Reflections on Newsweek Feb. 8, 2010 Cover Story (Anti-Depressants).

I’m a huge fan of Newsweek. A few years ago Charity called in and supported NPR for one of their fundraising drives and we received a free one year subscription to Newsweek – we’ve kept it ever since. We both love to read Newsweek – finding it informative and oftentimes approaching issues from multiple perspectives.

Tonight I am sadly disappointed. I finally had a chance to read the Feb. 8 2010 issue with a promising cover story on antidepressants by Sharon Begley. I had expected, in common Newsweek fashion, to find an extended report on the overall story supplemented by articles from various perspectives – I was sadly mistaken. Begley’s article used recent controversial findings to smack around the efficiency of anti-depressants rather ferociously, then there was a small, one-page response from Robert Klitzman, a psychiatrist, author, and professor at Columbia University.

Jon Meacham, what happened here? Begley’s article highlights some interesting and thought-provoking research findings, but doesn’t seem to seriously consider the issues with the research findings. Klitzman’s article, while raising some important issues, is too short to offer a resource defense against Begley’s article. Klitzman’s use of personal, subjective experience is entirely worthwhile, but in an article this short it seems to overshadow the more scientific issues relating to researchers’ methodology in acquiring these results.

I haven’t had time to read the original research publications and probably won’t…nor am I a qualified mental health professional…but as an individual who has suffered from Obsessive Compulsive Disorder (OCD) and Major Depressive Episodes for all of my conscious life, I’d like to share a few observations:

  • One must correlate not only the effectiveness of a single drug but the effectiveness of a class of drugs on the individual. For example, this study reflects that an individual in a clinical trial for say Prozac experiences only a 1% decrease in symptoms – similar or identical to a placebo effect. What the study does not correlate is how that same individual responds to different drugs used to treat the same disorder. For example – if this individual uses Zoloft, Paxil, etc. do they experience a more significant reduction in symptoms? One of the differences (for me) between Zoloft and Prozac is weight gain versus weight loss/stability. Future studies need to consider the effectiveness of a class of drugs in treatment of an individual versus an individual drug. Thus the question is, would any drug within this treatment class significantly reduce the symptoms of the sufferer? If so, this is a victory for “anti-depressants” in general. One cannot suggest that anti-depressants as a class are ineffective without considering their effectiveness as a class on the individual. Ineffectiveness in a case study of treatment of an individual with a single drug is not evidence that anti-depressants don’t work but that that specific anti-depressant doesn’t assist that individual.
  • The lumping in of the varied forms of depression is a significant issue as well. There are significant differences between the forms and intensity of depression which is further complicated by coexisting disorders. Yes, situational depression (e.g. death of a friend or family member) is likely to resolve itself – but this is very different from the depression which simply sits upon a person like a funk – with no rhyme or reason. Dysthymic Depression has different implications than a sudden Major Depressive Episode.
  • I’m not aware of anyone advocating that we pop anti-depressants like tic tacs and yet the article seems to indicate that these anti-depressants are being handed out to anyone who is experiencing a bit of grief. There is little disagreement, as far as I am aware, that medications are not a panacea for depression and that they should be utilized in moderation, in combination with other approaches, and for depression which appears to be ongoing and severely limiting rather than limited and minimal.
  • Begley recommends psychotherapy as an effective alternative treatment, but that is a very general class – much more general than the anti-depressants mentioned. What sort of psychotherapy is being referred to? Psychoanalysis? Cognitive-Behavioral?

I would have liked to see someone like Peter Kramer who wrote the excellent book Against Depression write a response to Begley’s article (I think Klitzman is also fully capable of writing an article of such a nature given a more extended page count…I mention Kramer because he has written extensively on this subject). In the end, I simply want to suggest that Newsweek should be more careful in how they handle topics like this. It felt extremely one-sided and was not provided the depth or breadth I’ve come to expect from Newsweek.

The article raises good questions. We need to be considering the efficiency of our antidepressants. We need to be pushing for alternative treatments that don’t require the introduction of potentially harmful chemicals into our bodies. We need to smash any mentality that considers every blue mood an instance of depression and worthy of a few pills.

But where, oh where, where the articles talking about what sorts of psychotherapy are effective for treating depression? Where was the article even defining depression? Where were the articles talking about the efficiency of these same anti-depressants for other disorders – for example Obsessive-Compulsive Disorder? Where were the articles on how to improve our system?

