February 26, 2008

Yet Another Study On Antidepressants, And No One Notices The Timing

Are we on this again?

"Study doubts the effectiveness of antidepressant drugs."  Or, even better, as per The Independent: "Antidepressant drugs don't work-- official study."

I don't know what passes for official nowadays.  The data is the exact same data that has existed for 30 years.  Yes, these authors are acting like they FOIA-ed the second Zapruder film, but let me assure you it's the same old data.  These authors did the exact same study in 2002.  So have twenty other groups.  This is not new. 

But it is news.  The question is why.

1.  I have a side question.  Why is it that when an article says something works, people are suspicious of bias, but when an article says something doesn't work, everyone thinks it's objective science?   IT'S ALL BIAS.  

2. People are completely missing the point of this paper and all the other recent  re-investigations, the true social and clinical consequences of them.  For example: they're saying antidepressants are no good.  Ok.  What do you think doctors are going to use  instead?  Psychoanalysis?  Nothing?  They're going to prescribe antipsychotics.  Are you listening to me?  I'm not even saying this is clinically wrong to do, but do you not see the setup?  Abre los ojos, man.

3. Previously, when SSRIs were being shown to be super effective, people suspected Pharma bias.  Now they are being shown to be ineffective, and people fail to see the bias.  IT'S THE EXACT SAME BIAS-  Pharma.  That's why there are popular press stories on this now, as opposed to five years ago.  GSK doesn't care that Paxil is ineffective.  Do you know why?  Because they want you on Lamictal.  (Again, this isn't to diminish Lamictal's or antipsychotics' usefulness.  I'm just talking politics.)

4.  And the handmaiden of Pharma is the academic.  You can't make a career studying generic medicines, because no one but the NIH will fund you to do it.  And nowhere save  Hollywood is there more cronyism and prejudice than at the NIH, so just forget it. You're an academic looking to cover your salary?  Get promoted?  The address on your grant application better read "Bristol Myers, Makers Of Awesome Abilify."  If it says "Bethesda Maryland," slit your wrists now.

5.  The study does not say that antidepressants don't work; it says that they don't work better than placebo.  Placebo is not nothing. The question someone should be asking is how the hell placebo generates 35% improvement in all but the most severely depressed.

5b.  ...And why the placebo works worse in the severely depressed.  Before you jump to the obvious answer, note that antidepressants had similar efficacy, independent of severity.

6.  If the drug had been no better than placebo, but placebo had only 2% efficacy, then yes, the drug would be worthless.  See the difference?

6b.  But that isn't true, either.  If any of the structural classists over at The Independent would care to explain how failure in Major Depressive Disorder can be extrapolated to OCD, panic, multiple myeloma,  etc, I'm listening.  "Mexicans don't work-- official study." 

6c.  "Why did you add multiple myeloma?  How's that?  It's an antidepressant, a psych drug."  No, it's called an antidepressant, it's used by psychiatrists.  You have no way of knowing what it actually is.  Look at the history of thalidomide.  "Girls named Candi are sluts-- official study."   While I'll agree that any parents who name their kid Candi are probably at risk for having a brass pole set up in the basement, you can't make any judgments about Candi herself based on her name.  Do you know why?  Because she didn't get to name herself.

There's a lot we can learn from the recent controversies surrounding antidepressants, and by a lot I mean only one thing, best articulated by Lewis Black:  "Doctors don't know.  They pretend to know.  Because they have a rectal thermometer in their pocket.  As if it was an appeal to a higher authority."





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