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Tilting at Windmills

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February 25, 2008
By: Kevin Drum

TALKING BACK TO PROZAC....A new meta-study conducted by Irving Kirsch of Hull University and five American and Canadian researchers has concluded that Prozac and other antidepressants in the SSRI family are essentially worthless. Compared to a placebo, they improved patients' scores on the most widely used depression scale by only 1.8 points:

The review breaks new ground because Kirsch and his colleagues have obtained for the first time what they believe is a full set of trial data for four antidepressants.

They requested the full data under freedom of information rules from the Food and Drug Administration, which licenses medicines in the US and requires all data when it makes a decision.

The pattern they saw from the trial results of fluoxetine (Prozac), paroxetine (Seroxat), venlafaxine (Effexor) and nefazodone (Serzone) was consistent. "Using complete data sets (including unpublished data) and a substantially larger data set of this type than has been previously reported, we find the overall effect of new-generation antidepressant medication is below recommended criteria for clinical significance," they write.

The complete study is here. I have no particular opinion about the quality of this study, and not really any special interest in SSRIs either. In fact, what really drew my attention was the range of news outlets that reported this news. According to Google News, here they are: the Guardian, the Independent, the London Times, the Telegraph, the BBC, Sky News, the Evening Standard, the Herald, the Financial Times, and the Daily Mail. In fact, it's getting big play from most of these folks, including screaming front page treatment from some.

So what's the deal? Why is this huge news in Britain, where most of the stories are making great hay out of the amount of taxpayer money the NHS is squandering on these drugs, and completely ignored here in the U.S.? The conspiracy theory version of the answer is obvious, but what's the real version? Do American newspaper editors universally know something that I (and their British colleagues) don't?

Kevin Drum 10:10 PM Permalink | Trackbacks | Comments (130)

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Comments

Yeah, they know who buys adspace.

Posted by: fredston on February 25, 2008 at 10:13 PM | PERMALINK

The English newspapers are real news outlets, and ours are just skanky placebos?

Posted by: Sparko on February 25, 2008 at 10:17 PM | PERMALINK

Psychiatry is a Nazi science.

Posted by: Tom Mapother IV on February 25, 2008 at 10:18 PM | PERMALINK

Without having looked at the results my first thought is that either:

A. The most widely used scale for depression is flawed.

B. There is great variability in the results of the drugs, such that many/most have a placebo effect while some are effective for certain patients.

A seems silly. B would indicate that antidepressants are overprescribed and that patients are not adequetely monitored. Most people that I know that have been on antidepressants have gone through a number of them to see how they worked, and were almost never tested afterwards. (Most of them met with a psychiatrist, but were not actually tested.)

Posted by: Saam Barrager on February 25, 2008 at 10:18 PM | PERMALINK

Wait a minute Kevin...I'm trying to remember something about Occam's Razor here...

Posted by: Augie on February 25, 2008 at 10:25 PM | PERMALINK

I find this hard to believe. I and several others close to me took various SSRIs at different points of our lives. Some made us worse, some did nothing but cause side effects, and eventually we found one that worked for us. If it is all placebo, why didn't that happen on the first one?

I'm not saying that there isn't a significant placebo effect for man, but there are many who failed to be helped by other drugs but are by a different one, eventually.

Posted by: Gore/Edwards 08 on February 25, 2008 at 10:25 PM | PERMALINK

1) don't put your trust in one study

2) Supposedly taking the SSRIs in combination with therapy works better than either one alone.

3) None of them worked on my depression...

Posted by: RepubAnon on February 25, 2008 at 10:33 PM | PERMALINK

Saam Barrager: There is also "C. Prozac is being massively over prescribed to people without real depression, for which the drug does nothing, and this swamps any real effect on actual depressives.

These days, it seems like Prozac gets given to anyone who has had a bad day.

Posted by: sburnap on February 25, 2008 at 10:33 PM | PERMALINK

Fwiw, I took Welbutrin when I was at a really, really low point.

I honestly believe it saved my life

Posted by: notmyusualnic on February 25, 2008 at 10:33 PM | PERMALINK

Seriously, you gotta try Prozac and clam dip.

Posted by: jerry on February 25, 2008 at 10:40 PM | PERMALINK

The Occam's Razor explanation: Tom Cruise got to the British press.

Posted by: Misplaced Patriot on February 25, 2008 at 10:44 PM | PERMALINK

I think sburnap is quite probably right.

Posted by: Gore/Edwards 08 on February 25, 2008 at 10:47 PM | PERMALINK

I'm not saying that there isn't a significant placebo effect for man, but there are many who failed to be helped by other drugs but are by a different one, eventually.

Not necessarily.

Depression can and does resolve itself. Before Prozac, most people who were depressed recovered without it. It's entirely possible that after a year or so of trying different drugs, the depression resolves itself and the effect is ascribed to whatever drug was being tried at the time. As to whether it's probable, I don't know. But I agree with others that anti-depressants are over-prescribed.

Posted by: Jennifer on February 25, 2008 at 10:48 PM | PERMALINK

Taking drugs for depression is, in the U.S., all vanity.

I had a friend who abused prozac, on the other hand, he loved it.

Placebo? So what am I to do about my dog's social anxiety problems?

Posted by: dontcallmefrancis on February 25, 2008 at 10:49 PM | PERMALINK

There's no conspircay. The media on both sides of the pond are doing what they always do. In the UK, they overdramatise a story for impact. In the US they downplay ignore a story if there's any possibility that it might have a meaningful impact.

Posted by: billy on February 25, 2008 at 10:52 PM | PERMALINK

It'd sure be a kick in the teeth to the researchers and British papers if Sburnap turned out to be right.

Posted by: ferd on February 25, 2008 at 10:54 PM | PERMALINK

I would guess that US Newspaper editors are on SSRI's and love them. I take 20 mgs of Prozac a day and am totally unconvinced by the study.

Posted by: Robert Waldmann on February 25, 2008 at 10:56 PM | PERMALINK

>"Saam Barrager: There is also "C. Prozac is being massively over prescribed to people without real depression, for which the drug does nothing, and this swamps any real effect on actual depressives."

Bingo.

Posted by: Buford on February 25, 2008 at 10:57 PM | PERMALINK

I've been on several SSRI's and have only been significantly helped by my current SSRI, Citalopram (generic Celexa). Psychological pharmaceutics seem to be a trial and error process on an individual level. If you had asked the effect of a previous SSRI I would have rated the effect low on the scale. And if you averaged them all it would significantly reduce the apparent impact of my current SSRI. To say though, that SSRI's "don't work" based on this study is disingenuous at best. Drug industries as rightfully the subject of a lot of media criticism but the media often tends to get carried away. See also the scare about increased suicide risk. But what happened when teenagers were prescribed less antidepressants? The teenage suicide rate increased.

Posted by: B from Big D on February 25, 2008 at 11:00 PM | PERMALINK

In the interest of accuracy: only Prozac and paroxetine (Paxil) of the listed drugs are SSRIs (Selective Serotonin Reuptake Inhibitors). Serzone and venlafaxine (Effexor) are serotonin-norepinephrine reuptake inhibitors, or SNRIs, with a molecular structure different from the SSRIs, and from each other.

Posted by: Zathras on February 25, 2008 at 11:02 PM | PERMALINK

The conspiracy theory version of the answer is obvious, but what's the real version?

What, it's a "conspiracy theory" that some people are selfish assholes, that some selfish assholes also happen to be in control of big industries or product lines, and that those people may not want their industries to go bottom-up overnight, so they sit on or even distort their way out of bad news?

Please, Kevin...

Isn't it well documented that this is what the cigarette industry did? Isn't this what we think Bush does with the Iraq war- they thought it was an oil goldmine, but they stepped in a turd instead? And plus they don't plan for the demise of our limited oil resources or environmental problems resulting from the use of fossil fuels because they just don't want their party to end?

I seem to recall a post from you about Frederosso this morning-- I got the distinct impression that you maybe thought the right-wingers are kinda right, and that we left-wingers need to be hemmed in by smart people who realize we just care about foreign borders to a fault. Try looking at reality and facing the facts that the guys on the other side of the aisle really are just nutty racists marching in lockstep stupidity.

Maybe you think you're not doing this, maybe you think with this post you're giving us the writing on the wall, but from my point of view it's just a little polite. Why don't you go whole-hog and spell it all out for people who would miss it without your help?

Posted by: Swan on February 25, 2008 at 11:03 PM | PERMALINK

Seriously, you gotta try Prozac and clam dip.

LOL It's really all about the ideal combination...

Posted by: Doc at the Radar Station on February 25, 2008 at 11:09 PM | PERMALINK

My wife was on Prozac for several years and let me put it this way - I could tell when she didn't take her meds. Unfortunately, it suppressed her sex drive and we had a sexless marriage for several years until her doctor finally agreed to change her meds. Now she takes a combo of Cymbalta and Welbutrin. AT first she just took Cymbalta by itself, but it seemed like it stopped working, so he added Welbutrin. She feels much better now.

Posted by: Pocket Rocket on February 25, 2008 at 11:09 PM | PERMALINK

This whole thing just reminds me of Brave New World and all those dystopian novels and sci-fi movies and TV shows. So much of that stuff came true, no? The visionaries of the past knew that the powerful were going to be pushing pills to us all sooner or later! But since when have the powerful been conscientious enough to be the kind of people you'd want recommending drugs to you? It didn't turn up much in the histories read by the George Orwells and the Aldous Huxleys and the Anthony Burgesses, that's for sure. But if you raise a couple of generations of Americans more or less in middle-class safety, we all kind of say "Yeah, right" while we're reading those novels until we find it's us on the spit roasting in the fire.

