The Antidepressant Wars in the Post-Truth Era

Tom Benjamin, PhD
20
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Sometimes there are advantages to being outside the mainstream media. Australia dodged a bullet when the UK press announced claims about antidepressants. There was some coverage, but it’s comforting to hope that when the press releases came this way, our astute journalists were aware that during the previous months our press had already just run a competing big medical story: “Prescription pills killing more people than street drugs.”1

But the February 2018 UK press releases were all the more potent because they were attributed to such hallowed sources as Lancet, Oxford University and the BBC.2 British tabloid press was even more florid with interpretations such as “GPs should prescribe anti-depressants to over a million more Brits, experts claim,” citing an “Oxford University study” that supposedly “found pills were up to 113 per cent more likely to tackle depression than no treatment at all — despite previous claims that they did not work.”3 Even at face value it seemed unlikely The Lancet would have used the words ‘pills’ and ‘tackle.’

At a New Zealand conference, overseas visitors went even further. One headline virtually accused critics of mass-scale negligent homicide: “Claims that antidepressants don’t work are dangerous and akin to climate change denial, mental health professionals and experts say,” citing supposed “’overwhelming evidence’ supporting the view that mental health problems were caused by chemical imbalances in the brain.”4

Yet at the same time across the Tasman Sea a Professor of Psychiatry, former Australian of the Year, was assuring ABC listeners in response to a question about “chemical imbalance” that this was attributable to the “drug companies, the DSM, the FDA … American psychiatrists … 40 years ago … now no one believes that any more. If you talk to any modern researcher in neuroscience or psychiatry no one would say that is the explanation. But when you go to a GP or even some psychiatrists they will still trot out that very simplistic explanation to people.”5

The big stakes in this are not being exaggerated. As Dr. AJ Frances put it: “We have a medical system that couldn’t’ve been conceived more brilliantly by an enemy of the United States.”6 Biopharmaceuticals are regularly cited as leading industries in the US economy. Any threat to them is a threat to the economy.

The Lancet authors note these drugs are now off patent “available worldwide and ready to use also in developing countries,” presumably for the “350 million people affected globally.” This would take numbers beyond the scale of a World War. Hundreds of millions dwarf current concerns about the numbers in school shootings, tsunamis, plagues, or even a nuclear bomb. It is more on the scale of an asteroid hit. Depending on which side of the drug story we pursue, we could be ‘saving’ or ‘killing’ all these millions of lives — or both! The numbers sound apocalyptic but highlight the human impact of traditional epidemiological percentages applied to a populous, troubled world. It could depress some that the Eve of Destruction hit record from 50 years ago still sounds like a current newscast.

The most straightforward empirical perspective for the entire saga lies not in the clinical or statistical sciences but in the social sciences. There is in fact a trove of incontrovertible evidence, i.e. language: the evidence of who said what, where, when.

Despite media attributions to ‘the authors,’ ‘scientists’ and ‘experts,’ the source paper in Lancet made no such direct claims about either millions of exclusively drug treatments, vast improvements, dangerous views of critics, or superiority of drug treatments. The authors went to some lengths to use neutral language. They specifically mentioned “modest effect sizes.

Nor does it appear that the authors made extreme or even controversial claims in subsequent briefings and interviews. A review of the news coverage shows that quotes mixed in as though from the actual article authors are commonly from the media itself or third party ‘talking heads’ they interviewed for comment. The Lancet paper even leaves open the possibility of other treatments being preferable: “because of inadequate resources, antidepressants are used more frequently than psychological interventions.” This could even support some other journalist interpreting this as a call for more psychological services, rather than more drugs.

Some of the greatest concerns have been about the long-term use of medications. The article concedes “a longlasting debate and concern about their efficacy and effectiveness, because short-term benefits are, on average, modest; and because long-term balance of benefits and harms is often understudied.” This does not indicate the debate has ended. The language is present tense —are” modest — not that some new breakthrough discovery has changed all this and they are no longer merely modest. Clearly, they remain “modest.”

Clinics are seeing cohorts of people who have been on a range of psychotropic medications for decades, and the article specifically cautions: “Some of the adverse effects of antidepressants occur over a prolonged period, meaning that positive results need to be taken with great caution, because the trials in this network meta-analysis were of short duration.”

