Furious Seasons

October 27, 2009

Study, BBC Claim Anti-Depressants Work Instantly, 6 Reasons To Be Skeptical

That's right: A study in this month's American Journal of Psychiatry was written up by the BBC yesterday--not sure if there was a report on the radio or TV--and framed as establishing that anti-depressants work "instantly" to quote the BBC's headline. That would run counter to what most researchers and patients believe to be true (and plenty of studies have shown to be true) that anti-depressants take as long as several weeks to deliver a measurable effect. What Oxford researchers found was that depressed patients had a quick response to an anti-depressant called Reboxetine. They established this by measuring how patients' negative thoughts improved (using emotional recall kinds of tests) and found that negative thoughts improved within a few hours and even did so in healthy, non-depressed volunteers taking the drug.

"Dr Harmer said: 'We found the antidepressants target the negative thoughts before the patient is aware of any change in feeling subjectively.'
"'Over time, this will affect our mood and how we feel because we are receiving more positive information.'"

Michael Thase, a psychiatry professor at the University of Pennsylvania, called the finding possibly "paradigm changing."

We live in interesting times when researchers can claim an anti-depressant is "working" when a patient has no sign of depression symptom improvement. As usual, several skeptical thoughts come to mind.

1. You don't know you are feeling better but you are is one of the study's main conclusions. That strikes me as a dubious claim, especially absent any knowledge of how the patients and healthy volunteers fared over time. I mean, isn't the point of treating depression to treat depression and not get all wound up about emotional recall tests? To the degree that it might predict later response to depression treatment, the response might be interesting.

2. The choice of Reboxetine (brand name Vestra) is an odd one. A recent study found it the least effective of all the modern anti-depressants and the FDA has not approved it for use in the US (which tells you something) and it's not widely-used in Europe. Why the researchers didn't choose a more commonly used medication is beyond me. It really doesn't tell doctors and patients much in a clinically useful way.

3. The study is of a small enough sample size--31 depressed patients, 30 healthy volunteers; half of each group on active medication--to make its findings little more than suggestive and not the paradigm changer Thase claims. It's research that needs to be replicated several times.

4. I'm not buying that someone on Reboxetine identifying more faces (two more on average) on a facial recognition test than someone not on Reboxetine means that much in a real world way. Maybe I'm being too skeptical here, but it doesn't quite add up.

5. The study's two primary authors (Guy Goodwin and Catherine Harmer--interesting name for a doc) have oddles of pharma funding in their past from the likes of AstraZeneca, BMS, Lilly and so on.

6. For the BBC to generalize from results of a Reboxetine study that its findings apply to all anti-depressants is complete bunk and lazy reporting and editing. And that's pretty much what the article and its headline claim.

Posted by Philip Dawdy at October 27, 2009 12:05 AM

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Comments

The BBC were just stupid in saying the study claims that they "work instantly" - the study authors never claimed this, they merely found that the antidepressants cause cognitive changes.

No-one is saying that antidepressants improve mood instantly. except the BBC.

Re points 2 and 6, these authors have previously used lots of other antidepressants and found similar results. As you would know if you'd done your homework... Interestingly David Healy was an author on one of these papers - and as we know he's always right! (except when he said ECT is good...)

Re point 5 she's not a doctor, she's a neuroscientist again you'd know this if you'd read the paper

