Roll up! Roll up! The ‘latest’ antidepressant research is out – ‘Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis’. The revelations by Cipriani et al are indeed startling. The drugs known as ‘antidepressants’ are actually supposed to work. Imagine that? Drugs that have been around for many decades and prescribed in their millions (mostly blockbusters), are thought to work – despite decades of controversy, black box warnings and many, many deaths.
As you might expect, the headlines were indeed wondrous. An Irish Times article provides the headline ‘Antidepressants work for treating depression, study finds’. While the article didn’t provide an author, a tweet by a Times Journalist shared the article, along with the message ‘I take anti-depressants and yes, they work. No shame in saying my brain doesn’t just make enough serotonin’. Jeez – back to the whole feckin serotonin fairytale again. Ireland really needs a medical journalist that can interpret the actual science – move along dears, no Robert Whitaker here..
According to the BBC, The Royal College of Psychiatrists said the study “finally puts to bed the controversy on anti-depressants”. Not surprisingly, the Irish College of Psychiatry also got in on the act, stating this ‘Important research which will also hopefully reduce the stigma around the important place antidepressants can have in the treatment of debilitating depression and reducing misery caused by it to circa 350 million people globally’. No doubt they have evidence for this massive cohort of serotonin-deficient depressives? Or better still, evidence that the drugs they have dished out so liberally over many decades actually work? Clearly, no amount of stigma or controversy should get in the way of prescribing – not even images of our dead loved ones. Sure, aren’t we far too sensitive altogether?
Parking the sarcasm, there were a few chinks of light in the media. I particularly liked a piece by Peter Hitchins from the Mail On Sunday, who wrote –
“We were told last week that researchers had ‘the final answer to the long-lasting controversy about whether antidepressants work for major depression’. I very much doubt it. Not only did the study (of old research, much of it paid for by the drug companies themselves) show very limited success for these pills. We are only just beginning to scrape the surface of what I suspect may be one of the biggest drug scandals of all time. If anyone insists to you that all is well, ask them this: have they had access to the drug companies’ own full testing records?”
Indeed, according to Irish scientist, Dr David Healy – “The Cipriani paper discussed today is junk. It is based on ghostwritten papers with no access to the data. No one – not MHRA or FDA have had access – none of the notional authors of these papers have had access – none can let an independent expert see what the data shows.”
Peter Gøtzsche, co-founder of the Cochrane Collaboration was equally clear. He stated –
“This huge systematic review (Cipriani et al 2018) does not add anything to the knowledge we already had about depression pills. Briefly, the effects as estimated on the Hamilton scale are very similar to those reported in a another huge meta-analysis in early 2017 (Jakobsen JC, Katakam KK, Schou A, et al. Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder. A systematic review with meta-analysis and Trial Sequential Analysis… We have done such an analysis based on clinical study reports of placebo-controlled trials we have obtained from European drug regulators (submitted for publication). I will not reveal the details before our results have been published, but our results are very different from those shown in the Lancet paper. The use of clinical study reports is crucial. The manufactures had excluded patients from their analyses, which we were able to include. This is generally not possible for the type of systematic review done by Cipriani et al. So, these results are also flawed and should not be trusted.”
Is it possible that the current debate on whether these drugs actually work or not (however idiotic that may seem considering the enormous number of prescriptions), is being done intentionally to take the spotlight off the emerging issue of antidepressant addiction? Despite vast evidence to the contrary, it seems medics are still largely blind to antidepressant addiction. Nevertheless, a report by the World Health Organisation listed three SSRI antidepressants among the highest-ranking drugs for which drug dependence had ever been reported (fluoxetine, paroxetine and sertraline). Notably, the WHO report found that using differing terminology, such as replacing ‘withdrawal-syndrome’ with ‘discontinuation-syndrome’, caused conceptual confusion. The report specifically stated that this was intentionally done to avoid associating SSRIs with dependence.
This Cipriani study, despite adding nothing new to science, may effectively be just another distracting hand at work. Nothing that scientists like Professors Healy and Gøtzsche can’t dismiss with relative ease, I’d imagine. Although, whether that will be reflected in the headlines, is anyone’s guess. As balanced as our chemically imbalanced minds?