Antidepressants and Overall Wellbeing

There was an interesting article published on April 12, 2014 in Psychotherapy and Psychosomatics.  It’s called The Efficacy of Antidepressants on Overall Well-Being and Self-Reported Depression Symptom Severity in Youth: A Meta-Analysis, by Gary Spielmans and Katherine Gerwig, both of the Psychology Department, Metropolitan State University, St. Paul, Minnesota.

The authors conducted a word-search in Medline, PsychINFO, and the Cochrane Central Register, and identified 8 studies that met their criteria.  They combined the data from these studies and concluded:

“Though limited by a small number of trials, our analyses suggest that antidepressants offer little to no benefit in improving overall well-being among depressed children and adolescents.”

In the Discussion section of the paper, they stated:

“We found no evidence that antidepressants offer any sort of clinically meaningful benefit for youth on self-report measures of depression, quality of life, global mental health, or parent reports of autonomy.”

The authors acknowledge that their study has limitations,  “…the most obvious being the small sample of included trials.”

“A larger sample of relevant trials may lead to differing conclusions.  However, even the strongest signal of efficacy in our results (a pooled statistically nonsignificant effect of g = 0.16 across measures of autonomous functioning, self-esteem, global mental health, and quality of life among adolescents) provides little reason to suspect any robust treatment effects.”

The article goes on to discuss the relative merits of self-report vs. practitioner ratings as measures of efficacy in antidepressant trials:

“Given the high emphasis on clinician-rated depression measures in the reporting of clinical trial outcomes and subsequent reviews…it seems that even the modest efficacy found in prior antidepressant meta-analyses is inflated.  Perhaps this is best illustrated by fluoxetine [Prozac].  The discord between small to moderate effect sizes on clinician-rated measures in three trials (0.52, 0.60, and 0.40)…and negligible to quite modest effects on self-reports (-0.07, 0.22, and 0.15) is notable.  Further, the only fluoxetine trial to report quality of life and global mental health outcomes found no treatment benefit.”

and

“It is unclear exactly how different outcome measures should be weighed, but our findings suggest that the overall benefits of antidepressants in youth have been overstated and that their overall benefit over placebo may be vanishingly small.”

And more disturbingly:

“…a recent systematic review found a much elevated risk of excessive arousal/agitation among youth taking antidepressants versus placebo…Data from a Food and Drug Administration systematic review also found that antidepressants were linked to a statistically significantly higher rate of hostility or agitation relative to placebo…Clearly, a more expansive examination of the risk-benefit ratio of antidepressants in youth, extending beyond clinician-rated depression measures and suicidality, is needed.”

. . . . . . . . 

The first review mentioned in the above quote is Offidani E. et al, 2013.  Here’s their conclusion:

“Risks of excessive mood elevation during antidepressant treatment, including mania-hypomania, were much greater than with placebo, and similar in juvenile anxiety and depressive disorders. Excessive arousal-activation in children or adolescents treated with antidepressants for anxiety as well as depressive disorders calls for particular caution and monitoring for potential risk of future bipolar disorder.”

The FDA review mentioned is the 131 page review by Tarak Hammad, MD, PhD on the link between suicidal behavior and antidepressants’ in youth.  On the link to hostility/agitation, Dr. Hammad stated:

“Although none of the individual trials had a statistically significant result, the overall RR [risk ratio] for Paxil and the overall RRs for all drugs and for all SSRIs were statistically significant showing an increase in the risk of developing these symptoms in the drug group as compared to the placebo group.” 

Perhaps it’s Time to Stop
Calling These Drugs Antidepressants

And, Incidentally

I found no links to the Spielmans, Gerwig article in the mainstream media.  In fact, I found only two outlets that picked it up:  MinnPost, where I found it, and MDLinx.  MinnPost is  ” . . . a non-profit, nonpartisan enterprise whose mission is to provide high-quality journalism for news-intense people who care about Minnesota.”  MDLinx is an online newsletter that  ” . . . aggregates medical articles and research from more than 1,200 peer-reviewed journals and leading news media on a daily basis.”

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This article first appeared on Philip Hickey’s website,
Behaviorism and Mental Health