Follow up post to selective publishing

Also, check out a recent post by Kevin Drum over at The Washington Monthly who raises a very good point:

I have no particular opinion about the quality of this study, and not really any special interest in SSRIs either. In fact, what really drew my attention was the range of news outlets that reported this news. According to Google News, here they are: the Guardian, the Independent, the London Times, the Telegraph, the BBC, Sky News, the Evening Standard, the Herald, the Financial Times, and the Daily Mail. In fact, it's getting big play from most of these folks, including screaming front page treatment from some.

So what's the deal? Why is this huge news in Britain, where most of the stories are making great hay out of the amount of taxpayer money the NHS is squandering on these drugs, and completely ignored here in the U.S.? The conspiracy theory version of the answer is obvious, but what's the real version? Do American newspaper editors universally know something that I (and their British colleagues) don't?

Furious Seasons covers it as well and links to a variety of other blogs (toward the end of the post) that cover the topic.

Selective publication on antidepressant efficacy and data

After the release of the U of Hull study on Tuesday, the AFP has written an article about doctors who are urging patients on antidepressants to continue taking them.

Louis Appleby, national clinical director for Mental Health, told the Press Association: "… the message to patients and doctors remains the same — anti-depressants are an appropriate treatment for moderate or severe depression."

I agree that patients on antid's should not cease medication cold turkey. (Trust me on this one. Even with proper tapering, the side effects are not pretty.) I waver on the idea that antid's are "appropriate treatment" for moderate-to-severe depression rather than a "form of treatment." Antidepressants can help, but I'm not sure I like the term "appropriate." But I likely am arguing semantics.

Since the results of the study originate from Britain (despite the fact that it also includes data from the FDA), I can only assume that news reports on this are more widespread over there. In my Philadelphia, USA-world, it seems a little bit off the radar to me. Let me know if I'm wrong.

To Mr. Appleby's credit, he has acknowledged that the British government plans to rigorously pursue routes of alternative treatment in light of the study.

The government has plans to expand the availability of psychological therapies as an alternative to drugs, Appleby explained, with extra investment and more psychological therapists.

"The evidence shows that these therapies are effective and often preferred by patients."

WebMD also covered the recent study.  Dr. Nada Stotland of the American Psychiatric Association insists that the study is not reflective of real psychiatry.

"We know that many people who are depressed do not respond to the first antidepressant they try," she says. "It can take up to an average of three different antidepressants until we find the one that works for a particular individual. Therefore, testing any single antidepressant on a group of depressed individuals will show that many of them do not improve."

Stotland has a point. Patients usually do not respond to the first antidepressant that is prescribed to them. About 30 percent of patients do not respond to antidepressants or experience no improvement until several weeks later.  Even then, patients who are on antidepressants for long-term maintenance, experience the return of depressive symptoms. An article from The New England Journal of Medicine evaluated the selective publishing of antidepressant trials with a positive efficacy:

Among 74 FDA-registered studies, 31%, accounting for 3449 study participants, were not published. Whether and how the studies were published were associated with the study outcome. A total of 37 studies viewed by the FDA as having positive results were published; 1 study viewed as positive was not published. Studies viewed by the FDA as having negative or questionable results were, with 3 exceptions, either not published (22 studies) or published in a way that, in our opinion, conveyed a positive outcome (11 studies). According to the published literature, it appeared that 94% of the trials conducted were positive. By contrast, the FDA analysis showed that 51% were positive.

The authors' conclusion: "Selective reporting of clinical trial results may have adverse consequences for researchers, study participants, health care professionals, and patients." It's an obvious statement; so obvious, it can be easily overlooked.

While it's important to shed light on the issue of treating depression with antidepressants, it seems as though many authors are cherry-picking favorable results to publish. Considering that much of these research studies are backed by drug companies, it's no surprise. Also, I can't fault the authors only. I recently freelanced for a medical publication and learned that many of the submitted articles are heavily rewritten by the editors. Editors are hard-pressed (and probably loath) to publish a piece that criticizes antidepressants when their biggest advertisers include such big names as Wyeth, Eli Lilly, and GlaxoSmithKline. Run enough of those pieces and a publication is quickly on its way to folding.

That's why it's stunning to read the U of Hull study that has somewhat of a negative slant toward antidepressants' effectiveness. While doctors are wisely advising patients to continue any antidepressants they may be on, currently drug makers have launched into damage-control mode.

In a statement, GlaxoSmithKline (GSK) representatives express "disappointment" at how the study was being reported by the media, suggesting that news reports may have caused "unnecessary alarm and concern for patients."

