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

[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.

[catamorphism.livejournal.com]

I think Kramer mostly has his ego backing his side up.

[springheel-jack.livejournal.com]

I taught Kramer in a medical ethics class once. He's just talking about his own clinical practice - i.e. it's all anecdotal. He oversold Prozac, but his overselling was in turn oversold. He wasn't saying that Prozac was a miracle drug, just that for some patients it had quite wonderous effects, that it seemed, in his view, to leave them "better than new." That complicates the relationship between the doctor and the patient. The doctor sees medication as cures to disease states, and if the medication seems to make the syndrome go away, the diagnosis is supported. That doesn't work with Prozac, because it has all kinds of subtle, global effects on character; it turns the whole of personality into a syndrome to be medicated. The rest of the book is a meditation on what that might mean for our normal ideas of character. This is now a common line of questioning, but he was one of the first to write a lot about it. It's an interesting book, actually, though it was too long. It should have stayed a longish think-piece in a magazine.