Ghostwriting

According to the International Herald Tribune (IHT), the Journal of the American Medical Association (JAMA) has published an article about Merck’s practice of writing research studies and then asking doctors to slap their names on them. This practice has called into question Merck’s marketing of Vioxx, a profitable cardiovascular drug that was pulled off the shelves due to its link to heart attacks.

Merck acknowledged Tuesday that it sometimes hired outside medical writers to draft research reports before handing them over to the doctors whose names eventually appear on the publication. But the company disputed the article’s conclusion that the authors do little of the actual research or analysis.

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One paper involved a study of Vioxx as a possible deterrent to Alzheimer’s progression.

The draft of the paper, dated August 2003, identified the lead writer as "External author?" But when it was published in 2005 in the journal Neuropsychopharmacology, the lead author was listed as Dr. Leon Thal, a well-known Alzheimer’s researcher at the University of California, San Diego.

The second author listed on the published Alzheimer’s paper, whose name had not been on the draft, was Ferris, the New York University professor. Ferris, reached by telephone Tuesday, said he had played an active role in the research and he was substantially involved in helping shape the final draft.
"It’s simply false that we didn’t contribute to the final publication," Ferris said.

A third author, also not named on the initial draft, was Dr. Louis Kirby, currently the medical director for the company Provista Life Sciences. In an e-mail message on Tuesday, Kirby said that as a clinical investigator for the study he had enrolled more patients, 109, than any of the other researchers. He also said he made revisions to the final document.

"The fact that the draft was written by a Merck employee for later discussion by all the authors does not in and of itself constitute ghostwriting," Kirby’s e-mail message said.

Uh, yeah it does.

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Pregnancy is NOT a mental illness

I stumbled upon Yankee Cowgirl’s blog that mentioned Congress is working on the MOTHERS (Mom’s Opportunity to Access Health, Education, Research, and Support for Postpartum Depression) Act which would “strongly encourage pregnant women into mental health programs – that means drugs – to combat even mild depression during or after giving birth.”

She links to a column written by Byron J. Richards on newswithviews.com. He writes:

The Mothers Act is pending legislation that will indoctrinate hundreds of thousands of mothers into taking dangerous psych drugs.

He goes on to slam Big Pharma about how they control Congress and how mothers don’t need psych drugs for a natural birth process.

The Mothers Act (S. 1375: Mom’s Opportunity to Access Health, Education, Research, and Support for Postpartum Depression Act) has the net affect of reclassifying the natural process of pregnancy and birth as a mental disorder that requires the use of unproven and extremely dangerous psychotropic medications (which can also easily harm the child).

These are some serious accusations. I got pretty riled up myself and decided to see what Congress said in the bill.

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Blood test for efficacy of antidepressants in the future?

Scientists have found that a biomarker for depression could show whether a person's antidepressant is working. The discovery could lead to something everyone in the psych world has been waiting for: a blood test of some kind.

The researchers looked at the interaction of neurotransmitters and a protein called Gs alpha. In brain cells, the protein acts like a kind of butler, passing messages from neurotransmitters on the outside and amplifying their messages, [study co-author Mark] Rasenick explained.

When the protein is working properly, it's like a butler whose "hands are just flying, cooking and cleaning at the same time," he said. But when the brain is depressed, "it just sits there in the corner."

That's an interesting observation. This might finally explain the difference between "depressed" brain activity and normal brain activity on an MRI. (By the way, has anyone had an MRI performed for depression?)

Researchers compared the proteins in the brains of people who committed suicide as a result of depression to those who did not. "They found the protein would have worked less effectively in the brain cells of the suicide victims."

Dr. Gregory Simon conceded that doctors cannot determine which antidepressant will work for which person.

"There's a long history of research using patterns of symptoms or biological measures — chemicals measured in blood or spinal fluid — to predict response to a particular antidepressant. None of those hoped-for predictors have significant value.

[Genetic tests] would not eliminate trial-and-error, but it would reduce the waiting time with each trial. But it's a long way from a study like this one to a test that's useful to patients and doctors."

