The Council for Evidence-based Psychiatry
22 February 2018
For immediate release:
Cipriani’s et al’s new research on whether antidepressants work has generated much excitement in the news media as well as the psychiatric community. The study has been represented by the Royal College of Psychiatrists as “finally putting to bed the controversy on anti-depressants“.
This statement is irresponsible and unsubstantiated, as the study actually supports what has been known for a long time, that various drugs can, unsurprisingly, have an impact on our mood, thoughts and motivation, but also differences between placebo and antidepressants are so minor that they are clinically insignificant, hardly registering at all in a person’s actual experience.
But even these differences can be accounted for. Most people on antidepressants experience some noticeable physical or mental alterations, and as a consequence realise they are on the active drug. This boosts the placebo effect of the antidepressant, helping explain these tiny differences away.
Furthermore, the trials only covered short-term antidepressant usage (8 weeks) in people with severe or moderate depression. Around 50% of patients have been taking antidepressants for more than two years, and the study tells us nothing about their effects over the long term. In fact, there is no evidence that long-term use has any benefits, and in real-world trials (STAR-D study) outcomes are very poor.
Lastly, and perhaps most importantly, the study does not bury the controversy around the damage caused by unnecessary long-term prescribing, the costs lost to the NHS, and the associated harms and disabling withdrawal effects these drugs cause in many patients, which often last for many years.
Overall, the study’s findings are highly limited, and do not support increasing antidepressant usage. Antidepressants are already being prescribed to around 10% of the UK population, and current guidelines do not even support their use by at least one-third of these patients.
This study, and the media coverage that has accompanied it, will unfortunately do nothing to help reduce this level of unnecessary prescribing and the consequent harms.
So the Psychiatric Technocracy rolls out the usual tired old propaganda again. After the school shooting in Florida I’ve seen a lot of people questioning and listening to the possibility that so called “Anti-depressants” have been involved in the majority of school shootings. Liz Wheeler, a major Twitter personality who has a nation wide TV show tweeted “My 8 ideas to solve gun violence” which included the statement “Study impact of psych drugs” – https://twitter.com/Liz_Wheeler/status/966360116600582144 … The TRUTH is coming out and Psychiatry think they can apply the same tired old tactics to cover up and mislead. It’s not going to work because the cat is out of the bag. The evidence is in and the Psychiatric/Pharma drug cartel days are numbered. Good riddance to them when the fall.
When I heard on the news this morning, I was not convinced at all by what I was being told. The emphases was on ‘medicine’ and ‘scientists’, to legitimise their ‘putting to bed for once and for all’ claims.
I am not convinced especially if they are telling me that scientists have agreed but not given any factual data to support it. Interesting to find out who these experts were and connections with pharmaceutical companies!!
Come ask me and I will tell them if it works or not! Does anyone ever get cured! don’t think so, they start to behave differently, meaning loose their own identity, personality and self-worth.
Its really important for the Royal College and other experts that they respond in a scientific way, and they haven’t.
The data is substantial, but its not great. They have to use commercially biased studies, some very old, exclude people with psychosis or suicidality, evaluate at just 8 weeks, and use an old slightly dodgy rating scale.
Then they find that the majority get quite a bit better whatever you do, and actually, from a distance, you can’t really say there’s much in it between placebo and drug (SMD 0.3). Actually after allowing for non-blinding there may not be anything. The two distributions (placebo and drug) are almost the same. This is distinctly odd for starters.
The researchers either felt they needed a way to magnify the drug differences to come up with a league table of drugs, or they felt there was a genuine subcategory of people who physically did actually respond to the drug. So they looked at the most improved 18% and found 50%+ more drug users in there than placebos. But that is totally consistent with there being only a very small difference in the two distributions. Its surprising when you first see it but its true, a tiny overall difference magnifies at the tail end of these distributions. And actually they may have just identified super-placebo responders. They should start to realise something’s up when the the high side-effect drugs come near the top, and also that fluoxetine has mysteriously gone from top of the league in under 18’s to the relegation zone in adults.
The main effect is the placebo effect – its massive. The drugs may be a slight added push on top – or just so-called active placebo, but that’s not the main effect, which is undoubtedly placebo. The main effect of an antidepressant is placebo, in fact, it just might be the only effect, but, granted, there is a small extra push from the drug in these limited studies.
But then everyone seems to have a few drinks and lose the plot, with talk of “final answers” and “putting to bed”. Even the level headed David Taylor proclaims that they are “much more effective” (even the the researchers could only use the word “modest”, Prof Taylor). Well either I have completely misread the statistics or they have, and I’m quite happy to accept that somehow I have got Cohens SMD completely confused. But the fact that none of their statements, including the researchers, link back to to the study at all and they quote no figures whatsoever looks bad. At the very least, the researchers, the Royal College, and David Taylor need to explain how their public statements relate to the study.
I come at it from the point of view of wanting to learn the truth, whatever that might be, so I expect the Royal College to be scientific about it, otherwise what are they there for?