The antidepressant-debunking study

[substitute]

There was a news release today about a study that appears to show the uselessness of popular antidepressants.

This was reported in the Guardian, among other places. The publication can be read here.

There are problems, as summarized:

1. PlOS is not an academic peer-reviewed journal. edit: They are in fact peer-reviewed, based on better information I have received by comments. Read the threads. They say they are peer-reviewed, but when you read their FAQ, you'll see this: "We involve the academic community in our peer review process as much as possible. After professional staff have determined that the paper falls within the scope of the journal, and is of a minimum acceptable quality, decisions on whether to send a paper out for in-depth review are made via a collaboration between experienced, professional editors who work full time at PLoS, and academic editors who are experts in their field."
   
   I'm not saying this is Wikipedia, but it's not the same thing as a traditional journal, either.
   
   
2. It's one study. Beware of an equivalency between "one metastudy showed that these three or four drugs didn't show a good outcome under these conditions" and "antidepressants don't work."
   
   
3. The study measured outcomes at six weeks. That isn't very long in a depression treatment, whether you're using Prozac or a trampoline.

That having been said, anything that keeps family doctors from throwing the best-advertised drug at every problem is going to be helpful at this juncture. And using any kind of medication (except possibly the trampoline) without counseling is, well, crazy.

Comments

[frozenrhino.livejournal.com]

I'm not saying this is Wikipedia


BWAAAAAAAAAAAAHAHAHAHAHAHAHAHAHAHAHAHAHAHA

D00d. You just made me snort peanut butter out my nose.

PEANUT BUTTER.

[skepticle.livejournal.com]

Werd.

Still would like to know more...

[substitute.livejournal.com]

exactly, yes. if this is replicated, especially in more traditional sources, it will be dynamite.

Peer-review

[(Anonymous)]

That is the definition of peer review. Every journal does that. You have a "stable" of reviewers that you can call on regularly - they are called "Academic Editors" but are not employees, just regular referees for the Journal's papers. Those inner-circle reviewers than choose additional outer-circle reviewers (from the global scientific community) who are the experts in the field. Both the Academic Editors and the outside reviewers review the manuscripts. Then they and the authors work together with Editors - the paid journal staff - to make the paper better.

If that is not peer-review, I don't know what is.

Re: Peer-review

[substitute.livejournal.com]

I know how peer review works. I worked at a medical journal for years.

Peer review doesn't involve the academic community "as much as possible." Peer review means sending it out to at least three known experts in the field, anonymously, and publishing or rejecting or requesting revision based on those reviews. What do they mean by "as much as possible" here? What is the role of their academic editor?

Re: Peer-review

[(Anonymous)]

There is not one Academic Editor - there are hundreds and they review papers for no pay, just like any other journal.

Managing Editor and a bunch of Assistant Editors send manuscripts to Academic Editors (choosing each carefully to match with the area of expertise). Academic Editors, who are not employees, review papers themselves AND pick additional experts to do additional reviews. Thus, each manuscript is reviewed by 3-4 experts in the field: one from the board of academic editors (who are NOT employees) and others from the broader community. The referees suggest that the paper gets published, revised or rejected. The Managing Editor makes the final decision.

That is, in short, the desciption of peer-review. Anonymity is not a part of the definiton as there are double-blind, single-blind and open review systems, depending on the journal. All three systems are still peer-review.

[lymandemsy.livejournal.com]

Of peer review itself, one recalls that Kim's MAGIC work was peer-reviewed, and published, by the journal Science, and, in the end, there was NO EVIDENCE to back it up.

[klikitak.livejournal.com]

SIX WEEKS?!

I don't follow many outcomes or samples, but how much can you really detect in such a short time?

zing!

[klikitak.livejournal.com]

I will take the trampoline though.

Re: zing!

[handstil.livejournal.com]

trampoline for momons ONLY!

[etb.livejournal.com]

I'm not saying this is Wikipedia, but it's not the same thing as a traditional journal, either.

I don't see how the section you quoted distinguishes PLoS Medicine from a "traditional journal" (by which I guess you mean a toll-access journal?).

[substitute.livejournal.com]

I'm delighted by the free as in beer and speech approach of PLOS.

My concern was that their peer review model was opaque and worded strangely, and suggested that they don't follow the full procedure one expects at a peer-reviewed journal.

I don't know for sure! I haven't worked there. But the combination of a new model in medical research publication and a contrarian, politically sensitive finding sets off alarm bells for me. I want a few more studies before I get excited about such a huge change.

[etb.livejournal.com]

My concern was that their peer review model was opaque and worded strangely, and suggested that they don't follow the full procedure one expects at a peer-reviewed journal.

That paragraph reads a bit like it's intended for the public, which has no idea how peer review works and is subjected to publisher propaganda (e.g. "open access equals government censorship"—yes, really). Saying that they "involve the academic community" sounds like it's meant to reassure people who are being told that OA journals are somehow destroying peer review, or are, in fact, equivalent to Wikipedia.

