Heroes Not Zombies

A study by Professor Kirsch and colleagues of Hull University has set a bit of a cat amongst the Pharma pigeons. It’s a pretty technical study but in summary what they did was got access to all the trial data submitted to the FDA by drug companies applying for licences for the big four new generation antidepressants – fluoxetine, venlafaxine, nefazodone, and paroxetine. This data, by the way, included trials which were not published but which they obtained access to through a Freedom of Information application.

What they found was that there was no evidence the drugs were more effective than placebo in patients with moderate or severe depression. They did show that the worse the depression at the outset of the trial, the greater the effect of the drug over placebo, but they did a fascinating analysis which showed that the explanation for this was likely to be the decreased placebo response in more severely depressed patients.

Given these are drugs with well known side effects and dangers, and that some 16.2 million prescriptions for these drugs were made in England in 2006, this study comes as something of a shock.

The responses to this study are even more interesting. Most experts and authorities quoted on the news items today have made the point that we all know that talking therapies work for depressed patients but that drugs are prescribed because there are insufficient numbers of therapists available. This is a shocking explanation. Drugs as a substitute for people. What’s the problem? Insufficient funds for the provision of enough therapists? Seems so. So why do we prefer to spend literally millions on drugs which probably don’t work instead? The answer lies partly in the way medicine is currently delivered. The priority is given to drugs. You can’t placebo control human care or loving attention. Maybe it’s time we began to change our priorities and save the drugs for when therapeutic relationships are not enough.

Does this study mean that people taking antidepressants should stop them because they are useless? NO. The problem with all this so-called “evidence” which comes from highly artificial clinical trials which seek to remove the human factors and average out the results to the point of dismissing the range of difference within the study group is that it fails to show us who might benefit most from a particular treatment. Within these studies are individuals who are substantially improved by the drug, and others for whom taking the drug was of no benefit at all. However, it is reasonable to assume that drugs alone are not enough. Depressed people need more care than mere pharmaceutical care.

Does it mean that we should invest in trying to treat depression with alternatives to drugs? YES. It’s about time we gave clinical priority to people in medicine, investing in sufficient numbers of well-trained doctors, nurses and therapists to give ill people the time and attention they need to become well – if possible, without the risks of prescribed medicines.