Anyway, all those rich kid execs running things-- God forbid they have to look like a bunch of losers because their whole pill company turns out to be selling duds. That sure doesn't make you look like Max Power when you show up at a cocktail party. So we all have to pay the price for it. "In Pills we trust."

Posted by: Swan on February 25, 2008 at 11:10 PM | PERMALINK

My wife strongly believes her meds have helped her a lot. I don't argue with her, she seems better.

But I have noticed that all people, myself included, are quite suggestible, and are helped a lot with only a sugar placebo.

Who knows for sure? "Science" by statistical medical study ain't physics; ever notice how often yesterday's dead-serious certainties about what's good or bad for you are flip-flopped?.

These drugs are strong, they're really quite new, and despite all the soothing reassurances from industry-financed experts, we really don't know what SSRIs are going to do to people's brains over the long run.

My wife is a grownup. But I wish she would stop. I've got some colored sugar pills.


Posted by: Joey Giraud on February 25, 2008 at 11:11 PM | PERMALINK

I almost died of depression and was saved by meds. I currently take Paxil, which allows me to live a normal life. I hate these studies and these reports. The Brits are much more opposed to the medical treatment of mental disorders than are Americans. I'm not surprised it's getting a lot of play there. But not because their journalists are more reliable than ours in this instance.

Posted by: Susan on February 25, 2008 at 11:12 PM | PERMALINK

I got this from the new article:

The only exception is in the most severely depressed patients, according to the authors

Which supports those who say it's the over prescribed population washing out those that need it. So maybe it didn't get picked up because "NEWSFLASH: Antidepressants are over prescribed!" is less a interesting and groundbreaking story than "NEWSFLASH: Dog chases cat, licks self."

Posted by: Mo on February 25, 2008 at 11:13 PM | PERMALINK

"Seriously, you gotta try Prozac and clam dip."

Oh wow, together?

Posted by: Roland Burton Hedley III on February 25, 2008 at 11:14 PM | PERMALINK

"I almost died of depression and was saved by meds."

Did you really almost die, or are you being dramatic?

Look, I'm sure you felt better after taking the pills. And it would be cruel to try to break the bubble of belief that's made that possible.

So never mind my first comment.

Posted by: Joey Giraud on February 25, 2008 at 11:21 PM | PERMALINK

Taking drugs for depression is, in the U.S., all vanity.

It takes a special kind of asshole to write something like that.

Yeah, I, like others that have commented, know plenty of people who have responded quite dramatically to SSRIs. Clearly they work in a lot of cases. Don't know what explains this study's findings, but a conspiracy theory ain't it.

Posted by: Saul on February 25, 2008 at 11:21 PM | PERMALINK

I wonder what would be revealed by looking carefully at this. I was in a position where I knew a fair number of people who were depressed and had tried antidepressants and almost all of them were dramatically helped by the drugs. Yes, I understand the difference between stories and data, but there are thousands of examples of people nearly suicidal who have got their life back by one or another antidepressant.

I suspect there is something very specific about the claim being made that isn't at all what we think is being claimed.

Posted by: JohnN on February 25, 2008 at 11:26 PM | PERMALINK

Two points.

First the 1.8 point improvement may be less than the 3 points arbitrarily defined as clinically significant but it is statistically significant and in the right direction. So the drugs are helping.

Second the drugs are being compared to a placebo not to no treatment. It is likely the difference compared to no treatment would be greater and it is unclear how in the real world you would prescribe a placebo.

Posted by: James B. Shearer on February 25, 2008 at 11:31 PM | PERMALINK

According to this book:

http://www.amazon.com/Medicine-Culture-Revised-Lynn-Payer/dp/0805048030

American doctors are more pro-drug than English doctors. The English pay more attention to potential drug side effects as well.

Posted by: lemmy caution on February 25, 2008 at 11:34 PM | PERMALINK

Prozac is a life saver...

Posted by: Obamazooid on February 25, 2008 at 11:35 PM | PERMALINK

"Prozac is a life saver..."

Really, which flavor?

I like the lime ones.

Posted by: ahoyhoy on February 25, 2008 at 11:39 PM | PERMALINK

I don't understand the people in this thread who talk about a meta-analysis as "just one study." It ain't. One interpretation of many studies, maybe. But the authors say something interesting right off the bat: "Meta-analyses of antidepressant medications have reported only modest benefits over placebo treatment...." That suggests they aren't the only people who've reached the same conclusions. But this is the first time I've seen this information splashed all over any country's newspapers....

I know one side-effect of SSRIs is that, in some people, they increase depression, and wonder if that group's depression spike is so great it nullifies the group the drugs actually work on (assuming said group exists). I'm too lazy to pore over all the stuff it would take to figure that out.

As an aside, if you really want to get into conspiracy theories, spend a day or so researching the efficacy of statins.

Posted by: MG on February 25, 2008 at 11:43 PM | PERMALINK

I took Prozac over a period of three years. For the first six months it worked great, then the effect tapered off to almost nothing and never returned.

It was a bit difficult to get off of, since stopping the medication made me feel worse. You have to taper off slowly. So my assessment was that it works for a while, then doesn't.

But even six months of effect might be of some value to get one through the a portion of a depressive period. After all, it's not uncommon to get over a depression in less than a year anyway, so if Prozac can scrub six of those months, there's some value. But on the whole I'm a bit skeptical of the drug's effectiveness.

I'd have preferred that my doctor could have prescribed me a bunch of Quaaludes and Preludin. That would have lifted my depression and made me feel quite good. But alas, the definition of "freedom" does not include the freedom to have fun drugs.

Posted by: Jonesy on February 25, 2008 at 11:46 PM | PERMALINK

Oxford University is the home of meta analysis. Basically, the larger the dataset, the better, to the point that quantity has a quality all its own (that phrase evidently came from Stalin with reference to beating the Germans, but it works exceedingly well for statistics). Oxford researchers including Doll and Peto got the meta-analysis wagon going.

All this has led to evidence-based medicine (check the Bandolier website for an intro).

I suspect American reporters are less familiar with this approach.

Posted by: David Martin on February 25, 2008 at 11:46 PM | PERMALINK

From a scientific point of view, "try it and see if it helps" is not a remotely legitimate methodology, not only because there's no way to exclude placebo effects, but also because there's no way to tell if any improvement you see might not have happened anyway. However from what I can see this is the way a hell of a lot of pharmacology gets administered.

Unfortunately there's probably no way around this, since individual humans and drugs interact in unpredictable ways.

it is unclear how in the real world you would prescribe a placebo.

However if you could figure out a way to do it you could save an immense amount of money. Of course with the internet there's probably no way to keep secret the fact that some drug or other is just a placebo, which is what you'd have to do to make it work.

Posted by: jimBOB on February 25, 2008 at 11:48 PM | PERMALINK

On my sentence beginning "I almost died." I had severe depressions at 16, 18, 20 and 24, which progressively got worse and included anxiety disorder that kept me from sleeping. When I went on the meds, I could sleep; that was the first step. After a month my mood improved. I still needed lots of counseling. That was over 20 years ago. When I went off the meds 10 years ago, I went back into the anxiety disorder, which would have triggered depression (even though there was nothing "to be depressed about").
So it's not a belief system.
I can believe that the meds are over-prescribed, but I can vouch even more that when they are needed, they often work amazingly well. (I won't use the word "miracle" because that will be considered too dramatic!)

Posted by: Susan on February 25, 2008 at 11:49 PM | PERMALINK

With regards to the press interest point you raised, you just observed the global media cycle at work: British papers go to press hours before their U.S. counterparts. Do the same search tomorrow morning and you'll see the story travel through the time zones to the U.S. editions. Or not. But at 10:10pm in New York, most U.S. papers have not put their next day's issues online yet, and thus nothing yet in Google News.

Posted by: anon on February 25, 2008 at 11:58 PM | PERMALINK

dontcallmefrancis:

You say you have a buddy who abused Prozac? It couldn't have done much for him. Antidepressants are not controlled substances; there's no risk in a person becoming addicted to them for effects other than their intended purposes.

Has ANYONE here ever, ever heard of someone being addicted (in the user in need of rehab way) to antidepressants?

I'm not entirely objective when I say my opinion of antidepressants (SSRIs or other) is that they are a viable tool (in conjunction with talk therapy) to overcoming one's depression. Is it just me, or do we seem to be regressing here when talking about depression, mental disorders, psychiatry, psychology, and et al as some ignis fatuus? We mustn't overlook that both psychology and psychiatry are, comparatively, infant fields.

And if one pill or another, placebo or drug-laden miracle drug, actually benefits the user, then why not? Whatever gets you up in the morning.

Posted by: Amanda on February 26, 2008 at 12:03 AM | PERMALINK

anon: it's only a five hour difference. When you look five hours later and don't see the stories in the prominent East Coast papers, will you change your mind?

The drug industry buys a lot of ads.

Posted by: Joe Buck on February 26, 2008 at 12:04 AM | PERMALINK

However if you could figure out a way to [prescribe placebos] you could save an immense amount of money.

Not to mention, no side effects!

In one of the many novels written about the characters in Star Trek, Mr. Spock casually mentions to McCoy that the entire medical system on the planet Vulcan is based on placebo.

I wonder if any scientists (psychologists? sociologists? philosophers?) have ever thought seriously about how such a system might be designed. We know the effect is real, otherwise it wouldn't be used in clinical trials as a control, rather than no treatment. There ought to be a way to harness it.