The Lancet article itself relies on statistics not widely understood by the general public or even most health professionals. Meta-analysis is specialized and a career in its own right. Perhaps a modest effect size might save lives. A claim in The Sun UK stated that the drugs were 113% more likely to ‘tackle’ depression; this might mean anything, e.g. someone “113%” taller than myself might either mean a head taller (100% of my height plus 13%) or the height of a giraffe (me standing on top of me plus 13% = 213%).

And 113% of what? There is no direct text string of “up to 113 percent” apparent in the Lancet article. So unless the journalist was experienced in meta-analysis, this would likely be an interpretation given them by someone unattributed. Perhaps the tabloid was being modest. It might have said “213%” as one of the few places in the article where the text-string ‘13’ appears in the source article is “ORs ranging between 2·13.” The authors define this as “summary odds ratios (ORs) for dichotomous outcomes.” ORs are usually shown as a decimal format, 2.13, rather than the 2·13 in the article, which at first glance might have led me to think it could denote a range from 2 to 13, since they used the phrase “ranging between 2·13.” Since the article uses a hyphen (1·89–2·41) to denote range, we might assume it to be a 2.13 figure, presumably referring to the probability of someone moving from one classification to another across a threshold criterion.

The Lancet article states this threshold to be “a reduction of ≥50% of the total score on a standardised observer-rating scale for depression.” That sounds impressive — less than half as depressed? But to someone untrained in meta-analytic argot, the word ‘standardised’ rings a bell as this term commonly refers to placement on a normal curve rather than raw score. Assuming they mean reduction of raw scores (and ignoring whether some of the item oddities in the scales may not directly assess depression), it raises the question of the starting level of those raw scores. An extremely depressed person might lower their scores and remain depressed. A low-scoring person might merely halve an already low score. It literally seems to mean that among those with much lowered symptoms more of them had received a pill that had some noticeable effect than from the group who had drawn an inactive placebo.

The OR refers not to the actual level of change in raw score but to the relative probability of a person who has a 50% reduction being in the drug group rather than the placebo group. But we’re only told the relative probabilities, not how many people this might be. Could there be a very small number who reduce scores by 50%? Would they be high or low scorers? Would those in the placebo group necessarily have far smaller reductions or nearly the same? The authors mention “the high percentage of placebo responders in antidepressant trials,” so how strongly do they respond? A cynic might ask if the threshold had been set to maximize the difference. If the figures are merely the ratio between numbers in drug and placebo groups, we are reliant on the authors to describe what this effect size might mean in raw score, let alone clinical terms, which they describe three times in the Lancet article as “modest.” This could be serving dual purposes as a statistical term relating to probabilities (more commonly termed “moderate”) or as a clinical benefits term, as when they say short-term benefits are, on average, modest.”

The intricacies of meta-analysis are for experts. Each dot on a plot has meaning, e.g. 2·13 or 2.13? But evidence anyone with a computer can check at home is — where in the Lancet article does it specifically spell out the “113 per cent” figure? Who interpreted this to the tabloids? And, if deciphered, what would such a figure mean in clinical practice? If an odds ratio, then does it mean in practice a few more people checked a few more items on a depression rating scale? People are much happier or less gloomy? Bill is 113% less depressed than Jenny or than he was last visit? Fewer suicide attempts? The Lancet article states, “We were not able to quantify some outcomes, such as global functioning.”

So after trying to work out what was said, the easier questions are who originally said it where and when. The most sensational interpretations and quotes are from the media and third parties interviewed about the paper. The lead Lancet author, Oxford’s Dr. Andrea Cipriani, told the BBC it was “the final answer … anti-depressants work …” but hedged rather unadventurously: “Medication should always be considered alongside other options, such as psychological therapies, where these are available, and the BBC cited the ‘authors’ as saying “it did not mean that anti-depressants should always be the first form of treatment.”7 Much of this is consistent with existing guidelines. The argument would be whether it was “the final answer” or any new answer at all.

It is no surprise that some of the press omitted the ‘other options’ and drew a straight inference that all this supposed life-saving treatment could now be unleashed because of the alleged new scientific findings about the drugs. This is a British literary trope, memorable from HG Wells’ War of the Worlds in which the Deputation waved a futile white flag, hoping to talk to the monsters, only to be turned to fire by the death ray.

