Last week yet another research study was released on the effectiveness of antidepressants. The study, published in the Journal of the American Medical Association, found that Paxil and Tofranil were about as effective as placebo for those people who have mild to moderate depression.
In this age of information overload, when all many people have time to do is scan the headlines or the link titles on their news aggregators, how the media present health information is important. I pay attention to the headlines because I think they tell you a lot about what the media want you to know about a story. They are the framers, the influencers. We often take away exactly what they want us to, whether it's the truth of the matter or not. So I took a look at how this newly published study was covered by some major news organizations intheir headlines.
The Wall Street Journal Health blog's take? Headline:"Placebos: Pretty Good for Depression"
Ugh. I found this to be one of the worst pieces I read on this study, even reading past the headline. No balanced look at the results whatsoever.
Good Morning America's (ABC) take? Headline: "Study: Antidepressants, Placebos Near Equally Effective" and the even better sub-head "Commonly Prescribed Antidepressants Had 'Negligible' Effect on Patients with Mild, Moderate, Even Severe Depression"
Really ABC? Common antidepressants have almost no effect even on patients with severe depression?
It wasn't just me who noticed what was going on last week. Gary Schwitzer at the Health News Review blog also took note of the confusion among various media when it came to covering this story.
I have this anecdotal feeling that the media REALLY like to write about psychotropic medication being ineffective. I have no proof of this, but I certainly see more stories about when things don't work than when they do.
Thankfully, there were more balanced discussions of this topic at certain news outlets, but they seemed to be the exception rather than the rule.
"Antidepressants do work for very severely depressed people, as well as for those whose mild depression is chronic. However, the researchers found, the pills don’t work for people who aren’t really depressed — people with short-term, minor depression whose problems tend to get better on their own. For many of them, it’s often been observed, merely participating in a drug trial (with its accompanying conversation, education and emphasis on self-care) can be anti-depressant enough."
Alex Spigel delved into the issue behind who participates in these studies on the effectiveness of antidepressants and how the severity, or lack thereof, of their depression is measured in NPR's Shots health blog:
" … the conclusion of the JAMA study that antidepressants work only in severly depressed people may be missing the mark. The drugs may not be so weak. Part of the problem could be an academic scale for measuring depression that pushes people with forms of the disorder that most doctors would consider to be moderate into the severe camp."
"… do the results really mean that antidepressants are ineffective? I don't think so. In order to understand the implications of the study, you have to understand how clinical trials are conducted, and how radically they differ from usual care."
Read Dr. Carlat's description of how some of these studies that end up getting reported in the news are actually conducted. (He's only written part 1 thus far.) It's eye-opening.
For me, information thatmight have been helpful to consumers was eitherleft out, not presented in a manner that could be easily understood, orleft until much later in the story:
1) This research was on onlytwo antidepressants. Not all of them.
2) It's not that the antidepressants didn't work. They just didn't work any better than placebo, which also had positive effects, for a certain group of people in the study.
If youhad gottenpast "Good Morning America's" awful headline, you would have read the following:
"The findings do not mean that the drugs or the placebos were frivolous for most users, Good Morning America chief medical editor Dr. Richard Besser said today. Rather, both the antidepressants and the placebos had a positive effect on the patients.
'You hear that headline and you think, 'Oh, my God, there is nothing out there that works for depression,' Besser said. 'The study actually found the exact opposite; that both placebo and medications were extremely effective at treating mild to moderate depression. What you can't tell from this study is what else is going on. Were these individuals getting what is most effective, which is talk therapy?'
Dr. Gary Kennedy, a professor of psychiatry and behavioral science at Montefiore Medical Center, Albert Einstein College of Medicine, said that analysis seemed logical, but was cautious of its conclusions.
'The finding that more severe depression is more likely to respond to antidepressant medication seems sound,' Kennedy said. 'But only six studies were used to generate the conclusion, and three of those studies used an antidepressant that few practicing physicians would prescribe nowadays.'"
Were the majority of consumers more likely to scan the headlines of USA Today or ABC.com or more likely to read the nuanced presentations of a New York Times op-ed piece? I'll give you two guesses and the first one doesn't count.
Dr. Besser of "Good Morning America" makes my point best with his statement "You hear that headline and you think 'Oh, my God, there is nothing out there that works for depression.'" That's exactly what people are going to think. People who are suffering greatly. People who may be considering suicide, including mothers with postpartum depression. Is that responsible journalism?
Update: Since I posted this earlier today, another piece has come out in the New York Times questioning the widespread acceptance of the study last week as proof that antidepressants don't work. Thanks to the NYT andDr. Richard Friedman.
"It has been clear for years that antidepressants barely outperform sugar pills, at least in the artificial environment of the double blind, placebo controlled study. It is also clear that most psychiatrists in the trenches are perplexed by these results, because in our practices we appear to see people responding very robustly to antidepressants — including those with only mild to moderate symptoms. So what gives?"
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