… uh, guess again, folks … the real story here isn’t entirely what you may think it is. Here’s a sample story on this revelation (this one from the New York Times):

The makers of antidepressants like Prozac and Paxil never published the results of about a third of the drug trials that they conducted to win government approval, misleading doctors and consumers about the drugs’ true effectiveness, a new analysis has found.

If this surprises you, why should it? Of course companies are going to publicize what’s in their best interest to publicize! FDA review of drug efficacy generally includes even those studies whose results aren’t favorable and may not have been published, so from a regulatory point of view, this is not a problem at all.

Now, I’m already on record as saying that the widely-touted 60% efficacy of antidepressants — which is supported by a majority of studies and therefore a sound conclusion — is not sufficient; that 60% efficacy of anything would not be acceptable in most other areas of life.

But come on, people, let’s not blow this out of proportion! We haven’t exactly discovered anything new here. In fact, I suspect this is really “invented” news, extracted as it is from information made public over the last couple of years. If this is the worst news they could find, after poring through this new information for that long a time, then let’s face it, it’s not that bad!

The cold hard fact is that antidepressants work for many people. The last thing we need is yet another mass-media blitz being plastered all over the country which tells people that they don’t work. Too many mood-disorder sufferers already get no treatment at all, convinced that nothing can help them … to add to their number, this way, is a travesty.

This is my term for when a mood-disorder patient is put on a medication, the dosage is raised, then another is tried, the dosage of that one raised, etc., in a fast-and-furious effort to find something — anything — that works. While providers often have good intentions behind putting a patient on the “medication mill,” ultimately, they’re more likely to do harm, than good.

People on the “medication mill” usually get there by being hospitalized, frequently due to a suicide attempt. The worry is that the person needs to have some improvement — soon — if they’re to be allowed to return home. There’s a very real sense, on the part of providers, as well as the patient’s family and friends, that something must be done quick, or all may be lost.

Generally there’s merit to this urgency; but the problem is that, even under the best conditions, it can take weeks for a medication to begin lifting or controlling someone’s mood. Not giving a medication ample time to “do its thing” and begin working, may end up putting off an improvement, as one after another is tried, none of them having been given long enough to do any good.

Look at it this way: Let’s say you are started on a medication. After 1 week, it appears not to work, so the dosage is raised. After another week, it’s still not working, so another medication is tried, repeating the same pattern. This might go on for 8 weeks or even more; but for all anyone knows, the first medication might have worked, had it been tried for a solid 4 weeks.

In psychiatry, giving a medication sufficient time to work is called a “fair trial.” Medical journals decry that providers aren’t allowing for a fair trial for any given drug a patient tries. So in this instance, I’m not the only one pointing out the problems with the “medication mill.”

One factor encouraging the medication mill, is managed care and government-insured medicine. Patients who are covered by managed care or government insurance (Medicare, Medicaid) are often pushed out the hospital doors as soon as possible. These companies and agencies pressure providers into taking chances, in order to get a patient just barely good enough to get out of the hospital. After that, they couldn’t give a damn what happens. All they know is that they aren’t paying a thousand dollars a day for the patient to be in the hospital.

What they fail to figure, however, is the long-term cost. Sure, getting someone improved enough to go home, quickly, is all well and good … but if, after that, they don’t improve much more, they stand a greater chance of relapsing into another depressive episode, and another, and so on.

What’s much better, in the long run, both emotionally for the patient and financially for the bill-payer, is to ensure that patients get “fair trials,” in a safe environment; this way they’ll be less likely to return to the hospital.

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Perhaps no single development has had more of an impact on the treatment of mood disorders, than the discovery of antidepressant medications, and for bipolar folks, mood stabilizers. Medications are the best-known treatments for mood disorders, and they are what most doctors will want to try first, when someone is initially diagnosed.

While medications are often a tremendous help for a patient, they cannot usually “cure” anyone. They are a step in the right direction, but only one step of many that need to be taken.

That antidepressants and mood stabilizers work is not in doubt — we know that statistically from clinical studies — but we still don’t know how they work. Researchers have made guesses, but that’s all they are — guesses. Too many things about them are uncertain or unknown.

Psychiatry commonly calls mood disorders “imbalances of brain chemicals.” But not only is this not very helpful, it doesn’t actually mean anything! Precisely what is being “balanced” against what? And how does depression represent an “imbalance?” Which chemicals are in question? Is there any way to test someone’s brain chemistry?

There are no answers to these questions, aside from some educated guesses.

Don’t get me wrong. I’m convinced that there is some sort of electrochemical brain malfunction at the heart of mood disorders-that’s not in doubt — I just dislike the phrase “chemical imbalance,” because ultimately, it’s gibberish. We need our terminology to have meaning, not lack it, if we’re to advance the cause of mood-disorder treatment.

Even when researchers thought they were onto something — it often turned out that they weren’t. For example, the inventors of buspirone thought they had devised an antidepressant of the class known as SSRIs (selective serotonin reuptake inhibitors) along the lines of Prozac. But during clinical trials, they discovered that buspirone isn’t effective against depression — but it is effective against anxiety. Ultimately, it was approved by the FDA as Buspar, an anxiolytic (anti-anxiety agent). It’s sometimes given to depression patients, but usually to alleviate associated anxiety, not the depression. Yet, every early indication had been that buspirone would work similarly to other SSRIs, which are effective for depression.

What went wrong with buspirone? No one knows. Chemically, it should work on depression … but it doesn’t.

In the case of bipolar disorder, it was discovered that anticonvulsants, long used to treat epilepsy, were effective in quelling mood fluctuations. Carbamazapine, gabapentin, lamotrigine, and several more, all help in this way — but no one knows what the connection is between convulsions and mania. Furthermore, another mood stabilizer, lithium, is unrelated to these — or anything kind of medication — and its workings are even more of a mystery.

So while we do have some effective medications for mood disorders, we have few answers as to how or why they work, and are at a loss to devise new ones, since even those that appear chemically-promising, can end up not helping.

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