Since Newsweek published its article on antidepressants last week, we’ve seen a wide range of opinions posted about it online.
Psych Central blogger and journalist Christine Stapleton asks, Am I treating my depression with expensive Tic Tacs? She reacted strongly to the main premise of the article — that antidepressants are nothing more than expensive Tic Tacs. It’s a personal but very real reaction from someone who has battled depression and has found relief in antidepressants — like millions of other Americans. Indeed, it echoes my own arguments. Research can inform us about many things in general, but they can never tell us anything about how a specific individual will benefit (or not).
Christine posted a followup entry today, Antidepressants: JAMA, Newsweek and balanced journalism, where she says, “I am even more convinced that circulation trumped sound journalism in the Newsweek article.” Indeed. If Newsweek was looking for balanced and insightful journalism, this was not the piece to do that.
Therese Borchard added her voice to the “antidepressants work” argument in her blog entry, Newsweek: Do Antidepressants Work? For Many People, YES!. She said it eloquently:
For folks like me, though, who are/were hanging on to life by a very thin and fraying thread, antidepressants can save lives. They have certainly given me back my life.
I think it’s relatively absurd to suggest to people who have been helped by antidepressants that they could have simply taken a sugar pill and experienced the same positive effects. That’s not been their experience. But maybe you don’t buy into the appeals to emotion and personal experiences.
Finally, the editor-in-chief of Psychiatric Times (and occasional Psych Central contributor) Ronald Pies, MD wrote an editorial entitled, Newsweek’s Topsy-Turvy Take on Antidepressants earlier this week. In it, Dr. Pies demonstrates the numerous flaws in the evidence that Newsweek relied upon:
Both the Kirsch and Fournier studies are “meta-analyses” of various individual antidepressant trials. Meta-analyses suffer from all the problems common to such “number-crunching” methods: if the individual studies are flawed, the meta-analysis is flawed. For example, the Kirsch meta-analysis looked only at studies carried out before 1999. The much-publicized Fournier study examined a total of 6 antidepressant trials (n=718) using just 2 antidepressants, paroxetine and imipramine. Two of the imipramine studies used doses that were either subtherapeutic (100 mg/day) or less than optimal (100 to 200 mg/day). Moreover, the design of the Fournier study intentionally excluded individual studies involving a “placebo washout” phase, which attempts to reduce the number of placebo-responders receiving active medication. By excluding such studies, the Fournier meta-analysis may have reduced the difference between placebo and antidepressant response rates.
The challenge of a mainstream publication like Newsweek doing any kind of fair and balanced job with a controversial issue such as this is immense. How do you keep perspective and summarize decades’ worth of research in a consumer-friendly format?
In most cases, it’s a daunting and near-impossible task. I don’t think a publication like Newsweek can do anything but present a one-sided view to such controversies, because of their complexity. That’s what mainstream media does — boil down complex issues into black-and-white “sides.” And while they pretend they don’t take a side, simply counting the amount of words given to one over the other demonstrates clearly that a bias in such articles exists.
I can’t say it any better than Dr. Pies in this closing to his editorial:
Yes, antidepressants are “oversold” in those Big Pharma ads, adorned with chirping birds and fluttering butterflies — in truth, antidepressants don’t work as well or as specifically as we’d like. Given the frequent side effects of many antidepressants, it is usually wise to initiate treatment with psychotherapy, in cases of mild-to-moderate, non-melancholic depression. Alas, psychotherapy is often difficult for patients to obtain or afford. Despite Newsweek’s supposedly “depressing news” about antidepressants, psychiatrists have good reason to keep these medications in their armamentarium — and patients with severe unipolar depression8 have good reason to consider taking them.
It’s worth the read: Newsweek’s Topsy-Turvy Take on Antidepressants
10 comments
I respectfully disagree with Dr. Grohol’s assessment.
If anything, the “Newsweek” article did not go far enough in debunking these drugs. Not only are antidepressants ineffective, but they are also dangerous, for at least two reasons:
1) People who take antidepressants often experience bad side-effects, most notably suicidal ideation (and, perhaps, actual acts of violence, either against self or others). I don’t think that Sharon Begley really stressed this point enough in her article.
2) People who take antidepressants are expending time and effort on a treatment that doesn’t actually work (or, rather, doesn’t work better than placebo) when those same people could have INSTEAD been focusing on treatments or strategies that do work better. Economists call this an “opportunity cost”.
I’ve had many conversations with clinicians who tell me, in essence, “I know these drugs work, because I’ve seen the results in my patients”. And I always follow-up by saying, “I know they work. The question is, ‘Do they work better than placebo?’ And you can’t possibly know the answer to that question from your personal experience, unless you’ve prescribed placebos to some of your patients and compared them to the non-placebo patients”.
I cannot agree with this more. Not to mention the intense pain they cause through their side effects. Google ssrisex. You can see the pain of all those inflicted by post ssri sexual dysfunction. For me I feel like I was robbed of my sex life by these drugs. Even 3 years after quitting I still have ED and lack of sensation in my male anatomy. This is no laughing matter. It means difficulty with relationships, sexual frustration, and honestly more depression. The initial depression that my GP gave me the drugs for was something I needed to go through. If only I hadn’t taken those drugs I’d probably be back on track with my life now. Now the main thing I am depressed about is my sexual problems. Sharon Begley did not write about this. I was in touch with her regarding it after the first article, as were many from our community. Unfortunately she said since newsweek was reorganizing they may not get a chance to publish on it but other people have. Just google Post SSRI Sexual Dysfunction.