The spin has created an epic science fiction classic, a ‘boys’ own’ world of tomorrow conspiracy adventure; scientific advances which had presumably been held back because of ‘dangerous’ cowardly views of extremist Luddite critics and timid or old-fashioned GPs. It conjures up the image of the timid softies, vainly hoping to communicate with the repulsive creature (in this case the Black Dog, the brain disease, chemical imbalance depression), rather than being action heroes saving hundreds of millions of Earth lives by courageously manning the professor’s magic bullet ray-gun invention (the wonder drugs).

A “suicide attempter” stands atop a building. Clint Eastwood asks: “Anyone try and talk him down?” The reply:”Yeah, but no luck. But now that you’re here…” After bravely climbing a ladder, confronting, tackling and saving the man, Mr. Eastwood says: “Now you know why they call me ‘Dirty Harry’ — every dirty job that comes along.” Mere talk therapy compared to a man of action willing to risk all and get hands dirty for life-saving results. Enough talk! The only thing that stops a bad guy with a chemical weapon is a good guy with a chemical weapon. Re-arm the doctors! Let them get on with it, run boldly into the building and .44-Magnum-blast that chemical-armed Black Dog.

By contrast with the jingoistic media, the Lancet article does not demean talk therapy, merely noting “inadequate resources” and “where these are available.” However, lest high-priced talk therapists take heart from this, the authors noted that no treatment at all can get results: “Depressive symptoms tend to spontaneously improve over time.” And even if the drugs beat placebos in trials, that doesn’t necessarily mean placebo (or doing nothing) is ineffective, merely less so. Would it be ‘modest’ to ‘spontaneously improve’ by doing nothing?

The article was explicit that the authors did not review or compare alternative treatments, all of which have their own supporters and critics, for example the well-publicized comparisons of physical exercise versus anti-depressants. The article specifically states, “We did not cover important clinical issues that might inform treatment decision making in routine clinical practice (eg, specific adverse events, withdrawal symptoms, or combination with non-pharmacological treatments).” These are the very “important clinical issues” that have been most questioned over decades, not whether these drugs were different from placebos.

It must be remembered that the Lancet article is not a report of a new treatment. It is in itself a secondary source, analysing and citing previous articles. So today’s public has been conditioned to ask which level of repartee is now the ‘fake news’? For example, the New Zealand article claimed that “mental health professionals and experts” viewed criticism as “incredibly dangerous,” but the only directly-attributed use of that term was from someone who said, “Speaking both as a mental health nurse and someone who’s [on] anti-depressants, … antidepressants saved my life…” Yet even this participant “…agreed that a conversation was needed on the issue of over diagnosis and overprescribing.”

Aren’t the latter the very issues that were the core of that conference titled: “Mental Health in Crisis”?8 Other media reported a completely different spin on the same conference: “Antidepressants don’t work and mental health system is failing, experts say.”9

Where else do we see such florid discourse and counter-accusations? The U.S. school gun debate? Nuclear disarmament? And in what sector other than mental health would someone cite being a patient as among their qualifications as an expert? I can’t see putting my hands up at a Dental Conference claiming expertise by saying, “It saved my tooth.”

So the most salient point I seek to make is that the original article was not what the general public would see. The news-reading public would likely not locate, let alone read or try to digest the source article. If I wasn’t employed in the sector, neither would I.

It is noteworthy that the Lancet site and the Lancet Facebook page made reference to those secondary and tertiary media sources rather than its own article or any presumed press release, let alone the original meta-analyzed source medical articles. Much medical news in the UK in particular comes through filters such as the UK Science Media Centre, which held briefings and cited “expert reaction.”10

Oxford, Lancet and BBC are prestigious. Mad in America was quick to pick up on the potential impact of this propaganda. Dr. Moncrief’s MIA article11 warned about the dangers of extrapolating the claims to the much larger population of the United States. It would fulfill the 80s prophesy of a Prozac Nation. Australia has a smaller population but a very high proportion of psychotropic medical prescriptions, so many thousands here might have been potentially influenced by this article and its press support.

