Depression Drugs Safe, Beneficial, Studies Say - However... & Critics Question Validity of Findings

[Guest guest]

Note the role of American Psychiatric Association in first article

herein, then in second article-excerpt herein.

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Depression Drugs Safe, Beneficial, Studies Say

Suicide Risk Rejected, But Critics Question Validity of Findings

By Rob Stein and Marc Kaufman

Washington Post Staff Writers

Sunday, January 1, 2006; A01

http://www.washingtonpost.com/wp-dyn/content/article/2005/12/31/AR2005123101119.\

html

Antidepressants, such as Prozac and similar drugs, help many patients

overcome their often disabling psychiatric disease and do not increase

the risk for suicide in adults, according to two large studies being

published today that counter recent concerns about the popular medications.

The findings from two independent, federally funded studies -- the first

of their kind -- spurred some psychiatrists to call for the Food and

Drug Administration to reevaluate its warnings about the drugs, which

have been blamed for a decline in their use.

" The take-home message from these studies is that we have treatment that

is effective and that the risk from depression is far greater than the

risk of treatment, " said Darrel A. Regier, director of research for the

American Psychiatric Association, a group that has been critical of the

warnings. " These studies are very important. "

Some other medical professionals, however, questioned the results,

saying they failed, for example, to show that the drugs were more

effective or safer than a placebo.

" The big bulk of the response to antidepressants is the placebo

response, " said Irving Kirsch, a psychologist at the University of

Plymouth in England. " I don't think these studies are very informative. "

Critics also said the findings indicate that most patients do not

benefit from the drugs. " These pills can be useful pills, but they don't

match up to the hype we've had that they really cure the illness, " said

psychiatrist Healy of Cardiff University in Wales, who added that

the research could not rule out the possibility that the medications

increase the risk for suicide among some patients. " As far as the risk

for suicide, this sheds very little light on that issue, " he said.

One of the new studies, of nearly 3,000 adults suffering from major

depression, found that about one-third experienced a full remission

within weeks of taking an antidepressant, while another 15 percent

experienced some improvement -- meaning nearly half got at least some

benefit. The second study, of more than 65,000 patients, found that the

risk of suicide for both adults and teenagers drops after treatment

begins, with the newest drugs appearing to be the safest.

Regier said the new studies provide strong evidence for the safety and

effectiveness of the drugs. And he said he fears that the FDA warnings,

which were issued in 2004 and 2005, could lead to an increase in

suicides because psychiatrists may be reluctant to prescribe the

antidepressants.

" What the FDA initiated was in some ways a natural experiment, " Regier

said. " This is the kind of rigorous scientific information the FDA

should consider in evaluating its decisions. "

Temple, the FDA's director of medical policy, called the findings

" reassuring " but said they do not settle the issue. The agency was

continuing to study the drugs' safety in the hopes of clarifying their

safety further, he said.

" There's no question that many psychiatrists are worried that the public

fuss about suicidality will lead to the failure of some patients to use

antidepressants when appropriate. We are very worried about that, too, "

Temple said.

After rapidly increasing in use for a decade, the number of

prescriptions for antidepressants dropped 2 percent for the first 10

months of 2005, according to IMS Health, a pharmaceutical consulting

company.

Antidepressants such as Prozac transformed the treatment of depression

because they were considered highly effective and safe, allowing many

more patients to use them. As a result, they quickly became among the

most widely used prescription medications. The drugs, however, fell

under a cloud when reports indicated they increased the risk for

suicidal thinking, particularly among teenagers.

Those reports led some critics to press for stronger FDA action, and in

2004 the agency ordered companies to include a " black box " warning

saying that antidepressants could increase suicidal thinking in young

people. That warning was followed by a July 2005 public advisory that

said adults beginning on antidepressants should be closely watched

because of preliminary studies suggesting that they, too, could be at

greater risk of suicidal thinking and behavior.

The new studies are the first large-scale efforts to independently

evaluate the drugs without using data from drug companies' studies. Both

were funded by the National Institute of Mental Health and conducted by

independent scientists. They are being published in today's issue of the

American Psychiatric Association's American Journal of Psychiatry.

