I don’t know what health news stories were circulating in other parts of the globe, but here in the UK we have not been able to move for the ‘revelation’ that, for the majority of people who take them, popular antidepressants work no better than placebo.

This story was spawned from the results of a newly published study which assessed the results of trials of four antidepressants including those of the SSRI (selective serotonin reuptake inhibitor) type, such as paroxetine (Seroxat) and fluoxetine (Prozac) [1]. What was interesting about this study is that it mixed up the results of not just published studies, but unpublished research too.

The reason that this is relevant is that the pharmaceutical industry is well known to engage in a spot of ‘publication bias’ when it suits it. This practice, essentially of publishing favourable results while ‘burying’ less useful data, can give doctors and their patients a very skewed impression of the effectiveness of a treatment. Putting published and unpublished (well, at least the stuff we can get our hands on…) together will inevitably give a more accurate guide to whether a treatment works or not.

In this case, the mix of published and unpublished data showed that antidepressants appear not to work any better than placebo for all but the most severely depressed. Seeing as the great majority of people who take antidepressants do not fall into the ‘severely depressed’ category, the results of this study suggest that, in the main, they’d be just as well off with a sugar pill as they are with their expensive and potentially toxic antidepressant.

While listening to the radio yesterday, I heard more than one commentator express concern about these results and what they mean, but at the same time warning people not to come off their meds. Go and ‘talk it through with your GP’ was the message. One might imagine that there’s going to be a fair few uncomfortable consultations going on over the next week or two as a result of these study results and the advice that antidepressant takers should chat it over with their doctor.

I suspect a fair few people are going to feel aggrieved at having taken antidepressants that have been licensed despite the fact that the data does not support this. But that’s only half the problem: if someone decides that they want to stop these drugs they may find they’re in for a hard time. The reality is that abrupt cessation (and even gradual weaning) from antidepressant drugs can give rise to quite debilitating ‘withdrawal’ symptoms including dizziness, anxiety, sleep disruption and mood swings.

So, not only may people have unwittingly been taking a drug which, generally speaking, is no better than placebo, but they may find getting off this drug quite difficult.

I am no expert on getting off antidepressants, but I can say from experience that individuals wanting to take this course generally need to wean off g-r-a-d-u-a-l-l-y over a few weeks or months and maybe even a year or so. This is generally best done in conjunction with a supportive doctor.

While this most recent study made big headlines yesterday, the fact is there’s nothing ‘new’ in this story really. As recently as January, a study was published that showed quite clearly that many ‘negative’ antidepressant studies are not published.
Some are calling for the publication of studies on antidepressants to be mandatory. I support this, but suggest it should be extended to all drugs, period.

And here’s another thing I’d like to see: drug companies acting responsibly by sponsoring educational programmes for doctors, the purpose of which is not to get them writing more prescriptions for antidepressants, but less. And how about them including in these programmes information on how best doctors can support their patients wishing to get off these drugs, particularly those suffering from withdrawal.

I have a feeling this isn’t going to happen anytime soon, as such events would be tacit admission of a problem that has been caused, at least in part, by the failure of drugs companies to freely and willingly disclose all their data. I have a feeling that drug companies may be forced to dig deep anyway: it’s not too difficult to imagine that some individuals will feel that some compensation is due, even if they have to go through the courts to get it.

References:

Kirsch I, et al. Initial severity and antidepressant benefits: a meta-analysis of data submitted to the food and drug administration. PLoS medicine. 2008:5(2):e45

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