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wvgirl
 Posted:
Mon Feb 25, 2008 7:39 pm |
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WorldCloseStudy casts doubt on anti-depressants
Financial Times FT.com
By Salamander Davoudi
Published: February 25 2008 19:25 | Last updated: February 25 2008 19:25
Prescribing anti-depressants to the vast majority of patients is futile, as the drugs have little or no impact at all, according to researchers.
Almost 50 clinical trials were reviewed by psychologists from the University of Hull who found that new-generation anti-depressants worked no better than a placebo – a dummy pill – for mildly depressed patients.
Even the trials that suggested some clinical benefit for the most severely depressed patients did not produce convincing evidence. Professor Irving Kirsch from the university’s pyschology department said: “The difference in improvement between patients taking placebos and patients taking anti-depressants is not very great.
“This means that depressed people can improve without chemical treatments. Given these results, there seems little reason to prescribe anti-depressant medication to any but the most severely depressed patients.”
The researchers focused on four widely prescribed anti-depressants and the clinical trials that were submitted to win licensing approval from the US Food and Drug Administration.
The drugs included fluoxetine (Prozac), venlafaxine (Efexor), and Paroxetine (Seroxat).
All belong to a family of drugs known as Selective Serotonin Reuptake Inhibitors (SSRIs). These drugs have become popular over the past 15 years as doctors consider them to be safer than tricyclic drugs that carried a high risk of overdose. In 2006, 31m prescriptions for anti-depressants were issued in England, up 27 per cent since 2001.
Alison Cobb, policy officer at mental health charity Mind, said: “This study represents a serious challenge to the predominance of pharmacological treatments for depression. Anti-depressants have been shown to help many people, but by no means all.”
“Too many GPs are being forced to dish out drugs because they don’t have proper access to psychological therapies services which are recommended by Nice.”
Mind is urging GPs to consider alternative therapies such as exercise – particularly outdoor exercise – which it believes has shown to be very effective in combating depression.
However, Dr Gary Bell, consultant psychiatrist at Capio Nightingale Hospitals, the provider of private psychiatry treatment, contested the conclusions of the Hull research. “Anti-depressants are one of the great breakthroughs in the treatment of depression in last 20 to 30 years,” he said.
“They do not always suit everybody but the results are often life-saving. People who do studies do not have the hands-on experience of using these medicines.”
According to the Royal College of Psychiatrists, at least one person in five will suffer from a depressive illness at some point.
Copyright The Financial Times Limited 2008
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© Copyright The Financial Times Ltd 2008.
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| wvgirl
Posted:
Mon Feb 25, 2008 10:17 pm |
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From The TimesFebruary 26, 2008
Depression drugs don’t work, finds data review
David Rose
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.”
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© Copyright 2008 Times Newspapers Ltd.
http://www.timesonline.co.uk/tol/life_and_style/health/article3434486.ece
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| wvgirl
Posted:
Mon Feb 25, 2008 10:19 pm |
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From The TimesFebruary 26, 2008
Why it is often better to prescribe conversation than antidepressant pills
Analysis: Martyn Lobley
Treating depression with drugs may not be new, but many doctors feel that patients expect to receive a packet of pills for their depression or anxiety as a matter of course.
Both GPs and the public have taken it on trust that SSRIs — a new generation of antidepressants hailed as just as good as older drugs, but without side-effects such as dry mouth, blurred vision and constipation — are going to be effective.
We have taken it on trust that a person who takes an SSRI, such as Prozac, and gets better has done so because of the drug. Patients who do not respond after four to six weeks of treatment either have their dose increased or are switched to an alternative SSRI with the expectation that they will not have to endure side-effects. But it seems that this absence of side-effects may mirror a similar lack of benefits for most patients.
This crucial finding has only come to light because a meta-analysis — combining the results of several smaller studies and analysing them as a whole — published today includes unpublished clinical trials. This research has seldom seen the light of day because of “publication bias” — if a drug company sponsors a trial that shows that their drug is no better than current medication or placebo — then the results are far less likely to appear in literature.
“Defeat depression” was a campaign in the 1990s that became a turning point for the uptake in SSRIs. It was backed by the Royal College of Psychiatrists and was designed to raise awareness among GPs and the public.
