Antidepressants Best With Severely Depressed
If you are mildly depressed an anti-depressant probably isn't going to do you much good.
An analysis of randomized trials indicates that compared with placebo, the magnitude of benefit of antidepressant medications varies with the severity of depressive symptoms, and may provide little benefit for patients with mild or moderate depression, but appear to provide substantial benefit for patients with very severe depression, according to an article in the January 6 issue of JAMA.
Antidepressant medications (ADM) are the current standard of treatment for major depressive disorder (MDD), but there is little evidence that they have a specific pharmacological effect relative to placebo for patients with less severe depression, according to background information in the article.
On the bright side the mildly depressed aren't as urgently in need of help. Best that a drug does the most good for those severely depressed.
The authors found that the efficacy of ADM treatment for depression varied considerably, depending on symptom severity. “True drug effects (an advantage of ADM over placebo) were nonexistent to negligible among depressed patients with mild, moderate, and even severe baseline symptoms, whereas they were large for patients with very severe symptoms.”
"Mind: Before You Quit Antidepressants ..." byRichard A Friedman, M.D.in the NYTimes on January 12, 2010:
... on close inspection, the new study does not stand up to that mountain of earlier evidence. ...
For the recent analysis in the journal, the authors identified 23 studies (out of several hundred clinical trials) that met their criteria for inclusion. Of those 23, they could get access to data on only 6, with a total of 718 subjects. Three trials tested the antidepressant Paxil ... and three used an older drug, imipramine, ...
... Robert J. DeRubeis, a professor of psychology at the University of Pennsylvania who is one of the new paper’s authors, told me, “Of course, we can’t know that these results generalize to other medications.”
... the authors of the new analysis gave themselves an additional handicap: they decided to exclude a whole class of studies, those that tried to correct for the so-called placebo response.
in randomized clinical trials that try to correct, or wash out, the placebo effect, patients with mild to moderate depression respond to antidepressants at rates nearly identical to patients with severe depression (who tend to have a much lower response to placebos).
Another drawback of the study is that its conclusions are based on studies that included only two antidepressants — when there are 25 or so on the market. By contrast, when the Food and Drug Administration wanted to investigate the safety of antidepressants, it analyzed data from some 300 clinical trials, with nearly 80,000 patients, involving about a dozen antidepressants.
Antidepressants are not interchangeable; studies show that a patient who fails to respond to one has about a 30 percent chance of responding to another.
the real test of an antidepressant is not just whether it can lift someone out of depression; it is whether it can keep depression from returning. For a vast majority of people with depression, the illness is chronic. Relapses and low-level symptoms between episodes are common.
Scores of studies show that antidepressants are highly effective in preventing relapse; on average, the risk of relapse in patients who continue on an antidepressant is one-half to one-third of those who are switched to a placebo.
Every once in a while, a landmark study comes along and overturns everyone’s cherished ideas about a particular treatment. But the current study is not one of them. ...