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Do antidepressants work better than placebo?

Scientists have been debating the efficacy of antidepressants for decades. The latest paper to throw its hat into the ring concludes that there is little evidence to show that they perform better than placebos.A re-analysis of a meta-analysis says that antidepressants lack evidence. In 2017, around 17.3 million adults in the United States experienced an…

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Do antidepressants work better than placebo?

Scientists have been debating the efficacy of antidepressants for decades. The latest paper to throw its hat into the ring concludes that there is little evidence to show that they perform better than placebos.A re-analysis of a meta-analysis says that antidepressants lack evidence.

In 2017, around 17.3 million adults in the United States experienced an episode of major depression.

Alongside talking therapies such as psychotherapy, many people with depression take antidepressants.

According to the Centers for Disease Control and Prevention (CDC), a 2011–2014 survey found that 12.7% of U.S. individuals aged 12 or above had taken antidepressant medication in the previous month.

That equates to almost 1 in 8 people.

Of these individuals, one-quarter had been taking antidepressants for at least 10 years.

Although many people use these drugs, there is still a great deal of controversy surrounding how well they work — and studies have generated conflicting results.

Why the doubt?

To a greater or lesser degree, all the factors below and more have combined to produce a situation where scientists are still not clear whether antidepressants work better than a placebo:

Pharmaceutical companies are keen to market the drugs they have spent years designing and testing.

Doctors want to provide medication to those with a reduced quality of life.

Patients are keen to try anything that might improve their well-being.

Journals are more likely to publish studies with positive findings.

The latest analysis to form part of this ongoing battle comes from scientists at the Nordic Cochrane Centre in Denmark. This time, the authors conclude that the current level of evidence in support of antidepressants is not sufficient to prove that they work better than placebo.

The review, which now appears in BMJ Open, is a response to a paper by Dr. Andrea Cipriani and team that The Lancet published in February 2018. In the paper, Dr. Cipriani and team compared the performance of 21 antidepressants.

They set out to “compare and rank antidepressants for the acute treatment of adults with unipolar major depressive disorder,” as a guide for doctors.

Their analysis was the largest of its kind; it included 522 trials and 116,477 participants. The researchers concluded that, among other things, “[a]ll antidepressants were more efficacious than placebo in adults with major depressive disorder.”

For many, these findings were definitive proof that antidepressants work.

However, “[t]he review received widespread media coverage, largely citing it as finally putting to rest any doubts regarding the efficacy of antidepressants,” explain the authors of the latest BMJ Open paper.

Reopening the data

Led by Dr. Klaus Monkholm, the authors of the new publication believe that the earlier work by Dr. Cipriani did not address certain biases in the data. Dr. Monkholm and others initially penned a critique in The Lancet in September 2018.

In it, the authors outline a number of issues. For instance, in an ideal study, participants are “blinded.” This means that they do not know whether they are receiving the drug or the placebo.

However, because antidepressants have well-known side effects, it is very difficult to conduct studies wherein participants are adequately blinded; in other words, participants are likely to know that they are in the experimental group rather than the placebo group.

Dr. Monkholm and his team believe that Dr. Cipriani did not adequately account for this.

Because so many people use antidepressants, the scientists decided to go beyond the critique. They set out to repeat Dr. Cipriani’s analysis, but this time, they would account for the biases they believe the team missed the first time.

The authors explain that they “aimed to provide a more comprehensive assessment.”

New look at a recent analysis of an old query

Dr. Monkholm and his team unearthed a range of concerns in the original Lancet analysis. Below, we have outlined just a few.

Firstly, in the original paper, Dr. Cipriani and his team reported that they followed the protocol set out in the Cochrane Handbook for Systematic Reviews of Interventions — the gold standard approach to these types of analysis.

However, Dr. Monkholm points out occasions where their work deviated from these guidelines.

The new BMJ Open paper also explains how Dr. Cipriani’s work did not adequately address publication bias. The authors write:

“Publication bias of antidepressant trials is pervasive and distorts the evidence base. Many industry funded antidepressant trials remain unpublished or are inadequately reported.”

They continue, “Cipriani et al. included 436 published and 86 unpublished studies, but as many as a thousand antidepressant studies may have been conducted.”

