Tuesday, April 22, 2008

Link to Relevant Papers in CMAJ

The paper by Katz et al. mentioned in the previous post can be found in the Canadian Medical Association Journal, April 8th Issue. There are also a couple of commentaries on the issue of depression there. The same issue also has a systematic review of screening instruments for depression.

Wednesday, April 9, 2008

More About the Antidepressant Effectiveness Debate

Recent media attention to the idea that antidepressants are less effective than claimed derived from studies re-analyzing data submitted to regulatory agencies. The methodological issue involved is publication bias - the extent of antidepressant effectiveness may have been exaggerated because the most favourable results were the ones that were eventually published, whereas less favourable results were not.

However, the discussion appears to have gone "over the top" and these studies have been mentioned many times in the past few months in the media as providing evidence that the medications are completely ineffective.

The reaction has resulted in some new voices emerging: One is a communication to physicians from Dr. Patrick White, who is the current head of the Canadian Psychiatric Association:

Another is a cautionary note regarding suicide in youth - not a directly related issue has also appeared in the news media. The study, by Katz et al. has apparently not yet been published in the peer reviewed literature, but suggests a possible increased suicide rate in Manitoba youth in conjunction with reduced physician visits and antidepressant prescribing after a Health Canada warning about the medications. The possibility that reduced use of antidepressants in response to a Health Canada warning about their safety may have led to an increase in youth suicides in Manitoba cautions against overstated and rather sweeping criticism of medications such as these - as these can have negative effects.

It would be best if the debate about the proper role of these medications were guided by scientific evidence - and this is one of the goals of the policy paper that is the purpose of this blog. Incidentally, it was featured in the Statistics Canada "Daily" on April 9, 2008.