Posted by: Neuroskeptic at October 27, 2009 04:43 AM

DECADES ago, yes, DECADES ago, Irv Yalom AND Carl Rogers CLEARLY delineated a range of CURATIVE factors for psychopathology including depression. They did this in a scientific manner, based upon clinical practice - based research. What did these guys, as well as others, figure out? It almost doesn't matter, as much as this fact: this decades-old line of KNOWLEDGE can entirely account for these findings. In other words, the paradigm was changed in the 1970s. The headline should be: drug study supports the emotional-cognitive psychological model of depression treatment. *Medical science is late to the scene.* Another headline could be: why are biomedical researchers BLIND to an entire, huge, explansive, well-known body of research? I mention Yalom and Rogers because they are literally studied by anyone who has studied any mental health issues beyond psych 101. Yalom noted that psychotherapy can almost INSTANTLY provide relief through what he called "instilllation of hope." This is the kick-off to a parade of curative factors. This emotional-cognitive phenomenon is then known to be followed by cognitive style changes, as mentioned in this study, that have been well-explored by another host of embarrasingly well-known researchers: Beck, Ellis, Seligman, and other cognitive researcher clinicians. Seligman understands this so well that HE, and others - Nolen-Hoeksuma, etc., are able to PREVENT depression. That is how thoroughly this mental illness phenomenon is known. You can get online and find Seligman's "Attributional Style Questionnaire." This current study would have done well to use it. Bottom line: the authors believe this study supports the view that depression is a biologically based brain disorder that should be treated biomedically, by drugs, while I believe it supports the view that depression is a psychological phenomenon in etiology, and treatment. The drug delivers the "installation of hope," which Yalom and others know can be achieved WITHIN one psychotehrapy session, AND even merely by getting and appointment with a seemingly helpful therapist, which provides the entree for the parade of other curative factors.

Posted by: MedsVsTherapy at October 27, 2009 06:50 AM

What a fucking cheek! Of course one can lead a person from a negative thought process to a positive one, but it doesn't take a fucking drug to do that. In fact, negative thought processes are remarkably superficial, as are positive ones... The default position is in the middle, somewhere.

Provided a patient's quack has reasonable communication skills, they'll have a greater impact than the snake oil remedy they're prescribing, I should think. Efficacious "instantly"! Fuck off!

Matt

Posted by: Matthew Holford at October 27, 2009 07:08 AM

"Efficacious "instantly"! Fuck off!"

No-one said that. Read the paper, or fuck off.

Posted by: Neuroskeptic at October 27, 2009 10:26 AM

Neuroskeptic wrote:
"No-one said that. Read the paper, or fuck off."

I will do neither. And you know nothing.

Matt

Posted by: Matthew Holford at October 27, 2009 05:01 PM

Neuroskeptic wrote:
""Efficacious "instantly"! Fuck off!"

No-one said that. Read the paper, or fuck off."

Incidentally, oh Font of All Wisdom, the BBC said that, so get your fucking facts right.

Matt

Posted by: Matthew Holford at October 27, 2009 06:40 PM

MedsvsTherapy, your comment makes a whole lot of sense. Thanks for sharing your knowledge with me. Your blog looks like it's a wealth of information, too.

Posted by: Scott at October 27, 2009 06:54 PM

I too am skeptical of this finding, and wonder how much can really be made of it. But I also find the irony irresistable... this drug is a selective norepinephrine reuptake inhibitor. In other words, no effect on serotonin, right? Holy cow! How can any treatment possibly help us improve our outlook without jacking up our all-important serotonin levels? Which any modern talk show host, bartender or used car salesman can tell you are the key to avoiding depression?

The AJP editorialist Dr. Michael Thase dances around this the same way as the BBC did: by talking vaguely about what "antidepressants" have been shown to do. And unlike the average BBC reporter, he should truly know better.

Meanwhile, maybe reboxetine will be approved to treat the Irish Alzheimer's (wherein we are said to forget everything but our grudges...) Watch out for that BBC!

Posted by: Johanna at October 27, 2009 08:21 PM

"How to take reboxetine

* Always read the manufacturer's information leaflet, where possible before beginning treatment.
* Try to take reboxetine at the same times each day to avoid missing any doses. If you do miss a dose don't worry, just take your next dose at the normal time. Never take two doses at the same time.
* You may have to take reboxetine for several weeks before you feel the full effect.
* Do not stop taking reboxetine without speaking to your doctor first. It is important that you continue to take reboxetine until your doctor advises you to stop.
* Never take more than the prescribed dose. If you suspect that you or someone else has taken an overdose of reboxetine contact your doctor or go to the accident and emergency department of your local hospital at once. Where possible take the container with you, even if it is empty.
* This medicine is for you. Never give it to others even if their condition appears to be the same as yours.

http://www.patient.co.uk/medicine/Reboxetine.htm

Don't you love the exact science?
It all has already gone to far.

