Reconsider recommendations for prescribing of antidepressants
Current recommendations for prescribing antidepressants need to be reconsidered, according to an article in the BMJ last week (2005;331:155).
Joanna Moncrieff, senior lecturer in social and community psychiatry
at University College London, and Irving Kirsch, professor of psychology
at the University of Plymouth, argue that, although the National Institute
for Health and Clinical Excellence guidelines recommend that antidepressants — and
selective serotonin reuptake inhibitors in particular — be first-line
treatment for moderate to severe depression, the data that NICE reviewed
suggest that SSRIs do not have a clinically meaningful advantage over
placebo. Moreover, they suggest that methodological artefacts may account
for the effects seen.
These artefacts include, they suggest, small differences being magnified
by manipulation of data, data being selectively presented and participants
noticing physiological effects of antidepressants, rendering trials non-blinded.
Carol Paton, chief pharmacist, Oxleas NHS Trust, and member of the guideline
development group for NICE’s clinical guideline on the management
of depression in primary and secondary care, commented: “The authors
eloquently raise a number of important issues that are worthy of wider
debate. However, they do not adequately address three important issues.
“First, they ignore the strong data on the efficacy of maintenance
treatment with antidepressants. Secondly, if, as the authors argue, the
evidence
for the efficacy of antidepressants is weak, then the evidence for an
increased risk of suicide is several orders of magnitude weaker. And,
finally, if the evidence base for antidepressants collapses, then so
too does the basis of psychological treatments,” Mrs Paton said.
“We also need to be mindful of the fact that ‘no treatment’ is
considerably less effective than placebo,” she added. |
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