The Council for Evidence Based Psychiatry [CEP] has laid down the gauntlet to a handful of psychiatrists who, it appears, believe antidepressant use can prevent suicide.
Last week Professor David Nutt, Professor Sir Simon Wessely and other senior psychiatrists responded to an article in The Times written by Health Correspondent, Chris Smyth.
Smyth quoted CEP Co-Founder Peter Gøtzsche in his article and this evoked a response from a number of psychiatrists who replied in a letter to The Times.
Sir, Depression can be a debilitating and lethal illness. Medication is a vital part of the treatment of the severest cases. Successful treatment with antidepressants definitely does not do “more harm than good” as you report (Apr 30).
We do not dispute that these drugs are of potentially less value for mild depression, but their effectiveness is maintained as the severity of the depression increases. Is that true of psychological treatment or exercise?
Depression is serious: 6,500 people commit suicide each year in the UK. Many of them are never offered antidepressants, and the blanket condemnation of antidepressants by Professor Peter Gøtzsche and colleagues will increase that proportion.
Professor David Nutt, Neuropsychopharmacology Unit, ICL
Professor Stephen Lawrie, Division of Psychiatry, Edinburgh
Professor Sir Simon Wessely, Royal College of Psychiatrists
Dr Seena Fazel, University of Oxford
Professor Guy Goodwin, European College of Neuropsychopharmacology
Professor Dinesh Bhugra, World Psychiatric Association
In response to the letter from Nutt et al, Peter Gøtzsche, Dr Joanna Moncrieff and Dr James Davies, of the CEP, wrote...
Sir, Further to the letter from Professor David Nutt and others, whatever the evidence on the efficacy of antidepressants — and the effects are weak even in severe depression — there is no doubt these drugs are being widely overprescribed, and not enough attention is being paid to the harms they can cause. We do not accept that reducing antidepressant prescribing will increase the number of suicides. Antidepressants have not been shown in reliable studies to reduce suicide, indeed they increase the risk of suicide in young people. There is also evidence that antidepressants may increase a whole range of adverse events in the elderly, including falls and fractures, and are associated with increased mortality.
Given these factors and the tendency of many psychiatrists to downplay the harms of overprescribing such medications, we invite Professor Nutt and his colleagues to a public debate where these views can be properly aired.
Professor Peter Gøtzsche, Nordic Cochrane Centre
Dr Joanna Moncrieff, University College London
Dr James Davies, University of Roehampton
Nutt et al have, so far, failed to reply to the invitation. I'd be really surprised if they take the gauntlet laid down by Messrs Gøtzsche, Moncrieff and Davies - Nutt et al have been backed into a corner here - if they come out with guns blazing they are liable to make themselves look silly. Using the defence that antidepressants prevent suicide in their initial letter to The Times was textbook psychobabble. They go down this route in the hope that patients, both past and present, support their claims with statements such as "Antidepressants saved my life" or "If it wasn't for antidepressants I'd probably be dead". Both statements come from the type of patient who, for whatever reason, have been duped into believing the claims of clever marketing, key opinion leaders [paid by the industry] and a fear that they just cannot get through the day without their daily fix of Prozac type drugs.
Nutt et al have now been publicly challenged to offer proof of this. To my knowledge, there is no proof that antidepressants can prevent suicide, in fact the evidence suggests that antidepressants actually can induce suicide.
Hats off to the CEP for showing how predictable the pro-pill brigade can be when one questions the safety and efficacy of antidepressants.
Incidentally, I wrote about David Nutt some years ago. Nutt was part of the Committee on the Safety of Medicines (CSM), an apparent independent body who have, for 40 years, advised the UK Licensing Authority on the quality, efficacy and safety of medicines - In other words they offered advice to the MHRA.
In 2004 Nutt held 300 shares in GlaxoSmithKline and was also a paid consultant for them. It's a pity Nutt didn't add this in his letter to The Times.
So, does Nutt have the bottle to get into a public debate about the safety of antidepressants?
Will he shy away because of his paid consultancy from GlaxoSmithKline and the shares he once held may be used against him and make his argument very weak. Will he and his colleagues be able to back up their claims with actual science or are their claims, as I suspect, just a theory based loosely around the pandemic promotion of these groups of medicines.
We have six pro pill pushers in Nutt, Lawrie, Wessely, Fazel, Goodwin and Bhugra. How long will we have to wait before the likes of Robert Gibbons and Patricia Casey poke their noses into something that appears to have upset those who choose to drug rather than look at the evidence that, for the majority, shows that these drugs just don't work.
My money is on Nutt et al declining the offer of a public debate. Why would they accept the offer to be publicly humiliated by scientific fact?
You can see the exchange of letters between the CEP and Nutt et al here.