When should the bereaved be medicated? For years, the official handbook… (File photo/AP )
It was a simple experiment in healing the bereaved: Twenty-two patients who had recently lost a spouse were given a widely used antidepressant.
The drug, marketed as Wellbutrin, improved “major depressive symptoms occurring shortly after the loss of a loved one,” the report in the Journal of Clinical Psychiatry concluded.
When, though, should the bereaved be medicated? For years, the official handbook of psychiatry, issued by the American Psychiatric Association, advised against diagnosing major depression when the distress is “better accounted for by bereavement.” Such grief, experts said, was better left to nature.
But that may be changing.
In what some prominent critics have called a bonanza for the drug companies, the American Psychiatric Association this month voted to drop the old warning against diagnosing depression in the bereaved, opening the way for more of them to be diagnosed with major depression — and thus, treated with antidepressants.
The change in the handbook, which could have significant financial implications for the $10 billion U.S. antidepressant market, was developed in large part by people affiliated with the pharmaceutical industry, an examination of financial disclosures shows.
The association itself depends in part on industry funding, and the majority of experts on the committee that drafted the new diagnostic guideline have either received research grants from the drug companies, held stock in them, or served them as speakers or consultants.
Drug companies have shown an interest in treating patients who have recently lost a loved one, having sponsored and published the results of at least three trials in which the bereaved were treated with antidepressants, including the Wellbutrin study.
The financial ties between the creators of the APA handbook and the industry far exceed limits recommended in 2009 by the Institute of Medicine, a branch of the National Academy of Sciences.
The IOM limits reflect the fear that patient health could be compromised when diagnostic and treatment guidelines, which are widely used by doctors, are written largely by industry-hired experts and issued by medical societies that depend on industry funding.
While no evidence has come to light showing that committee members broadened the diagnosis to aid the drug companies, the process of developing the handbook was fraught with financial links to the industry:
■ Eight of 11 members of the APA committee that spearheaded the change reported financial connections to pharmaceutical companies — either receiving speaking fees, consultant pay, research grants or holding stock, according to the disclosures filed with the association. Six of the 11 panelists reported financial ties during the time that the committee met, and two more reported financial ties in the five years leading up to the committee assignment, according to APA records.
■ A key adviser to the committee — he wrote the scientific justification for the change — was the lead author of the 2001 study on Wellbutrin, sponsored by GlaxoWellcome, showing that its antidepressant Wellbutrin could be used to treat bereavement.
■ In 2010, another APA panel developed guidelines on how to treat patients once they have been diagnosed with major depression, including advice on medication. Six of the seven panelists had received consultant pay, lecture fees or research support from pharmaceutical companies, according to their disclosures. The association also appointed an oversight panel that declared that the recommendations had been free of bias, but most of the members of the “independent review panel” had previous financial ties to the industry.
In an interview, APA chief executive James H. Scully Jr. noted that in preparing the new handbook the organization had taken steps to reduce conflicts of interest. Two years before the Institute of Medicine published its restrictions, the APA required that panel members regularly file disclosures and placed limits on their financial connections to drug companies.
Each work group member was allowed to receive as much as $10,000 a year in income from pharmaceutical companies and hold as much as $50,000 in stock. Members could also receive unlimited amounts of money from pharmaceutical companies to conduct research.
Scully said that if no financial ties were permitted, many knowledgeable psychiatrists would be excluded because so many university studies are funded by pharmaceutical companies.
“We think we are on the right track,” Scully said in an interview. “If we need to make more changes, we’ll make them.”
But critics of such relationships, including officials at the Institute of Medicine, argue that such ties could put public health at risk and note that problems have appeared in other guidelines issued by medical groups relying on industry money and expertise.