Psychiatric Research: Thoughts and Frustrations
Last month, I got a call from the Associated Press (AP) asking for comments about a study on SSRIs that had just been released in the New England Journal of Medicine. In short, the study focused on clinical trials involving more than 12,000 consumers and 12 different SSRIs. The study showed that 74 different trials involving almost 3,500 consumers—trials with results considered "unfavorable" by the researchers—were never published or made available to others. The AP wanted to know DBSA's reaction to this news. They also asked for my feedback on psychiatric medication, treatment and research in general. What follows are some of the thoughts I shared with them.
Selective publication of research trials
People seem to forget that occasionally the final research results point to fatal flaws in the design of the research itself, making the results unfit for publication. DBSA has long advocated for publication of all trials, both failed and successful, so that scientists can learn from each other's mistakes as well as their successes. We understand that neither an editor nor a researcher may find it appealing to publish the results of a failed trial, but we think it can help the field of psychiatric research move forward.
Medication and consumer confidence
The average consumer views taking medication with some skepticism, especially at the beginning of treatment. According to DBSA surveys, we worry about a medication changing our personality or becoming habit-forming. We also worry about the stigma of taking medication for a "mental illness." So, anything that undermines the public's confidence in medication is of concern. For many of us, medication is an important part of our treatment plan and one that we cannot afford to stop because we suddenly lack confidence in the research. DBSA serves nearly 5 million people each year, and so many of the stories we hear are a variation on this theme: "I was doing well and then I stopped taking my medication and my life fell apart." Stopping treatment without working with your doctor to do so almost guarantees disaster.
Finding the right medication to treat depression
Educated consumers have learned that it takes several trials of different medications, dosages and combinations of dosages before we get a good response to treatment. This is borne out by the large STAR*D study that shows that after three separate medication trials, more than 60% of people experienced remission. But the reality is that, while scientists are learning more every day about psychiatric illnesses like depression, there is far, far too much that is not understood about some of the brain's most basic functions. How can even the best researchers create good treatment options if we don't understand how this organ works? Add to this the fact that it can take 20 years for research results to reach the hands of practicing physicians, and we have a field that's lagging behind the science used to treat other diseases that affect other major organs of the body.
Funding for depression research
NIMH estimates that it will spend $334 million in depression research in 2008. That sounds impressive until you compare it with cancer research, which will receive $5.5 billion in funding. This despite the fact that, according to the World Health Organization, the burden of disease for depression is greater than the burden of disease for all cancers combined.
Look at it another way. More than 20 million people live with depression. In 2005, about 1 million people lived with HIV/AIDS, and the HIV/AIDS research budget that year was $2.9 billion. In stark contrast, the depression research budget was only $329 million.
This year, like every year, twice as many people will die by suicide than homicide, and yet our research dollars do not reflect this public health crisis.
It's beyond frustrating.
What are your thoughts on publishing the results of "failed" research? What do you think is needed to move psychiatric research (and its funding) forward?