More people should get pills to beat depression
The Times of London reports …
Dumbarton Health Centre in Artizan, where people are treated for depression.
February 22 2018 – Prozac, thought to be the most widely used antidepressant in history, is 52 per cent more effective than a placebo
Prozac, thought to be the most widely used antidepressant in history, is 52 per cent more effective than a placebo
More than a million extra people should be offered antidepressants after the largest study of its kind concluded that they worked, experts have said.
Patients and GPs must not be squeamish about treating mental health problems with drugs, according to scientists who found that every one of 21 common antidepressants was better than a placebo.
They criticised “ideological” resistance to antidepressants fuelled by a misguided belief that illness linked to social problems should not be treated with pills. They said that doctors should switch from the least effective antidepressants, including Prozac and citalopram, two of the most commonly prescribed in Britain, towards the best performing ones, which are up to twice as good as a placebo.
A global study led by researchers from Oxford University analysed data from 522 trials, half unpublished, involving 116,000 patients with moderate to severe depression, a level at which people struggle to work or socialise.
About two million people in Britain are thought to suffer from depression, yet studies suggest that only a sixth get the help they need. About 65 million antidepressant prescriptions are written in England each year, a figure that has doubled in a decade. This has led to concern about use of the drugs, which cost the NHS £267 million in 2016. Andrea Cipriani, who led the latest study, said: “Undertreated depression is a huge problem and we need to be aware of that. We tend to focus on overtreatment but we need to focus on this.”
His league table of antidepressants shows that the least effective, reboxetine, is 37 per cent better than a placebo. Patients given the best performer, amitriptyline, are up to 113 per cent more likely to have the severity of their symptoms halved. Dr Cipriani said that it was not clear which patients would respond to which drug but the findings would help doctors to make better decisions.
Drugs do not work for at least a third of patients. Dr Cipriani emphasised that people should not shun talking therapies, which are thought to be roughly as effective as antidepressants but are more expensive and often unavailable. He added: “Patients should be aware of the potential benefits from antidepressants and always speak to doctors about the most suitable treatment for them.”
John Geddes, senior author of the paper, published in The Lancet, said that widespread criticism of antidepressants “puts people off accessing effective treatment” and they should be reassured. “There’s something about taking a drug for a mental health problem that people think, ‘That’s not what I want to do’, so it’s important to be clear about the efficacy,” Professor Geddes said. “We do tend to be a bit squeamish about it . . . If it was cancer and only one in six were getting access to effective treatment we’d think there was something squiffy going on.” He estimated that at least a million more people should have drugs or psychotherapy.
Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said: “Taking antidepressants is frequently portrayed as a negative thing or something done only when other therapies are not available or have failed, but this in itself can add to the unfortunate stigma that sometimes exists around people with mental health conditions. This research should reassure patients who are taking or are contemplating commencing antidepressants, and the doctors that prescribe them, that they are an effective treatment.”
Others pointed out that antidepressants were often used for other conditions such as anxiety or obsessive compulsive disorder and it was unclear whether they helped for these problems. A previous overview found that Prozac was the only drug that seemed to work for children and adolescents.
James Davies, a psychotherapist who co-founded the Council for Evidence-Based Psychiatry, said that it was still unclear how much difference the drugs made to everyday lives, adding: “This study does not cover the mildly depressed, which is a shame given about a third of people with mild depression get prescribed antidepressants as a consequence of presenting at their GP.”
However, Carmine Pariante, from the Royal College of Psychiatrists, said: “This meta-analysis finally puts to bed the controversy on antidepressants.”
DRUGS OF CHOICE
How much better medicines are than placebo (and number of NHS prescriptions)
Amitriptyline 113 per cent (12.9 million): Discovered in the 1950s, the main tricyclic, which blocks uptake of two neurotransmitters. Also used for migraine and chronic pain. Overdoses particularly fatal.
Mirtazapine 89 per cent (7.5 million): Different mechanism from most other common antidepressants. Can lead to increased appetite.
Duloxetine 85 per cent (1.8 million): Inhibits re-uptake of both serotonin and another neurotransmitter. Also used for incontinence.
Venlafaxine 78 per cent (3.9 million): Inhibits re-uptake of both serotonin and another neurotransmitter. Has higher risk of withdrawal symptoms
Paroxetine 75 per cent (1.4 million): Common drug of the type known as selective serotonin reuptake inhibitors (SSRI). Sold as Seroxat, it is also used for OCD, panic disorder, PTSD and anxiety. Has higher risk of withdrawal symptoms such as headache, anxiety, dizziness and sweating.
Fluoxetine 52 per cent (6.6 million): Prozac, the best known SSRI and original blockbuster antidepressant, thought to be the most widely used in history. Also used for OCD and bulimia.
Citalopram 52 per cent (14.6 million): Most commonly used SSRI in NHS. Side effects include yawning, confusion and aggression.
Clomipramine 49 per cent (306,000): Tricyclic also used for phobias and cataplexy, a condition where strong emotion causes sudden muscle weakness and collapse.
Reboxetine 37 per cent (31,000): Inhibits reuptake of a different neurotransmitter to most antidepressants
Milnacipran 74 per cent (4); Fluvoxamine 69 per cent (24,000); Escitalopram 68 per cent (1 million); Nefazodone 67 per cent (169); Sertraline 67 per cent (11.2 million); Vortioxetine 66 per cent (13,000); Agomelatine 65 per cent (21,000); Vilazodone 60 per cent (0); Levominacipran 59 per cent (0); Bupropion 58 per cent (0); Trazodone 51 per cent (1.1 million); Desvenlaxafine 49 per cent (0).
Source: The Lancet/NHS Digital/BNF