The claim that this article “puts to bed the controversy” and has settled a scientific debate is the most portentous. The Lancet article itself, had anyone bothered to read it, clearly pointed out that the authors did not investigate “adverse events, withdrawal symptoms, or non-pharmacological treatments.” These are the typical controversies from within the literature and profession over many years rather than whether these drugs “work.”

There is no scientific or news value in finding that psychotropic drugs are more active than sugar pills. Water, vodka and gin look alike, but the psychoactive properties of alcohol are immediately apparent to anyone sampling them, even wearing a blindfold and blocked nose. Any supermarket substance like alcohol, caffeine and cigarettes, let alone the Laudanum or Medicine Show nostrums of the earlier centuries, will have an effect and be easily distinguished from a placebo.

The more important issue is how they compare with an active placebo, i.e. a substance that gives a buzz or other effect, and even more importantly how they compare with alternative treatments like psychotherapy and activities such as physical exercise, let alone social interventions that might ameliorate whatever was depressing them in the first place. One might well expect placebo to be effective. Depression is a state of mind. It’s not like toothache. It should be no surprise that a placebo response which is a state of mind, “I’m being treated,” might have an impact.

Which straw man ever said psychoactive substances “don’t work”? The problem, more commonly, is that these potions work too well. We’ve known for centuries that they are not placebos. Imagine the furore in substituting the Egyptian pyramid crew’s beer, the Union Soldier’s alcoholic ‘medicinal’ Bitters, or the British Navvy’s rum ration with coloured water! Bayer’s miracle painkiller drug Heroin was removed from the market not because of lack of effect but the opposite. It was recreational. It was addictive. Wars were and are fought over opium and cocaine. There have long been movements to prohibit alcohol because its sedative and disinhibiting properties are so popular that it has led to social problems. Marijuana enthusiasts form political groups.

So to find that substances like antidepressants are more psychoactive than an inactive placebo is no finding. It’s long been known and assumed. What had been surprising was the earlier number of findings that seemed not to be able to detect a treatment difference from placebo. That negative history had not been some mere fear or bias but had been the research history. The Lancet authors specifically mention this history of negative findings: “Depressive symptoms tend to spontaneously improve over time and this phenomenon contributes to the high percentage of placebo responders in antidepressant trials.” That is not the language of ‘the past’ now ‘put to bed.’ The authors are not here referring to the drugs, but rather to the trials, the depression condition itself, and natural human response. They are speaking in present tense, with no indication that human nature had now changed.

The article observed that “drugs tended to show a better efficacy profile when they were novel and used as experimental treatments than when they had become old,” echoing the old medical placebo adage: “Use the new medicines while they still work.”

So before even starting to probe deeper, and without learning the arcane language of meta-analysis, we have at least some solid incontrovertible evidence available to all that the claims in the press do not directly match the text of the source article. This is UK English, not the Dead Sea Scrolls. Even a non-English-speaker with a word processor can comb through the text of the Lancet article and news releases to see precisely who said what, where and when.

Show 11 footnotes

  1. Daily Telegraph, Australia, Dec 18, 2017
  2.  Cipriani A, Furukawa TA, Salanti G, Geddes JR, Higgins JP, Churchill R, Watanabe N, Nakagawa A, Omori IM, McGuire H, Tansella M, Barbui C. (2009) Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis Lancet. Feb 28;373(9665):746-58. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/fulltext
  3.  The Sun, UK, 21st February 2018 https://www.thesun.co.uk/news/5638272/gps-dish-out-antidepressants-to-brits/
  4.  https://www.stuff.co.nz/the-press/news/101845845/claims-antidepressants-dont-work-dangerous-doctors-say
  5.  Professor Patrick McGorry, speaking to Life Matters: Depression, anxiety and the pros and cons of antidepressants, Monday 5 February 2018 9:06AM  http://www.abc.net.au/radionational/programs/lifematters/depression,-anxiety-and-the-pros-and-cons-of-antidepressants/9391218
  6.  Dr AJ Frances Dartmouth College (2013)
  7.  Anti-depressants: Major study finds they work, BBC News, 22 February 2018.
  8.  “Mental Health in Crisis” New Zealand College of Clinical Psychologists, 26 Feb 2018, Christchurch
  9.  https://www.stuff.co.nz/national/health/101759156/antidepressants-dont-work-and-mental-health-system-is-failing-experts-say
  10.  http://www.sciencemediacentre.org/expert-reaction-to-largest-review-of-antidepressants/
  11.  https://joannamoncrieff.com/2018/02/24/challenging-the-new-hype-about-antidepressants/

20 COMMENTS

  1. I have no doubt this modestly positive report on antidepressants has more to do with maintaining strong drug sales than it has to do with anything else.

