1 Boring Old Man

I’ve been mildly obsessed with that graph I redrew from the Undurraga’s and Baldessarini’s article [Randomized, Placebo-Controlled Trials of Antidepressants for Acute Major Depression: Thirty-Year Meta-Analytic Review] [what was that all about?…, meta meta meta meta meta meta…]. I’ve claimed that I understood why it stuck in my mind like glue – but I must’ve been wrong about that because it wouldn’t go away. This morning, I woke up knowing why. In case you forgot, this is the graph I’m talking about [on the right]. It’s a plot of the RR [Response Rate] for all the Randomized, Double-Blind, Placebo-Controlled Clinical Trials of antidepressants since 1980 [if X = mean % fall in rating scale then X_drug ÷ X_placebo = RR] [RR = 1 would be no difference between drug and placebo]. The various colors are the different classes of drugs [primarily the Tricyclics, the SSRIs, and the SNRIs].

When I first read the article, I looked at these two small graphs and my mind saw that those lines [the Drug and Placebo Responder trend lines] crossed near 2008. My thought then was "about right!" I put the article aside for a few days before I got to writing about it, and that initial thought got lost in the shuffle. But I know what my thought meant. I see 2008 as the time when the jig was up for the pseudoscientists in psychiatry. That was the year Senator Grassley and Paul Thacker exposed the undeclared conflicts of interest in many of our KOLs. That was the year when Charlie Nemeroff was finally deposed as Chairman at Emory. That was the year that marked the beginning of the fall of Alan Schatzberg at Stanford and Martin Keller at Brown. It was the year that John Rush fled to Singapore. It was the beginning of the end of Joseph Biederman’s Bipolar Child reign of error. It was the year when the absurd excesses of pseudoscience in psychiatry had gone too far to be tolerated.

So the colored ball graph is more than the decline in responsiveness to antidepressants or the absurd increase in responsiveness to placebos; it’s even more than the obverse of the rise of the Clinical Research Industry; it’s an index of how far psychiatry itself had to fall to be recognized as having been co-opted by something resembling a racket, a scam, whatever you want to call the corrupt alliance of academic and organized psychiatry with a variety of industries that are actually ultimately interested in the demise of the specialty – hoping to replace it with an even more gullible cohort of primary care physicians who’ll just write the prescriptions and keep things cheap.

I recognize that I’m doing what I am decrying, co-opting a graph to say something I think already [but it’s my blog and I can over-read whatever I choose to over-read]. The point remains that we’ve reached the end of an era. Those who think they can keep the post-DSM-III, post-Prozac dream alive going forward are the ones in trouble. It’s probably the real reason so many of us are so terminally disgruntled about the DSM-5 Revision process. They’re trying to push on down the road as if it could go on forever, failing to notice that they’re out of pavement. The bubble has burst and they didn’t hear it pop.