The debate will go on

Overall, Dr. Monkholm argues that the studies involved in the meta-analysis had short durations and were therefore not necessarily applicable to people who take antidepressants for years.

Also, effect sizes were relatively small, and although statistically significant, they may not be clinically significant.

The authors also note that in the groups that took antidepressants, there were relatively high drop out rates in many of the studies. According to the authors, this suggests “that the benefits of antidepressants may not outweigh the harms.”

Alongside flaws in the analysis, the authors also claim that “their results were nontransparently presented.” This meant that it was not possible to work out how some of the analyses were conducted.

“Taken together, the evidence does not support definitive conclusions regarding the efficacy of antidepressants for depression in adults, including whether they are more efficacious than placebo for depression.”

Although the authors do not claim that antidepressants do not work, they conclude that the evidence is still not strong enough. They call for larger, longer, more rigorous studies. A question as crucial as this is likely to receive ongoing attention.
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Vitamin D sufficiency may reduce complications of COVID-19

A recent small-scale study has concluded that hospitalized patients with COVID-19 are less likely to have life threatening complications if they have sufficient vitamin D levels.A new study demonstrates that people with sufficient levels of vitamin D are less likely to develop life threatening COVID-19 complications when hospitalized with the disease.The research, published in the…

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Vitamin D sufficiency may reduce complications of COVID-19

A recent small-scale study has concluded that hospitalized patients with COVID-19 are less likely to have life threatening complications if they have sufficient vitamin D levels.A new study demonstrates that people with sufficient levels of vitamin D are less likely to develop life threatening COVID-19 complications when hospitalized with the disease.The research, published in the journal PLOS ONE, could be valuable for doctors attempting to reduce the mortality rates of COVID-19 in the absence of an effective vaccine.If further studies back up these findings, vitamin D supplements might offer a cost-effective way to limit the risk of severe COVID-19. It is important to note that this recent study has several limitations, which we address below.Stay informed with live updates on the current COVID-19 outbreak and visit our coronavirus hub for more advice on prevention and treatment.Since the sudden emergence of the virus SARS-CoV-2 and the disease that it causes, COVID-19, scientists have paid a great deal of attention to the development of a vaccine. Experts consider a vaccine to be crucial in reducing the effects of the virus, even if it is not yet clear to what extent an initial vaccine would moderate rates of transmission and infection.Alongside the endeavor to develop a vaccine, researchers are also focusing on developing effective COVID-19 treatments. Even if none can make a person immune to the virus, treatments may be able to reduce the disease’s severity.The Food and Drug Administration (FDA) have approved two drugs as treatments for COVID-19: remdesivir and dexamethasone.Another candidate is vitamin D. Research has suggested that it might, in theory, be effective, but corroborating this requires further efforts.Rather than analyzing the effects of vitamin D as COVID-19 treatment, the researchers behind the present study looked at the effects of a person’s vitamin D levels on the severity of the disease.To do so, they analyzed data from patients with confirmed COVID-19 who had been admitted to the Sina Hospital, in Tehran, Iran.Of the 611 people admitted with confirmed COVID-19 before May 1, 2020, there were records of the 25-hydroxyvitamin D levels, an indication of overall vitamin D levels, for 235 patients. Their mean age was 58.7 years, ranging from 20–90 years, and 37.4% were older than 65.The researchers classified the patients into two groups: those with vitamin D levels of at least 30 nanograms per milliliter (ng/ml) — an amount considered sufficient by the Endocrine Society — and those with lower values.They then analyzed the severity of the patients’ COVID-19 signs and symptoms using guidelines from the Centers for Disease Control and Prevention (CDC). Severe or critical disease might involve a range of issues, including shortness of breath, respiratory failure, or a significantly reduced blood oxygen level.After cross-checking the patients’ vitamin D levels with the severity of their COVID-19 symptoms and accounting for confounding factors, the researchers found that having a vitamin D level of above 30 ng/ml was significantly associated with having less severe COVID-19.Among the 235 patients with confirmed COVID-19, only 32.8% had sufficient levels of the vitamin.The researchers also found that the patients with sufficient vitamin D had higher blood lymphocyte counts and lower levels of C-reactive protein in their blood — both of which indicate a positive immune response.The researchers speculate that this may have reduced the likelihood of developing cytokine storm, which can cause acute respiratory distress syndrome in COVID-19 patients, sometimes resulting in death.The findings highlight, the researchers say, that vitamin D sufficiency may be important in the eventuality that people develop COVID-19 alongside another respiratory disease, such as influenza.According to the study’s corresponding author, Dr. Michael F. Holick, director of the General Clinical Research Unit at the medical campus of Boston University, in Massachusetts, “There is great concern that the combination of an influenza infection and a coronal viral infection could substantially increase hospitalizations and death due to complications from these viral infections.”For the researchers, their findings suggest that vitamin D supplementation would be valuable. As Dr. Holick notes: “Because vitamin D deficiency and insufficiency is so widespread in children and adults in the United States and worldwide, especially in the winter months, it is prudent for everyone to take a vitamin D supplement to reduce [the] risk of being infected and having complications from COVID-19.”It is worthing noting the present study’s limitations. First, the researchers only had access to a relatively small number of patients. Before drawing solid conclusions, scientists need to carry out much larger studies.Also, various issues can influence both vitamin D status and COVID-19 severity, such as socioeconomic factors and smoking status. The scientists accounted for neither of these in their analysis.Also, because the study was cross-sectional, the researchers could not prove that vitamin D insufficiency caused an increase in disease severity. To address these limitations, the researchers call for “large-scale studies and randomized clinical trials.”For live updates on the latest developments regarding the novel coronavirus and COVID-19, click here.
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Video gaming as a child related to improvements in memory

