Tag: antidepressant medication

Researchers question the overstated results of a large antidepressant meta-analysis and point to cultural pressures to turn to these drugs for a quick fix.

Most doctors still affect surprise at the idea SSRIs might come with withdrawal problems. Regulators knew very clearly since 2002 about the problems, but have decided to leave any communication of these issues in company hands.

The results of the nationwide study, analyzing data from over one million women, suggest that hormonal contraceptive use may increase the risk of depression and use of antidepressants, especially for adolescents.

All the fuss about Study 329 centers on its 8-week acute phase. But this study had a 24-week Continuation Phase that has never been published. Until Now.

If you’ve read recent reports that state “US suicide rates surge to a 30 year high,” you might first justify the reality with the fact that things feel very wrong in our world today. On a personal, national, and planetary level, people are suffering to survive and the distress is coming from all sides – medical to economic to existential. But you probably also wonder why more people are choosing this permanent and self-destructive path, and feel compelled to submit to seemingly logical appeals to provide these individuals more help and greater access to treatment. Surprise: that may be the last thing our population of hopeless and helpless needs. Life’s inevitable challenges are not the problem. It’s the drugs we use that are fueling suicide.

The assertion that the so-called antidepressants are being over-prescribed implies that there is a correct and appropriate level of prescribing and that depression is a chronic illness (just like diabetes). It has been an integral part of psychiatry's message that although depression might have been triggered by an external event, it is essentially an illness residing within the person's neurochemistry. The issue is not whether people should or shouldn't take pills. The issue is psychiatry pushing these dangerous serotonin-disruptive chemicals on people, under the pretense that they have an illness.

When we set out to restore GSK’s misreported Study 329 of paroxetine for adolescent depression under the RIAT initiative, we had no idea of the magnitude of the task we were undertaking. After almost a year, we were relieved to finally complete a draft and submit it to the BMJ, who had earlier indicated an interest in publishing our restoration. But that was the beginning of another year of peer review that we believed went beyond enhancing our paper and became rather an interrogation of our honesty and integrity. Frankly, we were offended that our work was subject to such checks when papers submitted by pharmaceutical companies with fraud convictions are not.

Psychiatry would long since have gone the way of phrenology and mesmerism but for the financial support it receives from the pharmaceutical industry. But the truth has a way of trickling out. Here are five recent stories that buck the psychiatry-friendly stance that has characterized the mainstream media for at least the past 50 years.

The largest-ever meta-analysis of antidepressant trials appeared yesterday in the British Medical Journal. Researchers from the Cochrane Collaboration reviewed 70 trials (involving 18,526 subjects), to find that - counter to the initially-reported findings - antidepressants doubled the risk of suicide and aggression in subjects under 18. This risk had been misrepresented in the original study reports, the authors say, and suggest that the risks to adults may be similarly under-reported.

If antidepressants are effective, and people with depression are more likely to be prescribed them, then you would expect the consequences of depression to start to lessen. One of those consequences, according to government statistics, is being out of work. But what we see is quite the opposite: Increasing use of antidepressants correlates with increased numbers of people with depression who are out of work and claiming benefits, and increasingly on a long-term basis. And this is at a time when disability due to other medical conditions has fallen.

Access to data is more important than access to information about conflicts of interest. It is only when there is access to the data that we can see if interests are conflicting and take that into account. Problems don’t get solved unless someone is motivated for some reason. We need the bias that pharmaceutical companies bring to bear in their defense of a product, along with the bias of those who might have been injured by a treatment. Both of these biases can distort the picture but it’s when people with differing points of view agree on what is right in front of their noses that we can begin to have some confidence about what we have.

In May 2014, the RIAT team asked GSK what the children who became suicidal in the course of Study 329 have since been told. The consent form says that anyone entering the study would be treated just the way they would be in normal clinical practice. In Study 329, the children taking imipramine were by design force titrated upwards to doses of the order of 300 mg, which is close to double the dose of imipramine given in adult trials by GSK or in normal clinical practice. In normal clinical practice it would be usual to inform somebody who had become suicidal on an SSRI that the treatment had caused their problem.

This past Saturday, I was on my way back from Europe to Boston, and while on a stop in Iceland, I checked my email and was directed to a new blog by Ronald Pies in Psychiatric Times, in which he once again revisited the question of whether American psychiatry, and the American Psychiatric Association (APA), ever promoted the idea that chemical imbalances caused mental disorders. And just like when I read his 2011 writings on this subject, I found myself wondering what to make of his post. Why was he so intent on maintaining psychiatry’s “innocence?” And why did it matter?

The authors of Study 329 began recruiting adolescents for a comparative study of Paxil, imipramine and placebo in 1994 and finished their investigations in 1997. They dropped a large number of their original cohort, so the randomness element in the study must be open to question. Late in 1998, SmithKline Beecham, the marketers of Paxil, acknowledged in an internal document that the study had shown that Paxil didn’t work for adolescents in terms of the two primary and six secondary outcomes they had established at the start of the study. In a nutshell, Study 329 was negative for efficacy and positive for harm, contrary to their succinct upbeat conclusion.

The conventional wisdom is that antidepressant medications are effective and safe. However, the scientific literature shows that the conventional wisdom is flawed. While all prescription medications have side effects, antidepressant medications appear to do more harm than good as treatments for depression.