Tag Archives: Anti-Depressants

The Perils of Data Mining

By Dr David Laing Dawson

Allowing computers to search through large medical data bases may one day discover a link, an association of great importance and one that stands up as actually a causal link. It is really the headlines associated with the reporting of these studies with which I have a problem.

These headlines appear on Google searches, Google news, newspapers, and trade epublications such as Psychiatry Times. I suppose the purpose of a headline or lead is to make the reader want to read the article, or in these cases, the research findings and the methodology.

If I read that eating bacon is going to double my chance of a heart attack I am compelled to read the actual study. In that case (an example from a few years ago) I concluded, after reading the actual study and juggling statistics with reality, that I would have to increase my bacon consumption from occasional to every day to increase my chance of dying from cardiovascular disease within the next ten years from 14 percent to 16 percent.

You can’t make good carbonara without bacon or prosciutto.

Butter is good, butter is bad, and now butter is good again.

These data mining exercises can never account for all variables, and they certainly don’t prove cause. In fact they are quite dumb in the sense of ignoring the obvious, and they seem often to be initiated with a prejudice, with the prejudice informing the headline but belied by the actual results of the study.

Others have pointed out that there is a very strong correlation between the presence of an ambulance and a road side accident. My satire on the subject would compare the rate of death from cancer in people who have taken anti cancer drugs with people who never have.

But I am writing this because of a Psychiatric Times headline that implied a causal relationship in the elderly between antidepressant treatment and hip fractures. Forcing me to read at least the synopsis of the study.

Comparing the elderly population (mean age 80) who were not taking antidepressants with those that were found that more of those taking antidepressants had suffered hip fractures. In the details of the study they found peak incidences of hip fracture 30 and 90 days before the initiation of antidepressants. Yes, before the initiation of antidepressants.

This throws the notion of antidepressants causing hip fractures out the window and hints at a much more complicated relationship between hip fractures, falls, osteoporosis, and depression. Depression is, after all, an illness that affects the body as well as the mind: (diet, life style, exercise, concentration, isolation, sleep, carelessness, memory, awareness, along with low mood).

Of course with the elderly all drugs need to be prescribed with added caution, often lower doses, and closely monitored. But if not newspaper editors at least the medical and science writers should refrain from writing headlines that are actually not supported by these data mining exercises.

But more often today all the other interpretations of the data, the cautions, the caveats, the list of missing variables, and the call for more research is added at the end. But few readers today, as we know, read more than the headlines and first paragraph.

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Yes Virginia, Psychiatric Medication Does Work.

By Marvin Ross

As I’ve said so many times, anecdotes are not proof of anything but I am going to use one to demonstrate the efficacy of anti-depressants. The anti-medication people do nothing but give anecdotes of the dangers of psychiatric medications and the difficulties some have going off them. When research is cited, they usually attack it as being biased and/or funded by big pharma.

Research does show that for most and when prescribed properly, these pharmaceutical agents do help. As an example, I’m the power of attorney for someone with Alzheimer’s Disease. When he was first being assessed by a family doctor, he came out as being depressed on the Beck Depression Inventory. While he was under going evaluation, he was given anti-depressants which he only took rarely.

However, when he had his diagnosis confirmed by the geriatric psychiatrist, it was recommended that he go back on and stay on the anti-depressant to help with both his depression and his anxiety. In order to ensure compliance with that and the Alzheimer’s med, he was given a weekly blister pack. The pharmacist loaded the pills for each day and for the proper time.

He saw the psychiatrist a few months later and was assessed again on the Mini Mental Status Exam (MMSE). The psychiatrist noted that not only did he appear more relaxed and less anxious than at the previous session, but that his dementia score had improved slightly – not because his dementia was better but because he had less anxiety.

Then, a few months later, the home care co-ordinator showed up to do a reassessment. She called me amazed. My friend, she said, was far more relaxed and showed no signs of anxiety or agitation which were evident when she first assessed him. As she said, “he still does not know where he lives or what the date is, but he is very relaxed about everything”.

Yes, this is an anecdote that and not a definitive study but it is an example of the benefit of this class of drugs. For a list of the meta analytic studies done for anti-depressants that do show efficacy, visit this webpage. Check out the home page on that site for other resources. Thanks to Robert Powitzky for pointing me to it.