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Psychiatric medications are no more effective

Published online by Cambridge University Press:  02 January 2018

Richard Braithwaite*
Affiliation:
Isle of Wight NHS Trust, email: richard.braithwaite@iow.nhs.uk
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Abstract

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Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © Royal College of Psychiatrists, 2013

Martin & Elworthy report that the biggest reason for prescribing electroconvulsive therapy (ECT) less frequently than before is the perception among psychiatrists that ‘more effective medication’ now exists. Reference Martin and Elworthy1 Unfortunately, the authors collude with this exaggerated view, claiming that ‘psychiatric medications have undoubtedly become more effective over recent years’. Their bold statement references a 2002 story in The New York Times.

Meta-analysis shows that the current first-line treatments for depressive disorder, selective serotonin reuptake inhibitors, are marginally less effective than older tricyclic antidepressants (TCAs), while serotonin-noradrenaline reuptake inhibitors show no statistically significant advantage over TCAs. Reference Machado, Iskedjian, Ruiza and Einarson2 One newer drug, reboxetine, does not work at all, Reference Eyding, Lelgemann, Grouven, Hrter, Kromp and Kaiser3 yet is inexplicably still licensed as an antidepressant.

Lithium remains the only true mood stabiliser: it is the only drug with efficacy in treating acute manic and depressive symptoms and in prophylaxis of manic and depressive symptoms in bipolar disorder. Reference Bauer and Mitchner4

One has to conclude that the prevailing delusion that treatments across psychiatry have become more effective has been mediated by the pharmaceutical industry. Psychiatrists should take their evidence from meta-analyses in peer-reviewed journals, not from advertising representatives and certainly not from the newsstand.

References

1 Martin, F, Elworthy, T. Scottish psychiatrists' attitudes to electroconvulsive therapy: survey analysis. Psychiatrist 2013; 37: 261–6.Google Scholar
2 Machado, M, Iskedjian, M, Ruiza, I, Einarson, TR. Remission, dropouts, and adverse drug reaction rates in major depressive disorder: a meta-analysis of head-to-head trials. Curr Med Res Opin 2006; 22: 1825–37.CrossRefGoogle ScholarPubMed
3 Eyding, D, Lelgemann, M, Grouven, U, Hrter, M, Kromp, M, Kaiser, T, et al. Reboxetine for acute treatment of major depression: systematic review and meta-analysis of published and unpublished placebo and selective serotonin reuptake inhibitor controlled trials. BMJ 2010; 341: c4737.Google Scholar
4 Bauer, MS, Mitchner, L. What is a ‘mood stabilizer’? An evidence-based response. Am J Psychiatry 2004; 161: 318.Google Scholar
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