Reboxetine in depression. NICE guidance differs, so where next?

Krishnadas, R. (2010) Reboxetine in depression. NICE guidance differs, so where next? British Medical Journal, 341, p. 6484. (doi: 10.1136/bmj.c6484)

Abstract

<p>Eyding and colleagues claim that reboxetine is an ineffective and potentially harmful antidepressant, and call for the mandatory publication of trial data to exclude publication bias.¹</p> <p>The updated guidelines from the National Institute for Health and Clinical Excellence (NICE) suggest that strong evidence favours reboxetine over placebo in achieving a response or remission of depressive symptoms.² The NICE meta-analyses included six trials published between 1997 and 2002. Eyding and colleagues included trials conducted up to 2006. However, the two meta-analyses had only three trials in common. Three studies thought to be good enough by NICE were rejected by Eyding and colleagues.</p> <p>In their seminal paper of 2008 Turner et al suggest that published studies on antidepressants are almost always positive, but only 51% are positive when unpublished negative studies are considered.³ Ghaemi suggests that if clinicians knew that the real evidence base for antidepressants was a score of 51 v 49, not 90 v 10, they might be more judicious in their prescription.⁴</p> <p>Inclusion of unpublished trials from the US Food and Drug Administration may not always be ideal because initial safety trials may be underdosed and fail to show any effects. A meta-analysis is only as good as the studies it includes. Hence the discrepancy between previous meta-analyses on the same subject.⁵</p> <p>Given the new evidence, what do we do with patients whose condition has responded to reboxetine? Should we switch to another antidepressant? Do we tell them that we were treating them with something more dangerous than placebo?</p>

• Item Type: Articles (Letter)
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Krishnadas, Dr Rajeev
• Authors: Krishnadas, R.
• Subjects: R Medicine > R Medicine (General)
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing
• Journal Name: British Medical Journal
• ISSN: 0959-8138
• ISSN (Online): 1756-1833