Geez, that's really too bad, Philip. Here I was imagining you down in sunny AZ and instead you were stuck in the snow and sleet in Seattle. I hope things look up soon. I really do. The very best of luck to you in 2009!!!

Congratulations! I'm not at all surprised that this story was highly-ranked. You provide a steady flow of necessary information about the pharmaceutical industry that somehow doesn't surface elsewhere as much as it ought to.

Nevertheless, I'm writing to express my disappointment at the fact that this story isn't some crazy newly-discovered link between anti-depressants and boobs. Ah, well. Maybe in 2009.

Happy New Year!

-Becca (Trouble With Spikol Intern)

You're back!
:)
This is the article that brought me to Furious Seasons.
I did two comments:
João Assis Brasil writes on Apr 8th, 2008 4:35pm
João Assis Brasil writes on Apr 9th, 2008 6:27pm
João= John
LOL
Thanks the Lord I went back in April 9th! It was when I've found out that the "author" had a blog.
And here I'm.
Happy 2009.

My Snow Rant:

The Puget Sound area is the lamest, most ridiculous area to live in when it snows. I can add a rant to this: 3 hours to get home on the freeway when the storm hit from the airport, it was a nightmare with NOT ONE SNOWPLOW IN SIGHT. The I-90 was an ice rink. This is usually a 35 minute drive. Salt? sand? how about people in charge with brains!? Just like the Westlake Center tree lighting after Thanksgiving, sponsored by the electric company and the freaking sound goes out, the only person who had the microphone work was Nickels the Idiot calling the tree "green"!!

Now we have pot holes from hell, and those will be around until summer!

Anti-depressants and boobs? I thought this was an article about menopause!

Congrats on the WW stats, that's a good article.

Philip-

When I worked for Bloomberg our most read story from 98-2004 was about a guy from NJ who put is you know what in the vacuum cleaner and got it cut off. Michael Lewis wrote a nice piece about it. once upon a time.

So it's not all just boobs and sex- it's also related to males.

yeah but so far it's all women commenting on the boob story!

Maybe all of Philip's male readers like tushies?

The Turner paper in the NEJM was certainly important, but I would hardly say that it proved that antidepressants' efficacy were "wildly" overstated.

If you actually read Turner's paper (see Fig. 3), when the unpublished studies were excluded, the mean effect size of the antidepressants was 0.41, which is moderate, and when they were included, the mean effect size was 0.31, which is still moderate. Medications that have a moderate effect size as not "wildly" effective, but only moderately so. No need for rhetorical exaggeration here.

Regardless, other than that bit of semantic criticism, the study was highly important, and forced people in my profession to be much more wary of published results when sponsored by drug companies whose only agenda is maximizing their profits.

Take care.

dguller, i would consider a 30 percent overstatement of efficacy to be pretty darn wild.

Philip:

I think that it is important to look at the actual mean values. For example, what if I told you that there is a drug that increases one's chances of getting Exploding Finger Syndrome by 1000%. 1000% sounds like a lot, but what if the actual incidence of Exploding Finger Syndrome is 0.00000001%. A 1000% increase means that the new incidence is 0.0000001. Doesn't seem like much of an increase when you look at the actual incidence.

I would make a similar argument about the antidepressants. Yes, a 30% overstatement is important, but whether the overstatement is included or not, the effect size of antidepressants still averaged to about a moderate level. A moderate effect size is not "wildly" effective, except in the imagination of a drug company PR department.

Regardless, it is important that you are popularizing the overstated efficacy of antidepressants to a wider audience. The 30% increase speaks for itself without the rhetorical flourishes. :)

Take care.

Congratulations about the WW article, Philip!

Rhetorical flourishes? Welcome to the blogosphere dguller. We've been over this. You're editing a blog! There is an established culture man, the sooner you look into that the higher you score on cultural literacy, the less you concern troll, a win-win all around!

http://www.nybooks.com/articles/21013

Read it.
THANX!

dguller,
It would be great if you started a blog. Your clinical experience would be of great help to help prevent people being prescribed wrongly.
There are psychiatrists blogging and they are doing a good job.

TAKE CARE.
(great title for your blog!)

I think it's important to look at the fact that not one negative study was published, not one, and only a handful of the studies that gave a "questionable" result. And given the fact that clinicians are bending over backwards to avoid negative results you can bet the negative values in those negative trials were "vastly" understated, and that effectiveness throughout was probably "vastly" overstated. What does "effectiveness" really mean in an 8-12 week antidepressant trial? That someone has a little buzz for awhile and thus feels a bit better and answers a few more subjective questions with a positive response compared to the beginning of the trial. I resent the use of the word "effectiveness" in this context because in how many cases could it possibly be a dramatic change in circumstances and a true healing of the patient in question? An antidepressant is never going to do that.

What does "effectiveness" really mean in an 8-12 week antidepressant trial?

