MONDAY, Nov. 17, 2008 (Health.com) — If you are feeling depressed and your physician says she knows just the medication to help you, don’t take her word for it.
There is no evidence to suggest that one antidepressant is more effective than another at making you feel better, according to new guidelines released Monday by the American College of Physicians (ACP). Cost and side effects do vary, however, and should play a role when choosing a medication.
The guidelines were based on an analysis—the largest of its kind to date—of more than 200 clinical trials of antidepressants that have flooded the market since the release of fluoxetine (Prozac) more than 20 years ago.
Antidepressants are among the most widely prescribed drugs in the United States and include selective serotonin-reuptake inhibitors (SSRIs) like fluoxetine, sertraline (Zoloft), and paroxetine (Paxil), as well as other drugs, such as bupropion (Wellbutrin) and citalopram (Celexa).
“The available evidence shows no clinical difference in the efficacy of these second-generation antidepressants,” says Amir Qaseem, MD, PhD, the lead author of the guidelines and a senior medical associate with the ACP. “Medication A is the same as Medication B. You can’t really say that one is better than the other.”
The most common side effects of each medication do vary significantly, however, as do the cost of the drugs.
Venlafaxine (also known by its brand name, Effexor) appears more likely to cause nausea than SSRIs, for instance, while paroxetine tends to result in more weight gain than other drugs. Doctors should forgo predicting which medication is most likely to work for any given patient, and should instead discuss the side effects that patients are able (and willing) to tolerate and what their budgets will allow, the guidelines say.
In addition to factoring in cost and side effects, the guidelines also recommend that doctors:
- Change or modify treatment if a patient doesn’t respond within six to eight weeks.
- Monitor patients regularly beginning one to two weeks after they start a drug, to make sure it’s working and to check for side effects. The U.S. Food and Drug Administration recommends close monitoring for suicidal thoughts and attempts, as the risk is higher in the first couple of months.
- Treat first-time depression patients (those experiencing their first episode) for four to nine months after they respond to treatment. Patients who have had two or more bouts of depression may need longer treatment.
About 1 in 5 adults in the United States experience depression at some point in their lifetime, and the economic burden of such depressive disorders is $83 billion, according to the ACP.
Comments (12)
While clinical trials are helpful, they just aren’t capable of determining one antidepressant is the same as all antidepressants. From personal experience I can tell you that the first antidepressants I took might as well have been a gelatin tablet. It just didn’t do anything. Through a process of trial and error I eventually found an antidepressant that worked for me. One of the problems with this type of reporting, is that it implies that since one is as good as another, if the first one doesn’t do anything for you, then you might not be inclined to try a different one, because of your statement that one antidepressant is the same as any others.
Your right there! The drugs are not all the same. Some work for some people and not for others. Just because all the drugs are useful for about 50% of the patients , does not mean that same as saying that they are all 50% useful for all the patients! In reality, each drug is about 50% likely to work for any particular patient. So, often, a person will need to try more than one before a working drug is found for them.
In typical fashion, the life-destroying sexual side effects of SSRI’s are not mentioned. Google “PSSD” for more info.
I’m surprised by the blatant lying and glossing over of important facts by both this article. For example: at least one component study of over 1,000 people found that 25% of patients who didn’t respond to SSRIs DID respond to slightly different drugs, like Wellbutrin. This was a significant number. Well gee, if all drugs are the same, then that shouldn’t happen, should it?
There’s also the glossed over fact that side effects are a HUGE part of treatment. In one study, 50% of people stopped a drug because of side effects. If a person is not taking a drug, it’s hard to figure out whether that drug works, isn’t it. So maybe a more expensive drug is the same, efficacy wise, as a cheap drug. But if that cheap drug causes significant side effects and the patient doesn’t take it, the insurance company/patient is throwing money out the window. A more expensive drug that the patient can take is a worthwhile investment.
