Tag Archives: antidepressants

100 ways to live to 100: 10 drugs to avoid whenever possible

Part of a series on WDDTY’s “free” advertorial report “100 ways to live to 100

10 drugs to avoid whenever possible

WDDTY frame this with a truly staggering statement of faith:

After 24 years of publishing WDDTY, we’re still searching for one single drug out there besides antibiotics that actually cures something. We still haven’t found one. Virtually all drugs are for maintenance—that is, they manage, ease or suppress symptoms, but they do not cure. In spite of assurances from the pharmaceutical industry that drugs can target certain receptors in the body with laser-like accuracy, the fact is that many unrelated systems in the body have identical receptors—which is why drugs invariably affect other parts of the body indiscriminately and cause side-effects.

There is a better, alternative solution to virtually every chronic health problem except emergency medicine, which is where orthodox medicine comes into its own. If you’ve been shot, stabbed or run over, or suffer a heart attack or stroke, then modern Western medicine is without parallel for fixing you. In those cases, get to a hospital without fail. Otherwise, here are the10 drugs you might be better off avoiding. In no particular order:

We’re pleased to be able to help WDDTY out here. Again, since this is not the first time WDDTY have made this claim.

  • Tetanus antitoxin cures tetanus.
  • Antimalarials cure malaria.
  • Chemotherapy cures liquid tumours especially in children.
  • Antivenins cure venomous bites.

But why exclude antibiotics? Not only are they the best known and least ambiguous example of drugs that cure, but WDDTY also disputes their utility. The exclusion of this class of drugs seems to be capricious and specifically designed to assert that, excluding the vast number of illnesses they can cure, doctors can’t cure anything. Of course, unlike quacks, doctors don’t claim to cure disease unless they actually can, but n the end this reminds us of something:

But ultimately this is a categorical fallacy. Think for a moment: what is the definition of a chronic disease? It’s one that cannot presently be cured. A hundred years ago, syphilis was a chronic disease. Now it’s not. So WDDTY are taking a class of diseases defined by the fact that medicine cannot currently cure them, and asserting that, shockingly, medicine cannot cure them.

Is maintenance and management of symptoms necessarily a bad thing? Ask a type I diabetic or an asthmatic. 

Are there better alternative solutions to “virtually every chronic health problem”? No. Minchin’s Law applies: these things are alternative because they have not been demonstrated to be better. In most cases they haven’t been demonstrated to be as good. Many of them don’t work at all, and several are actively harmful.

71 Statins

These can cause cancer and definitely cause muscle weakness.

So they might, but the benefit outweighs the risks according to large studies.

A meta analysis of randomised controlled trials found:

Conclusion In patients without established cardiovascular disease but with cardiovascular risk factors, statin use was associated with significantly improved survival and large reductions in the risk of major cardiovascular events.

WDDTY has a long-standing agenda against statins, leading to its promotion of the idea that cholesterol is OK as long as it’s the “good” kind, but this is mainly arguing backwards from ideological opposition to statins. As always, the NHS has more nuanced and more accurate information.

72 Prozac and other antidepressants

These can cause rebound anxiety, suicide and addiction, and have been sold to us on a faulty premise—there is no brain chemical imbalance to fix.

This is pure propaganda. Antidepressants and antipsychotics have a role in the management of acute disease, and trying to tough it out without them can and does lead to suicide.

Epidemiological analysis shows that SSRIs reduce suicide rates. There is a specific problem with use in children, but it’s uncertain whether this balances out or not – however, this does not undermine the conclusion that:

[T]he strongly positive results of the TADS study indicate that medication treatment is vital for effective treatment of adolescent depression. With the confusing results of studies to date, fluoxetine is a good first choice for antidepressant treatment of adolescents. However, there may be reasons that clinicians choose to start other antidepressants instead. For instance, adolescents with a good prior response to another antidepressant, who are currently on another antidepressant with good response, or who have a history of poor response to fluoxetine, would probably be started or stay on another antidepressant.

In other words, follow the data not the dogma.

73 Tumour necrosis factor (TNF)-blocking drugs

Meant to replace painkilling COX-2 inhibitor drugs, they’ve been linked to tuberculosis and cancer.

Having “been linked to cancer” is a standard WDDTY weasel phrase. Yes, there is a plausible link between TNF inhibitor|TNF inhibitorsW and cancer. This applies to both synthetic drugs and natural TNF inhibitors such as curcuminW, catechins and canabinoids.

As with any effective treatment, it’s a question of risks versus benefits.

74 Atypical antipsychotics

These next-generation drugs, classed as the ‘new’ antipsychotics, include olanzapine (Zyprexa), quetiapine (Seroquel) and risperidone (Risperdal). Studies show they’re no better than the older variety, and may cause Alzheimer’s disease and hasten mental decline in the elderly. They also cause sexual dysfunction and depression, and so make any psychiatric condition worse.44

Reference 44: Clin Neuropharmacol. 2005 May-Jun;28(3):111-4. Use of ziprasidone in parkinsonian patients with psychosis. Gómez-Esteban JC, Zarranz JJ, Velasco F, Lezcano E, Lachen MC, Rouco I, Barcena J, Boyero S, Ciordia R, Allue I.

