Wednesday, January 16, 2008

This is Why You Need A Psychiatrist

From today's Wall Street Journal, an article on how antidepressants aren't all they were cracked up to be: Antidepressants Under Scrutiny Over Efficacy. David Armstrong and Keith Winstein write,

"Since the overwhelming amount of published data on the drugs show they are effective, doctors unaware of the unpublished data are making inappropriate prescribing decisions that aren't in the best interest of their patients, according to researchers led by Erick Turner, a psychiatrist at Oregon Health & Science University. Sales of antidepressants total about $21 billion a year, according to IMS Health."

Actually, the issue at hand is that the pharmaceutical companies don't publish or make public the studies that don't show the results that will sell their meds. It's not a news release that we've suddenly realized that antidepressants don't always work. These are two separate issues. The WSJ article is based on a report in the New England Journal of Medicine, Selective Publication of Antidepressant and Its Influence on Apparent Efficacy, and it uses data on antidepressant studies to make this point. Okay, it's also about how antidepressants aren't as effective as the drug companies say they are, but this just doesn't surprise me. The WSJ article goes on to say,

"There is a view that these drugs are effective all the time," he (Dr. Turner) said. "I would say they only work 40% to 50% of the time," based on his reviews of the research at the FDA, "and they would say, 'What are you talking about? I have never seen a negative study.'" Dr. Turner, said he knew from his time with the agency that there were negative studies that hadn't been published.

There's someone out there who thought antidepressants work all the time? This is why people need psychiatrists, not primary care docs, managing their psych meds:

1) Even at high enough doses given for long enough (6 weeks), any given antidepressant may not work on any given patient. Or it may help with some symptoms and not others.

2) If one antidepressant doesn't work, another might.

3) If one antidepressant doesn't work, augmenting with a second medication may work.

4) As a patient suffering from Bipolar Disorder, depressed, moderate in severity, recurrent, said to me recently, "I think the therapy helps as much as the medicine."

I don't think it's news that a) anyone can write a prescription for Prozac and the patient may not get better, or b) this is complicated stuff.

The issue of the pharmaceutical agencies hiding their negative data is also not news. Personally, I think the legal penalties for withholding this information should be stiff enough to stand as a deterrent. You just don't hear of drug company CEO's in the cell next to Martha Stewart.