Antidepressant Nation Revisited

Dr. Marcia Angell has drawn harsh criticism from members of the psychiatric community for her essay doubting the efficacy of antidepressants, published in The New York Review of Books last month. This week, the Review published three reactions to her piece online, from some of the country’s major psychiatrists: Dr. John Oldham, president of the American Psychiatric Association; Dr. Daniel Carlat, professor of psychiatry at Tufts School of Medicine; and Drs. Richard Friedman and Andrew Nierenberg, professors of psychiatry at Cornell and Harvard medical schools, respectively.

It is worth noting that Angell’s critics take up only one of the major points of her original essay: the issue of whether or not antidepressants work. Serious attempts to comment on the potentially damaging effects of long-term drug use, the dubitability of the American Psychiatric Association’s “Diagnostic and Statistical Manual for Mental Disorders,” and the accelerating, arbitrary prescription of psychoactive drugs—to the effect of enriching the pharmaceutical industry as well as select psychiatrists—are conspicuously absent.

Among numerous finer points, the psychiatrists claim that Angell has failed to understand crucial research, misrepresented the psychiatric community’s prevailing views and otherwise mistaken fiction for fact. If true, these errors are serious, especially for someone as broadly credentialed as her. In a manner befitting her background, she carefully responds to each dispute, starting with what appears to be a fundamental difference between her and them: Her critics simply insist that psychoactive drugs are effective without offering up the hard evidence that science demands. She does not.

Angell has spent most of her professional life assessing the quality of clinical research on these drugs and is eminently qualified to speak on the subject. For the moment, her primary thesis remains intact: For the well being of psychiatric patients and the sake of understanding, the public, the press and the scientific community must resist settling for assurances from industry professionals and psychiatrists who benefit from current accepted standards of practice, and demand a program of rigorous research that will help us understand how antidepressants affect the human brain. –ARK

Marcia Angell in The New York Review of Books:

All three of these letters simply assume that psychoactive drugs are highly beneficial, but none of them provides references that would substantiate that belief. Our differences stem from the fact that I make no such assumption. Any treatment should be regarded with skepticism until its benefits, both short-term and long-term, have been proven in well-designed clinical trials, and those benefits have been shown to outweigh its harms. I question whether that is so for many psychoactive drugs now in widespread use. I have spent most of my professional life evaluating the quality of clinical research, and I believe it is especially poor in psychiatry.

Read more