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Exaggerating effect of antidepressants this report that “Zoloft found effective for youth depression” and subtitled “69% of children, teens who took antidepressant improved, study shows,” is typical of media coverage, which is often heavily influenced by drug company spin. T
he article’s headline, subtitle and first four paragraphs portray a new study as strong evidence favoring Zoloft as a treatment for child and adolescent depression. However, while the drug study showed that 69 percent of depressed patients improved on Zoloft, 59 percent of those given a placebo (a sugar pill) also improved. Moreover, the article later cites expert opinion that “the 10 percent improvement ... was not substantial” and that “the treatment effect in this is rather small.”
Therefore, the headline might better have said: “Billion-dollar antidepressant barely outperforms sugar pill in study funded by Zoloft’s manufacturer.”
Yet even this fails to do the matter justice. Virtually all drug studies compare sugar pill placebos with the experimental drug. Since psychiatric drugs typically have side effects and sugar pills do not, participants and doctors often figure out who’s getting the medicine and the sugar pill. This diminishes the “placebo effect,” which depends on the subject’s belief that he or she may be getting “real medicine.”
The psychiatric drug being tested therefore looks better than it really is, in comparison with the sugar-pill placebo. A truer test would be to compare the drug with an “active” placebo (a non-psychoactive substance that causes mild side effects), making it harder for subjects and doctors to guess who’s getting the drug and who isn’t.
Active placebos typically outperform sugar pill placebos by 10 to 15 percent, which could wipe out the 10 percent Zoloft advantage The Sun reported. Therefore, a comparison of the drug with an active placebo could easily produce the headline, “Zoloft fails to outperform placebo in major study.” Peter C. Dwyer Baltimore
The writer is a clinical social worker who works with special-needs children.
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The anti-depressant Zoloft works in children, too, according to the biggest study ever to look at the question.
In a study of 376 youngsters ages 6 through 17 with major depression, Zoloft worked better than dummy pills at reducing symptoms. Sixty-nine percent of children who took Zoloft for 10 weeks showed a substantial reduction in symptoms, compared with 59 percent who took dummy pills.
While that difference was not huge, the findings are significant because depression treatments have frequently failed to outperform placebos in previous research in children, said Dr. Christopher Varley a University of Washington psychiatry professor. Children tend to respond to placebos more than adults do because they are more suggestible, said Varley, who wrote an editorial accompanying the study in Wednesday’s Journal of the American Medical Association.
The study was funded by Pfizer Inc., which makes Zoloft. Many doctors already prescribe Zoloft for depressed children based on evidence that it works in adults, and will welcome results affirming that practice, Varley said. “There’s a crying need for all sorts of studies like this one,” Varley said.
Study author Dr. Karen Dineen Wagner agreed. “We have very little information about what’s safe and effective for treating this disorder in youth,” said Wagner, director of child and adolescent psychiatry at the University of Texas Medical Branch in Galveston. By some estimates, depression affects as many as 8 percent of teenagers and 3 percent of younger children.
Zoloft’s side effects in children included diarrhea and agitation but were mostly mild and uncommon. Prozac, made by Eli Lilly & Co., is the only newer anti-depressant officially approved for treating depression in children.
The government recently warned against using a similar drug, Paxil, in youngsters because of a potential increased risk of suicide. Both drugs and Zoloft are called selective serotonin re-uptake inhibitors, which increase brain activity of the mood-regulating chemical serotonin.
Pfizer shares rose 14 cents to close at $30.01 on the New York Stock Exchange
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