    What would I do if the drug was an neuroleptic? I’d point to the mortality rates, the mortality rates on and off drugs, and also at the extent to which chronicity is increasing.

    With so-called antidepressant neurotoxins, I’d go straight to the chronicity versus recovery rates, on and off drugs. That and the physical harm that sometimes comes of taking these chemicals.

    People do claim some of these drugs are life savers, but what does the hard science say? It could say something entirely different, such as this is a drug you really shouldn’t be putting in your body.

    “Spontaneous” remission, recovery, fill in the blank. Yep, I hear that happens. Karma might just put in an appearance, and turn your whole disappointing life around. Such remains a hope anyway, however slim.

  2. Considering majority people with mental illnesses take medicine can you refrain from scaring about on and off meds data. You’re not curing anybody but just making it more embarrassing. Find a new method of discord and discontent and leave us alone. You’re close to being the culprit now.

  3. Good info, on one hand. On the other,

    The intricacies of meta-analysis are for experts. Each dot on a plot has meaning, e.g. 2·13 or 2.13? But evidence anyone with a computer can check at home is — where in the Lancet article does it specifically spell out the “113 per cent” figure?

    Activists need to understand that fluidity at this level of argumentation is unnecessary in order to recognize that these neurotoxins are BRAIN POISON. That’s what the public needs to absorb.

  4. I would suggest that people head over to http://rpsychologist.com/d3/cohend/ and put in the effect size (SMD) of 0.3 cited in the Cipriani meta-analysis.

    Just look at it, the 2 distributions representing the response for drug and placebo that for the most part overlap, and then ask yourself how Britains leading psychopharmacologist describes this as “much better than placebo”.

    Is the SMD effect size the best way to look at this? Well, for me, yes, because it is visual, and I get a bit baffled by Number Needed to Treat, which is really another way of stating the effect size.

    As this article says, though, the statistics in the Cipriani meta-analysis were really hard to make sense of. So far as I can see, they took a category of people who had improved massively (>50% symptom improvement) in 8 weeks, and I think, but I’m not sure, this was 17.7% of patients, and looked at whether those “super-improvers” were taking drug or placebo. This is interesting but misleading. For one thing, its not telling you the degree to which, on average, people were better on the drug. The effect size tells you that, and judge for yourself how big you think that was. The other thing, of course, that you are inclined to miss, is that you can start to suspect from looking at the effect size graph that most of the effect is placebo, even amongst those super-improvers, even if you were on the drug. This placebo effect has been pretty accurately estimated by other researchers as 75%.

    You can see how it is possible to exaggerate the drug-placebo difference on the chart of the two responses that are really quite close together – if you go to the right hand side it does indeed look like there are a lot more drug-responders than placebos in there, but that doesn’t alter the fact that on average, there is not much difference.

    It looks as if the objective of the study was mainly to rank the (rather ineffective) drugs, and instead of using effect sizes which would all seem small and not much difference between them, they found a measure which magnified the differences, not just between drugs but between drug and placebo. That’s great, you get a nice league table, but the bottom line, for me at least, is that effect size of 0.30.

  5. Dr Benjamin, you say: “we have at least some solid incontrovertible evidence available to all that the claims in the press do not directly match the text of the source article.”

    Yes, but the way I see it, the journalists in the mainstream media did a pretty good job of accurately reporting what was fed to them by lead psychiatrists, including Cipriani. They were out in force that day, and all dutifully on message with the line “antidepressants work, and more people would benefit from treatment for depression…”

    A cursory Google search turned up these:

    1. Lead researcher Dr Andrea Cipriani, from the University of Oxford, told the BBC: “This study is the final answer to a long-standing controversy about whether anti-depressants work for depression… I think this is very good news for patients and clinicians.”

    2. Andrea Cipriani in The Metro: “Under-treated depression is a huge problem and we need to be aware of that. We tend to focus on over-treatment but we need to focus on this.”

