Newsweek: “Antidepressants do work, and many more people should take them: Major international study”
The Independent: “Doctors should prescribe more antidepressants for people with mental health problems, study finds”
The Telegraph: “The drugs do work: Anti-depressants should be given to a million more Britons, largest ever review claims”
American and British media have been rhapsodizing over the “largest ever” research project on antidepressants, published last month in the Lancet. They quote the study’s prestigious Oxford authors claiming their research proves millions more people should be taking antidepressants and that holding back is like denying needed treatment to patients with hypertension or cancer. The lead researcher says he’s “very excited” about the study’s results and boldly declares the “final answer” has been found regarding antidepressants’ effectiveness.
Yet, when one considers that 10 percent of Britons are already taking antidepressants (one in six in some areas), and 13 percent of Americans, including – shockingly – one in four middle-aged women (age 40-59), a nagging doubt arises about this headlong rush into ever-greater medicating of the population.
Add to this the raging debate, not just over antidepressants and suicidality, but also the question of homicidality – a controversy dramatized by the alarming increase in mass shootings in recent years and the disturbing correlation between the mostly young male perpetrators and the psychiatric medications, particularly antidepressants, they have been taking – and one suspects there is a lot more to this story.
To all appearances, the Oxford University study is indeed impressive – a broad meta-analysis of 522 randomized controlled trials spanning almost four decades and involving 21 different antidepressants. Its 18 authors represent not only Oxford’s psychiatric community, but also one or two experts each from France, Germany, Switzerland and the U.S. – plus seven from Japan. (Why seven? Consider that while antidepressant use has risen dramatically throughout the developed world, Japan lags far behind, even though depression has been called Japan’s “greatest public health issue” and suicide is sky high there.)
But beyond all the press hoopla, what does the new Oxford study actually conclude? Drum roll.
In the researchers’ own words, their study confirms: “All antidepressants were more efficacious than placebo in adults with major depressive disorder.”
That’s it. The much-heralded study simply purports to finally demonstrate that antidepressant drugs – which pharmaceutical companies, marketing firms, primetime TV commercials and the entire medical-psychiatric-mental health establishment have successfully coaxed literally tens of millions of people to depend on – actually work somewhat better than placebos, which is to say, better than nothing. Of the 21 antidepressants included in the massive data review, some were found to work just marginally better and some considerably better than sugar pills.
Why, one might wonder, should it be news that antidepressants work better than sugar pills? After all, some of these drugs have been around for 50 years, so one would hope their efficacy had been established before now.
That would be because past studies have actually shown that, in many cases, placebos worked just as well as – or even better than – antidepressants, except in severely depressed patients.
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‘You have to be suspicious’
The establishment media, notoriously lazy and reflexively pro-drug (who knows if that’s because pharmaceutical companies are huge sponsors of news?) rarely ask the right questions. Here’s a big one: Where in this “largest ever” review and “final answer” to antidepressant efficacy is there anything about adverse effects? After all, for decades the Food and Drug Administration has affirmed like a mantra the two paramount factors required in Americans’ prescription drugs: efficacy and safety.
When the subject of antidepressant side effects comes up, everyone knows the discussion isn’t about nausea, fatigue, weight gain, blurred vision and insomnia, but rather the giant elephant in the room: Every antidepressant sold in America, regardless of brand or dosage, bears a mandatory FDA black-box warning label for “suicidality.” The Food and Drug Administration imposed this requirement back in 2004 after large meta-analyses of randomized controlled trials revealed that patients under 25 given antidepressants were twice as likely to experience “suicidal thinking or suicidal behavior” as patients given placebos. And, as has become sadly evident in recent years, “suicidal ideation” is not that far from “homicidal ideation” – in plain language, murderous thoughts. Indeed, “homicidal ideation” is listed as a “rare adverse event” for at least one hugely popular antidepressant, Effexor.
Likewise, a large body of peer-reviewed research reveals serious perils to unborn babies – including the risk of autism, which currently afflicts a staggering one in 68 American children – if their mothers are taking antidepressants.
