As you can see from my previous post, I rely on evidence for all of my beliefs. Currently, I’m doing a clinical round in a psychiatry department and one of the most commonly prescribed drugs is antidepressants. A recent study in the New England Journal of Medicine (bow down to the almighty one) has exposed the Food and Drug Administration‘s (FDA) bias towards positive studies of antidepressants.
Not only was the FDA choosing to publicize mostly positive results, but studies with negative outcomes that showed no significant benefits to using antidepressants were presented in such a manner as if they showed benefit. One of the leading authors was a previous employee of the FDA and it was not until he left that he decided to publish a meta-analysis about it and reveal to the public what was going on.
This is a good example of the difference between evidence-based medicine and science-based medicine. Before this article was published, the evidence was there. The antidepressants were being prescribed in an evidence-based manner, but not a science-based one. Science incorporates in it a process by which evidence is examined, valued, and scrutinized. Here we see that antidepressants had the evidence, but the evidence was being cherry-picked and studies that lacked a beneficial outcome to antidepressants were being discarded in a biased manner. That is not a scientific approach.
I’ll be interested to see how this pans out. There will have to be many new studies done to determine the true benefit of taking antidepressants. This is gonna be a lot uglier than we might expect. There are many different types of antidepressants (tricyclics, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, etc.) and each category has lots of different antidepressants within it. Furthermore, antidepressants are used for things other than depression as well, such as obsessive-compulsive disorder (OCD) and panic disorder, to name a few.
It’s going to take scientists (especially those working for pharmaceutical companies) a long time to flesh out the exact benefits of many drugs on different psychiatric disorders. Nevertheless, my personal stance on antidepressants is that they are better than placebo (as stated in the NEJM study itself), but that they don’t work on everyone and probably not on the majority of people. They have definite effects in the body and there is no denying that. Which people benefit enough to outweigh the side effects and risks of the drugs is still yet to be determined in a conclusive manner.
And of course, whenever something like this occurs there are quacks out there like Dr. Mark Hyman who use these exposed faults of government organizations and pharmaceutical company-related advances to advertise their alternative medicine techniques. In his Huffington Post article (95% of people’s articles on there are bunk), he uses the seemingly ineffective benefit of antidepressants to promote Omega 3 fatty acids, and mercury toxicity checks (a common theme in the anti-vaccination movement), along with vitamin D and organic food.
His logical fallacy is as follows: The evidence of antidepressants seems to be less than originally believed, therefore use products without much evidence for helping depression instead! This is the logical fallacy of inconsistency because he is expecting sound evidence and science for pharmaceuticals but not for his own alternative methods.
The bottom line is that antidepressants probably are not as helpful for treating depression as we previously thought, but they do show some benefits. We need to use sound science-based techniques to review them as thoroughly as possible over the next few years. This does not mean that we should start treating ourselves with other “natural” and alternative medicine instead.