Researcher Critiques Misleading Media Coverage of Lancet Antidepressant Meta-Analysis

The BMJ’s clinical editor takes issue with uncritical media coverage of antidepressant network meta-analysis, outlining reporting missteps

Rebecca Troeger
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In a BMJ commentary entitled “Pop a million happy pills?” the journal’s clinical editor, Kate Adlington, suggests that much of the media coverage of The Lancet’s antidepressant network meta-analysis was insufficiently nuanced. The study has received ample attention and been the source of vigorous debate amongst researchers, clinicians, and patients since its publication in February.

“‘Pop more happy pills,’ screamed the Sun’s front page on 22 February… Many news outlets called for more prescribing,” Adlington writes. “But what about overtreatment, let alone the practical and financial implications?”

Photo Credit: Max Pixel

In February of this year, Andrea Cipriani, John Geddes, and colleagues published the results of a network meta-analysis comparing the efficacy and acceptability of 21 antidepressants in the treatment of major depressive disorder in adults. As the first large network meta-analysis (n = 116,477) of its kind, the study received widespread media attention and resulted in eye-catching headlines such as those included in Adlington’s commentary (e.g., The Sun’s “Pop more happy pills”). The study and its subsequent news coverage stirred up longstanding debates about the effectiveness of antidepressants and has prompted a number of response articles, tv interviews, and letters to the editor, as detailed here on this site.

In her commentary, Adlington highlights the unnuanced and at times sensational nature of the meta-analysis’s depiction by many mainstream news outlets. For example, the BBC’s headline on the study declared, “Antidepressants: major study finds they work.” Other sources essentially promoted increased prescribing in response to the study results; a piece in The Telegraph suggested that “a million more Britons” should receive antidepressants.

Such broad-brush headlines and content do not accurately reflect the study’s scope and results, Adlington contends. For example, the research did not focus on “prescribing practice,” nor did the published findings refer to numbers of “untreated people.” Rather, this “million” figure originated in a Guardian interview with one of the study’s co-authors, John Geddes, in which he stated that “at least one million more people per year [in the UK] should have access to effective treatment for depression, either drugs or psychotherapy.” Geddes’s recognition of antidepressants as one of the multiple possible treatment options was thus lost in The Telegraph piece; Geddes’s numbers have also been disputed.

Furthermore, many news stories about the study failed to address the study’s limitations fully. One such limitation is the discrepancy between the median length of the studies included in the meta-analysis (8 weeks), and the much longer average course of antidepressant use in practice. Additionally, Adlington points out that many of the news reports did not discuss “the small effect sizes, side effects, the predominance of pharma-sponsored trials, or other treatment options such as psychotherapy or cognitive behavioral therapy.”

Adlington goes on to note that the study results also received broad “professional endorsement.” Responses from those in the field included Carmine Pariante’s statement on behalf of the Royal College of Psychiatrists that “This meta-analysis finally puts to bed the controversy on antidepressants.” On this matter, Adlington writes,

“The study finding morphed into a media message that all antidepressants are effective in all depression. Nonetheless, the psychiatric and research communities seemed cautiously to confirm that the positive media coverage was justified.”

In closing, Adlington acknowledges the ongoing, divisive “ideological debate” about antidepressant use, a debate that predates The Lancet study and its news coverage. In light of the Twitter hashtags that sprung up in response to reporting on the study — #medsworkedforme and #medsdidntworkfor me – Adlington suggests that, “the study may well move the debate forward for patients.” She closes with a quote from Cipriani and Geddes, who told the BMJ, “Perhaps the most striking media outcome for all of us was the Twitter conversation. This seemed to reflect the true lived experience of people with depression and we find the tweets both humbling and moving.”

 

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Adlington, K. (2018). Pop a million happy pills? Antidepressants, nuance, and the media. BMJ: British Medical Journal (Online), 360. (Link)

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17 COMMENTS

  1. RE : https://drpeterbregginshow.podbean.com/e/the-dr-peter-breggin-hour-%E2%80%93-060818/

    I want to make something very clear to Peter Kinderman. We are not interested in MH professionals helping people off ‘medication’. We are interested in them being held accountable in a court of law for causing horrendous harm, death and in some cases murder (heart failure/Akathisia) to countless thousounds in the most dispicable deliberate way: they know what they are doing and have done. It is a crime committed by MH professionals and under cover of state sanctioned abuse. You could not think of a better way to torture someone without leaving a mark by ripping them off psych drugs knowing they will suffer horrendous withdrawal akathisia. Your colleagues know this and they – including the GMC and all the other agencies who protect their own kind and regulate themselves – damn well need to be held to account and face prosecution. We are the experts in helping people off neurotoxic drugs NOT MH professionals who know fully well they would never ever take a drug like Olanzapine yet inflict with force on others .

