New anti-depressants have little clinical benefit for most
patients, research suggests.
A University of Hull team concluded the drugs actively help only a
small group of the most severely depressed.
Marjorie Wallace, head of the mental health charity Sane, said that
if these results were confirmed they could be "very disturbing".
But the makers of Prozac and Seroxat, two of the commonest
anti-depressants, said they disagreed with the findings.
A spokesman for GlaxoSmithKline, which makes Seroxat, said the
study only looked at a "small subset of the total data available".
And Eli Lilly, which makes Prozac, said that "extensive scientific
and medical experience has demonstrated it is an effective
anti-depressant".
Patients are advised not to stop taking their medication without
first consulting a doctor.
The researchers accept many people believe the drugs do work for
them, but argue that could be a placebo effect - people feel better
simply because they are taking a medication which they think will help
them.
In total, the Hull team, who published their findings in the
journal PLoS Medicine, reviewed data on 47 clinical trials.
They reviewed published clinical trial data, and unpublished data
secured under Freedom of Information legislation.
They focused on drugs which work by increasing levels of the mood
controlling chemical serotonin in the brain.
These included fluoxetine (Prozac) and paroxetine (Seroxat), from
the class known as Selective Serotonin Reuptake Inhibitors (SSRIs),
alongside another similar drug called venlafaxine (Efexor) - all
commonly prescribed in the UK.
The number of prescriptions for anti-depressants hit a record high
of more than 31 million in England in 2006 - even though official
guidance stresses they should not be a first line treatment for mild
depression.
There were 16.2m prescriptions for SSRIs alone.
The researchers found that even the positive effects seen on
severely depressed patients were relatively small, and open to
interpretation.
The seemingly good result was based more on the fact that the dummy
placebo pills produced less of an effect in these patients, rather
than on any notable positive response to the anti-depressants
themselves.
Lead researcher Professor Irving Kirsch said: "The difference in
improvement between patients taking placebos and patients taking
anti-depressants is not very great.
"This means that depressed people can improve without chemical
treatments.
"Given these results, there seems little reason to prescribe
anti-depressant medication to any but the most severely depressed
patients, unless alternative treatments have failed to provide a
benefit."
Professor Kirsch said the findings called into question the current
system of reporting drug trials.
Dr Tim Kendall, deputy director of the Royal College of
Psychiatrists Research Unit, has published research concluding that
drug companies tend only to publish research which shows their
products in a good light.
He said the Hull findings undermined confidence in the ability to
draw meaningful conclusions about the merit of drugs based on
published data alone. He called for drug companies to be forced to
publish all their data.
The National Institute for Health and Clinical Excellence (NICE) is
currently reviewing its guidance on the use of antidepressants.
Marjorie Wallace of Sane commented: "If these results were upheld
in further studies, they would be very disturbing.
"The newer anti-depressants were the great hope for the future....
These findings could remove what has been seen as a vital choice for
thousands in treating what can be a life-threatening condition."
Dr Richard Tiner, of the Association of the British Pharmaceutical
Industry, said there was no doubt that was a "considerable placebo
effect" from anti-depressants when treating people with mild to
moderate symptoms.But he said no medicine would get a licence without
demonstrating it was better than a placebo.
Dr Tiner said: "These medicines have been licensed by a number of
regulatory authorities around the world, who looking at all the
evidence, have determined that they do work better than placebo."
Alan Johnson, the Health Secretary, has announced that 3,600
therapists are to be trained during the next three years in England to
increase patient access to talking therapies, which ministers see as a
better alternative to drugs.