1 Boring Old Man

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:

• VNS therapy in treatment-resistant depression: clinical evidence and putative neurobiological mechanisms
  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:

• Mood disorders and medical illness: a major public health problem
  by Evans DL and Charney DS
  Biological Psychiatry. 2003 Aug 1;54(3):177-80.
  ^{We acknowledge Sally K. Laden for editorial support.}

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:

• Efficacy of paroxetine in the treatment of adolescent major depression: a randomized, controlled trial
  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]:

• Recognition and Treatment of Psychiatric Disorders: A Psychopharmacology Handbook for Primary Care [Paperback]
  by Charles B. Nemeroff and Alan F. 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.