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| |  Newer Antidepressant Drugs As Effective As Older-Generation Treatments ROCKVILLE, MD -- March 18, 1999 -- Newer categories of antidepressant drugs are equal yet effective as older-generation antidepressants and roughly equal numbers of patients drop out of clinical trials because of side effects, according to a new evidence report comparing drug treatments for depression. The evidence report was conducted by the San Antonio Evidence-Based Practice Center on behalf of the Agency for Health Care Policy and Research (AHCPR). It found that selective serotonin reuptake inhibitors (SSRIs) are equally as effective in treating depression as older generation antidepressants, such as tricyclics. "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 Cynthia Mulrow, M.D., MSc, the study's lead investigator and a professor of medicine and geriatrics at The University of Texas Health Science Center at San Antonio (UTHSCSA). The study found that both newer- and older-generation antidepressants have side effects. Patients taking the newer antidepressants were more likely to have higher rates of diarrhea, nausea, insomnia and headache. The older drugs were likely to cause adverse effects on the heart and blood pressure and result in dry mouth, constipation, dizziness, blurred vision and tremors. While anecdotal reports suggest high rates of difficulty in sexual functioning, this report found little data that directly addressed this problem. "The good news for the many people suffering from depression is that this rigorous analysis of the scientific literature has endorsed the effectiveness of a wide array of medication options, however the risks and benefits of these options must be carefully weighed," said co-author John Williams, Jr., M.D. "In the studies we analysed, people dropped out of clinical trials for both older and newer antidepressants at similar rates because of drug side effects." The study did not compare drug costs for the nine categories of antidepressants, the dosing schedules, nor the risk of various drug-to-drug interactions. The report was designed to provide a comprehensive evaluation of the efficacy of newer pharmacotherapies and herbal medications, such as St. John's wort, kava kava and valeriana, for depressive disorders. "This analysis shows the importance of evaluating the evidence on the full range of treatments -- new and old, conventional and alternative -- so that clinicians have all the information available when making treatment decisions with their patients," said AHCPR administrator John Eisenberg, MD. "This type of broad-based, comparative analysis will be very useful to AHCPR's partners as they develop guidelines and other programs to improve the quality of depression treatment." The literature review found no evidence of effectiveness of kava kava and valeriana and concluded the that evidence about the effectiveness of St. John's wort is unclear. However, compared to a placebo, the literature suggests that St. John's wort shows promise for mild to moderate depression and may have fewer adverse effects reported than older generation antidepressants. The National Institutes of Health, through the National Institute of Mental Health, the National Center on Complimentary and Alternative Medicine, and the Office of Dietary Supplements, is now sponsoring a placebo-controlled, blinded clinical trial comparing St. John's wort to a selective serotonin reuptake inhibitor.
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