Peter Kramer takes up the question of the efficacy of SSRIs and the study that Kirsch is apparently leaning on
http://www.psychologytoday.com/blog/in-practice/200802/dead-horse
and more fully here:
http://www.slate.com/id/2182585/pagenum/all/#p2
A summary from the first one:
<quote>
In the current study, Kirsch found that when compared to healthier subjects, severely depressed subjects got more benefit from the drugs both absolutely and relative to the placebo. (The absolute peak was at the low end of the severely depressed category.) That’s what critics of these studies, including those who believe the antidepressants are effective, had predicted: because the less depressed groups had non-patients mixed in, there the noise would drown out the signal. Kirsch thinks the emperor has no clothes—the drugs don’t work. But in demonstrating high placebo response rates, his analysis may merely be confirming that a number of the subjects in the drug trials didn’t have depression in the first place. Again, this analysis is less about the medications, which have proved moderately effective in numerous studies, than about the past politics of presenting data to the FDA.
<unquote>
That's pretty much what my impression was. Kramer doesn't let the drug approval process off the hook, mind you.
I can't speak to antipsychotics, and am aware of their causing permanent side effects. But the rebound effect from SSRIs is no secret and considered in standard treatment: you're supposed to go off them slowly. With regard to the foolishness of trying to derive understanding of a disease from the treatments that alleviate the symptoms, what shall we make of scurvy and diabetes?
Perhaps the review fails to do the books justice, but I find it curious that it is a rare popular critique of psychiatry that acknowledges standard psychiatric treatment protocols and caveats for depression: ramping up dosages while watching for suicidal ideation, switching meds if side effects are too much, incorporating talk therapy, ramping the dose down slowly to avoid discontinuation syndrome.
Why is it usually a cartoon that gets critiqued? It seems that psychiatry and the medicines it uses are burdened with special scrutiny -- the scandal around Vioxx, which directly killed people, prompted critiques of drug development and testing without causing a reconsideration of NSAIDs. The questionable efficacy of coronary stents leaves the tenets of cardiology unscathed. Piling on pills to treat the side effects of pills appears to be a late-life right of passage. Yet the popular understanding of psychiatry never seems to have gotten beyond One Flew over the Cuckoo's Nest.
What's the deal? Is it the diddling with the self that freaks people out?
-- Andy