Posted by: Swift Loris on February 26, 2008 at 12:13 AM | PERMALINK
anon: it's only a five hour difference. When you look five hours later and don't see the stories in the prominent East Coast papers, will you change your mind?

The drug industry buys a lot of ads.
Posted by: Joe Buck on February 26, 2008 at 12:04 AM

Kevin has already said there's a "conspiracy theory" version, and a "real" version, so I don't know why some of you are arguing this. It's already been settled, and by arguing the "conspiracy theory" side, you're throwing all your credibility away and looking like a Dirty Fucking Hippie, which is the Worst Thing That Could Possibly Happen. You have to distinguish yourself from the rabble.

Posted by: MG on February 26, 2008 at 12:16 AM | PERMALINK

I see some interestiong things in the data [Table 1 of the PLoS paper]. The authors found a significat improvement in the measure of depression in 11 of the 35 pooled studies that used the drug and in no case was there a significant decrease in the depression measure. In addition there were 9 studies that were close to significance [lower confidence interval greater than 0.90]. The placebo groups showed that there was a significant worsening of the depression score in 4 out of the 35 while there was no case of improvement. In addition there were 4 studies that showed close to significant improvement in depression - and in all of these cases the drug group was close to or beyond the significance level. There were 8 studies that showed nearly a significant decrease in depression measures [upper confidence interval less than 1.1]. On a qualatiaive level, there appears to be a trend towards moderate improvement in the active-drug taking groups and a more curious small trend towards depression worsening in the placebo groups.

If one compares the results between drugs, the SNRI, venlafaxine [Effexor], appears to have a slight advantage - improvement seen in 4 0f the 6 studies reported.

In no case of the 35 trials was there a totally slam-dunk case for improvement in depression. All of the significant improvements seen. The highest lower confidence interval was 1.29.

All of the trials lasted 4-8 weeks. Most psychiatrists feel that there is a minimum of 2 weeks before any effect is noticeable. Unfortunately, the tables didn't show the length of the individual studies, so no information can be gleaned from the differences in length. I would say that longer-term studies need to be reported for comparison.

-- from someone on Cymbalta and Bupropion [generic Wellbutrin]

Posted by: natural cynic on February 26, 2008 at 12:18 AM | PERMALINK

Swift Loris

I remember reading an article some years back advocating harnessing the placebo effect.

I think the only way to do it is covertly; the whole effect depends on those taking the meds believing in their efficacy. If they knew they were inactive the pseudodrugs wouldn't work. Also, doctors prescribing the placebos would have to lie to their patients (unless you could devise a way for them to be hoodwinked as well). I'm guessing many doctors would have a real problem with that.

Of course maybe this is already happening. Maybe statins don't really work - the clinical support could be all faked and everybody taking them is just contributing to a huge scam.

Posted by: jimBOB on February 26, 2008 at 12:23 AM | PERMALINK

I'm sure the Scientologists are behind it all.

Posted by: stand on February 26, 2008 at 12:26 AM | PERMALINK

Also, if you're bringing up Star Trek, recall that the very sexist episode "Mudd's Women" had a placebo-only drug as a major plot point.

Posted by: jimBOB on February 26, 2008 at 12:27 AM | PERMALINK

Interesting how people who have never suffered from clinical depression are convinced that the drugs don't work, whereas people who have had depression are convinced that they do.

You'd think that the people who actually have the condition would be more credible when they talk about what has or hasn't helped them, but apparently never having had the disease now makes you an expert.

I am now prepared to counsel all diabetics on how to manage their disease. After all, all you need to do is not eat sugar and you're fine, right? It's not like you have to monitor your blood sugar levels or constantly adjust your medication or watch for complications or anything. It's not like there's any difference between a chronic disease and an acute one.

Yes, I take Wellbutrin and it's the only thing that allows me to hold down a job.

Posted by: Mnemosyne on February 26, 2008 at 12:36 AM | PERMALINK

Jennifer, you need to do some more research if you think depression is just something you get over in time. Yes, there is short-term acute depression, but there is also chronic depression that has nothing to do with one's external circumstances. There is a proven link between, for instance, aging and the reduction in one's seretonin levels. Not all people are affected, or sometimes it's genetic. I get so sick of people who just paint an illness with some broad brush, just because they don't have it.

I have witnessed near miracles of improvement in people's lives due to the right SSRI at the right dose (and yes, supplemental therapy accentuates the effect) of all ages, young and old.

No, not all SSRI's are created equal and some have no effect for some people, whereas other classes of ADs can help. And it's very common for the effect of a single kind of AD to lose its efficacy over time and a different one is required.

Posted by: CB on February 26, 2008 at 12:41 AM | PERMALINK

Interesting how people who have never suffered from clinical depression are convinced that the drugs don't work, whereas people who have had depression are convinced that they do.

Fallacy of the (many) excluded middles.

Are you seriously (yes, since you're the Mnemosyne I know that of course you are) suggesting that no one that has been prescribed an SSRI thinks they are valueless? Or that that's not some significant number of people that think they do nothing for them?

I've been prescribed several SSRIs -- they did nothing for me. I think that's possibly evidence they are vastly over prescribed and/or that for some people with clinical depression, the SSRIs, they do shit.

You'd think that the people who actually have the condition would be more credible when they talk about what has or hasn't helped them,

This is the fallacy of sampling on the dependent variable.

but apparently never having had the disease now makes you an expert.

Apparently you think that arrogance and snark is all it takes to makes you right.

Go on Mnemo, shout down anyone that disagrees with you.

Posted by: Johnny Five on February 26, 2008 at 12:50 AM | PERMALINK
Also, doctors prescribing the placebos would have to lie to their patients (unless you could devise a way for them to be hoodwinked as well). I'm guessing many doctors would have a real problem with that.

A conspiracy theorist would say that doctors are already hoodwinked, and have never seemed to complain all that much as long as the checks keep cashing. If I remember correctly, pharmaceutical companies spend something like 80% (40 billion bucks or so) of their marketing budget directly on doctors, and spend twice as much on marketing as they do on R&D, and that was a few years ago when I last looked it up -- growth of the figures had been accelerating for ten years then, so who knows where they are now. Unfortunately, I don't know what the "real" explanation for this is; perhaps Kevin could earn some credibility by explaining it.

Of course maybe this is already happening. Maybe statins don't really work - the clinical support could be all faked and everybody taking them is just contributing to a huge scam. Posted by: jimBOB on February 26, 2008 at 12:23 AM |

The frightening thing about statins is the data aren't faked. The drug companies don't even bother. No need to -- they just spend, spend, spend on marketing. Didn't Dr. Jarvik look so damn sincere when he was pushing those things on TV? And those bastards in Congress took this altruistic gig away from him.

Posted by: MG on February 26, 2008 at 12:55 AM | PERMALINK

It's well known in medical circles that you are more likely to prescribe a drug when it's new. There's a placebo effect that produces hope in the scientific community and among patients. Prozac seemed to work well in the beginning and it can be useful, although it's probably over-prescribed. It's easy for doctors to hand out pills and many patients prefer to go for the 'quick-fix' pill rather than discuss their problems

Posted by: bad credit credit cards on February 26, 2008 at 12:58 AM | PERMALINK

Day in and day out, the British press is far superior. Draw some conclusions please if you would.

Posted by: anon on February 26, 2008 at 1:02 AM | PERMALINK

I suffer from pretty severe Obsessive Compulsive Disorder, and Prozac has significantly improved my condition. It does suppress the libido somewhat, and that is an issue.

BTW, I urge all posters who think depression just clears up or that taking drugs is just vanity to please, please take mental illness issues more seriously.

Posted by: Joe on February 26, 2008 at 1:03 AM | PERMALINK

My wife is a psychiatrist who practices both talking therapies and pharmacological ones. She has observed for years that SSRIs can, indeed, be life-saving drugs, but she has also observed for years that their efficacy is greatest by far in those patients suffering from severe major depression. In other words her anecdotal experience is consistent with this report.

Are SSRI's overprescribed? Almost certainly - like many, many other drugs. But they are also an essential part of the arsenal of any psychiatrist who treats severely depressed patients.

Posted by: Fred from Pescadero on February 26, 2008 at 1:16 AM | PERMALINK

Antidepressants tend be looked at with suspicion, that they are some kind of "happiness pill" or that evil scientists are toying with the brain. These kind of man-should-not-play-God attitudes are more popular in Europe than the US.

Prozac saved my life, after three other drugs in that family (Paxil, Luvox, and Zoloft) had failed.

Posted by: Elizabeth Wurtzel fan on February 26, 2008 at 1:21 AM | PERMALINK

I sincerely believe that SSRI's can help some people, but those people also have to WANT to be helped and BELIEVE that the drug can help them. Placebo? Maybe. Maybe not. When it's you needing help, you really don't give a rat's behind just so long as it works.

I've had a life-long problem with depression. Spent a couple of years on Paxil. The most I can say about it was that it made me emotionally numb. I'm going through an absolutely devastating depression this past year, mid-forties hormone changes FTW! The only drugs that work on this seem to be the Psychedelics.

