More On Antidepressants

MORE ON ANTIDEPRESSANTS....This is obviously not the biggest deal in the world, but yesterday I noticed that a new study suggesting that certain antipressants weren't very effective had gotten big play in Britain and zero play in the U.S. Today I checked back, and the story had spread not only to more British sites, but also to news outlets in France, Germany, India, New Zealand, Canada, Thailand, and elsewhere. Mysteriously, though, the U.S. was still almost completely AWOL. There were short pieces on MSNBC and Fox, and longer pieces at the Washington Post and Time. That was pretty much it. It's really very strange that this story is being almost completely ignored here.

For what it's worth, the Time piece does a good job of explaining why the study is important:
Under the Freedom of Information Act, the researchers writing in PLoS Medicine were recently able to obtain [...] data, they believe, that lets them avoid a bias that often plagues reviews of previous research: the tendency for conclusive positive results to be published, sometimes more than once, and thus over-represented, while mediocre results can be ignored or even swept under the rug.

Drug companies claim the review is still flawed, however. One massive problem: there are many more recent studies than those surveyed in the article, which looked only at pre-approval trials conducted before 1999.

....The companies are correct in claiming there is far more data available on SSRI drugs now than there was 10 or 20 years ago. But Kirsch maintains that the results he and colleagues reviewed make up "the only data set we have that is not biased." He points out that currently, researchers are not compelled to produce all results to an independent body once the drugs have been approved; but until they are, they must hand over all data. For that reason, while the PLoS Medicine paper data may not be perfect, it may still be among the best we've got.
In other words, there might be a lot more data now, but it's hard to trust it because drug companies systematically suppress negative findings after they get FDA approval and no longer have to follow FDA rules. A few weeks ago the New York Times reported on a study that looked at precisely this question:
The new analysis, reviewing data from 74 trials involving 12 drugs, is the most thorough to date. And it documents a large difference: while 94 percent of the positive studies found their way into print, just 14 percent of those with disappointing or uncertain results did.
Now, for what it's worth, I find the results of the PLoS study a little hard to believe. Like a lot of commenters on last night's post, I've just heard too much anecdotal evidence from friends who have (eventually) been helped by various antidepressants. Maybe they were all kidding themselves, but that's a little hard to swallow.

But that aside, the PLoS study is still an important one. It's not the first one to question the efficacy of antidepressants, but are we already so jaded by this stuff that a confirming study isn't even worth reporting in the U.S.? If only for the insight it gives us into drug company testing practices, it seems like it's at least worth letting people know about.

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