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Jan 28, 2009 07:50 PM | 12
The glut of antidepressant drugs on the market and the ads for them may have you – not to mention doctors – wondering how to tell one from the other. But a new study sheds light on which ones may be most effective in battling the blues.
Topping the list of a dozen prescription antidepressants reviewed: Zoloft and Lexapro. Patients taking those drugs in trials were also the least likely to drop out. But because Zoloft, made by New York-based Pfizer, is now off patent and available in relatively cheap, generic form, it may be the better choice for patients starting antidepressant therapy, write authors of the study published today in The Lancet, who are from Italy, Greece, England and Japan.
The scientists reviewed 117 randomized trials – testing "new generation" meds called serotonin-reuptake inhibitors (SSRIs) that enhance the effect of that brain chemical – conducted between 1991 and 2007. The trials involved nearly 26,000 people, two-thirds of them women. Their findings: eight to 69 percent of patients in the trials responded to Zoloft and 51 percent to 69 percent of them responded to Lexapro, which is made by Forest Pharmaceuticals in New York. (The study of Zoloft with an 8 percent response rate was small and unusual; most studies showed more than a 50 percent response.)
Reboxetine, a Pfizer antidepressant not approved for use in the U.S., was the least effective, with 49 percent to 56 percent responding to it, according to the analysis.
"We have not had a chance to review this study, so it would be inappropriate for us to comment at this time," Pfizer spokesperson Chris Loder told ScientificAmerican.com.
The comparisons are "a new gold standard of reliable information" for doctors prescribing the meds and the patients taking them, writes. Sagar Parikh, a psychiatry professor at the University of Toronto in a commentary accompanying the study.
"They're all at least moderately effective, so how do you choose? Rather than saying everything is equal [when] in fact everything is not equal, you can now tell the patient, 'Here are a few that are the best in terms of strength, and here are the ones that are lightest in terms of side effects," Parikh tells ScientificAmerican.com. "Are you more worried about side effects and willing to sacrifice the potential power of the drug if it's easier on you?' Those who want the ones that are a bit more powerful, they can use this information to choose that."
The trials each lasted an average of eight weeks; most people take the drugs for six months to a year, Parikh notes The study did not examine withdrawal from the drugs.
Nonetheless, Parikh says the analysis is important because it was done without the financial backing of pharmaceutical companies, although a number of the authors have received funding from such companies in the past. The researchers also used statistical methods to take into account the problem of "positive publication bias," the tendency of drug-makers to publish and release only studies that show favorable results for their products. In addition, he says, the review also compared studies that used similar doses.
An estimated 15 million Americans suffer from major depression, according to the National Alliance on Mental Illness (NAMI). (In a 2007 book, sociology and social worker professors questioned whether depression is over-diagnosed.) Some 118 million antidepressant prescriptions were written during U.S. hospital and doctor's office visits in 2005 according to a 2007 Centers for Disease Control and Prevention (CDC) report.
Photo © iStockphoto/Randolph Pamphrey
Tags:
depression,
zoloft,
psychiatry,
paxil,
ssri,
antidepressants
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12 Comments
Add CommentAntidepressants are only a bandaid in dealing with depression, and a poor one at that. They come with dangerous side effects. The only way to overcome depression is by getting to the source of where the depression started in the first place, together with rebuilding the body and brain chemistry with proper nutrition.
Reply | Report Abuse | Link to thisAmericans suffer more from depression and anxiety because of poor social networks, over worked (compared to other Western Societies), dehumanizing conditions, and a poltitcal arena that uses fear as motivation.......Hence, once seen as a beacon of hope and inspiration, is now second or lower on the choice list of immigrants.
Reply | Report Abuse | Link to thisI was disappointed to see that the placebo data were not included in this article. For instance, this PLoS study (http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050045#s4) found not much benefit from the SSRIs above what placebos do, except in the most severely depressed who, as a group, don't respond to placebo.
