Antidepressants Don’t Help Mild Depression: Study
12 CommentsBy Ed Silverman // January 5th, 2010 // 4:06 pm
The ongoing debate over antidepressants and links to suicides prompts the medical community - notably, psychiatrists - to say the pills serve a needed purpose. Without the drugs, the argument goes, many patients may be in worse shape (background here). A new analysis in the Journal of the American Medical Association suggests the pills don’t do much for those with mild or moderate depression.
An analysis of randomized trials indicates that, compared with placebo, the “magnitude of benefit” of varies with the severity of symptoms, and may provide little benefit for those with mild or moderate depression. But the pills do appear to provide a substantial benefit for the severely depressed, according to the JAMA review. The article goes on to say there is little evidence antidepressants have a specific pharmacological effect relative to placebo for patients with less severe depression.
The researchers conducted a meta-analysis, which was funded by the National Insitutes of Mental Health, to estimate the benefit of the pills versus placebo across a wide range of “initial symptom severity” in patients diagnosed with depression. They combined data from six large-scale, placebo-controlled randomized trials, which included 718 adult outpatients. And they found that efficacy for treating depression varied considerably, depending on symptom severity (here is the abstract).
“What makes our findings surprising is the high level of depression symptom severity that appears to be required for clinically meaningful drug/placebo differences to emerge, particularly given the evidence that the majority of patients receiving ADM in clinical practice present with (measures of depression) below these levels,” the authors conclude. “Prescribers, policy makers, and consumers may not be aware that the efficacy of medications largely has been established on the basis of studies that have included only those individuals with more severe forms of depression. This important feature of the evidence base is not reflected in the implicit messages present in the marketing of these medications to clinicians and the public.”
“There is little mention of the fact that efficacy data often come from studies that exclude precisely those MDD (major depressive disorder) patients who derive little specific pharmacological benefit from taking medications.”
“Pending findings contrary to those reported here and those obtained (in previous studies)…efforts should be made to clarify to clinicians and prospective patients that whereas ADM can have a substantial effect with more severe depressions, there is little evidence to suggest that they produce specific pharmacological benefit for the majority of patients with less severe acute depressions.”
Matthew Holford
I’ve just left a comment on Furious Seasons, on this subject, but here goes, anyway…
The National Institute for Health and Clinical Excellence (NICE), in the UK, which has as part of its remit the assessment of drugs for use on the NHS, has held this position for several years, now. NICE also drafts guidelines for the benefit of quacks, and its Guidance on depression provides that drugs are largely ineffective in the treatment of mild/moderate depression and should be used as a last resort and only after other treatment options (counselling, predominantly, I suppose), have been tried.
My understanding, notwithstanding this Guidance, is that most scripts in the UK are written for mild depression… I guess your average quack doesn’t get much reading time.
Matt
Justice in MI
Good to see more data. Most clinicians with psych. training (not GPs or others) already know this.
Ana
Antidepressants SSRIs/SSNIs don’t even help MDD.
I know many patients that starts Prozac… it works for a while, stops working= change to Effexor, works for a while, stops working= change to Zoloft; works for a while, stops working= change to Paxil; works for a while, stops working= change to Cymbalta; works for a while, stops working= change to…
Some end up having ECT.
Give me a break! The “chemical imbalance” hypothesis has been taken as a theory that makes no sense for people who have a little time to search the web.
Same here in Brazil Matthew!
Many people are taking antidepressants for mild depression and other because of lost of job or divorce.
Diagnosing life that’s what some physicians are doing.
Laurie
While we’ve known these results for a long time based on real life patients using them, physicians are still prescribing these drugs for everything from a bad breakup to irritable bowel…..
So we have drugs being prescribed in the millions with minimal, if any, positive effect but potentially devastating side effects and withdrawal.
Buyer beware…there is no magic pill.
Justice in MI
Those who saw tonight’s PBS show on “negative emotion” will be pretty convinced there is a magic pill–one that will prevent irreversible brain damage unless you treat depression with meds asap.
Justice in MI
It’s obviously of crucial importance that we get this as right as the limits of studies allow. Having now read the JAMA article, there are certainly limits on the finding, as is acknowledged. Still, the key excerpt seems to me to be this:
“What makes our findings surprising is the high level of depression symptom severity that appears to be required for clinically meaningful drug/placebo differences to
emerge, particularly given the evidence
that the majority of patients receiving
ADM in clinical practice present with scores below these levels.”
While it is beyond the power of the study to estimate, it would be relevant to know–at least roughly–what “the majority of patients” means in this context; that is, roughly what percentage. 90% would have different implications than, say, 55%.
karen
Guess who will be trashing this study ASAP???
Big Pharma makes 10 Billion off pushing antidepressants every year and therfore they stand to lose 7 Billion yearly. They own Obama. Watch how quickly this legitimate study is trashed and disappears.
Wake up people and stop letting Big Pharma and Big Fed. Gov. control your lives!!!
O’h and even though the drugs aren’t effective in 70% of the cases to abate the depression they DO cause awful side effects like blunting of normal feelings and emotions, craving alcohol, other abnormal behaviors [list is endless] plus joint and mucle pain [ so then you go on painkillers like Vicodin that are addicting] and then you can’t sleep [so you get addicted to Ambien]….get the picture?
Lisa Van Syckel
Ed, this is actually old news,..
vince
Not to mention weight gain; diabetes and other side benefits of this class of drugs. How many scripts will that add.
harpy
“They own Obama.”?
Where’d you pull that from? Pharma owns Congress, luv. Both sides. Ever heard of Billy Tauzin? Tort reform? the Medicare donut? Chuck Grassley? Henry Waxman? Let’s keep our focus here.
karen
harpy
Yep, they own Obama and Congress. The 80 billion dollar deal he made behind closed doors in the fall right after he was elected. As long a we allow this unconstitutional nonsense to continue this problem will just escalate with many more unsuspecting victims falling prey to these horrible drugs even though they don’t work. Politics and drugs are connected. Follow the money!
jeffrey dach md
JAMA Says SSRI Antidepressants Work No Better Than Placebos For Mild to Moderate Depression
This JAMA article provides evidence that Premenstrual Dysphoric Disorder and other common forms of hormonal imbalance such as PMS are poorly served by SSRI antidepressants. An SSRI drug is simply the wrong treatment for PMS. The benefit of SSRI antidepressants for this group is the same as the benefit from placebo. In many cases, bioidentical progesterone works quite well for PMS with none of the adverse side effects associated with SSRI antidepressants. Adverse effects of SSRIs include sexual dysfunction, weight gain and sleep disturbance. Another troubling issue is increased suicide risk with SSRI drugs… For More:
http://jeffreydach.com/2010/01/21/jama-says-ssri-antidepressants-are-placebos-by-jeffrey-dach-md.aspx