"I've been taking reboxetine for 2 weeks now, hoping that the side effects would lessen in this time but they havent. Even a small task like hoovering brings on hot flushes esp my head, it feels as though its going to burst into flames, increased heart rate, breathlessness, sweating profusely, nausea followed by extremely cold and waves of goosebumps. I've been unable to leave my house without someone with me so its easier to stay at home. I feel worse now than I've ever felt, more depressed despondant alone and for the first time, panic attacks and thoughts of 'whats the point of me being alive' have entered my head."

http://experience.patient.co.uk/discussion.php?t=934&sid=e176b595f5091e7cab595b31cf9cdcfd

David Healy affair:

" JC: Healy did not provide conflict of interest statements for the papers in which he made dubious claims for the superiority or reboxetine

"DH: I did provide conflict of interest statements for articles on reboxetine in Primary Care Psychiatry but the journal chose not to publish them, and I have otherwise conformed to conflict of interest policies for any journals in which reboxetine related material was published."

Do your homework and read more here:
http://www.ahrp.org/COI/HealyColumbia1005/Coyne.php
and research more...

"they merely found that the antidepressants cause cognitive changes."
Posted by Neuroskeptic at October 27, 2009 04:43 AM

Yes! Some patients cannot recover from these changes even after stopping the drug.

Posted by: Ana at October 28, 2009 02:56 AM

Fine, the BBC said that, which was just bad reporting. The researchers didn't.

I trust you'll be writing to complain to the BBC and reading the original paper with interest to find out the real story, in the near future.

Signed,
The Font of All Wisdom

Posted by: Neuroskeptic at October 28, 2009 03:06 AM

Neuroskept,
My turn:

FUCK OFF.

I have already seen BBC doing good stuffs like Panorama about SSRIs and also an interview at Hardtalk with Stephen Sackur accusing GSK of greedy during a program with a GSK spokesperson.

Posted by: Ana at October 28, 2009 04:35 AM

BBC has also produced the great Stephen Fry "The Life oo a Maniac Depressive."

I 'ill send an e-mail to them as I have already and also participated at "Have your saying".

It was funny and I love giving my brilliant inputs on the last important events worldwide.
They must be missing me a lot!

Posted by: Ana at October 28, 2009 04:38 AM

Wow!!!!!!!!
Just received an e-mail by the producer of "Have your saying" asking me why I don't answer anymore and begging me to come back.

Posted by: Ana at October 28, 2009 04:42 AM

Great discussions. Plus, rude name-calling. I second the nomination to ban ppl engaging in name-calling.

Posted by: medsvstherapy at October 28, 2009 06:57 AM

Font of All Wisdom wrote:
"...I trust you'll be writing to complain to the BBC and reading the original paper with interest to find out the real story, in the near future."

No. I wrote and complained that its "Health" pages included a definition of depression that perpetuated the chemical imbalance myth.

In any case, I already know (to my satisfaction), what works - further input is largely irrelevant!

Matt

Posted by: Matthew Holford at October 28, 2009 10:56 AM

MIND, the respected mental health charity, recommend a walk in the country as a means of lifting depression. Like MIND, I favour avoiding psychotropic drugs and their all-too-frequent, all-too-nasty side-effects. And I applaud the Hull University team led by Prof Irving Kirsch, who in February last year brought out this refreshing research finding: http://www.telegraph.co.uk/news/uknews/1579876/Anti-depressants-no-better-than-dummy-pills.html

Not very often doctors seek to reduce pill-taking!

My own pragmatic, drug-free suggestion for lifting feelings of depression is to avoid dieting and cut down on salt and salty food.

Posted by: Margaret Wilde at October 31, 2009 02:16 PM