One pill makes you larger
And one pill makes you small
And the ones that mother gives you
Don't do anything at all
Go ask Alice
When she’s ten feet tall

And if you go chasing rabbits
And you know you're going to fall
Tell them a hookah smoking caterpillar has given you the call
Call Alice
When she was just small

When the men on the chess board
get up and tell you where to go
And you just had some kind of mushroom
And your mind is moving slow
Go ask Alice
I think she'll know

When logic and proportion
Have fallen sloppy dead
And the white knight is talking backwards
And the Red Queen's "Off with her head!"
Remember what the dormouse said

Feed your head
Feed your head

Posted by: arteclectic on February 26, 2008 at 1:27 AM | PERMALINK

Gore/Edwards has a great point. Why didn't the placebo kick on the the first anti-D tried? At the sane time, Jennifer is partially right. Jennifer forgot to mention, though, that like a physical illness such as MS that goes into "remission" but then flares up again, depression can do the same. To claim "spontaneous remission" of depression overstates the case, many times.

Personally, Celexa (generic) helped me with anxiety issues after losing my job 14 months ago and having to move from Dallas to a small east Texas town between College Station and Houston. I had tried OTC help, including 5HTP and trypotophan, but it wasn't doing enough.

Swift Loris: That Star Trek novel had a HUGE logic whole in it. If everybody knew the medical system was a placebo, well, then, it wouldn't work as a placebo any more. DUhhhh.

That said, the Guardian story showed that Big Pharma's ox is seriously being gored and they're not going to take it lying down.

After all, Lilly is marketing Prozac, under generic chemical name, as a pre-menstrual drug now.

Posted by: SocraticGadfly on February 26, 2008 at 1:33 AM | PERMALINK

Yes, but isn't the British press habitually going to give lots of play to lots of stories based on their scabrousness and sensationalism? God knows the American media is the pits, but the British press, tighter libel laws withstanding, is INFAMOUS for playing with the truth, playing with the facts, and just generally wallowing in the gutter.

The British press is like one big FoxNews round-the-clock police car chase video, with the addition of titties and soccer hooligans, and set before you with your morning juice (or whatever the lower orders consume).

The mediocre middle-class papers like the Evening Standard and the fallen and decayed Times wallow in a schizophrenic vision of a twee Ye Old England with contest entries and cream teas at manor houses, versus trendy pop culture stars. To show how tough and modern they are, the pea-brained writers, English versions of the snarky NYT writer what's-her-face, write whiny articles designed to take jumped-up celebrities down a peg, and talking about how really good shows and really good music are terrible, terrible, terrible.

Making a big splash about one study about pills is part and parcel with all of that. And did you hear that [name redacted, but it's Viscount Linley] had to get Scotland Yard to protect him from a blackmailer who supposedly had photos of him at gay-sex tryst??!!

The Times of London had lengthy articles in the Victorian age dealing with a shock-horror divorce case in the peerage and discussed all manner of deviant sexual practices, including coprophagy.

Posted by: Anon on February 26, 2008 at 1:46 AM | PERMALINK

One other comment on the study.

It's a meta-analysis, something about which many scientists are squeamish.

And, Anon, please tell us how you really feel about the British press! That said, you're not all wrong, at least, in your analysis.

Posted by: SocraticGadfly on February 26, 2008 at 2:00 AM | PERMALINK

I have to call shenanigans on this. As someone who has suffered with depression for a long time, I can tell you not all SSRIs are the same. Having been through four, the fifth actually worked for me. I'm talking a remarkable improvement.

I went from not being able to get out of bed, to being productive again. Moreover, when I quit smoking, I went from being depressed again, then having my dose upped to being ok.

If on the outside chance it is the placebo effect, I say fine. I have a quality of life I haven't had in years.

Posted by: dave on February 26, 2008 at 2:27 AM | PERMALINK

British quality press papers have much more consistently informative and well written editorial content than any others in the world with the possible exception or inclusion of the the Sydney Morning Herald. They seemed to be staffed with educated literate engaged people who know how to do quality journalism. As a token of this effort, I offer from the 26th edition of The Times a story not yet reported in Yankee papers: February 26, 2008, Mansion 'mistake' piles the pressure on Barack Obama... seems some of the money for OB's "house" came from an Iraqi sleazoid, one Nadhmi Auchi. I quote "A company related to Mr Auchi, who has a conviction for corruption in France, registered the loan to Mr Obama's bagman Antoin "Tony" Rezko on May 23 2005. Mr Auchi says the loan, through the Panamanian company Fintrade Services SA, was for $3.5 million. Three weeks later, Mr Obama bought a house on the city's South Side while Mr Rezko's wife bought the garden plot next door from the same seller on the same day, June 15."

So which American paper did the scut work on the house deal and published it? Tell me again, I didn't hear you.

Posted by: anon on February 26, 2008 at 2:48 AM | PERMALINK

"Not to mention, no side effects!"

The placebo effect works better when there are side effects. Sometimes in trials the placebo has a harmless but noticeable side effect so the patient will think they are in the treatment group.

Posted by: James B. Shearer on February 26, 2008 at 3:24 AM | PERMALINK

I Had a depression that darkened into obsessive thoughts about how to best do myself in. No heavy planning or reparation allowed on fictive suicidal jaunts because I spent most of my time clumped in bed reading politics. Had to keep the fantasies real. Maybe a flight off a catwalks on top of a Roman cathedral? I could feel the vertigo of the fall. I felt an urge to jump, I wanted to jump. I didnt, though. Observing these new vivid fantasies was enough for then.

In my saner times I would try to figure out how I could hide my suicide so my family would not catch on. My scenario was a trip to the Mexican Coast, which I love, playing in the beautiful water until exhaustion started to set in, and then swimming out using elementary backstroke, which uses very little energy, and can be swum while crying. Would I keep calmply swimming until I was exhausted? I didn't make the trip. Garish suicidal imaginings were pushed aside by plainer emotions. Black clouds of grief over what I had lost (mostly my doing) Re-tellings of the many moments I had pushed someone away to make a (hard) point. Cold breakups of relationships where I had no love to offer. The suicidal ideation wore off before the drugs kicked in. Some made my head fuzzy. Some neutered me. Some made me jumpy, ome made a noise like a train on a track inside my head. They didn't do much against the guilt, the blaming, the lethargy,the certainty that I was made wrong.

Did any work? Not really. Depression has brought in its pal anxiety and benzodiazopines do work for that. (course they're addictive).

Mostly, I learned to live with it. Don't be a bummer and let anyone know how bad you feel. Keep a job. Travel (not alone!) Read a lot. Don't sleep through weekends. Be funny at work. Keep in touch with family but don't say anything. Get that real human connection from your equally screwed up pothead girlfriend that you can, truly, understand as she wigs out.

And then slowly she the sickenss bit by bit and get better, regretting a big chunk of lost youth.

Posted by: tartar on February 26, 2008 at 3:26 AM | PERMALINK

There seem to be a number of specious arguments running through this thread, mostly from those who don't seem to have read anything but Drum's post.

First, academic research ranks a little higher than politicians. The researchers put their professional reputation on the line in print; politicians know we will forget tomorrow what they said today. So it's pretty snide to think they are skewing results for some preconceived agenda.

Second, the research says that for marginal to moderate depressives the results of drugs are unclear. They don't say the drugs have no value. The patients degree of depression is measured along with the result so they can isolate (within certain parameters) depressives of different levels and see the effects of treatments.

Third, the British have a healthy cynicism for most things, including medicine. There have been many articles over the years about (over-)diagnosis of ADD along with depression, etc., and the prescription of drugs to treat such, despite the fact it has not risen to the levels prevalent here. I went through my whole school life without knowing any fellow student on drugs that were not of choice. You can't say that today. What changed?

Fourth, this thread exposes the lack of comprehension and critical appraisal among some in the US. And this is an educated blog community.

All drugs are way over-prescribed. From antibiotics for viral infections to psychiatric cocktails. I always wonder why doctors don't have a placebo for prescription. After all, sometimes they work!

Posted by: notthere on February 26, 2008 at 3:34 AM | PERMALINK

They know that their wives, husbands, children would be completely insane without them and fit for the looney bin rather than a home. Believe me...

Posted by: Noneoftheabove on February 26, 2008 at 5:04 AM | PERMALINK

Why is this huge news in Britain, where most of the stories are making great hay out of the amount of taxpayer money the NHS is squandering on these drugs, and completely ignored here in the U.S.?

The answer is in the question. In Britain, health care is a public concern because it's publicly funded. If millions are being wasted on ineffective treatment, it's a direct issue for the taxpayer, and therefore front-page news.

The private health care systems of the US encourages Americans to think of treatments, expenditures, etc as individual, private concerns.

Posted by: Tracer Hand on February 26, 2008 at 5:41 AM | PERMALINK

The American papers got this right. The basic conclusion is that mild depressives only improve slightly if at all during the first month or two of treatment. Given the facts that mild depression is difficult to diagnose and that it is also difficult to pick the best medication and the best dosage, this is not big news.

Posted by: reino on February 26, 2008 at 6:54 AM | PERMALINK

I think I was overly-enthusiastic in my comments last night. I think I was alright except for my implicit assertion that big pharma may wield enough influence over the media to blackout a story like this. Of course, even the tobacco industry got a lot of bad press, in bits and pieces. If there's a media-corruption angle (what I still think Kevin wrongly calls a conspiracy theory) version to this story, it's much more likely something about the media self-selecting its stories. For two prominent recent examples, the media apparently self-selects its content to make Hillary look bad and Obama look good, and self-selects its content to make conservatives look good and to show off their arguments (this isn't to say, however, that Hillary never makes herself look bad or that the media doesn't spread fig leafs around to give itself the requisite amount of credibility before the masses of the uninformed and over-idealistic). In this case, the conservative media may feel that a big story about how a major corporate product is shit will contribute too much to populism right now. Despite the last comment (6:54 AM as I'm typing this) it's pretty conspicuous that America didn't want to discuss this story at all.

