Tuesday, February 26, 2008

The drugs don't work....?

A new study from the University of Hull suggests, apparently, that the new generation of anti-depressants have 'little effect'.

At least, this is how it has been reported on the BBC website.  The actual findings suggest that a placebo is just as effective as certain SSRI's in cases of mild to moderate depression, which is not quite the same thing as saying that the pills don't work. In cases of severe depression, anti-depressant medication is considerably more effective than a placebo. 

So, the breaking news guys is that placebos have....well, presumably  a placebo effect.  

The story here seems to be less about the efficacy of SSRI's, and more about lazy journalism, scientific illiteracy and our insatiable desire to sensationalise every bit of news that comes our way. 

(I can't believe I just wrote a post in defence of the pharmaceutical industry. I may need to lie down for a while.)


47 comments:

Adam Field said...

Lazy-ass journalists telling depressed people they've been exaggerating their depression, thus enforcing the dominant societal stigma of depression?

Surely not? ;)

Can you tell I've just finished a uni module on the social context of health and illness?

An Unreliable Witness said...

I spent three years at the University of Hull, and the anti-depressants certainly didn't work for me.

[Okay. Obvious joke, but it had to be be done. The university and city are quite nice, really.]

Misssy M said...

Yes I heard this report on the radio yesterday and it made me a little annoyed.

I can say for sure that not only did the pills work for me but I don't care HOW they worked.

Any positive vibes that someone just starting their medication for depression don't need to be trashed by ridiculous reporting like this.

Imagine if you heard that report the day the doctor prescribes you your Fluoxetine or whatever....

trousers said...

I don't think you wrote a post truly in defence of the pharma industry: or if you did, it's a very measured, specific defence. I also think it's fair enough to pull apart what the media said about all this to gain some perspective. I still think the pharmas are villains with respect to how they manipulate their trial data though.

The first blog piece I wrote (for someone else's site) was a very measured, cautious defence of antidepressants. I might have to post it up again out of interest.

Thing is, if the media builds the likes of Prozac up to be a wonder drug, then they're going to use studies like this to knock it down again.

Stray said...

You make some excellent points there Ms M!

To quote Mr Tony Soprano (quoting his own therapist):

Hope comes in many forms

I find the lack of simple understanding of statistics and data amongst journalists shocking. Bear in mind that I used to be one ... (is it something you ever truly recover from?).

Yes, it's possible that given any ten people with depression, 7 out of 10 of them will feel better whether given SSRIs or a placebo, or even psychotherapy. Whether they are the same 7 out of 10 people can never be known. This seems to be the fundamental point that the journalists miss.

The BBC also disappointed me with the remarkable hidden shallows of this deconstruction of the 'placebo effect':

--

The researchers accept many people believe the drugs do work for them, but argue that could be a placebo effect - people feel better simply because they are taking a medication which they think will help them.

--

There are obvious benefits simply in being taken seriously enough to get a prescription, in admitting how bad you feel to a doctor, in stopping pretending that you're just going to snap out of it ... but I also think there are some very practical 'side effects' of all tablets (including the sugar coated nothingness kind) in that people generally also modify their behaviour, at least initially. They drink less, go to bed earlier and stop trying to be super human ... that's purely a personal observation, I'm not quoting any clinical trial, but ffs, it's not just about believing that the drugs might make you better!

Having taken Citalopram (and at other times diazepam, dothiepin, thioridazine and risperidone) I have no doubt that SSRIs have a major effect on the brain - a really serious chemical change that affects everything from your sleep patterns to the amount of saliva in your mouth.

I share Misssy M's concerns, and wondered how many people taking SSRIs simply didn't bother taking their tablet last night after reading or hearing that toss. I'm not pro-medication but I am pro-information, and the only thing I learned from that particular report was how staggeringly unable to read beyond a press release and perform any meaningful analysis the 'news' media really are.

Frightening.

PS - picking up Mr Unreliable's point, I do hope they didn't actually do the research in Hull ... I'm pretty sure there's something in the water.

Ms Melancholy said...

Hey adam, I think in this instance I was concerned about their ability to interpret scientific data, although I'm generally with you in having a random dig at lazy ass journalism. Why waste the opportunity I say.

Hey Mr Witness, ah, I can't believe I missed the obvious hull/hell joke: of course the drugs don't work - try moving house instead. (Apologies to the reader from Hull. It's a joke....sort of.)

Hey Missy M, yes, I wondered exactly that. How many people would take this at face value and abandon their pills. I am no great fan of medication-only solutions, and I am certainly no great fan of the pharma industry, but there is no doubt that anti-depressants help many people to get through very difficult periods in their life. This kind of mis-reporting is massively unhelpful.

Hey trousers, post it up again, I'd be keen to read it. Mostly I think the pharma industry are self seeking, cynical bastards who manipulate their research without conscience. Combine that with shallow journalism and you have a match made in heaven. Haven't read the Guardian 2 cover story yet (the creation of the Prozac myth) but it sounds like you have it spot on.

Look forward to reading your post.

Hey lovely Stray, I knew I could rely on you on the scientific illiteracy front. Tony Soprano was right - it always amuses me that we want to dismiss something as a placebo as if that means that it doesn't work at all. I suspect all medical interventions have a placebo effect, but that doesn't mean we should withdraw them, does it?

I think you are right about Hull, by the way. But don't worry, global warming should sort that out.

(once again my sincere apologies to the reader from Hull)

Ms Melancholy said...
This comment has been removed by the author.
Reading the Signs said...

