Education And Debate

Benefits of new drugs are exaggerated

BMJ 1994; 309 doi: (Published 12 November 1994) Cite this as: BMJ 1994;309:1281
  1. D Owens
  1. Division of Psychiatry and Behavioural Sciences, Leeds University, Leeds LS2 9LT.

    Lately there has been a good deal of clamour from those who think that the recent additions to the antidepressant drug list known as selective serotonin reuptake inhibitors (fluoxetine, fluvoxamine, paroxetine and sertraline) should replace older, largely tricyclic, antidepressant drugs as the treatment of choice for depressive illness. How strong is their case?


    Randomised trials have shown the new drugs to be more effective than placebo, but the debate is about trials comparing serotonin reuptake inhibitors with tricyclic antidepressants. Selected studies have found greater recovery with serotonin reuptake inhibitors and are widely quoted by enthusiasts. However, several influential reviews have concluded that efficacy is about equal.*RF 1-3* A recent systematic review of 64 randomised controlled trials comparing serotonin reuptake inhibitors with established antidepressant drugs found similar benefit from new and old treatments; where data could be pooled in a meta-analysis no clear difference was found.4

    Because the treatment trials have mainly examined depression in primary care, specialists may be premature to count on equal effectiveness when treating patients referred to clinics and hospitals. Interest is shifting towards other clinical situations and we will soon be (or already are being) treated to claims that serotonin reuptake inhibitors are ideal for severe depression, resistant depression, continuing treatment, prophylaxis, and so on. In view of the lack of extra benefit so far shown, canny clinicians will …

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