Identify those who really need them, and wean other people off them
How to make better use of antidepressants
Identify those who really need them, and wean other people off them
爭論
全世界過量使用antidepressants, 抗憂鬱症藥--它們絕大多數情況的藥效如 placebo或 a dummy pill 稱為"安慰劑".....不過這些研究多是根據"非住院之病人" 所以"患者"還是要"當心...
The research, by Anglo-US experts, also claims that even part of the benefit seen in very depressed patients stems from their having a reduced response to the placebo - the term for the dummy pills against which trial drugs are usually compared - rather than an increased response to the antidepressant when compared with patients with less severe depression.
If correct, the findings - based on an analysis of 35 studies lodged with the US Food and Drug Administration by the drug makers - imply a massive overuse of the drugs worldwide.
The drugs in the analysis, which include the brands Effexor (venlafaxine), Aropax and Prozac, have achieved blockbuster sales since being introduced in the 1990s. There were nearly four million prescriptions written in Australia for the three drugs combined in 2006-07, costing the Pharmaceutical Benefits Scheme $130million. Venlafaxine, the most commonly prescribed of the three, was the eighth-biggest drain on the PBS in that year.
A fourth drug included in the research, nefazodone (Serzone), was withdrawn in Australia in 2004 after being linked to liver and eye problems.
The analysis - published in the US journal Public Library of Science Medicine - has been criticised by Australian experts, who say its findings are badly flawed.
Gordon Parker, director of the Black Dog Institute and professor of psychiatry at the University of NSW, recently argued in the British Medical Journal that depression was over-diagnosed.
But he said patients should not shy away from antidepressants as a result of this study, as the patients on whom the results were based "bear very little correlation to the people we see in real-life clinical practice".
In particular, participants in trials of antidepressants were usually hospital outpatients rather than admitted patients, they were not suicidal, and did not have drug or alcohol problems - criteria that limited the wider applicability of the results, Professor Parker said.
Patients with melancholic depression were often "in a very dark place" and rarely got onto clinical trials. But 65 to 70 per cent of these patients responded to antidepressants, whereas only 10 to 15 per cent improved after taking the placebo, he said.
"I'm particularly concerned about people who are benefiting from antidepressants, or would benefit, feeling that an effective treatment is useless or discredited (as a result of this research)," Professor Parker said.
Ian Hickie, director of the Brain and Mind Research Institute at Sydney University - who argued against Professor Parker in the same edition of the British Medical Journal - said the findings ignored the fact that suicide rates had fallen in countries where antidepressant use was most widespread. "It would be a mistake to say that drug treatment should be withheld for anything other than the most severe depression," he said.
"Even quite low levels of depression significantly increase suicide risk."
The study, led by Irving Kirsch, now at the Department of Psychology at the University of Hull, builds on earlier analyses of the same data he published in a different journal in 2002.
A spokesman for GlaxoSmithKline, which makes Aropax, said Professor Kirsch's team had "failed to acknowledge the very positive benefits these treatments have provided to patients".
- Additional reporting: The Times
全世界過量使用antidepressants, 抗憂鬱症藥--它們絕大多數情況的藥效如 placebo或 a dummy pill 稱為"安慰劑".....不過這些研究多是根據"非住院之病人" 所以"患者"還是要"當心...
(行政院衛生署自殺防治中心統計，自殺近年來一直名列在國人十大死因中，八十四年自殺死亡個案為一六一八人，九十五年自殺死亡躍升為四四０六人，顯示每年自殺死亡人數不斷的攀昇，且自殺死亡又以老年憂鬱症為高危險因子，台南市立醫院由身心科主任林忠義率領的醫療團隊，將 ...)
Depression drugs 'do not work'
Adam Cresswell, Health editor | February 27, 2008
NEW-GENERATION antidepressants, including the "happy pill" Prozac, may be no better at relieving the symptoms of depression than a dummy pill.
Controversial new research builds on earlier claims that the drugs work only for the most severely depressed patients, and there is no reason to prescribe them unless other treatments have failed.The research, by Anglo-US experts, also claims that even part of the benefit seen in very depressed patients stems from their having a reduced response to the placebo - the term for the dummy pills against which trial drugs are usually compared - rather than an increased response to the antidepressant when compared with patients with less severe depression.
If correct, the findings - based on an analysis of 35 studies lodged with the US Food and Drug Administration by the drug makers - imply a massive overuse of the drugs worldwide.
The drugs in the analysis, which include the brands Effexor (venlafaxine), Aropax and Prozac, have achieved blockbuster sales since being introduced in the 1990s. There were nearly four million prescriptions written in Australia for the three drugs combined in 2006-07, costing the Pharmaceutical Benefits Scheme $130million. Venlafaxine, the most commonly prescribed of the three, was the eighth-biggest drain on the PBS in that year.
A fourth drug included in the research, nefazodone (Serzone), was withdrawn in Australia in 2004 after being linked to liver and eye problems.
The analysis - published in the US journal Public Library of Science Medicine - has been criticised by Australian experts, who say its findings are badly flawed.
Gordon Parker, director of the Black Dog Institute and professor of psychiatry at the University of NSW, recently argued in the British Medical Journal that depression was over-diagnosed.
But he said patients should not shy away from antidepressants as a result of this study, as the patients on whom the results were based "bear very little correlation to the people we see in real-life clinical practice".
In particular, participants in trials of antidepressants were usually hospital outpatients rather than admitted patients, they were not suicidal, and did not have drug or alcohol problems - criteria that limited the wider applicability of the results, Professor Parker said.
Patients with melancholic depression were often "in a very dark place" and rarely got onto clinical trials. But 65 to 70 per cent of these patients responded to antidepressants, whereas only 10 to 15 per cent improved after taking the placebo, he said.
"I'm particularly concerned about people who are benefiting from antidepressants, or would benefit, feeling that an effective treatment is useless or discredited (as a result of this research)," Professor Parker said.
Ian Hickie, director of the Brain and Mind Research Institute at Sydney University - who argued against Professor Parker in the same edition of the British Medical Journal - said the findings ignored the fact that suicide rates had fallen in countries where antidepressant use was most widespread. "It would be a mistake to say that drug treatment should be withheld for anything other than the most severe depression," he said.
"Even quite low levels of depression significantly increase suicide risk."
The study, led by Irving Kirsch, now at the Department of Psychology at the University of Hull, builds on earlier analyses of the same data he published in a different journal in 2002.
A spokesman for GlaxoSmithKline, which makes Aropax, said Professor Kirsch's team had "failed to acknowledge the very positive benefits these treatments have provided to patients".
- Additional reporting: The Times
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