Effects of 10 commonly prescribed second-generation antidepressants studied

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Effects of 10 commonly prescribed second-generation antidepressants

studied

http://www.news-medical.net/?id=13232

Because clinical depression is so disabling and affects more than 16

percent of adults in the United States at some time in their lives,

researchers have worked hard to develop more effective treatments.

But how much better are the newer pharmaceuticals?

Many second-generation antidepressants, despite differences in drug

classification and cost, offer patients essentially the same benefits

with little variation in risks, University of North Carolina at

Chapel Hill researchers have found.

Such antidepressants include selective serotonin reuptake inhibitors

(SSRIs) and other drugs that affect the activity of neurotransmitters

in a selective way.

In a paper published online (Sept. 19) and to be published in the

October issue of the journal ls of Internal Medicine, Dr.

A. Hansen and colleagues examined the effects of 10 commonly

prescribed second-generation antidepressants. Those drugs included

familiar brand-name drugs such as Prozac, Zoloft, Effexor, Wellbutrin

and Paxil.

Hansen is assistant professor of pharmacy at the UNC School of

Pharmacy. The study he led involved investigating the medications'

role in the initial treatment of adults suffering from major

depression by combining and systematically analyzing data from 46

randomized, controlled trials.

Other authors, all at UNC, are Drs. Gerald Gartlehner and S.

Carey of the Cecil G. Sheps Center for Health Services Research, Dr.

Kathleen N. Lohr of the health policy and administration department

at the School of Public Health, and Bradley N. Gaynes of the School

of Medicine's psychiatry department. Carey, professor of medicine,

directs the Sheps Center. Gartlehner is associate director of the RTI-

UNC Evidence-based Practice Center.

" Past studies have compared the effectiveness of second-generation

antidepressants with that of placebo or older treatments but have not

systematically evaluated how the second-generation agents compared to

each other, " Hansen said. " Given the number of second-generation

treatments available, cost differences, widespread use and the

general lack of consensus in how the drugs compare, our research can

help patients, clinicians and policy makers decide which drug is

best. "

The bottom line was that one was about as good as another in terms of

effectiveness, but the likelihood that patients experienced certain

side effects differed between compounds, he said.

" Comparative evidence on these drugs suggests that there are only

minimal differences in efficacy, although some of the drugs come with

an increased risk of certain side effects, " Hansen

said. " Understanding the likelihood of the side effects and matching

this information with patients' lifestyle and preferences for

anticipated side effects may help improve drug treatment of

depression.

" Although our study did not specifically assess the impact of drug

costs or differences in dosing regimens on how patients fared, those

factors also may be important determinants in drug selection, " the

scientist said. " That's in the absence of patient preference or a

clear choice for which agent is best for a given person. "

Limitations of the study were that published data from some trials

was not as complete and comparable as researchers would have

preferred, Hansen said. Most data was from trials sponsored by drug

companies, and questions remain as to how unbiased such studies are.

Support for the investigation came to the Cecil G. Sheps Center for

Health Services Research from the Drug Effectiveness Review Project,

a collaborative program coordinated by the Center for Evidence-Based

Policy at the Oregon Health and Science University.

In 2000, the economic burden of depression was estimated to be $83.1

billion, Hansen said. Although drug treatment does not work for all

patients, drugs are usually considered the first and potentially best

treatment in part since primary care physicians prescribe the

majority of antidepressants in this country.

http://www.unc.edu/