Nursing Times’ weekly series sifts the facts from the fiction
What did the media say?
The media reported that new generation antidepressants have little clinical benefit for most patients, except those with the most severe forms of depression
What did the research show?
The researchers carried out a meta-analysis review of data on all clinical trials submitted to the US Food and Drug Administration for the licensing of the four new-generation antidepressants – fluoxetine, venlafaxine, nefazodone and paroxetine – including information not previously published in journals.
The dataset comprised 35 clinical trials involving 5,133 patients, 3,292 of whom had been randomised to medication and 1,841 to placebo. The researchers compared how favourably the drugs and placebo acted on the Hamilton Rating Scale of Depression, a 17–21 item questionnaire.
They calculated that the mean improvement for the drug groups was 9.60 points on the HRSD and 7.80 in the placebo groups – a mean drug-placebo difference of 1.80 points. This is below the three-point difference suggested by NICE for ‘significant clinical benefit’.
What did the researchers say?
The authors, led by Irving Kirsch, from Hull University’s psychology department, said: ‘We find that the overall effect of new-generation antidepressant medications is below recommended criteria for clinical significance.
‘We also find that efficacy reaches clinical significance only in trials involving the most extremely depressed patients, and that this pattern is due to a decrease in the response to placebo rather than an increase in the response to medication.’
What does this mean for nursing practice?
Sheila Hollins, president of the Royal College of Psychiatrists, said: ‘The researchers claim to have obtained a full set of research data for the first time, and they should be commended for achieving this. But we must stress that anyone currently taking antidepressants should first contact their own doctor before considering stopping their medication, as is the case with any form of prescribed medication.’
But Alison Cobb, a treatment expert at the charity Mind, added: ‘This new study makes a serious challenge to the predominance of drugs in treating depression. Many people find antidepressants helpful but they certainly don’t work for everyone. One size certainly doesn’t fit all when it comes to treating depression.’