CNN’s story about the potential future use of a type of anti-inflammatory drug to treat depression is based largely on research described in a news release issued by the University of Cambridge.
The story accurately reports serious interest by the principal investigator of the new research, and others, in tantalizing links between the immune system’s responsive inflammatory chemicals–cytokines–and mental illness. In this case, the investigators accumulated evidence for the potential value of anti-cytokine therapy by focusing on anti-depressant effects of the drugs reported as side effects in a meta-analysis of 7 substantial clinical studies, mostly involving those with autoimmune diseases such as rheumatoid arthritis and psoriasis. The story quotes the principal investigator’s explanation for those links.
But unlike the study and the news release (which we also reviewed), it waits until the last two sentences to point out that the antidepressant effects of anti-cytokine drugs are at best “mild,” and essentially fails to point out that even if the new drugs were eventually proven safe and effective for depression, it’s likely that only a small subset of depressed people–those with chronic inflammation and resistant to current antidepressants–would find benefit over and above what other treatments already offer.
It’s worth noting that the news release did a better job of pointing out the limitations and side effects of any use of anti-cytokines in the future; and of making clear that randomized clinical trials are needed even to get near the point of using the drugs. Neither the news release nor the story, though, talked about the cost of this relatively new class of anti-inflammatories, some of which which are currently heavily advertised, but used to treat only severe cases of autoimmune disorders.
Depression is a major worldwide disability that often goes undiagnosed or untreated. The National Institute of Mental Health estimates worldwide prevalence at 3.7 percent of adults and some estimates put the U.S. adult prevalence for major depressive illness as high as 7 percent. The costs in disability, lost productivity, and treatment are staggering; access to therapists is increasingly difficult.
First-line drug therapies are often effective, but for many with chronic depression, don’t work. As a result, news about new classes of drugs or combinations of drugs to treat depression, brings huge audiences, and good coverage of such news must reflect practical realities and limitations.
Information on the steep costs of some of these drugs is readily available, along with data on whether insurers will pay for them. There is no discussion of costs in the story about this, nor does the story mention a single one of the drugs by name–adalimubab and etanercept are two–so that readers can look for themselves.
It is particularly important to mention cost in this case because biologics (the drug class in question) are notoriously expensive (adalimubab is estimated around $1,600 a month) while most first-line generic treatments for depression, like SSRIs, are much more affordable (often less than $20/month).
The story makes–and attributes–statements saying studies showed the use of the anti-cytokines “improved symptoms of depression” and “lessened symptoms of depression” even in the absence of efficacy for reducing inflammation. But there are no statistics given to explain what “lessened” or “improved” means and very little about the 20 studies on which the researchers’ conclusions about the potential anti-depressant benefits of the new drugs are based.
Except for a modest reference to clinical trials “still testing their efficacy and safety” for human use, and a sentence saying that “side effects must also be investigated,” the discussion of harms in this story would leave readers with the impression that these drugs don’t have any notable, already-well-known side effects. But they do.
A quick check of one of the drugs (etanercept) for example, currently prescribed for some autoimmune conditions, notes that serious side effects may include heart failure, lethal blood disorders and serious infections brought on by the suppression of the immune system by way of reductions in inflammation.
Seeking the input of an independent source to discuss these harms and risks as they compare to standard antidepressant treatment would have been helpful, too.
The story mentions there was a meta-analysis of 20 randomized clinical trials, but offers no information about the makeup of the patient populations in those trials, the specific drugs involved in the trials, or baseline symptoms and diagnoses.
As we note in our review of the news release, the meta-analysis was limited in what it could extrapolate because the anti-depressive effect was a secondary outcome of these clinical trials, which were all looking at these drugs for how they treat serious autoimmune disorders, not depression. The news release did better on this one.
No mongering here, as depression is a serious illness.
The story would have been stronger if it had included information on the prevalence of serious depression, and the makeup of the subset of people who might benefit from the new drugs.
Also, making the connection between inflammation (a vaguely defined and far-reaching phenomenon) and depression could inspire some unfounded concerns among readers that they or their family members are at risk for the latter.
The CNN story offers a quote from a source not associated with the research; and it offers links to websites and other sources where readers could find out more about funding and sponsorship of the study. This is a strong point of the story.
The story makes an oblique and somewhat misleading reference to research suggesting anti-cytokines are better than “antipsychotic” medicines, but no reference at all to types and use of antidepressants, many of which are effective.
The story notes that more research needs to be done before the new anti-inflammatories could be prescribed as a direct therapy for depression, and one of the researchers notes that it’s too early to prescribe them for depression. We also liked that the story mentioned other diseases that are treated by anti-inflammatories.
The story does note what is novel about anti-cytokines and their possible link to mental illness, although the story would have been stronger had it connected the dots more specifically about the possible mechanism by which inflammation might affect the chemistry of the depressed brain and mind.
The story, as noted earlier, relies heavily on a news release, but CNN’s writer did interview an independent source.