That's the question and the fact that negative results are not reported as you said Sara.

Since the eighties clinical trials have less to due with science and more to due with politics, economy and greed.
Lethal combination.
A drug that has killed five during clinical trials is on the market: Cymbalta.
FDA doesn't care post-market vigilance.

Sara:

First, it is untrue that no negative study was published. According to the Turner study in the NEJM, three negative studies were published as negative (two for Paxil, one for Remeron; total of 197 subjects), and five were published in a way that minimized the negative result (two for Celexa, one for Prozac, one for Remeron, one for Effexor; total of 663 subjects). You can find the information on Figures 1 and 2. That fact in no way justifies the lack of publication of the other 16 negative studies (total of 2,240 subjects).

Second, you are absolutely correct that the short-term trials that are solely designed to gain FDA approval are inappropriate to gauge the genuine efficacy or inefficacy of antidepressants. They are supposed to pass the lowest bar the FDA sets for drug approval, and there are a variety of methodological problems with them, as well. Better evidence exists in the studies that lasted a few months in duration, and even better evidence exists that shows subjects on antidepressants have a significantly lower relapse rate than placebo when the duration is extended beyond six months.

Third, I also agree that an antidepressant will not bring lasting improvement, except possibly in a minority of patients. The majority who experience depression have experienced a significant loss of something, someone or some conception of themselves, and need to integrate that loss into their new sense of self in order to find lasting improvement.

I believe that most of the benefit of antidepressants comes from the cognitive and behavioural changes that follow their use – e.g. becoming more active, interacting with more people, returning to work, reacquiring a sense of agency and influence in the world, etc. – and not from the medication per se, which merely gives depressed people a lift in mood, a boost in energy, and so on, that allows them to make the necessary changes in their lives. However, this is just my opinion, and I am unaware of any studies that I am aware of that have looked into this issue, but I would be very interested to find any! :)

Take care.

Flawedplan:

Maybe you're right.

Ana:

Great title for a blog! :) I'll keep thinking about it. Oh, and happy new year. :)

Take care. ;)

dguller,

I assume you that many people would be grateful if you started a blog of your own.
I'm not the first one to tell you to do it.
We are very anxious waiting for your blog.
But don't ever stop coming here, please.
You have to do your work.
I'm happy to know that your patients have cognitive an behavior changes due to antidepressants:
e.g. becoming more active, interacting with more people, returning to work, reacquiring a sense of agency and influence in the world, etc. – and not from the medication per se, which merely gives depressed people a lift in mood, a boost in energy, and so on, that allows them to make the necessary changes in their lives.

according to own words.
This is very good! I have some blog friends who are trying hard to adjust to antidepressants and are changing from one to another without success for years.
I know people who are in the same situation in the real world.
Some don't trust or are fearing their psychiatrists.
I hope, as you are just starting your career, you are one of those who have ideals. Those who want to change things in some degree.

TAKE CARE of your patients

I believe you are on vacations, aren't you?
I'm sure they are missing you.
First, you have already show how much you know.
Second, the relationship between patient and doctor is very important.
Third, you have answered so well all questions people have addressed you! It only displays the wonderful person you are.

Thank you!

TAKE CARE

blogspot.com is very good. User friendly. I know you will love it.
You can post once a week. I believe that next week it will not be possible because it seems it's been a long time you don't go to the office.
Your patients are missing you.
Specially those who are not eating. Don't let them starve.

I would read Guller's blog. Definately.

still waiting to see what part of Lenny Bruce's joke the male readers here like better-
though.

And a side note to Mr. Guller - lots of readers here on FS were motivated by Philip and other readers to start their blogs.

Ana:

Thank you so much for your kind words. :)

DGuller,
Not at all!

Susan,
Hope you are fine!
Unfortunately we will not meet on D Guller's blog.
I don't think I have too mush in common with D Guller's views on treatments.
I respect his views but it's not part of my ethos going to psychiatrists's blogs and flood their posts with my views.
I consider it disrespectful. I rather visit blogs that share my understandings and ideas.
I feel much more better this way and I believe this is what I have to do.

Phillip, I've been busy blaming the boys' breasts and mastectomies on Risperdal the ATYPICAL antipsychotic as opposed to the antidepressant, as it is obvious, visual, and disgusting. After the SSRIs got a black box warning, it seems that a thundering herd of psychiatrists switched kids over onto atypical antipsychotics - numbers now in the zillions. Also taking them are kids with ADHD and ADD. But their long term effect seems very unclear to date and the boobs becomes the most obvious and disgusting thing to point to.

I hope to use this gross example on the Hill where I hope to talk with Rep. Bart Stupak, who has called for a total makeover of the FDA. It would make my YEAR if the atypicals could get a black box up to age eighteen. Then what would the shrinks do? I guess they could switch to some other lethal drugs.....

D Guller...

