On June 19th, Joanna Moncrieff and Carmine Pariante held an online antidepressant Q&A session with host Danny Whittaker. There was an initial debate, followed by 30 minutes of viewer-submitted questions. Prof. Pariante is Professor of Biological Psychiatry at Kings College London and Dr. Moncrieff is a practising psychiatrist, part-time academic and author.
I made notes whilst carefully following this debate to try and ensure the accuracy of the following comments.
The statements below are believed to reflect what was said in the debate.
They are possibly paraphrased, and are documented in good faith, and to the best of my ability.
When it was apparently opined that clinical trials (“studies”) funded by the pharmaceutical industry were not manipulated, for this viewer, credibility was lost.
Who funds the Continuing Medical Education (C.M.E.) for prescribers of psychotropic drugs?
C.M.E. is a process mandatory for professional appraisal and re-accreditation.
This vast educational enterprise appears to be largely a drug marketing exercise masquerading as post-graduate – lifelong, “evidence based” professional learning???
Study 329, and its subsequent published re-evaluation, hardly convinces us that pharma-funded antidepressant trials are free from market driven manipulation.
I believe that the words next stated were close to the following (albeit not verbatim perhaps): –
“Pharma input into the prescribing of antidepressants is zero”.
Any course content schedule for a C.M.E. Primary Care Update on M.H. and psychiatric drug prescribing would usually identify the exact opposite to that claim.
Prominently displayed behind the right shoulder of one speaker is a certificate from:
“The American Psychiatric Institute For Research and Education”.
I believe that it reads on: –
APA/Astra Zeneca Young Minds In Psychiatry International (?)Award.
This hardly endorses a pharma-free zone, although of course, it might be simply a historical artefact?
Two hours, and I heard no discussion of SSRI/SNRI induced AKATHISIA.
Nevertheless, an important and courageous input for Evidence Based Psychiatry from the other speaker.
Some of the straw clutching from Pariante was delightful , Joanna struggling to keep a straight face, at one point did she seem to fall off her chair?
Pariante’s main point seemed to be that there must be some people who get significant benefit from the drug in order for the distribution to be bell-shaped, and we just need to find out why, because then we can target the drugs better. Really? Sure about that? What about placebos that have an almost identical bell curve, are we going to target placebo therapy too?
Then we have that the effect is small but beautifully consistent. What we have, is that the two most prescribed antidepressants in the UK have an effect size of 0.23 and 0.24, when it’s already been agreed that Kirsch’s 0.3 amounts to negligible. So we have been something that does practically nothing, and at what harm?
Then we had “but just take the mood item”. Slap. Publication bias, only reported if convenient.
Then we had neurogenesis again. But who on earth said depression was about a shortage of brain cells anyway?
At the end of the day, flooding your brain with seratonin was a bold 1980s experiment that failed, that’s it, let the hypothesis and the drugs go, it’s over. Put more energy and money behind psychosocial initiatives.