In August 2011 a leading psychiatrist and author, Dr Colin A Ross1, presented in Sydney and included information detailing the results of clinical trials into antidepressants versus placebos. The general understanding is that antidepressants get better results than placebos.
He said however, when antidepressants are compared against an “active placebo” (another drug which is not expected to improve depression) no difference in performance is found.
It has long appeared in the literature concerning clinical trials that patients (and staff) know if they are receiving a drug or a sugar pill, by the presence or absence of side-effects. By using an active placebo all the subjects experience side-effects, confusing everyone as to who is getting the real antidepressant. Then there is no demonstrated benefit of antidepressants over placebos.
Therefore is it a good use of government expenditure to be supplying antidepressants when they don’t work? Does it concern you that people may get sexual dysfunction, anxiety, an increase in suicidal ideation, panic attacks, hostility or aggression etc, for no proven benefit? Are you concerned that doctors who do not want to prescribe antidepressants have limited choice when the prevailing “best practice” is to do so?
At a TED conference in 2011, Dr Ben Goldacre gave a 14 minute talk which was posted online. http://www.ted.com/talks/ben_goldacre_battling_bad_science.html#.TpJ6HvxNerA.email He is an epidemiologist and was speaking about bad science, particularly in medicine. He referred to the fact that more than half the data on antidepressants has not been made available to the Cochrane group2 investigating the effectiveness of these drugs. What are they hiding? If their data proves the drugs are effective they would leap to have the Cochrane group corroborate their claims.
I highly recommend the talk; it is fast paced and entertaining. He makes the point that scrutiny into research is vital for our community to make wise choices about our health practices.
There is hope
Dr Peter Breggin, an American psychiatrist, and one of the most known critics of psychiatry, reported in his blog (19th Aug 2011), “Apparently two British-based companies, GlaxoSmithKline and Astra Zeneca have announced that they no longer intend to research, develop or market any new antidepressants.” http://www.huffingtonpost.com/dr-peter-breggin/empathic-psychotherapy-_b_924494.html He says that because of the growing evidence against antidepressants and increased law suits, “the cost of litigation — even while settling almost every case — has grown overwhelming.”
I read Peter Breggin’s more recent post (16th Nov 2011) where he pulls together research arguing that antidepressants can perpetuate and thereby create long term depression. Rather than fixing the problem, they may be making people worse. I encourage you to read it. http://www.huffingtonpost.com/dr-peter-breggin/antidepressants-long-term-depression_b_1077185.html
Why did I write this article?
Many colleagues I know have an interest in delivering psychotherapy. It is not always easy and we are not always successful. However, we understand there are a multitude of ways to help people with their problems. From what I have read of the scientific critiques of antidepressants, the cost-benefit analysis does not favour use of these drugs.
People often assume that even if they don’t work, they are harmless and worth a try. Breggin argues they are not harmless. Furthermore, even where the client is free from obvious serious side-effects, we do not know the long term effects. And their prescription adds to the idea their “depression” is an illness rather than something they do – I do not use this phrase to blame sufferers. I want people who feel depressed to understand they can learn skills and new perspectives, and take actions which will make them forever likely to better manage life’s challenges.
I am concerned the idea of this alleged ‘illness’ lessens the likelihood that people will see themselves as resourceful and capable of solving problems. (I acknowledge some will need help to do this.)
What can we all do about this?
Do we want to stand idle while drug companies promote false ideas like there is a pill which will dissolve unhappiness?
If we want Medicare and government to support the provision of psychotherapy, then it seems useful to break down the false rhetoric of a chemical imbalance causing depression. Such misinformation sees antidepressants routinely used as the first line of treatment.
In the public mental health services, psychotherapy is offered to a tiny proportion of its clients, out of errant conclusions, from poor science.
I think that much more assistance can be delivered by a trained workforce who are not restrained by misinformation, which is then translated into inadequate practices and policies.
A helpful strategy is to circulate information which will inform people, counter past ideas, and promote discussion, as I am doing.
- 1. [Dr Colin Ross is an author of several books including, “Pseudo-Science in Biological Psychiatry: Blaming the Body,” Colin A. Ross and Alvin Pam, John Wiley & Sons Inc, NY. 1995. I read this in 2000 and kept reading this literature ever since.]
- 2. [The Cochrane group is a highly respected, non-profit collaboration of researchers. They seek access to the data of all clinical trials, assess the methodology, the analysis and conclusions.]