1. Our paper on lithium in drinking water and suicides in Switzerland was just accepted for publication. It is to our knowledge the first pre-registered study on this topic. We found a near perfect null-result. 2. Background: lithium is considered to be suicide protective in therapeutic doses and some are convinced it is THE drug in suicide prevention. However, with new evidence, appropriate statistical methods, and results for suic attempts, uncertainty remains

https://x.com/PloederlM/status/1625778975917199362

1. Beitrag zu Antidepressiva (AD) im geschätzten Kulturradio Ö1 mit einer sympathischen Moderatorin die selber Erfahrungen mit Depressionen und AD hat.
Neben vielen guten Infos sind aber leider einige falsche oder veraltete Infos dabei. Ein 🧵 später
oe1.orf.at/programm/20240… 2. "Psychologische" Absetzsymptome nach langer Einnahme. Falsch. Es gibt gute Hinweise dass problematische Entzugssymptome körperlicher Natur sind. Ja, man darf oder sogar soll dazu Entzugssymptome sagen.

1. Last year @NaudetFlorian and I pointed out severe problems in a review about lithium in drinking water and suicide. The problems are summarized in the thread below. So what happened afterwards?

https://twitter.com/NaudetFlorian/status/1672857939617382400

2. To recap the most severe error: the author correlated suicide-rates w lithium-levels in international studies (each dot is a study). But this was a mix of suic-RATES (per 100,000) and suic-rate-RATIOS standardized to 1 in some studies or to 100 in others. You can't mix this!

A. A long thread in response to @royperlis, Harvard professor of psychiatry, who recently suggested that SSRIs should be available over the counter, as they “have repeatedly been shown to be safe and effective for treating major depression and anxiety disorders” 1 B. In the following, I will examine some of his arguments, as they are either in contradiction to the evidence or give a biased, uncritical summary on the evidence. I was blocked after saying that the harm/benefit ratio is problematic for the majority. Refs are available online.

1/ Last year a study was published about escitalopram for GAD for children/adolescents, where it was concluded that ‘Escitalopram reduced anxiety symptoms and was well tolerated.’’. In our letter, we disagreed.

https://twitter.com/PloederlM/status/1678268123386970112

2/ mainly because only the primary outcome was just below the significance threshold, the effect size was likely not clinically meaningful, and there was a significantly higher risk for suicide ideation (not discussed at all in the paper) and adverse events with esc than placebo

1/ Escitalopram now approved for generalized anxiety disorders for children & adolescents. FDA considers it as safe and effective for this new indication, based on a recent RCT. Let's have a look at this trial ->

https://twitter.com/CarlatPsych/status/1678117061447278592

2/ In the RCT, Strawn et al. (2023) concluded that “Escitalopram reduced anxiety symptoms and was well tolerated”. But this conclusion is not supported by the data presented.
liebertpub.com/doi/full/10.10…

1/ The "15% additional responders with antidepressants compared to placebo" message, based on the very good patient-level meta-analysis from 2022 deserves clarification.
bmj.com/content/378/bm… 2/ In the analysis of >70,000 patients, the average drug-placebo difference was only 1.75 points on the Hamilton scale. Definitely not clinically significant. However, there is a deviation from the normal distribution, thus the average drug-placebo difference may be misleading

1/ This is one of the most depressing article I've encountered for a long time. I knew that publication practices in medicine are problematic, but I didn't know *how* bad it is. Perhaps more in a thread later.
Thanks @Liikennepsykol1 for the paper.

https://twitter.com/davidmenkes/status/1626798865553965057

@Liikennepsykol1 2/ Part of the game is the Journal impact factor. Not news. But I did not know that all this part of the game is to produce convenient research, meaning that papers should be citable - quality is secondary

1/ Lithium & suicide: there is some (fierce) discussion about the suicide preventive potential of lithium. Some say it is a fact that lithium prevents suicides. However, an unbiased look at the evidence reveals that there IS uncertainty which should be acknowledged. A thread. 2/ There are meta-analyses concluding that lithium significantly reduced suicides - this one is perhaps the one most often cited

No other psychopharmacological tx has such effects. This is what I also told again and again in my talks, too.bmj.com/content/346/bm…

1. There seem to be several issues with this new paper about lithium in tap water and suicide. Thanks for sending me a pdf >

https://twitter.com/PloederlM/status/1622662574222237697

2. Suicide rates were standardized. Austria had the lowest rate (0.8 / 100.000). This doesn't fit w other data. Austria is known to have > 10/100000 suicides.
Same discrepancy for Hungary. Study says England has ca 100/100000, but this can't be true, see data from WHO

1/ Our new paper about moon and suicide is out
nature.com/articles/s4138… 2/ Background: 2020, researchers reported an elevation of suicides in the area of Oulu, Finland. But only among younger women in winter. Surprisingly, it was not discussed that this might have been a false positive, given the wealth of data showing an overall null-finding.

