[net-gold] PSYCHOLOGY: DISORDERS DEPRESSION : MEDICAL: PHARMACY PHARMACEUTICAL PHARMACOLOGY DRUG: Antidepressant Pills May Help Only Most Severe Cases (Update2)
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- Date: Sat, 9 Jan 2010 11:59:58 -0500 (EST)
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Date: Wed, 6 Jan 2010 14:51:30 -0500 (EST)
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Subject: PSYCHOLOGY: DISORDERS DEPRESSION : MEDICAL: PHARMACY PHARMACEUTICAL
PHARMACOLOGY DRUG: Antidepressant Pills May Help Only Most Severe Cases
(Update2)
.
PSYCHOLOGY: DISORDERS DEPRESSION :
MEDICAL: PHARMACY PHARMACEUTICAL PHARMACOLOGY DRUG:
Antidepressant Pills May Help Only Most Severe Cases (Update2)
Antidepressant Pills May Help Only Most Severe Cases (Update2)
January 06, 2010, 04:43 AM EST
(Adds Glaxo comment in sixth paragraph.)
By Simeon Bennett
<http://www.businessweek.com/news/2010-01-05/
antidepressants-don-t-help-those-with-mild-disorder-study-says.html>
A shorter URL for the above link:
<http://tinyurl.com/ydbyuld>
Jan. 6 (Bloomberg) -- Antidepressants such as those made by GlaxoSmithKline Plc
may be no better than dummy pills for people with mild or moderate depression,
according to a study that suggests 70 percent of patients wouldnt benefit from
the drugs.
In a review of six trials of antidepressants involving more than 700 patients
published yesterday in the Journal of the American Medical Association,
researchers led by Jay Fournier at the University of Pennsylvania found the
drugs helped only those patients with the most severe depression. Most trials
excluded patients with milder forms of the disorder, the authors said.
About 70 percent of patients have a form of depression below the level at which
they would benefit from medication, Fournier and colleagues wrote, citing a
2002 study. Doctors, policy makers and sufferers should be made aware that
theres little evidence to show the treatments will benefit patients with less
severe symptoms, the authors said.
This important feature of the evidence base is not reflected in the implicit
messages present in the marketing of these medications to clinicians and the
public, they said.
The researchers combined data from six trials, including three of paroxetine,
the main ingredient in London-based Glaxos Paxil and Seroxat pills, and three
of imipramine, an older generic medicine.
<snip>
Study finds medication of little help to patients with mild, moderate
depression
Only people with severe depression benefit from antidepressants, says research
published in the Journal of the American Medical Assn. Others do better with
nonmedical approaches.
By Shari Roan
January 6, 2010
<http://www.latimes.com/news/nationworld/nation/
la-sci-depression6-2010jan06,0,4335963.story?track=rss>
A shorter URL for the above link:
<http://tinyurl.com/yh2pmh6>
The current analysis attempted to quantify how much of antidepressants' benefit
is attributable to chemical effects on the brain and how much can be explained
by other factors, such as visiting a doctor, taking action to feel better or
merely the passage of time.
Researchers reviewed six randomized, placebo-controlled studies with a total of
718 patients who took either an antidepressant or placebo. The patients were
adults with levels of depression ranging from mild to very severe based on the
Hamilton Depression Rating Scale, a questionnaire widely used in depression
research. The studies did not exclude patients who were likely to have a strong
response to a placebo. Researchers then compared the patients' depression
scores at the beginning of treatment with those after at least six weeks of
treatment.
The study found that the magnitude of the drugs' benefit increased with the
baseline level of depression. The effect of treatment was similar in people
with mild, moderate and severe symptoms, regardless of whether they took an
antidepressant or placebo. Only the people who rated very severe on the
depression scale at the start of the study showed measurable improvements on
antidepressants.
"There is no doubt that there are tremendous benefits from antidepressants, as
our study showed," DeRubeis said. "But this study helps us resolve, to some
degree, the question of how much benefit people can expect from the medicines
themselves when symptoms are not severe."
Other research has also found that antidepressants are most effective for
severe symptoms, said Dr. Philip Wang, deputy director of the National
Institute of Mental Health.
Milder depression may not respond to antidepressants
By Anne Harding, Health.com
January 6, 2010 11:43 a.m. EST
CNN Health
<http://www.cnn.com/2010/HEALTH/01/06/mild.depression.antidepressants/>
Fournier and his colleagues looked at 2,164 clinical trials of antidepressants
in all, but they ultimately excluded all but six from their analysis for a
variety of reasons -- because they weren't placebo-controlled or were shorter
than six weeks long, for instance.
