CBC: Antidepressant drugs do work, review on almost 120,000 patients concludes

[[lo...]]

This is one of the Twitter threads.

 

 

And another one

 

 

And press release from today

 

https://nevertrustadoctor.wordpress.com/2018/02/28/media-release-rcpsych-challenged-over-potentially-burying-inconvenient-antidepressant-data/

 

Watch this space!!! 

[[be...]]

Wow!  Just read all of the above and the press release, signed by 10 doctors and professors.  Excellent, just excellent work!  :thumbsup: :thumbsup:

[[La...]]

Yes, excellent work! Impressive letter and list of professionals who support it. It's great to see this kind of challenge to such misleading information.

[[Ma...]]

:thumbsup: :thumbsup: :thumbsup: :thumbsup: :thumbsup: :thumbsup: :thumbsup: :thumbsup: :thumbsup: :thumbsup: :thumbsup: :thumbsup: :thumbsup: :thumbsup: :thumbsup: :thumbsup: :thumbsup: :thumbsup:

[[lo...]]

Thank you.

 

And Dr Peter Gordon, psychiatrist in Scotland has posted correspondence with Prof David Baldwin on his blog ...

 

So evidence for prescribing A/Ds beyond two years is sparse.

 

https://holeousia.com/2018/02/28/a-letter-in-the-times-pills-for-depression/

 

It will be very interesting to see what happens next.

 

:thumbsup: :thumbsup:

[[be...]]

A lot going on in the UK today, besides the weather.  I hope Fiona, you don't mind I post this.  The complaint was lodged.   

 

March 9/18

 

Patients, academics and psychiatrists formally complain that the president of Royal College of Psychiatrists has misled the public over antidepressant safety

 

http://cepuk.org/2018/03/09/patients-academics-psychiatrists-formally-complain-president-royal-college-psychiatrists-misled-public-antidepressant-safety/

 

The formal complaint:  http://cepuk.org/wp-content/uploads/2018/03/Complaint-to-RCPsych.pdf

[[lo...]]

Thanks very much for posting.  it will be interesting to see what happens next.  The whole thing is really very depressing.  I read last night that the NHS in Scotland has approved a trial of an antidepressant for 7-11 year olds.  See David Healy's submission.

 

http://www.parliament.scot/S5_PublicPetitionsCommittee/Submissions%202018/PE1651_SSSSSS.pdf

 

 

 

 

[[La...]]

It's definitely depressing, Fiona, but the fact that so many people have spoken up -- including academics and psychiatrists -- is something that I find amazing. I can assure you that no such action is taking place on this side of the Atlantic, at least as far as I've heard. I am encouraged by the actions of CEPUK members. They act on their convictions. They take a stand, and they stand up for those who cannot. Highly, highly commendable, in my opinion.

[[be...]]

It is highly commendable and amazing.  Even psychiatrists spoke up.  There are 59 comments after this, the previous post on CEPUK, http://cepuk.org/2018/03/01/royal-college-psychiatrists-challenged-burying-inconvenient-antidepressant-data/ , including from Gwen Olsen, the ex-pharmaceutical rep.  I so wish something like this, anything was happening here in Canada and in the States and everywhere else.

 

All I could do was send the info, again to our news stations, and to the BC College of Physicians and Surgeons, hoping for some follow-up after the regurgitation of that Lancet review.  They ought to know what is happening in the UK. 

 

It is depressing Fiona, that this, the truth, has to even be fought for, so hard.  I can only skim the article you posted.  It too upsetting to read full-on right now.

[[La...]]

Yes, agreed, benzohno. Good for you for sending things! You never know....

 

 

[[be...]]

Thanks Lapis    Yup, you never know.  Even if one person reads it, gets it, it's something...

[[lo...]]

Something is happening here every day at the moment, I can't really keep up and don't always post things ...

 

We have a new suicide prevention strategy announced in Scotland, well the consultation phase anyway.  So that is being criticised.

 

We have another petition in the Scottish Parliament which I may have mentioned before.  You can see my submission there and others of course.

 

http://www.parliament.scot/GettingInvolved/Petitions/PE01627

 

There is another article in the BMJ today ...

 

http://www.bmj.com/content/360/bmj.k1069

 

Full BMJ article text copied here:

 

Given the news reports, you’d be forgiven for thinking that the Lancet’s recent meta-analysis was the last word on drug treatment for depression, but Kate Adlington finds that the debate is far from over

 

“Pop more happy pills,” screamed the Sun’s front page on 22 February. It referred to the first major network meta-analysis comparing 21 antidepressants for acute depression in adults, published in the Lancet.1 All were found to be more effective than placebo for short term treatment.2

 

“Antidepressants: major study finds they work,” said the BBC. “The drugs do work: antidepressants are effective, study shows,” announced Sarah Boseley in the Guardian,3 in contrast to her coverage of a previous meta-analysis almost a decade ago: “Prozac, used by 40m people, does not work say scientists.”45

 

Many news outlets called for more prescribing: “Antidepressants should be given to a million more Britons,” instructed the Telegraph.6 But what about overtreatment, let alone the practical and financial implications?