Posted by: Swan on February 26, 2008 at 8:17 AM | PERMALINK

Jennifer, you need to do some more research if you think depression is just something you get over in time. Yes, there is short-term acute depression, but there is also chronic depression that has nothing to do with one's external circumstances. There is a proven link between, for instance, aging and the reduction in one's seretonin levels. Not all people are affected, or sometimes it's genetic. I get so sick of people who just paint an illness with some broad brush, just because they don't have it.

CB, you need to check your assumptions at the door before jumping off on someone whose life experience you know nothing about. FWIW, I suffered from periodic bouts of severe depression over a span of 20 years. I'm still here, and I'm not depressed, and I've never been on an anti-depressant, excepting one time that I tried Wellbutrin and found that it made me too nervous to sit still, made my head crawl, and made it impossible for me to concentrate. Because I had already had to learn ways of trying to cope with the illness before Prozac was ever invented, after the Wellbutrin experience I decided I was better off unmedicated. So feel free to "get sick" of my observation, borne of personal experience...be my fricken' guest, pal.

Posted by: Jennifer on February 26, 2008 at 8:58 AM | PERMALINK

These news stories are likely as exaggerated as the claims of the manufacturers who push these drugs. One reason why the drugs work "no better" than a placebo is that they are utilized for people who don't need them and therefore cannot benefit from them in the first place. I would wager money that there is a class of patients who really do benefit -- but these patients are either hard to identify or, just as likely, no one tries very hard.

SSRI work by acting on a very specific chemical mechanism in the brain. If this mechanism is functioning correctly in your brain these drugs will never help you no matter how depressed you feel. If even 30% of the people taking these drugs don't have the problem they were designed to address, this is the likely result of any study aimed at judging the efficacy of the drug. It's not the fault of the DRUG; it's the fault of the PRESCRIBERS AND MANUFACTURERS who prescribe and market it as a "happy pill" instead of as a treatment of a specific biological mechanism gone awry.

I sometimes hang out on a chat board regarding infertility, and I can't tell you how many patients rant and rave because their fertility physicians won't agree to give them SSRIs for their infertility related stress. These doctors are ridiculed when, in fact, they are being good doctors by recognizing that stress and depression are totally different conditions.

Posted by: Barbara on February 26, 2008 at 9:01 AM | PERMALINK

Looking at the data it seems that one of the problems is that the press has confounded drugs that do work with drugs that don't and used the result to day that none of them work. Furthermore, fluoxotine appears to not have much benefit on people that aren't very depressed.

Overprescribed? yes, probably. Not worth trying on patients that are severely depressed? I don't think so. Depression has an observable effect within the brain. Anatomy changes, chemistry changes. These changes take away your ability to change your thoughts, to do rational assesments, and to change your neuronal structure. You can think your way into depression maybe, but you can't think your way out.

Prozac takes a long time to have its full effect. Getting its full effect requires that the depressed person be very disciplined about taking his or her meds, in spite of the fact that they can't perceive any immediate benefit. Missing two days a week will destroy any benefit. Are these issues controlled for in the studies cited?

Finally, the reason to be suspicious of a meta-study is that it's far easier for bias to creep in. There's no double blind protocol equivalent to the judgements made in combining the data. And yes, there are judgements.

Posted by: Doctor Jay on February 26, 2008 at 9:30 AM | PERMALINK

Dang, there are a lot of people on anti-depressants around here...

Posted by: rusrus on February 26, 2008 at 9:45 AM | PERMALINK

My life is a monument to depression. I'm pretty much demobilized by inner demons. And everytime I try an anti-depressant, I feel much worse.

What keeps me going is exercise. It's not only the cheapest anti-depressant but it's the only one with positive side-effects. If I skip a day, I notice it. If I skip two days, I feel like crap.

SSRIs are blunt instruments in a war against physical lassitude. You can deaden yourself so your body/mind's complaint is less evident. Or, you can live as you're supposed to: actively.

Posted by: walt on February 26, 2008 at 9:54 AM | PERMALINK

I was 57 when I first had a bout of clinical depression. No doubt in my mind that it came about because of things, but the number one thing was probably an absolutely necessary medication that I had to take fore a year. There was no doubt in my mind that the depression was of a clinical sort. I could just tell. It was as if someone I didn't know had taken control of my whole emotional make-up. In over half a century, I've had as many difficult times as most people, but just feeling like that was the worst. I fear going back to that dark place more than anything else, including death. I asked the doctor for anti-depressant and got generic Celexa. It didn't seem to be doing much after a couple of weeks. A friend who is also a biologist told me that the dosage I was on was too low to have any real effect. I asked the doctor about it and he agreed to up the dosage to the standard amount. In the next couple of weeks after that I started to get myself and my life back. If it was a placebo reaction, it would have worked when I didn't know that my dosage was low, don't you think?

Posted by: pat on February 26, 2008 at 10:01 AM | PERMALINK

walt, it's different for different people. I require 90 minutes of exercise per day at least 4 days a week to be productive. However, some depressive episodes are so bad that this won't help. That's why I keep a spare bottle of Lexapro in my medicine cabinet. It's not worth taking all the time to account for the possibility that, at some point, my body might need it, but we need to stop pretending it isn't helpful at all. At a certain point, we need to stop glorifying these debilitating depressive episodes. It's no way to live.

Posted by: ANoN on February 26, 2008 at 10:19 AM | PERMALINK

"A. The most widely used scale for depression is flawed."

I think this is the case. Read the definition for depression in the DSM. It is incredibly broad. This comes from the fact that a bunch of people sit around and vote as to what is pathological and what isn't, and what symptoms will fall under a particular name or concept.

At some point in time, we will get a more fine-grained analysis of "depression" and we will wind up many, many different kinds of depression (as opposed to the few we have now). Brain imaging will help with this.

Any good psychiatrist will tell you two things: a) that there clearly are many psychopathologies and b) they clearly react to all sorts of influences, including antidepressants. (You'll also get a third--that right now, psychiatry is much more an art than a science.)

Posted by: MattD on February 26, 2008 at 10:27 AM | PERMALINK

Whatever happened to putting on the headphones and smoking a joint?

Posted by: dr sardonicus on February 26, 2008 at 10:32 AM | PERMALINK

Btw, before there were SSRIs, there were tricyclics, and they're still more effective than SSRIs in treating depression. The reason why SSRIs caught on were a) fewer side effects and b) massive marketing.

There also are quite a few non-SSRI antidepressants. And, many people under the care of a good psychiatrist aren't taking just an SSRI; they are taking other drugs to augment the SSRI.

Posted by: MattD on February 26, 2008 at 10:33 AM | PERMALINK

Walt, exercise didn't work for my anxiety issues.

And, Tartar, speaking of that, why are you taking benzos for anxiety? Antidepressants can be very good for that.

Latest “Anon”: Perhaps not in as much depth as the Times of London, but the NYT mentioned Auchi here a month ago.

Posted by: SocraticGadfly on February 26, 2008 at 10:37 AM | PERMALINK

Socrates, I tried Buspar for anxiety. Absolutely no effect.

My experience is my own, of course. What I find interesting "out there" is that depression is not an issue in Third World countries. What is it about prosperity that makes people vulnerable to disabling depression? While I think we can speculate about too-much leisure time or the mechanization of our lives, it's clear that modernism isn't without its pitfalls.

We evolved in much harsher circumstances. We now live in a radically different environment. We ignore this obvious truth at our peril. Medicalizing this problem is an aspect of that problem.

Posted by: walt on February 26, 2008 at 10:55 AM | PERMALINK

These days, it seems like Prozac gets given to anyone who has had a bad day.

Perhaps true, but on the converse, depression is one of the most massively undertreated diseases out there. The majority of people suffering from depression will never even seek treatment, much less be given SSRIs or other medication.

Here's the paradox: if all you're having is a bad day, you're generally capable of going to the doctor and getting a prescription. If you're depressed, you're often not even functional enough to seek out and visit a doctor to get treatment.

Posted by: Stefan on February 26, 2008 at 10:55 AM | PERMALINK

Before Prozac, most people who were depressed recovered without it.

Well, except for the ones who killed themselves.

Posted by: Stefan on February 26, 2008 at 11:01 AM | PERMALINK

What I find interesting "out there" is that depression is not an issue in Third World countries. What is it about prosperity that makes people vulnerable to disabling depression?

That's not really true. People in Third World countries get depressed about as much as they do here, they just don't get diagnosed with depression. They certainly feel hopeless, sad, lethargic, anxious, etc. etc. about as much, it's just that without a diagnosis, they don't call what they feel depression. Lacking access to prescriptions and talk therapy, they also have to self-medicate more and so many people who are actually depressives instead present as alcoholics, drug addicts, etc., with their coping mechanism masking the true underlying illness.

Posted by: Stefan on February 26, 2008 at 11:19 AM | PERMALINK

Depression can and does resolve itself.

I am in the R D Laing camp, which means I think mental disorders are defenses of the mind to protect against abuse or pain derived from one's environment. I think the work of Milton Erickson supports this conclusion. Hypnosis works to solve many of the problems of depression; the solutions are based on the patients' life experiences.

My main objection to antidepressants is economic. They are not cures but maintenance drugs to be taken in perpetuity. Antidepressants provide a great cash flow, so there is an incentive to game statistics and overstate the positive and understate the negative effects of these drugs.

