy In Today’s Crazy World: 3 Secrets From Research
Eric Barker, Barking Up The Wrong Tree, April 24th, 2018.

Sometimes it feels like the world is actively conspiring against your happiness. There are a record number of people on antidepressants. Enough people in Western nations consume–and then excrete–the medications that they’re at detectable levels in the water supply.

From Lost Connections: Uncovering the Real Causes of Depression–and the Unexpected Solutions:

Some one in five U.S. adults is taking at least one drug for a psychiatric problem; nearly one in four middle-aged women in the United States is taking antidepressants at any given time… You can’t escape it: when scientists test the water supply of Western countries, they always find it is laced with antidepressants, because so many of us are taking them and excreting them that they simply can’t be filtered out of the water we drink every day.

For the past few decades we’ve lived under the idea that depression is caused by a chemical imbalance in your noggin. And while that is true for some people, more and more research is showing that our dissatisfaction may be due less to a broken brain and more to a broken life.

You don’t see so rapid a surge in cases of depression because our genetics or grey matter changed overnight. The world has shifted in ways that are detrimental to the psychological needs of the human animal. That persistent feeling of vague dissatisfaction may be a normal response to abnormal circumstances. The canary in the coal mine.

So journalist Johann Hari spent three years on a journey of over forty thousand miles conducting more than 200 interviews with social scientists and psychologists to discover what was wrong with the way we live today that was causing such an explosion of unhappiness.

His excellent book is Lost Connections: Uncovering the Real Causes of Depression–and the Unexpected Solutions.

What he found was that while our world has become very technologically connected, all the sources of unhappiness stem from a growing disconnection in other areas of our lives.

Disconnection From Other People: Loneliness is the equivalent of being punched in the face. I mean, literally.

Your stress response to both–the increase in your body’s cortisol level–is the same.

From Lost Connections: Uncovering the Real Causes of Depression–and the Unexpected Solutions:

Feeling lonely, it turned out, caused your cortisol levels to absolutely soar–as much as some of the most disturbing things that can ever happen to you. Becoming acutely lonely, the experiment found, was as stressful as experiencing a physical attack. It’s worth repeating. Being deeply lonely seemed to cause as much stress as being punched by a stranger.

And have no illusions, loneliness is an epidemic in the modern world. A few decades ago, the average US citizen reported having three close friends. Since 2004 the most common answer is… Zero.

I can already hear some people crowing: “I might be dissatisfied but how could it be due to loneliness? I’m always around people.”

Turns out there’s a difference between being lonely and feeling lonely. This is why someone who works a job surrounded by people and then goes home to a spouse and children, can spend very little time alone–and yet still feel profoundly lonely.

From Lost Connections: Uncovering the Real Causes of Depression–and the Unexpected Solutions:

In his studies, it turned out that feeling lonely was different from simply being alone. Surprisingly, the sensation of loneliness didn’t have much to do with how many people you spoke to every day, or every week. Some of the people in his study who felt most lonely actually talked to lots of people every day. “There’s a relatively low correlation between the objective connections and perceived connections,” he says.

So what do we need to do? To prevent feeling lonely, we must share something with those around us–something meaningful to both you and them. A belief. A cause. An activity. A goal. We need to be “in it together”–not merely together in the middle of a faceless crowd.

From Lost Connections: Uncovering the Real Causes of Depression–and the Unexpected Solutions:

As he researched this, John discovered that there was a missing ingredient to loneliness, and to recovering from it. To end loneliness, you need other people–plus something else. You also need, he explained to me, to feel you are sharing something with the other person, or the group, that is meaningful to both of you. You have to be in it together–and “it” can be anything that you both think has meaning and value.

So join a group. Harvard researcher Robert Putnam has studied group activities for decades–everything from bowling leagues to volunteer groups.

Between 1985 and 1994 involvement in community organizations declined by 45%.

From Lost Connections: Uncovering the Real Causes of Depression–and the Unexpected Solutions:

Today, people still bowl, but they do it alone. They’re in their own lane, doing their own thing. The collective structure has collapsed. Think about everything else we do to come together–like supporting your kid’s school, say. “In the ten short years between 1985 and 1994” alone, he wrote, “active involvement in community organizations … fell by 45 percent.”

