The Efficacy Crusades

"Lifesavers or Active Placebos?"

The Efficacy of Antidepressants has long been the subject of debate - Are Antidepressants effective for treating Mental Disorders or are they merely Placebos with side effects? Our friends over at Psychiatric Times published an article about a recent heated exchange. . . . A very public one, and one I see no end in sight for. For my own amusement I call it "The Efficacy Crusades" - has a kitschy ring to it don't you think???

It's an in-depth piece so here's an amuse-bouche to titillate the palate (yet another food reference for the foodies). . . .

" . . . Marcia Angell, MD, Senior Lecturer on Social Medicine at Harvard Medical School and former Editor-in-Chief of The New England Journal of Medicine . . . contend[s] that clinical trials have failed to find antidepressants effective at all in mild to moderate depression; that many psychiatric drugs have devastating adverse effects, especially in children and when used long-term . . . Antidepressants and other psychiatric drugs, Angell charged, “are greatly overused, mainly because of the pharmaceutical industry’s influence on the psychiatric profession.” She also criticized the quality of clinical research in psychiatry as “especially poor” and the DSM as lacking validity, ever widening the scope of mental disorders and justifying “the use of psychoactive drugs.". . .”

Harsh, Dr. Angell . . . I thought I was tough nut! But it sounds to me like all your words are bit, well I'll just leave this to the Professionals -

Peter Kramer, MD, Clinical Professor of Psychiatry and Human Behavior at Brown University and author of "Listening to Prozac" and "Against Depression"  . . . offered a spirited defense of antidepressants in his op-ed rebuttal to Angell and others. “It is dangerous for the press to hammer away at the theme that antidepressants are placebos. They’re not. To give the impression that they are is to cause needless suffering." . . . 

The article continues to respond to each of the accusations, backing it all up with some pretty incredible research. Though, I think the most important point is summed up by Dr. Kramer. As for the over-prescribing caused by pharmaceutical's supposed death-grip on Psychiatry -

". . . in the August 1, 2011, issue of "Health Affairs", researchers from Johns Hopkins Bloomberg School of Public Health found that much of the growth in antidepressant use can be attributed to prescribing by non-psychiatrist providers without any ac-companying psychiatric diagnosis. . . While there are data suggesting that both underuse and overuse of psychiatric medications occur. . .Thomas Insel, MD, director of the NIMH, said a more critical issue is that “only about half of those with major depression receive care."

To provoke even more thought from fellow Artists who are affected by Mental Disorders, I will turn to our friend Kay Jamison, PhD, Professor of Psychiatry at the Johns Hopkins University School of Medicine and perhaps the most famous author on manic-depressive illness. . . Jamison isn't fond of  the simplistic notion of a "Mad Genius." She has a good point too - most emotionally unstable people are not extraordinarily creative, and most extraordinarily creative people are not emotionally unstable. . . Though she does explore the question: how might mania or depression contribute to creative accomplishment?

Before this Mad Chef returns to the kitchen, I must acknowledge the Sous-chef equally responsible for this tasting - a fellow Mad Boy indeed . . .

The Mad Boy