Good news for the skeptics about this research study: It was funded by the U.S. Public Health Service and the American Foundation for Suicide Prevention. But a test simply to see if an antidepressant is working has the smell of pharma somewhere on it.

(Hat tip: Ephphatha)

Take two pills and call me if there's a birth defect

A recent article in the NYT reported that two studies released in The New England Journal of Medicine claim that an antidepressant could potentially increase the risk of a baby being born with a birth defect, but, uh,  it's unlikely and "confined to a few rare defects."

Benedict Carey, author of the article, points out that the studies didn't have a good sampling to really prove that assertion:

"In both studies, researchers interviewed mothers of more than 9,500 infants with birth defects, including cleft palate and heart valve problems. They found that mothers who remember being on antidepressants like Zoloft, Paxil, or Prozac while pregnant were at no higher risk for most defects than a control group of women who said they had not taken antidepressants."

So what's it's sounding like for me is that researchers got a group of expecting moms together, basically said, "Hey, have you taken an antidepressant?" and the ones who said yes were placed in one control group and the ones who said no were placed in another. How reliable.

Having been part of a clinical trial for bipolar disorder, I know it's likely these women got paid for their participation in this study. (Most people do, from what I understand.) So some could essentially have lied in the hopes they could snag $100. It doesn't sound like these women agreed to have their past medical history released to researchers that could prove they've been on antidepressant medication, they could have just been like:

"Uh, yeah. I took the antidepressant with the happy little egg sad face thingy."

Doctor: "Zoloft?"

"Yeah, yeah! That one. It maketed me alllll better."

Remember – it's mothers who "remembered" being on antidepressants while pregnant, not medical histories that proved that they've at least been prescribed the medication.

One doctor, not involved in the research, had reservations about the so-called findings:

"These are important papers, but they don't close the questions of whether there are major effects" of these drugs on developing babies, said Dr. Timothy Oberlander, a developmental pediatrician at the University of British Columbia, who was not involved in the studies.

Despite the seemingly positive outcomes that "support doctors' assurances that antidepressants are not a major cause of serious physical problems in newborns," both studies uncovered some pretty serious – but considered rare – conditions.

"One of the studies, led by Carol Louik of Boston University and financed in part by the drug makers GlaxoSmithKline and Sanofi-Aventis, found that use of Paxil was associated with an increased risk of a rare heart defect, which the company had previously reported.

The other study, led by Sura Alwan of the University of British Columbia, found that use of antidepressants increased the risk of craniosynostosis, a condition in which the bones in the skull fuse prematurely. Rare gastric and neural tube defects may also be more common in babies exposed to the medication, the studies suggested."

But don't worry, pregnant moms – the risks are low, "appear remote, and confined to a few rare defects." So, hey, even if your baby DID develop a rare defect, at least it's rare! [sarcasm]

I'd take the chance of depression if it meant my baby had a better chance of being born healthy. I'm lucky – I couldn't take Lamictal if I got pregnant. I wish antidepressants would have the same instruction.

Hypomanic Watch

Brainstorm Your Way Out of a Bad Mood

Feeling down? Think fast – literally. A recent study from Princeton and Harvard found that when people were made to brainstorm rapidly, they felt happier, more energized, and more creative. "It’s like taking your mind for a run," saus Emily Pronin, Ph.D., an assistant professor of psychology at Princeton. Test it yourself: Quickly come up with 20 ways to improve your health, or speed-read the newspaper and watch your mood soar. – Shape, February 2007

Sounds like a plan for hypomanics.

Loose Screws Mental Health News

A new Canadian study has found that most workers who struggled with depression had job performances were affected. (Nothing new here, right?)

“On average, the study says, depressed workers reported 32 days in the past year during which symptoms had resulted in ‘their being totally unable to work or carry out normal activities.’”

Seems like people really are taking ‘mental health’ days these days.


