Wednesday, June 26, 2013

Antidepressant Wars / Depression is REALLY hard to treat

One of the areas of controversy that emerged in recent years were claims that antidepressants didn't work very well, or not at all. These assertions were mostly based on analyses of unpublished data. These suggested that positive trials were more likely to be published and therefore that the effects of these treatments had perhaps been exaggerated. However, meta-analyses of the controlled trials were consistent in showing modest efficacy for the medications. A part of the politics of this development in the literature, according to a recent blog post by Dr. James Coyne, is that the results were seized upon by an 'anti-psychiatry' crowd including those with a professional interest in advocating for non-pharmacological treatments. For this reason, a recent meta-analysis was conducted of placebo controlled trials of psychotherapy for depression - those that used the same type of control used in pharmaceutical trials, a "sugar pill" control. These trials show similarly weak effects. Please see the detailed discussion in Dr. Coyne's blog, here, for more a more detailed discussion. Politics aside, my view is that these result emphasize something that clinicians who treat depression and people that suffer from it already know. This condition is hard to treat - there is rarely an easy answer and management is very often a long-term proposition. I don't think it helps for researchers and advocates to divide themselves into camps and to try to beat each other up in "antidepressant wars." We are going to need to seek slow and incremental progress through clinical AND health service advancement and reform if we are to make substantial progress against this condition.