WAAHHHH. I’m just here gathering info for a report. Depression……poor little babies..if you had lived my life as tough as it has been, you poor babies would be dead ir insane already, you would realize that you sometimes have to pull your butt up and stand up on your own, with your own strength and stop taking a drug for everything. With all the tough times I have been through, i am happy to still be alive and i’m not going to blame my depression on some chemical imbalance, so i can take the latest “popular” drug….you people are so brainwashed. I am so glad I was taught to not be dependent on all of the “crutches” you people have. Now that you are all riled up and fighting mad, what drug will take to calm you down? Sad, sad, you are an anchor on our society neck…….
Jan,
Some people may have a tendency to develop chemical imbalances in the brain when subjected to traumatic life experiences. I am glad that you have survived your tough times without having to resort to drugs, but you should not look down on people who do have to resort to taking medication. Everybody is different and everybody’s life is different, therefore you should not compare your life to other people’s lives.
I agree 100% with Kate, Ken and Veronica. This article is horribly written and the study was not done well at all. It disgusts me that this kind of misinformation is out there.
Anyone with any understanding of the drugs knows they work in fundamentally different ways. I am on Wellbutrin now and it works wonderfully, whereas Zoloft did nothing for me – because it’s a completely different kind of medicine, working with completely different brain chemicals. Saying that “they are all the same” is just plain false.
Bad Writing. I can’t help but think that the author did this on purpose to elicit reader responses. Here’s my take on what he should have been conveyed: Fundamentally, antidepressants are intended to work the same, if “the same” refers to the drugs intended outcome- the alleviation of depression. The mechanisms by which they affect neurochemistry and eliminate depression, however, vary significantly. Hence one drug does not fit all. Depressed brains vary in their need for adjustment of dopamine, serotonin, and neuroepinephrine levels etc. Different drugs affect one or more of these chemical levels in the brain differently. Side affects vary by drug, dosage, and individual metabolisms.
By the way Jam, your hostile response is indicative of someone who may benefit from an antidepressant. You clearly have some misdirected anger. Exercise may help also.
Spot on, Beverly. The study drilled into each drug’s efficacy and directs doctors and patients to seriously employ/weight OTHER criteria in selecting an AD. The study confirms what docs and the rest of us have experienced first hand – some work for certain folks, others don’t. Don’t throw the baby out with the bathwater!
There are contradictions in this article that make me question the vetting of articles for this site. No experienced psychiatrist could really claim that any antidepressant will work effectively for any patient. Welbutrin works well for some, but it not only did not work for me, it caused severe side-effects. Zoloft relieved symptoms, but did not work as well as Effexor. At a time of serious crisis, Effexor couldn’t do the job, even at highest possible dose, but Cymbalta has really made a difference. And yes, there are differences in side-effects–for me. I’m scared some idiot-official will mandate that only Prozac can be prescribed for depressed people dependent on Medicaid or state medical programs, just because it’s cheaper. Hey, idiot, or whoever wrote this article: they don’t work the same for ME!
I am on Cymbalta, an SNRI, 90 mgs daily. Were SNRI’s included in this study or only SSRI’s? And picking up on Tim’s comment, my insurance copy has sent me letters almost calling my phsyciarist an idiot for having me on this more expensive drug and also about taking 90 mgs rather than the standard target dose of 60 mgs. The clinical studies said that 120 mgs is no more effective than 60 mgs. But a couple of months ago I tried cutting back to 60 mgs to try to lessen side effects (sleepiness) and my symptoms started to come back. So I went back to 90 mgs. and they went away in a couple of days. Right after I went back to the 90 mgs., the insurance company sent me a nasty letter and even called my home.
Modern pharmacology in treatment of depression
and borderlines: Antidepressants Valdoxan Agomelatine
Zoloft Koaksil Coaxil drug abuse Lerivon side effects
Tianeptine Coaxil Paroxetine Paxil Seroxat Amitriptyline
Elavil, Endep Venlafaxine Cymbalta Duloxetine Ixel
Milnacipran Lerivon Mianserin
http://home-psychiatrist.blogspot.com/