January 1, 2006
US studies find antidepressants work for some
By Susan Heavey
WASHINGTON (Reuters) - Suicidal behavior among adults
taking antidepressants drops almost as soon as they begin
medication, researchers said on Sunday in findings that experts
said confirm their effectiveness in older patients.
The decline was especially significant among patients
taking newer drugs to treat depression, including selective
serotonin reuptake inhibitors, or SSRIs, compared to those
taking older medicines.
The findings, published in the January issue of the
American Journal of Psychiatry, come as experts grapple with
whether such drugs can provoke suicidal tendencies.
In 2004, the Food and Drug Administration concluded there
was a higher risk of suicidal behavior among children and
teenagers and ordered strong label warnings. In July, it said
there may be a link in adults and urged close monitoring.
However, after reviewing more than 65,000 patient records
from 1992 to 2003, researchers in Seattle found fewer suicide
attempts or deaths after patients began medication.
In the six months after medication, there were 76 attempts
severe enough to require a hospital visit compared with 73
attempts in the three months prior.
Adolescents showed more attempts than adults, but there was
not enough data for a strong conclusion. About 6 percent of
patients were 17 and younger, according to the study funded by
the National Institute of Mental Health (NIMH).
Researchers reviewed records from the Group Health
Cooperative health plan.
"The conventional wisdom that the first few weeks of
treatment are especially risky doesn't seem to be true," said
psychiatrist Gregory Simon, a researcher for the cooperative.
AT ODDS WITH THE FDA
His conclusion differs from the FDA's, he said, because his
team reviewed behavior in the time before treatment rather than
once medication began, as in placebo-controlled trials.
Others questioned such a broad statement, saying the
records included patients with previous suicidal behavior who
could skew results. They also did not count thoughts or other
symptoms not requiring hospitalization.
"If you've selected for people who've had a suicide attempt
... it's not surprising the suicide rate goes down with
treatment," said University of Florida psychiatrist Wayne
Goodman, an FDA advisor. "I think you have to be careful what
conclusion you draw."
Goodman and others said the findings confirm
antidepressants help adults. They also welcomed the strikingly
higher improvement among patients taking newer medications,
such as Eli Lilly & Co's Prozac.
Other antidepressants include GlaxoSmithKline's Paxil,
Pfizer's Zoloft and Forest Laboratories's Celexa, among others.
To be sure, Simon said, suicide risk still exists and
patients should be monitored closely.
FDA spokeswoman Susan Cruzan said the analysis would not
affect current warnings, which offered "good information." She
added the FDA was continuing its review for adults.
DRUGS OFFER HALF A CHANCE
Another study, also published in the journal on Sunday,
found depression medications help about half who take them.
Researchers at 14 medical institutions found about 33
percent of 3,000 patients taking Celexa fully recovered from
their symptoms, which can include a change in sleep patterns,
eating habits or concentration.
Another 10 to 15 percent found some relief, while the rest,
about 53 percent, had no improvement.
Officials for NIMH, which sponsored the study, said the
results will help uncover why only certain patients benefit.
"The real goal ... is how to best help the 70 percent of
patients for whom treatment with a representative SSRI is not
enough for remission," NIMH Director Dr. Thomas Insel said.
The results come from the first phase of a four-phase
study, called STAR-D. Other medicines were offered in later
phases of the ongoing study, led by the University of Texas
Southwestern Medical Center.