    • Yes, all the psychiatrists were taught in med school that both the antidepressants and the antipsychotics can create “psychosis,” too, via anticholinergic toxidrome. But they deny this adamantly to their clients, since antidepressant and/or antipsychotic induced anticholinergic toxidrome is not a billable DSM disorder.

      https://en.wikipedia.org/wiki/Toxidrome

      Today’s psychiatrists really do all deserve to be jailed, especially given that the actual primary function of today’s “mental health professions,” according to their own medical literature, is profiteering off of covering up child abuse, which is illegal.

      https://www.madinamerica.com/2016/04/heal-for-life/

      But the DSM based “mental health” system was actually, by design, set up to be a child abuse covering up system. Since NO “mental health professional” may EVER bill ANY insurance company for EVER helping ANY child abuse victim EVER, without first misdiagnosing them with one of the invalid but billable DSM disorders.

      https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

      And when a society has a multibillion dollar, primarily child abuse covering up, “mental health” system, that society will ultimately be ruled by pedophiles and child traffickers. Thank you, child rape covering up, child abuse victim silencing, defaming, torturing, and murdering, pedophile empowering “mental health professionals.”

      https://thegoldwater.com/news/5068-President-Trump-Signs-3-HISTORIC-Human-Trafficking-Bills
      http://anonymous-news.com/putin-west-controlled-satanic-pedophiles/

      You are the enemies within, as the psychiatrists have always been historically, in country after country after country. It’s a shame you were not intelligent enough to learn from your industry’s historical mistakes, and now you’re committing mass genocide of the American population for profit.

      https://www.youtube.com/watch?v=x0wGf5BaUmc
      https://www.naturalnews.com/049860_psych_drugs_medical_holocaust_Big_Pharma.html

      Maybe the “mental health professionals” should some day stop believing in their scientifically invalid DSM “bible,” and start being a part of the societal solutions, rather than being a huge part of our society’s problems. Did none of you in the “mental health industry” have the foresight to realize that creating a multibillion dollar, primarily child abuse covering up industry, would also function to aid, abet, and empower the child molesters? Talk about “lacking insight.”

      • I so agree. I am a victim. I think anyone who prescribes psych meds is committing a crime against humanity. This includes the “caretakers” giving these toxins to the children of refugees. I have such a hard time understanding how anyone can condone the use of chemicals for behaviour control. These drugs do not heal. They cause harm. That harm is how they work. Jail would be too nice. I am 100% dependent on colonics and have been for a year. The medical establishment won’t even diagnose me accurately since they refuse to acknowledge the true cause. They have labelled me with IBS constipation. When I die the death notice will not say that the drug killed me. That would be too much paperwork. Too much conflict. Too much covering for one another. Yes I am angry.

  2. “Kate Adlington, suggests that much of the media coverage of The Lancet’s antidepressant network meta-analysis was insufficiently nuanced…”

    This makes me so angry! There can be no doubt that all media coverage was very carefully orchestrated by the Royal College of Psychiatrists via the Science Media Centre. Professor Sir Simon Wessely is conveniently on the Board of Trustees of this shady “charity”.

    In fact, the journalists in the mainstream media did a pretty good job of accurately reporting what was fed to them by the lead authors of the study and other high-profile, media savvy psychiatrists. They were out in force and all dutifully on message with the line “antidepressants work, and more people would benefit from treatment for depression…”

    Here it is again…

    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:

    6. 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 via the Press Association 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.”

    7. The Raconteur:

    John 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.

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

    “Such broad-brush headlines and content do not accurately reflect the study’s scope and results, Adlington contends…”

    But this was NOT media spin – it was deliberately put out there by Psychiatry’s PR machine.

    • It’s very normal to believe what the Official Medical system tells us, especially if we are told, that what they tell us can be backed up with hard facts.

      On the other hand I notice that the Official media don’t publish much by way of proven recovery by means other than medical intervention – especially within the “schizophrenia / bi polar” area.

