"Dr. Nobody" Slams JAMA Again; Prophylactic Antidepressant Use Is Real Issue, Says Leo

Last Updated Sep 9, 2009 11:16 AM EDT

Dr. Jonathan Leo has again taken JAMA to task over its failure to disclose links between researchers publishing studies in its pages and Forest Labs, which funded them. Previously, JAMA caused a stink by calling Leo "a nobody and a nothing" (he's a professor of neuroanatomy at Lincoln Memorial University-DeBusk College of Osteopathic Medicine) and then demanding silence from any academic who alerted JAMA to conflicts among its authors.

In a recent commentary published in the journal Society, Leo argues that the real scandal is the notion that certain patients should be prophylactically dosed with antidepressants even though they may not be depressed. The JAMA study (whose authors had an undisclosed financial relationship with Forest) looked at the use of Lexapro in stroke patients; 37 percent of stroke patients become depressed, Leo says. Leo wrote:

The ultimate goal of the research group who authored the study is to prevent depression from developing in stroke patients not treatment of depression but the prevention of depression, an important distinction. While it would certainly increase the market share for Lexapro, the idea of prophylactically medicating a large group of people with no psychiatric diagnosis so that a minority of them will not develop depression later on is an initiative worthy of vigorous debate.
The authors of the Lexapro stroke study were later quoted in USA Today saying all stroke patients should receive antidepressants (even though their 149-patient study was so small that only 50 patients in it actually received Lexapro.)

Leo also points out that the original Lexapro stroke study protocol in 2002 called for examining another Forest drug, Celexa, but was switched to Lexapro in 2003 after the FDA approved Lexapro. NIMH nonetheless funded the protocol, Leo says, which:

... allowed government funds to be spent to investigate the use of the more expensive on-patent medication instead of the cheaper generic medication.
JAMA's "silence while we investigate" policy has since been removed from its web site.