Well, I see one person picked up on the problems with your (cynical) review. Let me continue. First, anti-depressants aren’t all the same thing. When used in a randomized clinical trial (RCT), the medication is not being adjusted to individuals. When used in clinical medicine, the physician will try different meds until finding the most effective one, because anti-depressants aren’t all the same thing and individual response differs. Second, in the entire article there’s no mention of anything other than a placebo-controlled trial, when in fact any medication, any treatment, is generally tested against current standard of care, in addition to placebo — because if it isn’t better than the current standard, there’s no point in going into phase 3 or 4 studies.
Your resource, Newman, first talks about how drug companies have no cap on the number of trials they can run. Well, yeah, except money. RCTs are expensive, have to be registered at government databases, generally have outside overview, and no company is going to crank these out in the hopes of hitting statistical significance because of multiple testing effect, which Newman and you seem to be implying without really understanding it. Granted, they could crank trials sub rosa, but then if they come up with good results, they wouldn’t be able to publish them.’
Nevertheless, Newman assures us (and you do, too, I assume) that “ The reality is that there are way more trials that have found no difference than that have found superiority,” Newman says of trials pitting prescription antidepressants against placebos. “Those null trials never get published or released and are not included in most meta-analyses — including the most recent one published in Lancet.” How the blazes does she know this? By the very description she gives, she would need to know or be an insider at many drug companies to be told this information. This is sheer fabrication.
I’m unclear on the point you’re making with “ Another important point: There are very few clinical trials that compare antidepressants to no treatment at all.” Of course not — what’s on trial is the drug, not the rest of the treatment that accompanies the drug. So why raise the point at all? Why is this an “important point”?
On side-effects — patients are of course informed of side-effects — and usually even patients on placebo develop those side-effects, so that’s not really a tip-off — but again, placebo-only trials are not the research standard.
And while in one paragraph you make the point that a placebo-only prescription is unethical, in the paragraph following, Newman proposes treatment with no meds, asserting that “ Patients who take pills tend to relapse as soon as they stop and tend not to put the same effort into psychotherapy that they would have without meds.” I don’t know of any research to support that, and suspect she is citing her own anecdotal clinical experience. I recommend she take a course in evidence-based medicine; all the cool kids are doing it.
This illness, depression, is one of the commonest seen in primary care. It’s also one of the more difficult to diagnose, as presentation can run a gamut of symptoms. It is also probably the most deadly of common illnesses in primary care. We have treatments that work. Like most treatments that work, adjustments for the individual are required, but with patience people can be helped and deaths prevented. I’m at a loss to understand why this pseudo-controversy around pharmaceutical treatment for depression continues, but not for hypertension, multiple sclerosis, and Parkinson’s Disease (all of which have efficacious non-pharm treatment modalities).