A new study exploring the link between video games and cognition finds that playing video games as a child can improve a person’s working memory years later on specific tasks.Video games can be a contentious topic, particularly among parents or caregivers who may be concerned about the effects of spending hours in front of the…

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Video gaming as a child related to improvements in memory

A new study exploring the link between video games and cognition finds that playing video games as a child can improve a person’s working memory years later on specific tasks.Video games can be a contentious topic, particularly among parents or caregivers who may be concerned about the effects of spending hours in front of the console.Yet, it seems that some video gaming could actually be beneficial. Recent studies have shown that playing video games could improve learning and may even protect against dementia in older adults.The authors of a recent review of the evidence on video games concluded that gaming could have benefits for both cognitive and emotional skills.In a new study, which features in the journal Frontiers in Human Neuroscience, researchers from the Universitat Oberta de Catalunya in Barcelona trained volunteers to play “Super Mario 64” — a game that researchers have previously shown to induce structural changes in parts of the brain associated with executive function and spatial memory.The new study found that people who played video games as children showed greater improvements in their working memory than those who did not, suggesting that video games can have long lasting benefits for cognition.This study combined video game playing with transcranial magnetic stimulation (TMS), a noninvasive form of brain stimulation that scientists have studied as a treatment for mood disorders. In 2008, the Food and Drug Administration (FDA) approved its use for the treatment of major depression when other approaches have failed.Studies have also shown TMS to boost cognitive performance under some conditions, with more than 60 studies reporting that the treatment led to significant improvements in cognition, including in working memory (holding and manipulating information over a short period).The researchers behind the new study wanted to find out whether combining video game training and TMS could enhance cognitive function more than either element alone.They asked 27 healthy volunteers, with an average age of 29 years, to take part in 10 video game training sessions, during each of which they played “Super Mario 64” for an hour and a half.At the end of each session, the researchers applied TMS to part of the prefrontal cortex, which is at the front of the brain and is important for complex cognitive functions, such as working memory and reasoning. The researchers assessed the cognitive function of the participants before the study started, at the end of the 10 sessions, and 15 days after this.They assessed a range of cognitive functions, including reaction time, working memory, attention span, visuospatial skills, and problem-solving.Although the results overall showed very limited changes in cognitive ability, which seemed to result only from the video game training and not the TMS, the researchers did find that participants with early experience of video gaming had improved working memory.“People who were avid gamers before adolescence, despite no longer playing, performed better with the working memory tasks, which require mentally holding and manipulating information to get a result,” explains lead author of the study Dr. Marc Palaus, Ph.D.People with prior experience of playing video games (but not the actual game in the study) also showed improvements in processing and were better able to focus on relevant stimuli during the tasks.“People who played regularly as children performed better from the outset in processing 3D objects, although these differences were mitigated after the period of training in video gaming, when both groups showed similar levels,” adds Dr. Palaus.The results suggest that video games may induce cognitive changes that last for years after people have stopped playing.Dr. Palaus says that video games that provide motivation — making the player want to keep on playing — and also get more difficult to stay challenging require intensive use of brain resources, which makes them ideal for boosting cognitive ability.“Video games are a perfect recipe for strengthening our cognitive skills, almost without our noticing.”– Dr. Marc Palaus, Ph.D. It is important to note that this study included a small number of participants who were all healthy, young, and highly educated, meaning that the findings might not be more widely applicable.Talking about the findings of their study, Dr. Palaus stressed that these improvements only have a limited effect on the performance of other activities not linked to video gaming, as is the case with most cognitive training.
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Lax gun laws in neighboring states may increase firearm deaths