How could major downside risks like these not be considered relevant in the biggest study ever, especially in light of the almost giddy conclusions expressed in the media by the study’s authors?
“Only about one in six people with depression receive effective treatment in high-income countries,” lamented professor John Geddes, Oxford’s chief of psychiatry and a co-author of the study, according to the Telegraph. “If you recognize that people are suffering from a disorder, you should expect to get access to effective treatment. Let’s make the number 6 out of 6.”
One doctor who knows a great deal about antidepressants’ effects on unborn babies is Adam Urato, M.D., chief of maternal-fetal medicine at MetroWest Medical Center in Framingham, Massachusetts.
“What many people are missing, plain and simple,” Urato told me in a phone interview, “is that antidepressants are chemical compounds. Is it better or worse to have more and more of the population ingesting these drugs – which means, more and more women of child-bearing age ingesting them?”
Urato makes it clear from the get-go he is not against treating pregnant women who are depressed – including, in some circumstances, with antidepressants.
“Depression is an awful, horrible condition for people,” he said, “and they need good care, compassion and accurate info about treatment – including the risks.”
Noting that “these drugs readily cross the placenta and affect all of the baby’s organs,” Urato said “it becomes a chemical-exposure issue. It doesn’t make sense to say they won’t have downstream effects on the baby.”
Urato explains the many possible adverse effects on in-utero babies attributed to SSRI (selective serotonin reuptake inhibitor) antidepressants taken by their mothers, when the drug chemically plays havoc with the developing child’s natural serotonin levels:
Serotonin is a critical neurotransmitter and cell-signaling molecule. From the brain, it signals the neurons where to go, what to do and how to develop. It signals the heart; it plays an active role in the gut; and it plays an important role in the formation of the lungs. What it does during development is basically everything.
Moreover, he says more broadly: “When it comes to drug exposures in pregnancy, the arc of history bends toward showing increasing harm over time. We have seen this again and again. There are many examples of medications that were once thought to be safe for developing babies. But with enough time and scientific study, we came to realize that the drugs caused harm to the developing babies. Synthetic chemical compounds passing into a baby and entering its cells and organs throughout development are likely to cause harm. It’s not rocket science – it’s simple common sense.”
Urato came back again and again to a key point: “People sometimes think those of us who raise these concerns think pregnant women shouldn’t be treated for depression, but that’s incorrect. No one is arguing to ignore depressed pregnant women. The question is how to treat – psychotherapy, exercise and, for some, medication.”
What does he think specifically about the Oxford study?
“Antidepressants are profitable products, made by powerful, wealthy corporations with lots of influence,” Urato said. “Whenever you hear a research effort that delivers the same message as the drug companies, you have to be suspicious. Everyone wants to know the truth about these products – do they work or not, are they safe or not – and when the message of the study aligns with what the corporations want the public to hear, you have to be suspicious.”
His suspicions are shared by British health journalist John Naish, who disclosed in the Daily Mail that “nearly 80 percent of the studies analyzed by the Oxford study had been funded by pharmaceutical companies.”
No link between antidepressants and violence?
Geddes, Oxford’s chief of psychiatry, criticized doctors reluctant to prescribe antidepressants, asking: “What would we think if [patients with] high blood pressure or cancer … simply weren’t getting access to available treatment? I think we do tend to be a bit squeamish about it; it’s more stigmatized. Some people don’t think they are illnesses or disorders.”
I contacted Geddes to ask about his apparent enthusiasm for medicating “6 out of 6” depressed people in light of antidepressants’ serious side effects, including suicide, violence and the risks to the fetus for pregnant women taking the meds.
Geddes told me the news media misinterpreted his comments: “Given the rates of under-treatment, and in response to the question of how many more people in the U.K. need treatment, I answered [their questions]: ‘It’s likely to be at least 1 million more people per year should have access to effective treatment for depression (either drug or psychotherapy). The choice will need to be made by doctor and patient.’ Some journalists may have misinterpreted this as referring only to drugs. Obviously, any joint decision between patient and doctor needs to take into account the full range of risks and benefits, as with any other medical treatment.”
