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Antidepressant drugs don't work –

[b:b7aed06e2c]By Jeremy Laurance, Health Editor

Tuesday, 26 February 2008 [/b:b7aed06e2c]

They are among the biggest-selling drugs of all time, the \"happiness pills\" that supposedly lift the moods of those who suffer depression and are taken by millions of people in the UK every year.

But one of the largest studies of modern antidepressant drugs has found that they have no clinically significant effect. In other words, they don't work.

The finding will send shock waves through the medical profession and patients and raises serious questions about the regulation of the multinational pharmaceutical industry, which was accused yesterday of withholding data on the drugs.

It also came as Alan Johnson, the Health Secretary, announced that 3,600 therapists are to be trained during the next three years to provide nationwide access through the GP service to \"talking treatments\" for depression, instead of drugs, in a £170m scheme. The popularity of the new generation of antidepressants, which include the best known brands Prozac and Seroxat, soared after they were launched in the late 1980s, heavily promoted by drug companies as safer and leading to fewer side-effects than the older tricyclic antidepressants.

The publication in 1994 of Listening to Prozac by Peter Kramer, in which he suggested anyone with too little \"joy juice\" might give themselves a dose of the \"mood brightener\" Prozac , lifted sales into the stratosphere.

In the UK, an estimated 3.5 million people take the drugs, collectively known as selective serotonin reuptake inhibitors (SSRIs), in any one year and 29 million prescriptions were issued in 2004. Prozac, the best known of the SSRIs made by Eli Lilly, was the world's fastest-selling drug until it was overtaken by Viagra.

In the study, researchers conducted a meta-analysis of all 47 clinical trials, published and unpublished, submitted to the Food and Drug Administration in the US, made in support of licensing applications for six of the best known antidepressant drugs, including Prozac, Seroxat – which is made by GlaxoSmithKline – and Efexor made by Wyeth. The results showed the drugs were effective only in a very small group of the most extremely depressed.

Two drugs were excluded from the study because of incomplete data. A third drug, chemical name nafazodone, has been withdrawn from the market because of side-effects.

Professor Irving Kirsch of the University of Hull, who led the study published in the online journal Public Library of Science (PLoS) Medicine , said the data submitted to the FDA would also have been submitted to the licensing authorities in Britain and Europe. It showed the drugs produced a \"very small\" improvement compared with placebo of two points on the 51-point Hamilton depression scale.

That was sufficient to grant the drugs a licence but did not meet the minimum three-point difference required by the National Institute for Clinical Excellence (Nice) to establish \"clinical\" significance. Yet Nice approved the drugs for use on the NHS in the UK because it only had access to the published trials, which showed a larger effect.

Professor Kirsch said: \"Given these results, there seems to be little reason to prescribe antidepressant medication to any but the most severely depressed patients, unless alternative treatments have failed to provide a benefit. This study raises serious issues that need to be addressed surrounding drug licensing and how drug trial data is reported.\"

Five years ago, there were allegations that antidepressant drugs were addictive and could trigger suicides. All but Prozac were banned for children, although a major investigation on the safety of medicines cleared them of causing suicide in adults.

Alternative treatments for depression, such as counselling or physical exercise , should be tried first, Professor Kirsch said. The pharmaceutical companies had withheld data that was available to the licensing authorities so that doctors and patients did not understand the true efficacy, or lack of it, of the drugs.

\"This has been the frustration. It has made it very difficult to answer the question of whether the drugs work. The pharmaceutical companies should be obliged when they get a drug licensed to make all the data available to the public. When you analyse all the trials of these SSRIs, both published and unpublished, it leads you to more sober conclusions,\" he said.

Tim Kendall, deputy director of the Royal College of Psychiatrists' research unit, said the findings, if proved true, would not be surprising. As head of the National Collaborating Centre for Nice guidelines on mental health, he said it had proved impossible to get access to unpublished trials in the past.

\"The companies have this data but they will not release it. When we were drawing up the guidelines on prescribing antidepressants to children [in 2004] we wrote to all the companies asking for it but they said no. The Government pledged in its manifesto to compel the drug companies to give access to their data but that commitment has not been met.\"

The new finding would make doctors \"much more cautious about prescribing the drugs,\" Mr Kendall added.

GlaxoSmithKline, makers of Seroxat, said the authors of the study had \"failed to acknowledge\" the very positive benefits of SSRIs and their conclusions were \"at odds with the very positive benefits seen in actual clinical practice.\" A spokesperson added: \"This one study should not be used to cause unnecessary alarm for patients.

Lilly said in a statement: \"Extensive scientific and medical experience has demonstrated that fluoxetine [Prozac] is an effective antidepressant.

Wyeth said: \"We recognise the need for both pharmacological and non-pharmacological treatments for depression.\"

On the new training for therapists, Mr Johnson said the programme signalled a decisive shift away from drugs in favour of non-drug treatments for depression. \"We are not taking the decision away from clinicians,\" he said.