A source at last! So what does it say?

Twelve patients with Parkinson disease and psychosis were included in an open-label 12-week trial of ziprasidone. Two patients withdrew from the treatment because of adverse effects. The remaining 10 patients reported a significant improvement in psychiatric symptoms. Altogether, there was no deterioration of motor symptoms (UPDRS III score: basal 40.4 +/- 11.1, first month 41.1 +/- 10.8; final visit, 37.7 +/- 13.3). Two patients (20%) suffered a slight deterioration in motor symptoms and another patient suffered deterioration of gait. No analytic alterations or serious adverse effects that could limit the use of ziprasidone were observed. Although controlled trials are needed, the findings suggest that ziprasidone may be effective in parkinsonian patients with psychosis.

Is it just me, or does that say pretty much the opposite of what WDDTY claim? Be in no doubt: ziprasidoneW is an atypical antidepressant, the fifth such to be licensed by the FDA.

This is unusually dishonest even by WDDTY’s standards: the paper supports the use of the drug in Parkinson’s sufferers, but this is spun as a recommendation against it.

75 Anticholinergic drugs

These have a long list of side effects, including dementia.

This is not specific to anticholinergicW drugs, but to anticholinergics generally, including plants of the solanacae family, henbane and mandrake.

They also have a long list of beneficial effects. They suppress muscle spasms, for example, so are often used in gastritis and ulcerative colitis. But the major source of adverse reactions appears to be in recreational drug users, not least because medical use tends not to be long-term. One of the better known anticholinergics is butylscopolamineW, marketed under trade names such as Buscopan, which is used to control stomach cramps. It tends to be used episodically and not chronically.

76 Bisphosphonates

These osteoporosis drugs can halt bone loss, but they’ve also been linked to high rates of atrial fibrillation, a heart-rhythm disorder that can lead to stroke.45

Reference 45: N Engl J Med, 2007; 356: 1809–22: Once-Yearly Zoledronic Acid for Treatment of Postmenopausal Osteoporosis, Black et. al.

RESULTS: Treatment with zoledronic acid reduced the risk of morphometric vertebral fracture by 70% during a 3-year period, as compared with placebo (3.3% in the zoledronic-acid group vs. 10.9% in the placebo group; relative risk, 0.30; 95% confidence interval [CI], 0.24 to 0.38) and reduced the risk of hip fracture by 41% (1.4% in the zoledronic-acid group vs. 2.5% in the placebo group; hazard ratio, 0.59; 95% CI, 0.42 to 0.83). Nonvertebral fractures, clinical fractures, and clinical vertebral fractures were reduced by 25%, 33%, and 77%, respectively (P<0.001 for all comparisons). Zoledronic acid was also associated with a significant improvement in bone mineral density and bone metabolism markers. Adverse events, including change in renal function, were similar in the two study groups. However, serious atrial fibrillation occurred more frequently in the zoledronic acid group (in 50 vs. 20 patients, P<0.001).

The question then would be: are you better off suffering a hip fracture due to untreated osteoporosis, or atrial fibrillation, which may or may not result in a stroke?

WDDTY claims to be all about informed choice, but by giving only a tiny subset of the information, they actively impede a properly informed choice. It’s about as much use as advising everybody never to leave the house in case they get knocked over crossing the road.

77Aspirin

It’s the ultimate just-in-case lifestyle drug, taken to ward off heart disease and stroke, but it actually increases the risk of stroke sevenfold.46 It can also cause serious gastrointestinal bleeding. Other NSAIDs now carry warnings regarding their cardiovascular and gastrointestinal risks—and guess what? They haven’t been proven to reduce inflammation.

Reference 46: Lancet Neurol, 2007; 6: 487–93 Change in incidence and aetiology of intracerebral haemorrhage in Oxfordshire, UK, between 1981 and 2006: a population-based study. Lovelock CE, Molyneux AJ, Rothwell PM; Oxford Vascular Study.

This is a long-term study of stroke risk which finds that in the over-75s long term use of antithrombotics (aspirin) is associated with an increase in stroke incidence. This is most likely to be based on a population with higher dosages, as the prophylactic dose recommendation has reduced over time.

Reliable sources support low dose aspirin as a prophylactic against heart disease and stroke, unreliable sources promote more aspirin (mainly out of date) or none (WDDTY and other natural-woo promoters).

The Mayo Clinic has a useful reference. One interesting point that WDDTY didn’t make is that if you’re already taking aspirin daily, stopping can cause a rebound effect and actually trigger a stroke. Let’s hope nobody suffers a stroke after following WDDTY’s advice and sues them.

