South African psychiatrists react to reporting on anti-depressant medication

Anti-depressants don't work” and “Sugar pills are as effective as Prozac” are headlines that have been published globally over the last few weeks, but local psychiatrists urgently want to set the record straight. The articles allege that drugs have no clinical effect on mildly or moderately depressed patients.

The South African Society of Psychiatrists (SASOP) says that these articles are sensationalized and misinterpret what the results of the study in question actually established.

In summary, the study sought to examine the effective of antidepressant medications on a variety of patients involved in certain clinical trials. The study found that the improvement in patients with mild depression when on medication was no better than those patients within the study on placebo. Psychiatrists have been aware of the possible limited effects of anti-depressants on patients with only mild depression for years. International guidelines recommend psychotherapy for mild to moderate depression, and psychiatrists discourage “pill popping” and, in fact, recommend antidepressant medications for moderate, severe and very severe depression in conjunction with psychotherapy.

The main issue which SASOP has is that these articles can be very misleading, besides which the study, led by psychologist Professor Irving Kirsch, does not properly define what is meant by mild, moderate and severe depression. The subsequent media articles also inaccurately give the impression that these treatments are ineffective across all levels of depression. Kirsch, who is a professor of psychology and not psychiatry, and as such has no medical training in psychopharmacology, only used a “few selected articles, and interpreted these in a selected way” says Dr Eugene Allers, Past President and convenor of the anti-stigma division at SASOP.

What these ambiguous articles did not include was that this very same study found that medications such as fluoxetine (Prozac), venlafaxine, nefazadone and paroxetine were all more effective than placebo in treating depressed patients. When the initial severity of the depression increased, patients were less likely to respond to placebo. The difference between drug and placebo was therefore higher in patients with more severe depression. Another study, conducted by Judd, Rapaport and Yonkers et al and published in the American Journal of Psychiatry (2004) found that patients do experience improvement of the depression while taking an antidepressant like fluoxetine.

These articles failed to acknowledge the very positive benefits which anti-depressants have provided for many years to patients and families globally. In fact a substantial body of scientific evidence and medical experience show that a treatment such as fluoxetine is effective in treating depression and remains an important treatment option for people with depression. Regulatory agencies around the world have approved these drugs for use by patients suffering from depression.

Since its discovery in 1972, fluoxetine has become one of the world's most studied medicines. More than 50 million patients in more than 125 countries have taken this treatment, and more than 12 000 patients have participated in clinical trials specifically for this treatment.

“Our concern is that patients who read sweeping statements such as this may stop taking their anti-depressants. This can result in severe relapses and could even result in patients attempting or committing suicide,” says Dr Allers. SASOP would like to advise patients to consult their psychiatrist prior to stopping any medication. Those patients under the care of a general practitioner should discuss the matter with him or her or contact a member at SASOP.

Depression, with a prevalence of more than 10% in South Africa, is a serious illness with potentially serious consequences for the patient, including decreased work and social functioning and suicide. Patients suffering from depression often need the assistance of a healthcare professional, as well as psychotherapy and / or medication to recover. Medication is particularly important in patients with moderate to severe and very severe major depression.

“When it comes to antidepressant therapy, treatment decisions are best made by physicians and patients based on individual patient needs and clinical presentation,” explains Dr Frans Korb, psychiatrist and clinical research physician. Fluoxetine has been found by the FDA and other regulatory bodies, including the Medicines Control Council of South Africa (MCC), to be safe and effective in the management of major depressive disorders.