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Back to Psychiatry Articles
 Article
author: Dr. K. Eisele, B.S., M.D. Psychiatrist.
USA.
Wednesday 27th February, 2008
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Use of serotonin reuptake inhibitors (SSRI) may be no more
effective than placebo; Dr. K. Eisele points to several
weaknesses in the study. |
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This article is in response to an announcement by
researchers quoted in many UK publications this week,
stating that the class of anti-depressants known as SSRIs
(selective serotonin reuptake inhibitors) and SNRIs
(serotonin-norepinephrine reuptake inhibitors) are no more
effective than placebos. I looked at the NHS (National
Health Services) website to get more information about this
new research, and found that this was a systematic review of
studies previously done on these medicines. It was not a
randomized controlled trial (RCT) in and of itself, which is
the “gold standard” for scientific research; it was,
basically, a book report.
The specific medications included in this review of the
literature are: fluoxetine, venlafaxine, nefa-zodone, paroxetine,
sertraline, and citalopram. However, of the 47 RCTs supplied by the
FDA, the results of only 35 were included in the review. FDA data on
fluoxetine, venlafaxine, nefazodone, and paroxetine was used. Data
on the other anti-depressants came from post-FDA-approval studies.
The review found that “antidepressants improved symptoms more than
placebo, and this difference was statistically significant.” The
rest of the story resulting in the announcement that these medicines
don’t work comes down to the researchers’ own interpretations. For
example, anti-depressants were more effective for more severely
depressed patients, but the researchers report that the more
seriously depressed patients did not respond as well to placebo as
those with milder depression. This is one way to look at it, but one
could also conclude that those test subjects with severe depression
were possibly those who would show neurochemical depression if such
a test existed.
On the NHS website,
click here, the strengths and limitations of the study are
pointed out. They range from only drug-company data was reviewed, to
the researchers had to use estimates because some of the figures
were missing. Perhaps the biggest limitation is that symptoms of
depression are highly individualized and the review only takes into
account symptoms that are measured by one scale. This implies that
only one type of depression is really being measured, and from the
results of the report, it seems that those with the most severe of
symptoms are the true test subjects since these individuals had the
best response to anti-depressant therapy.
All this begs the question, I think, about the effectiveness of
anti-depressants on those with mild depression. In modern psychiatry
residency programs, it is widely preached that without a serious
impairment to a prospective patient’s ability to function, there can
be no diagnosis. And, if there is no diagnosis, there is hardly a
reason for medication. In addition, according to evidence-based
medicine, which is the standard of care, the best treatment for
depression is medication in combination with psychotherapy.
The NHS also emphasizes that “the assessment of severity [of
one’s depression] is a skilled task and an individual’s response to
treatment may vary.” The NHS is not in favor of anyone stopping
their anti-depressant medication without first speaking to their
physician.
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