‘Internal documents show that in 1990, Lilly scientists were pressured by corporate executives to alter records on physician experiences with Prozac, changing mentions of suicide attempt to “overdose” and suicidal thoughts to “depression”. Researchers say that most US doctors do not know to warn patients of the potentially dangerous effect which, according to published literature on the topic, can be alleviated with sedatives or by going off the drug.’ – Boston Globe 2000
I recently noticed a 2008 paper, More Depressing News on Antidepressants: Should We Panic?, published in the journal Psychiatry (Edgemont), targeting practising psychiatrists globally. It appears to be a response to the 2008 paper Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy, which I wrote about previously.
According to the author, “we should be careful not to over interpret” the paper in question’s findings. It is because “some methodological problems…seem to exaggerate the bias…”. And because “…a similar publication bias has been reported for many other types of medications in other fields of medicine”.
It’s unclear what the “methodological problems” are that the author proposed exaggerated the bias. Regardless, I’m not sure how one might “over-interpret” the findings of such a study. Other than that, it seems to have exposed a significant amount of publication bias in favour of positive results concerning trials performed to assess the effectiveness of antidepressants.
The assertion regarding similar publication bias for other medication categories could be more explicit. Nevertheless, it strengthens the argument proposing an issue with publication bias, suggesting that it is a systemic problem with pharmaceuticals in general.
The author then suggests a different study type that might be more appropriate to “appreciate the efficacy of antidepressant medication”. Again, it attempts to divert away from the issue of publication bias by throwing mud at the particular type of studies getting examined. The author suggests that “the results of short-term, randomised, clinical trials of depression are not good barometers of the efficacy of antidepressants in clinical practice”.
Regardless, the ability of such studies to act as a barometer would be enhanced by a lack of publication bias, allowing positive and negative results to get published.
According to the author, the preferable studies “are more complex and require more subjects to determine statistical significance”, are “significantly more costly” and “not surprisingly…are performed much less frequently”.
So, rather than performing affordable and accessible short-term studies with as little publication bias as possible, we should focus on complex, difficult-to-conduct studies, of which only a few exist and require large amounts of funding rarely made available.
The author concludes that “while antidepressants have recently taken some heavy blows (e.g. increased suicidal ideation in younger patients), a well-informed read of…prevailing data reaffirms their efficacy and supports their continued use as the main weapon against depression.”
I guess the “prevailing data” is that found in short-term studies which were allowed publication due to their positive findings. And some studies with questionable positive outcomes. As well as the results of long-term, difficult-to-perform studies, which managed to get funding, and only include “patients whose depressive episodes have improved in response to antidepressant treatment”.
I wonder if data on suicides (or suicidal ideation) occurring after short-term use gets excluded from said “prevailing data”. I suppose it’s fair enough in light of the author’s comments concerning short-term studies. He said they are “the bane of pharmaceutical manufacturers of antidepressant medications who spend millions of dollars trying to demonstrate their drugs’ efficacy only to be undermined by large placebo response rates.” Fascinating.
Finally, I found it interesting that the author is an Associate Professor from the Department of Psychiatry at the University of California. And he has received research funding, consulting, or speaking fees from a minimum of ten pharmaceutical companies, including “Abbott Laboratories, AstraZeneca, Argolyn Biosciences, Eli Lilly and Co., Bristol-Myers Squibb, Solvay, Janssen, Wyeth, McNeil, and Shire”.
Some of the drugs made by these corporations include Luvox, Seroquel, Prozac, Abilify, Haldol, Risperdal, Cymbalta, and Effexor, as well as many other “antidepressants” and “anti-psychotic” medications.
A declared financial relationship between the author and various corporations producing the antidepressant drugs may not be, on its own, enough to discredit this paper. But combined with a flawed, illogical and potentially biased argument, one certainly has grounds, at the very least, to be sceptical.
Copyright 2021, by Dan M @ CowsEatGrass. All rights reserved (except for quotations and images having their own protected copyrights). This copyright protects author-publisher Dan M’s right to future publication of his work in any manner, in any and all media — utilizing technology now known or hereafter devised — throughout the world in perpetuity. Everything described in this publication is for information purposes only. The author-publisher, Dan M, is not directly or indirectly presenting or recommending any part of this publication’s data as a diagnosis or prescription for any ailment of any reader. If anyone uses this information without the advice of their professional health adviser, they are prescribing for themselves, and the author- publisher assumes no responsibility or liability. Persons using any of this data do so at their own risk and must take personal responsibility for what they don’t know as well as for what they do know.
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The Economist: Artist: Satoshi Kambayashi