Update 2/06/10: I’d like to thank Peter Kramer for taking the time to comment on this article and would like to point everyone’s attention to the several articles he has written in response to Newsweek’s article and the underlying research used in the article

  • Here is an article for Slate that Kramer wrote explaining Irving Kirsch’s understanding of tianeptine and why it isn’t the clear-cut evidence Kirsch suggests. Kramer has some fairly strong words for Newsweek, “To set aside the testimony of animal model research, brain enzyme research, the new work on neurogenesis, and on and on—this stance has the whiff about it of science denial. It is one that a major magazine should have showcased cautiously, if at all, and only after having done some serious homework.”
  • Here is another article for Slate in which Kramer evaluates the results of the recent JAMA study and demonstrates significant concerns acknowledged by the U. Penn researchers themselves concerning the efficacy of drawing conclusions on minor depression from this study.
  • Finally, Kramer responds to arguments that individual responses to placebos are significant by noting that the test groups in studies reflecting this result oftentimes include a number of test subjects who don’t have the disorder – thus the apparent efficiency of placebos.

8 Replies to “Reflections on Newsweek Feb. 8, 2010 Cover Story (Anti-Depressants).”

  1. I agree that the Newsweek cover story was contentious and one-sided, and in a way that used to be uncharacteristic of the magazine. I did make a very partial reply, posted here: http://www.doublex.com/blog/xxfactor/how-do-antidepressants-work-newsweek-gets-it-wrong
    If you click on the hyperlinks in that posting (esp. “here” and “elsewhere” at the top), they will take you to other postings where I discuss the research at the core of the Newsweek piece.

  2. Dave….a couple thoughts:

    We’ve subscribed to Newsweek for years (well, Brad has) and it’s quality has significantly deteriorated in the last year since their big ‘makeover.’ Seriously, it is not a news magazine anymore, but is trying to compete with alarmist blogs. Its like the People magazine of news now. So, it’s not surprising that they don’t have good reporting–that is few and far between now–and it wasn’t always like this.

    Secondly, from my own experiences and from what I read, there is a major problem in the US particularly with over prescribing antidepressants. It is easier for a doctor to simply prescribe them without taking the time to figure out what the problem is. For me…I had a vitamin deficiency caused by another prescription I was taking and once I started a multivitamin, I was 100% better than I was on antidepressants. I had to figure this out on my own though…my doctor didn’t take the time to figure this out. And I think this happens a lot. Plus, when a GP prescribes an antidepressant they rarely require counseling in addition to it, so it seems more like an easy fix that doesn’t necessarily address the whole problem.

    I am not saying that antidepressants are not necessary and helpful–they certainly are for some people. But as a population, we have so many issues of poor diet, poor sleep, stress, and other crap, that those need to be addressed first, or at least simultaneously with medicine. And you’re right, there are tons of different kinds of depression, so if the article doesn’t address that, that is a major fail. It also fails if it doesn’t explain how helpful antidepressants are for some people.

    Anyway, we’ve yet to get the issue (it comes to our house 5 days late, although it used to come on time, we’ve called Newsweek and they say they can’t do anything…any mark against them! We should call it ‘News-from-last-Week 😉 ), but those are just my thoughts. Phew, that was long…sorry!

    1. Kara,
      Thanks for taking the time to post your thoughts. I think you bring up an interesting perspective on over-prescribing antidepressants – but I think this actually reflects different issues than the effectiveness of anti-depressants. Namely:
      1. As a nation we need to make the choice to pay our GP’s better. There is little attraction for individuals to enter the GP field – especially financially. Right now we are facing a severe shortage of GP’s resulting in a lowering of quality in the care we receive from GP’s. GP’s who overprescribe antidepressants do so not because of an overconfidence in their efficacy to fix problems but out of a need to churn out more patients in less time. I think that Walmart and similar super-chains have developed an innovative way to reduce this problem by allowing practices to be established within their walls that can handle most simple requests in a timely fashion with less qualified practitioners. This would free GP’s to be more involved in the long-term health of their patients, rather than the distribution of antibiotics, referrals, and other such distractions.
      2. The healthcare industry is one of a few industries that is remarkably antiquated when it comes to appropriate use of technology. There is a significant need to innovate technologically within the medical field which would yield nearly unimaginable improvements in the quality of treatments. Electronic health records, automatic number crunching and analysis of an individual’s health history, use of personal health monitoring devices, could all significantly reduce the costs in time and finances related to treatment. Issues such as your vitamin deficiency should be automatically recognized by computer analysis – rather than hoping that an overworked GP recognizes that the side-effect from a medication you are using can result in a vitamin deficiency.
      3. I wholeheartedly agree that as a nation we have many other significant issues. I know I personally struggle in the areas of diet, sleep, and stress. I think that ideally we should be dealing with these simultaneously to or sometimes even before medication – on the other hand, oftentimes individuals are not prepared to tackle these challenges until they have experienced some relief via medication. I do not think it is wise for individuals to appeal to anti-depressants as a cure-all, on the other hand, true depression, etc. (in my experience) receives only partial allayment via changes in diet, anxiety, and sleep. These may take a 10 point depression down to 7, but I don’t think they will ever take it down to 0 or even 3 or 4.
      Thanks again. 🙂
      Dave.

