Do antidepressants work?

Jacob Stegenga

aeon.co

Originally published 5 Mar 19

Here is an excerpt:

To see this, consider an analogy. Imagine we are testing a drug for weight loss. For every 100 subjects in the drug group, three subjects lose one kilogramme and 97 subjects gain five kilos. For every 100 subjects in the placebo group, two lose four kilos and 98 subjects do not gain or lose any weight. How effective is the drug for weight loss? The odds ratio of weight loss is 1.5, and yet this number tells us nothing about how much weight people on average gain or lose – indeed, the number entirely conceals the real effects of the drug. Though this is an extreme analogy, it shows how cautious we must be when interpreting this celebrated meta-analysis. Unfortunately, however, in response to this work, many leading psychiatrists celebrated, and news headlines misleadingly claimed ‘The drugs do work.’ On the winding route from the hard work of these researchers to the news reports where you were most likely to hear about that study, a simple number became a lie.

When analysed properly, the best evidence indicates that antidepressants are not clinically beneficial. The meta-analyses worth considering, such as the one above, involve attempts to gather evidence from all trials on antidepressants, including those that remain unpublished. Of course it is impossible to know that a meta-analysis includes all unpublished evidence, because publication bias is characterised by deception, either inadvertent or wilful. Nevertheless, these meta-analyses are serious attempts to address publication bias by finding as much data as possible. What, then, do they show?

In meta-analyses that include as much of the evidence as possible, the severity of depression among subjects who receive antidepressants goes down by approximately two points compared with subjects who receive a placebo. Two points. Remember, a depression score can go down by double that amount simply if a subject stops fidgeting. This result, found by both champions and critics of antidepressants, has been replicated year after year for more than a decade (see, for example, the meta-analyses led by Irving Kirsch in 2008, by J C Fournier in 2010, and by Janus Christian Jakobsen in 2017). The phenomena of blind-breaking, the placebo effect and unresolved publication bias could easily account for this trivial two-point reduction in severity scores.

The info is here.

Stop ignoring misconduct

Donald S. Kornfeld & Sandra L. Titus
Nature
Originally posted 31 August 2016

The history of science shows that irreproducibility is not a product of our times. Some 350 years ago, the chemist Robert Boyle penned essays on “the unsuccessfulness of experiments”. He warned readers to be sceptical of reported work. “You will meet with several Observations and Experiments, which ... may upon further tryal disappoint your expectation.” He attributed the problem to a 'lack of skill in the scientist and the lack of purity of the ingredients', and what would today be referred to as inadequate statistical power.

By 1830, polymath Charles Babbage was writing in more cynical terms. In Reflections on the Decline of Science in England, he complains of “several species of impositions that have been practised in science”, namely “hoaxing, forging, trimming and cooking”.

In other words, irreproducibility is the product of two factors: faulty research practices and fraud.

The article is here.

The Dark Side of Emotional Intelligence

In some jobs, being in touch with emotions is essential. In others, it seems to be a detriment. And like any skill, being able to read people can be used for good or evil.

Adam Grant
The Atlantic
Originally published January 2, 2014

Here is an excerpt:

Emotional intelligence is important, but the unbridled enthusiasm has obscured a dark side. New evidence shows that when people hone their emotional skills, they become better at manipulating others. When you’re good at controlling your own emotions, you can disguise your true feelings. When you know what others are feeling, you can tug at their heartstrings and motivate them to act against their own best interests.

Social scientists have begun to document this dark side of emotional intelligence. In emerging research led by University of Cambridge professor Jochen Menges, when a leader gave an inspiring speech filled with emotion, the audience was less likely to scrutinize the message and remembered less of the content. Ironically, audience members were so moved by the speech that they claimed to recall more of it.

The authors call this the awestruck effect, but it might just as easily be described as the dumbstruck effect. One observer reflected that Hitler’s persuasive impact came from his ability to strategically express emotions—he would “tear open his heart”—and these emotions affected his followers to the point that they would “stop thinking critically and just emote.”

The entire story is here.

The Best Treatment Of Anxiety May Not Involve The Drugs That Recent Literature Suggests

Medical News Today

A recent data analysis that was published in the British Medical Journal (BMJ) suggested that antidepressant drugs may offer the best treatment for generalized anxiety disorder. This new data analysis that is published in the recent issue of Psychotherapy and Psychosomatics suggests that BMJ is faulty and biased by conflict of interest.

Generalized anxiety disorder, the constant and fearful worry and fearful anticipation of events, is a common disturbance. A recent data analysis that was published in the British Medical Journal (BMJ) suggested that antidepressant drugs may offer the best treatment for generalized anxiety disorder. A new data analysis that is published in the recent issue of Psychotherapy and Psychosomatics suggests that BMJ is faulty and biased by conflict of interest.

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Although the study was allegedly independent, all authors had financial ties with Lundbeck and other pharmaceutical companies which manufactured the drugs that were included and discussed in the meta-analysis. The meta-analysis performed by Baldwin and colleagues is likely to yield misleading conclusions, particularly for the busy clinician who has no time to check its faulty procedures and the lack of appropriate clinical integration. The publication of this paper calls for a reassessment of journals' policies concerned with reviews, editorials and meta-analyses.

The entire article can be found here.