Tonight I am sadly disappointed. I finally had a chance to read the Feb. 8 2010 issue with a promising cover story on antidepressants by Sharon Begley. I had expected, in common Newsweek fashion, to find an extended report on the overall story supplemented by articles from various perspectives – I was sadly mistaken. Begley’s article used recent controversial findings to smack around the efficiency of anti-depressants rather ferociously, then there was a small, one-page response from Robert Klitzman, a psychiatrist, author, and professor at Columbia University.

Jon Meacham, what happened here? Begley’s article highlights some interesting and thought-provoking research findings, but doesn’t seem to seriously consider the issues with the research findings. Klitzman’s article, while raising some important issues, is too short to offer a resource defense against Begley’s article. Klitzman’s use of personal, subjective experience is entirely worthwhile, but in an article this short it seems to overshadow the more scientific issues relating to researchers’ methodology in acquiring these results.

I haven’t had time to read the original research publications and probably won’t…nor am I a qualified mental health professional…but as an individual who has suffered from Obsessive Compulsive Disorder (OCD) and Major Depressive Episodes for all of my conscious life, I’d like to share a few observations:

• One must correlate not only the effectiveness of a single drug but the effectiveness of a class of drugs on the individual. For example, this study reflects that an individual in a clinical trial for say Prozac experiences only a 1% decrease in symptoms – similar or identical to a placebo effect. What the study does not correlate is how that same individual responds to different drugs used to treat the same disorder. For example – if this individual uses Zoloft, Paxil, etc. do they experience a more significant reduction in symptoms? One of the differences (for me) between Zoloft and Prozac is weight gain versus weight loss/stability. Future studies need to consider the effectiveness of a class of drugs in treatment of an individual versus an individual drug. Thus the question is, would any drug within this treatment class significantly reduce the symptoms of the sufferer? If so, this is a victory for “anti-depressants” in general. One cannot suggest that anti-depressants as a class are ineffective without considering their effectiveness as a class on the individual. Ineffectiveness in a case study of treatment of an individual with a single drug is not evidence that anti-depressants don’t work but that that specific anti-depressant doesn’t assist that individual.
• The lumping in of the varied forms of depression is a significant issue as well. There are significant differences between the forms and intensity of depression which is further complicated by coexisting disorders. Yes, situational depression (e.g. death of a friend or family member) is likely to resolve itself – but this is very different from the depression which simply sits upon a person like a funk – with no rhyme or reason. Dysthymic Depression has different implications than a sudden Major Depressive Episode.
• I’m not aware of anyone advocating that we pop anti-depressants like tic tacs and yet the article seems to indicate that these anti-depressants are being handed out to anyone who is experiencing a bit of grief. There is little disagreement, as far as I am aware, that medications are not a panacea for depression and that they should be utilized in moderation, in combination with other approaches, and for depression which appears to be ongoing and severely limiting rather than limited and minimal.
• Begley recommends psychotherapy as an effective alternative treatment, but that is a very general class – much more general than the anti-depressants mentioned. What sort of psychotherapy is being referred to? Psychoanalysis? Cognitive-Behavioral?

I would have liked to see someone like Peter Kramer who wrote the excellent book Against Depression write a response to Begley’s article (I think Klitzman is also fully capable of writing an article of such a nature given a more extended page count…I mention Kramer because he has written extensively on this subject). In the end, I simply want to suggest that Newsweek should be more careful in how they handle topics like this. It felt extremely one-sided and was not provided the depth or breadth I’ve come to expect from Newsweek.

The article raises good questions. We need to be considering the efficiency of our antidepressants. We need to be pushing for alternative treatments that don’t require the introduction of potentially harmful chemicals into our bodies. We need to smash any mentality that considers every blue mood an instance of depression and worthy of a few pills.

But where, oh where, where the articles talking about what sorts of psychotherapy are effective for treating depression? Where was the article even defining depression? Where were the articles talking about the efficiency of these same anti-depressants for other disorders – for example Obsessive-Compulsive Disorder? Where were the articles on how to improve our system?

Update 2/06/10: I’d like to thank Peter Kramer for taking the time to comment on this article and would like to point everyone’s attention to the several articles he has written in response to Newsweek’s article and the underlying research used in the article

• Here is an article for Slate that Kramer wrote explaining Irving Kirsch’s understanding of tianeptine and why it isn’t the clear-cut evidence Kirsch suggests. Kramer has some fairly strong words for Newsweek, “To set aside the testimony of animal model research, brain enzyme research, the new work on neurogenesis, and on and on—this stance has the whiff about it of science denial. It is one that a major magazine should have showcased cautiously, if at all, and only after having done some serious homework.”
• Here is another article for Slate in which Kramer evaluates the results of the recent JAMA study and demonstrates significant concerns acknowledged by the U. Penn researchers themselves concerning the efficacy of drawing conclusions on minor depression from this study.
• Finally, Kramer responds to arguments that individual responses to placebos are significant by noting that the test groups in studies reflecting this result oftentimes include a number of test subjects who don’t have the disorder – thus the apparent efficiency of placebos.