New research examines antidepressant efficacy

Evelyn Lewin

23/07/2019 4:04:19 PM

A new paper questions previous findings that antidepressants are more efficacious than placebo for adults with major depressive disorder.

Antidepressant efficacy.
‘Depression care is complex and not all treatments work for everybody’: Dr Caroline Johnson

Depression is a prevalent mental health illness, affecting around one million Australians in any one year.
Taking antidepressants is also common, with the Australian Bureau of Statistics finding there were 1.7 million people (7.8% of the population) who had at least one Pharmaceutical Benefits Scheme (PBS)-subsidised prescription for antidepressant medication filled in 2011.
However, a new paper led by Danish psychiatrist Dr Klaus Munkholm and published in BMJ Open has questioned their efficacy.
Specifically, Dr Munkholm’s research assessed a previous paper published in The Lancet, led by Dr Andrea Cipriani, which compared the performance of 21 antidepressants. That analysis, the largest of its kind involving 522 trials and 116,477 participants, concluded ‘all antidepressants were more efficacious than placebo in adults with major depressive disorder’.
But despite accompanying widespread coverage claiming the study absolved ‘any doubts’ regarding the efficacy of antidepressants, Dr Munkholm expressed doubts, including that the original paper did not address biases in the data.
It is these supposed biases – including publication bias – which the most recent research has explored in an effort to provide a ‘more comprehensive’ assessment.
It found the evidence does not support definitive conclusions regarding the benefits of antidepressants for depression in adults, and stated it is unclear whether antidepressants are more efficacious than placebo.
Dr Caroline Johnson, a GP and Senior Lecturer in General Practice at the University of Melbourne, told newsGP while it’s ‘well known’ antidepressants don’t work for everyone and that the placebo response is high, most GPs accept antidepressants have a role to play for many patients.
She also believes while the paper should help GPs guide patients with regard to treatment options, the results of trials into treating depression don’t necessarily translate well to clinical practice.
‘These trials are talking about [treatment for] depression and the world we work in in “GP-land” is much messier than the world of a randomised controlled trial,’ she said.
‘It’s another bit of evidence that reminds us we should be careful in how we communicate to patients the benefits of antidepressants, and I think GPs already do this.
‘We need to get that delicate balance of giving patients hope and helping them realise medication is not a “magic bullet” for most people … [it] is part of the picture but there are many other things that they need to be doing as well.’
However, Dr Johnson hopes this new paper doesn’t lead to unintended consequences.
‘Depression care is complex … not all treatments work for everybody but also not all treatments work on their own and GPs do have experience in trying combinations of pharmacological and non-pharmacological therapies,’ she said.
‘It’s really important that patients don’t just suddenly stop their antidepressants because they read this in the media.’
Another concern is that it could deter patients from seeking help altogether, as they might interpret the findings as saying that antidepressants are of no benefit.
‘As GPs … you need to provide patients with hope that depression is treatable, because it is,’ she said.
‘But you also need to provide clear advice that picking the right antidepressant is complex; that they don’t work for everybody and that there are lots of other things that might work just as well, but sometimes we only know that by trial and error.
‘Your job as a GP is to help the patient make an informed decision about what path they want to take and support them over time to find the solution that works best for that individual.’

Antidepressants Depression Mental health Mental illness

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