Is antidepressant research coming to an end?

With unemployment rising, public spending cuts becoming a reality, and the very real risk of a "double dip recession" on the horizon, we can expect many more people going to visit their GP with depression. 

With few alternatives to antidepressants readily available, you would be forgiven for thinking that the pharmaceutical companies would be rubbing their hands together in glee at the prospect of all those additional prescriptions.  But in a thoughtful analysis of trends within the pharmaceutical industry, the Financial Times notes that the opposite is true. 

The major pharmaceutical companies that manufacture antidepressants are taking money away from further research.  There are two reasons for this.  First, the entry criteria for people volunteering to participate in research has become much tighter.  Because it is now widely recognised that antidepressants are only effective in those with the most severe depression, finding volunteers who are able/willing to participate and are not already taking an antidepressant is difficult.  The FT article suggests that the practice of inflating patients' symptoms so that they qualify for research trials has created a growing placebo effect - once the trial starts, there is no longer an incentive to inflate the symptoms, so everyone appears to get better!  This is catastrophic for pharmaceutical companies that have to show their drug is significantly better than placebo.

Second, many of the Prozac generation of SSRI, SNRI and SSNRI antidepressants are available in cheap, generic form.  With pressure on prescribers to use generic drugs before branded ones, this leaves the big antidepressant manufacturers facing relatively low returns on investment into new drugs.

The reigning back of an antidepressant market that at its height in 2006 brought in $20.2bn worldwide will be viewed as a good thing in many quarters.  There has always been a concern that the pharmaceutical industry was "disease mongering" (broadening the definition of depression to include vast areas of ordinary human sadness) and that high levels of public spending on antidepressants was taking vital funds away from the development of early interventions and talking treatments.  However, the drop in pharmaceutical companies' spending on research is revealing the shockingly low level of public funding of research into mental health in general and depression in particular.

While those with mild-moderate depression can look to alternative treatments for a solution to their condition, those severe and enduring depression must hope for a breakthrough by one of the smaller, specialist pharmaceutical companies that are still prepared to invest in research into the biology of depression.