Sunday, December 12, 2010

The drugs don't work, and yet they do

I've been busy lately and not able to focus much on the blog. My OLF (old lady friend) who I wrote about two posts ago got out of the hospital after three days and is bouncing around like a someone half her age. She was telling everyone she knew that she didn't need to go to the hospital and I did her no favor by taking her there. So, I read her the Riot Act, telling her that her symptoms were such that I would have been negligent if I didn't take her to the hospital. What I was trying to impress on her was that at her age, not having regular, reliable medical care isn't going to work for her much longer. She was having none of it.

This and pre-Christmas preparations have distracted me from being able to focus on cranking out a decent post. Here's what I was working on before I got side-tracked.

The Drugs Don't Work is the title of a 2009 article in Prospect magazine ("Good writing about things that matter"). I won't bore you with summary of the article, except to say that it's an in-depth review of "The Emperor's New Drugs," by Irving Kirsch, yet another book that claims that antidepressant SSRI's are worse than useless. While many of us are heartened that we finally are getting to hear the bad news about antidepressants and neuroleptics, when it comes to antidepressants, we also know that these kinds of meds work for most people. David Nutt, of Imperial College, who heads one of the largest departments of psychopharmacology in Britain says "Antidepressants work in clinical practice, and everybody knows they work."

We all know they work, due to something called the placebo effect, and we also know that while they in most cases are quick depression busters, they come with the price tag of side effects. (Peter Jones, psychiatry prof at Cambridge University, makes the astonishing claim in the article that no teenager ever committed suicide while in a clinical trial.) Kirsch's contribution is to point out that there cannot possibly be blinded studies on this particular class of medications because the clinical trial participants will quickly figure out if they are on an SSRI because they will be experiencing side effects.

The key to the placebo effect in clinical trials is expectation. People who believe they are taking the real drug are more confident that they are improving, and improve they will, even if they are on the placebo. The article explains that research shows the worse your depression, the more you will improve on an SSRI. According to Kirsch, as dosages increase in response to increasing depression, the side effects increase, too, making it more obvious to the patient that they are taking the real drug. So much for double blind trials.

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