For those of you who haven't seen it, 60 Minutes recently did a segment (you can watch it at the end of this post) on the effects of antidepressants, specifically the difference in results between antidepressants and placebos. Now, everyone knows I have depression. No secret there. Most people also know that I've been on antidepressants of one variety or another since I was thirteen years old. So naturally, I was curious when people on Facebook started paying attention to this segment and decided to watch it all the way through. Now, as someone who has repeatedly had to try to convince people that depression actually exists, that it's a serious disorder, that medication and therapy can help, and that I'm not just weak and/or crazy, I'm of course a little defensive when it comes to these kinds of stories. So, take this post with a grain of salt if you'd like, but also keep in mind that I do recognize my own bias and try to push it back so I can be more objective.
The point of this 60 Minutes segment was to examine the opinions and research of one Irving Kirsch, a psychologist and assistant director of the Placebo Studies Program at Harvard. Kirsch claims that, according to his research, antidepressant drugs usually only provide relief from depression because of a placebo effect. In his own research studies and trials (and many others, according to the segment), antidepressants had little or no more effect on patients than placebo pills. In other words, patients on antidepressants do get better, but only because they think they're supposed to since they're on medication.
Now, the segment goes on and on about studies that back this up and about various experts who at least partially agree with these findings. I'm not saying that these experts are wrong. I'm not a scientist or expert in any way, shape, or form. However, there were several things about this segment that I disliked.
First of all, I thought this segment did a lot of damage to those of us who have spent our lives trying to get people to take the disorder seriously. This felt like a major boost to the "there's nothing actually wrong with you" and "it's all in your head" crowds, simply because the segment didn't take time to address the disorder itself, only the medication... and if you're claiming the effectiveness of the medication is all due to mentality and not chemistry, you REALLY need to address the fact that the same rule does not apply to the disorder itself. 60 Minutes lightly patted that issue on the head for five seconds when Kirsch spoke about the placebo effect surrounding knee surgery as well (apparently just having your knee cut open and sewn back up without any repairs taking place is enough to restore you to health and help you climb mountains again?), but that didn't do much to ease the overall "you can fix your own depression with the power of thought" feeling surrounding the segment.
Now, if you listen carefully to the experts featured in the segment, there are some phrases and points that keep getting mentioned, though the segment doesn't go into much depth or explanation with them. The most obvious of these repetitions is how these experts keep saying that this lack of effectiveness from antidepressants was found only in patients with mild to moderate depression, not those patients with severe depression. In fact, I found it very frustrating that Kirsch never explained WHO the patients were in his research. What disorders did these people have? Antidepressants are used to treat a variety of conditions including major depressive disorder, dysthymia, fibromyalgia, eating disorders, ADHD, and various anxiety disorders. If these patients all had major depressive disorder (as the segment would lead you to believe, even though it's never actually stated), what severity of the illness did this research participants have? Was there a fair representation of the entire spectrum or was he strictly trying to look at the placebo effect on patients with mild to moderate depression, since those are the only findings he keeps giving us? This segment goes on and on about how antidepressants have a clinically insignificant effect on the disorder in patients with mild to moderate depression, but it doesn't give any findings at all in connection with patients with severe depression. It also doesn't bother to give any information at all on the differences between these varying degrees of depression. How is anybody watching this segment supposed to get the full picture or decide how meaningful Kirsch's research really is?
Another thing the segment never mentions is what antidepressants were researched. "Antidepressant" is a very general term to cover a variety of drugs. Most people on antidepressants at least know that there are many significant differences between MAOIs, SSRIs, and SNRIs. Just looking at my own history, I've been on four or five different antidepressants, each with its own unique formula. Not once does this segment tell us which drugs are tested or whether or not there's any difference in the effectiveness of these drugs when they're compared with one another.