Reply | Report Abuse | Link to thisI don't know whether to laugh or cry when someone attributes serious and chronic depression to diet. This isn't about the downer one gets from sugar or alcohol. My family members have suffered with this long before there were food additives, money to spend on too much sugar, and they weren't drinking when they were growing up. Today I have been again spending the day trying to accomplish something and getting nowhere. It's hard to be productive (understatement) in a manner expected by others, such as employers. As usual I have been alternating between brief periods of dizziness while sitting still, a constant fight to attend to words, a constant fight to not lose the hours of the day, and crying episodes that just pop up. Trying to harness and direct my purpose and thoughts is like herding cats. I say this with three degrees in applied psychology - never completed in someone's idea of a good timeline. Medications reign in the chaos, but they are my no means a cure. I have given up the love of my life, 30 years ago, to ensure this type of torture was not passed on to that wonderful man's kids; he so wanted a family, and he was healthy. Exit left. Medications are not a cure. Diet, aside from attending to the obvious issues, is laughable. This is a chemical wash that just constantly comes and goes over me on its own.
Reply | Report Abuse | Link to thisI wish we had a better way to look into it. Most sites you review will state that the drug is significantly (or statistically) greater improvement compared to placebo. Here is the fascinating thing - its not as significant as I would have guessed. For example in Lexapro, one study shows that 49% of the users respond.( just to compare - response rate of infections to Penicillin is more like 85%) In the same study 28% of the placebo users responded. So, do we assume that probably only about 21% really responded due to the Lexapro? Nope. That can't be presumed either.
Reply | Report Abuse | Link to thisAlso, because we are not talking about an objective test of whether or not something is true or false we can't even state that the "improvement" truly exists. (as a comparison - we know if someone still has the infection because we can objectively test their blood)
We diagnose depression by asking questions and having folks rate their feelings. But on any given day people who are clinically depressed may be feeling better or worse than any other given day and the only way to account for that is with statistical assumptions. And like all assumptions - are entirely the perspective of the person doing the assuming. In this case the person running the test.
And lets discuss the expectation influence of both the tester in asking/recording the questions and the patient when responding to the diagnostic questions. Your assumptions about the expected outcome shape the way you view the world and how you behave. Or in this case answer questions.
The folks who pay for the tests are hoping for positive test results. The folks who give the tests are hoping for positive test results. The folks who are taking the meds are hoping for positive test results.....
And yet still the results are not so spectacular.
And finally - this always mentioned and never really explored disclosure....Most of the studies are of short-term duration - usually 8 weeks. But sometimes they go really wild and do 16 weeks. The few studies that do look into long term results show significant drops in responses.
I am just saying....
The drugs aren't working so well. The placebos are working amazingly well though.
Don't take my Lexapro away!
Reply | Report Abuse | Link to thisI recently saw a NYT story about drug company illegal marketing of Prozac "look alikes" like Lexapro and then just came across this blog comment. I am compelled to add my personal experience to the conversation.
I now understand that I spent years treating depression -- with alcohol, street drugs, sobriety, counseling, diet, exercise, divorce; and then after considering that my problem might be depression with light therapy and finally antidepressants.
Anyway one happy day 17 years ago I was startled to notice that I had been driving home for the last 2 days without weighing the pros and cons of suicide! and without crying! I had just started taking Prozac but was not expecting any result for a couple of weeks yet. I hadn't "felt" anything -- not queezy, buzzed or spacy. The suicidal thoughts just hadn't occured to me. What a relief!
I had that relief as long as I took the Prozac as prescribed -- (there were a couple of times when I felt so normal I'd ease out of it but then would resume after a crisis of suicidal thinking). But after about 3 years I began acting with what is now called extreme social anxiety. In order to finish the last semester of college I quit Prozac and used counselling and the help of my new husband to beat off the suicidal thinking. It was exhausting work for both of us.
After several weeks my doc put me on Serazone, and that worked great for about 4 years until they found it adversly impacted liver function and I was switched to Lexapro.
Lexapro has been great now for about 10 years (except for lowered libedo) and the couple of times we did a "trial withdrawl" the suicidal thinking would creep back in eventually. So I accepted having to take a pill. Now I just enjoy having a nice life.
