One Third Of Antidepressant Studies Never Published

A new study—”the most thorough to date,” writes the New York Times—shows that about a third of the studies for some of the market’s most successful antidepressants (Paxil, Prozac, Zoloft, Effexor) were never published because they didn’t have favorable results. “While 94 percent of the positive studies found their way into print, just 14 percent of those with disappointing or uncertain results did.” The implication is that the makers of these drugs intentionally misled consumers and the federal government on their effectiveness.

Dr. Turner said the selective reporting of favorable studies sets up patients for disappointment. “The bottom line for people considering an antidepressant, I think, is that they should be more circumspect about taking it,” he said, “and not be so shocked if it doesn’t work the first time and think something’s wrong with them.”
For doctors, he said, “They end up asking, ‘How come these drugs seem to work so well in all these studies, and I’m not getting that response?'”

An industry spokesman claims that the findings are based on clinical trials completed before 2004, “and since then we’ve put to rest the myth that companies have anything to hide.”

con_pharmatimeline.jpg

Yes, now it is all settled—please buy more drugs.

“Antidepressant Studies Unpublished” [New York Times]
(Photo: Getty)

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  1. nrwfos says:

    Yes, that would explain why Effexor is so addictive and hard to get off. I’m currently waging that battle now.

  2. Wasn’t there a whole Law&Order episode featuring this? Is Consumerist copying L&W like L&W copied the Consumerist last night?

  3. TechnoDestructo says:

    You forgot to link the mistrust survey.
    [consumerist.com]

  4. fizzyg says:

    A great majority of scientific studies with uncertain results never get into print. That’s a basic research truth. The other issue would be whether the disappointing results were basically findings of null effects…in other words that no differences existed. If that’s the case then generally that’s difficult to get published as well, and it doesn’t matter if you’re looking at a medical field or a non-threatening behavioral science area. Many researchers want this to change, as even null results let you know what not to look at again, but it’s not something that will change soon.

  5. Coder4Life says:

    @nrwfos: Paxil is the same way. Most of these drugs are not addictive rather they are very hard to actually get off, and will cause issues with sleep and other functions. For instance I have only been on Paxil for about a month, last week I missed 2 doses of it and could not fall sleep at all. I took it the next day and it got better. The day after I started getting lseep again.

    The doctors forget to tell you that once you are on these drugs, good luck getting off of them w/out them just ruining your life..

  6. nrwfos says:

    @fizzyg:
    It’s a very expensive thing that may have “null effects”. Personally, I am very angry at not being informed of the “results” of tests on this product. I guess that we should be grateful that drug salespeople load all these onto physicians and assure them they work when all they really do is empty your wallet and make you addicted to something that is hell to get off. I’m doing a lot more of my own health and medication research these days thanks to this experience. I’m still depressed – even more so now thanks to this battle – and having a really bad time on a drug my doctor was assured would be a big help. That’s what the literature said.

  7. nrwfos says:

    @Coder4Life:
    Oh, yeah. I know about the effects. Loss of short term memory and brain “shocks” are right up there with what I really don’t appreciate.

  8. @Coder4Life: “The doctors forget to tell you that once you are on these drugs, good luck getting off of them w/out them just ruining your life..”

    They sure as hinky-heck should be telling you that, if only so you don’t quit cold-turkey on your own and suffer the terrible “withdrawal” side effects. You should always taper under the supervision of a doctor.

    (Incidentally, missed dose effects depend quite a bit on the half-life of the drug (as well as the drug’s withdrawl effects generally); longer half-lives often mean you don’t notice a missed dose, while a short half-life can mean you’re in immediate withdrawal if you miss.)

    I had an unpleasant-but-manageable changeover experience last year when I switched antidepressants. But I was well-aware of what was coming and, of course, under a doctor’s supervision.

  9. ekthesy says:

    @Eyebrows McGee: @nrwfos:

    Ah geez. This is what I don’t like to hear. I’ve been self-medicating for depression with “nonpharmaceutical herbal substances” and I’ve recently stopped that for an SSRI, not either of the ones you two mentioned.

    It seems like either way, I’m gonna be addicted to something, which is depressing in and of itself. And at least I was using an ostensibly natural product beforehand…

  10. bohemian says:

    There was a bunch of things in the news this week that Vitorin doesn’t do squat. Just taking the cheap statin drug alone does.

    The drug companies have been pushing Lyrica really hard as a crossover drug for fibromyalgia. I’m on a support group for people with fibro and about half of them have tried Lyrica and of those people it worked for maybe a little over half of them. But all of them have had horrible side effects in many cases as bad and debilitating as their neuro pain was. But I have been pimped this drug hard by three doctors in the last few months. They all have Lyrica notepads, pens, clipboards and free samples. The drug literature for this one doesn’t mention that you can’t just stop taking it once you start and it is very hard to get off of. Or the so so chances of it doing something that is over all positive. Some people have side effects of being dizzy and weak to the point they can’t drive anymore.
    You might get some slight reduction in your over all pain but you will be house bound and fat.

