.
PSYCHOLOGY: DISORDERS DEPRESSION :
MEDICAL: PHARMACY PHARMACEUTICAL
PHARMACOLOGY DRUG:
Antidepressant Pills May Help Only Most Severe Cases (Update2)
Antidepressant Pills May Help Only Most Severe Cases (Update2)
January 06, 2010, 04:43 AM EST
(Adds Glaxo comment in sixth paragraph.)
By Simeon Bennett
<http://www.businessweek.com/news/2010-01-05/
antidepressants-don-t-help-those-with-mild-disorder-study-says.html>
A shorter URL for the above link:
<http://tinyurl.com/ydbyuld>
Jan. 6 (Bloomberg) -- Antidepressants such as those made by
GlaxoSmithKline Plc may be no better than dummy pills for people with mild
or moderate depression, according to a study that suggests 70 percent of
patients wouldnt benefit from the drugs.
In a review of six trials of antidepressants involving more than 700
patients published yesterday in the Journal of the American Medical
Association, researchers led by Jay Fournier at the University of
Pennsylvania found the drugs helped only those patients with the most
severe depression. Most trials excluded patients with milder forms of the
disorder, the authors said.
About 70 percent of patients have a form of depression below the level at
which they would benefit from medication, Fournier and colleagues wrote,
citing a 2002 study. Doctors, policy makers and sufferers should be made
aware that theres little evidence to show the treatments will benefit
patients with less severe symptoms, the authors said.
This important feature of the evidence base is not reflected in the
implicit messages present in the marketing of these medications to
clinicians and the public, they said.
The researchers combined data from six trials, including three of
paroxetine, the main ingredient in London-based Glaxos Paxil and Seroxat
pills, and three of imipramine, an older generic medicine.
<snip>
Study finds medication of little help to patients with mild, moderate
depression
Only people with severe depression benefit from antidepressants, says
research published in the Journal of the American Medical Assn. Others do
better with nonmedical approaches.
By Shari Roan
January 6, 2010
<http://www.latimes.com/news/nationworld/nation/
la-sci-depression6-2010jan06,0,4335963.story?track=rss>
A shorter URL for the above link:
<http://tinyurl.com/yh2pmh6>
The current analysis attempted to quantify how much of antidepressants'
benefit is attributable to chemical effects on the brain and how much can
be explained by other factors, such as visiting a doctor, taking action to
feel better or merely the passage of time.
Researchers reviewed six randomized, placebo-controlled studies with a
total of 718 patients who took either an antidepressant or placebo. The
patients were adults with levels of depression ranging from mild to very
severe based on the Hamilton Depression Rating Scale, a questionnaire
widely used in depression research. The studies did not exclude patients
who were likely to have a strong response to a placebo. Researchers then
compared the patients' depression scores at the beginning of treatment
with those after at least six weeks of treatment.
The study found that the magnitude of the drugs' benefit increased with
the baseline level of depression. The effect of treatment was similar in
people with mild, moderate and severe symptoms, regardless of whether they
took an antidepressant or placebo. Only the people who rated very severe
on the depression scale at the start of the study showed measurable
improvements on antidepressants.
"There is no doubt that there are tremendous benefits from
antidepressants, as our study showed," DeRubeis said. "But this study
helps us resolve, to some degree, the question of how much benefit people
can expect from the medicines themselves when symptoms are not severe."
Other research has also found that antidepressants are most effective for
severe symptoms, said Dr. Philip Wang, deputy director of the National
Institute of Mental Health.
Milder depression may not respond to antidepressants
By Anne Harding,
Health.com
January 6, 2010 11:43 a.m. EST
CNN Health
<http://www.cnn.com/2010/HEALTH/01/06/mild.depression.antidepressants/>
Fournier and his colleagues looked at 2,164 clinical trials of
antidepressants in all, but they ultimately excluded all but six from
their analysis for a variety of reasons -- because they weren't
placebo-controlled or were shorter than six weeks long, for instance.