Finally, at the end of the segment, 60 Minutes sloppily tacked on two very important pieces of the puzzle. Previously in the segment, it was stated that all this data on whether or not antidepressants are any more effective than placebos was based on the patients' short-term results. However, Eli Lilly, the company that produces the drug I take, stated at the end of the segment that their own research showed that antidepressants were more effective than placebos in the long-term. As someone who has suffered from depression for a decade, that's kind of an important piece for me. But did the segment shed any light on that? Not at all. Eli Lilly also stated that patients on placebos were more prone to relapses than patients on the actual antidepressants. That's also an extremely significant point to examine. The cycle of remission and relapse is something so important to patients suffering from depression, so if the studies show that antidepressants prove more effective in preventing relapse than placebos, that's really something that needs to be made clear.
In other words, I thought that the segment was thought-provoking and raised an important issue, but it left much to be desired. In the end, I found it too inflammatory and one-sided to do any real good for those suffering from depression. So basically, I just want people who watch it to be very careful about falling for what Kirsch is saying without asking some really important questions not covered by the segment. But you don't have to listen to me. Watch the segment and form your own opinions on it.
Treating Depression: Is there a placebo effect? - 60 Minutes
My question: How on EARTH did they manage to fill up 60 minutes of time with only one piece of information? "Placebos do stuff! Antidepressants don't! Let's just make fart jokes for the next hour now that we've got that out of the way!"
ReplyDeleteYou are so correct--that last piece of info about the long-term versus the short-term is so right on, and so very important. From the sound of it, this whole issue was vastly misrepresented, and I'm very sorry for that. Thanks for bringing this to light, lady, and keep talking about it. We need to get over being afraid of facing our problems as a culture and just accept that things like depression are real and are suffocating if not dealt with. Why they are perpetuating this circle of ignorance is beyond me.
Luckily it was really only fourteen minutes of talking about one piece of information, but in order to give the argument the coverage it needs, they should've added more time and less repetition of one side of the issue. I know these people make a living by putting out stories that are sensationalistic, and the more one-sided, the more shocking the story... but still, I wish they would be a bit more careful about balancing out their information to provide the public with a clearer picture. Not doing so with this type of story is dangerous. At the end of that segment, they specifically had to tell people not to quit taking their antidepressants without first consulting a doctor.
DeleteThanks for the support, Emma. Hopefully this story will blow over until there's more concrete evidence on ALL aspects of antidepressant treatment, and if it doesn't, then I just hope this post convinces a few people to look at the issue more closely and not fall for the sensationalism.
Actually, fart jokes an 60 Minutes have a lot in common, in my book ... but who ever reads that ;-)
ReplyDeleteI;m glad to see this post and the fact that you are putting your writing talent and real-life experience to work. Do you know how little authoritative information there is on depression and other "buzz word" afflictions, like ADD/ADHD and such which is NOT funded/driven by drug companies looking for profit, government agencies who usually bend over backward to parrot what the drug companies tell them to say, or Rupert Murdock?
You actually have something here. Good stuff that you could make areal blog from You are your father's daughter, after all. Help people Get the Flick.
Thanks, Dave. You're right; it's very hard to find unbiased information on psychiatric illnesses these days since so much of what's out there is published by drug companies looking to make a profit. The other problem is that a lot of people don't understand the qualifications a patient needs to meet in order to be diagnosed with one of these illnesses. It's a major problem in convincing people that these illnesses do exist and that they can be very serious. It also leads a lot of parents and individuals to diagnose themselves or their children with an illness because there's so little public knowledge of the qualifications. People go "Oh, I'm sad, so I must have depression," or "My kid is too hyper so he must have ADHD." So basically, what you find is a lot of biased information from drug companies and a lot of incorrect information from people who know nothing about psychology and have just heard gossip or incomplete information circulating on these "buzz word" illnesses, as you say. It all constantly feeds this environment of stereotypes and disbelief.
DeletePsychiatry and psychology are new and constantly evolving fields, but there's a major lack of information being given to the public on a regular basis to keep them updated on the changes in the field, leading to a great deal of misconception and stigma. That's why I'm especially disappointed in this 60 Minutes segment. They had a great opportunity to provide detailed, accurate information to the public through this rather attention-grabbing debate, but the information they provided was so incomplete and skewed that they just made things worse, in my opinion.