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.
In an EXCELLENT, must-readop-ed piece in the New York Times, Judith Warner wrote (God bless her):
"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."
" … 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?
"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?"
Photo credit: © photo-Dave – Fotolia
What an excellent post Katherine. Thank you for doing all that background research and sharing it with us.
I figured I might as well prepare something for all of us (clinicians and patients alike) who are going to start hearing that all antidepressants are ineffective.
As always, thanks for finding all this information and presenting the truth of it all to the rest of us. Truly enlightening. I am horrified, to be quite honest. For every 10 steps we make in the right direction regarding destigmatization, irresponsible journalism such as this that only serves to put the fog back up on the windshield as far as the public's awareness is concerned takes us 50 steps backward. Horrible, utterly horrible. Wish we could do something to open up the eyes of those in the media (and keep them open once & for all) who wield so much power with respect to the stigma of mental illness and yet abuse it all too often, failing all too many people by not doing the right thing (i.e., responsible journalism). Is it always going to be about attention-getting headlines, rather than truthful headlines?
When I see this type of headline I think about the many moms I've talked to who were seeing their OB or pcp and taking a dose that wasn't effective (mostly too low). The women with more severe mood/anxiety disorders more often end up with psychiatrists and *seem* to do better. Is it really that the medication wasn't effective, or was it something else? One would think that a controlled study would be, well, better controlled than random doctors but it does make me wonder. The women with mild to moderate PMDs…perhaps give up on meds and "muscle" their way through it. 🙁
How truly maddening and irresponsible! I though NPR did a good job of covering these studies, and they noted that placebo was as effective as antidepressants for those with mild to moderate bcs people with mild to moderate often get better simply bcs they are getting some attention/help–a therapist friend of mine tells me that many studies have found that the expectation that help is on the way is actually enough to make many, many people feel better pretty quickly (in other words, doesn't mean that antidepressants aren't effective, just that they're no more effective than other forms of help for this particular group bcs this group's depression requires less intense treatment). NPR also noted that the studies found a/ds to be helpful with severe depression.
Thankfully not everyone tries to sensationalize. But enough do, and those are often the media outlets that are most widely followed. It just gives ammunition to the people who want to convince everyone that medication is NEVER the answer. It's definitely not always the answer, and I do believe there is a problem with too many primary care physicians just handing it out to people who don't need it, but it's not "never the answer".
People would prefer to muscle through it as if there's someone waiting to give us an award if we succeed. Like we'll get extra credit or something. There is no A+ for effort just because you don't reach out for some form of professional help.
Thank you for taking the time to sift through these headlines and get to the bottom of what the study is really about. I agree that we need to get past the sensationalism and focus on the message that there IS hope for people with all levels of depression. Some may not need medication, and will get better just knowing someone is there to help. This is GOOD news. Some of us DO need and respond to medication, though, and this study should not be used to suggest otherwise.
Let's not stigmatize or criticize EITHER those who need to take medication or those who choose not to–as long as mom can get better as quickly as possible to bond with, care for, and enjoy her baby.