Mental health experts in the United States reacted cautiously to the British announcements and said the usefulness of the recommendation against starting medication for cases of mild depression would depend on how it was defined and how long other interventions are tried.
While agreeing that talk therapy had been proved to be as effective as medications in cases of mild depression, Darrel Regier, director of research and education at the American Psychiatric Association, said patients may not have easy access to such treatment, which must be administered by trained professionals. Medications, however, can be prescribed by any general physician, he said.
Pilling said some of the simpler recommendations would be accessible to anyone: "Run around the park and go to the gym," he said.
Explaining that 70 percent of the patients in British doctor's offices have mild depression, Pilling added: "Many people with mild depression will be able to go to work and getting on. Someone with severe depression will struggle to get out of the house."
Goodheart, a psychologist, welcomed the British suggestion that talk therapy be tried before medications. Most states do not allow psychologists to prescribe drugs. She described techniques such as cognitive behavior therapy and interpersonal therapy as safe, effective and long-lasting, but she was more cautious about the other suggestions.
"Watchful waiting is not really a treatment," she said. "Once someone is diagnosed with depression . . . even if it is mild, I think we would recommend that you offer treatment."
The British guidelines said it is appropriate to treat patients with moderate depression with antidepressants. And patients with severe depression, Pilling said, ought to be started on a combination of medication and talk therapy.
The companion report issued by the British regulatory agency said Effexor should be prescribed only by specialists and should not be taken by patients with heart disease. But patients doing well on the drug should finish their course of treatment, the British regulators said.
Wyeth, the maker of Effexor, said in a statement that higher rates of side effects in patients taking the drug occurred because the medication was used on very sick patients after other drugs had been ineffective. The patients' underlying illnesses, not Effexor, were responsible for the problems, the company said.
"Restricting access to medication is not in the best interest of patients and is a backward step in the treatment of depression in this country," said Allison Jeynes-Ellis, Wyeth's medical director in the United Kingdom.
In a statement yesterday evening, the FDA said it has requested new data from Wyeth and will review it as soon as possible. "We will also work with the MHRA to fully understand the basis for their decision," the statement said.
On Wall Street yesterday, the stock of Pfizer Inc., which makes Zoloft, fell 2.4 percent, to $27.21. Last year, Zoloft accounted for $3.1 billion of the firm's $45 billion in revenue. Shares of Wyeth fell 3 percent, to $40.27. Effexor, with $2.7 billion in sales last year, was the single largest contributor to Wyeth's revenue of $15.8 billion.
Staff writer Brooke A. Masters contributed to this report.