\"For many, medication is successful. But talking therapies can have dramatic effects. We have put a lot of emphasis on medication in the past and it is about time we redressed the balance and put more emphasis on talking treatments.\"

The treatments that do work

* Exercise: Helps some people with depression. Douglas Adams, author of The Hitchhiker's Guide to the Galaxy, said running helped him cope with depression.

* Friends: Talking through your feelings can help in mild depression with a friend or relative or in a self-help group.

* Cognitive behavioural therapy: Teaches you to challenge negative thoughts and feelings of hopelessness.

* Interpersonal therapy: Focuses on relationships and problems such as difficulties with communication.

* Counselling: Helps you think about the problems in your life and find new ways of dealing with them.

* Antidepressants: Increasingly seen as a second-line treatment, if exercise or talking treatments do not work.

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14 Replies

  • Posted

    Okay, Melbi< (yawn!) that made me tired.....heres what I think....

    A) Jeremy Laurence, (or whoever wrote the article) is a bit (duh!)...would you not agree? But I was under the impression that this pill was to help alleviate irritable moods, (ie) lows and high, I was not led to believe that the prescribing of such drugs were to provide us all with [b:f37c2e578e]\"Happiness\".More that they are given out to patients who feel they are sunk and sinking further...and basically cannot cope!

    B), \"Talking Treatments\"....oh what a wonderful idea, [/b:f37c2e578e] is this writer living on cloud 9? Great if you can get the right access and correct treatment, which would mean the correct diagnosis!!! (you are stretched over an array of the discourse of disorders,- assumed to exist on the dsm-IV scale.)

    C) Professor Kirsch can just go and take a long walk off a very short and slippery pier!

    D) Physical exercise ...well yes(Obviously it would help! ). It would also help if Icould see so that I could stop falling over and bumping myself!

    E) CBT, friends, oh god dont let me waffle on about interpersonal therapy....Ironically my thesis was on this ( pile of p*ss!) ....Counselling Yep...alll good things and should be encouraged in treating patients with stress/anxiety /depressive disorders! (Duh!!!!) :P :P :P :P :P

    [b:f37c2e578e]SORRY!!!but I am having a very cheeky day...idont know if you will be ablt to understand my waffle....

    I saw a dog drowling reminded me of a date I went on with a soap dodger...and a Mcdonalds....YUCk! :lol: :lol: :oops: :lol: :roll: [/b:f37c2e578e]

  • Posted

    Hi Melbi + Tiny Tears

    I'm not sure that it is a good idea to create panic in people who are already suffering. Studies of this kind can only be of any real use if all data is available. As access to as yet unpublished data is denied how can this be a true study?

    Personally I shall continue with my medication as I do feel better with it (most of the time anyway) and I think others should do the same. The worry of this report is that some may stop taking their medication without their Drs knowledge or following a reduction programme.

    I do think though that other treatments such as counselling / therapy etc should not be ignored but it's not easy to get this help. In my area there was until very recently a long waiting list to see a counsellor. I was refered for counselling in October 2007 + got my first appointment 11 February 2008, which was a cancellation so they slot me in so to speak, but for many this is just too long to wait. I think peopke sholud do what they feel is right for them, follow their Drs advice and sod the media.

    Best wishes Nicky Jane x

  • Posted

    My worries too! How many will come off their medication bruptly? This could cause some very nasty and unwanted side effects. I stopped taking mine years ago because I felt better - big mistake - I plummeted like a rocket falling from the sky which resulted in me taking an overdose.

    Although the last couple of days I have been feeling extremely low I do feel the tablets are working. Does that sound silly lol.

    Now what about these side effects from citalopram - the 'imagine something is happening that isn't' one.

    Not able to sleep last night (nothinbg new there) I lay in bed looking at the digital clock as the red light was making me feel sleepy (strange woman that I am) when all of a sudden the whole house shook! Light on ceiling swinging, mirror (large one) swaying side to side. Bed shook.

    I thought wow I know they said one of the side effects is this imagining something is happening that really isnt but I didn't expect it to feel so real!!!

    Thank goodness I read the news this morning lol.

    Anyone else feel the earthquake?

    Melbi x

  • Posted

    Thanks for that Lin.

    I'm wondering what my doctor will say on Friday about it all.

    Melbi x

  • Posted

    Hi again Melbi

    Sorry your having a few low days, hang on in there, at least your getting your sense of humor back..... even us lot couldn't whip up an imaginary earthquake lol

    We all felt it too, house shaking, loud noise etc the whole household was up & out of bed at 1.oo am we're not too far from the epicentre so it was quite an experience, all the neighbours lights were on and some out in the street in boxer shorts (not a pretty sight)!!! not too much damage locally though.


