In a rare behind-the-scenes disclosure (due to a lawsuit), the public is seeing for one of the first times the degree and depth some pharmaceutical companies will go to in order to publish positive results about their drug. Using the same peer-review process that is supposed to prevent abuses by researchers and drug companies and provide other professionals (and the public) with objective data. And the same peer-review process that is used by the U.S. Food and Drug Administration (FDA) to approve medications as safe and effective.
CL Psych provides us with a further analysis of Paxil study 329, one where apparently the researchers went to great lengths to find efficacy. Why the re-examination of this study?
Because another study was just published in the International Jouranl of Risk and Safety in Medicine. The new study examined the internal documents, full dataset and drafts that were released related to a lawsuit against the makers of Paxil. The damning findings from the new study?
5.1. Were the results for study 329 positive or negative?
There was no significant efficacy difference between paroxetine and placebo on the two primary outcomes or six secondary outcomes in the original protocol. At least 19 additional outcomes were tested. Study 329 was positive on 4 of 27 known outcomes (15%). There was a significantly higher rate of SAEs with paroxetine than with placebo. Consequently, study 329 was negative for efficacy and positive for harm.
5.2. Did selective reporting occur?
Claims that paroxetine was “generally well tolerated and effective” arose from selective reporting of the 15% of outcomes that were positive and selective under reporting of the other efficacy and SAE findings. The JAACAP paper has been defended on the grounds that readers could read in the results table that the two outcomes described as primary elsewhere (but not in that table) were negative.
However readers are more likely to be influenced by the abstract than the tables of a clinical trial report, as evidenced by the continued retransmitting of the false impression that study 329 found “significant efficacy on one of the two primary endpoints”. A likely cause of this misunderstanding is the conflation of ‘remission’ and ‘responder’ and especially the false statement that “paroxetine separated statistically from placebo at end point among 4 of the parameters: [including] response (i.e. primary outcome measure) . . .”.
In other words, the researchers carefully picked over the data to present only the data in the published study that were most favorable to the drug that paid for the study — Paxil. This pretty much shows the major, gaping hole in the peer-review process — that journals can only ask questions about what they’re told about. If researchers conceal the true design of a study (or negative data), then journals will get a biased picture. And then happily publish such a picture completely oblivious to the truth.
Another surprising finding was that the study wasn’t written by the authors listed. It was ghostwritten by someone with a master’s degree. You need look no further than the first draft to see the proof of this. I don’t know whether this is standard operating procedure for studies of this size, but you’d expect such authorship would be noted as it is in traditional publishing.
You can read all about the picking apart of Study 329 over at Healthy Skepticism. The scary thing is that nobody knows how widespread these kinds of biases are in the published research. This is one study out of thousands of similar peer-reviewed, published studies. Could other published studies suffer from similar problems? And if so, to what degree is the published literature tainted by these kinds of underhanded methods?
We may never know.
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Current Depression Medications: Do The Benefits Outweigh the Harm?
Presently, for the treatment of depression and other what some claim are mental disorders, as they are questionable, selective serotonin reuptake inhibitors are the drugs of choice by most prescribers. Such meds, meds that affect the mind, are called psychotropic medications. SSRIs also include a few meds in this class with the addition of a norepinephrine uptake inhibitor added to the SSRI, and these are referred to SNRI medications. Examples of SNRIs are Cymbalta and Effexor. Some consider these classes of meds a next generation after benzodiazepines, as there are similarities regarding their intake by others, yet the mechanisms of action are clearly different, but not their continued use and popularity by others.
Some Definitions:
Serotonin is a neurotransmitter thought to be associated with mood. The hypothesis was first suggested in the mid 1960s that this neurotransmitter may play a role in moods and emotions in humans. Yet to this day, the serotonin correlation with such behavioral and mental conditions is only theoretical. In fact, the psychiatrist’s bible, which is the DSM, states that the definite etiology of depression remains a mystery and is unknown. So a chemical imbalance in the brain is not proven to be the cause of mood disorders, it is only suspected with limited scientific evidence. In fact, diagnosing diseases such as depression is based on subjective assessment only, as interpreted by the prescriber, so one could question the accuracy of such diagnoses.
Norepinephrine is a stress hormone, which many believe help those who have such mood disorders as depression. Basically, with the theory that by adding this hormone, the SSRI will be more efficacious for a patient prescribed such a med.
And depression is only one of those mood disorders that may exist, yet possibly the most devastating one. An accurate diagnosis of these mood conditions lack complete accuracy, as they can only be defined conceptually, so the diagnosis is dependent on subjective criteria, such as questionnaires. There is no objective diagnostic testing for depression. Yet the diagnosis of depression in patients has increased quite a bit over the decades. Also, few would argue that depression does not exist in other people. Yet, one may contemplate, actually how many other people are really depressed?
Several decades ago, less than 1 percent of the U.S. populations were thought to have depression. Today, it is believed that about 10 percent of the populations have depression at some time in their lives. Why this great increase in the growth of this condition remains unknown and is subject to speculation. What is known is that the psychiatry specialty is the one specialty most paid to by certain pharmaceutical companies for ultimately and eventual support of their psychotropic meds, as this industry clearly desires market growth of these products. Regardless, SSRIs and SRNIs are the preferred treatment methods if depression or other mood disorders are suspected by a health care provider. Yet these meds discussed clearly are not the only treatments, medicinally or otherwise, for depression and other related disease states.
