The antidepressant debate should move on

G. Kirov and A. Korszun

Neuropsychiatric Genetics Unit, Tenovus Building, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, UK

EDITED BY STANLEY ZAMMIT

Declaration of interest

G.K. and A.K. have received grants from Janssen Research Foundation and Glaxo-SmithKline for conducting molecular genetic studies in psychiatric disorders. G.K. has received honoraria from Janssen Cilag for delivering lectures.

In her editorial Moncrieff (2002) ignored decades of work and focused on a few pieces of research, one of them from 1965. The editorial was followed by a letter criticising this view (Malt, 2002), which was, however, published under the title ‘The antidepressant debate continues’. This title might leave the impression that the effectiveness of antidepressants is still questionable.

Some of our colleagues might conclude that antidepressants have no proven effect and their patients should discontinue them. The consequences of such actions have been researched extensively: the relapse rates are approximately twice as high for patients who stop their medication in the first 2–6 months beyond the point of remission, compared with those who continue treatment (e.g. Anderson et al, 2000; Hirschfeld, 2001). Other patients might be denied an effective treatment. Going through all the evidence, which includes comparisons with other treatments and between different classes of antidepressants, animal work, and tryptophan and noradrenalin depletion experiments in people responsive to antidepressants, would be like reinventing the wheel, and is not the subject of this letter. As the rest of us continue to learn of advancements being made to refine and improve the pharmacotherapy of depression, is it possible that there is a group believing that antidepressants really do not have an effect? There is indeed an anti-depressant debate–but it is not whether they work but rather how they work that is the current focus of interest.

REFERENCES

Anderson, I. M., Nutt, D. J. & Deakin, J. F.W. (2000) Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 1993 British Association for Psychopharmacology guidelines. Journal of Psychopharmacology, 14, 3–20.[CrossRef][Medline]

Hirschfeld, R. M. A. (2001) Clinical importance of long-term antidepressant treatment. British Journal of Psychiatry, 179 (suppl. 42), s4–s8.[Abstract/Free Full Text]

Malt, U. F. (2002) The antidepressant debate continues (letter). British Journal of Psychiatry, 181, 531.[Free Full Text]

Moncrieff, J. (2002) The antidepressant debate. British Journal of Psychiatry, 180, 193–194.[Free Full Text]





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