Magazine article Clinical Psychiatry News

Antidepressants Aren't All They're Cracked Up to Be. (Trials Overstate Efficacy)

Magazine article Clinical Psychiatry News

Antidepressants Aren't All They're Cracked Up to Be. (Trials Overstate Efficacy)

Article excerpt

ALBUQUERQUE--If it seems like antidepressant therapy isn't as effective in your hands as reported in the published literature, you're not alone.

The fact is, the stringent inclusion and exclusion criteria routinely used in pharmacologic antidepressant clinical trials enable investigators to paint an unrealistically rosy picture of the drugs' performance. This renders the trials largely irrelevant to real-world clinical practice, Dr. Michael J. Gitlin said at a psychiatric symposium sponsored by the University of New Mexico.

"People who go into studies are not representative of the people in your practice. The classic patients who come to see us are borderlines with comorbid drug abuse who don't comply-and those are the people who get excluded from research studies," said Dr. Gitlin, professor of clinical psychiatry and director of the mood disorders clinic at the University of California, Los Angeles, Neuropsychiatric Hospital.

He cited a recent provocative study by Dr. Mark Zimmerman of Brown University in Providence, R.I., and colleagues. The investigators applied the standard research inclusion/ exclusion criteria to 346 patients with current major depression who presented to an outpatient practice.

When they were done, six-sevenths of the patients were deemed ineligible for pharmacologic treatment trials of depression. Common reasons included comorbid anxiety disorder in 53%, a bipolar or psychotic subtype of depression in 16%, and a comorbid substance abuse disorder in 8%, a figure which Dr. Gitlin said "seems strikingly low" in his own experience.

Other common reasons for exclusion were insufficient severity of depressive symptoms and current suicidal ideation (Am. …

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