January 6, 2010

Polar opposite headlines on antidepressant effectiveness stories

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A study published in JAMA this week drew markedly different news coverage. The LA Times headline read: “Study finds medication of little help to patients with mild, moderate depression.”

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But the HealthDay wire service, whose story appeared on the websites of BusinessWeek, MSN, Yahoo News, and ABCNews.com among others, had a glaringly different headline and framing perspective that read: “Severely depressed gain most from antidepressants.”

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The HealthDay story went on to state:

But the findings are not actually that surprising, said one expert, and don’t necessarily mean that people with mild-to-moderate depression should not try antidepressants.

“I’m not sure this is a finding that’s counter to giving medication to people with mild-to-moderate depression,” said Dr. Gregory Asnis, director of the anxiety and depression program at Montefiore Medical Center in New York City.

Why they conducted this interview but didn’t quote any of the study authors is odd.

The Times reported:

Hundreds of studies have attested to the benefits of antidepressants over placebos, (senior author Robert J. DeRubeis) said. But many studies involve only participants with severe depression. Confusion arises, he said, “because there is a tendency to generalize the findings to mean that all depressed people benefit from medications.”

That seems to be an important point.

Meantime, USA Today reported other important perspectives from the author and from another source:

“The health establishment needs to take stock and ask about costs and benefits” of antidepressants, DeRubeis says. Meanwhile, he says, his study “should give one pause” about prescribing antidepressants to mildly, moderately or even severely depressed patients. Instead, he says, doctors might want to consider non-drug options, such as exercise or psychotherapy.

Such findings “demonstrate a failure in the system: These drugs were not thoroughly tested in mild to moderate depression prior to their approval,” says Thomas Moore, a senior scientist at the Institute for Safe Medication Practices in Horsham, Pa., and co-author of the 2008 paper. “Any new antidepressants should be.”

So which is it?

The study should give pause about prescribing antidepressants? or

This is no reason to avoid meds?

Looks like it depends on which story you read.

(Addendum: Just moments after I posted this, I saw that MedPageToday.com posted its story on this study. It offers a very reasonable and wide-ranging look at the study, the questions it raises, and the possible limitations of the research.)

Comments

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Paul Scott

January 6, 2010 at 3:41 pm

Deacon and Kirsch reported this same finding two years ago in PLoS, but received little attn. They found that efficacy above that of placebo, which was considerable, was not so great even for severe patients. Perhaps our society is more receptive to this news now that other drugs (atypicals) are increasingly being added to the SSRI scrip. But I am struck by the lengths to which health reporters often go to demonstrate their deference to a popular drug in the face of a critical study, when they really only need to report the study, as you say.

Paul Scott

January 6, 2010 at 5:17 pm

A correction to my last post. Deacon and Kirsch found the drugs did in fact provide a clinically meaningful benefit, but only after a patient reached a score of 28 on the HAM-D, which is, I believe, your basic laying in bed and crying all day level of depression. For everyone less depressed than that the drugs did not provide any meaningful improvement above that considerable benefit provided by placebo. FYI, I wrote about all of this in 2008 in Men’s Health, in an article entitled, “Was the Prozac Revolution All in Our Heads?” Never rated by HNR, unfortunately!

Paul Scott

January 6, 2010 at 6:03 pm

One more story on the study, this one on NPR. But at the end, an NIMH doc says “he thinks” some people are helped by the drugs who have mild depression. We can believe that apparently, devoid of evidence, because “he thinks” that:
“Dr.Philip Wang, deputy director of the National Institute of Mental Health, agrees. Even consumers with mild symptoms shouldn’t necessarily be scared off of drugs, he says.
‘They don’t not work for everyone, and they don’t work for everyone,’Wang says. ‘I think buried within the group are people who do respond if they have mild or moderate depression.'”
http://www.npr.org/templates/story/story.php?storyId=122287985