The important thing to remember is that a paediatric dose confers most of the benefit, but most of the risk studies refer to an adult dose, two to four times as great. As always discuss it with your doctor, not some anti-medicine crank.

78 HRT and the Pill

Their cancer connections are finally indisputable, even though drug companies keep fighting the evidence.

We already covered HRT. The pill? WDDTY really are becoming more reactionary over time.

Here’s what Cancer Research UK say about the Pill:

  • There’s a small increase in risk of breast cancer, which reduces when you stop taking the pill and returns to normal by 10 years after you stop taking it.
  • There’s an association with cervical cancer, likely to be down to the fact that cervical cancer is rarely seen in women whoa re not sexually active.
  • There’s a reduction in the risk of ovarian cancer, and the longer you take the pill the lower the risk gets.
  • There’s a reduction in cancer of the uterus which lasts for around 15 years after you stop taking the pill.
  • There may also be a reduction in bowel cancer.

Oh, and you tend not to get pregnant.

Your doctor knows all this, it’s safe to take your doctor’s advice rather than the ideological nonsense form WDDTY.

79 Antiepileptic drugs

These can lead to suicide and also cause potentially fatal liver failure. Many of the newer ones like Keppra (levetiracetam), Topamax (topiramate) and Sabril (vigabatrin) increase the risk of depression and suicide or self-harm threefold.47

Reference 47: Neurology. 2010 Jul 27;75(4):335-40. Use of antiepileptic drugs in epilepsy and the risk of self-harm or suicidal behavior. Andersohn F, Schade R, Willich SN, Garbe E.

Once again, WDDTY misrepresents the source. Here’s what it actually says:

Newer AEDs with a rather high frequency of depressive symptoms in clinical trials may also increase the risk of self-harm or suicidal behavior in clinical practice. For the most commonly used other groups of AEDs, no increase in risk was observed.

So: older AEDs do not increase the risk of suicide. Newer ones might, so doctors should be on the lookout for symptoms of depression. Which may well be partly due to the well documented tendency of practitioners to be more conservative and report more adverse reactions in new drugs than for well understood ones, where they know that symptoms are unlikely to be directly related.  Nothing to see here, move along please…

It’s hard to express how inappropriate it is to issue a blanket warning against antiepileptic drugs based on a misrepresentation of early studies on an entirely new class of drug that’s only recently entered clinical practice.

80 Zetia and other second-generation cholesterol-lowering drugs

Not only do these drugs not work, but they’re also hard on the liver.

We totally understand: cholesterol is natural so trying to control it is evil. Heart attacks are natural too, as is dying by the age of 40.

NICE don’t endorse ezetimibeW other than in cases where statins are not well tolerated, or as an adjunct to statins where cholesterol remains stubbornly high. It’s a relatively new class of drug and the evidence base is changing fairly quickly. Your doctor should be reading up on this, so it’s worth discussing the findings of ENHANCE and, when published, IMPROVE-IT with your doctor. As always, the advice form your doctor is likely to be evidence-based not ideology-based like WDDTY.

Cholesterol levels are a proxy marker and the jury is still out on whether reducing cholesterol levels is a valid end in itself; however, the outcome of statin trials does indicate a significant reduction in cardiac events so it does seem likely.


Errata and corrections:

  • Thanks to Andrew Crysell for spotting a schoolboy howler in the first section, fixed on 27/12/2013

WDDTY on depression

depression
Until coffee was discovered, people committed suicide all the time. Sometimes twice a day.

WDDTY makes some predictably reckless claims about depression, a serious condition which, if neglected, can destroy (both metaphorically and literally) the life of the sufferer and those around him or her. Needless to say, they conflate “feeling a bit low” with clinical depression, because money. The NHS has information on the symptoms of clinical depression here, with a simple test anyone can do. There is advice on what to do and telephone numbers to call if the situation is urgent. Certainly modern medicine does not yet have a perfect answer to the problem of depression, which presents in a number of forms and may well have a number of causes; nevertheless, this imperfect response is infinitely preferable to the completely and dangerously wrong fuckwittery to be found on the WDDTY website.

For example:

The great depression deception (WDDTY, Vol 23.3, June 2012)
Chronic depression has been described as the disease of modern times. It afflicts 121 million people worldwide (1), which equates to around one in 10 adults, while one out of every 13 Europeans is currently (2) taking an SSRI (selective serotonin reuptake inhibitor) antidepressant such as Prozac to counter it.

