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Antidepressant Regimens: Who can you trust?

Ethical Questions in Healthcare

“I trusted my senator on the issue. Then I find out an interested corporation is one of her biggest campaign contributors!”

Frustrating and hurtful, isn’t it? Who can you trust anymore?

And guess what? The same applies to those who make and promote those psychotropic meds you rely upon.

This piece was to be a review of opposing studies on an antidepressant regimen. But my digging uncovered some unsavory conflict of interest issues that – well – rubbed me the wrong way.

So if I do my job well, you’ll learn something about both. Consider it a 2 for 1 special…

2 Antidepressants Are Better Than 1

A 2009 study suggests combination antidepressant therapy may be more effective than using just one in the treatment of major depressive disorder (MDD). The study was published in the December 2009 issue of the American Journal of Psychiatry.

Specifically, the research cited the use of mirtazapine (Remeron) in combination with fluoxetine (Prozac), venlafaxine (Effexor), or bupropion (Wellbutrin).

According to study lead Pierre Blier, MD, PhD…

“The study results, which add to a growing body of evidence, suggest that use of antidepressant combinations from treatment initiation may double the likelihood of remission compared with use of a single medication.”

1 Antidepressant Is Better Than 2

A brand new study suggests combination antidepressant therapy offers no advantage over using just one in the treatment of MDD. And the research goes on to underscore the potential for more misery from ramped-up side effects.

The work was part of the Combining Medications to Enhance Depression Outcomes (CO-MED) study. It was published in the July 2011 issue of the American Journal of Psychiatry.

The study used combinations of escitalopram (Lexapro) and sustained-release bupropion (Wellbutrin SR), as well as extended-release venlafaxine (Effexor XR) and mirtazapine (Remeron).

According to study lead John A. Rush, MD, “ICRMN”…

“We found no clinical advantage over escitalopram-placebo from either combination of antidepressant medications in terms of either remission or response rate at either 12 weeks or 7 months.”

Who Can You Trust? (…this is where it gets really good.)

Well, it seems Dr. Blier of the 2009 study didn’t much care for the the 2011 work. He pointed-out some major problems with the CO-MED study and suggested we all practice caution as we interpret the results.

Frankly, I wouldn’t trust Blier or Rush. Why? They’re on Big Pharma’s payroll!

Blier: Astra-Zeneca (Seroquel), Biovail/Valeant (Wellbutrin XL), Bristol-Myers Squibb (Abilify, Buspar), Eli Lilly (Cymbalta, Zyprexa, Strattera, Symbyax), Lundbeck (Cipralex, Serdolect), Mitsubishi Pharma, Janssen (Haldol, Risperdal), Novartis (Trileptal, Focalin), Pfizer (Xanax, Zoloft, Effexor, Geodon, Nardil, Navane, Neurontin, Pristiq, Halcion), Sanofi-Aventis, Sepracor, Servier, Schering-Plough/Merck, Takeda, and Wyeth/Pfizer.

Rush, ICRMN: Otsuka and Forest Labs (Lexapro, Viibryd). He owns stock in Pfizer.

Did you notice the “ICRMN” credential after Rush’s name? It stands for “I Can’t Remember My Name.”

And how did earn that credential? Well, sometimes, like in this piece, he’s referred to as August John Rush. In his Singapore Clinical Research Institute profile he prefers A. John Rush. And in the CO-MED study he goes by John A. Rush.

Now, I did a lot of digging to come up with that information. And if all three aren’t the same man, I’ll publish a retraction (but I’m thinking I’m spot-on).

By the way, the first link in the detail of Rush’s name merry-go-round will take you to the Citizens Commission on Human Rights International website. In addition to others, some not-so-nice things are said about Dr. ICRMN…

“Former Vice-Chairman of the Dept. of Clinical Sciences at the University of Texas Southwestern Medical Center…He reported only $3,000 of the nearly $18,000 that Eli Lilly paid him in 2001.  Between 2000 and 2007, he failed to report another $12,000 from various drug companies.”

Now working in Singapore? Hmmm…

And you know what’s even more disturbing about all of this? Physicians such as Dr. ICRMN are involved in studies funded by the National Institutes of Health (NIH)!

And they’re playing a major role in putting together the new Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition (DSM-V). Do you think that provides amazing access and privilege to Big Pharma?

The Wrap

I ran a piece in March of last year entitled “Psychiatrists on the Take? No Way!(?).” The revelations in the article are disturbing. And with all the talk of cleaning things up, along comes Dr. ICRMN’s involvement in a July 2011 study.

Isn’t it a shame that conflict of interest issues have to cast shadows of doubt upon what may well be meaningful and helpful work?

Seriously, is nothing sacred anymore? Hmmm…

Well, did I do my job by dialing you in on two topics of importance?

I guess the bigger question is – are Big Pharma and the physicians we pay very well – and are supposed to trust – doing theirs?

I just dunno…

Would you like to catch a list of all chipur articles on meds and supplements for depression, anxiety, and bipolar disorder? Click here, and you’re there.

Thanks to medscape.com for the resource.

  • Not long after the piece went live, I received this email (he gave me permission to post it)…

    Hi Bill, I am writing to you to comment on you article about using multiple anti-depressants. Nice write up! I just wanted to point something out. You mention the Citizens Commission on Human Rights. I don’t know if the information you got from that website is correct or not. It may very well be. However, that is an organization run by the Church or Scientology. They have very strong views against psychiatry and modern therapeutic practices both medication and talk therapy.

    In the past the CCHR has been successfully sued for defamation and libel for publishing incorrect things about mental health professionals. It is not my place to question the tenets of their beliefs but I feel strongly that the medications and therapies I have received have saved my life. I would hate to see someone who truly needs help be influenced away from getting that help by that organization.

    I know that this is an email but if it would help please share any and all of what I wrote with the other chipur readers.

    Love the site! Andrew

    • I really appreciate your well-written and informed email. chipur readers, Andrew is correct – CCHR is an advocacy group of the Church of Scientology. The C of S is opposed to both psychiatry and psychology. They encourage alternative care based upon spiritual healing.

      Andrew makes a great point re someone turning away from much needed care because of the influence of the C of S. 

      I might add, I am not opposed to psychotropic medications. Managed antidepressant and benzo treatment helped me turn the corner re my anxiety disorders.

      So please don’t interpret my Big Pharma rants as an effort to steer anyone away from psychotropics. The only thing I’m trying to do is encourage transparency, fairness, respect, honesty, and objectivity. Physicians and corporations ought to know better.

      It’s all about trust!

  • Julie

    The unfortunate thing is that pretty much all of the studies are done by people connected to the Big Pharm companies in some way or another. The studies are done to prove something in one way or another and because they’ve already written up what they want it to prove they can (and often will) twist the results to prove their desired outcome.

    In the first study, are all of those drugs owned by the same company? Just a thought that crossed my mind.  Is the second study possibly done by a company that only has their hands on ONE ad med and wants to prove it as the best?

    • Hi Julie…

      I’m thinkin’ that’s how it goes, or at least a variation thereof.

      I can tell you Dr. Blair from the first study gets $$$ from the folks that market Remeron. Or at least he did at the time of the study. And, of course, Remeron is mentioned in his work.

      Again, I believe in the relief/healing power of psychotropic meds – when they’re thoughtfully prescribed based upon objective research. This kind of stuff so taints the effort.

      Bill