    Thanks Lin for the info - will check it out.

    Best wishes Nicky Jane x

  • Posted

    Hi Nicky Jane

    I even phoned by fella after it happened and asked if he had felt it. He told me to go to sleep and it was probably just the tablets!

    Imagine his shock and surprise when he turned his TV on this morning and saw it on the news!

    Well - here goes - off out shopping now - wonder if I see anything or feel anything unsual while out on my travels lol.

    Sheesh - I'm only on 10 mg goodness knows what will happen if doctor increases the dose on Friday.

    Still feeling relieved that the earthquake really did happen - although my fella is quite disappointed that he wasn't present when the earth moved for me and he missed it! :roll:

    Melbi x

    Don't know why but my mood has just gone from 0 (crap) to 10 (feeling pretty good)

    Stranger things have happened at sea? Who are they trying to kid?

    Have a good day all.

    Melbi x

  • Posted

    [b:6c91723f06]Gosh a write on and on...rubbish!!!

    Anyway, I think that article about antids should have been banned from being published.......who knows, most people cant do statistics , add up and then quantify the information on that basis!!!! Can they :?: :?: :?:

    PROPOGANDA,,,, a little piece of information, to fill out some time on there news updates.....well, thats what i think!!!

    :roll: Melbi....whats this about an aerthquake.?..youve not been in one have you :?: :?: :?: :?: :?:

    Sorry, I am soooo spaced out...........returned from victim, support........I realised that as I sat there and cried, there is not really anything I can do with does not matter who I talk to ...the thoughts are still there :shock: So after speaking to a really nice woman, I walk home with the effing tears rolling down my face and the body tension...I manage to calm down outside my local Scotmid, think9ng......CHOCOLATE....I NEED CHOCOLATE!!!!!! sO HERE i AM SITTING IN FRONT OF MY COMPUTER, YEP, HAVING A BAR OF CHOCOLATE!!! yUM yUM smile [/b:6c91723f06]

  • Posted

    [b:3a02c438b8]WHAT PLANET EARTH....NO. [/b:3a02c438b8]Maybe Jupiter
  • Posted

    You missed the earthquake? Katy! :roll:

    I'm sitting here now undecided - do I not bother trying to sleep and keep myself entertained all night or do I try and go to sleep - if I don't fall asleep I have to go through all the stress and anguish and anger for not getting to sleep.

    If I don't try, I won't know!

    Decisions, decisions :shock:

  • Posted

    Hey Melbi............dont fight the insomnia............I say just enjoy it......take advantage of it!! Sometimes i get up and clean the (well)my manky kitchen!!!!!!!

    i think the worst thing you can do is fight the insomnia...if you feel tired during the day.try and put your head down and get a wee nap..20 mins can just give you a small respite.....dont fight it soo hard(well, thats what I have concluded over the last god knows how many months!!!!!). take care, luv Tiny tears,,, you could type to me, if yu feel like it........I really do not mind! smile

  • Posted

    After 5 solid hours of sleep I feel so groggy. I just dont want to come round lol feeling so relaxed at the moment.

    Rubbed more Tiger balm into neck, back and shoulders this morning and it has eased the pain.

    Definitely recommend it for those tense aching muscles.

    Melbi x

  • Posted

    Melbi, 5 hours...not soo bad!!!!! I had about 3....but hey thats not that bad either!!!!!

    [b:ede5af3f38]I spoke to my sister last night. She was soo understanding, I am amazed!!!! :shock: :shock: :shock:

    :roll: Feeling a bit better today......though cant think cearly about my children are just soooo lovely.......whatever I decide to do.............its so infair on them!!! Will I always be seen a s th enemy????

    God........I think that neighbour must drive his car on 2nd hand veggie fat, (probably :thief: taken from school or somethin!!!) :lol: :lol: Quite cool 8) 8) if you think about it :lol: :lol: :lol:

    Man trying to fix my kitchen handle , said, \"You do not do enough drugs......thats why you cant get a job round here\" :lol: :lol: . Followed by \"Nice Flat\" [b]Must have needed his eyes examined... :lol: :lol: Bless him!!!! Oh and ...the kitchen handles break as my children keep swinging from them, he says.....\"Were you never a child?\"....Hmmmmmm....(yep....[/b:ede5af3f38]AND i STILL THINK I AM ONE) :lol: :lol:

    Pregnant friend (bumps) :lol: :lol: into me :lol: (sorry she really is a nice lovely friend)...and asks...\"how are you?\" :blackcat: My reply.... :bleep: She says\"You sound like tarzan today\" :lol:

    Okay...I am in tooo goood a mood....come on...whens it going to happen????? I must be on my big fat cat is looking at me like, [b:ede5af3f38]Shes pure mad!!!!! :lol: :lol: [/b:ede5af3f38]


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