      • I hope I’m not wandering off too much here:-

        According to the British Psychological Society:
        “..An overview of the current state of knowledge in the field, concluding that psychosis can be understood and treated in the same way as other psychological problems such as anxiety or shyness…”

        I presume this would also Include “Depression” at all Psychological Levels.

      • So called schizophrenia has been treated by empathic talk therapists successfully for a very long time. One need only look to Bert Karom for compelling accounts of people he has worked with.

        Bipolar is a tougher nut to crack because nearly all of the so-called bipolar people were unhinged by antidepressants or prescribed stimulants. The aversive states that are induced by chemicals don’t respond to talk/listen therapy the way a trauma-induced state of chronic terror can in a so-called schizophrenic. If the molecules are still in the body or the injury they caused hasn’t healed, you can no sooner banish it with psychology than you could banish arsenic poisoning.

        It’s a horrible bind for the person diagnosed as bipolar after taking antidepressanrs. If they say

        “I’m not bipolar. I’m 30 or 35 or 50 years old and I have never felt or behaved like this before. It’s the antidepressant. It even says so in the patient information insert,”

        they are told

        “You are mistaken. The antidepressant has uncovered an underlying condition; that is all, and now that you know you are bipolar, you must do the right thing and take drugs for the rest of your life.

        They might be so sophisticated as to point out that in DSM-IV,

        “there was such a thing as mania precipitated by antidepressant drugs, which was not to be confused with bipolar disorders.”

        “Shush, child. It’s different in DSM-5, because Chun and Dunner did an analysis of drug trials and found that switching to mania from depression while on an antidepressant occurred at about the same rate in people in drug trials taking antidepressants as it did in depressed people who were not in clinical trials and not on antidepressants.”

        “That’s very interesting, but the fact that the percentages are the same doesn’t mean that both groups’ “switchers” switched into mania for the same reasons.”

        “You mustn’t try to outthink the researchers. Did you study statistics?

        Plus,” asserts the patient, “there is a difference. In antidepressant trials, patients are carefully screened to omit any that might be bipolar. These are people who did not have any signs whatsoever of any underlying condition.”

        “Dear, dear patient, screening is imperfect.”

        It is very hard for them to recover because to recover requires a long period off all drugs. Few psychiatrists know that, I’d wager. They’ll start in with drugs called mood stabilizers that are anything but. Topamax makes you cry all day and reduces your IQ and memory so badly that you mess up half the things you try, which gives you some serious and lingering problems and more to cry about. Onto the beloved second-generation antipsychotics. Seroquel makes you drool and might even keep you from standing up at first. Long term you’re looking at diabetes and cataracts. Abilify=disabilify. For a nearly unbearable state of being, akathisia is amazingly common among Abilify-takers. As an add-on to an antidepressant. Abilify-taking caused akathisia in 25% of clinical trial subjects, but the FDA still approved it. In so-called bipolar patients’ trials, where it was meant as an anti-manic, “agitation” was reported but interestingly, akathisia was not, at least in the summary I read. Presumably people were told that their mania had worsened and given more drugs. In the Abilify-plus-antidepressant trials, some of the afflicted were still enduring akathisia when the trial they were in was over.

        No matter what drug an antidepressant-induced mania victim is given, it will create adverse mood and cognition effects, because they don’t need drugs mood-altering drugs. They need not-drugs. They aren’t psychotic and they aren’t manic. Also because that’s what psychiatric drugs do.

        If they decide that all these drugs are destroying them and stop taking them, they might be hit with withdrawal phenomena that might send them crawling back to the doctor for relief. Big mistake. The original prescriber will never cop to the drugs’ persistent long-term harm, which is what withdrawal is: suffering caused by a drug you are no longer taking. That’s when it’s time to find a real doctor who recognizes the suffering caused by psychiatric drugs. Do these exist? There are a few. Not that there is much that they can do, but if they can explain what’s happening and offer symptomatic relief it might keep despair at bay.

        • Thanks for this Better life. You certainly know your stuff.

          Extreme Anxiety was my problem when I quit the neuroleptics, and it nearly had me back on them again. But thankfully, I found useful ways to accommodate it.
          This is why I say that there’s no such thing as “Schizophrenia”, and any good therapist should be able to help a person along their way. My parting diagnosis was “Schizo affective Disorder”. The “affective” I believe was to explain my iatrogenic suicide attempts.

          I consumed all the neuroleptics antidepressants and mood stabilisers and remained chronically “sick” – but I recovered through Psychothereuptic means (and stopping “medication”).

    • Auntie Psychiatry – excellent work to the BS main media normalising drug machine.