It aimed to encourage patients to admit to symptoms that might indicate an underlying depressive illness, even when they were presenting mainly with physical symptoms.
GPs were instructed to take such symptoms seriously, but many doctors felt that the campaign’s hidden agenda was to encourage more frequent SSRI prescribing. In 2008 there may be more suitable treatments available, such as cognitive behavioural therapy (CBT), where the focus is on “talking rather than taking”. However, the funding has not been forthcoming for CBT — the waiting lists are unacceptably long — and as a result many patients receive a prescription for an antidepressant. This is often simply to tide them over until they are seen in an appropriate setting. The irony is that patients then sometimes find it hard to stop their SSRIs, which in any case should not be stopped suddenly because this can induce withdrawal symptoms.
In the same way that I would order a panel of blood tests or scans to get to the bottom of a physical symptom, I often ask patients to complete a standardised mental health questionnaire (the hospital anxiety and depression scale, or HAD for short) before advising which course of action is most likely to help them.
The HAD scale is valuable in that it differentiates between patients whose symptoms primarily reflect anxiety, who in the main do not need drug treatment, and those whose symptoms are mainly depressive. It also quantifies the severity of the patient’s symptoms. Those whose scores indicate only a mild or moderately severe depression are usually best advised to avoid prescription drugs, though they might wish to try an over-the-counter product such as St John’s wort (hypericum).
Those whose symptoms suggest a moderately severe depression might be encouraged to undergo a course of CBT in an effort to relieve their symptoms. It is essential that GPs take patients who present with symptoms of anxiety and depression seriously but this does not necessarily require the prescription of an antidepressant drug. As today’s evidence underlines, such a prescription may, for some patients, not be worth the paper it’s written on.
Dr Martyn Lobley is a GP in southeast London
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© Copyright 2008 Times Newspapers Ltd.
http://www.timesonline.co.uk/tol/life_and_style/health/article3434492.ece
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| wvgirl
Posted:
Mon Feb 25, 2008 10:21 pm |
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From The TimesFebruary 26, 2008
Drug efficacy could be all in the genes
Mark Henderson, Science Editor
also suggest a possible reason for the mixed research evidence for the effectiveness of selective serotonin reuptake inhibitors (SSRIs), which include Prozac and Seroxat. SSRIs account for most of the 31 million antidepressant prescriptions in Britain each year. The drugs, however, remain stubbornly ineffective for many people. Research has shown that they are only slightly more effective than inert sugar pills across the population as a whole, and many of their benefits are thought to derive from the placebo effect.
There is also growing concern that some SSRIs may be linked to an increased risk of suicidal thoughts, particularly among adolescents.
The research, led by Roy Perlis, of Massachusetts General Hospital, Boston, suggests that individuals’ genetic profiles may at least in part influence the different effects that the drugs have on different patients. The findings could indicate that the variable picture of effectiveness occurs because only some people are genetically amenable to SSRIs.
The small benefit of the drug over a placebo, seen in many trials, could be the result of a masking effect caused by the inclusion of patients whose genes make them immune to SSRIs. The lack of effect on these patients may be obscuring a much greater benefit among those who are able to respond to the drugs.
In the longer term, further findings about the genes that govern people’s response to SSRIs could lead to tests that can determine whether they are likely to work for particular patients.
Those whose genes mean that the drugs will probably be ineffective could then avoid taking medication from which they will not benefit, yet which can have side-effects including impotence, loss of libido, nausea and, in rare cases, suicidal thoughts.
The study is published in the journal Neuropsychopharmacology.
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© Copyright 2008 Times Newspapers Ltd.
http://www.timesonline.co.uk/tol/life_and_style/health/article3434491.ece
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Joined: 23 Mar 2006
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Location: Almost Heaven
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| wvgirl
Posted:
Wed Feb 27, 2008 8:03 pm |
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Don't stop taking anti-depressants, doctors urge
Feb 27 05:28 AM US/Eastern
Doctors urged patients to keep taking their anti-depressants Wednesday despite a scientific study showing that the drugs are little more effective than placebos in treating depression.
Doctors are warning their patients not to suddenly stop taking the medication prescribed to them.
