The Trouble with Pharmaceutical Studies

The Trouble with Pharmaceutical Studies

What is the best way to research the effectiveness of anti-depressants?

 

 

The NYT often contains interesting articles and Op-Ed pieces about mental health issues and the current edition is no different; today’s online edition features an Op-Ed piece entitled “In Defense of Anti-Depressants.” The author Peter D. Kramers, mentions several instances in which doctors don’t even consider prescribing anti-depressants because they truthfully believe that anti-depressants have limited abilities to treat patients.

 

Peter D. Kramers argues that anti-depressants might actually have some benefits, but also explains why anti-depressants were vilified in the first place.

He cites a past scandal involving the New England Journal of Medicine. The journalpublishedseveral articles favorable to anti-depressants were published, while the articles and studies that appeared unfavorable to anti-depressants were not published. After the scandal broke out, doctors understandably started distrusting anti-depressants and their effectiveness to treat minor depression and other symptoms.

 

The writer then begins a complex analysis of the different studies testing the efficacy of anti-depressants and identifies some of the serious errors that researchers make in either attempts to get the results they would like or just by the nature of the studies themselves. One problem is that many of the research subjects in the studies are not actually suffering from depression at all, which makes it difficult to determine how effective a particular medication is in treating depression.

 

Another issue related to pharmaceutical studies in general is that certain kinds of studies yield different results depending on the particular problem. There are two basic kinds of studies: narrow and broad. Narrow studies work better with a specific problem, while broad studies seem to work better for those who are chronically ill.

 

Peter D. Kramers pinpoints another problem in medical research; some study fail participants to honestly state whether or not the medication (or placebo) has helped them or not. One way to combat this particular issue used by researchers is called a “placebo washout.” Researchers will provide a certain number of participants in any given study with placebos; after a period of time, if the participants taking a placebo report an improvement in their symptoms, they are subsequently kicked out of the study. Ironically, several doctors and medical experts later argued that using the “placebo washout” actually downplayed the placebo effect for medications.

 

While it’s definitely interesting to note the relative importance of the various study and research methods needed by pharmaceutical companies to gain FDA approval for their medications, I believe anecdotal evidence from actual patients suffering from unipolar or bipolar depression is also of value. I do know that different medications work differently on different patients, but most of the people I know who underwent severe depressions benefited more from the correct combination of medications than they did from anything else.

 

When the media just reports about the placebo effects of anti-depressants, it almost makes it seem like anyone taking anti-depressants is weak.

 

In fact, it’s just the opposite. As anyone who has suffered from a serious depression knows, only the strong survive. Seeking help is not a sign of weakness, but a sign of strength.