Famed biologist E.O. Wilson once said, “People must belong to a tribe.” Increasingly, we don’t.

Disconnection From Values: Your pursue “intrinsic values” when you do something solely because you love it. You pursue “extrinsic values” when you chase money or status. Being a patriotic soldier is intrinsic; being a mercenary is extrinsic.

The lesson from the research is clear: the more extrinsically motivated you are, the more you feel motivated by money or status, the more depressed and anxious you are.

From Lost Connections: Uncovering the Real Causes of Depression–and the Unexpected Solutions:

Twenty-two different studies have, in the years since, found that the more materialistic and extrinsically motivated you become, the more depressed you will be. Twelve different studies found that the more materialistic and extrinsically motivated you become, the more anxious you will be. Similar studies, inspired by Tim’s work and using similar techniques, have now been carried out in Britain, Denmark, Germany, India, South Korea, Russia, Romania, Australia, and Canada–and the results, all over the world, keep coming back the same.

I know some people are jumping to say, “Well, I’m not like that!” But, to a degree, we have all become more extrinsically motivated. We all care, to some degree, what others think of us and technology often amplifies this to toxic levels. Facebook and Instagram have become gladiatorial status tournaments to show off how cool our lives are.

But when we’re counting “likes” on social media, we let others control our self-esteem. And that places your own happiness outside your control. Not good.

And even if you win, you lose. Studies show that the achievement of extrinsic goals–the fancy car and the impressive promotion–bring no lasting happiness. None. Meanwhile, when we pursue intrinsic goals like being a better parent or trying to improve our writing skills so our blog posts don’t suck, we feel much happier and less anxious.

From Lost Connections: Uncovering the Real Causes of Depression–and the Unexpected Solutions:

People who achieved their extrinsic goals didn’t experience any increase in day-to-day happiness–none. They spent a huge amount of energy chasing these goals, but when they fulfilled them, they felt the same as they had at the start…. But people who achieved their intrinsic goals did become significantly happier, and less depressed and anxious. You could track the movement. As they worked at it and felt they became (for example) a better friend–not because they wanted anything out of it but because they felt it was a good thing to do–they became more satisfied with life.

You experience “flow” when you’re so involved in something that you lose track of time. You know the old saying: “time flies when you’re having fun.” Flow is a huge contributor to happiness.

And the more focused we are on extrinsic goals like status, the fewer flow states we experience.

From Lost Connections: Uncovering the Real Causes of Depression–and the Unexpected Solutions:

But when Tim studied highly materialistic people, he discovered they experience significantly fewer flow states than the rest of us. Why would that be? He seems to have found an explanation. Imagine if, when Tim was playing the piano every day, he kept thinking: Am I the best piano player in Illinois? Are people going to applaud this performance? Am I going to get paid for this? How much?

So what should we do? Yeah, we all have to pay the bills and achieving a decent level of status is a good thing, but we need to start choosing more activities that serve those intrinsic values.

Spending more time with those we love rather than those who can help us get ahead. More time playing the guitar because it’s fun rather than sharpening our Excel skills to get that promotion.

Spend a little more time with people that make you smile and doing the things that make you smile–simply because they make you smile.

So you’re connecting with people and connecting with your intrinsic values. Great. What’s another connection we’re getting less and less of?

Disconnection From Nature: All other things being equal, move closer to nature and you’ll be happier. Move away from nature and you’ll be more depressed.

From Lost Connections: Uncovering the Real Causes of Depression–and the Unexpected Solutions:

…the people who moved to green areas saw a big reduction in depression, and the people who moved away from green areas saw a big increase in depression.

Some might say that’s because rural areas have less crime or less pollution or… Wrong.

If you live in the part of a big city with lots of trees, you get happier. Cart yourself over to the section of the city that’s nothing but concrete and you get sadder.