Hi Ms M,
I was once prescribed Prozac - not for depression, but because at one point someone had the idea that it helped with symptoms of M.E. I asked about possible side-effects and was told there would be none at all. "It's just like taking a pinch of salt," said the GP. I was one of those who reacted to the drug by becoming violently agitated and panic-ridden. I have never before or since experienced such terror. GP said this couldn't possibly be down to the drug and urged me to keep taking it. Symptoms went 24 hours after stopping Prozac. Since then, stories have filtered out about other people who have reacted in similar (or worse) fashion. What troubles me about the 'placebo' talk is that it somehow suggests that Prozac, of itself, doesn't actually do anything. Clearly it does, and sometimes with catastrophic effects which are still not much talked about.

Absolute Vanilla (& Atyllah) said...

Are you telling me I could just have well spent a year or so eating Smarties? I think I'm going to lie down too.

trousers said...

I've just posted it up again now Ms M, so feel free to pop over and have a look :)

Daniel said...

I used to pop in here ages ago, it's so nice to see you've kept this up.

And changes too... wow!

What gave it away for me was a beautiful little post you wrote about your Son and weddings and men and women; must be a year ago perhaps. We can never keep anything to ourselves, can we.

In a six-degrees-of-separation-thing, I am now at the Hull Uni and Irving Kirsch (co-author of this research) is a Professor (takes all the glory, does none of the work) in my department.

Alas, you may want to get up from that lie down, this analysis was only possible because Freedom of Info requests were made to obtain the material Big Pharma was suppressing about the efficacy of SSRIs in mild depressive epsiodes - much as they did/still do around the whole Seroxat/Teenage suicide issue.

NICE have implicitly known about this since 2004 and changed the prescribing guidelines accordingly; unfortunately pills are quicker and cheaper to provide than a dose of talking therapy - and the number of scripts rises inexorably skyward.

There was a notable absence in media reporting of quite a bit of new research suggesting a depression can sometimes be a worthwhile thing - presumably because while it may be worthwhile to the individual, it isn't to Big Pharma, Welfare or the Economy in general.

My Best Wishes.

Badger said...

All I want know is why the font on your blog has suddenly gone all fat and wrong. Make it stop please.

Badger x

Böbø said...

Don't tell me the druggies have got to you to!!!! NOOoooooooo!

Oh don't look at me like that ... OK, I'll be Adult if you insist.

Ms Melancholy said...

Hi there Ms Signs - I agree...of course these drugs have an impact. We can't mess with our very delicate brain chemistry and surely not have an impact? For some people they are a life saver, whilst for some - and unfortunately you were one of them - they are downright dangerous. That's partly why I felt so irritated at the suggestion in the BBC report that they 'don't work'. I think all this research proves is that placebos do work, and tells us bugger all about anti-depressants.

Hey absolute vanilla, I think the answer to that is probably yes. Sorry. But at least you saved your teeth from all that sugar :)

Hey trousers, popping over there right now x

Hi there daniel, how lovely to see you back here! I have often wondered where you slipped off to (and I shan't make another cheap jibe about Hull.) Really glad you are studying - you will be an asset to any psychology department. I haven't read anything worth reading about this particular piece of research, apart from the scurrilous practices of the drug companies. You got any plans to blog again? I do think you should x

Hey Badger, I just thought the previous font was too small! Maybe I just need to wear my glasses instead......

Hi there Bobo, yes, I am indeed in the pay of the big pharmaceuticals and shall be carrying advertising any time soon. Every girl has her price, I am told.

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infinitedawn said...

I find it interesting that journalists never ask the question that results like these beg, to my mind at least. That being: If they have a significant effect on severe depression but only the equivalent of a placebo effect in mild to moderate depression - well, why?

Is it because there is something different going on chemically in the brain with severe depression or is it that the right drugs have not been found yet? Are the drugs simply not good enough, as yet, to really see a notable effect with mild/moderate depression? Perhaps they're not yet specific enough, perhaps depression is more complicated than we imagine.

These drugs are great compared to the chemical straight jackets of 20 odd years ago - so just imagine what the next breakthrough will bring.

It's not that the drugs don't work, it's just that they may not work equally for everybody. That doesn't mean stop taking them but it should mean the media puts the message out to folks to put pressure on the medical/pharmaceutical industries to keep looking for better answers.

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PatientGuard said...
This comment has been removed by the author.
PatientGuard said...

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פסיכיאטר said...

התפקיד של כל פסיכיאטר הוא להגיע לאיבון נכון של הבעיה הנפשית. גדולתו של פסיכיאטר, יחד עם זאת, היא לאמר מתי אין לאדם בעיה ולא להתעקש על טיפול פסיכיאטרי

Philippe said...

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Addiction

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Nealbo said...

Anti-depressants do play their role - although of course should not be relied on as a cure.

William Hambleton Bishop, MA said...

Wow you get an awesome string of comments here - The placebo effect is truly an awesome deal - and to answer some peoples questions - no you would not get the same result from simply eating candy - the placebo works because the pharma companies or doctors or researchers have been able to succesfully get you to believe that they can help - this is not a negative thing - in short if you believe that something or someone can help you - then they can - credit is still deserved for earning that credibility which led to your ability to believe in them. as to whether we need pharmasuticals - the answer is the same with everything else in life - yes and no - with money being as important as it currently is to people - there will always be overselling of everything.... but certain people absolutely have benefits from pills...is what it is really........

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Firstly, I think what constitutes change is so subjective. Therapists often have different definitions than their patients. For me, I think there is a large variance between getting better and feeling better. That said I never intrude upon a patients wish to seek a medical option even though it goes against my psychotherapy practice. Adam

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