Personal Experiences

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