 

Prescribing practice

More importantly, what about the evidence? The study did not consider prescribing practice; neither did it mention a million untreated people. In fact, the paper’s coauthor John Geddes had mentioned this figure in an interview with the Guardian: “It is likely that at least one million more people per year [in the UK] should have access to effective treatment for depression, either drugs or psychotherapy.”3 The headlines missed his nuance, and the legitimacy of his numbers has been questioned.7

 

Press coverage was rich in generalisation, despite the limitations given in the Lancet’s press release. The Sun said that “pills were up to 113 per cent more likely to tackle depression than no treatment at all”8—but only amitriptyline had the highest odds ratio of 2.13. And few news reports differentiated mild depression from the more severe symptoms of most study participants.

 

Largely they also omitted to mention the small effect sizes, side effects, the predominance of pharma sponsored trials, or other treatment options such as psychotherapy or cognitive behavioural therapy.

 

The Daily Mail later devoted two pages to caution.9 James Davies, a member of the Council for Evidence-based Psychiatry which publicises the risks of psychiatric drugs, emphasised that the average length of prescription for people taking antidepressants is much longer than the two month courses studied.9

 

Professional endorsement

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.

 

Carmine Pariante, for the Royal College of Psychiatrists, decreed, “This meta-analysis finally puts to bed the controversy on antidepressants.”10 Results from many previous antidepressant studies have been scattered and inconsistent (an “evidence myth constructed from a thousand randomized trials”11).

 

The network meta-analysis made the largest amount of published and unpublished data to date available for scrutiny. Allan Young, psychiatry professor at King’s College London, is on balance confident about the findings. “Network meta-analyses are now widely accepted but depend on the data put in,” he told The BMJ. “This study used a large amount of high quality data so it can be trusted.”

 

Practical advice came from Helen Stokes-Lampard, chair of the Royal College of General Practitioners: “Although antidepressants are of proven benefit—as this study shows—no doctor wants their patients to become reliant on medication; so, where possible, GPs will explore alternative treatments, such as talking therapies or CBT.”2 But given long waiting times for NHS psychological and mental health services, antidepressants could help in the short term.

 

Ideological debate

The ideological debate about the use of antidepressants has long been fervent and polarised. Many people, including some psychiatrists, dispute that depression can be treated with drugs rather than by resolving underlying social determinants. Few declare their financial or ideological interests when commenting on research. It is unlikely that any study will settle the matter for these opponents; the London consultant psychiatrist Derek Summerfield suggested recently that doctors prescribe antidepressants “by reflex” when they can’t help a patient’s “social predicament.”12

 

The study may well move the debate forward for patients. The hashtags #medsworkedforme and #medsdidntworkforme were trending soon after publication. Geddes and Andrea Cipriani, another of the authors, 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. A step forward to fight stigma in mental health.”

 

Footnotes

Competing interests: I have read and understood BMJ policy on declaration of interests and declare that I’m a psychiatry trainee and sit on the professional practice and ethics committee at the Royal College of Psychiatry.

 

I have written the following response.

 

Members of the online prescribed dependent and support community were utterly dismayed by the widespread misleading newspaper headlines suggesting that the debate around antidepressants had finally been settled as a consequence of the recent meta-analysis reported in the Lancet.(1) It seemed that the publicity had been designed deliberately to mislead the public. This comes soon after Public Health England's announcement of a year long review of prescribed drug dependence, including of course dependence on antidepressants.(2) A letter in the Times newspaper on 24 February by Prof Wendy Burn and Prof David Baldwin caused further distress. The letter stated ‘We know that in the vast majority of patients, any unpleasant symptoms experienced on discontinuing antidepressants have resolved within two weeks of stopping treatment’. (3) This letter is now the subject of a formal complaint to the Royal College of Psychiatrists. (4) Members of the online community have attempted to engage with the Royal College and individual psychiatrists via Twitter, with little success. The hashtags #medsworkedforme and #medsdidntworkforme simply polarise the "discussion" with personal experiences being recounted by those who have benefitted and those who have been harmed. They are no substitute for a robust discussion of the evidence base for benefits (short and long-term), the risks of dependence, the withdrawal difficulties which can be immense, and the resulting iatrogenic harm which many patients are reporting. Until this happens, the general public and patients alike will continue to be misinformed and will inevitably make decisions about their health based on incomplete, inaccurate and biased information. This whole episode serves only to diminish the standing of psychiatry.

