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Antidepressants - Why bother?

BELLEVUE, WASHINGTON. Several psychiatrists have argued that it is unethical for clinical trials of antidepressants to include placebo controls when an effective treatment (antidepressants) is available. A group of researchers from the Northwest Clinical Research Center and Brown University in Providence, Rhode Island now thoroughly debunks this notion. The researchers evaluated the results of 45 studies aimed at evaluating the effectiveness of seven new antidepressants (Prozac, Zoloft, Paxil, Effexor, Serzone, Remeron, and Wellbutrin SR). They obtained their data directly from the Food and Drug Administration (FDA). Among the 19,639 study participants (moderately to severely depressed) 34 committed suicide (0.8 per cent/year) and 130 (2.9 per cent/year) attempted suicide during the studies. There were no significant differences in suicide rates among drug takers and placebo takers. Annual rates of suicide were 0.4 per cent for placebo takers, 0.7 per cent for patients taking established tricyclic antidepressants (imipramine, amitriptyline or trazodone), and 0.8 per cent among patients taking the new antidepressants. Annual rates of attempted suicide were 2.7 per cent, 3.4 per cent, and 2.8 per cent respectively. The researchers conclude that omitting the placebo group in tests of antidepressants cannot be justified on the grounds that they are more likely to commit suicide than are treated patients.

Analysis of the FDA database also led to the surprising conclusion that placebos were nearly as effective as both established and new antidepressants in reducing the symptoms of depression. Using the Hamilton Depression Rating Scale as a yardstick the researchers concluded that the average extent of symptom reduction was 40.7 per cent with the new antidepressants, 41.7 per cent with the tricylics, and 30.9 per cent with the placebo. So less than 10 per cent improvement separated the new antidepressants from the placebo. As a matter of fact, 15 studies out of 42 found placebos to be more effective than active drugs compared to 18 studies which found the new antidepressants more effective.
Khan, Arif, et al. Symptom reduction and suicide risk in patients treated with placebo in antidepressant clinical trials. Archives of General Psychiatry, Vol. 57, April 2000, pp. 311-17

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