Doctors are also guilty of prescribing them based on flimsy evidence of clinical depression. I know of two people prescribed antidepressants who were not clinically depressed. One was on blood thinners that was making her depressed and the other was a teenager (18) having problems with an overbearing mother. The person on blood thinners explicitly asked the doctor for antidepressants, who prescribed them, and the teenager's girlfriend's mother, a psychologist, found a way to have Paxil prescribed to her daughter's beau. These drugs are too easily obtained and the patient's reactions to them are not properly observed, in my opinion.

Posted by: Brojo on February 26, 2008 at 11:38 AM | PERMALINK

I went to a fabulous party given by a pharmaceutical company touting their great work in anti-depressants once and was shocked at how poorly the pills actually did vs. placebo. They did tout that a mix of anti-depressants and other medication does do a significantly better job. But then again, that's their assessment. Take that as you may.

A huge factor here as well is that most people are not just clinically depressed, they are in fact bi-polar so the medication may not be the correct one in the first place, nor may the diagnosis of clinically depressed be correct.

Posted by: Julene on February 26, 2008 at 11:44 AM | PERMALINK

Having personal experience with the use of Paxil, I can tell you that if you need it you need it. I was prescribed the SSRI during a family crisis and felt a lifetime of social anxiety fall away. I am now on a very low dose and attempts to cut that dose in half result in a return of the anxiety feelings and severe insomnia that persists for weeks. I don't believe this is withdrawal, I believe it is evidence of the baseline dose that I require to function normally.

I realize this is annecdotal. I also believe that large trials are confounded by mixed diagnosis/response populations.

Just don't throw the baby out with the bath water.

Posted by: Lindata on February 26, 2008 at 11:55 AM | PERMALINK

I've never heard of any study comparing Third World depression rates to that of advanced industrialized nations. It seems obvious that depression does exist there, along with coping mechanisms like alcohol and drug use. Having traveled in places like Mexico and India, however, it seems far from self-evident that people there are as unhappy as we are. If anything, the opposite appears to be true.

I'm not opposed to drug use per se. Altering one's consciousness to make life more bearable doesn't seem in any way evil or wrong. What disturbs me is the expensive medicalization of depression. There's something a bit too convenient about prescribing costly drugs for nebulous problems. If we're really going to explore the entire issue of depression, we ought to enlist more than Big Pharma and their agents here. Exercise, nutrition, and simple social ecology need to be studied. I suspect the reason there won't be any extensive research here illustrates how corporate power overwhelms basic human needs.

Posted by: walt on February 26, 2008 at 11:56 AM | PERMALINK

One other complaint about antidepressants is the assumption people should not be depressed. Our society values productivity, so also values mental outlooks that increase productivity. Antidepressants are the pharmaceutical choice of monopolists for the workforce, which must be productively happy regardless of the environment. Antidepressants may be partly responsible for the elections of W. Bush.

Depression was once known as melancholy, and considered a source of artistic inspiration. That kind of art has been replaced by the works of Thomas Kinkade and Jeff Koons.

I do not want to belittle the depression of others. If antidepressants help them feel better, that is great. People should seek help for their problems.

Posted by: Brojo on February 26, 2008 at 12:23 PM | PERMALINK

If nobody's mentioned Scientologists previously, allow me.

Posted by: on February 26, 2008 at 12:28 PM | PERMALINK

Dr. S - tried that with booze - I ended up in AA (thankfully!)

I'm glad others wrote about their experiences with depression. When I first read this thread I was so angry I wanted to spit. To those of you minimizing the experience of depression - I truly hope you NEVER have to go through it. You have no idea.

I finally sought help 12 years ago. Believe me, I had NO interest in taking drugs. I came from a "bootstraps" mentality. Life sucks - so what - deal with it. After about 3 months that constant feeling in my gut disappeared. I didn't even know I had it until it was gone.

Are they over prescribed - probably.

I am VERY fortunate that I have been cared for by excellent an psychiatrist and therapists.

Posted by: mo on February 26, 2008 at 12:40 PM | PERMALINK
So what's the deal? Why is this huge news in Britain, where most of the stories are making great hay out of the amount of taxpayer money the NHS is squandering on these drugs, and completely ignored here in the U.S.? The conspiracy theory version of the answer is obvious, but what's the real version?

Follow the money.

Do American newspaper editors universally know something that I (and their British colleagues) don't?

American newspaper editors know that prescription drug advertisements are a major source of their salaries. Presumably this is less true in the UK.

Posted by: cmdicely on February 26, 2008 at 12:42 PM | PERMALINK

Related:
Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy

Posted by: cmdicely on February 26, 2008 at 12:49 PM | PERMALINK

Before Prozac, most people who were depressed recovered without it.

Well, except for the ones who killed themselves.

Posted by: Stefan on February 26, 2008 at 11:01 AM

Well, DUH. Why do you think I said "most"? But let's not be overly dramatic. The vast majority of people with clinical depression, medicated or not, never even attempt suicide, never mind succeeding at it. Then there are the ones who are on medication who both attempt and succeed. But tell ya what - if you have a point to make in regard to anti-depressants saving lives, get the data for suicides per 100,000 in the years pre-Prozac and the other drugs, and then get the data for suicides per 100,000 in the years since, and see if you find a measurable positive difference. I have no idea if you will or not, but on a hunch I'd say the numbers have probably stayed fairly constant.

FWIW, my original observation was that depression can and does resolve itself over time in most cases. This is indisputable fact, because people became depressed before the medications were available and recovered and many people still do recover without meds. Is it miserable while it's going on? Yes. Is it life threatening? For some, yes. Did I claim that there was no value to any of the anti-depressives? No, I merely speculated that it's possible that after a period of time trying different medications, the depression resolves itself and whatever medication is being taken at the time is credited. That was a speculation clearly stated, and to the best of my knowledge, no one has ever tested to see if this may, in fact, be happening in some or perhaps many cases. If you have access to data that clearly disproves or contradicts this hypothesis, please share with the class.

I think some people here could benefit from more closely reading what others have posted.

Posted by: on February 26, 2008 at 1:00 PM | PERMALINK

So the pharmaceutical folks won't be selling as much Prozac, etc., in the future? That explains why more and more suicidal pets are being prescribed anti-depressants.

Posted by: Bob on February 26, 2008 at 1:27 PM | PERMALINK

If you don't suffer from depression or aren't closely involved with - as in, "married to" - someone who does, SHUT THE FUCK UP AND GET OFF THIS FUCKING THREAD.

I swear to god, there is nothing that boils my blood faster than ignorant motherfuckers going "aren't you just being dramatic?" and the like. The disease is real, and incredibly debilitating.

The treatment works like this: drugs, therapy, exercise. And the problem is, the drugs usually aren't very good. And while Prozac works for person A, it might not work for person B. And it takes weeks, sometimes months to find this out. So , in order to find the drug that's right for you - if there even is one - it could take a year or more. An incredibly ugly, painful year. Or more. If you're really, really lucky, you find one that works a little. Enough to give you the breathing space to get into therapy. To exercise. To look at the sun.

Now, add in the wonderful world of American healthcare. IF you're lucky enough to find health insurance, you better not tell them you're depressed, or you're kicked to the curb. But as soon as you see a doctor, they can't prescribe fast enough - it's cheaper and faster than, you know, treatment, and hey, first one to make their quota gets to go on the Mediterranean cruise! Yay!

My point? Some of the drugs work some of the time. And as evil as the drug companies seem to the uninformed, the work they do occasionaly saves the lives of the people we love. Could the pills be better? Could the way they're distributed be better? Hells-to-the-yes. But, as I mentioned above, if you, your spouse or your kid doesn't have the disease, you do not know what you're talking about.
So shut the fuck up.

Posted by: cazart on February 26, 2008 at 1:28 PM | PERMALINK

A. The most widely used scale for depression is flawed.

I'll second this as well. Between the UK and the US there are easily half a dozen or more batteries of questions commonly in use for diagnosing depression. I have taken many of them, either in a clinical setting or out of curiosity, and I can confirm that they are all over the map.

Depression is manifested in a broad array of symptoms, and most of the tests are around 12-18 questions. So, if the questions don't happen to address the symptoms you are experiencing your diagnosis may portray you as better than you are. I'm sure the opposite is possible as well. In addition, most people who are prescribed antidepressants are getting them through their GP. They aren't seeing an actual psychiatrist. I think that explains a lot of the mis-diagnosis and mis-prescribing that goes on.

Posted by: Joe Bob on February 26, 2008 at 1:50 PM | PERMALINK

I am one of the people that Prozac has been a miracle drug for. I have multiple-generational depression, including a suicide in my great grandfather so it is primarily genetic. In our family, we are either drunks or depressed back to when we came from England in the very early 1900's. In this generation, it continues with my brother and his kids all being substance dependent and depressed and my sister and I are on low dose antidepressants. We have no biological kids. Mine are adopted.

My sister and I are highly educated and successful, happy and fully functional as long as we stay on the medications and go into counseling when we need it. Our parents were on medications and counseling for depression. One study does not a truth make! I am a specialist in suicide and suicide prevention and at the end of my career, in psychiatric nursing education.

Depression is NOT a character failing but a biochemical disease that has its etiology in the environment and in the biochemical nature of the person with strong genetic links in many. Sometimes counseling and a change in the environment is all it takes to change the biochemistry and sometimes it needs a booster from medication. Every person is different. What doesn't work well is a family doc writing a prescription and sending the person out with no counseling and no follow up! You can thank managed care for that stupidity. It is dangerous and flawed medical care!!!!!

Posted by: rain39 on February 26, 2008 at 1:55 PM | PERMALINK

Brojo on February 26, 2008 at 12:23 PM

Your comment portrays what I consider a trite view of what depression is. It's not bad moods, and it's not artistic temperament.

