The Pharmaceutical Journal
Vol 268 No 7185 p197-203
16 February 2002

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Which? Online (www.which.net)

Risks and benefits of antidepressants should be aired more fully with patients

Patients and prescribers should be given more information about the risks and benefits of antidepressants because, if they were given more facts, more people would consider alternatives, the author of a Health Which? report believes (February 2002, p22).

The report states that several clinicians have voiced concerns about the effectiveness of antidepressants and about their unwanted effects being underplayed. Dr Joanna Moncrieff, department of psychiatry and behavioural sciences, University College London, is quoted as saying: "On the basis of evidence far less solid than generally portrayed, more and more people are being put on these medicines."

The report also suggests that the margin of improvement seen in patients treated with antidepressants is often small compared with those given placebo, and that drug companies pick and choose the trial results they want published.

David Taylor, chief pharmacist, Maudsley Hospital, London, addressed two issues raised by the report. He told The Journal that the authors argue that withdrawal symptoms related to SSRI antidepressants could be termed symptoms of dependence.

However, Mr Taylor said: "At no stage do patients crave the medication once it has been discontinued. It is not like stopping smoking, they simply feel ill." He added that no one would argue that patients who suffer tachycardia after stopping beta-blockers were addicted to beta-blockers.

On the issue of efficacy, Mr Taylor said that the fact that drug companies might suppress negative data was the same for all drugs. "Depression is not unusual in this respect," he said. "I agree that people should be better informed [about side effects] and this report gives us fair warning that we should be as honest as possible with patients." He added that he would recommend that patients suffering moderate to severe depression should be prescribed an antidepressant because the benefits outweigh the risks involved.

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