Tragically, they are all being poorly served by medicine, which is working with an unproven, and flawed, theory of the causes of depression, and with drugs that are doing more harm than good (3).
Instead, a new theory is developing that suggests that depression is the byproduct of the body’s natural inflammatory response to infection (4). If true, an anti-inflammatory would be a better drug therapy than an SSRI (5), and this is supported by the evidence (6), which has found that the SSRI drugs are ineffective in around two-thirds of depressed people (7) (Am J Geriatr Psychiatry, 2011; 19: 839–50).(8)

  1. Wrong. The WHO says over 350 million and simple arithmetic says neither that nor WDDTY‘s figure equates to 10% of 7 billion.
  2. Untrue. The report WDDTY is presumably referring to says, according to Science Daily: “One in thirteen of adult European citizens — and 10% of middle-aged Europeans — took an antidepressant in the previous twelve months“.
  3. A blatant lie. The increase in antidepressant prescription over recent years correlates with a decrease in the suicide rate. While a direct link has not, as far as I know, been shown, it is certainly not evidence of the drugs “doing more harm than good”.
  4. Again, this is misleading. It suggests a single cause for depression. The study I found (dated 3 Sept, 2012, and published in Archives of General Psychiatry) looked at patients with moderately hard-to-treat depression who also suffered from chronic inflammatory diseases, because there is a known correlation between hard-to-treat depression and chronic inflammation.
  5. Again, this erroneously assumes a single cause for depression, and on the basis of a single study to boot. It’s like saying all cancers can be treated by the same drug, or that if we find a treatment for cystic fibrosis it will also work for other genetic disorders, such as dwarfism and Down’s.
  6. Which, you will note, is not forthcoming. Unsupported assertion.
  7. I can find no other instance of this assertion, which I can only conclude has been internally (i.e. rectally) sourced by the anonymous author. Or again, it may be based on a single study on a specific population, and WDDTY has once more massaged the language to make it apply to the general case.
  8. This is the best part of all. I looked up the article at Am J Geriatr Psychiatry, 2011; 19: 839–50. It is not the study the author is referring to. Or, if it is, he/she has been spectacularly dishonest in presenting it. The reference is, in full: The American Journal of Geriatric Psychiatry Volume 19, Issue 10 , Pages 839-850, October 2011 “Complementary Use of Tai Chi Chih Augments Escitalopram Treatment of Geriatric Depression: A Randomized Controlled Trial”

Geriatric depression. In people who have doubtless suffered chronic inflammation for a long time, on top of all the other problems of ageing, and who are taking an anti-depressant. All the abstract confirms is what we suspected all along: a little gentle exercise and socialising does you good, especially as you get older, frailer, and more likely to find yourself isolated.

There’s more to that WDDTY article, much more: all of it similarly debatable, disingenuous or downright dishonest. It all boils down to the usual “self-diagnosis and supplements” mantra you expect from the anti-health extremists. Here’s a second example from another piece, this time online:

Coffee helps ward of depression and suicidal thoughts (30 July 2013)

Caffeine in coffee acts as a mild antidepressant that could even be enough to stop someone committing suicide.
Drinking two or more cups of coffee day reduces the risk of suicide by around 45 per cent, say researchers at the Harvard School of Public Health. They think that caffeine boosts mood hormones in the brain, and stops us feeling depressed. But the benefits seem to stop at around three cups, or 400 mg of caffeine a day, they say.

The published research is here. Notice the title: “Coffee, caffeine, and risk of completed suicide” – completed suicide is not the same thing as suicidal thoughts, or even suicide attempts. It’s a pretty crude measure, really. Notice that WDDTY uses affirmative verbs – “helps”, “acts” – while the researchers themselves carefully employ the conditional – “may”, “appears” and so on. And a “lowered risk of depression” is not the same thing as “stops depression”, otherwise no coffee drinkers anywhere would ever be depressed.

There are other examples of WDDTY’s reckless, misleading and irresponsible reporting on depression, mostly involving the old warhorse of nutrition. Depression is due to bad diet, to lack of various B-vitamins, to hypothyroidism… Well, the last one isn’t entirely false: untreated hypothyroidism can result in depression, but the assertion that “diagnosing hypothyroidism isn’t easy” is a downright lie. It’s very easy; all you need is a blood test. The test is a bit of a pain, admittedly, but only for the patient who’s forgotten to bring music or a podcast to listen to. The biology side of it is pretty simple.

My third and final example of WDDTY’s deadly fuckwittery on the subject is this headline from their webshite. Just the headline, as it’s quite evil enough:

Alternatives to drugs for depression

I find ripping the balls out of WDDTY’s vicious, mercenary falsehoods a briefly stimulating alternative to getting roaring drunk and playing Pink Floyd’s The Wall at neighbour-baiting volume, but it hasn’t cured my depression. Nor will taking extra doses of vitamins that I already get a full daily dose of in my normal diet. Drinking more coffee not only doesn’t cheer me up, it proactively treats any incipient constipation for the next 48 hours, so stuff that. No, all things considered, I’ll keep taking the pills, thank you very much, and make sure I always have someone to get in touch with when things get on top of me.

Also posted at Plague of Mice

WDDTY invents advice from researchers on antidepressant use in pregnancy and Autism

Two major drug groups could cause autism
Autism is a fertile hunting ground for quacks and cranks. Pseudoscience is rampant. It’s hugely draining for parents, there is precious little anyone can do about it, and the causes are unknown. It’s notorious as the foundation of Andrew Wakefield’s fraudulent MMR studies, and quack treatments such as chelation therapy and bleach drinking cross the line into child abuse. Parents are driven to horrific and desperate lengths, often by the very cranks who claim to support them.

