Good to see your back is in good enough shape to let you post, Philip.
Thanks for this - I am going to need more memory soon for all your great finds.
And here's one for you - now there are fluoroquinolone antibiotics, eeek!

I agree that this is a step in the right direction, but I do wonder, what else is there really to do at this time? I worry about getting diabetes, and family will support me in trying not to get it, UNTIL my psychiatrist wants to put me on drugs known to raise blood sugar and contain warnings to monitor it; then, they tell me not to worry about it and it's more important to get control of my OCD and panic disorder. I'm not arguing I NEED to get control of my disorders, but I'm scared as hell about getting diabetes, knowing how addicted to sugar I am, and the risks! Diabetes kills, or at least leads to major life changes to remain healthy.

I have not read the article, but that journal is not generally a reliable source of information. It is the house organ of a right-wing organization. See this post by Orac on Respectful Insolence for details:

http://scienceblogs.com/insolence/2006/03/journal_of_american_physicians.php

Hey Philip,

There is one thing I'd wish you'd touch on here. You say 11-30% of patients with depression or related conditions who take SSRIs benefited beyond the placebo effect on normal doses.

I really wish you'd describe what "benefited" means. Is it a score on a standardized instrument? If so, which one? And also, many really standard ones, the BDI for example, only look at symptoms in the past week. Does it mean they've gotten rid of the Major Depressive Disorder Diagnosis?

If it is a standardized instrument thing, do you think an improvement on the instrument translates to a real quality of life improvement.

Also, I am a little rusty on my statistics, and I would love it if you could talk about what an effect size means in practical terms. I know it is a measure in standard deviation units, and thus an effect size of 20% means the improvement was 1/5 of a standard deviation. I would love any kind of practical interpretation of an effect size.

Philip Dawdy responds: natalie, both the article author and myself are using the term broadly, whereas the studies themselves do not use consistent measures of benefit, so in this case benefits is a mix of 'response' to the drugs and 'remission from depression' and 'improvement in depression symptoms.'

Marilyn definitely has a point but read the article for yourself. Still I have to admit it's not the ideal venue for a point of view I support. It does appear to be a journal with an agenda.

"I know I'm far from the only reader of this article who appreciates the fact that some doctors are finally pressing for caution in the use of SSRIs and anti-depressants."

Finally!
It is about time.
I'm still skeptical.
I believe that once a year a researcher write something about it.
Last year, I believe it was on March, there was an article claiming the same.
The whole year passed and nothing has happened.
Ana

I often do not read comments on the site, so a number of readers may not see the comments below about the history of this journal. Given the information on wikipedia (and other sources), if accurate, there is good reason to doubt the review process at this publication. Given how commendable a job (I mean absolutely no irony with this) you have done of highlighting these issues within psychiatry journals, I really hope you choose to make mention of the journal's history in a brief follow-up in one of your own posts. I point fellow physicians to your blog and I think that including a reference to this journal without further qualification can make it easier for them to dismiss some of your other posts. One final point: we have clearly seen that "judging the paper on it's own merits" is not always as straightforward as it seems. Though the paper may be making a fair point overall, there are other articles that make similar (and more nuanced) arguments in more reputable publications. Given that you chose to highlight the paper in your blog, I hope you can invest the time, if at all feasible, to look more closely at this journal and post something about this in a brief follow-up post. Thanks.

None of the antidepressants or antipsychotics did anything for my anxiety. I've been off all medication since May and doctors just don't understand that this stuff doesn't work. A new doctor was all like "Which of the SSRIs worked best?" It's like, I've been off medication since May and there is no difference in a lot of my anxiety when I was on cocktails of antidepressants, antipsychotics, stimulants, amphetamines, benzodiazepines and a mood stabolizers than on no medication at all. SSRIs especially don't do anything.

I have been taking prozac 20 years off and on. Imagine my surprise at age 25, when I started prozac, that I started having suicidal ideation. At that time, this was long, long prior to their being any link. This is funny, as I was taking it due to depression. What it seemed to do, is speed up my thinking, so that suicidality got pushed very quickly into my mind, wheras, at my prior "depressed" self, the mind was dealing with things as they came along. Glad I didn't kill myself.

The other thing they don't tell you about anti depressants is that just being prescribed them can immediately make it impossible for you to EVER work in some feilds such as law enforcement or education. They need to start mentioning this so people can make an informed choice. One of my sisters friends got completely Fcked out of a promising career teaching English in japan like this.