    Medical professionals are pitching these drugs based on what the drug reps are telling and giving them.

  11. youbastid says:

    I’m sure the top brass weren’t aware of this before, and they’ll be taking it very seriously down the line.

    Although I don’t like that this report lumped “Disappointing” with “Uncertain.” I don’t think it’s necessarily wrong of them to withhold the uncertain ones, but I’d like to know exactly what the percentage of withheld “Disappointing” results were.

  12. Nemesis_Enforcer says:

    @ekthesy: I think it depends on the strength of the dosage and the drug. Last year I was taking Prozac and then I got laid off so my insurance lapsed for about 3 months. So I had to make do without anything, I noticed a difference bu not OMG I am dieing. More like my asshole meter just went up and my wife got so tired of it she asked for prozac from her doctor so she could give it to me. BTW we both have the same PCP so I got the same dosage etc.

    Now when I tried Lexapro before I found Prozac the side effects were bad. I was one of the “few” who suffered a sexual side effect. I could get excited but no finishing ability for about 2 hours. Wife loved it me…ehh not so much.

  13. Pigmann says:

    Hey, I take Effexor. Bring on the class action lawsuit so I can at least have some money to buy my pain away with.

  14. ghettoimp says:

    Best. Timeline. Ever.

  15. topgun says:

    Now I’m depressed.

  16. bunnymen says:

    @nrwfos: Hey, been there. I’m really sorry that you, and anyone else, has to go through that hell. The way I ended up kicking was to get on 20 mgs of Celexa (the old school formula). That was much easier to kick after I’d properly recovered from trying to get off Effexor (plus it’s easier to halve and space out doses – I felt almost no effects getting off over the course of two months).

    Ugh. I still get angry thinking about the bitch who prescribed it and all the doctors afterward who “hadn’t heard of” any discontinuation side effects.

  17. fizzyg says:

    @nrwfos: Oh I don’t think it’s fair at all. I’m just saying that it’s common across research topics.

  18. bunnymen says:

    @bunnymen: And if I was abmiguous at all, I stopped the Effexor altogether when I started the Celexa.

  19. Adam Rock says:

    I took Effexor for about a month. Took two weeks to scale down, another two for the electricity coursing through my muscles to go away. Scary stuff.

    There are support groups for leaving these drugs.

  20. @ekthesy: “I’m gonna be addicted to something, which is depressing in and of itself. And at least I was using an ostensibly natural product beforehand…”

    It’s not technically an “addiction.” But your body adjusts to the drug, and when you stop taking it, there are effects as your body readjusts to normal. There are many drugs that when you stop taking them, your body goes through an adjustment phase — your acne might go out of control coming off birth control, for example, and then settle down after a cycle or two. Or even with vitamins — you might get constipated (or diarrhea, depending on the vitamin!) when you stop taking it.

    For me, the “withdrawal” consisted of headaches (treatable with Tylenol, but annoying), minor sleep disruptions (doc gave me sleep aid), and a tingling sensation in my hands and face (face, not feet). The last was irritating, but I had actually experienced it (in less intense form) as a side effect before, so it wasn’t a shock. We basically scheduled a couple-week taper, and I scheduled the first week I was completely off the old drug to be one where I didn’t have a lot going on. The first couple days my head really bothered me and I was glad to be able to curl in my bed with a book, but thereafter I was basically fine, just felt a little under the weather.

    There’s a whole catalog of side effects and withdrawal effects, so your mileage will vary. The primary side effects I got were dry mouth (very common) and the tingling (relatively uncommon). You could very well end up with “better” side effects — or worse ones — or none at all!

  21. textilesdiva says:

    Heh.

    And the psychiatrist at student health today just could not fathom why I preferred the older, cheaper drug (lithium) that I’ve been on before with no problems, to a brand-spanking-new one that he says works well (Abilify), or even over a slightly less new one (Lamictal).

    He actually said “There’s no reason to distrust the pharmaceutical industry”. A$$hat, you might have the degree, but I’m the one who swallowed their pride and is actually going to take the damn drugs.

  22. rjhiggins says:

    @Coder4Life: I would suggest you get a new doctor. My doctor was very clear on this, and recommended tapering off by reducing the dosage. There were definitely side effects, but I was prepared for them.

    Keep in mind that finding the right SSRI in the right dosage is anything but an exact science. It can take months of experimentation, working with your doctor (preferably a psychiatrist with more in-depth knowledge than your GP) to find what works for you.

