Seroxat does not work in majority of depressed patients says latest study – Prof Nutt disagrees

Seroxat does not work in majority of depressed patients says latest study – so writes The New Scientist – old news you might think:

The antidepressant Prozac and related drugs are no better than placebo in treating all but the most severely depressed patients, according to a damaging assessment of the latest generation of antidepressants.

SSRIs, or selective serotonin reuptake inhibitors, were supposed to revolutionise care of depression – by treating symptoms without the side effects of older drugs, such as tricyclics.

But despite selling in vast quantities, a new meta-analysis of these drugs, from data presented to the US Food and Drug Administration (FDA), appears to suggest that for most patients they do not work. A previous study had indicated that the benefits of antidepressants might be exaggerated.

UK and US researchers led by Irving Kirsch of Hull University, UK, studied all clinical trials submitted to the FDA for the licensing of the four SSRIs: fluoxetine (Prozac), venlafaxine, nefazodone, and paroxetine (Seroxat or Paxil), for which full datasets were available. They conclude that, “compared with placebo, the new-generation antidepressants do not produce clinically significant improvements in depression in patients who initially have moderate or even very severe depression”.

However not everyone agrees with these new findings – in the UK, Professor David Nutt has been speaking out against the Kirsch study – using reasoned, scientific argument:

“Anti-depressants work in clinical practice,” says Nutt. “Everybody knows they work.”

And there’s more – he says the study [Kirsch] itself is rubbish.

He says failed drug trials often remain unpublished because their design is shoddy or their results uninteresting.

He criticises the PLoS paper as a “mishmash of quality trials and lousy trials leading to a false criticism of these drugs”, which he maintains do help those with depression even if their effectiveness falls below the NICE’s “arbitrary” threshold. Dr Nutt thinks it is misleading to compare these drugs with placebos, since what matters is that they work when compared with some alternatives, such as “talk therapy”, for which he believes there is even less evidence of effectiveness.

And still he goes on: “There is good evidence of antidepressant efficacy from other types of studies, especially relapse prevention, which show significant benefit over placebo.”

I wonder why David Nutt takes this point of view?

Maybe the answer lies here – Professor Nutt has acted as a consultant to Pfizer, GSK, MSD, Novartis, Asahi, Organon, Cypress, Lilly, Janssen, Lundbeck, Wyeth. He has speaking honoraria (in addition to above) with Reckitt-Benkiser and Cephalon. Grants or clinical trial payments from MSD, GSK, Novartis, Servier, Janssen, Yamanouchi, Lundbeck, Pfizer, Wyeth, Organon.

He has shares in GSK (ex-Wellcome).

Professor Nutt also promoted Seroxat at Glaxo’s launch of Seroxat for “social anxiety disorder”.

Conflict of interest, David?

More about Nutt and adult ADHD here.