A US study suggests strong gun control regulations reduce a state’s firearm deaths, but having neighbors with more lenient laws undermines their effect.Share on PinterestNew research suggests that one state’s lax gun laws could undo the effects of its neighbor’s stricter firearm regulations.In 2017, 39,773 people died from gun-related injuries in the United States, according…

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Lax gun laws in neighboring states may increase firearm deaths

A US study suggests strong gun control regulations reduce a state’s firearm deaths, but having neighbors with more lenient laws undermines their effect.Share on PinterestNew research suggests that one state’s lax gun laws could undo the effects of its neighbor’s stricter firearm regulations.In 2017, 39,773 people died from gun-related injuries in the United States, according to the National Center for Injury Prevention and Control.Overall, research indicates that stronger state laws governing the sale and ownership of firearms reduce firearm-related deaths. However, some states have relatively high rates of gun deaths despite strict regulations. To investigate why this might be the case, scientists at the University of Alabama at Birmingham, and the Boston University School of Public Health at Boston, MA, looked into the effects of firearm laws in neighboring states.They used the Web-based Injury Statistics Query and Reporting System to obtain figures for firearm-related deaths in the 48 adjacent U.S. states from 2000 to 2017. There were 578,022 firearm deaths in total, including homicides and suicides, but excluding deaths due to shootings by police or other law enforcement agents. The scientists also searched the State Firearm Laws Database for laws in each state regarding:background checksgun dealer regulationsbuyer regulationsgun-trafficking lawsThe team used the number of these laws as a proxy for gun control strength in each state.If you would like to check your registration status or register to vote, we have added some useful links at the bottom of this article.Overall, stronger state gun laws were associated with reduced firearm deaths, but having a neighboring state with more permissive laws undermined this protective effect.Larger policy differences across state borders were associated with increased gun-related deaths, suicides, and homicides, though the results were statistically stronger for suicide than homicide.The authors conclude:“This study adds to the growing literature emphasizing the role played by neighboring states’ firearm regulations in addition to own-state firearm regulations in firearm deaths. Failing to account for neighboring states with weaker laws, in some instances, can make a state’s own regulations appear less effective in reducing firearm deaths.”The scientists calculate that, on average, failure to account for weaker firearm laws in neighboring states make it appear as though a state’s laws were about 20% less effective at reducing deaths than they really were.They report their findings in the American Journal of Preventive Medicine.The researchers write that higher prices and strong marketing regulations can lead consumers to purchase firearms in adjacent, relatively unregulated markets. They say these are a frequent source of the guns used in crimes.They believe their work supports the case for more cooperative legislation between neighboring states and at the federal level.“I think the main message of this study is that to solve a nationwide problem we need to think of a nationwide or at least a regional-level (i.e. multistate) approach, like we may also need for the COVID-19 pandemic,” says Dr. Ye Liu, who is a doctoral student in the Department of Health Care Organization and Policy at the University of Alabama and the first author of the study. “An ‘each state on its own’ approach is ultimately inadequate to address one of the biggest public health challenges in this country,” Dr. Liu adds.The authors acknowledge the number of gun-control laws may not perfectly reflect the strictness of a state’s regulations. In addition, they note states may vary in how diligently they enforce these laws.They call for further studies that might use alternative measures of regulatory strength, focus on specific categories of law, or explore the effects of regulations in more distant states. To check your voter registration status, click here to visit VoteAmerica, a nonprofit, nonpartisan organization dedicated to increasing voter turnout. They can also help you register to vote, vote by mail, request an absentee ballot, or find your polling place.
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