  3. Lexapro is a permanent life long cure for any depression if you can survive the treatment. I was prompted by a marriage counselor to go to my doctor and request drugs for my OCD symptoms (checking, intrusive sad thoughts, previous eating disorders as a teen and heavy drinking.) I went to my husband’s pcp who never met me before. He gave me a depression self-test and diagnosed me with depression and anxiety, and then prescribed me Lexapro and Rozerem since I had a terrible insomnia problem. He also decided it was a good idea to start kissing me and grabbing me in his office. The Lexapro did such a good job getting me up and doing things, lots of things, but unfortunately, I believe it also may have made me nervous because it raised my blood pressure from it’s usual 120/80 to 145/110. I was really up, up, up. I could drink twelve shots of straight liquor and still be walking around for hours. This was the busiest year of my life. I managed to get 2 DUI’s 4 drunk in publics and an involuntary commit for suicide, attend 2 rehab’s, a hypnotherapist, weekly ASAP programs, all while working full time an taking care of a young child. During the course of my medical treatment, I was seen by 3 psychiatrists, 4 doctors, and numerous counselors. Most of the follow up treatment involved numerous more drugs, anti-buse, campral, and Buspar. All of which I had to stop taking due to side effects such as full body tremors and falling down. Finally, after the second DUI which I was also charged with a felony for pinching a police officers butt, I decided maybe I should stop taking the Lexapro b/c I seemed to have developed some obsession with alcohol and I could see I was also becoming delusional. So, while in jail, I requested no more medication for 1 week and was able to fully withdraw from Lexapro, although the depression side effects of the withdrawal lasted about three months. I met numerous other women in jail for DUI’s while on Zoloft, Lexapro and Abilify and others for shoplifting on Zanax. My depression is 100% permanently cured. I no longer ever feel sad about my life. I have never killed anyone driving drunk, I didn’t kill myself, I am no longer in jail, I didn’t get my kid taken away from me, I am not in a mental institution, and I don’t have a lethal diastolic blood pressure of 110 anymore. No matter what happens in my life now, I am always hopeful and never depressed. I know things could be much worse.

  4. Thought you might find this article, from the New Yorker, of interest. Not so much an article that draws a conclusion as it is an exploration of the conflict between those who believe anti-depressants treat an actual disease via chemical action in the brain, and those who assign the medications efficacy to placebo effect. Well written and informative.

    http://www.newyorker.com/arts/critics/atlarge/2010/03/01/100301crat_atlarge_menand?currentPage=all

  5. I’m coming at this article from an entire different perspective. I’m a licensed, board-certified cognitive behavioral therapist, diplomate of the board–psychology, who’s been crying in the wilderness for years over the lack of accurate information about depression. Neuroscience has all the answers for getting out of depression without drugs for anybody willing to look. Depression is not a brain disease. It’s an agonizing neural pattern formed in the brain by chronic over-reaction to stress. The pattern can be replaced, through the brain’s neuroplasticity, by a healthier pattern.

    The key to change is: the process of pain perception. All pain and depression is produced in the subcortex. There’s no pain/depression in the neocortex. Signals, that pain/depression are being produced subcortically, must go up the brain, and not only be received, but be acknowledged in the neocortex before a human being can feel any pain/depression.

    That’s why hypnosis works. And why football players can even break a bone and feel no pain when concentration on their game thoughtjams acknowledgment, in their neocortex, that pain’s being produced in their subcortex. One can “brainswitch” out of depression the same way.
    Depression diagnoses are being widely discredited.

    1. A.B. – I really appreciate you taking the time to post your comments, and I’ve bookmarked your blog so I can read through the articles in the near future. I would agree with you on the efficiency of CBT as a method of treatment for psychiatric illnesses. However, I am concerned by any treatment philosophy which emphasizes one tool to the exclusion of all others. In my, much less professional opinion, CBT should be one tool alongside of numerous others for the treatment of these illnesses – including medication.
      The variety of responses we see amongst individuals to various forms of treatment (e.g. medications, CBT, psychoanalytic, nutritional) indicate to me that there are significant varieties in the causes and interactions of various psychiatric illnesses. We oftentimes are unaware of how various factors interact to form a unique pattern which requires a certain form of treatment – but if we see success in one area we cannot discard all other areas due to this.
      I’d qualify my article by stating that I am not attempting to suggest medication is the sole or even primary remedy for mental illness but that it should not be excluded from the toolbox. I am a fan of other forms of treatment – CBT, etc. just doesn’t seem to be under the same criticism as medication (especially in the Newsweek articles).

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.