sally’s world…

Posted on Friday 29 April 2011

Depression is one of the most prevalent and costly brain diseases. In the last major epidemiology study conducted in the United States, major depression had an overall lifetime prevalence rate of 17.1% (21% in women and 13% in men), and comparable figures have been obtained worldwide. These findings represent an increase of approximately 6% in the 15 years since the previous study…
Affective disorders account for considerable psychiatric morbidity (pain and suffering), but also significant disability and consequent loss of productivity. Depression has been estimated to be the second leading cause of disability worldwide, surpassed only by ischemic heart disease. Moreover, depression is often associated with comorbid psychiatric disorders, most notably anxiety disorders (panic disorder, generalized anxiety disorder, social anxiety disorder, obsessive−compulsive disorder and post-traumatic stress disorder). The mean age of onset of depression has markedly decreased from the 40- to 50-year-old range noted several years ago to the 25- to 35-year range, and this phenomenon has been observed worldwide. Depression often goes undetected, especially in children, adolescents and the elderly. Mood disorders are associated with a significant risk for suicide, which remains one of the top ten causes of death in the United States and in many countries throughout the world. Depression is a major independent risk factor for the development of coronary artery disease and stroke, and possibly other major medical disorders.

I wrote a previous version of this post, but as I was in the process of publishing it, it evaporated into  the ether of cyberspace – an event I see as a sign, but I’ll get to that in a moment. First, I’d like to revisit that quote up there from my last post [depression, Depression, and Alchemy…]. It begins with the topic sentence, "Depression is one of the most prevalent and costly brain diseases." So right out of the gate, Depression is a standalone – not Major Depressive Disorder. The emotion [depression] has become a disease, and a brain disease at that. Even more, it’s a major public health problem – prevalent and costly.

About the time I got through that sentence the first time I wrote it, there was a mail ping. It was a comment on my last post saying, "Whenever I see a journal article lead off with this anodyne theme I know there’s trouble ahead. The theme has been internalized by all the professional writers who do the ghostwriting for all the too-busy KOLs – we know who they are." As usual, Dr. Carroll is on the mark. The quote is from Sally Laden‘s article  in 2004 [edited by Dr. Nemeroff et al]. It was the one that lost Nemeroff the editorship of NeuroPsychoPharmacology:

  • by Nemeroff CB, Mayberg HS, Krahl SE, McNamara J, Frazer A, Henry TR, George MS, Charney DS, Brannan SK
    Neuropsychopharmacology. 2006 Jul;31(7):1345-55.
      Acknowledgements: We thank Sally Laden for editorial support in developing early drafts of this manuscript. We maintained complete control over the direction and content of the paper. Preparation of this report was supported by an unrestricted educational grant from Cyberonics Inc.

On that occasion, she was writing for Cyberonics, the maker of the VNS device. Her introduction goes on with the public health theme. Depression was not only an epidemic. It was growing, affecting more people, arising earlier in their lives, and threatening to silently gobble up our youth. It was predisposing us to disease and suicide. Depression the disease was a spreading epidemic.

Sally Laden had already alerted us to the dangers Depression posed to our physical health and longevity in an article commissioned by GSK and edited by Drs. Evans and Charney. Ms. Laden’s authorship and GSK’s sponsorship was documented for us by Paul Thacker of POGO. The title says it all:

Sally had also already done her part to save kids from the Depression epidemic by writing up Dr. Martin Keller’s Study 329 for GSK. The study concluded, "Paroxetine is generally well tolerated and effective for major depression in adolescents." Again, her authorship was well documented by Paul Thacker of POGO:

  • by Keller MB, Ryan ND, Strober M, Klein RG, Kutcher SP, Birmaher B, Hagino OR, Koplewicz H, Carlson GA, Clarke GN, Emslie GJ, Feinberg D, Geller B, Kusumakar V, Papatheodorou G, Sack WH, Sweeney M, Wagner KD, Weller EB, Winters NC, Oakes R, and McCafferty JP
    Journal of the American Academy of Child and Adolescent Psychiatry. 2001 Jul;40(7):762-72.
      This study was supported by a grant from GlaxoSmithKline… The authors acknowledge the contributions of the following individuals:… Editorial assistance was provided by Sally K. Laden, M.S.