From Lost Connections: Uncovering the Real Causes of Depression–and the Unexpected Solutions:

They compared deprived inner-city areas that had some green space to very similar deprived inner-city areas without green space. Everything else–like levels of social connections–was the same. But it turned out there was less stress and despair in the greener neighborhood.

We simply weren’t meant to spend all our time going from cubicle to couch. Feeling happier can be as simple as spending more time in nature.

The research all says that exercise makes us happier. Guess what? When you exercise outdoors the effect is even stronger.

From Lost Connections: Uncovering the Real Causes of Depression–and the Unexpected Solutions:

When scientists have compared people who run on treadmills in the gym with people who run in nature, they found that both see a reduction in depression–but it’s higher for the people who run in nature.

So what happens when you make a consistent, concerted effort to be happier?

You fail miserably. No joke. Deliberate efforts to be happier do not work… in the US and UK, that is.

From Lost Connections: Uncovering the Real Causes of Depression–and the Unexpected Solutions:

They tracked thousands of people, some of whom had decided to deliberately pursue happiness and some of whom hadn’t. When they compared the results, they found something they had not expected. If you deliberately try to become happy, you will not become happier–if you live in the United States. But if you live in Russia, Japan, or Taiwan, you will become happier.

What’s going on? It’s not that happiness is unachievable or that hard work isn’t rewarded. The issue here is that the US and UK have the most individualistic cultures. And so the efforts people in those countries make are usually individualistic…

But happiness comes from our connections to other people.

And so when we work toward just making ourselves happy as individuals we often fail. But when we work towards the happiness of a group, we usually succeed.

From Lost Connections: Uncovering the Real Causes of Depression–and the Unexpected Solutions:

“The more you think happiness is a social thing, the better off you are,” Brett explained to me, summarizing her findings and reams of other social science.

The modern world promotes a culture of “be yourself.” But if you want to be happy, that isn’t always the best idea.

To find more joy, spend a little less time being you and little more time being us.

You can choose to be happy. Stop listening to fake new and read straight time. Volunteer in grassroot, mix with winners, serve the community.

 

[ginfreely]

https://news.tfionline.com/post/173319329722/how-to-be-happy-in-todays-crazy-world-3-secrets

How To Be Happy In Today’s Crazy World: 3 Secrets From Research
Eric Barker, Barking Up The Wrong Tree, April 24th, 2018.

Sometimes it feels like the world is actively conspiring against your happiness. There are a record number of people on antidepressants. Enough people in Western nations consume–and then excrete–the medications that they’re at detectable levels in the water supply.

From Lost Connections: Uncovering the Real Causes of Depression–and the Unexpected Solutions:

Some one in five U.S. adults is taking at least one drug for a psychiatric problem; nearly one in four middle-aged women in the United States is taking antidepressants at any given time… You can’t escape it: when scientists test the water supply of Western countries, they always find it is laced with antidepressants, because so many of us are taking them and excreting them that they simply can’t be filtered out of the water we drink every day.

For the past few decades we’ve lived under the idea that depression is caused by a chemical imbalance in your noggin. And while that is true for some people, more and more research is showing that our dissatisfaction may be due less to a broken brain and more to a broken life.

You don’t see so rapid a surge in cases of depression because our genetics or grey matter changed overnight. The world has shifted in ways that are detrimental to the psychological needs of the human animal. That persistent feeling of vague dissatisfaction may be a normal response to abnormal circumstances. The canary in the coal mine.

So journalist Johann Hari spent three years on a journey of over forty thousand miles conducting more than 200 interviews with social scientists and psychologists to discover what was wrong with the way we live today that was causing such an explosion of unhappiness.

His excellent book is Lost Connections: Uncovering the Real Causes of Depression–and the Unexpected Solutions.

What he found was that while our world has become very technologically connected, all the sources of unhappiness stem from a growing disconnection in other areas of our lives.

Disconnection From Other People: Loneliness is the equivalent of being punched in the face. I mean, literally.

Your stress response to both–the increase in your body’s cortisol level–is the same.

