Depression drugs don’t work, finds data review

[Sash]

Millions of people taking commonly prescribed antidepressants such as Prozac and Seroxat might as well be taking a placebo, according to the first study to include unpublished evidence.

The new generation of antidepressant drugs work no better than a placebo for the majority of patients with mild or even severe depression, comprehensive research of clinical trials has found.

The researchers said that the drug was more effective than a placebo in severely depressed patients but that this was because of a decreased placebo effect.

The study, described as “fantastically important” by British experts, comes as the Government publishes plans to help people to manage depression without popping pills.

More than £291 million was spent on antidepressants in 2006, including nearly £120 million on SSRIs. As many as one in five people suffers depression at some point. With that in mind, ministers will today publish plans to train 3,600 therapists to treat depression. Spending on counselling and other psychological therapies will rise to at least £30 million a year.

The study, by Irving Kirsch, from the Department of Psychology at the University of Hull, is the first to examine both published and unpublished evidence of the effectiveness of selective serotonin reuptake inhibitors (SSRIs), which account for 16 million NHS prescriptions a year. It suggests that the effectiveness of the drugs may have been exaggerated in the past by drugs companies cherry-picking the best results for publication.

The National Institute for Health and Clinical Excellence (NICE), which is due to review its guidance on treating depression, said that it would consider the study.

Mental health charities say that most GPs admit that they are still overprescribing SSRIs, which are considered as effective as older drugs but with fewer side-effects. SSRIs account for more than half of all antidrepressant prescriptions, despite guidelines from NICE in 2004 that they should not be used as a first-stop remedy.

American and British experts led by Professor Kirsch examined the clinical trials submitted to gain licences for four commonly used SSRIs, including fluoxetine (better known as Prozac), venlafaxine (Efexor) and paroxetine (Seroxat).

The study is published today in the journal PLoS (Public Library of Science) Medicine. Analysing both the unpublished and published data from the trials, the team found little evidence that the drugs were much better than a placebo.

“Given these results there seems little reason to prescribe antide-pressant medication to any but the most severely depressed patients, unless alternative treatments have failed,” Professor Kirsch said. “The difference in improvement between patients taking placebos and patients taking antidepressants is not very great. This means that depressed people can improve without chemical treatments.” He added that the study “raises serious issues that need to be addressed surrounding drug licensing and how drug trial data is reported”.

The data for all 47 clinical trials for the drugs were released by the US Food and Drug Administration under freedom of information rules. They included unpublished trials that were not made available to NICE when it recommended the drugs for use on the NHS. “Had NICE seen all the relevant unpublished studies, it might have come to a different conclusion,” Professor Kirsch said.

Tim Kendall, a deputy director of the Royal College of Psychiatrists Research Unit, who helped to formulate the NICE guidance, said that the findings were “fantastically important” and that it was “dangerous” for drug companies not to have to publish their full data. He added: “Three of these drugs are some of the most commonly used antidepressants in this country. It’s not mandatory for drug companies to publish all this research. I think it should be.”

SSRIs are not prescribed to patients under 18 because of the risk of suicide.Drugs watchdogs in Europe are considering tighter controls on the development of new medicines, The Times reported this month, and may soon require regulators to monitor psychiatric effects and the risk of suicide more closely during clinical trials.

A spokesman for GlaxoSmithKline, which makes Seroxat, said: “The authors have failed to acknowledge the very positive benefits these treatments have provided to patients and their families dealing with depression and their conclusions are at odds with what has been seen in actual clinical practice. This one study should not be used to cause unnecessary alarm and concern for patients.”

A spokesman for Eli Lilly, which makes Prozac, said: “Extensive scientific and medical experience has demonstrated that fluoxetine is an effective antidepressant.”


Depression drugs don’t work, finds data review - Times Online

[Ferrari]

If yuor deprest & taking thoes drugs then that imfomasions going to make yuo mor deprest

[meow]

why dont they just give them plecebos if plecebos are as effective ?