Over 30 million scripts of these types of meds are written annually, and the franchise is around 20 billion dollars a year, with some of the meds costing over 3 dollars per tablet. There are about ten different SSRI/SRNI meds available, many of which are now generic, yet essentially, they appear to be similar in regards to their efficacy and adverse events. The newest one, a SNRI called Pristiq, was approved in 2008, and is believed to being promoted for treatment for menopause. The first one of these SSRI meds was Prozac, which was available in 1988, and the drug was greatly praised for its ability to transform the lives of those who consumed this medication in the years that followed. Some termed Prozac, ‘the happy pill’. In addition, as the years went by and more drugs in this class became available, Prozac was the one of preference for many doctors for children. A favorable book was published specifically regarding this medication soon after it became so popular with others.
Furthermore, these meds have received additional indications besides depression for some really questionable conditions, such as social phobia and premenstrual syndrome. With the latter, I find it hard to believe that a natural female experience can be considered a treatable disease. Social phobia is a personality trait, in my opinion, which has been called shyness or perhaps a term coined by Dr. Carl Jung, which is introversion, so this probably should not be labeled a treatable disease as well. There are other indications for certain behavioral manifestations as well with the different SSRIs or SRNIs. So the market continues to grow with these meds. Yet, it is believed that these meds are effective in only about half of those who take them, so they are not going to be beneficial for those suspected of having certain medical illnesses treated by such meds. The makers of such meds seemed to have created such conditions besides depression for additional utilization of these types of medications, and are active and have been active in forming symbiotic relationships with related disease- specific support groups, such as providing financial support for screenings for the indicated conditions of their meds- screening of children and adolescents in particular, I understand, and as a layperson, I consider such activities dangerous and inappropriate for several reasons.
Danger and concerns by others primarily involves the adverse effects associated with these types of meds, which include suicidal thoughts and actions, violence, including acts of homicide, and aggression, among others, and the makers of such drugs are suspected to have known about these effects and did not share them with the public in a timely and critical manner. While most SSRIs and SNRIs are approved for use in adults only, prescribing these meds to children and adolescents has drawn the most attention and debate with others, such as those in the medical profession as well as citizen watchdog groups. The reasons for this attention are due to the potential off-label use of these meds in this population, yet what may be most shocking is the fact that some of the makers of these meds did not release clinical study information about the risks of suicide as well as the other adverse events related to such populations, including the decreased efficacy of SSRIs in general, which is believed to be less than 10 percent more effective than a placebo. Paxil caught the attention of the government regarding this issue of data suppression some time ago, this hiding such important information- Elliot Spitzer specifically, as I recall.
And there are very serious questions about the use of SSRIs in children and adolescents regarding the effects of these meds on them. For example, do the SSRIs correct or create brain states considered not within normal limits, which in effect could cause harm rather than benefit? Are adolescents really depressed, or just experiencing what was once considered normal teenage angst? Do SSRIs have an effect on the brain development and their identity of such young people? Do adolescents in particular become dangerous or bizarre due to SSRIs interfering with the myelination occurring in their still developing brains? No one seems to know the correct answer to such questions, yet the danger associated with the use of SSRIs does in fact exist. It is observed in some who take such meds, but not all who take these meds. Yet health care providers possibly should be much more aware of these possibilities
Finally, if SSRIs are discontinued, immediately in particular instead of a gradual discontinuation, withdrawals are believed to be quite brutal, and may be a catalyst for suicide in itself, as not only are these meds habit forming, but discontinuing these meds, I understand, leaves the brain in a state of neurochemical instability, as the neurons are recalibrating upon discontinuation of the SSRI that altered the brain of the consumer of this type of med. This occurs to some degree with any psychotropic med, yet the withdrawals can reach a state of danger for the victim in some classes of meds such as SSRIs, it is believed.
SSRIs and SRNIs have been claimed by doctors and patients to be extremely beneficial for the patient’s well -being regarding the patient’s mental issues where these types of meds are used, yet the risk factors associated with this class of medications may outweigh any perceived benefit for the patient taking such a drug. Considering the lack of efficacy that has been demonstrated objectively, along with the deadly adverse events with these meds only recently brought to the attention of others, other treatment options should probably be considered, but that is up to the discretion of the prescriber.
“I use to care, but now I take a pill for that.†— Author unknown
Dan Abshear
DONT TAKE PAXIL. Run for your life! This is a bad medication. It is a med that numbs you out, but you can’t get off it. I had a doctor switch my antidepressant med to Paxil, not thinking it would matter. Boy was I wrong. I started sweating profusely and called the doctor who immediately put me on hormones to aleviate the (hot flashes) which was really heavy sweating. This is a main side effect of Paxil. Then I went to my doctor to quit taking Paxil and see if the sweating stopped. I was on 20mg and She gave me a schedule of weaning of 10 mg for 2 weeks, 5mg. for two weeks, then 5 mg. every other day. But I got the withdrawl flu, caused by weaning off Paxil. I have had diaharrea for 4 weeks. When I got down to 5 mg. evey other day, I was so angry, I could have punched a hole in the wall. I was so close to suicide…I finally called my doctor and asked her to give me liquid Paxil so I can wean myself off by 1 mg. at a time. My stomach is gurgling and I can’t eat, and I hope I feel good soon.
These studies do not control for Subliminal Distraction exposure. They assume that the drug and placebo are the only active agents.
I cannot find any study that demonstrates awareness of this simple problem discovered and solved forty years ago.
VisionAndPsychosis.Net