Do you seriously think it is good for the mental health of vulnerable males to take SSRI's and develop breasts or as in some instances produce and secrete breast milk? (another known side effect)

Have you ever looked at the list of common side effect symptoms on the patient information leaflets of these drugs which you are promoting..
The side effects themselves would make anyone miserable ..
So to prescribe a drug like an SSRI, which is potentially going to increase the chances of an individual developing sexual problems, agitation, anxiety , worsening depression, suicidal thoughts and aggression etc , how is that beneficial ?
How are those side effects going to help an individual whose self esteem is already non-existent? ..

I think you are more genuine than most psychiatrists ..
But also I think that you are as blind sided to your SSRI medication regimes as your patients are spell binded by their "effects"..

Of course by tinkering with someone's serotonin system you would get a a change in mood..

But this change in mood is false, illusional and transient..
It does not change the psyche, emotional being, or address the root causes of why they became mentally unwell..

When ecstasy pills first hit the mainstream , people took them at raves because they released a flood of serotonin, endorphins and dopamine their brains... giving them a false sense of happiness... SSRI's work in the same way...
They give people a false sense of well being...
The SSRI agenda is not that far away from Huxley's "Soma" in "A Brave New World" ...
In fact, we are eerily close to it..

Before Ecstasy pills became illegal drugs, they were used experimentally by therapists in client sessions because the effect they produce is in fact closer to empathy than the ecstasy...

There is probably more known about the dangers of ecstasy than there is about long term SSRI use, the general population have been used as guinea pigs, and you and your profession have condoned it, promoted it, and in a lot of ways, profited from it..

It doesn't take much to write a script, but it does take much more to genuinely understand people's problems..
Maybe your profession should start doing that instead of attempting to turn the entire human race into drugged up zombies?

Unfortunately truthman, we know psychiatry is based on a medication based paradigm for treatment, and therefore, nothing will change.

Happy New Year, my friend truthman30. :)

truthman30:

"It doesn't take much to write a script, but it does take much more to genuinely understand people's problems.."

Amen.

I admit to being sceptical that antidepressants are an appropriate agent for people to use to make changes in their lives for the better. I also wonder if therapy conducted under the influence of antidepressants would really be getting at the core emotional issues that are necessary to discern for someone to make the kind of changes they need to improve their lives. It's my experience that antidepressants interfere with and inhibit constructive therapy in part by impairing judgment, causing emotional blunting and/or disinhibition, and other bizarre out of character personality changes.

I've experienced that dguller, the judicious use of drugs got the ball rolling in psychotherapy in my own life, enabling me to approach repugnant material directly and start working through it. Sara I don't know what therapy conducted under the influence of antidepressants would look like but it sounds ominous. But the drugs are not the "agent" of change in psychotherapy, the person is; which is why so many avoid it I guess.

"I also wonder if therapy conducted under the influence of antidepressants would really be getting at the core emotional issues that are necessary to discern for someone to make the kind of changes they need to improve their lives."

Sara,
This is a very important issue.
Fortunately I've started therapy before being prescribed.
After being on drugs I had to be very careful and know what was "me" and what was side effects but sometimes I didn't recognize a side effect or a withdrawal symptom.

"I also wonder if therapy conducted under the influence of antidepressants would really be getting at the core emotional issues that are necessary to discern for someone to make the kind of changes they need to improve their lives."

Great thought.My opinion: yes. If you recognize the depressogenic thoughts and behavior patterns, and circumstances, and change them to better, less-depressogenic, then you will get better.

However, my thought on a similar topic is that anxiety medications will interfere with psychotherapeutic progress. Behavioral and cog/behavioral interventions for anxiety problems generally depend upon a person getting into the threatening situations, feeling the freaky emotions, mastering (tolerating or reducing) them thru various strategies, and thus overcoming the anxiety problem. This works for fear of publ;ic speaking, flying, generally works for OCD problems, panic attacks, specific phobias like snakes, etc.

when you take an anti-anxiety drug, you quell the anxiousness, versus get into the anxiety and learn to master it. Many people actually have the range of things or situations that provoke fear start to take up more of the real-estate of their lives when on anti-anxiety. so, the anx meds can make you get worse, not better.

plus, you get the idea that you won't be able to [fill in the blank: fly, public-speak, etc] without the drug, so you lose confidence, and start restricting your social real estate. you retreat ever more. and various anx problems sometimes end up snowballing into -plus agoraphobia.

Great article for WW. My New Year's Eve was weird too, and I am in Arizona, where it was cold and rainy over Christmas. Hopefully January will be nice and you can make the trip down here. I'm from the upper midwest originally where they have lots of snowplows and use plenty of salt and sand. Still it can be treacherous. Anytime the temp went above freezing my dad would take the car to get washed to get the salt off of it. Definitely lived in the Rust Belt.

I hope you have a great 2009 and I appreciate your blog, which I just discovered a few months ago.