The SCAM community (naturally) tries to pin the blame on the bogeyman du jour: vaccines, of course, antibiotics, mercury, fluoride in the water, electrosensitivity – and here, antidepressants.

There are three truly evil aspects of this story. First, it screams about a threefold increase in risk, when actually it goes from 0.6% to 1.3% . Second, it screams cause when the study referenced explicitly repudiates this, as well it should – a case control study has no way of telling if, for example, there is a genetic cause which is a cofactor in both maternal depression and autism. Third, and worst by far, it lays a burden of guilt at the feet of the mothers, without any good evidence to back this.

There’s no doubt that the less medication a pregnant mother uses, the better. On the other hand the dramatic effects of depression are well documented. There is always  a balance of risk and benefit in any effective treatment (whatever the peddlers of natural woo tell you to the contrary).  WDDTY cynically exploit and exaggerate the risks, and ignore the benefits, in order to serve their own agenda – a case this eloquent blog post makes very clearly.

 

Reblogged from NurtureMyBaby with permission

“What Doctors Don’t Tell You” is a magazine that apparently, for the princely sum of £3.95 “aims to meet the demand of those seeking information about alternatives to conventional medicine.”

In my opinion this should actually read misinformation. And as GP, Margaret McCartney, put it “The only ethical way I can see of selling it is if it is kept behind the counter in a plastic bag, with a label saying the contents are dangerous.”

Yet supermarkets continue to stock it (apart from Waitrose), despite many people making them aware of issues with its content.

If you’ve not heard of this magazine before there are many, many blog posts about the misinformation presented in this magazine. On cancer and chemotherapy. HIV/AIDSHomeopathyThe HPV vaccineMMR.

There’s a master list of posts over on Josephine Jones’s blog too, as well as a whole blog dedicated solely to highlighting the issues with this magazine.

autism-antidepressantsIn this post I want to talk specifically about the article titled “Two major drug groups could cause autism” found on page 17 of the November edition that states:

“Women who take certain prescription drugs while pregnant are increasing the chances of Autism in their child”

The drugs that the magazine “reports” on are antidepressants and Epilim. I wanted to take a closer look at the claims made about antidepressants. I tend to get my knickers in a twist about flippant pill shaming so any hint of that and my interest is piqued.

I checked the reference that the magazine points you to and I don’t think it backs up what is written.

The magazine tells you:

“All antidepressants, including the newer generation of SSRIs, triple the chances of the unborn child developing autism”

There’s a few issues with this statement in my eyes.

Absolute risk versus relative risk

“Triples the chances” Crikey. Sounds dramatic doesn’t it. Well first off the “triples” figure is not backed up by the results in the paper. We can look at that in a bit more detail later.

But a big issue I have with this is that WDDTY have done that thing, where, in order to make a story sound a bit more exciting, a bit more headline grabbing, they have reported solely on the relative risk.

This seems to happen quite a lot in the media in general, it’s certainly not unique to WDDTY. It’s frequent enough that Cancer Research UK have gone to the trouble of writing a pretty good explanation of the meanings of relative and absolute risks here.

The relative risk tells us:

“how much more, or less, likely the disease is in one group, compared to another.”

When it is reported that the risk is tripled, this could mean that the risk is 20% in one group and 60% in another. Or it could mean the risk is 0.1% in one group and 0.3% in another. The figures I’ve given in these examples are known as “absolute risks”

As there is a big difference between a 60% risk and a 0.3% risk, you can see that to solely report on the relative risk with no mention of the actual figures involved ie. the underlying absolute risks does not give the full picture. From looking at the WDDTY article we have no idea what the absolute risks are, nor is the writer clear about the two groups being compared.

I’m no expert, but looking at the actual paper, I tried to work out where this “triple the chances” came from. I’m not entirely sure.

In very (and probably, over-) simple terms, the research took a load of people with autism (cases) and then took a load of people who matched the autism group in terms of sex and age, but did not suffer from autism. This second group is known as the control group. Then they looked at information on the parents of the people in both groups and looked at how many suffered from depression and how many mothers took antidepressants during the pregnancy, including the type of antidepressant.

Then they did lots of clever number crunching. It’s impossible within the scope of this blog post to go into the details of the statistical analysis that was performed. But a key conclusion that they reached is that:

“Any antidepressant use during pregnancy in mothers of cases was 1.3% compared with 0.6% of controls equating to an almost twofold increase in risk of autism spectrum disorder”

So it seems that the figures for the absolute risks in these two groups are rather low and ultimately, when they did all their odds ratio calculations, it showed almost double the risk, not triple. I think reporting on the figures shown above, alongside the relative risk, would have given WDDTY’s article a bit of a different feel.

