HENRY

Oh this is going to be a scandal - a large-scale meta-analysis of anti-depressant medication has shown that Prozac, the third most prescribed antidepressant in the US, doesn’t work.

The paper (Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration) obtained all the clinical trial information from the US Food and Drug Administration (FDA) about the six most widely-prescribed selective serotonin reuptake inhibitors (SSRIs) - fluoxetine (i.e. Prozac), venlafaxine (Effexor), nefazodone (Serzone), paroxetine (Seroxat, Paxil), sertraline (Zoloft, Lustral), and citalopram. The authors then compared the effect of these SSRIs to a placebo (a pill with no effect).

Strikingly the results of this meta-analysis show that “the overall effect of new-generation antidepressant medications is below recommended criteria for clinical significance”. Or, the effect of these drugs is not significantly different to that of the placebos. Even more damning, the authors show that whilst the SSRIs have more of an effect on people with higher levels of depression, this is because the placebos stop working as well at higher levels of depression.

The Guardian has some excellent coverage on this paper, where they quote one of the co-authors:

“Given these results, there seems little reason to prescribe antidepressant medication to any but the most severely depressed patients, unless alternative treatments have failed,” says Kirsch. “This study raises serious issues that need to be addressed surrounding drug licensing and how drug trial data is reported.”

Ouch, and what’s worse, once these findings get reported in the media, all that placebo effect is going to disappear too, making these as worthless as candy.

Kirsch, I., Deacon, B.J., Huedo-Medina, T.B., Scoboria, A., Moore, T.J., Johnson, B.T. (2008). Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration. PLoS Medicine, 5(2), e45. DOI: 10.1371/journal.pmed.0050045

Posted on February 27th, 2008 by Simon Greenhill