Thursday, July 21, 2005

Take sugar tablets instead?

Efficacy of antidepressants in adults -- Moncrieff and Kirsch 331 (7509): 155 -- BMJ

Wow, this story in the British Medical Journal will cause a lot of controversy, I expect. Bottom line: it's not so clear that antidepressants are better than placebo. The article summary is:

"The NICE review data suggest that selective serotonin reuptake inhibitors do not have a clinically meaningful advantage over placebo, which is consistent with other recent meta-analyses. In addition, methodological artefacts may account for the small effect seen. Evidence that antidepressants are more effective in more severe conditions is not strong, and data on long term outcome of depression and suicide do not provide convincing evidence of benefit. In children, the balance of benefits to risks is now recognised as unfavourable. We suggest this may also be the case for adults, given the continuing uncertainty about the possible risk of increased suicidality as well as other known adverse effects. This conclusion implies the need for a thorough re-evaluation of current approaches to depression and further development of alternatives to drug treatment. Since antidepressants have become society's main response to distress, expectations raised by decades of their use will also need to be addressed."

I should point out that placebo tablets will only work if you don't know they are placebo (so I am not seriously suggesting swapping your tablets for sugar ones!) However, as I have mentioned in an earlier post, cognitive therapy has got years of good results behind it now. Try it, depressed Lefties!

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