(It is all a bit tricky, and my understanding of the numbers and the way the study was done means that the above percentages do not relate directly to risks in women that do take antidepressants versus those that don’t – so it is a bit unfair to simply say that they should have quoted these numbers as absolute risks – but I think some context is needed other than just saying “triples” – this all goes to show the really big problems with just taking numbers out of context in the manner that WDDTY have done. I’m sorry if my attempt to clarify the numbers has made matters worse. Perhaps I should delete all of this section and just say – “I think you’ll find it’s a bit more complicated than that”)

That’s not to say that relative risks are unimportant, indeed they are of great importance in decision-making – comparing risk/benefit of one exposure/treatment vs another, but the absolute risks do put them in context, and I feel that context is important.

Sadly, context is frequently missing in WDDTY. (Another example of missing context can be seen in an article on UTIs and antibiotics, where in failing to tell us the actual purpose of the research they cite, WDDTY try and take a figure from the paper and extrapolate it to the general population, thus having us believe that 70% of women can get better from uncomplicated UTIs without antibiotics, when the figure is actually estimated to be 25 – 50%)

To be fair to WDDTY, (I don’t know why I keep bothering to do that) I think I can see where they got the “triples” figure from. I think (from looking at table 4 in the paper) it is from looking at a link between depressed women taking antidepressants and autism in offspring, rather than a link between taking antidepressants and autism in offspring. (Antidepressants can be prescribed for things other than depression, such as neuropathic pain.)

I think this serves to highlight the importance of my earlier question of what two groups are we comparing when we talk about a tripled risk, and it also highlights the general importance of context.

Causality

The paper this article is based on is very cautious about saying that antidepressant use directly causes autism. It says:

“it is not possible to conclude whether the association between antidepressant use and autism spectrum disorder reflects severe depression during pregnancy or is a direct effect of the drug.”

And

“Caution is required before making causal assumptions or clinical decisions based on observational studies”

I don’t think this is reflected in what we see in WDDTY. I think the two statements I’ve already quoted from the magazine infer that autism is caused by the drugs. Here they are again:

“Women who take certain prescription drugs while pregnant are increasing the chances of Autism in their child”

“All antidepressants, including the newer generation of SSRIs, triple the chances of the unborn child developing autism”

Notice that in that first sentence, it’s not even the drugs that WDDTY wants to blame, it’s the women themselves that are increasing the chances by taking the drugs.

No consideration at all that it might be the severity of the depression that could result in an increased risk of Autism and that perhaps treatment might reduce the risk (the researchers even explicitly say this later, as we’ll see, so I’m not sure what WDDTY’s excuse is for failing to mention this.)

Certainly no consideration for the fact that it is not the individual fault of any women that she might end up in a position where taking antidepressants is necessary. Just a straight up blame game, yep, take these drugs and YOU, pregnant lady, are increasing the risk of damaging your unborn child. I can’t put into words how much I’m annoyed by the way WDDTY frames this sentence.

I’m not the only one who sees a problem with how happy WDDTY seem to be to blame pregnant women.SouthwarkBelle has also written about the way WDDTY misrepresent this research.

Perspective

Further reading of the paper offers further perspective on the figures:

“From a public health perspective, if antidepressant use had a causal relation with autism spectrum disorders, it would explain less than 1% of cases”

The actual figure, given elsewhere in the paper is 0.6%. So looking at it this way, not only is “triples” inaccurate, it also appears to be a little alarmist. What would you do if you were a responsible health journalist, would you report on an invented tripled risk or would you report on the 0.6% of cases that would result if antidepressant use did cause autism?

(I think ideally, you might write more than 3 paragraphs, so that you can go into a little more depth and provide context)

Also of relevance is this:

“All associations were higher in cases of autism without intellectual disability, there being no evidence of an increased risk of autism with intellectual disability.”

Once again if WDDTY looked closely at the study and were careful to point out this detail….well it paints the research in a different light doesn’t it? An association between anti-depressants and autism was found but only with autism without an intellectual disability. Less alarmist, for sure, not really WDDTY’s style.

“Seek out non-drug therapies, say researchers”

Now we move onto what I find to be the worst part of the article. Here is the full sentence I’m talking about:

“So women who suffer from depression during pregnancy should seek out non-drug therapies, say researchers from the University of Bristol”

Gosh. If I was pregnant and had decided to take or stay on antidepressants, I think I’d already be quite concerned by the article so far. But that is quite a recommendation from the researchers isn’t it? Quite firm advice. The researchers must be certain about the clinical implications of their research.

Apart from of course, they are not, as we’ve already seen from the quote about clinical decisions requiring caution.

