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Large meta-analysis ends doubts about efficacy of antidepressants

BMJ 2018; 360 doi: (Published 22 February 2018) Cite this as: BMJ 2018;360:k847

Rapid Response:

Antidepressants are still over prescribed!

I guess I am naturally skeptical. I have read this meta-analysis and its conclusion. Its conclusion is that in major Depressive illness antidepressants seem to work better than placebo by about 50% (the CIs are wide). This is hardly new, and a Cochrane review came to the same conclusion in 2009.[1]

The point is this. The average follow up is only 8-12 weeks, yet we have patients taking these for decades. What is the natural resolution of Depression? Why in this paper is there no mention of NNTs, just odds ratios?

It seems likely to be the same as before at around 9. [1] Therefore the vast majority of people being prescribed antidepressants do not benefit.

Also this is major depressive illness not typical of primary care. But medication will be prescribed in less severe cases without good evidence of benefit. Talk based treatments work better and should be first line. The problems linked to antidepressants are much higher than are reported. [2] Where is the research on long term data of efficacy and safety of antidepressants?

The suggestion from the authors that we should prescribe more antidepressants is simply wrong and not supported by the evidence.

[1] Arroll B, Elley CR, Fishman T, et al. (2009) Antidepressants versus placebo for depression in primary care. Cochrane Database Syst Rev (3):CD007954.

Competing interests: No competing interests

22 February 2018
Des Spence
General Practice
Maryhill , Glasgow