Monday 14 May 2012

Drug Withdrawal Symptoms-Antidepressant Drugs-Moderate Depression-Clinical Trials

60 Minutes Weighs In on Antidepressants

I was just checking out on line yesterday's "60 Minutes" segment--;storyMediaBox
--that features a friend, Dr. Irving Kirsch of Harvard, a psychologist whose work on placebo effect and expectancy I have long admired. But the segment is only peripherally about placebo effect; it's rather about Kirsch's now oft-repeated finding that except for severe depression, the difference between antidepressants and placebos in clinical trials is negligible.
As seems typical, the news program featured as "gosh golly gee whiz" news stuff that we've been over in this blog many times before:

  • The serotonin theory of depression, on which most antidepressant therapy is based, is either only a part of the story or else dead wrong

  • The drug companies selectively publish the drug trials that show benefit and selectively hide the trials that don't

  • Several independent investigations have agreed with Kirsch's original work that in mild to moderate depression, there is hardly any difference between drug and placebo effects
  • What I personally found new was an interview with a British psychaitrist reporting that the UK National Health Service had independently replicated Kirsch's studies and found the same results. So they are now actively discouraging the use of antidepressant drugs for mild-to-moderate depression (the categories for which prescriptions in the US have exploded in the past 20 years) and are now busy working hard to implement--guess what--psychotherapy counseling and exercise programs which work just as well for those patients.
    If I had any major quibble with the program, it was that the magic words "side effects" were first mentioned at around 11:30 of the 13:40 segment (by the British psychiatrist). Those words tell the whole story. Placebos might be equivalent to drug in regards to benefits--but certainly not with regard to adverse reactions. We have been incredibly slow (aided by aggressive drug company marketing) to realize in medicine that most of these "nonaddictive" drugs actually have serious withdrawal syndromes, such that the worsening symptoms when patients go off their antidepressants--interpreted by the drug companies as sure proof that they work--might just as well be drug withdrawal symptoms as recurrence-of-depression symptoms.
    The other fun part of the program was watching the US psychiatrist (and of course, consultant for several drug firms) who was put on to defend the track record of these drugs. He naturally made no mention of side effects whatever, but he did insist that in his own independent studies, 14% of moderately depressed patients do better on drug than on placebo. (He admitted that it was a wash in mild depression.) In his mind this justified current practice. Can you believe it--14%??? For a condition where the drugs have serious side effects and where talk therapy or exercise work as well? And that's apparently the best rebuttal the drug industry can come up with?
    I must here repeat the usual disclaimer--don't try this at home--if you're depressed see your doctor and do what the doctor says, and above all don't discontinue any drug without the doctor's advice. read more..

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