Tuesday, April 8, 2008
Paroxetine vs. Placebo for depression
Depression is a serious condition and Paroxetine (Paxil®) has been in my toolbox as one of many treatment choices for over a decade. I've seen patients who are put on SSRI medications like Paroxetine have dramatic improvement in just a few weeks.
Now new evidence has emerged that shows placebo is as good as Paroxetine for treating depression and (of course), placebo has fewer side effects.
We all know that trials favorable to a product are more likely to be published. Investigators in Italy report a large study of 29 published and 11 unpublished randomized trials that included patients with moderate to severe depression. When they compared the patients who received placebo to Paroxetine, they found that it was not better in therapeutic effectiveness. The Paroxetine patients improved on some features but the placebo patients were less suicidal. More patients dropped out of the Paroxetine study because of side effects.
Damn, we physicians hate it when data proves us wrong, but if we are willing to change our practices when new information is presented, it benefits everyone. We do need, however, to be vigilant and review all the data before we make decisions. That includes this new study. I would certainly not take a patient off Paxil if they are doing well.
I think this shows us that placebo and mind-body connection are powerful instruments for healing.
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