 

End of letter

 

We are of course concerned about where this is all leading but we just keep plugging away.

 

I spend most of my time online on Twitter, Facebook, etc etc.

[[lo...]]

Article in the Scottish press today ....

 

http://www.heraldscotland.com/news/health/16077230.Psychiatrists_accused_of__dangerous__and__misleading__comments_on_antidepressant_withdrawal/

 

And more exchanges on Twitter after Prof Clare Gerada (GP) was on BBC Radio 4 .. downplaying the withdrawal effects again ...

 

Just as she did with benzo withdrawal in 2011 on BBC Radio 4 .. and the programme is still available online.

 

Fiona 

 

 

[[La...]]

Excellent article! I'm glad to see it. If people read it, they will, at the very least, be aware that not everyone is in agreement about the validity of the claims that withdrawal effects are rare and that antidepressants are good for everyone. 

[[lo...]]

Thanks, Lapis, we are pleased with the support we are getting from the Scottish press now.

[[La...]]

Kudos to you and everyone else there who continue to challenge the status quo!

[[be...]]

Really good to see that article Fiona. 

[[St...]]

Thank you for posting about the developing response in Scotland.  Quite a good article in the Herald.

 

Noticed the discussion in your twitter feed re the Danish study.  It gives me a headache to hear the authors/defenders and the critical doctor stuck in a semantic tug of war over whether SSRI's are "addictive" or cause "addiction."  I wish defenders of the hypothesis of physiological dependence (leading to withdrawal syndrome) would stop using the term "addiction" and instead use "physiological dependence."  Insisting on "addiction" simply allows the denialists (be they Pharma-toadies or ignoramus) to trot out the red herrings that SSRI patients don't start craving More drugs and don't start Taking More than prescribed and don't start acting like junkies by trolling the streets for "illegal ssris." 

 

Granted, after this we still have to deal with the establishment-trope that withdrawal symptoms (be they based on tolerance, tachphylaxis ("poop out"), tapering or, finally, stopping SSRIs) are "the mental illness resurfacing," as opposed to withdrawal symptoms caused by the fact that the patient is now physiologically dependent.  But at least on this point there does not seem to be much argument that  adverse symptoms showing up in response to tolerance/tachpylaxis/tapering/quitting disappear upon quick reinstatement.  So the causal role of the drug itself - vs. the patient's "mental illness" - is hard to dispute.

 

Again, thank you for keeping us updated and for. your spirited and very effective work on behalf of us all! 

 

It would be so interesting to be able to have a 60-Minutes style segment on prime time TV in the US reporting on all this.

 

Oddly, or not, there has been ZERO coverage to my knowledge in the US media except on Mad In America.  I would love to be wrong.

[[lo...]]

I suppose the US isn't particularly interested in the goings-ons here with our Royal College.  Most newspapers are not reporting on it here.  The Scottish press is because we are so persistent!!  I don't know what the outcome is going to be.  It just goes on and on and on.

[[lo...]]

An article has appeared in the New York Times today, it is reasonably balanced.

 

https://www.nytimes.com/2018/03/12/upshot/do-antidepressants-work.html

[[La...]]

Thanks so much for sharing that article, Fiona! Perhaps it deserves its own thread so that it's not buried. It's a good read -- yes, balanced -- and the last line is extremely important for everybody here. That is, "If patients want answers, they will need to demand the research themselves."

 

Exactly. And that's why we're all here supporting each other while dealing with issues surrounding adverse reactions to medications. Whether it's benzodiazepines or antidepressants, there are still many unanswered questions.

 

Here's the whole text of the last paragraph -- a particularly pertinent one:

 

Even with so much research on antidepressants, there are still many unanswered questions. It’s unclear if drug companies would be interested in the results, or indeed why they would be. The drugs are already being widely used, and no regulatory agency is requiring more data. If patients want answers, they will need to demand the research themselves.   

[[lo...]]

thanks, Lapis, can you post it for me, I am getting really tired and hands/fingers sore ..

[[La...]]

Sure, Fiona. Will do.

[[lo...]]

Thank you.  :thumbsup:

[[St...]]

Thank you Lapis for posting the NYTimes article.

First one in the US, that I know of.

Yes, very gingerly balanced - viz. the language you quoted. 

It was a bit surprising to see no mention at all re the scandal around the RCP's statements on withdrawal duration and the complaint now formally filed by Dr. Read et al.  You would think that would be part of any serious news story about the article at this point in the timeline.