Shouting "Screw You" At Prozac


Found via Kevin Drum at the Washington Monthly, an interesting new metastudy written up in the UK Guardian that casts doubt on the effectiveness of such SSRIs and SSNIs commonly prescribed for depression as Prozac and Effexor.

An excerpt from the Guardian account:

The study examined all available data on the drugs, including results from clinical trials that the manufacturers chose not to publish at the time. The trials compared the effect on patients taking the drugs with those given a placebo or sugar pill.

When all the data was pulled together, it appeared that patients had improved—but those on placebo improved just as much as those on the drugs.

The only exception is in the most severely depressed patients, according to the authors—Prof Irving Kirsch from the department of psychology at Hull University and colleagues in the US and Canada. But that is probably because the placebo stopped working so well, they say, rather than the drugs having worked better.

"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.

The paper, published today in the journal PLoS (Public Library of Science) Medicine, is likely to have a significant impact on the prescribing of the drugs.

The pattern they saw from the trial results of fluoxetine (Prozac), paroxetine (Seroxat), venlafaxine (Effexor) and nefazodone (Serzone) was consistent. "Using complete data sets (including unpublished data) and a substantially larger data set of this type than has been previously reported, we find the overall effect of new-generation antidepressant medication is below recommended criteria for clinical significance," they write.

From my own perspective on the rolling juggernaut of psychatric medicine, I somehow doubt the optimistic "likely to have a significant impact" bit. Especially given Kevin Drum's observation on how little play this has gotten in American media, which still seems to be the case.

Drum's comment thread is very interesting and worth at least skimming for those who care about this topic. Lots of people jousting with the results, some of them of the level of intellectual sophistication of those who note that, damn, that horoscope that day really described exactly what I was going through; others raise the notion that the study might be misleading for either conflating some drugs that work with others and dragging down the working drugs average, or for mixing subjects who really are depressed with a bevy of people to whom the drugs were misprescribed and thus don't work.

The full study, from the open-access Public Library of Science.

Ronald Bailey wrote back in July 2007 for reason on the fascinating world of public access open source scientific journals such as Public Library of Science.

This July 2007 reason feature by me touches on some of the things that psychiatric medical science can't quite tell us.

And see this July 2000 reason interview with psychiatric critic Thomas Szasz, conducted by Jacob Sullum.