Drug Study: Anti-Depressant Meds no Better than Sunshine, Exercise, Smiling a Lot
The Journal of American Medicine (JAMA) reports that some anti-depressants are no more effective than placebo pills, exercise or exposure to sunshine for patients who suffer from mild or moderate depression.
The latest study could settle a long-standing debate within the psychiatric community about drugs like Prozac, Paxil, Effexor and other so-called Selective Serotonin Reuptake Inhibitors (SSRIs). The results come after six large drug trials of 728 men and women, about half of them with severe depression and half with more moderate symptoms.
While the study does not imply that the drugs are worthless for anyone with moderate to serious depression, its conclusions provide one likely explanation for the sharp disagreement among experts about the drugs’ overall effectiveness.
Previous studies of SSRIs have painted a confusing picture. Industry-funded trials have generally found that the drugs sharply reduce symptoms. But other studies that were not as highly publicized showed no significant benefits compared with placebos.
Scientists have always suspected a strong link between levels of the chemical Serotonin in the human brain and fluctuations in mood. Data from previous trials on two types of drugs and finds that their effectiveness varies according to the severity of the depression being treated.
Previous analyses had found a similar pattern. But the JAMA study is the first to analyze responses from hundreds of people being treated for more moderate symptoms, as are most people who seek care.
“I think the study could dampen enthusiasm for antidepressant medications a bit, and that may be a good thing,” said Dr. Erick H. Turner, a psychiatrist at Oregon Health and Science University, in a recent interview with the New York Times. “People’s expectations for the drugs won’t be so high, and doctors won’t be surprised if they’re not curing every patient they see with medications.”
A team of researchers, including psychologists who favor Psychotherapy (or talk therapy) and doctors who consult widely with drug makers, performed the new analysis, using government grants.
Three of the trials were of Paxil, from GlaxoSmithKline and the other three were of imipramine, an older generic drug from the class known as tricyclics. The team, led by Jay C. Fournier and Robert J. DeRubeis of the University of Pennsylvania, found that compared with placebos, the drugs caused a much steeper reduction in symptoms of severe depression (cases scoring 25 or higher on a standard scale of depression severity, putting them in the top quarter of the sample). Patients with scores of less than 25 got little or no added benefit from the medications.
such findings may have an impact on whether or not health insurers cover these drugs in the future.
“We were able to give an overall estimate of effectiveness for the first time in this more moderate severity range, from 14 to 20 on the scale, in which there’s no question that doctors would likely consider prescribing medication,” Dr. DeRubeis tells the Times.
“The message for patients with mild to moderate depression,” Dr. DeRubeis said, “is, ‘Look, medications are always an option, but there’s little evidence that they add to other efforts to shake the depression — whether it’s exercise, seeing the doctor, reading about the disorder or going for psychotherapy.’ ”
The latest study could settle a long-standing debate within the psychiatric community about drugs like Prozac, Paxil, Effexor and other so-called Selective Serotonin Reuptake Inhibitors (SSRIs). The results come after six large drug trials of 728 men and women, about half of them with severe depression and half with more moderate symptoms.
While the study does not imply that the drugs are worthless for anyone with moderate to serious depression, its conclusions provide one likely explanation for the sharp disagreement among experts about the drugs’ overall effectiveness.
Previous studies of SSRIs have painted a confusing picture. Industry-funded trials have generally found that the drugs sharply reduce symptoms. But other studies that were not as highly publicized showed no significant benefits compared with placebos.
Scientists have always suspected a strong link between levels of the chemical Serotonin in the human brain and fluctuations in mood. Data from previous trials on two types of drugs and finds that their effectiveness varies according to the severity of the depression being treated.
Previous analyses had found a similar pattern. But the JAMA study is the first to analyze responses from hundreds of people being treated for more moderate symptoms, as are most people who seek care.
“I think the study could dampen enthusiasm for antidepressant medications a bit, and that may be a good thing,” said Dr. Erick H. Turner, a psychiatrist at Oregon Health and Science University, in a recent interview with the New York Times. “People’s expectations for the drugs won’t be so high, and doctors won’t be surprised if they’re not curing every patient they see with medications.”
A team of researchers, including psychologists who favor Psychotherapy (or talk therapy) and doctors who consult widely with drug makers, performed the new analysis, using government grants.
Three of the trials were of Paxil, from GlaxoSmithKline and the other three were of imipramine, an older generic drug from the class known as tricyclics. The team, led by Jay C. Fournier and Robert J. DeRubeis of the University of Pennsylvania, found that compared with placebos, the drugs caused a much steeper reduction in symptoms of severe depression (cases scoring 25 or higher on a standard scale of depression severity, putting them in the top quarter of the sample). Patients with scores of less than 25 got little or no added benefit from the medications.
such findings may have an impact on whether or not health insurers cover these drugs in the future.
“We were able to give an overall estimate of effectiveness for the first time in this more moderate severity range, from 14 to 20 on the scale, in which there’s no question that doctors would likely consider prescribing medication,” Dr. DeRubeis tells the Times.
“The message for patients with mild to moderate depression,” Dr. DeRubeis said, “is, ‘Look, medications are always an option, but there’s little evidence that they add to other efforts to shake the depression — whether it’s exercise, seeing the doctor, reading about the disorder or going for psychotherapy.’ ”
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