Press release/ position statements regarding the matter of "Anti- depressants don't work"
On 26/02/08 Sky News broadcast an item regarding the use of anti-depressants. The "cover title" was "Anti-depressants don't work". This was subsequently broadcast on a number of radio stations locally as well as published in a number of local South African newspapers.
Sky News interviewed Professor Irving Kirsch, who is a professor of psychology. His study, led by the University of Hull team, and published in the Public Library of Science, meta-analyzed all the data submitted to the food and drug administration (FDA) for the registration of 4 of the most widely prescribed anti-depressants. The researchers used the U.S. Freedom of Information Act to obtain the data from 47 clinical trials, including previously unpublished figures. The article alleges that drugs had no clinical effect on mildly or moderately depressed patients, as the improvement in depression amongst the patients getting the trial drug was no better than those getting a dummy pill. They also allege that benefits were seen in only a small group of patients who were the most extremely depressed.
The South African Society of Psychiatrists (SASOP) would like to indicate that this information has already been known for many years. International guidelines do recommend psychotherapy for mild to possibly moderate depression. However in cases of moderate to severe depression an anti-depressant is added to the comprehensive regime. To make blanket statements like "sugar pills are as effective as Prozac" or that "anti-depressants don't work" (Sky News.com) is irresponsible reporting. A balanced report should have included interviews from psychiatrists either from the Royal College of Psychiatrists or The World Psychiatric Association. It should also be noted that Professor Kirsch is a professor of psychology. Psychiatrists are medical specialists with extensive training in psychopharmacology and psychotherapy.
In the medical journal "Prevention & Treatment", Donald F. Klein, a highly respected, internationally known psychiatrist, responds by commenting that Kirsch's work derives its information from a miniscule group of unrepresentative, inconsistently, and erroneously selected articles and is arbitrarily analyzed by obscure, misleading "effect size". Further, he stated that there are numerous problems with the meta-analytical approach.
Kirsch and his co-workers have failed to acknowledge the very positive benefits anti-depressants have provided to patients and their families, and they are at odds with what has been seen in actual clinical practice. This analysis has only examined a small subset of the total data available, while regulatory bodies around the world have conducted extensive reviews and evaluations of all the data available.
The article by Professor Kirsch is also misleading in that he does not define exactly what he means by mild, moderate and severe depression. Interpretation of the HAM-D rating scale for depression is that scores of 7 and less indicate no depression, 8 to 17 is mild depression, 18 to 27 is moderate depression, 28 to 37 is severe depression and > 37 is very severe depression. The diagnosis of mild depression is often confused with an adjustment disorder diagnosis. The treatment of adjustment disorder and mild depression is psychotherapy. Psychiatrists discourage the use of "pill popping" and in fact recommend anti-depressants for moderate, severe and very severe depression in conjunction with psychotherapy. Also if one looks at Professor Kirsch's study, one has to interpret his findings with caution in that if you are studying people who have mild depression the percentage improvement in terms of the lowering of the HAM-D rating scale scores will be much smaller compared to those who have very severe depression. Therefore one has to compare "apples with apples".
SASOP's concern is that patients who read sweeping statements like "anti-depressants don't work" or "sugar pills are as effective as Prozac" (Sky News .com) may stop taking their anti-depressants. This can result in severe relapses and or result in patients attempting or committing suicide. Who then takes responsibility?
SASOP would like to advise patients to consult their psychiatrists prior to stopping any medication. For those patients who are under the care of a general practitioner, they should discuss the matter with him/her and if they are unable to get an adequate response they may contact members of SASOP. Contact telephone numbers are as follows:-
Prof. Margaret G. Nair – Office hours 031 202 6421 – after hours 031 368 3636
Dr Eugene Allers – office hours 011 421 1254 cell number 082 652 0692
Dr Thabo Rangaka – office hours 086 6005130 cell number 082 494 6013 or visit the SASOP website at www.sasop.co.za to find the contact details of psychiatrists near you.
ON BEHALF OF SASOP
PROFESSOR MARGARET NAIR ( Past President and anti-stigma division)
DR EUGENE ALLERS (Past President and convener anti-stigma division)
DR THABO RANGAKA (President and public relations division)