The researchers found that, on average, the benefits of antidepressants over
placebo were "minimal or nonexistent" in people whose depression was less than
"very severe" according to American Psychiatric Association guidelines. Even
people with "severe" depression"-- which is one step below "very severe" --did
not experience a significant effect from antidepressants compared to placebo,
the study reports.
"It's a very well done paper in a top journal, and they're raising a serious
question," says Hellerstein. But, he says, the findings aren't comprehensive
enough to indicate whether doctors should continue to prescribe antidepressants
to people with mild or moderate depressive symptoms.
Health.com: Should you take antidepressants?
The drugs included in the study are rarely used as first-line treatments today,
Hellerstein says, and two of the imipramine studies included in the analysis
used a low dose. In addition, he says, the longest study Fournier and his team
included lasted 11 weeks; some drugs take longer than that to produce their
full effect, whereas the placebo effect is strongest in the first few weeks of
treatment.
Both Hellerstein and Fournier also point out that the patients in the placebo
arm of the studies received attention and care in addition to a fake pill. They
were assessed regularly, talked about their symptoms with a professional, and
received physical and psychiatric exams -- all of which could have been
therapeutic for people who may have been isolated, suffering in silence, or
dragging themselves to work every day.
"It seems like that, in and of itself, provided some benefit for
Media contact Jordan Reese 215-573-6604 jreese@xxxxxxxxx
Penn Study Shows Antidepressants Work Best for Severe Depression, Provide
Little to No Benefit Otherwise
January 05, 2010
University of Pennsylvania
Office of University Communications
<http://www.upenn.edu/pennnews/article.php?id=1791>
PHILADELPHIA - A study of 30 years of antidepressant-drug treatment data
published today in the Journal of the American Medical Association shows that
the benefit of antidepressant medication compared with placebo may be minimal
or nonexistent in patients with mild or moderate symptoms. University of
Pennsylvania researchers say, however, the benefit of medications is
substantial for patients with very severe depression.
Ultimately, according to the study, the majority of patients who were
prescribed antidepressants did not suffer from a severity of depression that
would be improved by the medications.
The research team, led by psychologists at Penn, analyzed data from studies
that spanned a 30-year period to gauge the benefit of antidepressant medication
compared to placebo pills across a range of patients with varying degrees of
depression. The team collected data from placebo-controlled trials of
antidepressants approved by the U.S. Food and Drug Administration for the
treatment of Major or Minor Depressive Disorder. Studies comprised adult
outpatients and included a medication vs. placebo comparison for at least six
weeks. Researchers calculated depression severity scores before and after
treatment using the standard Hamilton Rating Scale for Depression.
<snip>
The results imply that doctors who are advising treatment for patients with
mild or moderate cases of depression should consider the lack of evidence for
specific benefits of the medications and compare the expected costs and
benefits of the medications against alternatives such as self-help, exercise or
psychological therapy.
THE STUDY CITATION
Antidepressant Drug Effects and Depression Severity
A Patient-Level Meta-analysis
Jay C. Fournier, MA; Robert J. DeRubeis, PhD; Steven D. Hollon, PhD; Sona
Dimidjian, PhD; Jay D. Amsterdam, MD; Richard C. Shelton, MD; Jan Fawcett, MD
JAMA. 2010;303(1):47-53.
Context Antidepressant medications represent the best established treatment
for major depressive disorder, but there is little evidence that they have a
specific pharmacological effect relative to pill placebo for patients with less
severe depression.
Objective To estimate the relative benefit of medication vs placebo across a
wide range of initial symptom severity in patients diagnosed with depression.
Data Sources PubMed, PsycINFO, and the Cochrane Library databases were
searched from January 1980 through March 2009, along with references from
meta-analyses and reviews.
<http://jama.ama-assn.org/cgi/content/full/303/1/47?home>
Full Text: This is a fee based subscription publication.
Find in a Library:
JAMA : the journal of the American Medical Association.
Author: American Medical Association.
Publisher: Chicago : American Medical Association, 1960-
<http://www.worldcat.org/oclc/1124917&referer=brief_results>
----------------------------------------------
The complete articles may be read at the URLs provided for each.
WEBBIB0910
Sincerely,
David Dillard
Temple University
(215) 204 - 4584
jwne@xxxxxxxxxx
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