I follow the open access movement fairly closely (for kicks; computer scientists are ahead of the curve here), and if there was anything seriously wrong with PLoS Medicine's process, I think I would have heard, even if it were only a chorus of "they suck but all the other OA journals are fine".

[catamorphism.livejournal.com]

Quite. The bit you (substitute) quoted actually doesn't prove that PLoS Medicine is any different from a non-free journal -- proving that it is different would require more details about who PLoS's professional staff are and how their qualifications compare to the qualifications of non-free journals' editorial staff (within the same field).

[substitute.livejournal.com]

I agree. It's not that the open source model means anything bad at all. There are non-free journals that people in a particular field do not respect because they have poor peer review policies or other flaws.

Considering what's at stake, I want to be careful about results from *any* journal with both a brand new model for academic publishing and a study result that changes so much, in a way that so many people will find vindicating.

[handstil.livejournal.com]

6 weeks! I don't decide if I like a shampoo is 6 weeks!

[substitute.livejournal.com]

And you use shampoo as an antidepressant.

[sooz.livejournal.com]

hair dye kinda works for nico.. so why not :P

[fannishly.livejournal.com]

Oh wow, what a bomb. Thanks for the link.

It's interesting because I just read a chapter of Peter Kramer's Listening to Prozac for my Medical Ethics class. He is all about how incredibly well Prozac works, not only for depression but also for "rejection sensitivity" and whatnot, and he cites lots of cases from his own practice where, according to him, he used the drug to good effect. If I understand him correctly -- this wasn't in the particular chapter I read, but I extrapolated -- he used the drug in fact to diagnose people in certain instances; I think that's what he means by "listening" to a medicine. The book is all about how Prozac can possibly be used cosmetically, not to treat depression but to enhance personality traits. And wow, if Prozac really isn't effective for depression (six weeks of it at least) -- that really is a bomb!

[substitute.livejournal.com]

I wonder what kind of studies Kramer has to back his side up, other than his own experience? That's a lot of enthusiasm for one drug.

[springheel-jack.livejournal.com]

He did meta-analysis on just short-term studies because those were the ones that were submitted with the original new-drug application. He also got a bunch of other comparable studies from the literature. The idea was to do a re-analysis of the data that the FDA used to approve the drug, only using the wider pool of similar studies available now.

This is the third time he's done exactly the same meta-analysis. He has a big fancy metaphysical theory about the placebo effect, about its separate existence as a real, clinical thing (I personally don't agree, but it's not here or there), and his attacks on psych drugs are in that context. Every time he does one of these meta-studies, the profession looks at them and says something like, "even for a meta-analysis this is tendentious. You fit curves to obvious outliers, cherry-pick the data sets, and so-on. But still, it's suggestive, given that everyone's data is showing similarly that these drugs are not as effective as we want. It's time for more, bigger longitudinal studies to nail this down." Then nobody does those. Then he releases yet another identical meta-analysis of essentially the same data and it gets the same headlines, and so on and on.

Antidepressants Don't Work

[(Anonymous)]

The study only points out what many of us have been seeing. All of us have different DNA and different metabolisms. Some herbs and vitamins work better than others. The first thing that is needed is proper nutrition and a good physical exam. As the director of Novus Medical Detox, I often see patients who are on alcohol or opioids, central nervous system depressants, also taking antidepressants. When they detox they find they don't need the antidepressants.

This is good news because a Swedish study showed that 52% of the 2006 suicides by women on antidepressants. Since antidepressants work no better than placebos and are less effective than exercise in dealing with depression.

There is a prescription drug epidemic and these are leaders in the list of terrible abuses.

Steve Hayes
http://novusdetox.com

Re: Antidepressants Don't Work

[substitute.livejournal.com]

I agree that antidepressants are over-prescribed.

The assertion that they "don't work" and that "herbs and vitamins" are a better approach is entirely religious, however, and I cannot agree.

[la-lisa.livejournal.com]

I smell CCHR (Citizen's Committee on Human Rights) at work here, the Scientology fronth group that hates psychiatry. Granted, I do agree with them that too many meds are rx'ed to kids (Ablify for pre-teens, holy mother of god). And I do see a lot of "throw a pill at her" family doctors (like my friend's wife who takes a prozac every three days--not the time release one for PMS either) a sub clinical level and has been doing ttis for 6 years because according to her she is menopausal, wiht no cognitive therapy or anything else--and no suggestion ot lay off the booze and pot either> Idiots.

Anyway this journal looks like a crock, the study is a crock and while I am a firm believer in diet, nutrition and exercise to help the body do its thing, I also think that sometimes the body needs extra help in the form of neuro-supliments like SSRIs etc.

CCHR has managed ot get a few articles placed recently and this just smells like their crap.

Bring on the lithium crystals, Scottie! No wonder Spock was so mellow.

Abilify for kids is BS though. Exercise, no sugar, decent parenting.

[substitute.livejournal.com]

From what springheel_jack said, it looks like this guy is a legit scientist who is just very interested in the placebo effect, and not a CCHR clone.

There are a lot of babies flying around with the bathwater; I'm just going to maintain my course and wait and see.