Does a "Poisonous Fog" Hang Over Clinical Trials for Anti-Depressants?

When we think of the movies, we don’t instantly think of clinical trials, but a new psychological thriller may well change that by focusing the spotlight on big pharma and anti-depressants.

The Steven Soderbergh film, Side-Effects, poses more questions than it answers. It depicts one of the main characters, Dr. Jonathan Banks (played by Jude Law), as a caring but overambitious psychiatrist who has moved ‘across the pond’ from the U.K. “because Americans have a healthier attitude towards mental illness.” Although the impression the viewer gets is that the only thing healthier about it all will be Dr Banks’ wallet at the end.

The film raises many important issues regarding the complex relationships that the pharmaceutical industry has with prescribing psychiatrists, as well as ethical clinical trials and academic credibility. Significantly, it also poses the question whether psychiatrists can indeed be duped by their patients, who (for reasons best known to themselves) may display characteristic traits (classic side-effects) of anti-depressant medication, despite their non-compliance. It’s an interesting angle to consider, especially if the said behavior is implicated in any antisocial, criminal or harmful circumstances warranting intervention by courts of law.

The hapless Banks soon realizes that not only has he been duped by his patient but also by his colleague Dr. Victoria Siebert (Welsh-born Catherine Zeta-Jones), who, as author of a less than meticulous piece of research into the (fictional) new wonder drug ‘Ablixa’ has financially benefited from insider trading. So everyone is happy… or so it seems. Banks gets rich, the patient (Emily) gets fixed and Siebert makes a name for herself. That is until in a moment of absolute sanity - yes, you read it correctly sanity - Emily (the patient) acts crazily and gets away with it on the grounds of Not Guilty by Reason of Insanity (due to ‘taking’ Ablixa).

A memorable quote in the film relates to the question of culpable guilt….Did the person do it? Are they guilty? Banks replies, “In this case, those are two very different things”.

We all know that being prescribed a drug does not confer automatic compliance and it could be said that the patients for whom anti-depressants are prescribed are the ones who are most likely not to take them. The ‘poisonous fog’ of depression descends upon patients, clouding judgment and stealing their motivation to commit to the most simple of daily tasks such as medication compliance. It is the responsibility of those involved in clinical research to ensure that such cases like ‘Ablixa’ never become reality.

The film leaves us feeling uncomfortable and wondering whether we should be more afraid of depressed patients who are not taking their medication or those who are.