From Lost Connections: Uncovering the Real Causes of Depression–and the Unexpected Solutions:

Feeling lonely, it turned out, caused your cortisol levels to absolutely soar–as much as some of the most disturbing things that can ever happen to you. Becoming acutely lonely, the experiment found, was as stressful as experiencing a physical attack. It’s worth repeating. Being deeply lonely seemed to cause as much stress as being punched by a stranger.

And have no illusions, loneliness is an epidemic in the modern world. A few decades ago, the average US citizen reported having three close friends. Since 2004 the most common answer is… Zero.

I can already hear some people crowing: “I might be dissatisfied but how could it be due to loneliness? I’m always around people.”

Turns out there’s a difference between being lonely and feeling lonely. This is why someone who works a job surrounded by people and then goes home to a spouse and children, can spend very little time alone–and yet still feel profoundly lonely.

From Lost Connections: Uncovering the Real Causes of Depression–and the Unexpected Solutions:

In his studies, it turned out that feeling lonely was different from simply being alone. Surprisingly, the sensation of loneliness didn’t have much to do with how many people you spoke to every day, or every week. Some of the people in his study who felt most lonely actually talked to lots of people every day. “There’s a relatively low correlation between the objective connections and perceived connections,” he says.

So what do we need to do? To prevent feeling lonely, we must share something with those around us–something meaningful to both you and them. A belief. A cause. An activity. A goal. We need to be “in it together”–not merely together in the middle of a faceless crowd.

From Lost Connections: Uncovering the Real Causes of Depression–and the Unexpected Solutions:

As he researched this, John discovered that there was a missing ingredient to loneliness, and to recovering from it. To end loneliness, you need other people–plus something else. You also need, he explained to me, to feel you are sharing something with the other person, or the group, that is meaningful to both of you. You have to be in it together–and “it” can be anything that you both think has meaning and value.

So join a group. Harvard researcher Robert Putnam has studied group activities for decades–everything from bowling leagues to volunteer groups.

Between 1985 and 1994 involvement in community organizations declined by 45%.

From Lost Connections: Uncovering the Real Causes of Depression–and the Unexpected Solutions:

Today, people still bowl, but they do it alone. They’re in their own lane, doing their own thing. The collective structure has collapsed. Think about everything else we do to come together–like supporting your kid’s school, say. “In the ten short years between 1985 and 1994” alone, he wrote, “active involvement in community organizations … fell by 45 percent.”

Famed biologist E.O. Wilson once said, “People must belong to a tribe.” Increasingly, we don’t.

Disconnection From Values: Your pursue “intrinsic values” when you do something solely because you love it. You pursue “extrinsic values” when you chase money or status. Being a patriotic soldier is intrinsic; being a mercenary is extrinsic.

The lesson from the research is clear: the more extrinsically motivated you are, the more you feel motivated by money or status, the more depressed and anxious you are.

From Lost Connections: Uncovering the Real Causes of Depression–and the Unexpected Solutions:

Twenty-two different studies have, in the years since, found that the more materialistic and extrinsically motivated you become, the more depressed you will be. Twelve different studies found that the more materialistic and extrinsically motivated you become, the more anxious you will be. Similar studies, inspired by Tim’s work and using similar techniques, have now been carried out in Britain, Denmark, Germany, India, South Korea, Russia, Romania, Australia, and Canada–and the results, all over the world, keep coming back the same.

I know some people are jumping to say, “Well, I’m not like that!” But, to a degree, we have all become more extrinsically motivated. We all care, to some degree, what others think of us and technology often amplifies this to toxic levels. Facebook and Instagram have become gladiatorial status tournaments to show off how cool our lives are.

But when we’re counting “likes” on social media, we let others control our self-esteem. And that places your own happiness outside your control. Not good.

And even if you win, you lose. Studies show that the achievement of extrinsic goals–the fancy car and the impressive promotion–bring no lasting happiness. None. Meanwhile, when we pursue intrinsic goals like being a better parent or trying to improve our writing skills so our blog posts don’t suck, we feel much happier and less anxious.