Likewise, taking antidepressants isn't the difference between feeling blue and being a happy office drone. It can be the difference between thinking about killing yourself every day, versus not.

Posted by: Joe Bob on February 26, 2008 at 2:01 PM | PERMALINK

Besides combining drugs of different classes, this meta-study doesn't factor the effectiveness of ADs when combined with other treatment options. Hard to pinpoint causation when (as is common these days), multiple treatments are tried at once.


I have a close friend who's recovering from severe depression (she spent weeks in a behavioral ward until the drugs kicked in). The meds (Cymbalta) seemed to help but her docs did throw the kitchen sink at the problem. She also has talk therapy, daily meditation, exercise, and taking of supplements: Omega 3, Folic Acid and vitamin B-12. These three seem to make ADs more effective.
http://www.usatoday.com/news/health/2007-03-06-aps-omega_N.htm http://www.ncbi.nlm.nih.gov/pubmed/15671130


Posted by: beowulf on February 26, 2008 at 2:15 PM | PERMALINK

Okay, ever so slightly OT, but wd like some input from what may be a cluster of depressive women/medical workers gathered here.

I had black-dog depressions from the onset of puberty (ages 13, 16, 18, 24 [hospitalized for that one], into my 30s). Tried suicide once. In my 40s, I found Paxil, which kept me on the up and up through menopause.

Then, after menopause, everything went away. 10 years, depression-free, despite some extraordinarily stressful events in my life.

Has anyone hear ever heard of instances of depression completely related to hormones?

BTW, for the last 10 years, Paxil was there for me. Do not dis the Paxil.

Posted by: Ellent on February 26, 2008 at 2:15 PM | PERMALINK

Yeah, Ellent, a relative of mine had super-bad depression - 2 rounds of ECT - but when she hit menopause, she improved radically. So radically, that she's actually starting to become one of those annoying "Why don't you just get over it?" people!

Proving once again that god has a very, very sick sense of humor.

Posted by: cazart on February 26, 2008 at 2:26 PM | PERMALINK

Why more reporting in UK than US press? Quite possibly because UK is justifiably less worshipful of psychiatry than the US. Psychiatry is the least scientific (an argument could be made totally unscientific) branch of medicine, which in its scramble to implement "evidence-based" practices admits that even non-psychiatrist doctors have always just winged it. Why do people think some 100,000 people annually in the US are killed by medical errors?

Posted by: Nemo on February 26, 2008 at 2:27 PM | PERMALINK

"Before Prozac, most people who were depressed recovered without it."

More likely, they just kept their heads down and persevered and engaged in all kinds of coping behaviors that were created hell on earth for themselves and their loved ones. If my father were still alive I'd introduce you to him. Believe, me his depression never "got better."

Posted by: on February 26, 2008 at 2:53 PM | PERMALINK

Are you seriously (yes, since you're the Mnemosyne I know that of course you are) suggesting that no one that has been prescribed an SSRI thinks they are valueless? Or that that's not some significant number of people that think they do nothing for them?

I'm suggesting that people who have never been depressed shouldn't be deciding that those of us who did need medication to get better are weak and stupid and have been snowed by the pharmaceutical industry into thinking that antidepressants help us.

I've been prescribed several SSRIs -- they did nothing for me. I think that's possibly evidence they are vastly over prescribed and/or that for some people with clinical depression, the SSRIs, they do shit.

I've never been prescribed an SSRI. Wellbutrin is classed as an atypical antidepressant. And yet I still have people on this thread saying I must be weak and stupid if I take medication.

Including you, so thanks so much for that.

Posted by: Mnemosyne on February 26, 2008 at 2:55 PM | PERMALINK

OOOH - you mean there may be a positive side to the "fun" stuff women of a certain age experience!

Yeah! As much as I am grateful for my mental health care professionals - it doesn't mean I'm happy to have to check in with the head doctor every six months. :-)

Posted by: mo on February 26, 2008 at 3:00 PM | PERMALINK

I live on the UES of NYC and I think all the rich women and socialites are on some kind of anti-depressant, anxiety whatever drug. It is a social thing like having an iPod, everyone has one.

Most people DO NOT need these pills. Life comes with ups and downs and everyday is different. Find out what is wrong with your attitude before you take a pill to cover up the feelings.

Posted by: lilybart on February 26, 2008 at 3:03 PM | PERMALINK

More likely, they just kept their heads down and persevered and engaged in all kinds of coping behaviors that were created hell on earth for themselves and their loved ones. If my father were still alive I'd introduce you to him. Believe, me his depression never "got better."

Indeed. They became alcoholics, they became drug addicts, they became homeless, they fell into multiple affairs in search of a love they could never find, they got into fights and beat their children, or at best they just kept living sad grey lives of miserable quiet desperation.

Posted by: Stefan on February 26, 2008 at 3:32 PM | PERMALINK

It's really amusing to read the insightful comments such as lilybarts...Most people DO NOT need these pills.
How exactly would you know that? The fact that you don't need them? That people you don't like may take them? That's really deep thinking. Any other conditions into which you have such great insight?

The arrogance of the healthy is funny, the attitude that other people couldn't suffer from something that doesn't bother you. People should just get over it, right? I mean, what do they have to be depressed about?

At the risk of sounding like a whining, first-world complainer, it's the chemicals, stupid. I have nothing to be depressed about, but I am. After three meds that didn't work (or made it worse), I found one that helps. That experience makes it hard for me to believe a placebo effect is at work. But even if it is, so what?

I'll just have to live with the fact I may be depriving the world of an artistic masterpiece that would have stemmed from my "melancholy" (what a quaint, Victorian outlook that is). Maybe I would have just recovered on my own, as someone else asserted everybody used to do. There's a great example of a fact-free assertion.

Even some of the people who post here, who I'd wager are far more educated than most, seem to have wild misconceptions about depression. And also a tendency to let their views on drug companies and mass media trump all critical thinking. Sometimes more than one thing can be true at the same time. Maybe anti-depressants both enrich drug companies and help some people. Is that too complicated to get hold of?

Posted by: jrw on February 26, 2008 at 4:03 PM | PERMALINK
And yet I still have people on this thread saying I must be weak and stupid if I take medication.

In point of fact, the only one who has even referred to such an argument in this thread is you (you've played the victim with it twice.) No one, however, has actually made the argument you are complaining of in this thread.

Posted by: cmdicely on February 26, 2008 at 4:11 PM | PERMALINK

Most people DO NOT need these pills. Life comes with ups and downs and everyday is different. Find out what is wrong with your attitude before you take a pill to cover up the feelings.

Fucking moron. Depression is a serious and often deadly illness, not "something wrong with your attitude." It's not daily "ups and downs", it's a chronic and severe mood disorder that prevents the sufferer from engaging in rational thought and behavior.

Posted by: Stefan on February 26, 2008 at 4:16 PM | PERMALINK

I live on the UES of NYC and I think all the rich women and socialites are on some kind of anti-depressant, anxiety whatever drug.

I've also lived on the Upper East Side. I don't seem to recall that the mere fact of living there gave me any special insight into the pscyhopharmacological causes and treatments of clinical depression, or an ability to perform instant diagnoses of the mental states of the people passing me on the street, but then again, I'm not you.....

Posted by: Stefan on February 26, 2008 at 4:19 PM | PERMALINK

I qualified my comment at 12:23 twice.

There were two points I was trying to make. Our society is very concerned about making sure everyone is happy all of the time. Most depressions do not result in lost lives. That does not mean I trivialize the depression of others. Like any pain, only the person experiencing it knows what it feels like. If these drugs help those people, that is great. However, that leads me to say that if those who self-medicate are helped by their drugs of choice, they should be allowed to use them, too.

One question I have about the serotonin uptake inhibitors is do they make people happy or do they make people alpha types?

I have probably suffered from severe depression for forty years. I do not want to take a pharmaceutically approved drug. I do not trust them for these types of 'medications' and I do not want to enrich them. I worry these drugs might prevent me from realizing the pain it means to be an American. The institutional need to feel good all of the time, abetted by psychiatry and big pharma, may be one reason why Americans allow so much killing to be done in their name. Perhaps antidepressants prevent people from complaining about unjust wars rudely.

Posted by: Brojo on February 26, 2008 at 4:36 PM | PERMALINK

Brojo, sometimes the personal IS NOT the political. Anti-depressants are not happy pills. They don't mask any righteous pain or indignation, nor do they make you vote Republican, buy an Escalade or want to invade smaller countries just for the hell of it. They won't, at least in my experience, change any of your core beliefs, or even your preference for breakfast cereal. All they do is restore, or claim to restore, or try to restore, your brain chemistry to it's "normal" state.

Posted by: jrw on February 26, 2008 at 4:48 PM | PERMALINK

One question I have about the serotonin uptake inhibitors is do they make people happy or do they make people alpha types?

Neither. Is removing a crushing sense of apathy and hopelessness going to make you happy? No, not unless you were doing things that make you happy. Will it make you an alpha type? No, not unless you were already an alpha type.

Will treating a broken leg and then removing the cast from your leg make you a runner? No, but it removes an obstruction from being a runner.

Will antidepressants interfere with grief? No--the depression itself interferes with grief, but removing all ways to deal with it other than the frozen hopelessness.

What's with this idea that antidepressants add happiness as compared to unthawing a brain frozen in hopelessness? Once the depression isn't overwhelming you then have a choice of all sorts of emotions--anger, grief, sarcasm, warm fuzzies--none of which are available during the depression itself.

