Best Antidepressants?

One in ten American adults may be taking an antidepressant, one study based on statistics from 2005 found.  That's a LOT of people, so a study published in this issue of Annals of Internal Medicine should be of interest, as it compares so-called 'second generation' antidepressant medications and finds no clear front-runner.  As Rick and I discuss in this week's podcast, the study does help distinguish likely side effects.  And as I conclude in this week's YouTube, the study may therefore help physicians and patients sort among the multitude of choices.

While this particular study is a meta-analysis, a type of paper Rick and I often disparage because it compiles data from several other investigations and attempts to draw conclusions from the mix, Rick calls the ones included here appropriate and fairly rigorous. The investigators limited them to head-to-head comparisons of two drugs, continued for a minimum of six weeks and conducted in a randomized, controlled fashion.  To assess harmful aspects related to use of second generation antidepressants, observational studies with at least 1000 participants of 12 weeks duration or more were also included.  The final analysis represented 234 studies.  What did they find?

Disappointingly, more than one-third of people suffering from acute major depressive disorder failed to respond to a second-generation antidepressant within a 6-12 week window.  Over half of subjects included in this analysis failed to respond at all.  Yikes!  This clearly points to the need for better antidepressants, or better yet, effective prevention strategies for the 16% of adults who will experience major depressive disorder in their lifetime. 

Side effects were able to discriminate somewhat between the different drugs.  Common side effects included sweating, tremor, diarrhea, dizziness, dry mouth, fatigue, headache, nausea, sexual dysfunction and weight gain. Rick and I agree that patients and physicians need to become familiar with the likelihood that a particular medication will be associated with especially onerous or unacceptable side effects for that person and chose accordingly.  Since primary care physicians are very likely to prescribe antidepressants, the onus is on them to remain abreast of the side effect details of this burgeoning class of medications. 

What about that very worrisome side effect known in the medical parlance as 'suididality' or thoughts of suicide?  Data crunched here indicate that 1 in 166 people being treated with one of these medications reported such thoughts, but the authors admit that the numbers were too few to draw conclusions related to a particular drug.

How about study limitations?  Those may include the fact that the majority of studies included in this analysis were industry sponsored, and sometimes compared two drugs made by the same pharmaceutical house.  The authors state that antidepressants are the fourth best-selling class of medications in the US, so the companies are clearly vested in outcomes.  For the rest of us, that may read 'caveat emptor.'

Other studies this week include a rise in the number of people who are complaining of knee pain, the efficacy of a single dose of flu vaccine in pregnant women, both also in Annals, and remaining over-prescription of antibiotics for upper respiratory infections in kids in Pediatrics.  Until next week, y'all live well.

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Discover the Most Common Antidepressant Drugs | Daily Health Tips
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Receive the Best Antidepressant and Get Away with Depression | Healthy Women
January 18, 2012 at 7:07 pm

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