I don't know what health news has been circulating in other parts of the globe, but here in the U.K., we have not been able to move due to stories about the "revelation" that, for the majority of people who take them, popular antidepressants work no better than placebos.
Stories about this were spawned from the results of a newly published study that assessed the results of the trials of four antidepressants, including SSRIs (selective serotonin reuptake inhibitors) such as paroxetine (Seroxat, Paxil) and fluoxetine (Prozac) [1]. What was interesting about this study is that it mixed the results of published as well as unpublished research.
Revealing More Data
The reason this is relevant is that the pharmaceutical industry, when it suits itself, is well-known to engage in publication bias. This practice, essentially of publishing favorable results while burying less useful data, can give doctors and their patients a rather skewed impression of the effectiveness of a given treatment. Putting published research as well as unpublished material together will inevitably give a more accurate guide to whether a treatment works or not.
In this case, the mix showed that antidepressants appear not to work any better than placebos for all but the most severely depressed. Since the great majority of people who take antidepressants do not fall into the severely depressed category, the results of this study suggest that, on the whole, they are just as well-off with a sugar pill as they are with their expensive and potentially toxic antidepressants.
While listening to the radio yesterday, I heard more than one commentator express concern about these results and about what might they mean. At the same time, they warned people not to come off medications abruptly. Go and "talk it through with your GP" was the message. One might imagine that there's going to be a fair few uncomfortable GP consultations going on over the next week or two as a result of these study findings.
Giving Up Is Hard to Do
I suspect many people are going to feel aggrieved at having already taken antidepressants, despite the fact that the data does not support their efficacy. But that's only half the problem: If people decide 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 a placebo, they may actually be worse off than if they had taken only the placebo, since getting off the drug itself is 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 very gradually over a few weeks or months and maybe even over a year or so. And generally this is best done under the care of a supportive doctor.
While this most recent study made big headlines, the fact is, there's really nothing new in this story. As recently as January, an article was published that showed quite clearly that many "negative" antidepressant studies are not even published.
Some people are calling for the mandatory publication of antidepressant studies. I support this, but suggest the call should be extended to all drugs—period.
Withdrawal Support
I'd also like to see the drug companies acting responsibly by sponsoring educational programs for doctors, the purpose of which being not to get them to write more prescriptions for antidepressants, but to get them to write fewer. And how about including information in these programs on how doctors can best support patients wishing to get off these drugs, particularly those suffering from withdrawal?
I have a feeling that this isn't going to happen anytime soon though, as it might amount to the tacit admission that a problem has been caused, at least in part, by the failure of drug companies to freely and willingly disclose all their data.
I have an inkling that drug companies may be forced to dig deep anyway, though: 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.
Reference:
[1] 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
Dr. John Briffa is a London-based doctor and author with an interest in nutrition and natural medicine.
Dr. Briffa's Web site
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