When patients are diagnosed with depression, the first treatment their doctor suggests is often antidepressant medication. Antidepressants have been a go-to therapy for decades. But recent research — and some soul-searching among mental health providers — is starting to raise questions about that automatic response to very complicated issues: What causes depression, and what is the best way to treat it?
In asking if medications are effective in treating depression, the answer is not as simple as many would hope. Depending on whom you ask, the response may range from “pretty good” to “not much better than a placebo” to “more harmful than helpful.”
[See: Am I Just Sad — or Actually Depressed?]
The Science of Antidepressants
Antidepressants are based on the science of neurobiology. Nerve cells in the brain use chemicals called neurotransmitters to pass impulses from cell to cell. Depression may be caused by an imbalance of some of these chemicals. Antidepressants help brain cells produce or better use these chemicals.
According to the National Institute of Mental Health, the most popular antidepressants are called selective serotonin reuptake inhibitors, or SSRIs. Other widely prescribed antidepressants are serotonin and norepinephrine reuptake inhibitors, or SNRIs. Bupropion, a third type of antidepressant, is also used to treat seasonal affective disorder (and to help with smoking cessation). The National Institutes of Health, or NIH, says these three types of medication are more popular than older classes of drugs, such as tricyclics, tetracyclics and monoamine oxidase inhibitors, because they have fewer and less severe side effects.
The NIH also says patients respond better to some antidepressant medications than to others, but that each works about as well as the next to relieve symptoms of depression and to keep symptoms from returning.
But how well is that?
Differences of Opinion
The NIH says they do work but, again, not as much as you might have been led to believe.
In a review of several studies on antidepressant efficacy, the NIH reports that when patients are treated without antidepressants, about 20 to 40 out of 100 people who took a placebo saw their symptoms improve within six to eight weeks. For those treated with antidepressants, about 40 to 60 out of 100 people noticed an improvement in the same time period. So, antidepressants helped about 20 more people out of 100. That improvement is statistically significant, but hardly represents a panacea.
[See: 11 Simple, Proven Ways to Optimize Your Mental Health.]
Dr. Maria Oquendo, professor and chair of psychiatry at the Perelman School of Medicine at the University of Pennsylvania, and current president of the American Psychiatric Association, agrees that about 40 percent of people on medications get better, but that patients often have to try several meds to find the one that works.
“As with cholesterol or high blood pressure, the same is true with depression. You try a couple things because something doesn’t work or has side effects that you can’t tolerate,” Oquendo says. The reasons that some meds don’t work are unclear. “Some target serotonin, some target dopamine, and thus far we have been unable to target approaches,” she says, adding that combining medications with some form of therapy increases the odds of recovery.
Other mental health professionals take a dimmer view of antidepressants. Michael D. Yapko, a retired clinical psychologist who now gives workshops to other providers on depression and its treatment, feels that these drugs are at best ineffective. “They are barely better than a placebo,” he says. “Psychiatry has postulated an imbalance in brain chemicals, which is good for selling drugs but not for treating people. In Britain they do not use drugs at all except in extreme cases, because of how ineffective and unsafe they are.”
A study in the Journal of the American Medical Association supports his claim. It concludes that, while medications are substantially better than a placebo for patients with very severe depression, those benefits “may be minimal or nonexistent, on average, in patients with mild or moderate symptoms.”
What’s more, other research has found that non-medical therapies can be just as effective as antidepressants. Exercise, for instance, may be better than meds in relieving mild to moderate symptoms, and it has none of the negative side effects. For seasonal affective disorder, light therapy is often enough to boost mood, again with no side effects.
Antidepressants in ‘Crisis’
A 2012 study in the Yale Journal of Biology and Medicine titled ” Antidepressants and Advertising: Psychopharmaceuticals in Crisis” puts this question in a larger context, arguing that whether antidepressants are effective, “is not a straightforward objective question, but rather a larger social contest involving scientific debate, the political history of the pharmaceutical industry, cultural discourses surrounding the role of drugs in society, and the interpretive flexibility of personal experience.”
It supports Yapko’s claims by stating that “antidepressant advertising propagates narrowly biological explanations of depression (especially the seductive notion of simple neurochemical imbalance or deficiency) and leaves out any mention of how often symptom relief may occur because of non-pharmacological interventions. At the same time, it would seem that drug companies are using advertising precisely to inflate such non-pharmacological effects, with the goal of attracting consumers to antidepressants, and then keeping them on them.”
To be clear, this is not to say antidepressants have no place in the treatment of depression. More severe cases clearly benefit from medical therapy. Patients in “crisis” who may be contemplating harming themselves or others should seek immediate help, which often includes medication.
[See: 9 Things to Do or Say When a Loved One Talks About Taking Their Life.]
However, those with milder cases should talk to a mental health specialist to determine if antidepressant medication is a smart choice for them. They should also consider other forms of treatment first. As easy as it is to “take a pill,” medication may not be the best path to recovery.
“This is an emotionally charged issue,” Yapko says. Billions of dollars in pharmaceutical sales are at stake, and “medication is still the most common form of treatment, unfortunately, which is why the problem is getting bigger, not smaller. Using drugs after the problem is already there isn’t especially effective. Meanwhile, the person’s life is slipping away.”
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How Effective Are Drug Treatments for Depression? originally appeared on usnews.com
