Paxil: How Effective Is It for Major Depression in Adults?

Major depression continues to be one of the most common and debilitating chronic mood problems afflicting adults. According to the Mayo Clinic, there is no quick fix for those who have this disease. Appropriate treatment includes a long process of psychotherapy, lifestyle changes, and medication. Recently, several studies have indicated that the antidepressant drug Paxil (paroxetine) may increase the risk of suicidal thoughts or even attempted suicide in certain patients. As a member of the class of drugs known as selective serotonin reuptake inhibitors (SSRIs), Paxil is one of the most frequently prescribed treatments for depression on the market. The concern over suicide has led researchers to look back at previous studies in an attempt to reassess both the effectiveness and the safety of this particular medication.

Researchers studied the results of 40 double-blind, placebo-controlled clinical trials of Paxil. As a whole, the trials included nearly 7,000 adult participants, most of whom were diagnosed with either moderate or major depression. In a typical clinical trial of a medication, participants who leave the trial early are not taken into account; their data are incomplete and inconclusive. For the present review, however, researchers considered early withdrawal to be an indicator of either ineffective treatment or adverse effects. Surprisingly, the same proportion of trial participants left their respective studies early, regardless of whether they were taking placebo or Paxil. One would expect that more of those taking Paxil would remain in the study, but the numbers tell a different story. The researchers point out another flaw in depression research in general—the dependence on rating scales rather than overt and empirical evidence. Because depression is a psychological illness with few, if any, quantifiable symptoms, gauging its severity becomes very subjective.

When researchers pooled the results from all 40 trials together, the beneficial effects of Paxil were significant but only marginally more significant than placebo. If 100 patients are treated with Paxil, then an average of 53 of them will have a positive response, compared with 42 for placebo. In essence, this medication performs only 11% better than a sugar pill. When researchers considered the potential adverse effects of Paxil, including suicidal tendencies and attempted suicides, the picture became even murkier. Of all the SSRIs, Paxil has been shown to produce the greatest spike in suicidal thoughts, especially in young adults and adolescents.

The researchers conclude that the fields of psychology and pharmacology are in need of better experimental design. They argue that current designs overstate the effectiveness of antidepressant medications while simultaneously downplaying adverse effects. For Paxil at least, a closer look at a large cross-section of data reveals that it may not be quite as effective as once thought. As always, doctors should carefully screen their patients before prescribing any antidepressant medications. Any hint of suicidal tendencies argues against its prescription.

References

1. Barbui, C., Furukawa, T.A., Cipriani, A. (2008). Effectiveness of paroxetine in the treatment of acute major depression in adults: a systematic re-examination of published and unpublished data from randomized trials. Canadian Medical Association Journal, 178(3), 296-305.
2. MayoClinic.com. (n.d.). Depression (major depression). Retrieved March 8, 2012, from http://www.mayoclinic.com/health/depression/DS00175

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