Martin & Elworthy report that the biggest reason for prescribing electroconvulsive therapy (ECT) less frequently than before is the perception among psychiatrists that ‘more effective medication’ now exists. Reference Fitzgerald1 Unfortunately, the authors collude with this exaggerated view, claiming that ‘psychiatric medications have undoubtedly become more effective over recent years’. Their bold statement references a 2002 story in The New York Times.
Meta-analysis shows that the current first-line treatments for depressive disorder, selective serotonin reuptake inhibitors, are marginally less effective than older tricyclic antidepressants (TCAs), while serotonin-noradrenaline reuptake inhibitors show no statistically significant advantage over TCAs. Reference Ley2 One newer drug, reboxetine, does not work at all, Reference Osterberg and Blasche3 yet is inexplicably still licensed as an antidepressant.
Lithium remains the only true mood stabiliser: it is the only drug with efficacy in treating acute manic and depressive symptoms and in prophylaxis of manic and depressive symptoms in bipolar disorder.4
One has to conclude that the prevailing delusion that treatments across psychiatry have become more effective has been mediated by the pharmaceutical industry. Psychiatrists should take their evidence from meta-analyses in peer-reviewed journals, not from advertising representatives and certainly not from the newsstand.
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