Anti-depressant confusion

confusion by keynee

The NY Times publishes a defense of anti-depressants:

IN terms of perception, these are hard times for antidepressants. A number of articles have suggested that the drugs are no more effective than placebos.

Last month brought an especially high-profile debunking. In an essay in The New York Review of Books, Marcia Angell, former editor in chief of The New England Journal of Medicine, favorably entertained the premise that “psychoactive drugs are useless.” Earlier, a USA Today piece about a study done by the psychologist Robert DeRubeis had the headline, “Antidepressant lift may be all in your head,” and shortly after, a Newsweek cover piece discussed research by the psychologist Irving Kirsch arguing that the drugs were no more effective than a placebo.

Could this be true? Could drugs that are ingested by one in 10 Americans each year, drugs that have changed the way that mental illness is treated, really be a hoax, a mistake or a concept gone wrong?

This supposition is worrisome. Antidepressants work — ordinarily well, on a par with other medications doctors prescribe. Yes, certain researchers have questioned their efficacy in particular areas — sometimes, I believe, on the basis of shaky data. And yet, the notion that they aren’t effective in general is influencing treatment.

However, I recently came across this post about a scandal in a federally funded study of anti-depressants:

1. The study was designed to produce an inflated “remission” rate
2. Various statistical manipulations were used to inflate the reported “remission” rate
3. In its press releases, the NIMH further hyped the already inflated results
4. The STAR*D investigators hid the long-term results
5. The STAR*D investigators failed to publish the data that was gathered to assess global outcomes

I’m completely open to the suggestions that comparisons to placebo miss people for whom the drug was very effective (and people for whom the drug was harmful), but this scandal begs the question, if these drugs are as effective as the NY Times piece says, why fudge the numbers? Why not publish ALL the data?

It’s too bad that profit and politics make it so difficult to find the facts.

UPDATE: Since I first drafted this post, Whitaker has offered a detailed response to the NY Times piece that doesn’t lend itself to snippets. Read that response here.

NOTE: Neither Dawn Farm or I are anti-medication. If that’s your impression, please read the FAQs in the right column.