Tuesday, June 15, 2010

Talking therapies are more effective than Prozac-type drugs, says scientist

The conclusions below by Prof. Cherry (Kirsch is German for Cherry) are certainly tempting but I would need to see more about the taxonomy of depression used in the study concerned. There is a tendency to class all mental states with suicidal ideation as "depression" but I have long maintained that a variety of mental states could give rise to suicidal ideation and it could be that the three different drugs mentioned below work on different sources of "depression" -- so all give positive results.

And calling the results a placebo effect is pretty absurd. All three drugs gave relief rates at roughly twice the normal placebo level

Antidepressants of the Prozac type are no better than a placebo, a leading psychologist has claimed. According to Irving Kirsch, the evidence is overwhelming that there is no link between depression and serotonin, the brain chemical that such drugs are supposed to affect.

Practising psychiatrists, however, say that it would be disastrous to use stricter criteria for the prescription of antidepressants on the basis of Professor Kirsch’s research findings. “Be very careful what you advise, because we in the surgeries will be left to pick up the pieces,” said Amjad Uppal, a consultant psychiatrist for the Gloucestershire NHS Trust.

Last year in England the NHS issued 39 million prescriptions to treat depression, more than half being for “selective serotonin reuptake inhibitor” (SSRI) drugs. Three million people took antidepressants daily. Antidepressants including Prozac and the newer generation of SSRIs, such as Seroxat, are taken to increase the level of serotonin in the brain.

Professor Kirsch argued that they worked through the placebo effect — patients expect to be made to feel better — and said that “talking treatments” such as cognitive behavioural therapy were more effective in the long term.

“Although the chemical-imbalance theory is often presented as if it were fact, it is actually a controversial hypothesis,” he said. “This is about as close as a theory gets in science to being disproven by the evidence.”

Others maintain that antidepressants do have an active biochemical influence. “We do not fully understand how these drugs work, but there is evidence that they influence the number of neurons and the connections between neurons. You can’t draw conclusions about this because of the nature of the study,” said Hamish McAllister- Williams, a consultant psychiatrist and psychopharmacologist at Newcastle University.

He said that depression was a dangerous illness, noting that sufferers were at as high a risk of a heart attack as those who smoked 20 cigarettes a day.

Dr McAllister-Williams believed that “at least a proportion” of the effect of the drugs was “due to active ingredients, but either way they work and we really need an effective treatment”. Dr Uppal said: “I have a very high threshold for prescribing antidepressants, but there’s no doubt in my mind they work. Research studies are artificial and do not capture the difference between effectiveness and efficacy.”

Professor Kirsch’s research, presented at The Times Cheltenham Science Festival, shows that a new drug, tianeptine, is just as effective as SSRIs in treating depression. Tianeptine, which is a serotonin reuptake enhancer, actually decreases the level of the chemical.

In comparisons of tianeptine with SSRIs and the earlier tricyclic antidepressants, the three produced virtually identical response rates: 63 per cent of patients responded to tianeptine, 62 per cent to SSRIs and 65 per cent to tricyclics. If drugs having three different effects on serotonin brought similar benefits, these could not be due to their specific chemical activity, Professor Kirsch said. “The idea that the neurotransmitter serotonin is a causal factor in depression is wrong.”


Simple drug could save 100,000 lives each year - Lancet

AN easy-to-use blood-clotting drug that costs just a few dollars could save up to 100,000 lives each year from road accidents and violence.

The Lancet reports doctors at the London School of Hygiene and Tropical Medicine tested an off-patent treatment called tranexamic acid (TXA) among 20,000 severely-injured adults in 274 hospitals in 40 countries.

Participants received either one gram of TXA by injection followed by another one gram in a drip over the following eight hours, or a dummy lookalike. TXA reduced the risk of death by any cause by 10 per cent compared with the placebo, the paper said. When it came to the risk of death by bleeding, TXA scored a reduction of 15 per cent over the placebo.

Each year, more than a million people die as a result of traffic injuries, and another 1.6 million die as a result of acts of violence, and many could be saved by swift action to stop haemorrhaging, the researchers said. "Each year about 600,000 injured patients bleed to death worldwide," said lead author Ian Roberts, a professor of epidemiology. "Injuries may be accidental, for example, road crashes, or intentional, such as shootings, stabbings or land-mine injuries, and the majority of deaths occur soon after injury."

TXA works by reducing the breakdown of clots. The drug is manufactured by a number of companies, and a gram of it costs about $4.50.

If TXA became widely available and was used promptly, it could save as many as 100,000 lives a year, 13,000 of them in India and 12,000 in China, where road deaths are surging, the paper said. "The drug is inexpensive and could be given in hospitals worldwide," said Etienne Krug, director of violence and injury prevention and disability at the UN's World Health Organisation. "It is essential that doctors are aware of these results and take them into account in the emergency management of seriously injured patients."

The trial was carried out to see whether TXA was effective and whether it had bad side effects, such as increasing the risk of heart attacks, strokes and lung clots. On the latter score, there was no increase in any of these complications, the authors said.


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