The researchers found that, on average, the benefits of antidepressants
over placebo were "minimal or nonexistent" in people whose depression was
less than "very severe" according to American Psychiatric Association
guidelines. Even people with "severe" depression"-- which is one step
below "very severe" --did not experience a significant effect from
antidepressants compared to placebo, the study reports.
"It's a very well done paper in a top journal, and they're raising a
serious question," says Hellerstein. But, he says, the findings aren't
comprehensive enough to indicate whether doctors should continue to
prescribe antidepressants to people with mild or moderate depressive
symptoms.
Health.com: Should you take antidepressants?
The drugs included in the study are rarely used as first-line treatments
today, Hellerstein says, and two of the imipramine studies included in the
analysis used a low dose. In addition, he says, the longest study Fournier
and his team included lasted 11 weeks; some drugs take longer than that to
produce their full effect, whereas the placebo effect is strongest in the
first few weeks of treatment.
Both Hellerstein and Fournier also point out that the patients in the
placebo arm of the studies received attention and care in addition to a
fake pill. They were assessed regularly, talked about their symptoms with
a professional, and received physical and psychiatric exams -- all of
which could have been therapeutic for people who may have been isolated,
suffering in silence, or dragging themselves to work every day.
"It seems like that, in and of itself, provided some benefit for
Media contact Jordan Reese 215-573-6604 [log in to unmask]
Penn Study Shows Antidepressants Work Best for Severe Depression, Provide
Little to No Benefit Otherwise
January 05, 2010
University of Pennsylvania
Office of University Communications
<http://www.upenn.edu/pennnews/article.php?id=1791>
PHILADELPHIA - A study of 30 years of antidepressant-drug treatment data
published today in the Journal of the American Medical Association shows
that the benefit of antidepressant medication compared with placebo may be
minimal or nonexistent in patients with mild or moderate symptoms.
University of Pennsylvania researchers say, however, the benefit of
medications is substantial for patients with very severe depression.
Ultimately, according to the study, the majority of patients who were
prescribed antidepressants did not suffer from a severity of depression
that would be improved by the medications.
The research team, led by psychologists at Penn, analyzed data from
studies that spanned a 30-year period to gauge the benefit of
antidepressant medication compared to placebo pills across a range of
patients with varying degrees of depression. The team collected data from
placebo-controlled trials of antidepressants approved by the U.S. Food and
Drug Administration for the treatment of Major or Minor Depressive
Disorder. Studies comprised adult outpatients and included a medication
vs. placebo comparison for at least six weeks. Researchers calculated
depression severity scores before and after treatment using the standard
Hamilton Rating Scale for Depression.
<snip>
The results imply that doctors who are advising treatment for patients
with mild or moderate cases of depression should consider the lack of
evidence for specific benefits of the medications and compare the expected
costs and benefits of the medications against alternatives such as
self-help, exercise or psychological therapy.
THE STUDY CITATION
Antidepressant Drug Effects and Depression Severity
A Patient-Level Meta-analysis
Jay C. Fournier, MA; Robert J. DeRubeis, PhD; Steven D. Hollon, PhD; Sona
Dimidjian, PhD; Jay D. Amsterdam, MD; Richard C. Shelton, MD; Jan Fawcett,
MD
JAMA. 2010;303(1):47-53.
Context Antidepressant medications represent the best established
treatment for major depressive disorder, but there is little evidence that
they have a specific pharmacological effect relative to pill placebo for
patients with less severe depression.
Objective To estimate the relative benefit of medication vs placebo
across a wide range of initial symptom severity in patients diagnosed with
depression.
Data Sources PubMed, PsycINFO, and the Cochrane Library databases were
searched from January 1980 through March 2009, along with references from
meta-analyses and reviews.
<http://jama.ama-assn.org/cgi/content/full/303/1/47?home>
Full Text: This is a fee based subscription publication.
Find in a Library:
JAMA : the journal of the American Medical Association.
Author: American Medical Association.
Publisher: Chicago : American Medical Association, 1960-
<http://www.worldcat.org/oclc/1124917&referer=brief_results>
----------------------------------------------
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