[meow]

Ive been doing some research in related fields and in fact this is misleading.

there are now what are called double blind cross over trials, where people are tried on two diferent drugs, one after the other, the finding suggest that for various types of drugs, not just antidepresants, each drug maybe barely significantly better than a plecebo when compared 1:1 but when there is a choice of several drugs, each slightly better than a plecebo, the chance of one or the other of them working is about double, where as for the placebo it remains about the same.

this is quite a step forward in the way we eveluate drugs against plecebos, and shows up real effectiveness, for some catagories of drugs, the statistical probability rises to very nearly 90% success rate.

whats more interesting is new areas of research that aim to home in on why one drug works for one group of patients and not others, and again, in many areas, careffull examination of detailed symptoms reveals patterns that predict much better wich drug is more aproriate.

actually i say new, this has been going on since 2000, but is a long process, and is finaly coming into diagnostic manuals for psychiatric diseases in america in 2009. this means the Uk will put them into practice in about 20029.

[teflon]

Originally Posted by meow

each drug maybe barely significantly better than a plecebo when compared 1:1 but when there is a choice of several drugs, each slightly better than a plecebo, the chance of one or the other of them working is about double, where as for the placebo it remains about the same.

[meow]

Originally Posted by teflon

sorry gues i not explained it too well, ....

say for depresion a plecebo works for 15% of people, and 2 diferent drugs each work for 20%, this is quite low statisticaly.

however if one drug doesnt work there is a chance that the other drug will.
the chance of success when using wichever drug works might rise to 30% or even more wich is now way better statisticaly than plecebo.

this is what double blind cross over trials do.

[Puratech]

Are the drugs likely to be very different chemically?

Like you have 10 drugs, which each only work on say 15% of depressed peoples, but theyre not linked so like theres a fairly good chance if you try all 10, most people will find 1 or 2 that work. Individually though because the success rate is so low that by comparison a placebo may appear to work for say 5-10% of people making the drug not seem very effective.

[meow]

yeah thats basically it exactly.

even drugs whose active ingredients are suposedly chemicaly identical but have slightly diferent delivery mechanisms such as sustained release, can actually vary greatly.

many of the drugs have the exact same intended mode of action, however they are chemically diferent,
particularly SSRI s. I think antidepressants is the one area where there is by far the most different types available.

many of the drugs are listed as having an unknown mode of action !!!

unfortunatly some of the antipsycotic drugs have a very low success rate still.
but in the cases where they do work the results are such that its realy noticable.
clearly comparing to a plecebo doesnt give a true picture, as like i said before the good old plecebo does somehow give such an incredible performance lolz.
part of the reason for the low suces rate compared to plecebo is poor diagnostic criterea, ie theres no test to indicate wich drug wil work. this would improve if it was posible to identify more clearly wich cases responded to the drugs available however the brain is the most complicated device around, and psycotic illness is the most difficult area, partly becuase the patients themselves are unable to realy understand whats going on and so evaluation is difficult. maybe also becuase they are unable to make a fuss or atract so much attention, or people just think they arnt worth bothering with.

[teflon]

I wonder if the placebo effect could be used on athletes at the Olympics. We could tell the British runners that they were getting a super-dooper, high-tech, undetectable steroid and maybe they would actually run faster.

[meow]

Originally Posted by teflon

I wonder if the placebo effect could be used on athletes at the Olympics. We could tell the British runners that they were getting a super-dooper, high-tech, undetectable steroid and maybe they would actually run faster.

yep, you would be surprised, something like that is highly suceptable to confidence, and anything that boosts confidence can have effect on your whole body, as the brain controls motivation and has a big effect on hormones wich is obvioulsy critical.

one test they did with headache pills :- they told one group they were geting the best pills available, (but they were in fact sugar pills), the second group they were given pretty good painkillers but were told they wer just geting plecebos. the first group had far better releif from headache !! yet in double blind trials the painkiller is still one of the most effective.

but it only works if you can fool them properly. if you tell someone a sugar pill is a plecebo it probably doesnt help, although ive not sure if this has even been tested.

however they may start drug testing for plecebos.