Fight! The ethics of antidepressant use.

fight

The age old debate over antidepressant use rolls on this week with the publication of a new provisional review by Davis et al in the Philosophy, Ethics, and Humanities in Medicine journal.  They are responding to the Ioannidis paper from 2008: Effectiveness of antidepressants; an evidence based myth constructed from a thousand controlled trials, which concluded that:

There is no reason to take antidepressants, they probably won’t work.

Davis et al disagree with Ioannidis’ key ascertion that antidepressants have no greater efficacy than placebo:

We present the efficacy from hundreds of trials in terms of the percentage of patients with a substantial clinical response (a 50% improvement or more symptomatic reduction). This meta-analysis finds that 42-70% of depressed patients improve with drug and 21%-39% improve with placebo. The response benefit of antidepressant treatment is 33%-11% greater than placebo.

They go on to conclude:

We find no empirical or ethical reason why psychiatrists should not try to help depressed patients with drugs and/or with psychotherapeutic/ behavioral treatments given evidence of efficacy even though our treatment knowledge has limitations.

This debate is not going to disappear any time soon.

Links

Davis JM, Giakas WJ, Que J, Passad P, Leucht S. Should We Treat Depression with drugs or psychological interventions? A Reply to Ioannidis. Philos Ethics Humanit Med. 2011 May 10;6(1):8.

John PA Ioannidis. Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials? Philos Ethics Humanit Med. 2008; 3: 14. Published online 2008 May 27. doi: 10.1186/1747-5341-3-14.

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Andre Tomlin

Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol with his wife, dog and three little elflings.

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