Science journalists get depression wrong by dissing SSRIs and overhyping PLoS story

No, I still don’t believe memes exist, at least not in a strong sense, but the word is a handy catch-all. Anyway, that’s besides the point.

A set of psychology researchers say that media use of “chemical imbalance” to describe depression is scientifically inaccurate. Rightly, they note that the idea comes from classical Greece’s concept of the four “humors” in the body.

However, the researchers then have to follow up on the overhyped recent Public Library of Science report and claim, as does the author of the World Science story, that modern anti-depressants really don’t work:

The drugs, known as Selective Serotonin Reuptake Inhibitors or SSRIs, recently turned out to be largely ineffective.

Boy, that’s wrong in several ways. First, the PLoS story only claimed that antidepressants were relatively ineffective in mild or moderate depression, not all depressions.

Second, the PLoS authors overstated their case. From the study:

On average, the SSRIs improved the HRSD score of patients by 1.8 points more than the placebo, whereas NICE has defined a significant clinical benefit for antidepressants as a drug–placebo difference in the improvement of the HRSD score of 3 points.

That may not be great effectiveness, but it’s nowhere near “largely ineffective.” And, since milder depressions are usually likely to ring up lower diagnostic scores, the numeric steps of improvement, by HRSD scores, that provide relief, will be lesser anyway.

Beyond that, the third misstatement is to claim we don’t know how antidepressants work. It’s true that we don’t know details, such as not knowing which of the several different serotonin receptors in different types of neurons are affected, in one way, by depression, and then reaffected, or unaffected, by SSRIs, or tricyclics, or MAOs, for that matter. But, we do know that serotonin

Finally, both the World Science story and the original PLoS study omitted (either threw neglect or else deliberately) one huge issue:

Brain imaging studies, MRIs, show placebos given to patients in antidepressant studies affect a different part of the brain than do actual antidepressants.

If the omission, especially on the part of PLoS authors, was deliberate, it’s a definite science ethics issue. Even if through neglect or ignorance, it’s another definite “issue” with their study.

And, given that this finding was reported six years ago, it shouldn’t have been ignored.