On March 26, 1990 Newsweek had a picture of a Prozac capsule on their cover. The cover stated that Prozac was a “Breakthough Drug for Depression”.
My take on the recent antidepressant article was: 1. Someone in the upper echelons of Newsweek [or a loved one] was hurt badly by antidepressant use.
2. Most of the antidepressants are going generic now and pharma wants the general public to know that the new atypical antipsychotics, with their patent still intact, are a good antidepressant.
3. Newsweek has a scoop on a new type of antidepressant to replace SSRIs and SNRIs and they want the general public to read their hype when they say the new type of antidepressant is more effective than the SSRIs & SNRIs.
Personally, I favor number one as the reason for publishing their article. I have seen this exact same thing happen in a major newpaper in the south back in the year 1994.
Yeah, everyone who gets an antidepressant has major depression, and that is why instead of a 60-70% response rate, now we see only a 30-40% rate.
What? Maybe, like with bipolar disorder and ADD, we are now seeing too many people diagnosed with depression and since those without the true features do not respond to medication. Maybe it is time for psychiatry to start paying attention to the referrals that want us to medicate for adjustment disorder and biochemically restore psychosocioeconomic woes. I’m sure Lexapro or Pristiq will get people a job, make a $10,000 bank deposit, salvage the marriage, get the neighbors to shut up, and mom and dad will be more loving and supportive after screwing up one’s childhood.
Pay no attention to the man behind the curtain. Just grab your sample pack of meds and get the hell out! Hey, maybe I should get a hologram of Freud’s face and just shout out insults and tell patients to bring me the witch’s broom stick.
Hell, no place like home, eh?
I was prescribed about 7 anti depressants over a period of four years. I went on double and in some cases quadruple dosages. None of them worked. These companies are fraudulent and the psychiatrists frankly don’t have enough scientific training (scientific training is different from medical training) to tell the difference. I have had many friends who have taken antidepressants. I have yet to hear of them working for anyone.
When are you going to stop crying about this? This is the third post on the this stupid article.
Take your stupid pills if they make you feel better but stop crying about people who disagree with you. Your little whining may be keeping someone who is being hurt by the medications from seeking better alternatives.
Nothing works for everybody.
Antidepressants may well not work. First, they didn’t work on me, at all (as opposed to even a bit), as well as didn’t work on thousands, or millions of others that took them for depression. Perhaps it’s that me and them aren’t susceptible to a placebo effect and see things for what they are. The Newsweek study certainly rings true with that. Never mind the thesis justifying antidepressants itself isn’t even proven. The whole thing smells deception no matter how. They don’t know if it’s ‘serotonin’. They don’t know anything, plus millions don’t get truly better on them, plus there’s a strong placebo likelihood, plus a study comes out, even if not perfect, still sounds convincing.
Now as for some that got better ‘on them’, great. It doesn’t matter if it was placebo as long as they improved. But what about those who aren’t affected by placebo. When will real treatments be looked into.
I see clients all the time who are given antidepressants without a basic work-up. Many have no blood work, their thyroid and hormonal levels have not been checked, and they have never been assessed for nutritional problems that affect mood (allergens, Vitamin D, magnesium, Omega 3s, lithium, other trace minerals that are no longer in the food supply.) If the cell membrane is too “stiff” because of an Omega 6/3 imbalance, if the minerals needed by transporters to carry neurotransmitters into the cells are missing, then we cannot expect normal function. And they also need an assessment of exercise, sunlight, quality of work and relationships.
One of my clients, a retired detective, was given the assignment to find a volunteer position in children’s advocacy since it was clear that he missed being a hero. That with nutritional counseling, a previously ineffective SSRI, acupuncture for PTSD and exercise caused a cascade of new behaviors and a significant lessening of depression. Was it the SSRI? I doubt it.
As Robert Whitaker points out in Anatomy of an Epidemic, ALL antidepressants cause serotonergic downregulation, a direct effect that is not benign, but is ignored by psychiatry.
Serotonin downregulation probably causes the common side effect of emotional blunting, as well as sexual dysfunction and difficulty in withdrawal from the medication.
Only psychiatry could claim emotional anesthesia as a triumph over depression.
Furthermore, people who suffer emotional blunting from medication are maintained on the medication to forestall withdrawal syndrome, which is not necessarily mild or transitory. In the US, where 10% of the population (2/3 of them women) are on psychiatric medication, there are probably millions of people in this state.
As Robert Whitaker argues, chronic medication leads to decreased functioning and decreased functioning leads to more medication. Somehow psychiatry counts this as success, but statistically long-term outcomes are poor and psychiatric disability is rising.
The perception of success of antidepressants depends on medicine’s obliviousness to adverse outcomes. Eventually, so many people will be harmed by antidepressants, biological psychiatry’s house of cards will come crashing down.
First, kill all the lawyers…, then take out the psychiatrists…
Then the world will be a better place.
Seriously, the source of all the worlds ills can be traced back to a Lawyer, a Psychologist, or a corrupt clergyman/congressman. All these drugs being prescribed to adults and children? It can’t be really necessary. 50 yrs ago no one was on drugs, and now just about everyone seems to be on one drug or another. That can’t be right.
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