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A Dissenting Opinion

Posted by plosmedicine on 31 Mar 2009 at 00:23 GMT

Author: John Armstrong
Position: Retired
Submitted Date: March 17, 2008
Published Date: March 18, 2008
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

Now that the authors have had their chance to respond to the responders, I’d like to put in my two cents worth. I am a 70-year old male. I struggled with depression from my early 20’s to my early 50’s. During that time I saw numerous psychiatrists and took just about every antidepressant drug on the market: MAOI’s, TCA’s, along with a few “atypical” ones. Most of them “worked” in the sense that they helped alleviate my symptoms but even the ones that worked best left a lot to be desired. I also tried a year of “psychotherapy” that I now look back upon as a waste of time and money. Shortly after Prozac (fluoxetine) came on the market in the late 80’s, my Internist gave me some samples of it. After a few weeks of some unpleasant symptoms, I began to feel better. As time went on I felt better than I had felt at any time during the previous 30 years. I’ve never looked back. I still take a 20mg capsule of fluoxetine every day. I can get a 100-day supply at my local Costco for less than $12, which works out to about 12 cents a day. During the almost 20 years I have been taking it, I have never since been troubled by depression. There have been times that I have been unhappy about something, but depression is a very different thing from unhappiness (Tomi Gomory, one of your responders, to the contrary). Anyone who tells me that my response has been due to a placebo effect will be placed in the same category as those who tell me that the war in Iraq has been a roaring success or that the U.S. economy is in great shape.

I would like to make some comments on the issue of the relevance of clinical experience versus clinical trials. The trials involving fluoxetine (my comments relate only to this single drug) that the paper was based upon are over 20 years old. Since then, it has been used by thousands of doctors on millions of patients. To dismiss this record of clinical experience by comparing it to bloodletting and leeches is to demonstrate an intellectual arrogance that does not befit an impartial researcher. A pattern in the responses to your paper has been that medical doctors who have actually prescribed the drugs (presumably including fluoxetine) have generally supported their use. A few patients, like me, have also responded positively to their experiences. Many, if not most, of the ones that have praised the paper have been social workers, psychologists, and other non-MD’s.

I would also like for someone to point me to a paper that provides compelling evidence that any kind of psychotherapy works for any kind of “true” depression. And by “evidence”, I mean the same kind of rigorously controlled clinical trials that are demanded for drugs, medical devices, and procedures: placebo controlled, double blind, randomized, etc. I don’t believe such a paper exists because I don’t believe that it is possible to conduct such a trial. So when psychotherapy is recommended as a first-line treatment of depression, such a recommendation represents the triumph of hope and faith over science.

No competing interests declared.