Enough to make you depressed

Issue 

The profit-driven, multi-billion-dollar treatment of depression has been exposed as little less than a fraud. The selective publication of trials has meant that large corporations have been able to make misleading claims for their drugs.

Trials of drugs such as Prozac and Seorxat, a family of drugs known as SSRIs, have had their results published if the figures are favourable, or have had them withheld when they are unfavourable.

SSRIs — selective serotonin reuptake inhibitors — are the largest group of drugs prescribed for depression. Newly analysed data suggests that the SSRIs offer little improvement over placebos in most patients.

In research published in PLoS Medicine on February 26, a team led by Professor Irving Kirsch of Britain's Hull University concluded that there is little reason to prescribe antidepressants to the majority of depressed people. The report found that the drugs are effective for a small number of the most depressed patients and that they are being overprescribed to those with mild to moderate depression.

For the majority of patients, "antidepressant medications have reported only modest benefits over placebo treatment, and when unpublished trial data are included, the benefit falls below accepted criteria for clinical significance".

The findings indicate that non-drug therapies such as "talking therapies" may be more useful. The study also shows how the pursuit of profits distorts medical treatment. The new findings have come about because researchers in the US, Britain and Canada used freedom of information legislation to obtain data presented to regulators when drugs companies apply for licences.

This data reveals that published and unpublished trials show that the drugs are safe to use. However, data is supplied on a selective basis to both the medical profession and those government bodies that subsidise the drugs for patients.

The February 26 British Independent quoted Peter Littlejohns, the public health director of Britain's National Institute for Health and Clinical Excellence, as saying: "Obviously we have access to the published data and we do ask the industry for unpublished data, but it is up to the companies whether to deliver it or not. We have no power to demand it. The issue is that it relies on the good will of the industry."

The Independent also quoted Professor Mike Clarke of the Cochrane Centre, which has conducted 3000 reviews of published trials to establish best medical practice. Clarke commented, "When we ask for details of a trial the company might tell us nothing … researchers trying to make sense of trials for decision-makers need to have access to this data. If we have only got access to half of the data, when we see evidence that a drug works we don't know whether to believe it or not. It makes us doubtful — that's the big worry."

Kirsch's team found that "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. Given these results, there seems 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 licencing and how drug-trial data is reported. Despite the effectiveness of the anti-depressants being brought into question for the majority of patients, sudden withdrawal from the medications may have very real consequences. Medical experts warn that those taking anti-depressants should not stop taking medications without medical supervision, as there are known serious side-effects if the use of the anti-depressants stops abruptly.

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