Two days ago I woke up to widespread media coverage in the major newspapers and TV stations announcing that antidepressants really do work. I wondered what significant breakthrough had been made. Surely something really important must have happened to warrant all these headlines and pronouncements. It was covered by BBC News, BBC Scotland News, STV News, BBC Newsnight and elsewhere. It was discussed on BBC Radio 2, Jeremy Vine Show and BBC TV, Victoria Derbyshire. It was also of course circulated on social media by RCPsych and the mass media.
It took me a little time to find out what all the drama was about. It soon became clear that a study had been reported in the Lancet medical journal, a meta-analysis of 522 clinical trials of antidepressants which concluded that the drugs are effective over 8 weeks for major depressive disorder. This is after many decades of said drugs being on the market. I was rather astonished that this was the reason for the widespread coverage. I was even further dumbfounded to hear that RCPsych was suggesting one million more patients should be prescribed the drugs. After all it was less than a month since the announcement by Public Health England that a year long review should be conducted on prescribed drug dependence. Such is the concern about the ever-increasing numbers of patients becoming drug dependent.
The Herald newspaper in Scotland also carried the news but removed the link from its website after complaints from campaigners in Scotland. The newspaper has of course given excellent support to the campaigns on both prescribed drug dependence and consent to mental health treatment for 16-18 year olds.
I was dismayed that the Lancet paper publicity stunt had been orchestrated for the benefit of psychiatry and not in any way for the benefit of patients. Many discerning members of the public will not have been fooled by these headlines but many of those suffering from depression may have been given false hope and reassurance that antidepressants are indeed much more effective than they really are. No mention was made in the headlines that the studies were very short term and no mention was made about the adverse effects of the drugs, the risks of dependence, the immense difficulties of withdrawal for many, the complete lack of dedicated withdrawal services. The idea that the NHS could cope with an additional one million patients at a time when it is struggling to meet current demand also seemed highly irresponsible. I was left feeling desperately sad that this is how psychiatry behaves when so many are being harmed by these drugs and there is no research and no ways of alleviating the suffering of those harmed. My general feelings were felt by many others and some have chosen to comment publicly and with more authority than myself.
Dr Peter Gordon, psychiatrist in NHS Scotland, wrote the following about the Lancet study.
“From my perspective this meta-analysis confirms that antidepressants, used over 8 weeks can improve mood in those diagnosed as experiencing severe depression. However, this study cannot say much beyond this, such as the balance between benefits and harms or the appropriate length of treatment. As such, the authors (as reported here) cannot justify statements about under-treatment.”
And Dr Des Spence, Glasgow GP, I am sure spoke for many of his colleagues in general practice, disagreeing that many more patients should be prescribed these drugs.
http://www.bmj.com/content/360/bmj.k847/rr
Dr Joanna Moncrieff, psychiatrist, also provided critical comment, stating that
“The extraordinary media hype over the latest meta-analysis of antidepressants puts the discussion of these drugs back years.”
Bob Fiddaman supplied an excellent critiqued the events of the day. He is better equipped to do this than I am and his comments are well worth reading. I certainly felt that by the end of the day Prof Andrea Cipriani, lead author of the paper, was looking rather foolish.
https://fiddaman.blogspot.co.uk/2018/02/media-frenzy-antidepressants-are-safe.html#.WpG_rbacaXR
The New Scientist carried the headline that almost every newspaper headline about this study was wrong.
Council for Evidence Based Psychiatry said the new research study added little to the debate.
Do antidepressants work? The new research proves nothing new
And Prof Peter Gotzsche commented that the review added nothing new.
Dr James Davies, Roehampton University and Dr Helen Stokes-Lampard, RCGP appeared on BBC Newsnight. Dr Davies gave excellent critical comment which had not been apparent during the day on mainstream TV.
https://www.bbc.co.uk/iplayer/episode/b09sqj83/newsnight-22022018
The Daily Mail published two articles the following day presenting critical comment on the media coverage the previous day.
http://www.dailymail.co.uk/health/article-5424795/Study-says-GPs-hand-antidepressants.html
And a number of letters were published in The Guardian in response to the coverage the previous day.
https://www.theguardian.com/science/2018/feb/23/why-we-are-sceptical-of-antidepressant-analysis
Dr Peter Kinderman disagreed that more pills were the answer to life’s problems.
https://news.liverpool.ac.uk/2018/02/22/drugs-not-answer/
The Lancet meta-analysis
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/fulltext
Media coverage – 22 February 2018
https://www.thetimes.co.uk/article/more-people-should-get-pills-to-beat-depression-sv5vhczss
http://www.bbc.co.uk/news/health-43143889
https://www.thesun.co.uk/news/5638272/gps-dish-out-antidepressants-to-brits/
nevertrustadoctor 
The effects size was 0.3, the same as Irving Kirsch, who proved that antidepressants only work as placebos. So they analysed the extreme end of the spectrum of response and found the differences they cite there. But response rate is not a viable efficacy measure, and would not be the measure by which a psychiatric drug would get approved, for example. The various experts seemed to have forgotten their first year statistics.
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Thank you, Daniel.
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