… in and that’s the kicker, ain’t it? I mean, lots of people are on them; but do the little buggers actually work?
The New York Review of Books (scroll down) has for awhile been the go-to place for essays by writers who question the utility of antidepressants for many (not all – some people do benefit from some antidepressants) of the people prescribed them; but obviously, as The Guardian‘s headline suggests, the subject – as vast stretches of Europe and America chomp down on them – is very much out there.
If the very question as posed seems to you outrageous, impossible, obscene, consider for a moment the way antidepressants are made. Not that you really want to know. It’s like the thing about how sausages are made. Better not to go there.
But let’s go. Let’s ask why Louisiana’s attorney general is suing Pfizer, maker of Zoloft. For $987 million. Or so.
Attorney General Buddy Caldwell claims Zoloft is barely more effective at treating depression than a placebo, but Pfizer has persuaded doctors and consumers otherwise…
Long before Zoloft was approved by the FDA, Pfizer knew it had “serious issues with efficacy” because in early Zoloft trials, the placebo group actually had better results, the state claims.
“These early trials showed that ‘placebo still seems to be the most effective group’ and that “there is still no striking evidence of beneficial drug effect with placebo often being the superior treatment,'” the complaint states.
“Nonetheless Pfizer chose to go forward in attempting FDA approval.”
The attorney general claims that to do this, Pfizer published only information that pertained to Zoloft efficacy, and suppressed conflicting studies.
Pfizer then engaged in a “ghostwriting program to misleadingly enhance Zoloft’s credibility,” the lawsuit states. [Note: Most American med schools have no policies at all on the practice of ghostwriting among their professors.]
… Louisiana claims that despite numerous studies that show that Zoloft is “no more effective than a sugar pill at treating depression,” Pfizer’s ad campaign included a large sales force that visited healthcare professionals on a routine basis, took them out to luxurious diners and events during which salespeople promoted Zoloft.
Laissez les bons temps roulez! And as for those sad sacks – let ’em eat expensive sugar pills.
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One more note: Pfizer will settle. A thousand million dollars is nothing to Pfizer. Cost of doing business.
October 31st, 2013 at 1:08PM
The short answer is psychiatry has worked itself into an epistemologic quagmire, and as a result we cannot really give a good answer. After the construct of depression was dumbed down in 1980, the stage was set for diagnostic inflation and rampant prescribing of antidepressant drugs. And it’s not just the work of Pharma. There is plenty of blame to go around, but I would single out the American Psychiatric Association.
There is no doubt much antidepressant use is futile. Here are some links:
http://hcrenewal.blogspot.com/2009/04/in-defense-of-psychiatric-diagnoses-and.html
http://www.ncbi.nlm.nih.gov/pubmed/22329467
October 31st, 2013 at 1:11PM
Yes – the futility is heartbreaking, but the waste of money and hope – and health – is angering.
Thanks for the links.
October 31st, 2013 at 7:58PM
how did this get going in Jindal’s state? that’s bizarre but kind of great in its own way, maybe it will start a national trend.
November 1st, 2013 at 6:44AM
Obviously, the way to go is with placebos.
You might be amused to learn that when I was in nursing school near Tel Aviv, placebos were referred to as “GMG”, short for “gornisht mit gornisht”.
November 1st, 2013 at 6:59AM
janet: LOL!
November 1st, 2013 at 3:43PM
jg, but sadly isn’t that the catch that you have to sell it as some-thing for it to take effect?
November 2nd, 2013 at 11:18PM
dmf- Not actually. Some research has shown that placebos are effective even when you tell the patient that he is receiving a placebo.
When I first started working in psychiatry, we’d use placebos for patients having anxiety attacks. The doctor would say to me “Give this person an injection of GMG” “The regular one, doctor?” I would ask, “Or the forte? The one we just got from Switzerland?”
“Give her the forte,” the doctor would say, and I’d draw up half a cc of saline for injection.
“Now this is going to hurt at first, ” I’d tell the patient, “but after a minute or two, you will feel just fine.” And that’s exactly what would happen.
November 3rd, 2013 at 6:39AM
janet: The Swiss formulation is the best.