| Authors | Herxheimer A, Mintzes B |
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| Source | Canadian Medical Association Journal. 2004 February 17;170(4):487-489. |
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| Abstract | Family physicians are repeatedly told that depression is underrecognized in patients of all ages and that lack of treatment can lead to serious harm. Selective serotonin reuptake inhibitors (SSRIs) and other, newer, antidepressants have been regarded as the treatment of choice in primary care, and inadequate reimbursement for non-drug alternatives such as cognitive and behavioural therapy has left little room for alternatives. It is understandable, then, that prescribers and parents in the United Kingdom were dismayed by a recent warning from their national regulatory body (the Medicines and Healthcare products Regulatory Agency) that SSRIs are largely ineffective in the treatment of major depression in children and adolescents and can cause suicidal behaviour and self-harm. This warning is disturbing it itself, but it also leads to the question, Why did it take so long to discover this lack of benefit and potential for harm?
Part of the answer lies in the gap that exists between the quality of evidence needed to get a drug to market and the actual treatment needs of patients. A first episode of major depressive disorder typically lasts 7 to 9 months, and recurrence is common. However, the duration of most randomized controlled trials of antidepressants before marketing is only 6 to 8 weeks. One key measured outcome is a change in the patient's score on a physician-administered questionnaire such as the Hamilton Depression Rating Scale (HAM-D). Such scales combine many different outcomes, and it is rarely clear from trial reports in exactly what ways patients felt better or worse. The HAM-D scale uses a single question to assess suicide risk, a measure that David Healy has roundly criticized as inadequate. Further, in published studies, adverse drug reaction (ADR) reporting is often cursory. |
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| Code | CHSPR 04:03R |
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