From Our 2008 Archives
The Truth About Antidepressants
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A new study says some antidepressants are mostly ineffective, but many previous studies show the opposite.
Daniel J. DeNoon
Reviewed By Louise Chang, MD
A controversial new study suggests the widely prescribed antidepressants Prozac, Paxil, and Effexor work no better than placebo for most patients who take them, and many depression experts now cry foul.
What does the new study say about the ineffectiveness of antidepressants?
In findings published in the February issue of the journal PloS Medicine, researchers conclude that when taken as a whole, the data show that only a small group of the most severely depressed patients benefit from taking one of the antidepressants.
For less severely depressed patients, the antidepressants were found to work no better than placebos, leading the researchers to conclude that most patients who take antidepressants probably shouldn't be on them.
Does this study contradict numerous positive studies on antidepressants?
Yes, it does. In a statement, American Psychiatric Association President-elect Nada Stotland, MD, maintains that studies like this one, which compare a single drug to placebo, do not accurately reflect the way doctors prescribe antidepressants today.
Stotland says many people who are depressed do not respond to the first antidepressant they try. "It may take up to an average of three or more different antidepressants until we find the one that works for a particular individual. Therefore, testing any single antidepressant on a group of depressed individuals will show that many of them do not improve."
What do other findings show about using antidepressants?
Numerous studies support the benefit of antidepressants in improving mood, increasing ability to function socially, and easing physical complaints of joint pain, insomnia, and low energy.
According to Ronald R. Fieve, MD, psychopharmacologist and professor of clinical psychiatry at Columbia Presbyterian Medical Center in New York City, its not unusual for an antidepressant to take two to six weeks to have an effect on a patient's mood.
"People must realize that we've come a long way in reducing the side effects of antidepressants since first prescribing the tricyclics," Fieve says. "And while drug companies have reduced medication side effects with the newer [antidepressants], there's still not much improvement with onset of action or efficacy."
Fieve notes that in his practice, a good number of patients dramatically come out of their depression within 10 days to two weeks. "About 65% see improvement on the first antidepressant, and 85% of patients succeed on one to three antidepressant trials."
Why wouldn't an antidepressant work?
According to Fieve, sometimes the doctor chooses the wrong antidepressant, or the right antidepressant in the wrong dosage, or does not administer the antidepressant for at least six weeks at the highest dose tolerable to achieve full therapeutic results.
In addition, if the depressed patient has problems with alcohol or drug abuse and takes an antidepressant, the medication isn't getting at the real problem. There are also patients who are heavily medicated on tranquilizers who wonder why an antidepressant doesn't work to ease their depression. Coming off the tranquilizers may improve mood, Fieve says.
Can alternative treatments help in treating depression?
But what about those with major depressive disorder? "Medications are necessary," Fieve says. "Psychotherapy is also a useful adjunct in combination with medications."
What about teens and antidepressants?
The latest findings published in The Journal of the American Medical Association show that depressed teens who don't respond well to the first prescribed antidepressant medication begin to improve if they are switched to a different antidepressant medication and also offered "talk" therapy.
The combination—switching medications and offering talk therapy—works better than simply changing medications, the researchers found, although switching medications alone also offers improvement.
What are the common signs of depression?
Symptoms of depression vary per person but may include depressed mood most of the day, particularly in the morning, diminished interest or pleasure in activities, weight loss or gain, insomnia or excessive sleep, fatigue or loss of energy, impaired concentration, and feelings of worthlessness or guilt, among others.
Teens and children with depression may experience apathy, social withdrawal, weight loss, insomnia, fatigue, isolation from family and friends, a drop in school performance, and even drug or alcohol abuse.
Fieve said there are standard guidelines for diagnosing and treating a host of mood disorders, including major depression, dysthymia, seasonal affective disorder (SAD), bipolar depression, and others published in the American Psychiatric Association's Diagnostic and Statistical Manual, Fourth Edition - the DSM-IV.
What causes depression?
The causes of depression are many. For some, depression occurs after loss of a loved one, a change in one's life such as getting divorced, or after being diagnosed with a serious medical disease. For others, depression just happens, possibly because of their family history. Medications can cause depression, and nearly 30% of people with substance abuse problems also have major depression.
How do most doctors treat depression?
Standard treatment of depression includes antidepressants and/or psychotherapy, as well as a multifaceted program of diet and lifestyle changes and alternative therapies. Experts believe that different treatment approaches work for different people—and it's not easy to predict what might work.
What if my antidepressant doesn't seem to work?
Talk to your doctor. You may need to try a different type of antidepressant until you find the right fit and may need additional treatment, such as talk therapy. Just like with any chronic medical condition, it takes patience and perseverance to get the best outcome with depression.
SOURCES: Ronald R. Fieve, MD, New York City. Kirsch, I. PLoS Medicine, February 2008; vol 5: online edition. WebMD Health News: "Antidepressants No Better Than Placebo?" WebMD Medical Reference: "Understanding Depression - Symptoms." WebMD Health News: "Hope May Take Time After Depression." WebMD Health News: "Teen Depression: Try Therapy, Switch Medication."
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