Prozac: No better than placebo?

A major new meta-analysis, as reported in The Guardian, makes exactly that claim. The full study, published in the Public Library of Science, is here. And, it’s not just Prozac; another major selective serotonin reuptake inhibitor antidepressant, Paxil, get the same critical nyet, as do two serotonin-norepinephrine reuptake inhibitor antidepressant:

The review breaks new ground because Kirsch and his colleagues have obtained for the first time what they believe is a full set of trial data for four antidepressants.

They requested the full data under freedom of information rules from the Food and Drug Administration, which licenses medicines in the US and requires all data when it makes a decision.

The pattern they saw from the trial results of fluoxetine (Prozac), paroxetine (Seroxat) [Paxil in the U.S.], venlafaxine (Effexor) and nefazodone (Serzone) was consistent.

“Using complete data sets (including unpublished data) and a substantially larger data set of this type than has been previously reported, we find the overall effect of new-generation antidepressant medication is below recommended criteria for clinical significance,” they write.

I think the conclusion is somewhat overstated, and meta-analysis research in general is sometimes overhyped; nonetheless, is this anywhere near bogus? I think the research probably is pretty solid.

In any case, Big Pharma is HUGELY worried and wasted no time to attack.

In adults, however, the depression-beating benefits were thought to outweigh the risks. Since its launch in the US in 1988, some 40 million people have taken Prozac, earning tens of billions of dollars for the manufacturer, Eli Lilly. Although the patent lapsed in 2001, fluoxetine continues to make the company money — it is now the active ingredient in Sarafem, a pill sold by Lilly for premenstrual syndrome.

Eli Lilly was defiant last night. “Extensive scientific and medical experience has demonstrated that fluoxetine is an effective antidepressant,” it said in a statement. “Since its discovery in 1972, fluoxetine has become one of the world's most-studied medicines. Lilly is proud of the difference fluoxetine has made to millions of people living with depression.”

A spokesman for GlaxoSmithKline, which makes Seroxat, said the authors had failed to acknowledge the “very positive” benefits of the treatment and their conclusions were “at odds with what has been seen in actual clinical practice.”

Hey, if you can remarket an antidepressant as another drug, as Lilly did by rebranding Prozac as a pre-menstrual issues drug after its patent expired, you’re going to be dollar-sensitive.

That said, as someone currently on citalopram (generic Celexa), and having run through comments on a post on this on Political Animal, I have a few thoughts.

First, if antidepressants did work BECAUSE they were placebos, why wouldn’t the placebo effect work with the first antidepressant? Why do so many people, unfortunately, try three or four before finding the right one for them?

Second, claiming a “spontaneous remission” for depression, saying that means we can and should go back to pre-drug days, is not just naïve but dangerous. Like a physical illness such as MS that goes into “remission” but then flares up again, depression can do the same.

Finally, we know too little, still, about brain chemistry to know exactly how antidepressants work. Therefore, claiming we know they don’t work is premature, even if that does prove to be the case 20-30 years from now.

Missing from Democratic presidential campaigns, Feb. 25 version

1. A call to allow carbon tariffs as part of WTO reform. (This is only a partial miss on Obama’s side. He has said he wants to reform WTO at the Doha round to get some environmental standards in there, but I doubt that he wants to go that far.

2. A national office of insurance regulation. If a national healthcare system is run through private insurers, a federal regulatory office is vital. Both Clinton and Obama have been silent on this.

Such an office would ideally regulate home and auto insurance, too, since state regulatory agencies are toothless. (Life insurance, as an investment product, already has some federal regulation.)

100 years’ = ‘soon’ = Another McCain lie on Iraq

Schmuck Talk Express™ (and invented by this very blogger) is now claiming the war in Iraq will be over soon. This new line of BS, different from previous such lines, is far away from the “100 years of war” comments of previous weeks:

“My friends, the war will be over soon...” McCain told the crowd. “The insurgency will go on for years and years and years. But it will be handled by the Iraqis, not by us.”

“And then we decide what kind of security arrangement we want to have with the Iraqis.”

This, McCain has indicated, was what he was referring to in January when he said that troops could be in Iraq for 100 years.

“In Korea we've had, as you know, ever since the Korean War, we’ve had a military presence in South Korea. So my Democrat friends like to distort that comment.”

Let’s count all the different lies or distortions. Let’s start at the bottom.

South Korea didn’t have an ongoing insurgency since the end of the Korean War.

Related to that, South Korea faced North Korea, a separate country, across a clearly defined border.

Second, if Iraqis are supposed to handle an insurgency after “date X,” why do they need our troops there?

Third, McCain put no such context on his “100 years” statement when he uttered it. It’s clear he’s trying to backtrack.

Want a HELOC? Grab a chair, sit down, and wait

Your local bank is tightening the spigot on home equity lines of credit and similar loan mechanisms. Countrywide alone sent a mass mailing to 122,000 homeowners telling them their credit lines had been frozen.

Well, THAT ought to help continue the plunge into recession.

Existing home sales hit nine-year low

The National Association of Realtors (not headed by Herbert Hoover), may continue to insist a housing rebound is just around the corner, but this report indicates otherwise.

U.S. says it favors binding greenhouse gas goals — we’ll see

The pudding that will have, or dispel, the proof on this claim will be brought out for dessert in April.

Even if Daniel Price is serious (by the way, note his title — assistant to the president for international economic affairs, and nothing environmental), specific targets mean nothing if they’re too weak. I can be a police chief, and talk about reducing crime all I want, but if my specific target is a 1 percent reduction from this year, 10 years from now, then I’m all talk.