As far as drug trials go, I know they are tricky to intrepret, but I hope the powers that be don't start to "pile on" before someone does a comprehensive double blind test. My guess is that they would find that there are differences amoung the antidepressants. And they might be genetic -- my 40 year old daughter has found that Lexapro is the only thing that works for her.
Tina,
Reply | Report Abuse | Link to thisI hope no one takes away your Lexapro. I am all for what works for you. My frustration comes from 20 years of trying a variety of drugs and finding little to no improvement. My current cocktail is expensive and scary. And I am starting to question the relevance of the drugs to my situation.
I do agree that it is probably individual and so what works for one persons situation does not work for another.
There are lots of people who are helped by the drugs. And I have actually heard a great many positive feedback stories on people who have been diagnosed with social anxiety disorder.
I wish they could map the physiological structure of these issues. I think it would help so much more.
Good Life to you and your daughter.
It is a major concern to think that the study results are effected by the pharmaceutical companies financial backbone. I have learned that not only are patients not aware of the procedure in getting these drugs approved but know very little of the dangerous side effects to be considered before choosing an antidepressant dependacy lifestyle.
Reply | Report Abuse | Link to thisPatients need to take some responsibility to do a little research before accepting this type of treatment plan. Pharmaceutical companies have alot of monetary persuasion tactics and doctors are reliant on what these companies are feeding them. It is also a challenge to get your hands on the necessary resources to make an educated decision. From my own recent research, I have come to the conclusion that these drugs have little efficacy and a huge number of dangerous side effects that I would not be willing to take the risk, but take the alternative routes that are out there instead.
about 4-6 years ago, I would have disagreed with you, but now I am clearly seeing your point. I was slightly overweight, but still good looking. Had an old depression creep up on me and slowly start to eat away at my productivity. I went to therapy, found the roots of the depression. Within the next 4 years I exercised vigorously with a personal trainer 3x a week, ate only healthy foods. Got my body fat to less than 10%. Got a great job that I absolutely love and is rewarding(I teach digital artists), have lots of friends and relationships that are nurturing.... But... It didn't stop the depression. Puzzling to me, I thought. I took care of almost every reason WHY I would be depressed and it did nothing to alleviate it.. That is when I came to the conclusion that it MUST be chemically related. I haven't started any antidepressants out of fear.(2 family members and a good friend took Prozac and they lost their minds for a long time before recovering, one even went psychotic for a bit.)
Reply | Report Abuse | Link to thisMy point being is that if you come from a good family and healthy childhood, you could never understand just how damaging early childhood neglect and abuse can be to an adult's life(I'm 35). Simply being healthy is NOT going to cut it.
One just read an abc.com article about how none of the newer antidepressants work. Then there is other information stating that older antidepressants are more proven to be effective. Then this study puts two newer antidepressants at the top altogether. It's crazy. Zoloft and Lexapro belong to the group of newer 'sugar pills'. The whole theory they're based on is a joke. This is why they far from know how to treat the condition.
Reply | Report Abuse | Link to thisI am the first to say that antidepressant pills or SSRI's are thrown around without, what seems to be, any sufficient reason to take them. From all the side effects that have been discussed already, I read an article on CNN about the connection with Zoloft and children born with Autism. It is devastating to hear that medications are being prescribe to pregnant women with the risk of having a child permanently damage by something that could’ve been avoided by the doctor. It shouldn’t be the first solution the doctors suggest.
Reply | Report Abuse | Link to thisI am the first to say that antidepressant pills or SSRI's are thrown around without, what seems to be, any sufficient reason to take them. From all the side effects that have been discussed already, I read an article on CNN about the connection with Zoloft and children born with Autism. It is devastating to hear that medications are being prescribe to pregnant women with the risk of having a child permanently damage by something that could’ve been avoided by the doctor. It shouldn’t be the first solution the doctors suggest. I would suggest that if any ones family has been affected in this way because of the antidepressant that was prescribed to them to contact his firm at 1-855-Zoloft1.
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