Fair enough. But when I asked Geddes how concerned he was about antidepressant-induced suicidality extending into violence, I got a surprising answer.
While acknowledging suicidality is a real issue, Geddes didn’t concede any risk of violence.
“There is evidence of a link between depression and violence as with several other mental disorders,” he told me, “but it is unknown whether antidepressants add to this risk.”
Really, I asked him? “Doesn’t the presence of the FDA’s mandatory black-box warning for suicidality up to age 25 pretty much point to some ‘link’ between antidepressants and violence, especially considering that suicide is a form of violence (i.e. the taking of a human life, albeit one’s own life)?”
“Yes, sorry,” Gettes responded by email. “I should have specified ‘violence to others.’ The FDA warning is of course based on evidence as we have previously discussed – see for example ‘Risk of suicidal behavior in adults taking antidepressants.'”
Ironically, the same medical journal has more recently published an antidepressant study showing that “SSRIs double the risk of suicide and violence in healthy adults.”
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‘Overhyping benefits, concealing harms’
Reality check: Despite the Oxford authors’ nods toward talk therapy and counseling, it’s abundantly clear they are true believers in widespread medicating being the only practical solution to the world’s supposed depression pandemic. After all, they observe, talk therapy is all but unavailable, with the Telegraph reporting 41 percent of depressed Brits referred by their doctors for counseling “have a three-month wait between referral and treatment.”
Thus, despite the already astronomical numbers of people taking these controversial drugs, the big push continues – by the pharmaceutical manufacturers, the research community (whose work is often funded by the drug companies), physicians and the ever-cheerleading news media.
But just for a moment, let’s take in the 30,000-foot view.
We live in an age when hundreds of millions of people have serious “mental health problems” – code for traumatic, life-disrupting, mental-emotional-spiritual problems that modern medicine in a post-Christian secular world, long on technology but short on real understanding, treats overwhelmingly by drugging people. What could possibly go wrong?
Fortunately, not all experts share this sunny view of massive psychotropic medicating being the solution to all human distress. Some, like Urato, are outspoken with regard to the serious risks. And there are others speaking out.
One of the highest-profile voices sounding the alarm is Dr. David Healy, an internationally respected psychiatrist, psycho-pharmacologist and author of 20 books, including “Pharmageddon.”
Based in the U.K., Healy didn’t hold back when I asked him for his most candid assessment of the Oxford study. In fact, he pretty much ripped it to shreds.
“This paper is junk,” he began, saying it “is based on ghostwritten papers with no access to the data.”
“No one,” he said, “not the regulators such as MHRA [Medicines and Healthcare products Regulatory Agency, Britain’s version of the Food and Drug Administration] or FDA, have had access. Few if any of the notional authors of the papers will have had access, and none of them can let me or any independent experts have access.”
But Healy was just warming up.
“In the case of at least one of these drugs – Paroxetine – there have been fraud charges for over-hyping the benefits and hiding the harms,” he said. “We have to assume the same holds true for pretty well every paper.”
Fraud charges? Indeed, as the New York Times reported in 2012: “In the largest settlement involving a pharmaceutical company, the British drugmaker GlaxoSmithKline agreed to plead guilty to criminal charges and pay $3 billion in fines for promoting its best-selling antidepressants for unapproved uses and failing to report safety data about a top diabetes drug, federal prosecutors announced Monday. The agreement also includes civil penalties for improper marketing of a half-dozen other drugs.”
Actually, it was worse than that. “For years,” a Vox report disclosed, “the drug company GlaxoSmithKline was illegally persuading doctors to prescribe paroxetine, sold under the brand name Paxil, as an antidepressant for children and teenagers. They did so by citing what’s known as Study 329 – research that was funded by the drug company and published in 2001, claiming to show that Paxil is ‘well tolerated and effective’ for kids.”
“That marketing effort worked,” the report added. “In 2002 alone, doctors wrote two million Paxil prescriptions for children and adolescents.”
