- ROCKVILLE, Maryland (CNN) -- A sweeping government study of antidepressants
found that Prozac and other drugs of its generation worked no better and
no worse than older medicines to alleviate major depression.
- Selective serotonin reuptake inhibitors
(SSRIs) such as Prozac have been prescribed widely since they came on
the market, but authors of Thursday's study suggested older drugs such
as tricyclics may be better tolerated by some patients.
- "SSRIs are therapies of choice for
many practitioners, but there are a lot of options out there, and no particular
class of drugs is routinely more effective than others," said Dr.
Cynthia D. Mulrow, the study's lead author.
- The San Antonio Evidence-Based Practice
Center reviewed hundreds of clinical studies on 32 drugs, including three
herbal treatments, for the Agency for Health Care Policy and Research,
a division of the Department of Health and Human Services.
- A closer look at drug side effects
- Researchers found that roughly equal
numbers of patients dropped out of clinical trials for newer and older
antidepressants due to side effects. The SSRIs were more likely to cause
diarrhea, nausea, insomnia and headaches. The older drugs had more adverse
effects on the heart and on blood pressure, as well as dry mouth, constipation,
dizziness, blurred vision and tremors.
- Study authors looked for data on sexual
dysfunction, a common complaint about the SSRI drugs, but were unable
to find enough data to address that problem.
- "What can make the difference is
how well matched a given individual with depression is with a given treatment,"
said Dr. Matthew Rudorfer, who commented on the report in The New York
- Caution advised before use in children
- Whether any antidepressant would work
for children was still an open question, according to researchers, who
could not find enough data on that issue.
- And for mildly depressed people, there
was not enough research to establish whether any of the antidepressants
were effective. Still, authors said a few studies of dysthymia, a chronic
low-level depression, suggested that SSRIs may help lift a patient's spirits.
- Alternatives, including St. John's wort
- Medical literature was reviewed for three
herbal treatments -- kava kava, valeriana and St. John's wort -- but
researchers were unable to find evidence of effectiveness yet for any
of the herbal compounds.
- However, St. John's wort "holds
promise for mild to moderate depression and may have fewer adverse effects
reported than older-generation antidepressants," said the study's
authors. They also noted that a controlled, blinded clinical trial is
underway to compare St. John's wort with an SSRI drug.
- Depression and mood disorders affect
an estimated one in five Americans sometime during a lifetime. The report
described depressive disorders, including major depression and dysthymia,
as serious, disabling illnesses.