Of course these news reports are "unnecessary" to GSK. Letting patients know that their antidepressants might not work better than sugar pills isn't good for business. However, GSK's reps were kind enough to balance out their statement, adding "counseling and lifestyle changes" also are important aspects of treating depression. Then, the company accuses the researchers of selectively reporting their data:

"GSK fully endorses public disclosure of clinical trial results for its medicines and is actively committed to communicating data relevant to patient care," the statement reads. "All the data related to GSK's clinical trial results of [Paxil], regardless of study outcome, are available at the company's clinical trials register at 20 www.gsk.com."

Tell that to the estimated 5,000 Americans who have filed a lawsuit against GSK regarding Paxil. Still, Kirsch, who has received consulting fees from Squibb and Pfizer, insists "the [drug companies] certainly do publish selectively."

I'm inclined to agree.

Bloggers & Blogging

I’m blogging mobile via e-mail right now. Friday, February 29th will be my last day at work. As a result, my workload is dwindling and my opportunity for blogging has significantly increased with all the free time that I currently have (and will have) on my hands.

In the meantime, I am slowly making my rounds to read the few blogs I can access at work. For example, Liz Spikol falls under the Philadelphia Weekly so she’s able to get around the filters. I also have been able to access Furious Seasons (FS).

Speaking of FS, it’s been a long time since I’ve read the site (or any other blogs, for that matter) so upon my return, I stumble upon a heated argument in the comments section of Dawdy’s post on a NYC psychologist who was killed and a psychiatrist who was stabbed. The subsequent post addresses these comments and then more angry comments ensue as a result. Granted, the post occurred some time ago (Feb. 15), but it was a little jarring to come across those comments as I start to read blogs again. Considering the sensitivity of the topic, I was disturbed a little more than usual. Feel free to click on the links and see what all the hullabaloo was about.

My husband and I have decided that I will be leaving my job as a result of the dustup among me and my coworkers. I hope to take this time and try my hand at freelance writing, editing, and/or proofreading. I don’t know whether I’ll be any good or not but I can only hope that the reason for my student loan will be worthwhile. I’ve promised myself at least one week of a vacation (next week), but I like to stay busy and I’m not quite sure if it will be restful. I’ll likely be doing more reading, thinking, and blogging. I’ve decided that many of the articles I’d write would cover mental health topics (in all of its forms). It’s about as medical as I can get in the medically editorial-heavy Philadelphia area.

I’ll finally bite the bullet on Monday (March 3) and sit down and clean out my inboxes -my personal inbox and the one linked to this account (they’re separate). If you commented on this site back in August 2007, don’t be surprised to finally receive a reply. I also recently acquired an iTouch for my birthday so I am also able to access and read e-mails from any place that provides me with free wireless access. I’ll probably avoid lengthy replies on my Touch, however. There are many bloggers that I have been thinking about during the past several months – you know who you are! – and I hope to be in touch with many of you soon.

I’m looking forward to finally doing something that I’ve wanted to do for a very long time. It’s scary to jump into the unknown but it’s also somewhat exciting too. I may pull a Philip Dawdy and stick a PayPal button on this site. I don’t expect to raise ANYTHING close to what he gets but it’ll be better than the pennies I find here and there on the ground. I may consider some ads on the site even though Google didn’t work out so well.

But enough talk for now. I hope to provide some action soon.

Do antidepressants provide psychosomatic improvement?

Despite all the hype surrounding antidepressants and their effectiveness, the AP has reported on a new study from the University of Hull in Britain that says antidepressants only help severely depressed people and “work no better than placebos in many patients.”

The drugs used in the study: Prozac (fluoxetine), Effexor (venlafaxine), Paxil/Seroxat (paroxetine), and Serzone (nefazodone).

Irving Kirsch, who headed the study, said: “Although patients get better when they take antidepressants, they also get better when they take a placebo, and the difference in improvement is not very great. This means that depressed people can improve without chemical treatments.” (AP)

This is a pretty controversial finding considering the widespread use of antidepressants among those who have been diagnosed with clinical depression and other forms of mental illness, i.e. anxiety.

According the NIH, depression (the clinical term is major depressive disorder) affects an estimated 14.8 million American adults. CNN cites a study from the U.S. Centers for Disease Control and Prevention that says 2.4 billion drugs were prescribed in 2005; of those, 118 million were antidepressants. I can only imagine as “awareness” of depression increases, the number of prescribed antid’s has increased as well.

Adult use of antidepressants almost tripled between the periods 1988-1994 and 1999-2000.

Between 1995 and 2002, the most recent year for which statistics are available, the use of these drugs rose 48 percent, the CDC reported.