Here’s what else they say:

“….the results of the present study as well as the US study present a major dilemma in relation to clinical advice to pregnant women with depression. If antidepressants increase the risk of autism spectrum disorder, it would be reasonable to warn women about this possibility. However, if the association actually reflects the risk of autism spectrum disorder related to the non-genetic effects of severe depression during pregnancy, treatment may reduce the risk. Informed decisions would also need to consider weighing the wider risks of untreated depression with the other adverse outcomes related to antidepressant use. With the current evidence, if the potential risk of autism were a consideration in the decision-making process, it may be reasonable to think about, wherever appropriate, non-drug approaches such as psychological treatments. However, their timely availability to pregnant women will need to be enhanced.”

It’s just not the same as what was written in this magazine is it? I have to wonder how the folk at WDDTY translate “a major dilemma in relation to clinical advice to pregnant women” into what I read as a quite firm statement telling pregnant women suffering from depression to “seek out non drug therapies” I recognise that there is mention of non-drug approaches by the research, but saying “it may be reasonable to think about, wherever appropriate” is very different from saying “should” I really think that once again WDDTY has taken a study and misrepresented it. Either that or the researchers spoke to WDDTY and made additional comments on the research aside from what is published.

Only that is not the case either.

I had email correspondence with Dr Dheeraj Rai, the lead author of the BMJ paper who said,

“It would be unwise to suggest that clinical decisions be based solely on our one study. As we mention in our paper, it is not yet clear whether the associations that were observed between antidepressant use during pregnancy and offspring autism were causal, or related to the risk associated with the underlying depression. Although future research will help answer this question, it is understandable that the possibility of potential harm creates concern. However, decisions regarding treatment require a large number of considerations including type and severity of symptoms, risks to mother and baby, and potential benefits. Doctors or other relevant healthcare practitioners can discuss these with concerned women in relation to their personal circumstances and help them to make informed decisions.”

I know it can’t be easy to simplify such a study into a small accessible, informative snippet, (and I wonder how wise it is to attempt it at all) but I’m just not impressed with the job done here. I hate to think that a pregnant woman struggling to make decisions around antidepressants in pregnancy might read this at take it at face value. And I also hate to think of the Mum who has a child with Autism and took antidepressants during pregnancy, who reads this and ends up feeling to blame.

I also think, that in ignoring the complexities surrounding making decisions around antidepressant use in pregnancy, WDDTY trivialise depression. Their flippant suggestion of seeking out non drug therapies shows no understanding of the condition and the effect it can have on a person. By making such a suggestion, I would argue that WDDTY contribute to the stigma surrounding mental health and potentially their writing could affect more than just the person that chooses to read it. Elsewhere they have done a similar thing with TB patients, ie contribute to stigma, by promoting fear of and discrimination towards people that they would have you believe are suffering from a disease that is incurable (Note: TB is curable).

For responsible advice on anti – depressants and pregnancy read here.

What can be done?

This magazine is damaging. If people trust this magazine with its impressive sounding references without realising the extent to which it misleads, then they will make decisions about health based on wrong information and possibly form attitudes towards patient groups that result in discrimination.

The way they write about cancer and quack cures does nothing but sell false hope. (Read that blog post if you get a chance – it sums up my views on this magazine very well)

Having it available in Smiths and supermarkets with its glossy cover gives it a certain air of respectability it does not deserve. The thought of anyone I care about being seriously ill and picking up this magazine for advice scares me. I wouldn’t want them to use it to educate themselves about depression either, being that it’s something that I personally suffer from.

Myself and many others, would love to raise awareness of the bad reporting in this magazine and get this magazine out of high street stores, and have been making their views known to the relevant companies.

Waitrose have already listened to peoples’ views and have decided to stop stocking it. But the likes of WH Smiths, Tesco, Asda and Sainsbury’s are less responsive. (Sainsbury’s did say they were going to stop selling it, however they appear to have backtracked)

Putting more pressure on these big chains could make a huge difference.

If Tesco and Asda can withdraw their mental health patient costumes because they recognise that selling them reinforces stigma and causes damage to those living with mental illness, then when the damage that this magazine could cause is brought to their attention they ought to act accordingly. If you agree, and fancy letting your views known then here are some email addresses:

[email protected]

[email protected]

Sainsbury’s can be emailed here

[email protected]

The more people who are aware of the misleading information in this magazine the better. So if you agree that this magazine is problematic please spread the word in whatever ways you can. Twitter it(#wddty), Facebook it, blog it, tell your neighbour, if you find a copy speak to the manager of the store or have a word with the pharmacist. Whatever small things you can do. Whatever you think is appropriate.

As always, please let me know if anything is unclear or you feel I have made any mistakes.

See also

Use of Selective Serotonin Reuptake Inhibitors during Pregnancy and Risk of Autism, Anders Hviid, Dr.Med.Sci., Mads Melbye, M.D., Dr.Med.Sci., and Björn Pasternak, M.D., Ph.D. N Engl J Med 2013; 369:2406-2415:

CONCLUSIONS: We did not detect a significant association between maternal use of SSRIs during pregnancy and autism spectrum disorder in the offspring. On the basis of the upper boundary of the confidence interval, our study could not rule out a relative risk up to 1.61, and therefore the association warrants further study. (Funded by the Danish Health and Medicines Authority.)

