ANTIDEPRESSANTS: Older Drugs as Effective as New Ones?
While older, cheaper antidepressants are just as effective as newer ones such as Prozac and Zoloft, the older drugs have more serious side effects, according to a study released last month by the Agency for Health Care Policy and Research. The Washington Post reports that the study, a meta-analysis of 315 clinical trials, was conducted in part in response to pressure from HMOs. "'Medications for depression are frequently the number one or number two drug cost' for health plans," said study author John Williams of the South Texas Veterans Healthcare System. The older antidepressants, classified as tricyclics, can cause dry mouth, tremors and dizziness -- 100% of patients on tricyclics say they "feel they're on medication," compared to just 50% on newer antidepressants, known as selective serotonin reuptake inhibitors. SSRIs, however, can cause insomnia and sexual dysfunction. The meta-analysis found that patients on either type of drug treatment had similar dropout rates. It also found that 50% to 60% on either class of drugs responded well, compared to just 30% to 40% on placebos, dispelling the claim that placebos are just as effective as antidepressants. Prescriptions for tricyclics have remained relatively steady, climbing from 43 million in 1994 to 51 million last year, while prescriptions for SSRIs jumped during the same time period from 35 million to 77 million. One reason may be that doctors feel safer prescribing SSRIs to potentially suicidal patients. "Ten times the daily therapeutic dose (of many tricyclics) can kill a patient, but it's virtually impossible to die from an overdose on SSRIs," said Martin Keller, chair of the Brown University Department of Psychiatry (Kaufman, 4/6).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.