Posted by: Kady in California on February 26, 2008 at 4:58 PM | PERMALINK

""Before Prozac, most people who were depressed recovered without it."

More likely, they just kept their heads down and persevered and engaged in all kinds of coping behaviors that were created hell on earth for themselves and their loved ones."


Yes, exactly. I come from a family where this has been the case for at least four generations. Depression and feelings of extreme alienation and loneliness fueled abuse, rejection, violence and alcoholism. I was finally able to break the chain for myself (don't dare try to have children, though) through a combination of counseling, nutrition and exercise, and sheer determination to live a constructive rather than destructive life. I succeeded up to a point, but was never free of the darkness. I was enduring rather than living. I did try Welbutrin, prescribed for my ADD, but it did nothing other than make me sleepy. Then I had a bad bout of the winter blues (aka SAD) when I was living in northern Europe, and tried first Prozac (way too strong for me), and then a very low dose of Zoloft. For the first time I felt like I was living, enjoying myself rather than clenching my teeth against a pain and anxiety that never went away. I can feel the chemical difference, and so I'm quite convinced that it's not a placebo. Nor does it "numb" my feelings as some have suggested--that's what I was using alcohol for. What it does is dial down the irrational and constant feeling of distress and despair that I felt so that I can feel something else, something more appropriate to my situation and true to who I chose to be. What I do with those feelings and with my life is my responsibility to manage--what the SSRI does is to give me a normal degree of choice and control. It also seems to help my ADD a lot. I won't say that it's saved my life, but it's definitely made it worth living.

I think the average benefit quantified by this metastudy just reflects the wide variation in individual results, and the fact that many people have to try several ADs before they find the one that works for them. If I averaged the benefits of the 4-5 psychiatric drugs I've taken in my life, the score would be pretty low, and would not accurately reflect how amazingly well the right drug worked for me. Everyone needs to work it out for themselves on a case-by-case basis.

Posted by: Jess on February 26, 2008 at 5:12 PM | PERMALINK

Perhaps it's impossible to understand depression if you've never lived with it or lived with someone who is depressed? As Stefan said, two things can both be correct: ADs can be extremely helpful to many people and totally misused for others. Drug cos. and doctors and insurers have all contributed to the phenomenon of labeling short-term psychological distress as "depression" that can be treated by SSRIs.

Antibiotics, for instance, are totally misused when they are prescribed for viruses. That doesn't mean they don't work for bacterial infections. And yet, if you did a study on the efficacy of antibiotics that didn't distinguish between the two (or between patients who used them correctly and those who didn't), you might come to the startling conclusion that antibiotics are no better than placebos in treating infections. There is a lurking variable here (probably several): Not every drug works for every person; there is a dose response issue for many patients; many patients are incorrectly prescribed the drug because it can't help them. None of that means the drugs don't work as intended for many people.

Posted by: Barbara on February 26, 2008 at 5:27 PM | PERMALINK

One question I have about the serotonin uptake inhibitors is do they make people happy or do they make people alpha types?

SSRIs and similar drugs used to treat depression aren't designed to make you happy. They're designed to make you not suicidal and incapacitated with crippling misery. The base goal is merely to get you back to relatively normal. They don't lift up your mood, they stabilize it back to a baseline of normality.

Posted by: Stefan on February 26, 2008 at 5:37 PM | PERMALINK

What Jess & JRW said....

I help people with money - I'm totally pre-occupied, worried & down regarding the state of the US economy.

In the past this would make me very anxious, I would feel like my head was going to explode and then go home & have a glass (really a bottle) of wine.

Today I still feel a little anxious, but I now have the ability to concentrate, read and try & figure out how to keep people from losing money and have a cup of coffee at my AA meeting.

That's the difference. Like I said before, I sincerely hope that those of you who have not been touched by this never have to experience it.

Got to run & make that coffee.....

Posted by: mo on February 26, 2008 at 5:42 PM | PERMALINK

I just thought of something - I was living on the UES when this all came to a head for me - maybe that's what did to me - NOT!

Some people are such boneheads.

Posted by: mo on February 26, 2008 at 5:51 PM | PERMALINK

"What's with this idea that antidepressants add happiness as compared to unthawing a brain frozen in hopelessness? Once the depression isn't overwhelming you then have a choice of all sorts of emotions--anger, grief, sarcasm, warm fuzzies--none of which are available during the depression itself."

VERY well put, Kady! I'm going to have to remember that one for the next time a "friend" claims that I'm taking happy pills instead of dealing with life. I keep trying to explain that now I CAN deal with life, instead of wrestling with imaginary demons. I love that I'm finally able to be engaged, productive, and connected with people and the real world, instead of stuck in a Hieronymus Bosch painting. If this is some sort of deluded cop-out, then all I can say is "bring it on"!

Posted by: Jess on February 26, 2008 at 6:43 PM | PERMALINK

"SHUT THE FUCK UP AND GET OFF THIS FUCKING THREAD."

You're being dramatic.

Posted by: Joey Giraud on February 26, 2008 at 7:03 PM | PERMALINK
SSRIs and similar drugs used to treat depression aren't designed to make you happy. They're designed to make you not suicidal and incapacitated with crippling misery.

Well, no. They are designed to treat very specific functional abnormalities which may have some combination of suicidal ideation, incapacitation, misery, flat affect, etc., as symptoms.

Just as its important to realize they don't exist to make you happy, its important to realize that they don't directly treat the symptoms; they are designed to treat underlying physical problems that may underlie the symptoms in some patients. And different anti-depressants treat different underlying problems, and accurately determining which underlying problem exists is, to say the least, difficult.

Posted by: cmdicely on February 26, 2008 at 7:18 PM | PERMALINK

"The difference in improvement between the antidepressant and placebo reached clinical significance, however, in patients with initial HRSD scores of more than 28—that is, in the most severely depressed patients."

You wonder if the dosages in the studies were sufficient for people suffering from "mild" to "moderate" depression. I don't know that people with mild to moderate depression often seek out treatment but there are plenty of reasons people with chronic, major depression may want to describe themselves as having mild to moderate depression. These are not very useful drugs at low dosages.

Posted by: Linus on February 27, 2008 at 12:07 AM | PERMALINK

You're being dramatic.

Perhaps many people would not be depressed if alpha types took serotonin uptake accelerators.

Many of the proponents of antidepressants claim they are more productive because they are not crippled with misery. They think being productive is what is best for them. It certainly is what is best for their employers and creditors, and may very well be what is best for them, given the circumstances of our political economy.

depriving the world of an artistic masterpiece

Ernest Hemmingway propably would not have become the great writer many consider him to be if he would have treated his discontent. Maybe he would have been better off using antidepressants, and maybe he would not have ended his life in suicide. I would counsel anyone to find a way not to be miserable, even if it meant depriving the world of a masterpiece.

James Joyce and George Orwell both allowed their life ending ailments to become acute before seeking any treatment for them. I would guess some form of discontent or depression prevented them from extending their lives and productivity, and that that discontent was a driving force behind their art. One of Michelangelo's last pieces was an unfinished virgin in sackcloth. It is said that at the end of his life he was consumed with debilitating doubt that prevented him from finishing his work. Was that depression/discontent also the inspiration for his earlier works? We do not know.

Often melancholy is referred to as a muse. Melpomene was the muse of tragedy. Tragedy is considered one of the greatest of art forms. It is great for viewing, but not necessarily a great life style.

Posted by: Brojo on February 27, 2008 at 12:31 PM | PERMALINK

Brojo, you're missing the point of what severe depression does. Hemmingway, Orwell, & Joyce weren't severely/clinically/cripplingly depressed... at least not when they wrote 1984, Ulysses, etc.

If they had been cripplingly depressed, they would have thought of the plots of those books, laid in bed, rehashed them, and never put pen to paper. That's what depression does to people.

When the shrouds of depression are pulled away, what you find isn't somebody "happy" in the normal sense, just somebody functioning enough to be happy if circumstances merit it.

To put it in a way you might understand...

there are all sorts of liberal political activists, and great writers/painters/composers out there who will never lead a movement, or write a book, -- because their depression keeps them from being "alpha" enough to do so.

Posted by: NebraskaBoy on February 28, 2008 at 5:07 AM | PERMALINK

Taking drugs to resolve depression seems a little like an IT tech resolving computer problems by pouring liquids on the hardware.

It could indeed be that your brain chemicals are imbalanced, but what if your neurons are miswired or there's too much sensory overload in your environment or you were never taught how to resolve problems or you were programmed to deal with life by curling into a ball because during your developmental years, your parents reacted to your success by indifference and/or punishment -- with criticism as to how you could have done better, and by raising expectations until no matter what you do, they are disappointed? Not that I'm speaking from experience . . . .

Perhaps many problems in the brain can be resolved by ingesting chemicals. Or maybe those chemicals just dull the pain, while the problem continues.


Posted by: Joe S. on March 1, 2008 at 9:21 AM | PERMALINK

I don't know the reasons, but I think the US media did a better job of reporting this story than the UK press. Ben Goldacre, the Guardian's own "bad science" reporter, described the paper as being "ridiculously badly misreported" in the UK media.

http://www.badscience.net/?p=620

The language log claim that the Guardian's story "crosses the line into plain falsehood, and so do the stories in several other major UK papers."

http://itre.cis.upenn.edu/~myl/languagelog/archives/005420.html

So in the future, despite being a liberal lefty, it will be Fox for me when I need objective coverage of news stories...

Posted by: Phil on March 1, 2008 at 1:29 PM | PERMALINK




 

 

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