JAMA: Antidepressants don't work for most people

[MikeyBSN]

i apologize if this has been posted already, but i found it very interesting. personally, i've never believed that anti-depressants work very well for depression. i do think that paxil works for anxiety, but that's about it. considering the staggering number of patients on these medications, i think that we should take a hard look at what we're giving people and why. not saying i believe for certian that anti-depressants don't work in most people, but i think we should take a step away from the cupcakes that our friendly pfizer rep brought for us today and take a second look at some objective studies.

antidepressants most likely have little or no effect on the majority of those suffering from slight or non-severe forms of depression, and placebos were often observed to have just as much perceived beneficial affect.

antidepressants are, however, very efficient in combating severe depression. ...the study was published wednesday in the journal of the american medical association (jama.)

...

trial end results showed that whatever the drug used, the conclusions were the same -- in cases of severe depression, antidepressants were much more effective than placebos, but on the other hand, the beneficial effects of drug molecules was observed to be minimal, or even nonexistent, in patients treated with drugs adapted to conditions of mild depression, and placebos worked just as well.

....

it appears that neither patients or healthcare professionals are aware that most studies which claim to demonstrate the efficiency of various antidepressants only used patients suffering from severe forms of depression, which would spin the study conclusions.

http://www.fleshandstone.net/healthandsciencenews/1731.html

[LorenM]

This report makes me very sad...

[elkpark]

Many of us in psych have been talking about this for many years. It's always been my empirical observation that antidepressants don't seem to do much of anything for anyone. When drug companies are trying to get a new antidepressant approved for the market, they have to do multiple studies to come up with one that shows the drug is even minimally better than a placebo -- just enough better to meet the bar set by the FDA for "efficacy" -- and then they promptly bury all the studies they did that showed no significant response over a placebo.

Of course, part of the problem is that the placebo effect is so strong in depression -- studies have been done that found that (significant numbers of) depressed people who were told they were being put on a waiting list for treatment started feeling better, just knowing they were going to get treatment at some point in the future.

One ad that drives me crazy is the one for Abilify as an adjunct (to antidepressants) for treatment of depression -- the announcer solemnly intones that (am I remembering correctly?) 2 out of 3 people being treated for depression are still depressed -- and then goes on to tout adding an antipsychotic to the mix. I always think to myself, hmmmmm, if two out of three people on antidepressants are still depressed, doesn't that suggest that antidepressants aren't doing much???? Why should people spend a fortune to take them, when they work that poorly??

[blueyesue]

Yet the side effects can be very real.

[Not_A_Hat_Person, RN]

One ad that drives me crazy is the one for Abilify as an adjunct (to antidepressants) for treatment of depression -- the announcer solemnly intones that (am I remembering correctly?) 2 out of 3 people being treated for depression are still depressed -- and then goes on to tout adding an antipsychotic to the mix. I always think to myself, hmmmmm, if two out of three people on antidepressants are still depressed, doesn't that suggest that antidepressants aren't doing much???? Why should people spend a fortune to take them, when they work that poorly??

Many diabetics take more than 1 drug (ex. Januvia and Metformin). Many people with Parkinson's disease take Sinemet and Comtan. Many people take caffeine and tylenol for headaches. Many cancer patients take multiple chemo drugs.

Most people wouldn't dream of telling a cancer patient that they don't need chemo, or that needing more than 1 chemo drug means chemo is useless. There's a reason that mental illness goes untreated.

[ghillbert, MSN, NP]

The summary is somewhat misleading. Actually it says that there is little effect for mild depression. Of course there is less effect when there is less disease. People with severe clinical depression do get benefit from them.

[netglow, ASN, RN]

I've always suspected this. What is hard is that the part of treatment that often is effective is difficult to initiate for the patient, and is time consuming, and requires the patient to be active in his/her own treatment plan.

I'm talking about finding a group to participate in some activity with that can be therapeutic, as well as activities that the individual can do that are achievement based but entertaining and of use to that person. Exercise. It's hard to catch someone when symptoms are mild and get them supported early on with this stuff. For many, this is nearly impossible simply due to work and obligations.

Wouldn't it be great if like in the movies, friends would come and sweep you away to some wonderful scenic place for you to lick your wounds for 6 months in luxury after you've been hit in the head by life?

[tewdles, RN]

What is worse is that antidepressants may not help that mild depression, but they may exacerbate it...watch for suicidal tendencies.

[elkpark]

Another part of the issue is that there have been several studies that have found that antidepressant medication plus psychotherapy is significantly more effective than either medication or psychotherapy alone -- however, many, probably the majority of people taking antidepressants are being "treated" by their family physician/NP/PA, and many family practice people hand out antidepressants like M&Ms without ever talking to people about getting into therapy.

[Kabin]

I agree with others on the question of data included for those prescribed by PCPs, pts or drs that give up after one med is tried, etc.

[Jules A, MSN]

Overall I'm a big fan of antidepressants for people struggling with depression. It can take a while to find the right one and they surely aren't a magic bullet but in my experience I've seen them successfully take enough of the gloomy edge off so people can move forward with their lives.

[MikeyBSN]

Many diabetics take more than 1 drug (ex. Januvia and Metformin). Many people with Parkinson's disease take Sinemet and Comtan. Many people take caffeine and tylenol for headaches. Many cancer patients take multiple chemo drugs.

Most people wouldn't dream of telling a cancer patient that they don't need chemo, or that needing more than 1 chemo drug means chemo is useless. There's a reason that mental illness goes untreated.

The difference is that many of those work well by themselves. Both Januvia and Metformin are clinically proven to lower blood glucose levels, they just might not lower it enough in certain patients. Here, the study shows that a single antidepressant doesn't significantly improve depression in mild or moderate cases. So if one doesn't work at all, then why would you add another?