Cymbalta? Zoloft? Wellbutrin? M&Ms?

[02/05/06 UPDATE BELOW]
I've been railing about the prescription drug marketing scene, and hadn't gotten around to asking a key question: What's the difference between one antidepressant and another? I did that this morning, and even my inch-deep Google search pulled up two significant pieces of reportage from journalistic sources (as opposed to people with commercial or ideological axes to grind):

1. A September 2005 article in Forbes, reporting on a study of the clinical trials of many of the best known antidepressants, (including Cymbalta, by the way) which concluded that there's little difference among them in terms of effectiveness. Even the differences in side effects are small. The greatest difference among them is price.

2. An article in September 2002 Psychiatric Times--which says it's the leading trade publication in the field--reporting on another study of some of the same FDA clinical trials data, noting that none of the trials showed the antidepressant being tested was significantly more effective than a placebo. This doesn't mean antidepressants aren't effective...just that they're apparently no more effective than placebos. Read it for yourself.

Full disclosure: I've been on Zoloft for over ten years, and I'm damn glad my doctors prescribed it. My point in bringing this information to your attention is, medicine isn't all science. And, advertising is the wrong way to decide which drug to prescribe. No calm voice telling you about side effects, with moaning violins playing in the background, balances the emotional sell of the commercial. "Ask your doctor if ______ is right for you" is the wrong advice. They're telling you to demand that your doctor justify not giving you a particular drug. Slick, huh. If the drug rep can't make the sale, they'll send in the patient.

Ask your doctor, "Doc, what can I do about the way I feel?" Then, "How did you decide that drug is right for me?" Why did my doctor prescribe Zoloft in the first place, when there were other drugs out there? Prozac, for one. This was before direct-to-consumer drug advertising was legal. Maybe it was because the Zoloft guy was the last drug rep he saw. I wish I'd asked him then.

All the TV advertising the pharmaceutical companies run--by some accounts, around $4 billion a year--is only a fraction of what they spend to sell directly to doctors. They spend even more billions to lobby governments.

UPDATE: Or, if you like, addendum. Recently, a group of physicians wrote in an article in the Journal of the American Medical Association that medical schools should ban gifts, samples and contributions to continuing education from pharmaceutical companies. Read about the article here.

This was going to be a short post. It's not. I hope it doesn't depress you. If it does, take a walk and buy some chocolate.