Will 2010 be a depressing year for antidepressants?
January 7, 2010, The Healthcare Channel http://thehcc.tv/
Much as 2009 was a bad year for the spine surgery industry, has a critical mass of negative data on antidepressants been reached to make 2010 the year where prescription trends decrease? The current JAMA has an article that is making national news. In the paper by J. Fournier, et al, the conclusion was:
“True drug effects (an advantage of ADM over placebo) were nonexistent to negligible among depressed patients with mild, moderate, and even severe baseline symptoms, whereas they were large for patients with very severe symptoms…….
Prescribers, policy makers, and consumers may not be aware that the efficacy of medications largely has been established on the basis of studies that have included only those individuals with more severe forms of depression. This important feature of the evidence base is not reflected in the implicit messages present in the marketing of these medications to clinicians and the public. There is little mention of the fact that efficacy data often come from studies that exclude precisely those MDD patients who derive little specific pharmacological benefit from taking medications. Pending findings contrary to those reported here and those obtained by Kirsch et al and Khan et al, efforts should be made to clarify to clinicians and prospective patients that whereas ADM can have a substantial effect with more severe depressions, there is little evidence to suggest that they produce specific pharmacological benefit for the majority of patients with less severe acute depressions.”
The JAMA article recommends that policymakers be informed of the limited efficacy of antidepressants and reassess recommendations. Some specific examples of changes that could be made at the policy level would be raising the tier level in Medicare Part D, making the drugs more expensive to use, or a revaluation of the label indications by the FDA, just to name a few.
The New York Times discussion of the Fournier JAMA paper quotes Erick Turner, MD: psychiatrist and former medical officer for the FDA who evaluated antidepressants. The HCC interviewed Dr. Dr. Turner about a related matter whereby industry-funded studies supporting the efficacy of antidepressants were biased because the negative studies were never published in many cases.
In addition to the above, a prominent Senator is now on the case of antidepressant abuse.
Senator Benjamin Cardin (D-MD) is investigating the high usage rate of antidepressants in the military. In many cases, the medications are administered in unsupervised battlefields. Coinciding with this is the soaring rate of suicide in the military. The HCC interview with Senator Cardin may be viewed in the video player section.
In 2008 and 2009, Senators Grassley and Kohl addressed the biasing influences of drug industry payments to psychiatrists. Prominent psychiatrists at Harvard, Emory, Stanford and others have been reprimanded for concealing large payments from the makers of antidepressants. Moreover, if healthcare reform becomes finalized, the Physician Sunshine Payment Act will add more pressure on the ability for drug companies to create “thought leaders” promoting antidepressants.
The growth of total prescriptions for all forms of antidepressants has been stagnant. The HCC combined the Total RX data from IMS Health for the class of drugs including SSRI (Prozac, Zoloft, Celexa, Paxil, etc), SNRI (Effexor, Pristiq, Cymbalta, etc), and newer classes (Wellbutrin, etc).
Although an astonishing 200 Million prescriptions for antidepressants were written in 2008, growth has been nearly flat for the last three years (we have preliminary 2009 numbers of TRX being 208 Million). Of note, all prescription drug usage as a whole is also down with the economic depression.
|
|
2004 |
2005 |
2006 |
2007 |
2008 |
|
Total RX all forms of antidepressants (000) |
181,815 |
183,468 |
195,856 |
202,313 |
206,468 |
|
year over year growth |
|
1% |
7% |
3% |
2% |
|
IMS health data |
|
|
|
|
|
Is this indicative of a market close to imploding rather than growing? The HCC will be following these trends and developments in 2010. Stay tuned.
FDA, Oregon H&S Univ, Psychiatry | apples49 | 
June 29, 2010 1:00 pm
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