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Research into treatments for mental illness is under threat

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d3747 (Published 14 June 2011) Cite this as: BMJ 2011;342:d3747

Re:Great news for mental health care

It is ironic that we read of this loss of research capacity at the
same time that more doubt is being expressed concerning the reliability of
past research that has encouraged the prescription, or over
prescription, of psychotropics to countless people, at huge cost.

Marcia Angell, an editor of The New England Journal of Medicine for
many years, recently reviewed three books that discuss the role of
psychiatry and psychotropics in the perceived " epidemic of mental
illness" that has struck the USA in recent decades. (1)

One of the books, by Irving Kirsch (2) contains information that was
obtained from the FDA under the Freedom of Information Act.
Angell writes " ..drug companies make very sure that that their positive
studies are published in medical journals and doctors know about them,
while the negative ones often languish unseen within the FDA... This
practice greatly biases the medical literature, medical education, and
treatment decisions. "

Kirsch obtained details of forty two trials of the six most widely
used antidepressants approved between 1987 and 1999.

" Most of them were negative. Overall, placebos were 82 % as
effective as the drugs, as measured by the Hamilton Depression Scale (HAM-
D ), a widely used score of symptoms of depression. The average difference
between drug and placebo was only 1.8 points on the HAM-D, a difference
that , while statistically significant, was clinically meaningless. The
results were much the same for all six drugs: they were all equally
unimpressive. Yet because the positive studies were extensively
publicized, while the negative ones were hidden, the public and medical
profession came to believe that these drugs were highly effective
antidepressants. "

These findings and comments will come as no surprise to the many
physicians who have viewed these drugs with suspicion, for decades, but
the damage continues.

1 The New York Review of Books, LV111-11, June 23-July 13 2011, p20-
23.
2 The Emperor's New Drugs: Exploding the Antidepressant Myth. Irving
Kirsch, Basic Books.

Competing interests: No competing interests

19 June 2011
Noel Thomas
GP
Maesteg, Wales