From Ben Goldacre’s essential Bad Science blog:

Yesterday the journal PLoS Medicine published a study which combined the results of 47 trials on some antidepressant drugs, including Prozac, and found only minimal benefits over placebo, except for the most depressed patients. It has been misreported as a definitive nail in the coffin: this is not true. It was a restricted analysis [see below] but, more importantly, on the question of antidepressants, it added very little. We already knew that SSRIs give only a modest benefit in mild and moderate depression and, indeed, for some time now, the NICE guidelines themselves have actively advised against using them in milder cases since 2004.

The full Bad Science posting is well worth reading – it makes some interesting points about how clinical trials could be regulated to stop drug companies burying studies that don’t support their product and also includes a link to download the full text of the study, for free.

It’s interesting, in news reports, to see the pharmaceutical industry protesting that the results of the study are “at odds with what has been seen in actual clinical practice” – e.g. the Eli Lilly and GlaxoSmithKline statements near the end of this report.

Meanwhile, psychoanalyst Darian Leader writes an interesting history of The Creation of the Prozac Myth, charting how the marketing of drugs has affected the diagnosis of depression over time to include the symptoms that the drugs have an effect on. As so often with articles written by psychoanalysts, he concludes with a swipe at cognitive therapies, likening them to drugs for offering a “quick fix” and not addressing underlying problems.

This rather leaves aside the effectiveness of psychoanalytic approaches, which haven’t shown up well in trials (although a small study last year on psychodynamic psychotherapy for panic disorder is “among the first to prove clinical efficacy for a psychoanalytic therapy for any major psychiatric disorder”).

I believe that the intelligent application of NLP modelling and second-order change interventions could actually achieve the holy grail of combining a quick fix with addressing underlying causes, because it works at the unconscious level (as opposed to trying to reach the underlying causes through conscious understanding, which takes a long time and probably makes you feel worse the more you talk about the problem).

Sorry about the rather impenetrable nature of the ‘second-order change’  linked article. If anyone knows of an article on the web explaining the not all that difficult concept of first- and second-order change in understandable language, please let me know. Otherwise I’ll write one soon!

Depression: Prozac doesn’t work (all that well

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