Drug use/Drug policy

Industry Influence on Mental Health Research: Depression as a Case Example

Cosgrove L, Patterson EH, Bursztajn HJ, Front Med (Lausanne). 2024 Jan 23;10:1320304 DOI: 10.3389/fmed.2023.1320304

Abstract:

Emotional distress has been rising since before the COVID-19 pandemic and the public is told that depression is a major public health problem. For example, in 2017 depressive disorders were ranked as the third leading cause of “years lost to disability” and the World Health Organization now ranks depression as the single largest contributor to global disability. Although critical appraisals of the epidemiological data raise questions about the accuracy of population-based depression estimates, the dominance of the medical model and the marketing of psychotropics as “magic bullets,” have contributed to a dramatic rise in the prescription of psychiatric drugs. Unfortunately, the pharmaceutical industry’s influence on psychiatric research and practice has resulted in over-estimates of the effectiveness of psychotropic medications and an under-reporting of harms. This is because the principles that govern commercial entities are incongruent with the principles that guide public health research and interventions. In order to conduct mental health research and develop interventions that are in the public’s best interest, we need non-reductionist epistemological and empirical approaches that incorporate a biopsychosocial perspective. Taking depression as a case example, we argue that the socio-political factors associated with emotional distress must be identified and addressed. We describe the harms of industry influence on mental health research and show how the emphasis on “scaling up” the diagnosis and treatment of depression is an insufficient response from a public health perspective. Solutions for reform are offered. Read more …


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Becoming a Phronimos: Evidence-Based Medicine, Clinical Decision Making, and the Role of Practical Wisdom in Primary Care

Cosgrove, L. & Shaughnessy, A. (2023), Journal of the American Board of Family Medicine. doi: 10.3122/jabfm.2023.230034R1

Abstract:

There has been much discussion about the overmedicalization of human experience and the problems incurred by overzealous action-oriented medical care. In this paper we describe the Aristotelean virtue of phronesis, or practical wisdom, and discuss how it can be developed by interested clinicians. We argue that becoming a phronimos requires conscious attention to one’s practice by using feedback to continually improve. But there must also be judicious adherence to clinical practice guidelines and advocacy for people-as-patients at individual, community, and national levels. Read more …


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New Treatments for Mental Disorders Should Routinely be Compared to Psychotherapy in Trials Conducted for Regulatory Purposes

Criste, I. Halvorsen, I. Cosgrove, L.  Naudet, F. (2022). Lancet Psychiatry, Volume 9, ISSUE 12, P934-936, December 2022, DOI:https://doi.org/10.1016/S2215-0366(22)00340-6

Abstract:

Treatments for mental disorders stem from various intervention classes, such as pharmacological, psychosocial, and physical. However, whereas drugs, biologics, and devices are formally regulated by public agencies, such as the US Food and Drug Administration or the European Medicines Agency, psychotherapies are largely unregulated. We are concerned that regulatory trials for the treatment of mental disorders exclude or do not evaluate psychotherapies, even when one is ostensibly a constituent of the combination therapy submitted for approval. In trials conducted for the regulatory approval of drug-assisted psychotherapies, such as 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for post-traumatic stress disorder (PTSD) and psilocybin-assisted therapy for treatment-resistant depression, there were no specific requirements for or an evaluation of the psychotherapy component. In the MDMA trial, both the treatment and the comparator groups received a bespoke psychological intervention, not previously tested in independently conducted randomised trials, instead of one of several evidence-based alternatives. Read more …


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Harm Reduction, Humanistic Psychology, and the CRPD

D’Ambrozio, G., Cosgrove, L., Lilly, S., & McCarthy, T. (2022), Journal of Humanistic Psychology, 0(0). https://doi.org/10.1177/00221678221136240

Abstract:

Harm reduction, which was initially developed as a public health response to illicit drug use, has relevance to the prescription of psychotropic medication. Indeed, focusing on the agency of people who use drugs—licit or illicit— facilitates a more authentic engagement with treatment. In this paper, we show how the framework of harm reduction is congruent with the guiding principles of both humanistic psychology and the Convention on the Rights of Persons with Disabilities (CRPD). Moreover, applying a harm reduction model to psychotropic drug use raises awareness that there are risks to taking these medications, risks which are frequently glossed over because of the emphasis on medication adherence and compliance. We provide case examples of organizations that take a person-centered (vs. medication- centered) approach to people experiencing mental health crises. In their unique ways, these organizations embody the principles of harm reduction and the humanistic impulse that informs the CRPD. Read more …


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Industry Effects on Evidence: A case study of long-acting injectable antipsychotics. 

Cosgrove, L., Mintzes, B.,  D’Ambrozio, G., Bursztajn, J., Shaughnessy, A. S. (2022).
Accountability in Research.  10.1080/08989621.2022.2082289 

Abstract:

A vigorously debated issue in the psychiatric literature is whether long-acting injectable antipsychotics (LAIs) show clinical benefit over antipsychotics taken orally. In addressing this question, it is critical that systematic reviews incorporate risk of bias assessments of trial data in a robust way and are free of undue industry influence. In this paper, we present a case analysis in which we identify some of the design problems in a recent systematic review on LAIs vs oral formulations. This case illustrates how evidence syntheses that are shaped by commercial interests may undermine patient-centered models of recovery and care. We offer recommendations that address both the bioethical and research design issues that arise in the systematic review process when researchers have financial conflicts of interest. Read more …

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Drivers of and Solutions for the Over-Use of Antidepressant Medication in Pediatric Populations

Cosgrove, L. Morrill, Z., Yusif, M., Vaswani, A., Cathcart, S., Troeger, R., and Karter,
J.M. (2020) Front. Psychiatry, 13 February 2020, Sec. Child and Adolescent Psychiatry, Volume 11 – 2020

Abstract:

Children in the United States and internationally are increasingly being diagnosed with depression and related psychiatric conditions and a recent study found that antidepressant (ADM) use in children and adolescents rose substantially in youth cohorts in five Western countries from 2005 to 2012. However, there has been ongoing controversy over the effectiveness and safety of ADM use in children, including concerns about ADM increasing suicidality and self-harm. In addition to the increase in the diagnosis of depression, commercially driven off-label prescriptions have been cited as a significant reason for high rates of pediatric ADM prescribing. In this commentary, we discuss two drivers of the overuse of ADM, both of which are products of an increasingly medicalized approach to mental health: 1) the demand for mental health and depression screening in youth, despite the lack of evidence to support it, and 2) the renewed momentum of the Global Mental Health Movement and concomitant calls to “scale up” the diagnosis and treatment of mental illness. Using the lens of institutional corruption, we identify the ways in which both guild and financial conflicts of interest create obstacles to rational prescribing practices in pediatric populations and offer suggestions for reform. Read more …

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