Ordinarily Well

Peter D. Kramer
Brown University
Conflicts: Profound and Unresolved
Naming names: is there an
(unbiased) doctor in the house? [BMJ
2008]

I am one of you
High school & college newspapers
Newsweek & Ralph Nader
organization
Trade paper & Psychology Today
NYTimes, Post, WSJ, Slate, Salon, etc.
Public radio
Books
Fallibility

Summarizing Outcome
Research
Depressed? You Should Be in
Therapy & Taking an Antidepressant
Antidepressant Lift May Be All in
Your Head
Popular Drugs May Help Only in
Severe Depression

You should be in therapy

Effect of Cognitive Therapy With
Antidepressant Medications vs
Antidepressants Alone on the Rate of
Recovery in Major Depressive Disorder
[JAMA Psychiatry 2014]
Penn, Vanderbilt, Rush [R&R]
Pragmatic trial

Look beyond the abstract

(or press release)
For most patients, extensive therapy
added little or nothing (possible
negative effects)
High rates of remission with
medication
High rates of recovery with
medication

Know the specific context

Importance of STAR*D [30%]
Success of medication may leave
little room for CT to enhance
recovery.
Hed: Work with your
psychopharmacologist

Know the general context

Its a battlefield
Zeitgeist has its favorites
[Standard therapies are extensively
tested]
[One-off wonders]

Know the researchers

Antidepressant Drug Effects and
Depression Severity [JAMA 2010]
Popular Drugs May Help Only in
Severe Depression
In Defense of Antidepressants [NYT
2011]

Check the references

Kirsch: Few mildly ill patients
307 patients from P-Vanderbilt trials
& 411 from elsewhere
Imipramine 100 mg =suboptimal.
Minor depression = trout in the
milk?
ADM is superior to placebo for
patients diagnosed with dysthymia

Trout in the Milk

Check the references

Kirsch: Few mildly ill patients
307 patients from P-Vanderbilt trials
& 411 from elsewhere
Imipramine 100 mg =suboptimal.
Minor depression = trout in the
milk?
ADM is superior to placebo for
patients diagnosed with dysthymia

Understand statistical
fallacies
Baseline score inflation
File drawer effect [man-bites-dog, checklists]
Differential sieve
Additivity
Differential dropout
Limitations of our tools: Meta-analysis

Spurious finding due to baseline

score inflation
90
80
70
60
50

Absent data

40

Bad data

30

Fair/moderate data

20

Good data

10
0

severe

non-severe

combined

Understand statistical
fallacies
Baseline score inflation
File drawer effect [man-bites-dog, checklists]
Differential sieve
Additivity
Differential dropout
Limitations of our tools: Meta-analysis

Follow up
Can People with Nonsevere Major
Depression Benefit from
Antidepressant Medication? (J Clin
Psy 2012)
825 patients with nonsevere major
depression (vs 103, and 718
altogether)
no incentive to inflate entry
scores.
Hed: ADs Help Up & Down the Line

How to get that story

Look beyond the abstract

Watch for the trout in the milk
Consider the context: broad & narrow
Know the players
Read the references
Consider fallacies
Beware one-off wonders
Follow up

My beat

and even

Ordinarily Well