Patients suffering from depression are expected to raise questions about the effectiveness of their treatment plan following controversial claims by researchers who said that Selective Serotonin Reuptake Inhibitor (SSRI) drugs like Prozac and Seroxat are barely more effective than sugar pills in treating most people with mild depression.
The study was led by Professor Irving Kirsch's from the University of Hull, who analysed 47 clinical trials and incorporated data not previously released by the drug companies.
Commenting on the findings, Kirsch said: "The difference in improvement between patients taking placebos and patients taking anti-depressants is not very great.
"Given these results, there seems little reason to prescribe anti-depressant medication to any but the most severely depressed patients unless alternative treatments have failed to provide a benefit."
But the study was met with calls for caution.
Louis Appleby, national clinical director for Mental Health, told the Press Association: "New guidance on the treatment of depression will be issued by Nice [the National Institute for Health and Clinical Excellence] later in the year, and this new study will be considered as the guidance is prepared.
"Until then, the message to patients and doctors remains the same -- anti-depressants are an appropriate treatment for moderate or severe depression."
The government has plans to expand the availability of psychological therapies as an alternative to drugs, Appleby explained, with extra investment and more psychological therapists.
"The evidence shows that these therapies are effective and often preferred by patients," Appleby concluded.
http://www.breitbart.com/article.php?id=080227102745.p467o58k&show_article=1
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Joined: 23 Mar 2006
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Location: Almost Heaven
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| suraja
Posted:
Thu Feb 28, 2008 12:10 am |
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Oh swell, instead of buying anti-depressants and making the pharmaceuticals rich, all I needed to do is buy a years supply of packets of sugar substitutes from the local super-market at a fraction of the cost that the pharma charges for pills=sugar pills/packets. Come to think of it, I don't have to buy it at all, just steal it from restaurants.
Thanks wvgirl, you just saved me a whole lot of $$. Although I'm not a dessert person, I love doughnuts and it seems like a couple of donuts a day will keep the blues away, at a fraction of the cost of anti-depressants.
$$$ to donuts, let's dance.  
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Joined: 23 Mar 2006
Posts: 526
Location: California
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| wvgirl
Posted:
Thu Feb 28, 2008 12:51 am |
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 I'm with you, girl. I think tomorrow I will splurge for a couple dozen donuts, one of those sunlight lamps, and hook it up to the treadmill. Sugar, sunshine, and exercise. I'll feel like a new woman by evening  Seriously, I take an anti-depressant/anti anxiety medication daily. It would be wonderful to not have to, and while I realize I am less depressed when I am exercising, getting fresh air/sunshine; I'm still not ready to just drop the medication. I've fought this for 18 years, many times I felt better after being on the medicine for awhile and would think "Oh, I must be cured" and take myself off of it only to end up sadder/fmore fearful months down the road and returning to the doc. I have tried self medication off and on throughout the years. That's not the answer. I have always worked outside of the home until this past year. We were at a place that I could guit my 40 hr a week job and just take care of the business end of our construction company and the problems we were facing with our grown/almost grown children. Anyway, I quit work, I changed meds (again) and there are still days I don't want to get out of bed. And I am not a lazy person. I've worked since I was 15 years old. Unless you've been there, it is unimaginable. My husband went thru 'situational depression' when he went through his divorce. But he doesn't get the whole chronic depression. He busts his ass everyday to make me happy and then I'm not. And until this past 2 years, he didn't realize that I have panic attacks. Alot of people I know would be surprised if they knew.  I've really shared more than I care to on an open board. I realize mental illness is for some a taboo subject, but was really surprised that no one had commented on the reports about anti depressants. So thank you Suraja. Now lets dance
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Location: Almost Heaven
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| tulsad
Posted:
Thu Feb 28, 2008 1:45 am |
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The release of these reports was inexcusable; I'm certain that there are going to be severe ramifications as the result of this group's desire for fame - at the expense of population already at risk of not getting treatment due to society's misconceptions/unwillingness to understand what clinical depression truly is.
Almost 50 clinical trials were reviewed by psychologists from the University of Hull who found that new-generation anti-depressants worked no better than a placebo – a dummy pill – for mildly depressed patients.
Clinical depression is a physical illness - "mildly depressed" is like saying a "slight case of diabetes." Fucking irresponsible idiots.
Let's dance, ladies.
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Sparkly Tree
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