The Controversial Placebo Effect of Antidepressants

The article linked below captures many facets of the complicated beast known as psychiatry under the influence of corporate pressure from Big Pharma.  In particular what struck me were the descriptions of how colleagues of Irving Kirsch, whose research exposes that antidepressants on the whole are no more effective than placebo, have been ostracized and dressed down for supporting him.

I could go on for days with shop talk about how as a therapist I approach my clients and their use of pharmaceuticals for mood stabilization.  My overall philosophy is to tread cautiously in those waters, and to support patient education and self-leadership.  I help clients do what they want to do after they have educated themselves as best they can about all of the relevant issues.

Anyway, for those who can stand to have the curtain pulled aside and to look directly at this beast of an issue:  Why Antidepressants Are No Better Than Placebos.

Please Don’t Feed the Doctors

We all know when a free lunch shows up at our workplace (see Confessions of a Drug Lunch Slut) it’s hard to resist the allure of those seafood salad finger sandwiches and bakery cookies. But the fact is, these little perks are influencing the practice of medicine big time. The New York Times today details the kind of marketing and so-called “education” that Forest Laboratories has been providing for Lexapro, and the kind of cash giveaways available for doctors who will hawk their wares. From the article:

[…] Forest’s 2004 plan for marketing Lexapro offers detailed information about how the company planned to direct this money to doctors.

Under “Rep Promotional Programs,” the document said the company planned to spend $34.7 million to pay 2,000 psychiatrists and primary care doctors to deliver 15,000 marketing lectures to their peers in one year.

“These meetings may be large-scale dinner programs with a slide presentation, small roundtable discussions or one-on-one advocate lunches,” the document states.

Let’s do the math — 2,000 doctors, $34.7 million dollars — that means each doctors is making an average of about $17,000 doing lectures for Forest Laboratories on the superior effectiveness of Lexapro, despite the fact that no real research exists to prove that it is more effective than other antidepressants in its class.

There is little doubt that antidepressant medications help some people. But so much money being spent to promote one medication over another is commercializing a practice which should be based on sound clinical evidence and careful decision-making by a professional who can help choose the best medication fit. Instead what we have are massive trends in prescribing that are largely driven by million-dollar marketing plans.

So, please, big Pharma, don’t feed the doctors. It causes them to behave in less patient-centered ways.