The Pharmaceutical Journal
Vol 270 No 7249 p671
17 May 2003

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Commonly used antidepressants are equally effective

The most commonly prescribed classes of antidepressants in primary care are equally effective, a review has shown. However, much of the evidence for antidepressant therapy comes from trials conducted in secondary care and the researchers suggest that study setting should be considered when antidepressants are licensed. The findings are published in a week when the safety of paroxetine (Seroxat) has been in the spotlight again, highlighted by the BBC television programme Panorama.

The research involved a systematic review and meta-analysis of studies examining the efficacy and tolerability of tricyclic antidepressants and selective serotonin re-uptake inhibitors (SSRIs) in primary care patients. Efficacy between SSRIs and tricyclic antidepressants did not differ significantly. A slight, but non-significant, effect in favour of tricyclics was found in terms of depression scale scores. However, in terms of tolerability, SSRIs fared better.

The researchers say that, although most patients with depression are treated in primary care, most treatment decisions are based on trials conducted in secondary care. “Since differences in tolerability of medicines exist between patients treated in different settings, it may be appropriate . . . to ensure that studies have been carried out in appropriate settings before granting specific antidepressants their licence.” (BMJ 2003; 326:1014.)

Last Sunday Panorama reported anecdotes of patients’ experiences of taking paroxetine. During the programme, mental health charity Mind claimed that the Medicines and Healthcare products Regulatory Agency (MHRA) had “failed in its duty as a public body responsible for the safety of prescribed drugs” over paroxetine.

The MHRA said that the benefits of paroxetine are still thought to outweigh the risk of adverse reactions. A new expert group is to be set up and the agency will consider the patient data collected as part of the Panorama programme.