Friday, October 14, 2016

New old news about antidepressant side effects

When this story on Psyblog went through my twitter feed because @PsychologyNow shared it this week, I was intrigued and then surprised to find it was a study I knew about... published two years ago. Hardly news, then.

But important nonetheless, and sufficient time has passed that we can look at how the study was received.

The paper reports findings based on online questionnaires completed by 1829 New Zealanders who had been prescribed antidepressants in the five years prior. The side-effects they had experienced were the main focus: although a recipients are usually warned about potential side effects, what they are warned about is not necessarily what is then experienced.
The authors identify some emotional or interpersonal effects and characterize them as 'closing down'

  • feeling emotionally numb
  • feeling not like myself
  • reduction in postive feelings
  • caring less about others 

Importantly, they address the question of whether these are caused by the drugs or by the depression. Because participants were asked to rate their level of depression before they started taking the drugs, the relationship between those levels and adverse effects could be checked: the authors conclude that the simplest explanation is that these adverse effects are caused by the drugs rather than the depression, although the authors also consider the possibility that those who feel the drugs are helpful pay less attention to these adverse effects.

The concern, anyway, is that over a third of participants were not told about these adverse effects beforehand, a trend that was decreasing over time - which is a challenge to the ideal that patients are given an informed choice over medication use.

There are to date 15 citations of this article in Scopus, 15 in Science Direct, and 29 in Google Scholar, so we stick with the latter for a quick check of how the finding was received.
1. Karanges et al. (2014) , Durisko et al. (2015), Busfield (2014), Demyttenaere et al. (2015)Botella et al. (2015)  (in Spanish), Hughes et al. (2016), Ruby (2016), Kleszcz (n.d.) and Donskoy (2015) simply report the main findings - although Demyttenaere et al. have an interesting argument themselves about what patients vs physicians expect treatment of depression to result in - and Donskoy cites in an article arguing that the lack of informed choice is a violation of human rights.
2. Read, Cartwright or Gibson cite the article  (10 times)
3. Högberg et al. (2014) focus on the idea that empathy is a hindrance to suicidal impulses and medication that causes a closing down ('care less syndrome') may thereby enable suicide.
4.  A book chapter dealing with the validity of the depression diagnosis
5. A biological experiment
5. Some unclear citations in work I can't access or in student theses (5 of these)

In two years' worth of citations then, I can't find a single objection to the findings. On the contrary, there is only more and more support for the idea that doctors who prescribe antidepressants don't tell patients enough about possible adverse effects. Some argue that this is a violation of human rights and others point out this in itself could affect suicide rates.

Does this resonate with you? Did doctors tell you enough? Let us know @hashtagpsych... Read, J., Cartwright, C., & Gibson, K. (2014). Adverse emotional and interpersonal effects reported by 1829 New Zealanders while taking antidepressants Psychiatry Research, 216 (1), 67-73 DOI: 10.1016/j.psychres.2014.01.042

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