    That’s one reason I have trouble with studies like this: Just because a particular antidepressant didn’t work for x percent of the subjects doesn’t mean it’s ineffective.

  23. Death says:

    My gf works at a lab that does a lot of nutrition research. Most studies are sponsored by the food industry, and unfavorable test results get squashed via threat of no future funding.

  24. Quaoar says:

    @Coder4Life:

    Any physician who prescribes a psychoactive drug and does not a) supply the consumer education documentation to the patient and b) does not provide a verbal description of how to take the drug, what to do for a missed dose, what major side effects to expect, and how to wean off the drug should be reported to the state board of medical examiners.

    Physicians are violating their medical ethics responsibilities to their patients if they do not “hold their patients’ hands” when prescribing psychoactive pharmaceuticals.

    Q

  25. Robobot says:

    The shrink I had as an adolescent told me as much. I take anything she said with a grain of salt because she horribly misdiagnosed me and left patronizing and triggering messages on my voicemail, but what she said about studies still makes sense.

    So, here’s an example she gave me: When news came about that adolescents taking SSRI drugs are *more* likely to suicide, the study that was published was incomplete. Obviously someone had an agenda. Anyone who has ever been depressed knows how completely emotionally and physically draining it is. Well, during the first 4 weeks of taking an SSRI, the first thing that changes in your mood is your energy level. You’re still depressed, but you have energy. If a suicidal kid is so depressed that they don’t have enough energy to off themselves, and they start taking a medication that restores that energy, of course they are more likely to commit suicide. But that’s just a 4 week time table, and when an adolescent is first prescribed an SSRI, they should be be heavily monitored anyway. Even she knew that. So someone just decided to publish “SSRI drugs make adolescents kill themselves!” without bothering to include the above facts.

  26. sjmoreau says:

    I was on Paxil for about 6 months and have been off since October…the withdrawal was the most miserable thing I have ever experienced and I now worse off than I was before I ever started even taking the medicine. I read a study after getting off the medicine that said that some 90% of Paxil users experience extreme withdrawal symptoms. I have since switched doctors and both he and my therapist have told me that Paxil is notorious for it’s side effects and my therapist described the withdrawal as “hellacious”. I wish I would have known that before I started…

  27. purkinje says:

    What’s really nifty about this study is that anyone who wants to know what it says can, you know, read it. Key point from the abstract: “We cannot determine whether the bias observed resulted from a failure to submit manuscripts on the part of authors and sponsors, from decisions by journal editors and reviewers not to publish, or both.”

    [content.nejm.org]

  28. nrwfos says:

    @rjhiggins: I’m not saying that the Effexor didn’t work. It helped me a lot. But I’m 58 and retirement is looming (more depression looms) so I’m looking ahead and seeing less in funds for meds. Hence my concern about being so dependent on such an expensive drug. I’m taping off very slowly. So far my muscles hurt the worst.

  29. HooFoot says:

    @nrwfos: Hang in there, buddy. Withdrawing from Effexor was the second worst experience of my life (death of my mother coming in first) and it made me ill for two months straight. But it was completely worth going off that poison! Effexor suppressed my depression—along with every other emotion that made me feel human. Depression sucks, but not feeling anything at all is absolute hell.

  30. mikelotus says:

    @nrwfos: for you perhaps, not for everyone.

  31. @nrwfos: IANAD, and I don’t know jack about Effexor, but one option for SSRI taper-and-withdrawal is to use something in a different families — like Wellbutrin — to buffer the withdrawal effects. I know a lot of people who had rotten tapers for whom the Wellbutrin/something similar basically solved the problem. (And I guess Wellbutrin doesn’t have a bad taper for most people, so you taper the one, spend a few weeks on Wellbutrin/whatever, then taper that.)

    I pay $20/mo for Wellbutrin generic, so it might be a better option even if you opted to stay on it.

  32. gticlutchburn says:

    scientology FTW!

  33. mmcnary says:

    Typical pharma solution:

    Measure with a micrometer

    Mark it with chalk

    cut it with an axe

  34. kat says:

    @HooFoot: Hang in there, buddy. Withdrawing from Effexor was the second worst experience of my life…and it made me ill for two months straight.

    Right there with you. I was on it for 5.5 years and my GP never told me a thing about the trip back downward. I tapered off by opening up the capsules each day and taking out 20 granules, staying on that level for a week, and taking 40 out the next, 60 the next, etc. I weathered brain shocks, night terrors, nearly crippling vertigo, hot flashes, vile flu-like symptoms, etc. Hell on earth, and it’s a crime that it’s still on the market. No one I’ve ever known who’s been on it has thought that the positive effects outweighed the withdrawal.

    Like HooFoot said – hang in there. Ridding yourself of that poison is one of the best things you’ll ever do for yourself.