Many psychiatrists see this statistic as good news — a sign that finally Americans feel comfortable asking for help with psychiatric problems. (CNN)

CNN quoted Dr. Kelly Posner, an assistant professor at Columbia University College of Physicians and Surgeons in New York City, who said that “25 percent of adults will have a major depressive episode sometime in their life, as will 8 percent of adolescents.” If 25 percent of adults have a “major depressive episode,” does that mean that those 25 percent will require antidepressants as well? I’m concerned about the relatively high number for adolescents. I’m not a fan of throwing pills at growing children.

In light of the U of Hull study, the first course of treatment regarding depression should be non-medicated therapy of some kind. Whether it be “talk” therapy or cognitive behavior therapy, tackling depression really should first be treated with psychologic therapy. Posner says “25 percent of adults will have a major depressive episode.” Major depressive episode does not equal clinical depression or major depressive disorder, for that matter. A major depressive episode could mean anything: bereavement, loss of employment, or a difficult situation without an immediate resolution. I am strongly against prescribing antidepressants to help people cope with “normal” life events. People feel as though that their grief is too much to bear so they go to the doctor in the hopes that an antidepressant will help “dull” their emotions. I can only hope that a doctor will be able to differentiate between true clinical depression and a difficult situation that could be helped without the use of psychiatric medication.

P.S. I looked up Dr. Posner’s conflicts of interest and they were “TBD.” I would feel better had it listed “no conflicts of interest to disclose.”

College shooting: Part 45,656

I don’t like this idea of college shootings becoming commonplace. I think there have been three or four major college shootings since the Virginia Tech incident.

Steve Kazmierczak, an alumnus of Northern Illinois University, went ballistic shooting up a geology class and killed five students before killing himself. The AP article sums up Kazmierczak’s demeanor:

Unlike Virginia Tech gunman Cho Seung-Hui — a sullen misfit who could barely look anyone in the eye, much less carry on a conversation — Kazmierczak appeared to fit in just fine.

The AP article cites that he "stopped taking [his] medication." It appears that he had no record of mental illness at all. He applied for and legally obtained a gun after a background check.

The issue of mental illness in these school shootings is constantly brought up. While I don’t dismiss the unstable mental health of Cho or Kazmierczak, I can’t help but wonder what this means for the rest of us who struggle with mental illness. If I tell someone that I have bipolar disorder, does that mean I’m likely to commit homicide and suicide despite the fact that I have a bubbly, outgoing, and talkative personality?

The link between mental illness and these school shootings will only continue to fuel the stigma relating to mental illness. Despite the fact that the majority of people who suffer from mental health problems are nonviolent, the minority who are violent will get the press coverage and become poster evidence for people like the TAC.

I can do this

I’ve been very reluctant to post for some time. To the point where the thought of posting gave me an anxiety attack. I also haven’t checked any of my e-mail accounts except the one I’m required to view: my work account. I think this blog has served a major purpose in allowing new readers to browse through previous posts that have been informative and, perhaps, helpful. Much of my blogging was done at work and for some time now, my job has blocked access to every single blog – including my own.

In the last week of January, I encountered an incident in which I found out three of my coworkers didn’t like me. I’d always had my suspicions but suspicions are different than knowing for a fact. For some unknown reason, one of my coworkers – we’ll call her Lisa – accidentally sent an e-mail to me that was intended for someone else. I read the e-mail from top to bottom and by process of elimination realized that the person being "dissed" in the e-mail was me. Lisa figured out that she accidentally sent the e-mail to me and came over to apologize about how "unprofessional" she had been and it was "rude" of her. She had been dealing with an "ear infection" lately which had made her cranky and blah blah blah. I began to tune a lot of her excuses out. Out of everyone on my team, I thought I had gotten along rather well with Lisa and now I was stunned, feeling completely backstabbed. Afterward, I received two apologetic e-mails: one from the coworker who SHOULD have gotten the e-mail (Ivy) and another coworker who had been included in the e-mail all along (Kristine). Friends and family encouraged me to tell my manager about the situation, however, I was afraid of what I call "tattletale" syndrome: go to the manager, say I received this e-mail in which so-and-so disrespected me, manager reprimands so-and-so, and then I get worse treatment.  I tried to rise above the incident by responding to my coworkers by saying that I’d like to work with them amicably on a professional level even if they didn’t like me on a personal level. They seemed to respect my decision. Lisa, now, feels absolutely horrible about the situation, but I am forced to work with her daily on the majority of my projects. Ivy will come to me when she has questions about work-related tasks, which is fine by me. Kristine does her best to avoid me and in most instances, won’t even make eye contact with me.

In any event, I have now come to the realization that I don’t want to be working there and they don’t want me to be working there so for the sake of my mental health, my husband and I have decided that it’s best that I resign.

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