Why are they prescribed so much? Because very little history is taken. If you look at who are one of the top providers of psychotropic drugs for women, that would explain why - OB/GYN. Most of my female students get their meds from them. My sister actually when to a GP and was prescribed antidepressants for depression caused by another problem she was having. I am no clinician, but when she told me the history of her problem, I was stunned to hear she had been prescribed Zoloft with NO follow-up visit recommended.
[email protected] wrote: > >Then I guess the question that follows is: why do so many providers confuse normal sadness and grieving with clinical depression? > >Is it a belief that happy is the default state for humans (see Ehrenreich's recent book) or a fear of being sued should a sad patient go home and commit acts of self-harm? Or just successful commercial promulgation mixed with greed? > >I am not imagining this: I've been offered anti-depressant and anti-anxiety meds as treatment for "troubled times", and I've had multiple students/acquaintances report the same. > >There is clearly a problem - perhaps the Begley article is going at it the wrong way. > >Nancy Melucci >LBCC >Long Beach CA > > > > >-----Original Message----- >From: Allen Esterson <[email protected]> >To: Teaching in the Psychological Sciences (TIPS) <[email protected]> >Sent: Mon, Feb 8, 2010 6:40 am >Subject: Re: [tips] Newsweek's Begley bashes antidepressants > > >?Nancy Melucci wrote on why she prefers not to take anti-depressants: >I have preserved my emotional integrity and physical health >by turning down psychopharmacogical therapies >that were offered to me during difficult times in my life >My emotions - pleasant or not, are some of the few things >that truly belong to me... >Leaving aside the issue of the efficacy of anti-depressants: With all >ue respect, Nancy, serious depression is not about "difficult times" >n one's life. And if you see depression in terms of emotions that >ruly belong to you, I don't think you could have experienced clinical >epression. The last thing you have when severely depressed are >motions – on the contrary, in addition to other things I could >escribe, there is a characteristic *absence* of emotional response to >nything. (That antidepressants are over-prescribed is something we can >ll agree on, but that's a different point to the one I'm making here.) >In the Newsweek article cited by Paul Bernhardt, Sharon Bagley refers >o Kirsch and Sapirstein's "seminal study in 1998", but fails to >ention studies that have challenged their conclusions: >"Validity of Clinical Trials of Antidepressants", F. M Quitkin et al. >mer. J. Psychiatry 2000; 157: 327-337. >bstract >ecent reports have criticized the design of antidepressant studies and >ave questioned their validity. These critics have concluded that >ntidepressants are no better than placebo treatment and that their >llusory superiority depends on methodologically flawed studies and >iased clinical evaluations. It has been suggested that the blind in >andomized trials is penetrable since clinician's guesses exceed chance >nd that only active placebo can appropriately camouflage the >ifference between drug and placebo response. Furthermore, evidence has >een cited to suggest that psychotherapy is as effective as >ntidepressants in both the acute and maintenance treatment of >epression. These positions are often accepted as valid and have been >roadly discussed in both the lay press and scientific literature. The >urpose of this review is to reassess the cited data that support these >ssertions. Method: The authors examined the specific studies that were >ited in these reports, evaluated their methodology, and conducted >ggregate analyses. Results: Analyses of the original sources failed to >ubstantiate 1) that standard antidepressants are no more effective >han placebo, 2) that active placebo offers an advantage over inactive >lacebo, or 3) that substantial evidence of a medication bias is >uggested by raters' treatment guesses exceeding chance. The authors >lso note that some researchers have suggested that the interpretation >f psychotherapy trials can be complicated by "allegiance effects." >onclusions: The issue of bias or allegiance effects for both >ntidepressant and psychotherapy research is real. Investigators of all >rientations must guard against potential bias. However, studies cited >s supporting the questionable validity of antidepressant trials fail >pon closer examination to support assertions that these trials are >nvalid. >Again: "Listening to Meta-Analysis but Hearing Bias." Donald F. Klein, >revention & Treatment, Volume 1, Article 0006c, 1998 >Abstract >irsch and Sapirstein (1998) present a meta-analysis of 19 studies, >ttempting to define the relationship of placebo to antidepressant drug >ffect. They conclude that the substantial majority of drug effect is >ue to placebo effect and the rest is either measurement error or >ctive placebo effect. The article is criticized because it derives >from a miniscule group of unrepresentative, inconsistently and >rroneously selected articles arbitrarily analyzed by an obscure, >isleading effect size. Further, numerous problems with the >eta-analytic approach, in general, and Kirsch and Sapirstein's use of >t, in particular, go undiscussed. The attempt to further segment the >lacebo response, by reference to psychotherapy trials incorporating >aiting lists, is confounded by disparate samples, despite Kirsch and >apirstein's claim of similarity. The failure of peer review and the >pportunity provided by an electronic journal for rapid discussion is >mphasized. >Klein also writes: "A major problem with meta-analysis is that the >ppearance of statistical rigor can lull the usual reader, who cannot >e expected to retrieve and analyze the original sources and is not >tatistically expert, into an uncritical, complacent mode (especially >f the conclusions