The Practice Guideline for the Treatment of Patients with Major Depressive Disorder is the primary resource for clinicians who treat patients with depression, which often involves prescribing drugs. Researchers from the University of Massachusetts, Boston, examined financial and intellectual conflicts of interest involved in the process of defining the guidelines to see if outside influences affect patient care.
Their conclusion isn’t pretty: “The prevalence of conflicts of interest among panel members was high. The quality of the evidence cited raises questions about the validity of the recommendations.”
The study, published in the Journal of Evaluation in Clinical Practice, showed that all of the people who devised the guidelines, published by the American Psychiatric Association (APA), had numerous financial ties to drug companies that manufacture antidepressants.
That’s like compiling a buying guide for safe automobiles when all of the authors work for Ford.
A lot of attention has been paid lately to psychotropic drugs (those that affect brain function, emotions and behavior) because of widespread concern that they are overprescribed and misprescribed. (See our recent blog posts, “Misuse of Antipsychotic Drugs Is Off the Charts,” and “Atypical Antipsychotic Use High in Children.”)
We’re all familiar with the suspect marketing behavior of drug manufacturers, but this study is an indictment of the behavior of the people we personally must trust with our lives.
The researchers evaluated the quality of the evidence the committee used to advise prescribing antidepressant medication. The APA recommends drugs as a first-line treatment for all levels of depression, but the study found that more than one-third of the research panelists cited in support of drugs for depression did not examine outpatients with major depressive disorder; 17 percent of their references didn’t measure clinically relevant results.
“The recommendation for antidepressants for mild depression is not congruent with the evidence,” the researchers said, noting that guidelines produced by the National Institute for Clinical Excellence say that antidepressants should not be first-line intervention for mild depression, and that Dutch guidelines recommend them as first-line treatment only in cases of severe depression because people may be exposed to unnecessary harm.
In order not to put patients at risk, the researchers said, it’s critical for groups developing clinical practice guidelines to pay attention to the quality of the studies they cite as well as to any bias resulting from conflicts of interest.
Every member of the APA guideline committee disclosed financial ties to the pharmaceutical industry. Some members had nine such relationships; some had 33.
None of them should have any.
Most of the committee members participated in pharmaceutical companies’ speakers’ bureaus. According to a UMass news release about the study, doctors serving on a speakers bureau are known as “Key Opinion Leaders” or “KoLs” because they are so important to the marketing of a drug. And some members of a separate independent panel charged with mitigating any effect of committee conflicts had undeclared financial relationships with drug manufactures.
Do these sound like people who should be treating your disorder, much less advising other professionals how to do it? Or do they sound like people who should be kept as far away from a clinical setting as the moon is from the Earth?