From Lost Connections: Uncovering the Real Causes of Depression–and the Unexpected Solutions:

People who achieved their extrinsic goals didn’t experience any increase in day-to-day happiness–none. They spent a huge amount of energy chasing these goals, but when they fulfilled them, they felt the same as they had at the start…. But people who achieved their intrinsic goals did become significantly happier, and less depressed and anxious. You could track the movement. As they worked at it and felt they became (for example) a better friend–not because they wanted anything out of it but because they felt it was a good thing to do–they became more satisfied with life.

You experience “flow” when you’re so involved in something that you lose track of time. You know the old saying: “time flies when you’re having fun.” Flow is a huge contributor to happiness.

And the more focused we are on extrinsic goals like status, the fewer flow states we experience.

From Lost Connections: Uncovering the Real Causes of Depression–and the Unexpected Solutions:

But when Tim studied highly materialistic people, he discovered they experience significantly fewer flow states than the rest of us. Why would that be? He seems to have found an explanation. Imagine if, when Tim was playing the piano every day, he kept thinking: Am I the best piano player in Illinois? Are people going to applaud this performance? Am I going to get paid for this? How much?

So what should we do? Yeah, we all have to pay the bills and achieving a decent level of status is a good thing, but we need to start choosing more activities that serve those intrinsic values.

Spending more time with those we love rather than those who can help us get ahead. More time playing the guitar because it’s fun rather than sharpening our Excel skills to get that promotion.

Spend a little more time with people that make you smile and doing the things that make you smile–simply because they make you smile.

So you’re connecting with people and connecting with your intrinsic values. Great. What’s another connection we’re getting less and less of?

Disconnection From Nature: All other things being equal, move closer to nature and you’ll be happier. Move away from nature and you’ll be more depressed.

From Lost Connections: Uncovering the Real Causes of Depression–and the Unexpected Solutions:

…the people who moved to green areas saw a big reduction in depression, and the people who moved away from green areas saw a big increase in depression.

Some might say that’s because rural areas have less crime or less pollution or… Wrong.

If you live in the part of a big city with lots of trees, you get happier. Cart yourself over to the section of the city that’s nothing but concrete and you get sadder.

From Lost Connections: Uncovering the Real Causes of Depression–and the Unexpected Solutions:

They compared deprived inner-city areas that had some green space to very similar deprived inner-city areas without green space. Everything else–like levels of social connections–was the same. But it turned out there was less stress and despair in the greener neighborhood.

We simply weren’t meant to spend all our time going from cubicle to couch. Feeling happier can be as simple as spending more time in nature.

The research all says that exercise makes us happier. Guess what? When you exercise outdoors the effect is even stronger.

From Lost Connections: Uncovering the Real Causes of Depression–and the Unexpected Solutions:

When scientists have compared people who run on treadmills in the gym with people who run in nature, they found that both see a reduction in depression–but it’s higher for the people who run in nature.

So what happens when you make a consistent, concerted effort to be happier?

You fail miserably. No joke. Deliberate efforts to be happier do not work… in the US and UK, that is.

From Lost Connections: Uncovering the Real Causes of Depression–and the Unexpected Solutions:

They tracked thousands of people, some of whom had decided to deliberately pursue happiness and some of whom hadn’t. When they compared the results, they found something they had not expected. If you deliberately try to become happy, you will not become happier–if you live in the United States. But if you live in Russia, Japan, or Taiwan, you will become happier.

What’s going on? It’s not that happiness is unachievable or that hard work isn’t rewarded. The issue here is that the US and UK have the most individualistic cultures. And so the efforts people in those countries make are usually individualistic…

But happiness comes from our connections to other people.

And so when we work toward just making ourselves happy as individuals we often fail. But when we work towards the happiness of a group, we usually succeed.

From Lost Connections: Uncovering the Real Causes of Depression–and the Unexpected Solutions:

“The more you think happiness is a social thing, the better off you are,” Brett explained to me, summarizing her findings and reams of other social science.

The modern world promotes a culture of “be yourself.” But if you want to be happy, that isn’t always the best idea.

To find more joy, spend a little less time being you and little more time being us.