    3. Carmine Pariante was another one on our screens:
    “This meta-analysis finally puts to bed the controversy on antidepressants, clearly showing that these drugs do work in lifting mood and helping most people with depression.”

    4. “Good news… antidepressants do work and, for most people, the side-effects are worth it.” Allan Young

    5. “It puts to bed the idea that antidepressants don’t work – all 21 antidepressants were more effective than placebo at treating depression”. Prof Anthony Cleare

    Then there was the “million more” claim:

    John Geddes, professor of epidemiological psychiatry at Oxford University, who worked on the study, told The Guardian: ‘It is likely that at least one million more people per year should have access to effective treatment for depression, either drugs or psychotherapy.’

    This was accurately reported in the Metro as…

    “It has been suggested a million more people per year in the UK should be given access to treatment for depression, through either drugs or talking therapies, with scientists saying the study proves drugs do work.”

    …and I haven’t even got onto the Burns & Baldwin letter to The Times.

    You talk of the “jingoistic media”, but all I see is Psychiatry’s PR machine doing its thing.

      • I think he actually said they were “safe and effective”, and I don’t think we need any context to ask why he is trying to mislead the public. For adolescents in particular, it’s well known that they raise the suicide risk, and the effect size is nowhere near large enough to justify “effective”. Did he not understand the numbers, or did he just not read the paper before commenting?

        • Pariante is on the panel of experts for the UK Science Media Centre, a Registered Charity where reputable mainstream journalists source their information about science. Professor Simon Wessely is on the board of Trustees. The mission of the SMC is… “To provide, for the benefit of the public and policymakers, accurate and evidence-based information about science and engineering through the media…”

          Here are Pariante’s words, taken from the SMC website:

          “This meta-analysis finally puts to bed the controversy on antidepressants, clearly showing that these drugs do work in lifting mood and helping most people with depression.”

          I’d say that “final answer on the subject” was taken from this, and that it is an accurate paraphrase.

          Pariante is a gift to Psychiatry, he is an extrovert who enjoys a high media profile. I have been following his antics for a while – it’s hard to know if he genuinely believes the things he says to the press, or if he’s just playing games. Either way, journalists use him because of his expert status and reputable credentials bestowed on him by the Science Media Centre. Last year I pursued a serious official complaint against the SMC about an untrue statement of Pariante’s which they had issued to the media. Here’s what happened…
          http://www.auntiepsychiatry.com/red.aspx?ha=smc

          • Thanks, Auntie, interesting. It seems that the adolescent suicidality claim cited by Pariante was thoroughly debunked in the literature prior to his statement (eg Sparks/Duncan 2013). Apparently neither the claimed fall in prescribing nor the rise in suicides in the US actually happened. Oh dear. A gift indeed!

          • I have found the quote now:
            “Lead researcher Dr Andrea Cipriani, from the University of Oxford, told the BBC: “This study is the final answer to a long-standing controversy about whether anti-depressants work for depression…””
            http://www.bbc.co.uk/news/health-43143889
            So it was one of the others who used the expression “final answer”.

  6. Wow thanks for the good laugh! I read their catch-phrases and wonder, too. “Modest effects.” Like what the heck? They tend to use vague or non-quantitative language, of course for darned good reason. Not only can depression not be measured, but since when is it an entity, some sort of bad area, bad cells or bad chemicals they could actually identify in the brain that can just be removed or zapped with electricity or drugs? They know. They are very good liars. Who makes money off the Lancet? And how is it funded?

  7. Bramble – that is very interesting. So, what is Pariante saying? He claims to be “widely quoted” as saying this, but where do these misquotes appear? Did a newspaper or journalist mistakenly attribute those words to Pariante rather than Cipriani? I can’t find an example of it anywhere… am I missing something?

      • Perhaps they are just speaking with one voice. There is another thing I find odd about the whole business: didn’t amitriptyline come out top? And yet they seem to be silent on that. Nothing about how they should drop SSRIs and go back to amitriptyline.
        I had never heard of Carmine Pariante before this. Looking for his quote I came across lots of stuff and at first sight it does look seductive – all this cutting edge science, prestigious institutions, visits from royalty, etc. And they have it all worked out – inflammation, small brains, etc. Inflammation seems to have taken over from chemical imbalances but what happened to brain circuits? And then I got a sobering thought: the world is still just the same, just as many depressed people and also I looked at his conflict of interests list and the fact that he is pals with Charles Nemeroff.
        That was a feeble reply you got auntie from the SMC. I remember years ago they were promoting Helen Mayberg and her deep brain stimulation. What happened to that? But I don’t know much about SMC. The one I am following with interest is MQ.