1/ Today I lost my temper when discussing w someone believing that all measures to control the pandemic, including vaccination was BS. I asked if she also mistrusts any advice from docs in general. She told me she uses homeopathy instead of visiting a GP. Thats when I exploded. 2/ Yes, there are problems and biases with evidence based medicine (EBM) and also in mainstream media. But there IS self-correction here. IMO, our public media learned a lot from "fake news" and is more sensible to communicate uncertainties.

1/ The serotonin-depression umbrella review by @joannamoncrieff @markhoro @HengartnerMP and others was (of course) criticized by KOLs in the science medie centre and by others, for example, because one recent review was not included. I took a closer look at this "missing" review

https://twitter.com/pash22/status/1550329977874292736

2/ As explained by the Moncrieff et al., not including this review was for a reason: "A review of tryptophan levels was not missed by our review which specified inclusion criteria of studies which measured serotonin or its metabolites....
bmj.com/content/378/bm…

This paper about the chemical imbalance theory will certainly stir some discussions.
"Claims by leading psychiatrists that the theory was only an ‘urban legend’ are not supported."
sciencedirect.com/science/articl… 11 of the 30 top "papers unequivocally supported the serotonin hypothesis of depression, claiming there was ‘overwhelming evidence’ of serotonin deficiency in depression (Nemeroff, 2002) ... and that the theory is ‘corroborated’ and ‘well-established’ (Middlemiss et al., 2002)."

1/ Saturday morning pain #1: Came across this media report about a study from the Medical University Vienna, with a catchy title (translated "Antidepressants re-tune your brain for new experiences again". Perhaps more about this study. But first ->
meduniwien.ac.at/web/ueber-uns/… 2/ I wanted to check if there are really so many studies showing that SSRIs can facilitate learning and memory, as the study mentions the discussion section.
sciencedirect.com/science/articl…

1/ This study suggests that adding isolated elements of psychotherapies may actually be harmful.
I wonder what happened between the skills coaches and the patients....
jamanetwork.com/journals/jama/… 2/ "Skills coaches did not provide psychotherapy but sent EHR portal messages to reinforce each visit to the online program and encourage practice of specific skills as well as outreach messages to participants without recent visits"

1./ Nun hat der unabhängige "Arzneimittelbrief" kritisch über das neue österreichische "State of the Art" Konsensuspapier zur Behandlungsresistenten Depression berichtet
der-arzneimittelbrief.de/de/Aktuelle-Au… 2/ "Es zieht folgendes Fazit: "Ein aktuelles österreichisches Konsensus-Statement zur Behandlung der therapieresistenten Depression hat beträchtliche inhaltliche und formale Mängel. Die Autoren haben erhebliche Interessenskonflikte mit pharmazeutischen Unternehmern....

1/ Do antidepressants work for severe depression? Minimal important differences (MID) based on our 2021 paper dx.doi.org/10.1136/bmjebm… compared to results from patient level meta-analyses, one for the HDRS-17
researchgate.net/publication/33…
one for the HDRS-6
doi.org/10.1016/S2215-… 2/ Counterargument: antidepressants work for truly depressed patients who are not in clinial trials. Problem: there is hardly any evidence supporting this argument. Plus, guidelines recommend tx with antidepressants for severe depression based on the clinical trial results.

1. We now have received some criticism for our new meta-analysis of observational studies about antidepressants and suicide. One criticism is that observational studies may suffer from indication bias and residual confounding. We clearly address that in the limitation section.

https://twitter.com/JDaviesPhD/status/1371726678456594433

2. So, do limitations of observational studies justify that our study is "rubbish", as one psychiatrist says (guess who 🙄). This criticism then applies, more or less, to all studies we used for the meta-analysis. Some of these studies appeared in respected psychiatric journals.

1. David, do you know me or my motives? It seems you don't have any idea about the situaion I am in. I have no financial benefit from the research. Quite the contrary, it seems to actually harm my career. It upsets colleagues, bc results are at odds with the psychiatric practice.

https://twitter.com/Foreman1David/status/1372154231524892675

2. Salzburg is small and everybody knows everyone. So, being in conflict with psychiatrists in my area can be damaging for private practice (BTW, I do private practice only on a very small scale, since my full time job is at the psychiatric clinic).

1/ Our new paper about the minimal important difference (MID) of antidepressants (AD). Because there is a paywall, here the main findings in a thread.
ebm.bmj.com/content/early/… 2/ First of all, Michael was the one who did most of the work, so credit goes to him! We had great discussions and chats, and I learned so much from this collaboration. His overview on the literature is outstanding!