Do antidepressants cause mud flinging?

Prospect magazine has an interesting article covering psychologist Irving Kirsch’s widely publicised meta-analyses that have questioned whether Prozac-style SSRI antidepressants are any better than placebo.

Kirsch has become well known for requesting unpublished trial data via the US Freedom of Information Act and pooling it with the published evidence. The conclusion of his latest re-analysis was that there was little difference between sugar pills and SSRIs in the treatment of depression.

This has kicked up all sorts of merry hell, not least because the media reported (and the Prospect article implies) that ‘antidepressants don’t work’ which is clearly false. They do work, but the debate is over how much of the effect is due to placebo.

It’s not quite as simple as it seems of course, as not everyone agrees with Kirsch’s methods and, as noted in an insightful 2008 paper, his argument is based on the assumption that people who respond to antidepressants also respond to placebo in a similar way, when we know there are individual variations in both.

Kirsch apparently has a book coming out shortly which is likely to restart the debate and it’s likely to be heated.

There are some hints of this in the article where several prominent psychiatric scientists give variations on the “don’t criticise the evidence, you’re harming children!” argument. In fact, head of the NHS trust where my research institution is based apparently blames ‘the media, and psychologists’ “who have a vested interest in constantly attacking antidepressants”. Yes, we’ve reached that level already.

We went through a very similar process when concerns over whether SSRIs increased suicidal thinking in adolescents were raised. Lots of similar mud-flinging ensued.

Interestingly, a meta-analysis of suicide attempts and suicidal thoughts in 372 trials just published in the British Medical Journal found that overall SSRIs had no effect on risk of self-harm, and that when the data was divided by age, there was a slight increase in thoughts and attempt in people younger than 25 and a slight decrease in adults aged over 65 (the comments on the article are also worth reading).

It’s probably worth saying that even in young people self-harm when taking antidepressants is very rare, but the fact that the drugs had no overall protective effect except in older people should give us pause for thought.

But getting people to focus on the evidence when they’re wound up is like getting people to focus on the fire exits during a strip show. We all accept the importance of doing so but few can quite manage it when the time comes.

Link to Prospect article on antidepressants (via @researchdigest)

Anxiety, an unauthorised biography

Photo by Flickr user dhammza. Click for sourceThe New York Times has an absolutely fantastic article on the psychology and neuroscience of anxiety and how an anxious temperament at birth can ebb and flow during our lifetime.

It’s an in-depth article that really does justice to the topic, looking at extensive research into our anxious states, but also carefully questioning some of the sloppy assumptions of many article where brain activity is described as directly representing mental states.

But having all the earmarks of anxiety in the brain does not always translate into a subjective experience of anxiety. “The brain state does not make it a disorder,” Kagan told me. “The brain state exists, and the statement ‘I’m anxious,’ exists, and the correlation is imperfect.” Two people can experience the same level of anxiety, he said, but one who has interesting work to distract her from the jittery feelings might do fine, while another who has just lost his job spends all day at home fretting and might be quicker to reach a point where the thrum becomes overwhelming. It’s all in the context, the interpretation, the ability to divert your attention from the knot in your gut.

The article is incredibly well written and it tackles a huge range of topics in the understanding of fear and anxiety. Highly recommended.

Link to NYT article ‘Understanding the Anxious Mind’ (via @mocost)

2009-10-02 Spike activity

Quick links from the past week in mind and brain news:

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USA Today has an interesting piece on how social networking sites are becoming research targets in health and psychology.

The oft-replicated finding in relationship research that, on average, women would be most hurt by romantic betrayal and men by sexual betrayal, is covered by Cognitive Daily.

New Scientist discusses a new imaging study that highlights the importance of the hippocampus in conceptual learning.

Love is a like a zoom lens, according to The Guardian. Sex is like a microscope, or an oscilloscope, depending on what you’re in to.

The New York Times has a piece on increased rates of dementia seen in American football players and how the NFL are trying to downplay the data.

Do people really lie three times within 10 minutes of meeting someone new? asks PsyBlog questioning the common statistic.

Time reports on a study finding that social comparisons with thin people who are big eaters can lead people to choose larger food portions.

Gamers are more aggressive to strangers, says New Scientist who clearly haven’t read the study which didn’t measure aggression to anyone.

Time magazine has another good article on how frequency of email contact can be modelled with a remarkable simple mathematical formula.

Religion protects against drug use in dance. Doping in ballroom dancing, who knew? (apart from Jesus)

Furious Seasons covers a new study finding that the majority of psychiatric drugs are prescribed by family doctors.

I wish I could be at the Encultured Brain conference, organised by the chaps from the excellent Neuroanthropology blog.

The Globe and Mail covers research on how women’s attitudes to their genitals is linked to orgasm frequency and health behaviour.

The development of implantable electronic <a href="Burst of Technology Helps Blind to See”>retinas is covered by The New York Times.

Both the British and American psychology associations have just launched their respective history of psychology websites.

New Scientist covers an overly melodramatic promo video by charity Autism Speaks and the spoof videos by people with autism.

The limits of a universal view of mental illness are discussed by Frontier Psychiatrist.

Psychiatric Times has concluded a three part series on the science behind fMRI brain scanning experiments.

Can the right kinds of play teach self-control in children? asks The New York Times as it discusses a radically different approach to child behaviour.

BBC News reports on a new study of treatment for drug addicts in the UK and finds treatment programme successes are encouraging.

Anticipating an interaction with an obese person provokes feelings of social power, reports the BPS Research Digest.

The Neurocritic has a neurogasm which looks more like a shampoo bottle than a drink but Paris Hilton is having one so it must be science, right?

The interesting origins of the British Prime Minister on antidepressants so what poppycock is tackled by Neuroskeptic.

Colbert on snus and placebo

Stephen Colbert did a brilliantly funny piece on his show the other night, tackling the introduction of ‘snus‘ to the USA, tobacco pouches that fit under the lip, and the increasing placebo effect, a topic which we discussed recently.

Colbert tries the snus pouches on the programme, which, I have to say, seem remarkably uninviting, and riffs on the health benefits of sugar pills with plenty of laughs.

Link to Stephen Colbert clip (thanks Veronica!)