The story gives good context about how prevalent depression is and how many people go without treatment of any kind, and reminds us that psychotherapy is also a viable treatment.
And yet the headline goes far beyond the scope of the study by claiming that “many more people” should take antidepressants. That assertion isn’t supported by anything in the story itself, and it’s a major misstep in our view, as treatment decisions should always be fully-informed, shared encounters between people and their physicians.
The story didn’t alert readers that most antidepressants were found to offer only a modest benefit, and side effects weren’t considered.
The story also missed study limitations and a conflict of interest for one of the people quoted.
Depression is a leading cause of disability worldwide. It can also be hard to treat — this story mentions the 40% failure rate for antidepressant medications — and many people with depression do not get treatment at all.
There has been lingering uncertainty about the effectiveness of some anti-depressants, since manufacturers tend to withhold studies that don’t show positive results and the FDA only approves drugs based on positive studies.
A analysis that provides a comprehensive assessment of currently available antidepressant medications is newsworthy, but journalists should be cautious in their interpretations.
Without mentioning any numbers, the story does say that the costs of antidepressant drugs tend to be lower than the other major treatment approach for depression, which is talk therapy.
The story would have been stronger with cost data. For example, the four drugs found most effective in the analysis– mirtazapine, escitalopram, venlafaxine, and sertraline — cost $8 to $12 for 30 tablets, according to the web site GoodRx. The study says, “All of the most effective antidepressants are now off patent and available in generic form.”
It also doesn’t mention that talk therapy may have more value for some patients because it can equip people with tools for life, and severe depression needs to be treated by a combination of drugs and talk therapy.
It can be difficult to quantify results when a study examines results from multiple clinical trials, because methods and results may vary. And yet, we’d like to see the baseline measure expressed in plain language to help orient readers before introducing relative changes from that baseline.
The story only reports, “Drugs ranged from more than one third more effective than a placebo to more than twice as effective.” Nowhere does the story explain to readers how “effective” is defined in the study, which was a 50% reduction (or more) in score on a rating scale for depression. The story didn’t note that antidepressant drug trials often find a placebo effect, which is why “twice as effective” as placebo is not zero.
We give some credit that the story mentioned the high failure rate for antidepressant medications overall — 40%.
The story also didn’t mention that the study characterized the benefits were “mostly modest.”
The story makes no mention of the various side effects that can occur with antidepressant medication, such as weight gain, insomnia, and loss of sexual desire.
The study authors looked at which drugs were more or less tolerated, and their analysis did not include adverse effects or withdrawal symptoms. Those facts weren’t included in the story.
The story does include information suggesting how large the analysis was — 522 drug trials with nearly 120,000 subjects reviewed — and that it was the “most comprehensive evidence currently available,” according to the authors.
But the story doesn’t mention any limitations, including the fact that the analysis didn’t examine how patients respond based on age, sex, severity of symptoms, or duration of illness.
The authors of the study also noted weak evidence for some drugs and the potential for unintentional errors in their complication of data.
Finally, they noted also noted that “some of the adverse effects of antidepressants occur over a prolonged period, meaning that positive results need to be taken with great caution, because the trials in this network meta-analysis were of short duration.”
The story gives readers clear numbers on the widespread problem of depression and the estimates of people with depression who go untreated. That’s laudable.
However, the assertion that “many more” people should be taking antidepressants constitutes a form of disease-mongering in our view because it’s unsupported by evidence and could lead some people to seek out drugs they might not benefit from.
The story provides quotes from three psychiatrists who were not authors on the study, taken from an online source called Science Media Centre.
It doesn’t say that one of them — Carmine Pariante — disclosed he received research funding from companies that make antidepressants. Pariante’s quote seems to have provided the basis for the story’s lead, which stated antidepressants “really do work.”
The story discusses the other major treatment approach for people with depression — talk therapy.
A wide range of antidepressant medications have been on the market for decades, so there’s no need to mention availability.
The lead bluntly states: “Antidepressant drugs really do work, a major new international study has proven.”
We think that’s the wrong takeaway. It wrongly implies there’s been widespread doubt that antidepressants in general are effective, and this analysis somehow puts all doubts to rest.
Study author Andrea Cipriani offered a more nuanced view, saying the findings should reassure people with depression that drugs can help.
The stated purpose of the analysis was to “compare and rank antidepressants” based on the totality of available data.
The lead apparently emanates from this quote in the second-to-last paragraph, by a researcher with an acknowledged conflict.
Carmine Pariante, a professor at the UK’s Institute of Psychiatry, Psychology and Neuroscience and spokesperson for the Royal College of Psychiatrists, said the study “finally puts to bed the controversy on antidepressants.”
The story quotes a news release from the Royal College of General Practitioners and pulls two other quotes from a list of “reactions” to the study put together by the Science Media Centre, which it does not attribute. Quotes from the study author were attributed to a press briefing.
While the story doesn’t technically rely on a news release, it doesn’t appear to include any original reporting.