        • Bramble – you are reflecting back all my own thoughts about this – thanks, it is very reassuring! Pariante masterfully puts out seductive lines to the press – he speaks with authority and confidence – who would stop to question him? For instance, in the DM piece he says…

          “Research shows between 50 and 60 per cent of patients respond well; for them, the drugs really are life-changing and they can get back to normal over the space of a few months”

          Sounds very plausible, but what is this “research”? I’m going to e-mail him to ask for the evidence – I doubt he’ll reply to me, but if he is going to make definitive statements like this to the press, he better have the studies on hand to back it up.

          Interesting that you mention Helen Mayberg. She’s still around, there was a press release issued in January… “Helen S. Mayberg, MD, Appointed Director of Newly Established Center for Advanced Circuit Therapeutics for the Icahn School of Medicine at Mount Sinai”
          Also, if you have the time (it’s long), read this…
          https://www.madinamerica.com/2018/01/brain-implants-spinning-trial-results-protect-product/

          • So the circuits have a center and are still in there with a sporting chance. I read the spinning trial results report. It goes on in the UK (DBS for depression) but isn’t much talked about. A couple of people who had undergone psychosurgery in England in recent years did so after having DBS.
            As for Carmine Pariante you can’t avoid him. He was in the Times today. Can be read here https://www.raconteur.net/healthcare/debate-antidepressants-work
            There was also John Geddes from Oxford with his line about GPs being “squeamish” about prescribing antidepressants. Is it about 60 million prescriptions a year now? And about 40,000 GPs? So that is about 1,500 prescriptions for antidepressants per GP per year. Squeamish?

          • When I saw this on youtube, I realised that Pariante really has some dangerous views that I sincerely hope he has some justification for:
            https://www.youtube.com/watch?v=Tpp4uPDjqDg&t=436s

            Basically he says that suicidal ideation and self-harm are separate and distinct from suicide, although they overlap. To tell the truth I was slightly lost already.

            He goes on to say that you can gauge the first from drug-placebo studies, and the second from ecological studies of national suicide and prescription rates. He is clearly blind to the ecological studies that disprove what he says, and even goes so far as to say that “all the studies” prove antidepressants reduce suicide.

            By drawing the distinction, he basically says the drug-placebo studies are invalid for assessing suicide risk, and that ecological studies, where with skill you can cherry pick your result, prove the matter “beyond all doubt”.

            From what little I have learnt, phrases like “all the studies”, and “beyond all doubt” are psychiatric euphemisms for “look, I can’t be bothered to argue with you, just trust the letters after my name will you?”

            Apparently, its only the hapless “susceptible individuals” who go on to have increased levels of self-harm and suicidal ideation after starting antidepressants, and we must not confuse these “non-lethal” reactions with an increase in the risk of suicide.

            This is spin.

  8. I’ve had to count to several million before leaving this comment. The Raconteur article (thanks Bramble!) has both Pariante and Geddes shifting gear – they are now going all-out to land those unsuspecting million extra people a year who need ‘treatment.’

    Geddes: Only one in six people with depression receive effective treatment with GPs “squeamish” to prescribe medication for mental health conditions.

    Pariante: We have a wealth of evidence that antidepressants do a good job for some people, and there are a lot of people who could benefit from them and now will.

    That’s bad enough, but Pariante’s “evidence” to the Parliamentary Health committee about Suicide Prevention left me dumbstruck. Everything you say is true, Concerned Carer, but “spin” is too kind a word for it. Listen to the bit from 4 mins to 5mins30secs – when I challenged him for the evidence on this last year, all he had was the debunked paper by Gibbons et al 2007!! He speaks with authority, and he speaks for his profession to the UK Parliament, and all he has to back it up is thoroughly discredited junk-science. That is something else!

    My main hope now is that Pariante and Geddes will go too far and bring the whole of the Royal College of Psychiatrists tumbling down on all their silly heads. Wouldn’t that be fun?