Hostname: page-component-7c8c6479df-fqc5m Total loading time: 0 Render date: 2024-03-28T20:26:28.677Z Has data issue: false hasContentIssue false

Author's reply

Published online by Cambridge University Press:  02 January 2018

J. Moncrieff*
Affiliation:
Royal Free and University College Medical School, University College London, Department of Psychiatry and Behavioural Sciences, Wolfson Building, 48 Riding House Street, London WIN 8AA, UK
Rights & Permissions [Opens in a new window]

Abstract

Type
Columns
Copyright
Copyright © 2003 The Royal College of Psychiatrists 

I would like to make some comments on the points raised by Kirov & Korszun and Anderson & Haddad. They both cite evidence from continuation and maintenance studies, but this is likely to be more flawed than evidence from acute treatment studies. In studies of long-term treatment, patients who have responded to acute treatment are randomised to continue active drugs or to be withdrawn to an inert placebo. However, it cannot be assumed that the state of having had treatment withdrawn is equivalent to never having had treatment in the first place. It is known that there is a discontinuation reaction with all classes of antidepressants (Reference Haddad, Lejoyeux and YoungHaddad et al, 1998). The symptoms of this reaction may themselves be mistaken for relapse, or they may unblind participants and predispose them to relapse because of fears of discontinuing treatment. This is likely to be a particular problem given that the initial sample of patients comprises people responsive to treatment who are therefore likely to have high expectations of the benefits of treatment.

In addition, the evidence on antidepressant effects and severity is complex. The majority of studies that show that increased efficacy correlates with increased severity are studies of out-patients. In in-patients, more-severe depression has been shown to respond less well to antidepressants than moderate depression does, independently of the presence of psychotic symptoms (Reference Kocsis, Croughan and KatzKocsis et al, 1990). In our meta-analysis we found no significant differences from placebo in in-patient studies (Reference Moncrieff, Wessely and HardyMoncrieff et al, 1998), which is in line with results from other large landmark in-patient studies such as the Medical Research Council study and the National Institute for Mental Health study described in my editorial (Reference MoncrieffMoncrieff, 2002).

Finally, if the benefits of antidepressants are so obvious, it seems surprising to me that we have little evidence that the burden of depressive illness is reducing in line with the vast expansion in antidepressant prescribing. In contrast, long-term incapacity related to depression has been rising rapidly both in absolute terms and in relation to other conditions (Reference Moncrieff and PommerleauMoncrieff & Pommerleau, 2000).

Footnotes

EDITED BY STANLEY ZAMMIT

References

Haddad, P., Lejoyeux, M. & Young, A. (1998) Antidepressant discontinuation reactions. BMJ, 316, 11051106.Google Scholar
Kocsis, J. H., Croughan, J. L., Katz, M. M., et al (1990) Response to treatment with antidepressants of patients with severe or moderate nonpsychotic depression and of patients with psychotic depression. American Journal of Psychiatry, 147, 621624.Google ScholarPubMed
Moncrieff, J. (2002) The antidepressant debate. British Journal of Psychiatry, 180, 193194.CrossRefGoogle ScholarPubMed
Moncrieff, J. & Pommerleau, J. (2000) Trendsin sickness benefits in Great Britain and the contribution of mental disorders. Journal of Public Health Medicine, 22, 5967.Google Scholar
Moncrieff, J., Wessely, S. & Hardy, R. (1998) Meta-analysis of trials comparing antidepressants with active placebos. British Journal of Psychiatry, 172, 227231.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.