Drug treatment for generalised anxiety disorder
BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d1216 (Published 11 March 2011) Cite this as: BMJ 2011;342:d1216
All rapid responses
Dear Editor,
I read with interest Baldwin and colleagues' meta-analysis on
pharmacotherapy for generalised anxiety disorder, and the excellent
editorial by Prof Furukawa that accompanied it.1 2 Despite the excellent
methodological critique, it is both worrying and disappointing that one of
the ways to discover evidence for efficacy/superiority of a treatment is
to use "newer" sophisticated statistical techniques to analyse the
existing data.
Consider this hypothetical question I am trying to answer - Am I a
better shooter than the current Olympic champion? In order to answer this
question, I indulge in a head to head competition with the champion in the
1000 yard free rifle category. There are many strategies I could utilise
to increase my chance of hitting the target. I could increase the number
of attempts, I could move closer to the target, or even better, I could
use a canon with guided missiles to hit the target. All of the above would
increase my chances of hitting the target, but none of them imply I am a
better shooter than the champion.
In view of the fact that pharmaceutical industries are reluctant to
invest in "neuropsychiatry", we are probably too late to search for newer
treatments. 3 May be its time to stop asking the question "which", and
start asking the question "why". For example, "Why" is there a difference
in treatment effects even between medications from the same class? "Why"
do some people not respond even to the treatment with the best evidence?
This seems to be a better way forward, rather than finding newer ways to
analyse data to demonstrate evidence.
References
1. Baldwin D, Woods R, Lawson R, Taylor D. Efficacy of drug
treatments for generalised anxiety disorder: systematic review and meta-
analysis. BMJ (Clinical research ed;342:d1199.
2. Furukawa TA. Drug treatment for generalised anxiety disorder. BMJ
(Clinical research ed;342:d1216.
3. Nierenberg AA. The perfect storm: CNS drug development in trouble.
CNS spectrums;15(5):282-3.
Competing interests: No competing interests
Re:Drug treatments for generalised anxiety disorder - are we asking the right questions?
I am very surprsied that you chose to publish this "research". Being
funded by Lundbeck one presumes that they chose the drugs to be compared.
It suggests that Escitalopram is a reasonable choice but it does not include
comparison with citalopram.
Escitolpram is the S-enantiomer of the antidepressant citalopram, a
selective serotonin reuptake inhibitor (SSRI). Citalopram is a racemic
mixture of R and S-enantiomers in a 1:1 ratio. Studies have demonstrated
that the antidepressant activity of citalopram resides in the S-
enantiomer.
I predict the company will be using this paper to get doctors to
prescribe their expensive patented drug instead of the virtually identical
and very much cheaper generic.
It will make the life of those of us who advise doctors on cost
effective prescribing that much more difficult
Competing interests: No competing interests