Intended for healthcare professionals

Rapid response to:

Practice Therapeutics

Initial drug treatment in Parkinson’s disease

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4669 (Published 18 September 2015) Cite this as: BMJ 2015;351:h4669
Symptomatic treatment of Parkinson’s disease infographic
Click for an interactive graphic, showing more treatments for initial management of Parkinson’s disease.

Rapid Response:

Reboxetine and MAO-B inhibitors

Dear Madam

Muzerengi and Clarke are correct to advise against use of most antidepressants in combination with the monoamine oxidase B inhibitors, Rasagiline and Selegiline (1). But it is unhelpful to state that Reboxetine can be used instead, because it is a drug that has no therapeutic effect whatsoever (2).

It is five years since a meta-analysis including unpublished trials proved that the "antidepressant" Reboxetine does not work (2). Yet, scandalously, the drug remains licensed in the United Kingdom (3) and elsewhere for treatment of depressive disorder. British guidance recommending Reboxetine (4), quoted in good faith by the authors, has never been amended. Patients continue to be exposed to its adverse effects whilst their illnesses go untreated.

It is not time for Reboxetine and all other debunked treatments to be delicensed?

I beg to remain, Madam, your most obedient servant,

Dr Richard Braithwaite
Consultant Psychiatrist

Isle of Wight NHS Trust
St Mary's Hospital
Newport
Isle of Wight
PO30 5TG

Muzerengi S, Clarke CE. Initial drug treatment in Parkinson’s disease. BMJ 2015; 351 :h4669
Eyding D, Lelgemann M, Grouven U, Härter M, Kromp M, Kaiser T, Kerekes MF, Gerken M, Wieseler B. Reboxetine for acute treatment of major depression: systematic review and meta-analysis of published and unpublished placebo and selective serotonin reuptake inhibitor controlled trials. BMJ 2010;341:c4737
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com [Accessed on 10 October 2015]
National Institute for Health and Care Excellence. Depression in adults with a chronic physical health problem: treatment and management. 2009. www.nice.org.uk/guidance/cg91 [Accessed on 10 October 2015]

Competing interests: No competing interests

10 October 2015
Richard Braithwaite
Consultant Psychiatrist
Isle of Wight NHS Trust
St Mary's Hospital, Newport, Isle of Wight PO30 5TG