Just fancy that! Odds ratios and autism

Drug News: WDDTY misrepresents news about drugs. I'm shocked. Shocked!
Drug News: WDDTY misrepresents news about drugs. I’m shocked. Shocked!

In “Medical McCarthyism“, Lynne McTaggart seeks to defend her inaccurate use of statistics and her undermining of the proven benefits of chemotherapy thus:

It all has to do with absolute vs relative risk. Let’s say you have osteoporosis, the brittle-bone disease. Your condition may be at a stage where your risk of suffering a fracture is 4 per cent, but the drug can reduce that risk to 2 per cent.

There are two ways of expressing the same thing: as a relative risk, the drug has a 50 per cent rate of effectiveness – it’s reduced your risk from 4 to 2 – and that sounds attractive, but in absolute terms its effectiveness is just 2 per cent.

For years researchers have been presenting the effectiveness of chemotherapy in terms of relative risk, and this has influenced the way the media has reported on cancer too.

What the original researchers concluded:

Although the number of children exposed prenatally to selective serotonin reuptake inhibitors in this population was low, results suggest that exposure, especially during the first trimester, may modestly increase the risk of ASD. The potential risk associated with exposure must be balanced with the risk to the mother or fetus of untreated mental health disorders. Further studies are needed to replicate and extend these findings.

Statistics nerds call this the “odds ratio”.

And of course WDDTY would never do such a thing.

Or would they?

One environmental cause could be antidepressants that were taken by the mother, especially during the first trimester. Researchers from Kaiser Permanente Northern California discovered that the drug more than doubles the risk of autism, especially if the mother was taking the drugs before conception or early in the pregnancy.

Doubles the risk, eh? What does the cited source say?

A history of maternal (adjusted odds ratio 1.49, 95% confidence interval 1.08 to 2.08) […] was associated with an increased risk of autism spectrum disorders in offspring. […] Assuming an unconfounded, causal association, antidepressant use during pregnancy explained 0.6% of the cases of autism spectrum disorder.

Yes, that’s right. Your risk of autism increases by 0.6% not 50% if you avoid the odds ratio trick that WDDTY don’t want you to use when it makes chemo look good. That’s from the Stockholm study cited in WDDTY, by the way, not the source they didn’t cite and from which the odds ratio of 2 is drawn.

The odds ratio is between 1.2 and 4.3 in the original Kaiser study; a wide odds ratio indicates either a weak correlation or a small study. In this case it’s the latter: this study is based on 20 cases matched against 50  controls. And unlike the source WDDTY used, this has a specific correlation with SSRIs. For some unaccountable reason WDDTY forgot to include this rather important item: the conclusion, usually considered the most important thing in a scientific study, not the one that you ignore in order to make pretty much the opposite case:

Although the number of children exposed prenatally to selective serotonin reuptake inhibitors in this population was low, results suggest that exposure, especially during the first trimester, may modestly increase the risk of ASD. The potential risk associated with exposure must be balanced with the risk to the mother or fetus of untreated mental health disorders. Further studies are needed to replicate and extend these findings.

So we’ve gained a valuable insight into the WDDTY editorial policy on statistics.

  • Look at the relative and the absolute risk.
  • Look at whether the outcome is favourable (improved survival) or unfavourable (greater risk of something).
  • For favourable outcomes, use the lower figure and castigate anyone who uses the higher.
  • For an unfavourable outcome, use the higher figure.
  • Forget the conclusions, stick with the WDDTY agenda.

For WDDTY’s probably statistically unsophisticated audience, the message is the important thing. Torture the statistics until they give the worst possible appearance, and go with that. It’s what they want to hear (or at least what you’ve told them they want to hear).

But there’s more:

In the subsample with available data on drugs, this association was confined to women reporting antidepressant use during pregnancy (3.34, 1.50 to 7.47, P=0.003), irrespective of whether selective serotonin reuptake inhibitors (SSRIs) or non-selective monoamine reuptake inhibitors were reported. All associations were higher in cases of autism without intellectual disability, there being no evidence of an increased risk of autism with intellectual disability.

So: antidepressants, of any type (thus reducing the chances of a biochemical cause) are associated with a small increase in the diagnosis of autism using the subjective (behavioural) but not the objective (intellectual disability) criteria. The association is not proven to be causal, and the lack of a common factor between the drugs compared with the obvious common factor of depression, raises a very real possibility that the autism has a common cause with the mother’s depression.

Early days yet and there may well be more to this in the discussions in the literature, but would a responsible health journalist use the claim that antidepressants cause a 50% increase in autism diagnosis?

Thanks to Southwark Belle for the tipoff and for pointing out a minor error, now fixed above.

What doctors don't tell you
Why don’t doctors tell you that antidepressants in pregnancy double the risk of autism?

Because it’s misleading and alarmist claptrap.