Tamar Kahn
27 February 2008
Cape Town — The South African Society of Psychiatrists (Sasop) has reacted cautiously to a study showing that new-generation antidepressants such as Prozac do not work for all but the most severely depressed patients.
The study, led by a University of Hull team and published yesterday in the Public Library of Science, analysed all the data submitted to the US Food and Drug Administration for the registration of four of the most widely prescribed antidepressants - fluoxitine (Prozac), venlafaxine (Effexor), nefazodone (Serzone) and paroxetine (Seroxat/Paxil).
According to Sasop, the prevalence of depression in SA is about 10%, and about a fifth of medical scheme members aged between 30 and 40 take antidepressants in any one year. All the drugs but nefazodone are widely used in SA.
The study has implications for patients and also raises questions about the extent to which the pharmaceutical industry withholds data on its drugs.
The researchers used the US Freedom of Information Act to obtain the data from 47 clinical trials, including previously unpublished figures. They found the drugs had no clinical effect for mildly or moderately depressed patients, as the improvement in depression among the patients getting the trial drug was no better than among those getting a dummy pill.
Benefits were seen in only a small group of patients who were the most extremely depressed to start out with -- and this benefit seemed to be because depressed patients did not respond as well to a placebo, rather than because they responded better to the drugs being tested.
Sasop's past president Eugene Allers said patients and doctors should not be alarmed by the study. "It doesn't say much more than we already know," he said. "International guidelines say psychotherapy is the preferred method of treatment for mild or moderate depression, and for more severe depression, psychotherapy combined with medication. Clinically, we definitely see a benefit from the drugs," he said.
Jonathan Broomberg, head of strategy for SA's biggest medical scheme Discovery Health, said the funder had no immediate plans to alter its policies on providing antidepressants .
"We will not make any changes until there has been thorough consultation with the psychiatry profession," he said. About 0,2% of Discovery's 2-million members were taking drugs included in the study, he said.
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