Researchers Push Treating Pregnant Women With Antidepressants: Pseudoscience Reaches New Heights in JAMA Report

In the face of recent studies documenting birth defects and increases in miscarriages resulting from antidepressant use during pregnancy, researchers want to push these drugs on pregnant women.

by Heidi Stevenson

4 October 2010

A metastudy on the effects of depression in pregnant women found what the authors termed only "modest" risks of preterm and low birth weight infants. So, their conclusion is to screen all pregnant women for depression—and treat them with antidepressants. They didn't bother to consider the risks of antidepressants taken during pregnancy. They simply decided that depression in pregnant women, no matter what the cause, should be drugged, no matter how severe the adverse effects.

Entitled "A Meta-analysis of Depression During Pregnancy and the Risk of Preterm Birth, Low Birth Weight, and Intrauterine Growth Restriction", the study, to be published today in the Journal of the American Medical Association's publication, Archives of General Psychology, summarizes its conclusions:

Women with depression during pregnancy are at increased risk for PTB [preterm birth] and LBW [low birth weight], although the magnitude of the effect varies as a function of depression measurement, country location, and US socioeconomic status. An important implication of these findings is that antenatal depression should be identified through universal screening and treated.

To be frank, it doesn't matter if the study was robust. On its face, the conclusions drawn are outrageous. At no point did the authors take into consideration any of the known adverse effects of antidepressants in general. Worse, they didn't bother to take into account that they're known to cause an increase in birth defects⁽¹⁾ and a 68% increase in miscarriages⁽²⁾.

  

Funding and Conflicts of Interest

When a conclusion is so obviously outrageous, one must wonder why. The answer, as usual, is found in the money trail. The study was funded by the National Institute of Mental Health (NIMH), which advocates drugs for virtually every mental problem. In depression, it is the first thing recommended.⁽³⁾ They advise against the herbal treatment St. John's Wort, suggest that psychotherapy can "help", and even advocate electroconvulsive therapy in some cases.

The researchers themselves are neck-deep in Big Pharma money. Grants, conference financing, and honoraria have been given to researchers by AstraZeneca, Dainippon Sumitomo, Eli Lilly, Forest Research Institute, Ortho-McNeil-Janssen, Pfizer, Roche Pharmaceuticals, Sanofi-Aventis, Schering-Plough, Sepracor, and United BioSource. Wayne Katon has served on advisory boards for Eli Lilly and Wyeth in the last two years.

Confounders

Confounders are factors in trial subjects that could affect outcomes. Race and ethnicity, smoking, drug use, marital abuse, and other confounders were noted by the authors:

Finally, prior evidence has shown that key variables in addition to depression, such as substance use or abuse, race/ethnicity or SES, and previous PTB, are strongly and consistently predictive of negative birth outcomes. Most of the studies in our meta-analysis (80%) controlled for at least 2 of these key predictors, but few controlled for all of them. In addition, most of the studies did not control for stressful life events and other psychiatric comorbidities of depression, such as antenatal anxiety, which has been linked with adverse birth outcomes in some studies.

So how did the authors deal with these confounders? Arrogantly, of course. They discussed them, and then ignored them. To paraphrase OJ's attorney: If it doesn't fit, ignore it.

In evading the issue of confounders, the study is rendered worthless. Its conclusions are invalid first because they reach beyond the topic studied—that is, they suggest conclusions that are not warranted by the claimed results. Second, the study is also invalid because it didn't account for confounders—indeed, arrogantly pointed them out and then ignored them.

This is as egregious an example of junk science as I've yet seen. It's simply not conceivable that the conclusion wasn't predetermined, with a pseudostudy set up to reach it.

Apparently, the new approach to medical research is: If the fact doesn't fit, ignore it.

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