Tuesday, July 12, 2011

Others Chime in on Peter Kramer and Antidepressants

Peter Kramer's New York Times article defending antidepressants has generated some debate. Felix Salmon, who blogs mostly on economic issues for Reuters, criticizes Kramer's article ("The antidepressant debate"). He concludes: "Does that mean I now believe that antidepressants do no good at all? No — as a good Bayesian, I'm not going to let a single article do that. But I was looking forward to a strong response to Angell. And the weakness of Kramer's essay only serves to confirm my suspicions that Angell and the anti-antidepressant crowd really are onto something.")

Robert Whitaker, the author of Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, criticizes Kramer's article in detail on his Psychology Today blog ("The New York Times' Defense of Antidepressants"). I criticized Whitaker's book in a previous post for relying on too many horror stories about patients and drugs, but, otherwise, the book does present much disturbing information. If Whitaker is wrong about some facts, then, now that the debate has been joined, someone should point that out.

Also, John Horgan on his Scientific American blog, criticizes Kramer's article and his previous work ("Are Antidepressants Just Placebos With Side Effects?"). No fan of Kramer, Horgan writes: "The Brave New World envisioned by Kramer was always a complete fantasy." He concludes, though, with a more moderate tone: "I sometimes suspect that psychiatric drugs work, to the extent that they do, simply by making people feel different. The suffering person interprets this difference as an improvement, in the same way that someone who is in a rut may feel better by traveling to another country. But does that mean that any psychoactive drug—Caffeine? Beer? Antihistamines? Psilocybin?—can in principle produce the same benefits as an SSRI, as Angell and Kirsch seem to suggest? Even for a skeptic like me, that seems hard to believe. We clearly need more research not only on alternatives to antidepressants (yoga, meditation, jogging, reading groups, journal-writing) but also on the drugs themselves, to understand why some people benefit so much from them while others don't. But more research will be helpful only if the results are reported—as all medical data should be but too often aren't—with absolute candor and transparency."

I am glad that there is an open debate on this subject. If antidepressants and other mind-altering drugs are prescribed too much, then this should be stopped. I am not qualified to opine on whether antidepressants should ever be used, but I think that, when we see advertisements that suggest that shyness is a medical disease ("social anxiety disorder") that should be treated with drugs, things have gone too far. (In their defense, I am sure that the psychiatric establishment would argue that the drugs are only for severe anxiety in social situation, however that is defined.)

Also, those who believe that the free market is always the best answer for healthcare issues should study how the pharmaceutical companies have essentially encouraged "opinion leaders" with lucrative contracts to tout their drugs to doctors and read the stories about how those who refused to play along suffered damage to their careers. Government has its problems too, and those conservatives who warn about the problem of captured regulators are raising a very real and valid concern. However, there is nothing like an open debate among experts and others to get at the truth. That is why this debate on the efficacy of antidepressants, and their potential harmful effects, is one that should be welcomed.

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