Her work with Dr. Keller was poorly received, and Study 329 has become a paradigm for the misrepresentation of science in the psychiatric literature – a legend with its own literature.

But Sally’s work with colleague Diane Coniglio in getting people treated early by their Primary Care Physicians for Depression had more staying power in their GSK financed 1999 book [edited and scrutinized by Drs. Nemeroff and Schatzberg]:

Sally Laden’s view of Depression as a brain disease of epidemic public health import had its roots in the coming of the DSM III and the creation of Major Depressive Disorder. Oh I know she didn’t ghost-write the DSM III. It was framed by psychiatrists who were responding to the disappointment in the results from the former generation’s psychological theories, the advances of neuroscience and psychopharmacology, and the financial realities of the era. But the Pharmaceutical Companies and a cooperative segment of biological psychiatrists gradually turned the disease of Depression into a gold mine. And I do expect that Sally’s corporate sponsors and the same group of psychiatrists had something to do with maintaining the Disease status of Depression, keeping the diagnostic category from evolving into something closer to the clinical reality.

Sally and her corporate bosses aren’t the only people raising the alarm  of an epidemic. So is author Robert Whitaker’s book, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. It’s a well done book, accurately sourced. The epidemic he writes about is the overmedication of Americans and their children by psychiatrists involved with the pharmaceutical industry. My only criticism of his book is that he fails to give Sally Laden and the ghost-writing industry adequate credit for their part in creating the mess he eloquently documents.

I began with, "I wrote a previous version of this post, but as I was in the process of publishing it, it evaporated into  the ether of cyberspace – an event I see as a sign." What I was referring to was my eeirie feeling that the disappearance of my post was related to how it ended. The ending went something like this. In my last post [depression, Depression, and Alchemy…], I was saying that while I accept that some Depressions have a biological basis, I remain unconvinced that most depression is a disease, a brain disease. That really is what I think, and I’m not worried that it’s a crazy opinion that comes from some dark neurotic recess of my mind. Yet that was my third version of that post, and a rambler at that. And as I wrote this post the first time, I realized that I was laboring over words, changing sentences, adding tentativeness or qualifiers. It’s as if I’m afraid I’d be discounted as some priest of the old religion, a Necromancer, a Sorcerer, an Alchemist – unwilling to move into the modern world of science and chemistry. I was even aware of fighting the impulse to use scientific jargon as if to prove that I’m a scientist after all. So in that first version of this post, I was diagnosing myself as having P.T.S.D. from the years of "evidence-based medicine" talk from people who I actually think are a bunch of opportunistic quacks. And when it evaporated into thin air, I decided that either I was right that I shouldn’t be so out front in saying bullshit on brain disease as the do-all and be-all in depression, or that I needed to write it straight through without editing and be done with it. I picked the second omen…
    April 29, 2011 | 8:22 PM

    I am in middle age and when I was trained we had a DSM that was, if I recall, about 30 pages long. Maybe it was longer but it was a thin pamphlet, and not a zillion page book. I long for a return to the pamphlet days of DSM. Diagnoses such as neurotic depression and neurotic anxiety seemed to work well. They were distinct conditions from the involutional melancholias and endogenous depressions that seemed to signify severe major depressions with likely heavy biological bases. The pharma revolution has brought madness to the field and dumbed it down with horrible consequences. I sometimes think you and Dr. Carroll are like Irish monks keeping alive the flame of psychiatric civilization in the midst of the Dark Ages of our profession. Keep up the good work!
    BTW, what’s with Nemeroff’s signature? I abhor handwriting analysis, but WTF is with the way he signs his last name? You could never make out “Nemeroff” from those ever bloating circles that expand to obscure the name. Is grandiosity indicated? LOL. Just kidding. But maybe not.

    April 29, 2011 | 9:09 PM

    DSM II
    April 30, 2011 | 12:08 AM

    I believe my comment disappeared, so I’ll give another shot.

    Another Paxil 329 study contributor making news on the political front in Canada

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