Playing piano is my intrinsic goal and increased my happiness tremendously indeed. I really experienced the “flow” mentioned in the article hahahahaha

.....
“You experience “flow” when you’re so involved in something that you lose track of time. You know the old saying: “time flies when you’re having fun.” Flow is a huge contributor to happiness.”

...,
“But when Tim studied highly materialistic people, he discovered they experience significantly fewer flow states than the rest of us. Why would that be? He seems to have found an explanation. Imagine if, when Tim was playing the piano every day, he kept thinking: Am I the best piano player in Illinois? Are people going to applaud this performance? Am I going to get paid for this? How much?”

 

[musashi]

Playing piano is my intrinsic goal and increased my happiness tremendously indeed. I really experienced the “flow” mentioned in the article hahahahaha

Dear @ginfreely, please continue doing that much more often!

 

[glockman]

You can choose to be happy. Stop listening to fake new and read straight time. Volunteer in grassroot, mix with winners, serve the community.

Yep, ignorance is bliss. And in order to remain happy, must vote for pap.

 

[ginfreely]

Dear @ginfreely, please continue doing that much more often!

I have been and will keep doing this. You may one day buy a ticket to hear my piano concerto.

 

[ginfreely]

Yep, ignorance is bliss. And in order to remain happy, must vote for pap.

Ignorance is bliss only for children. For adults, ignorance equates to laziness and stupidity. Wise adults find bliss amidst misery by converting negative to positive like me.

 

[musashi]

I have been and will keep doing this. You may one day buy a ticket to hear my piano concerto.

If you're hard-working enough, I believe you will be good enough to perform in public by the end of this year or next year at the latest.
But I would bother to buy that ticket only if I know it's you, @ginfreely, performing; so please tell me your real-life name (or at least your stage name), in order for me to know that it's really you performing; I'm honestly looking forward to seeing you perform live!

 

[Wunderfool]

If you're hard-working enough, I believe you will be good enough to perform in public by the end of this year or next year at the latest.
But I would bother to buy that ticket only if I know it's you, @ginfreely, performing; so please tell me your real-life name (or at least your stage name), in order for me to know that it's really you performing; I'm honestly looking forward to seeing you perform live!

It will be a sold out concert. All her Samsters and Malaysians friends will be there to give her their full support .

 

[Leongsam]

THE NEW HEALTH CARE

Do Antidepressants Work?

The most comprehensive study on them has recently been published, showing mostly modest effects.


By Aaron E. Carroll

• March 12, 2018

Image

Antidepressants are widely used, but there are still so many unanswered questions about them.CreditJonathan Nourok/Getty Images

More people in the United States are on antidepressants, as a percentage of the population, than any other country in the world. And yet the drugs’ efficacy has been hotly debated.

Some believe that the short-term benefits are much more modest than widely thought, and that harms may outweigh benefits in the long run. Others believe that they work, and that they can be life-changing.

Settling this debate has been much harder than you might think.

It’s not that we lack research. Many, many studies of antidepressants can be found in the peer-reviewed literature. The problem is that this has been a prime example of publication bias: Positive studies are likely to be released, with negative ones more likely to be buried in a drawer.

In 2008, a group of researchers made this point by doing a meta-analysis of antidepressant trials that were registered with the Food and Drug Administration as evidence in support of approvals for marketing or changes in labeling. Companies had to submit the results of registered trials to the F.D.A. regardless of the result. These trials also tend to have less data massaging — such as the cherry-picking of outcomes — than might be possible in journals.

The researchers found 74 studies, with more than 12,500 patients, for drugs approved between 1987 and 2004. About half of these trials had “positive” results, in that the antidepressant performed better than a placebo; the other half were “negative.” But if you looked only in the published literature, you’d get a much different picture. Nearly all of the positive studies are there. Only three of the negative studies appear in the literature as negative. Twenty-two were never published, and 11 were published but repackaged so that they appeared positive.

A second meta-analysis published that year also used F.D.A. data instead of the peer-reviewed literature, but asked a different question. Researchers wondered if the effectiveness of a study was related to the baseline levels of depression of its participants. The results suggested yes. The effectiveness of antidepressants was limited for those with moderate depression, and small for those with severe depression.

