Friday, November 17, 2006

What a BAD Piece in the New York Times

Op-ed contributor Andrew Solomon’s words are in quotes and italics followed by my thoughts. I would have liked to post all of his piece, but I don’t think the NYT would approve (copyright issues), so I’ll try to be selective.

“Depression is the leading cause of disability worldwide, according to the World Health Organization. It costs more in treatment and lost productivity than anything but heart disease.”

So far, so good

“Despite medical advances in the last 20 years that have greatly improved our ability to help those who suffer from depression, we lack an effective system for administering care.”

I wonder which medical advances he is speaking of. Maybe SSRI’s? Or Effexor? Or Cymbalta? In any case, there is no evidence that these new treatments have brought more than perhaps a minimal advantage over treatments which existed prior to 1986 (see here and here).

“Only a very small percentage of depressives who seek help receive appropriate treatment for their condition. Research often stalls short of being translated into useful medicine. Depressives continue to be stigmatized, which makes their lives even more difficult and lonely.”

Um, I think that if Mr. Solomon is so concerned about people with depression avoiding stigmatization, he may want to stop referring to them as “depressives,” as the term indicates that he is defining people with a label, and a rather negative one at that. I can assure you that nobody who is dealing with depression wants to be called a ‘depressive.’

“These problems are similar to those cancer patients once faced, and the best way to address them might be similar as well. We need a network of depression centers, much like the cancer centers established in the 1970s.”


“Following this model, the National Institute of Mental Health should coordinate and subsidize a national network of depression centers, ideally based at research universities with good hospitals and departments devoted to the subject.”


“Among the thousands of depressed people I have met with, the majority have sought treatment but feel that they are not getting good care. Many of them have been prescribed antidepressants by family doctors who lack training in psychiatry and have conducted only cursory interviews before rendering their diagnoses. Antidepressants vary in their chemistry and effects; and human brains vary as much as human minds. To treat the most complicated organ in the body appropriately demands considerable expertise.”

Apparently Mr. Solomon has never heard of psychotherapy. In case he’s wondering, it has a pretty good track record with ‘depressives,’ better than the meds he seems to be touting.


“(Full disclosure: my father is the chief executive of a pharmaceutical company that manufactures antidepressants.)”

Well, that clears things up a bit on my end.


“Before the cancer centers came around, cancer was as taboo as depression is now. But as antibiotics and vaccines for other illnesses lengthened life expectancy, cancer became more pervasive and less shameful. Depression, too, is becoming more widespread and more frequently diagnosed. Depression and bipolar illness will affect some 20 percent of Americans during their lives, and yet the stigma endures. People often come up to me after lectures to whisper about their affliction, as though everyone else in the room weren’t grappling with precisely the same thing.

It is neither wise nor feasible for a large proportion of the population to be trying to keep a secret. A national network that helped to medicalize depression in the public imagination would reduce sufferers’ shame. The very waiting rooms of depression centers would provide incontrovertible proof of the ubiquity of the illness and ease the isolation of sufferers. Within the centers, patients would find themselves the focus of an elite community of insight and support.”

Yeah, we should medicalize it! Call it a disease! I can see it now: someone is going to say just like a person with diabetes needs insulin, ‘depressives’ need serotonin. Oh, wait, that’s been done. It’s played – there is clearly no reliable biological marker for depression, but selling depression as a “disease” sure sells those pills – just ask Mr. Solomon’s father, the drug company executive (Forest Labs)!

…As it is established that these mental illnesses are not character defects, but instead can be characterized in terms of brain symptoms, the false distinctions between them and cancer or heart disease will become impossible to sustain…

We’ve made stellar progress in treating mental illness since the Prozac revolution but there is a catastrophic divide between research and practice. We must come up with a seamless way to support scientific progress and to administer the treatments we have, in order ultimately to alleviate as much suffering as possible.”

Indeed, if we are going to fix the gap between science and practice, I’d suggest 1) how about less polypharmacy (doling out a bunch of meds simultaneously), which has a very meager evidence base, and 2) how about psychotherapy first and maybe meds if psychotherapy does not work.

Mr. Solomon is clearly far out of touch with the evidence base, yet he writes books and is featured in the New York Times. That makes me feel like a “depressive.” Full text of his writing here, but it will not be available free online for long. His book has received rave reviews, though I’ve not read it, and I want to be clear that my comments only apply to his writing in the NYT today.

One more thing: "Prozac Revolution" -- did Mr. Solomon read Listening to Prozac one too many times?

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