Efficacy of antidepressants in adults

doi:10.1136/bmj.331.7509.155

BMJ 2005;331:155-157 (16 July), doi:10.1136/bmj.331.7509.155

Education and debate

Efficacy of antidepressants in adults

Joanna Moncrieff, senior lecturer in social and community psychiatry¹, Irving Kirsch, professor of psychology²

¹ Department of Mental Health Sciences, University College London, London W1N 8AA, ² School of Health and Social work, University of Plymouth, Plymouth

Correspondence to: J Moncrieff j.moncrieff@ucl.ac.uk

Most people with depression are initially treated with antidepressants.But how well do the data support their use, and should we reconsiderour strategy?

The first 150 words of the full text of this article appear below.

Introduction

The National Institute for Health and Clinical Excellence (NICE)recently recommended that antidepressants, in particular selectiveserotonin reuptake inhibitors, should be first line treatmentfor moderate or severe depression.¹ This conclusion has broadlybeen accepted as valid.² The message is essentially the sameas that of the Defeat Depression Campaign in the early 1990s,which probably contributed to the 253% rise in antidepressantprescribing in 10 years.¹ From our involvement in commentingon the evidence base for the guideline we believe these recommendationsignore NICE data. The continuing concern that selective serotoninreuptake inhibitors may increase the risk of suicidal behaviour^w1w2 means there needs to be further consideration of evidencefor the efficacy of antidepressants in adults as there has beenin children.

Efficacy

Although the NICE meta-analysis of placebo controlled trialsof selective serotonin reuptake inhibitors found significantdifferences in levels of symptoms, these were so small thatthe effects . . . [Full text of this article]

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Severity of depression

Methodological issues in antidepressant trials

Effect of antidepressants

Conclusions

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Hit parade
BMJ 2005 331: 462. [Extract] [Full Text]

Re-examining SSRIs for depression
BMJ 2005 331: 0. [Full Text]

Why stop at antidepressants?: Simon Hatcher
BMJ 2005 331: 158. [Extract] [Full Text] [PDF]

NICE guidelines for the management of depression: Hugh Middleton, Ian Shaw, Sally Hull, and Gene Feder
BMJ 2005 330: 267-268. [Extract] [Full Text] [PDF]

Evidence b(i)ased medicine—selective reporting from studies sponsored by pharmaceutical industry: review of studies in new drug applications: Hans Melander, Jane Ahlqvist-Rastad, Gertie Meijer, and Björn Beermann
BMJ 2003 326: 1171-1173. [Abstract] [Full Text] [PDF]

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RE: Efficacy of antidepressants in adults - Moncrieff J, Kirsch I. Efficacy of antidepressants in adults. BMJ 2005;331(7509):155-7: Frederic M. Quitkin, et al.
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