More doubts about Prozac

[unixronin]

Recently, Prozac and related SSRI antidepressants were dealt a blow when it was made public that Eli Lilly, Glaxo-SmithKline and the other manufacturers of the drugs had failed to disclose data from unfavorable clinical studies that showed patients using SSRIs had an increase as much as four to one in suicide risk.  Now, a new study from Hull University, using the data submitted to the FDA to gain approval for the drugs, has found that for most patients, SSRIs are no more effective than a placebo.

Eli Lilly, of course, defends the drugs' effectiveness; and another researcher, the head of psychopharmacology at Bristol University, says that "if they provide some sort of placebo benefit, this shouldn't be discounted."

Now, the thing that immediately occurs to me is this: If you have the choice between a placebo that is medically inert, and has no side effects that aren't psychosomatic, or a drug that performs no better than the placebo, but has a vicious side-effect profile and may quadruple your likelihood of suicide ... aren't you better off with the placebo?

Clarification:

I should point out that I have not read the studies cited; I have only read summaries.  My intention here was not to discuss the studies per se, but rather to question the idea that it's still a good idea to use a drug with known severe side-effects for it's placebo-like effect if it's (allegedly) no better than a placebo.

Comments

[smandal.livejournal.com]

Just read a Nature letter where a doctor supports these types of studies (and wants effectiveness studies to be freely available, rather than bound by corporate secrecy), but makes an interesting point:

Placebo effect is stronger in people with psychological/neurological problems. So the SSRIs still work, it's just more difficult to prove by comparing against placebo.

This still leaves open the issue of whether or not SSRIs should be prescribed if a sugar pill works just as well, on average.

[unixronin.livejournal.com]

Placebo effect is stronger in people with psychological/neurological problems. So the SSRIs still work, it's just more difficult to prove by comparing against placebo.

That is indeed an interesting detail.

This still leaves open the issue of whether or not SSRIs should be prescribed if a sugar pill works just as well, on average.

I don't see that it can do any harm to try the placebo first in cases where the doctor believes it prudent. I'm pretty certain the major drug company reps would even agree, provided the patient buys the sugar pills from them at the same price as the actual drug.... :p

[smandal.livejournal.com]

Huh, so that's what those "extended release" versions are :P