Bahrain is having a problem with Indians committing suicide in the country. In January, so far, three Indians have killed themselves. Triggers leading up to the suicides are theorized to be “mental or economic depression, stressful working conditions, low wages and poor housing.”


According to Dr. Brian Doyle, people with ADHD are at a higher risk for mood disorders such as major depressive disorder.

“In a recent study, 38.3% of individuals with a primary diagnosis of ADHD during the previous 12 months also had a mood disorder, compared with 5% of subjects who didn’t have ADHD.   The reverse is also true; individuals who have major depression are likelier to have ADHD than other persons.   In a Massachusetts General Hospital survey, 16% of adults with a primary diagnosis of major depressive disorder had a lifetime history of ADHD.”

Maybe I’m tired right now, but I couldn’t wrap my head around those statistics. Basically, if you’ve got a primary diagnosis of ADHD, you’re likely to have a mood disorder; if you’ve got MDD, you’re likely to also have ADHD; and if you’ve got a primary diagnosis of MDD, you probably have had ADHD for pretty much your whole life. That’s a lot to swallow.

“I am trying to screen more of my depressed patients for ADHD — especially if the patient’s depression is not responding well to treatment. The standard ADHD rating scales are a good place to start.”

I’ve heard it’s hard to screen adults for ADHD; on the flip side, I’ve also been told that it’s more difficult to find ADHD in women than in men. Dr. Doyle’s definitely on the right track here in keeping his eyes open for better ADHD screening. Perhaps I really do have ADHD.


While many celebrities are “outing” themselves on their depressive episodes, Dr. Deborah Serani’s got a list of other well-known people who have either admitted to or speculated to have experienced depression.


I’m late on the bandwagon with this but a study released in December shows that displaced women in Darfur suffer from severe depression. According to an article in Ms. Magazine:

“The International Medical Corps (IMC) posits that women’s multiple roles in society, along with constant stressors like low socioeconomic status, domestic violence, and the threat of rape when venturing outside, may account for the poor mental health of these displaced women. Women’s restricted access to education may also affect their ability to access proper care and make informed decisions about their own physical and mental health.”

And to think those of us in developed countries have problems.

“Almost one-third (31 percent) of women surveyed met the criteria for major depressive disorder while 63 percent reported suffering the emotional symptoms of depression. Five percent reported suicidal thoughts, 2 percent had attempted suicide, and another 2 percent of households had a member commit suicide in the past year. Nearly all of the respondents (98 percent) felt that counseling provided by humanitarian agencies would be the most helpful way of dealing with these feelings.”

It’s good to see that an overwhelming majority of women feel that counseling would help them. Sometimes, people in Western/developed countries take therapy for granted.

“Though depression rates are comparable to, or even lower than, those of other populations displaced by similar conflicts, the rates of suicide and suicidal ideation are ‘alarmingly high in contrast to general rates worldwide,’ according to the report.”

This, unfortunately, makes sense. Suicide is a reaction to ending constant pain. I admire women in Darfur who choose to live despite never-ending pain.  This article puts me to shame somewhat. I am incredibly blessed to have all the amenities of this country and encouragement and love from family and friends. However, I feel pretty stupid when I fall apart over minor things compared to the women in Darfur. It’s an awful cliché, but “I really do have a lot going for me; why am I depressed?”


ViagraFor men: Are you depressed and can’t get an erection? Don’t worry – Viagra can kill two birds with one stone!

A Canadian study (yes, another one) says that Viagra (sildenafil) can help improve mild depression and, of course, aid impotence in men.

“Dr. Sidney Kennedy and his team studied 184 men who had had erection problems for about four years and also met the criteria for minor, but not major, depression.

[After six weeks of treatment], the 98 men who received sildenafil had a 47 per cent reduction in their depression scores, indicating a change from mild to minimal depression. In comparison, men taking placebos had only a 26 per cent decrease in their scores, which remained in the range of mild depression.”

Pfizer’s getting their sales reps started on this one. Expect to see reps carrying Viagra brochures and info to psychiatrists eventually.