Go beyond the headlines.
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The take-home message from these two studies was that the effectiveness of antidepressants had been overstated, and that the benefit might be limited to far fewer patients than were actually using the drugs.

These points, and more, were made in a paper written by John Ioannidis in the journal Philosophy, Ethics, and Humanities in Medicine in 2008. He argued that the study designs and populations selected, especially the short length of many studies, biased them to positive results. He argued that while many studies achieved statistical significance, they failed to achieve clinical significance. He argued that we knew too little about long-term harms, and that we were being presented with biased information by looking only at published data.

This paper — “Effectiveness of Antidepressants: An Evidence Myth Constructed From a Thousand Randomized Trials?” — sowed lingering doubts about the use of antidepressants and the conduct of medical research. But recently, the most comprehensive antidepressants study to date was published, and it appears to be a thorough effort to overcome the hurdles of the past.


Researchers, including Dr. Ioannidis this time, searched the medical literature, regulatory agency websites and international registers for both published and unpublished double-blind randomized controlled trials, all the way till the beginning of 2016.

They looked for both placebo-controlled and head-to-head trials of 21 antidepressants used to treat adults for major depressive disorder. They used a “network meta-analysis technique,” which allows multiple treatments to be compared both within individual trials directly and across trials indirectly to a common comparator. They examined not only how well the drugs worked, but also how tolerated the treatment was — what they called acceptability.

They found 522 trials that included more than 116,000 participants. Of those, 86 were unpublished studies found on trial registries and company websites. An additional 15 were discovered through personal communication or by hand-searching review articles. The authors went an extra step and asked for unpublished data on the studies they found, getting it for more than half of the included trials.

The reassuring news is that all of the antidepressants were more effective than placebos. They varied modestly in terms of efficacy and acceptability, so each patient and doctor should discuss potential benefits and harms of individual drugs.

Further good news is that smaller trials did not have substantially different results from larger trials.

It also did not appear that industry sponsoring of trials correlated with significant differences in response or dropout rates. But — and this is a big “but” — the vast majority of trials are funded by industry. As a result, this meta-analysis may not have had enough data on non-industry trials to accurately determine if a difference exists.

There were also signs of “novelty” bias: Antidepressants seemed to perform better when they were newly released in the market but seemed to lose efficacy and acceptability in later years.

The bad news is that even though there were statistically significant differences, the effect sizes were still mostly modest. The benefits also applied only to people who were suffering from major depression, specifically in the short term. In other words, this study provides evidence that when people are found to have acute major depression, treatment with antidepressants works to improve outcomes in the first two months of therapy.

Because we lack good data, we still do not know how well antidepressants work for those with milder symptoms that fall short of major depression, especially if patients have been on the drugs for months or even years. Many people probably fall into that category, yet are still regularly prescribed antidepressants for extended periods.We don’t know how much of the benefit received from such use is a placebo effect versus a biological one.

I asked Dr. Ioannidis if the results of this new study were as radical as many news articles had suggested. He confirmed that this was a much-larger meta-analysis — with about 10 times more information — than the ones from a decade ago, with more unpublished data and more antidepressants covered. He’s also hopeful that future studies will be even better at informing individual-level responses, which might help to see if some patients benefit substantially even when others don’t seem to benefit at all.

But he thought that some of the exuberance in the news media might be a little overblown. “I am afraid that some news stories gave very crude interpretations that may be misleading, especially when their titles were too absolute, like ‘the drugs work’, ‘the debate is over’ and so forth,” he said. “The clinical (as opposed to statistical) significance of the treatment effects that we detected will continue to be contested, and it is still important to find ways that one can identify the specific patients who get the maximum benefit.”

Even with so much research on antidepressants, there are still many unanswered questions. It’s unclear if drug companies would be interested in the results, or indeed why they would be. The drugs are already being widely used, and no regulatory agency is requiring more data. If patients want answers, they will need to demand the research themselves.