Serotonin transporter gene and escitalopram: depressing medical science
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LETTER TO THE EDITOR
Serotonin transporter gene and escitalopram: depressing medical science Alain Braillon 1 Received: 7 May 2020 / Accepted: 19 June 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
The clinical trial evaluating 5HTTLPR and 5HTTLPR-rs25531 polymorphisms with the treatment response of escitalopram in patients with major depressive disorder deserved comment [1]. Firstly, could Mandal and colleagues provide the trial registration number? According to international guidelines accepted by the Journal in 2008 and detailed in its website, trial registration must be included in the article. Further, a registration of the trial cannot be found in the most commonly used public registry (clinicaltrials.gov). Secondly, the approval of the trial by an Institutional Ethics Committee, a most frequent case, questioned the independency of the decision. Thirdly, how participants were informed that: a) Antidepressants have no proven superiority vs. specific psychosocial interventions. Notably, cognitive behavioural therapy, interpersonal psychotherapy, or behavioural activation are robustly evidence based in the real-life setting and over the long term, are often preferred by patients, and are known to improve self-esteem, agency, and social functioning without serious adverse effects. (see 19–22 in [2]). This is a concern when considering the unbalanced introduction claiming “ selective serotonin reuptake inhibitors in clinical psychiatric practice led to remarkable advancement in the treatment of patients with major depressive disorder” [1]. Further, more than twothird of the patients in this series experienced a first episode of depression; accordingly psychotherapy must be proposed as the first line if no barrier to access. b) About safety issues. There is no robust evidence that escitalopram is superior in terms of efficacy for any approved indications when compared with other antidepressants, but there have been accumulating evidence since * Alain Braillon [email protected] 1
University Hospital, 80000 Amiens, France
2001; it ranks first for serious cardiovascular adverse effects: QT prolongation and deadly torsade de pointes [3]? The independent drug bulletin Prescrire International has been publishing for more than a decade a yearly list with a hundred of “drugs to avoid” (drugs more harmful than beneficial or availability of others with a better harmbenefit balance) which includes escitalopram [4]. This issue is a worldwide one and a global one. Why national drug agencies fail to fulfil their responsibilities even more when the duty of “safety” is stressed in their name as in France for the “National Agency for the Safety of Medicines and Health Products”? Why in 2017 escitalopram was the 20th most commonly prescribed medication in the US (49th in 2013) and citalopram the 26th (https://clincalc.com/DrugStats/Drugs/)? Why as search for escitalopram in clinicaltrials.gov retrieved 54 trials recruiting? Several trials’ investigation escitalopram have a placebo group, flying in the f
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