The Lancet Hurt My Patient
By Alen J. Salerian, MD
Soon after The Lancet – the British symbol of scholarly medical research – declared Zoloft and several other antidepressants ineffective, unsafe and potentially deadly for children and adolescents with depression in April 2004, my patient, Ann, quit her Zoloft.
Before Zoloft, Ann had been withdrawn, depressed and had problems with her 8th grade school work. She said, Zoloft was her little miracle. Here is what she wrote in her suicide note after stopping Zoloft: “If being alive means uncertainty of when my torture would end I would rather not live.”
Not taking Zoloft hurt Ann. For a lot of kids and teenagers, medications like Zoloft, which improve their brain chemistry, have extraordinary gifts of modern science. Zoloft and similar medications have allowed many kids to smell and taste success for the first time in their lives.
The sad truth is that The Lancet article should never have been published because it was fundamentally flawed and unfit for any scholarly medical journal. Most importantly, it had slender contact with scientific objectivity. Any scientific study must respect The Golden Rule: A comprehensive review of all the potential limitations to the study.
Dr, Whittington and his colleagues were naively dismissive of the possibility that a good many factors could have rendered their conclusions that, “all antidepressants are ineffective, unsafe, and potentially deadly for children with depression” incorrect.
Dr. Whittington and his colleagues failed to realize that the majority of the studies they analyzed had a fundamental and often serious error of design: Not to exclude from the study, the depressed kids and adolescents with an increased risk for future bipolar disorder. Neuroscience has already discovered that anyone with a bipolar illness is at high risk for adverse response to the administration of an antidepressant. Dr. Whittington’s oversight was understandable because of our collective knowledge of the complex biological and psychological factors contributing to various mood disorders were limited in the 1980’s and 1990’s when some of these studies began.
Dr. Whittington’s error was akin to research solely devoted to the personality traits of bus passengers based upon ten buses serving a college hockey tournament. An inexperienced researcher might conclude that most bus passengers enjoy hockey and frequently visit orthopedic surgeons.
The Lancet editorial, accompanying Dr. Whittington’s study was not kind to the pharmaceutical industry. “People around the world understand the desire to achieve success and to work in a profitable environment. They will not, however, tolerate the notion that in biomedical research, this could be at the expense of the children’s lives.”
Of course, the pharmaceutical companies are not angels and at times try to increase their profits, but it is a lie that they are all unethical, blinded by profit, and offer little for real health. But, an industry that tackles massive and complex brain disorders cannot be simple or error free.
Sometimes, the deep-rooted paranoia and prejudice against that pharmaceutical industry is capable of greed and destruction, so is mental illness. A depressed or unreasonably angry and volatile teenager could destroy or trigger havoc. If that sounds too alarming, remember the facts: the Columbine massacre and the sad truth that teen suicide is the third leading cause of death for teenagers.
The quickest way to score with public opinion is to expose a mean child killer. The British government immediately banned all antidepressants (with the exception of Prozac) for children. With hostile winds blowing, the FDA sent numerous warnings to parents and physicians about the dangers of antidepressants.
My patient Ann, many other patients and their parents heard the indignant shrills of The Lancet, The British government and the FDA as is they were sounds from hell.
“I felt The Lancet and the FDA put a knife through me,” said Ann’s father. While there is a presumed risk with Zoloft, without Zoloft my daughter almost died. A week after she restarted her Zoloft, she was feeling remarkably better.”
There comes a point in any public debate when common sense dictates and logic must prevail. That time is now for psychiatry, to face the truth that the number of kids and adolescents with depression is on the rise. The reasons for increased suicide and depression are complex. Yet, it is clear that genetic, biological, psychosocial and environmental factors have all been responsible for the dramatic worsening of our children’s mental health.
The lessons to be learned from the recent controversy is that the seemingly benevolent forces, such as the FDA and The Lancet may be as potentially harmful to our children as the presumed mean giants of the pharmaceutical industry.
Indeed, our children and teenagers have greatly benefited from both sides. The monumental challenges awaiting us and future generations of dealing with complex mental disorders will continue to require the muscle and brain of the pharmaceutical industry and the watchful and protective minds of countless government and independent scientists. For sure the new frontiers of brain research should spare a few behaviors: loss of objectivity and unnecessary pontification.