      Brian correlates those on AD’s or MfD to deaths:

      http://antidepaware.co.uk/inquest-reports/inquests-2018/

      What causes these deaths? For people who do not know, it is drug toxicity inducing a condition called Akathisia which is an utterly horrific psychotic condition so appalling people are in a whole heap of hurry to end their lives AND NOT ‘MENTAL ILLNESS’ . It happens because we all have DIFFERENT phenotypes (strengths) of metabolising enzymes. Therefore there is NO such thing as a one size fits all dose. To boot THERE IS a gene test which can predict the phenotype of the metabolising enzymes but no one gets it even though it has been around for something like two decades. See here and note the date:

      http://news.bbc.co.uk/1/hi/health/704577.stm

      This what makes SSRI’s so dangerous. Add to this – we ingest food stuffs herbs and spices which also inhibit and block the enzymes plus more and more people are on polypharmacy making the likelihood of Akathisia far far more likely.

      Please excuse any more word errors – drug abuse by psychiatrists did it to me.

  3. Auntie Psychiatry you are exactly right. The media coverage reflected what the psychiatrists told them, and was included in the press release. The general media isn’t going to try to interpret the study; they let the “experts” do that for them. The blaming of the media for the hyping of the study by psychiatrists and the researchers themselves — see Cipriani’s quote in your comment–is ridiculous. And BMJ should be commenting about that, not about how the media failed. The mainstream media did just what you would expect, quote the press release and experts in depression.

    • There is no doubt that there was an orchestrated misinformation campaign when the paper was “launched”. The journalists understandably trusted the words from authors and the experts. The paper itself started the myth with “more efficacious than placebo” because it sought to portray a small statistical difference as clinically significant. Furthermore, although the evidence for this was the largely unreported measure of the small effect size, the data they used to support this was their primary outcome of relative response ratios in a small subset of improved patients. But ask most people what the study actually measured, and they wouldn’t really know, they just trust the words in the conclusion.

      The SMC systematically ramped up the exaggeration with carefully crafted soundbites – but virtually none of SMC press release statements are valid, each one has a calculated and systematic failure of truth. For example, look for the words “most people”, “much more effective”, “compelling”, “work” and then consider that the UKs 2 most prescribed antidepressants, citalopram and fluoxetine had effect sizes of 0.24 and 0.23, way less than NICE consider clinically significant. And not one of those experts has sought to defend, elaborate or justify what is still published on the SMC website.

      I’m afraid what’s happening now is an orchestrated defence of the indefensible. Cipriani thinks people focus too much on clinical efficacy as if bemused as to the purpose of all the research money that goes into these things. Pariante is back pedalling and is so confused he thinks he said “final answer” when it was Cipriani, so clearly in the bunker the scripts are getting muddled up. And the BMJ is blaming the press for not being nuanced, when the airwaves were thick with over-emphatic BS from those who are paid to be honest.

      • @ConcernedCarer

        Absolutely true.

        Pariante is back pedalling and is so confused he thinks he said “final answer” when it was Cipriani, so clearly in the bunker the scripts are getting muddled up

        Yes, Professor Pariante got his knickers in a twist about being reported as saying this when, in fact, his own words were accurately reported from the SMC briefing. So he even managed to spread misinformation about himself! I can see why he’s such an asset to the Royal College of Psychiatrists.

    • Sorry Robert but surely the mainstream media can afford to be more questioning and avoid merely rewriting a press release they know to be the product of a marketing agency. The mainstream media often hype themselves to be ‘the first draft of history’, to be, like you, avid stubborn fearless investigators or holding a mirror up to society and sometimes they are. Surely with so much at stake here and not withstanding the current revenue crisis in media they can afford to do better or are we always to be badly served by media quiescent in the face of authority, manufacturing consent?

        • @Steve and @Whatuser
          There was more to it than simple press releases. This story made such a big splash because they used the Science Media Centre (SMC) to disseminate their message to journalists. What is the SMC? It is a UK registered charity, trusted by journalists as an independent source for science-based stories. Or, in the words of the SMC itself:

          “an independent press office helping to ensure that the public have access to the best scientific evidence and expertise through the news media when science hits the headlines”

          Last year I made a concerted attempt to challenge the SMC for distributing misleading information about antidepressants to journalists. I got nowhere, but the experience did provide inspiration for this cartoon:
          http://www.auntiepsychiatry.com/red.aspx?ha=smc