are congenial). This suspension of disbelief is >ncouraged by the conviction that peer review has carefully vetted both >he source and meta-analytic articles for misstatements, distortions, >oor inferences, and statistical malfeasances. Kirsch and Sapirstein >1998) provide a trenchant example of a tendentious article whose >epartures from any critical standard has not precluded publication and >as been foisted on an unsuspecting audience as a "peer reviewed" >ontribution to the literature. For instance, it seems evident that >hese peer reviewers did not retrieve and critically review these >rticles. As for some of the source articles, the adequacy of peer >eview is clearly questionable." >I recall I made a similar point on TIPS about the rapid electronic >ublication of the Kirsch et al. 2008 article, which got massive >ublicity thanks largely to the issuing of a press release. On the >ress coverage of this article Ben Goldacre ("Bad Science") wrote: >"Yesterday the journal PLoS Medicine published a study which combined >he results of 47 trials on some antidepressant drugs, including >rozac, and found only minimal benefits over placebo, except for the >ost depressed patients. It has been misreported as a definitive nail >n the coffin: this is not true. It was a restricted analysis [see >elow] but, more importantly, on the question of antidepressants, it >dded very little. >It seems to me that the media walk around with big sticky labels >arked “good” and “bad”. This meta-analysis is a fascinating bit of >ork, and it tells a damning story about the pharmaceutical industry’s >urying data, but it has also been ridiculously misreported, in the >irst day of its life… [e.g.] It did not look at all the trials ever >one on these drugs: it looked only at the trials done *before* the >rugs were licensed (none of them more than six weeks long), and >pecifically excluded all the trials done after they were licensed. It >s common for quacks and journalists to think that the moment of >icensing is some kind of definitive “it works” stamp of approval. It’s >ot, it’s just the beginning of the story of a drugs’ evidence, >sually." >ttp://www.badscience.net/?p=619 >In similar vein, Tim Kendall, deputy director of the Royal College of >sychiatry's research unit observed on BBC radio at the time: >“People should not take this study to mean there is definitely no >vidence that these drugs don’t work. There are hundreds and hundreds >ore trials that have been published, and unpublished no doubt, since >hese drugs were licenced.” >Incidentally, the statistics of the 2008 paper were questioned right >rom the beginning: >he drugs don't work? >ttp://pyjamasinbananas.blogspot.com/2008/02/dugs-dont-work.html >isrepresenting science >ttp://pyjamasinbananas.blogspot.com/2008/02/misrepresenting-science.html >ntidepressants redux >ttp://pyjamasinbananas.blogspot.com/2008/02/antidepressants-redux.html >ntidepressants redux part deux, updated >ttp://pyjamasinbananas.blogspot.com/2008/02/antidepressants-redux-2.html >inal analysis >ttp://pyjamasinbananas.blogspot.com/2008/03/final-analysis.html >egression in depression. >ttp://pyjamasinbananas.blogspot.com/2008/03/regression-in-depression.htm l >On these statistics, in an article on the Kirsch (2008) article in the >aily Telegraph Max Pemberton noted: >Most worryingly, the very basis of what is "statistically significant" >n his research is under question. A similar study of antidepressants' >fficacy, led by Prof Erick Turner and published this year in the New >ngland Journal of Medicine, found similar statistical results to Prof >irsch, but its interpretations were different: each drug they studied >as clinically superior to the placebo." >As Pemnberton notes: "This didn't make it into the press." >http://www.telegraph.co.uk/health/main.jhtml?xml=/health/2008/03/31/hmax131.xml >At the time of publication of Kirsch et al (2008) I looked into the >redentials of the co-authors. They are rather an odd bunch for such a >aper (details on request!), two being Assistant Professors of >sychology (one whose academic interest is in the field of memory), and >nother two were at the Center for Health Intervention and Prevention >University of Connecticut), where the main area of work is HIV/AIDS, >hough there is an "Obesity Interest Group": >ttp://www.chip.uconn.edu/res_area.htm >The only co-author with any explicit statistical credentials is Thomas >. Moore, Institute for Safe Medication Practices, Pennsylvania. >iography: A.B. from Cornell University, Ithaca, N.Y; Graduate courses >n statistics and statistical computing. Moore's website is here: >ttp://thomasjmoore.com/ >I can't help feeling that he's a rather odd choice for a co-author of >uch an important article. It's good to see he took graduate courses in >tatistics, though apparently there was no specific qualification to >how for it. >Allen Esterson >ormer lecturer, Science Department >outhwark College, London >ttp://www.esterson.org > >-- >ou are currently subscribed to tips as: [email protected]. >o unsubscribe click here: http://fsulist.frostburg.edu/u?id=12993.aba36cc3760e0b1c6a655f019a68b878&n=T&l=tips&o=419 >r send a blank email to leave-419-12993.aba36cc3760e0b1c6a655f019a68b...@fsulist.frostburg.edu > > >--- >You are currently subscribed to tips as: [email protected]. >To unsubscribe click here: http://fsulist.frostburg.edu/u?id=13162.50de294b9d4987a3c89b4a5cc4bdea62&n=T&l=tips&o=420 >or send a blank email to leave-420-13162.50de294b9d4987a3c89b4a5cc4bde...@fsulist.frostburg.edu ---------------------------------- Deb Dr. Deborah S. Briihl Dept. of Psychology and Counseling Valdosta State University 229-333-5994 [email protected] --- You are currently subscribed to tips as: [email protected]. To unsubscribe click here: http://fsulist.frostburg.edu/u?id=13090.68da6e6e5325aa33287ff385b70df5d5&n=T&l=tips&o=421 or send a blank email to leave-421-13090.68da6e6e5325aa33287ff385b70df...@fsulist.frostburg.edu