In fact, the BBC reported, GlaxoSmithKline’s “sales force bribed physicians to prescribe GSK products using every imaginable form of high-priced entertainment, from Hawaiian vacations [and] paying doctors millions of dollars to go on speaking tours, to tickets to Madonna concerts, said U.S. attorney Carmin Ortiz.”
Wait, rewind that part about doctors writing “two million Paxil prescriptions for children and adolescents” in 2002.
Unfortunately, the consequences of such corporate enthusiasm for putting kids on psychotropic drugs may go well beyond GlaxoSmithKline paying a huge fine. Consider that just months earlier, in November 2001, 12-year-old Chris Pittman had been taking two SSRI antidepressants, Paxil and Zoloft, before he murdered his grandparents and burned down their South Carolina home. Though Pittman’s lawyers argued that the two antidepressants were responsible for the boy shooting the only two people who had ever showed him any love in his turbulent, traumatic life, he was convicted of murder – later pled down to voluntary manslaughter – and is now serving a 25-year prison term.
Healy, noting the dangers of pharmaceutical companies’ “overhyping the benefits and hiding the harms” of their products, says Oxford’s “Dr. Cipriani and his colleagues know this,” adding: “Their paper contributes to a misleading of doctors and patients. He and they would be doing a much more important and noble job if they were to send a paper to the Lancet making this clear.”
Disappointed likewise in the U.K.’s premiere peer-reviewed medical journal, Healy adds: “For me, the publication of this paper and the media circus around it destroys the credibility of the Lancet.”
Healy also takes issue with the Oxford study’s ranking of antidepressants: “Lots of doctors around the country use sertraline today based on a very similar paper some years ago by Dr. Cipriani, which made sertraline [Zoloft] out to be the best SSRI – but when the unpublished sertraline trials are taken into account, it is close to the worst.”
Which brings us right back to the radioactive issue of antidepressants and violence.
‘These killings would never have happened’
In 2012, James Holmes entered a movie theater in Aurora, Colorado, during a midnight screening of “The Dark Knight Rises” and opened fire on the audience, killing 12 and injuring another 70. He had been taking the antidepressant Zoloft. Healy was brought in by the defense as an expert witness in the case. Although ultimately not called to testify during the trial, Healy later told the BBC that – having interviewed Holmes in prison and carefully reviewed his mental history and the specific antidepressant and dosage he was taking at the time: “These killings would never have happened had it not been for the medication James Holmes had been prescribed.”
Beyond the Aurora mass-shooting case, Healy confirms a common-sense truth that pharmaceutical manufacturers and marketers – and most doctors – will never concede: “Most drugs that can cause suicide, including the antidepressants, mood-stabilizers, antipsychotics, smoking cessation drugs and others, can also cause violence. The akathisia, psychotic decompensation, or emotional disinhibition these drugs trigger that lead some to suicide, lead others to violence.”
Meanwhile, many physicians are apparently thrilled by the Oxford study. Like Carmine Pariante, a professor at Britain’s Institute of Psychiatry, Psychology and Neuroscience, who was widely quoted in the media as saying, “This meta-analysis finally puts to bed the controversy on antidepressants.”
Well, not quite put to bed.
“The big problem for me or someone who uses these drugs,” summarized Healy, “is from the overhyping of benefits that are little more than the benefit you might get from alcohol, and the concealing of harms which are probably worse than the harms from alcohol.” In a world where the World Health Organization says more than 300 million people suffer from depression, “this has contributed to 10 percent of the population being on these drugs, over 80 percent of them for a year or more – most of whom continue with treatment because they can’t get off them.”
Read David Kupelian’s previous reporting on antidepressants and other psychotropic medications:
- Media ignoring 1 crucial factor in Florida school shooting
- Top doc: Media bias on antidepressants ‘astounding’
- Moms on antidepressants have babies with malformed brains
- Study: Moms on antidepressants risk having autistic baby boys
- Research confirms antidepressant-autism link
- New study: Antidepressants cause preterm birth
- 70 million Americans taking mind-altering drugs
- Americans ‘snapping’ by the millions
- The giant, gaping hole in Sandy Hook reporting
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