Depressing Anti-Depressants.

Economist “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 entitled ‘More Depressing News on Antidepressants’, published in the journal Psychiatry (Edgemont) targeting practising psychiatrists globally, which appears to be a response to the paper “Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy”, which I wrote about in a previous post.

According to the author “…we should be careful not to over interpret the finding of this paper…” as there are apparently, “some methodological problems that seem to exaggerate the bias…”, as well as the fact that “…a similar publication bias has been reported for many other types of medications in other fields of medicine.”

Apart from the fact that the author does not appear to explain the so called ‘methodological problems’ that he proposed had exaggerated the bias, I’m not sure how one might ‘over interpret’ the findings of such a study, other than to say that it exposed what appears to be a significant amount of publication bias in favour of positive results, in relation to trials performed in order to assess the effectiveness of anti depressants.

The assertion with regards to similar publication bias for other medication categories is a little confusing as it seems to strengthen the argument proposing an issue with publication bias, suggesting that it might be a systemic problem with regards to pharmaceuticals in general.

The author then goes on to suggest a different type of study which might be more appropriate in order to “appreciate the efficacy of antidepressant medication”, in what could be interpreted as an attempt to divert away from the issue of publication bias, by throwing mud at the particular type of studies being examined, suggesting that “the results of short-term, randomized, clinical trials of depression are not good barometers of the efficacy of antidepressants in clinical practice.”

Regardless of whether or not there is any truth to that argument, one would think that the ability of such studies to act as a barometer would be greatly enhanced by a lack of publication bias, allowing for both positive and negative results to be published.

According to the author, the type of studies which are preferable “are more complex and require more subjects to determine statistical significance”, are “significantly more costly” and “not surprisingly…are performed much less frequently.”

So, if I’m understanding this correctly, rather than continuing to perform and examine numerous affordable and more accessible short term studies with as little publication bias as possible, we should redirect our focus towards complex, difficult to perform studies of which only few exist, and which require large amounts of funding rarely made available.

The author concludes by saying that “while antidepressants have recently taken some heavy blows (e.g., their association with increased suicidal ideation in younger patients and the New England Journal of Medicine paper impugning their efficacy), a well-informed read of all the prevailing data reaffirms their efficacy and supports their continued use as the main weapon against depression.”

I’m guessing that the ‘prevailing data’ he is referring to here is that found in all of the short term studies which were allowed publication due to their positive findings, some studies potentially questionably conveyed as having positive outcomes, as well as the results of a few long term, difficult to perform studies, which managed to somehow find the funding necessary for their execution, and only include “patients whose depressive episodes have improved in response to antidepressant treatment”.

I imagine information regarding suicides or suicidal ideation occurring after short term use might be excluded from said ‘prevailing data.’ I suppose it is fair enough, when considered alongside the author’s comments with regard to short term studies being the “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.”

As a final note, I found it interesting to read that the author, an Associate Professor from the Department of Psychiatry at the University of California,
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, Effexor as well as many other so called anti depressants and anti psychotic medications.

Although a declared financial relationship between the author and numerous corporations producing many of the class of drugs being promoted and defended, may not be, on its own, enough to discredit this paper, when combined with what appears to be a flawed, illogical and potentially biased argument, one certainly has grounds, at the very least, to be sceptical.

See more here

More Depressing News on Antidepressants

Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy

#pharmaagenda
#arrogancebasedmedicine

The Economist: Artist: Satoshi Kambayashi

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