In one study, E. Simon of the Group Health ative, a large,

private nonprofit health insurance company based in Seattle, analyzed

data from 65,103 patients who took antidepressants between Jan. 1, 1992,

and June 30, 2003, comparing the rate of suicide attempts and death from

suicide attempts before and after treatment began -- the first such

study to track patients over time. Previous studies had examined reports

of suicidal thoughts among patients.

The researchers found that the risk of attempted suicide was 60 percent

lower in the month after treatment began and that it continued to

decline. While the overall risk for suicide was higher for adolescents

than adults, the reduction in risk was about the same for both groups.

When the researchers specifically examined 10 of the newest

antidepressants, such as Prozac -- the ones that have come under the

most suspicion -- they found that the risk was even lower.

While some people may react negatively to the drugs, the findings

indicate that for most patients the medications do not increase the risk

of suicide, Simon and others said.

" There may very well be individuals who are sensitive to these

medications, and doctors should monitor their patients carefully, " Simon

said. " But on average most people are not at higher risk. If anything,

they appear to be at lower risk for a serious attempt at suicide or

dying of suicide. "

The second study involved the first analysis of data from a $35 million

ongoing trial known as Star-D, which is designed to provide the first

large-scale analysis of various depression treatments in real-life settings.

The analysis involved 2,876 adults around the country who took the

antidepressant Celexa at 41 sites representing different types of

settings, including clinics, psychiatrists' offices and primary care

providers' offices, for up to 14 weeks. Within an average of eight

weeks, 28 to 33 percent of patients experienced a complete remission,

and 10 to 15 percent experienced some improvement, the researchers found.

Although the response rate in some previous studies has been better,

researchers said the findings were encouraging because drugs often fail

to perform as well in real-world settings, where many of the patients

also have other mental or physical problems and treatment is often more

complicated. There was no indication the drugs increased the risk for

suicide.

" This is very good news, " said psychiatrist Rush of the University

of Texas Southwestern Medical Center at Dallas, who led the study. " We

were able to achieve a significant level of remission in a group of

patients who are difficult to treat in a real-world setting. That's

encouraging. "

The study will continue to evaluate how best to treat patients who do

not respond, including whether other drugs or a combination of drugs and

therapy may be effective. The current FDA review of suicidal thinking in

adults taking antidepressants will ultimately analyze much of the

existing clinical data on the subject. It is scheduled to be completed

this summer.

© 2006 The Washington Post Company

December 30, 2005

The Making of Mental Patients

Inside TeenScreen

By SANDRA LUCAS

http://www.counterpunch.org/lucas12302005.html

In October, 2004, after taking TeenScreen, a 10-minute computer test

developed in the psychiatric department of Columbia University, 16-year-old

Chelsea Rhoades of Indiana was told she had two mental health problems,

obsessive compulsive disorder (OCD) and social anxiety disorder. The

diagnoses were based upon Chelsea's responses that she liked to help clean

the house and didn't " party " much.

Chelsea is one of countless children who get labeled with fraudulent

diagnoses every day. The difference in her case is that her parents, who

were unaware that TeenScreen had infiltrated their daughter's school and

had not given permission for the screening, reacted quickly. They filed a

lawsuit against the officials of the high school who allowed the test to be

administered and the TeenScreen program. In doing so, the Rhoades took a

stand for all parents across the nation.

The unscientific nature of psychiatric labeling was admitted to by the

American Psychiatric Association's own president, Sharfstein, when

he stated on June 27, 2005, during an interview on the Today Show, " We do

not have a clean cut lab test [for diagnosing mental illness or chemical

imbalance of the brain.] "

His admission was quickly followed by another similar statement from

psychiatrist Mark Graff, Chairman of the American Psychiatric Association

Committee of Public Affairs, " Chemical imbalance: it's a shorthand term

really, it's probably drug industry derived. We don't have tests because to

do it, you'd probably have to take a chunk of brain out of someone - not a

good idea. " Graff did more than admit to there being no science behind the

chemical imbalance theory. He also pointed out the incestuous relationship

between the drug industries and psychiatry....

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