Depression drugs' worth questioned

Pharmac says a British study claiming a new class of antidepressants have no "clinically meaningful advantage" raises questions about whether its spending on the drugs is good value for money.

But health experts say the drugs, known as selective serotonin reuptake inhibitors (SSRIs), are the "best technology" available.

The study, published in the British Medical Journal, reviewed previous studies looking at the efficacy of SSRIs in treating depression in adults.

It said the data showed the drugs did not have a clinically meaningful advantage over placebo.

The authors suggested a re-evaluation of current approaches to treating depression and further alternatives to drug treatment.

Pharmac figures show the number of adults taking SSRIs has steadily increased. In June 2000 approximately 79,460 adults were taking them. By June last year that figure had jumped to 125,400.

Pharmac chief executive Wayne McNee said the study raised questions about whether Pharmac was getting good value for the money it was investing in antidepressants.

Last year it spent $27.5 million of its $565 million total budget on anti-depressants - mostly on SSRIs.

"The other question raised is, what are the alternatives? It's important that patients are treated," said Mr McNee.

He said Pharmac would seek a meeting with the College of Psychiatrists to discuss the issue.

Dr Allen Fraser, chairman of the Royal Australian and New Zealand College of Psychiatrists, said the authors had a valid point in saying study data did not strongly support anti-depressants being much better than placebos.

But that could be attributed to the fact that many people who took part in drug trials and met the criteria for depression would not in fact be treated with drugs. Many would be treated with cognitive behaviour therapy or by changes to their lifestyle, and were unlikely to experience a marked difference with drugs.

Dr Fraser said in practice antidepressants were a "lifesaver" for some people and he believed they were under-used. Many people waited too long to seek treatment while others did not seek help at all.

"The message I give to patients is that this is our best technology at the moment. It's not perfect, it does work for a lot of people, it's worthwhile trying."

Ministry of Health spokesman Dr Stewart Jessamine said the British study was an opinion piece and took an opposing view to Britain's National Institute of Clinical Excellence, a body of experts which looked at the best evidence available before producing guidelines for antidepressant use.