#PeterKramer says: Listen more to Prozac

In an extensive New York Times op-ed, psychiatrist Peter Kramer, well-known as the author of "Listening to Prozac," says we should take those recent studies that claim, especially for mild to moderate depression, that antidepressants are little better than placebos, with a fair-sized grain of salt.

About that claim, he says:

This supposition is worrisome. Antidepressants work — ordinarily well, on a par with other medications doctors prescribe. Yes, certain researchers have questioned their efficacy in particular areas — sometimes, I believe, on the basis of shaky data. And yet, the notion that they aren’t effective in general is influencing treatment.

Kramer's argument is basically this, as I understand it:
1. Because we still don't have exact description for what depression is, the so-called "placebo response" may be confounded by imprecision in knowing who had depression in the first place and whether they have "recovered" or not;
2. Related to that, problems of recruitment of trial volunteers.

Of that second issue, he says:

The problem is so big that entrepreneurs have founded businesses promising to identify genuinely ill research subjects. The companies use video links to screen patients at central locations where (contrary to the practice at centers where trials are run) reviewers have no incentives for enrolling subjects. In early comparisons, off-site raters rejected about 40 percent of subjects who had been accepted locally — on the ground that those subjects did not have severe enough symptoms to qualify for treatment. If this result is typical, many subjects labeled mildly depressed in the F.D.A. data don’t have depression and might well respond to placebos as readily as to antidepressants.

Related to both one and two, he says more focused studies are more accurate than more diffuse ones, and longer-term ones more accurate than shorter-term.

I'm sure that's true, just as in psychology and sociology. And, that's exactly where we're at with depression - a juncture of medicine and the social sciences.

Why has the media bought into the "antidepressants don't work," then?

Kramer says, indirectly, it's a mix of media liking "hot" stories and the "Big Pharma" effect.

The first will continue to be with us, and on science stories, only get worse in the future. The second will probably be made worse by Internet surfing and conspiracy thinking.