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Study suggests overall benefit from antidepressants

Rating

4 Star

Study suggests overall benefit from antidepressants

Our Review Summary

Reporters usually don’t write the headlines, but we wish someone would have changed the headline on this story.  The body of the story conveyed important questions – about the number needed to treat – and about differences in treating the elderly – that perhaps were worthy of headline attention.

 

Why This Matters

The story tried to capture why this is important in its opening sentence:

Despite recent debate about how well antidepressants really work in people with only mild or moderate depression, a new analysis of drug studies suggests they may have some benefit across the board.

But there is a nuance here.  The previous patient level meta-analysis (JAMA) included fewer studies, but across a broader spectrum of depression (minor depression to major depression), and some with longer followup  The current study and more included trials (good) restricted their analyses to studies enrolling patients with major depression (also good – this is the group for whom it appears treatment is most indicated) but only have short-term results (not so good).  Although this level of detail is probably beyond what is needed for a general circulation story, pointing out WHY these 2 studies may have found different results and specifically noting that the results apply to those with major depressive disorder would be helpful

Criteria

Does the story adequately discuss the costs of the intervention?

Not Applicable

The costs of antidepressants weren’t discussed, but perhaps that is understandable in this kind of broad overview of a meta-analysis. Fluoxetine (prozac) and venalfaxine (effexor) are now both generic.  So costs are pretty low.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

The story gave detailed breakdowns of percent improvement in scores on depression tests and provided an estimate of the number needed to treat in order for one to benefit.  The difference in benefits between older and younger patients was highlighted.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

There was at least the acknowledgement that these drugs do carry side effects – but none was specified nor quantified.

Does the story seem to grasp the quality of the evidence?

Satisfactory

Several of the limitations of the meta-analysis were mentioned in the story.

Of course, one key limitation in such cases is how they selected studies for the analyses (ones already available to them from the National Institute of Mental Health and from drug companies).  This may not bias the results but may bias the interpretation (the authors say they only know these effects for prozac/effexor and can’t comment on other drugs; that could possibly lead a reader to incorrectly conclude that only prozac/effexor are shown to be effective.)

Does the story commit disease-mongering?

Satisfactory

No disease mongering about depression here.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story interviewed Irving Kirsch, frequently cited/quoted on antidepressant research issues.

It also did a good job of noting potential conflicts of interest.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story at least noted alternatives including psychotherapy and exercise, but didn’t give information about the effects, pros/cons of these options.

Does the story establish the availability of the treatment/test/product/procedure?

Not Applicable

The availability of antidepressants was not in question.

Does the story establish the true novelty of the approach?

Not Satisfactory

The story didn’t analyze the novelty claim that the researchers made:

“To our knowledge, this is the first research
synthesis in this area to use complete longitudinal
person-level data from a large set of published and
unpublished studies. The results do not support previous
findings that antidepressants show little benefit except
for severe depression.”

The second point was made in the story, but perhaps the story should have explained a bit more about the methodological reasons for why this analysis was – or what made it – different or important.

As to the first (questionable) part of the claim, what’s novel is this: more studies than the previous analysis, adolescents/adults/older adults included and analyzed by these groups.

Does the story appear to rely solely or largely on a news release?

Satisfactory

The story did not rely on a news release.

Total Score: 5 of 8 Satisfactory

Comments (2)

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Paul Scott

March 13, 2012 at 9:22 pm

As much as I appreciate your approach to evaluating health stories, I feel as though your checklist is inadequate in this instance. It lacks the historical context to this issue and the parties writing this paper and its sibling paper on suicide and SSRI’s in teens which appeared in February. Why, Reuters might ask, does the Gibbons study evaluate just two antidepressants (Effexor and Prozac)? The manufacturers of these drugs, Lilly and Pfizer, are behind the only two left on patent (Pristiq and Cymbalta). Does it bother the journalists that the data analyzed in these studies cannot be viewed — it is proprietary to the drug makers. Does it bother the journalists that this study comes on the heels of another Gibbons analysis of the class for suicidality in children? Does this start to look like a campaign to rebut the persistent safety and effectiveness concerns regarding this class of drugs, and for marketing purposes? Gibbons has swarmed the issue of the black box in successive articles over the past five years making a claim the BMJ called “misleading” and “reckless”, and one which even his coauthor refuted, yet persists even this month in making erroneous statements about an uptick in suicide following the warning (it preceded the warning, and it ended the very next year) to press like NPR and the LA Times who did not challenge it. He has received money from Lilly and Pfizer, of course. The authors are part of the story. There’s better reporting on this campaign in the blogs. I recommend one written by a psychiatrist at 1boringoldman.com, who summarized the arrival of the two papers and the quick series of press appearances by Gibbons as “a ‘roll-out’ for the articles” pre-arranged by the drug industry.

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Paul Scott

March 14, 2012 at 2:59 pm

Correction: the uptick in suicides in 2004 preceded the drop-off in prescriptions following the warning, not the warning itself.

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