I've been seeing occasional studies go by about the use of anti-depressants in treating depression. Some seem to imply that they are at least over-prescribed (which may in itself not be all that bad, if the side effects are negligible), and that the primarily work by the placebo effect. Anybody know something definite on this?
Yes. Antidepressants have been around for more than fifty years and are effective in treating depressive disorders. They do absolutely work.
I've been seeing occasional studies.. ..that the[y] primarily work by the placebo effect.
I think I know where you might be getting this idea.....
Some members of the press and general public are questioning the efficacy of all antidepressants based on the conclusions of a 2010 meta-analysis* in which two antidepressants, Imipramine and Paroxetine, where used in the six studies analyzed. The analysis team concluded the following (emphasis mine):
“[E]fforts should be made to clarify to clinicians and prospective patients that whereas [antidepressant medication] can have a substantial effect with more severe depressions, there is little evidence to suggest . . . specific pharmacological benefit for the majority of patients with less severe acute depressions.”
Much of the confusion about the use of these drugs comes from using the term "depression" out of a medical context. There is a big difference between feeling depressed for a few days and having a depressive disorder. From the NIMH:
When a person has a depressive disorder, it interferes with daily life, normal functioning, and causes pain for both the person with the disorder and those who care about him or her.
Some general forms of depressive disorder (also from the NIMH)...
- Major depressive disorder, also called major depression, is characterized by a combination of symptoms that interfere with a person's ability to work, sleep, study, eat, and enjoy once–pleasurable activities. Major depression is disabling and prevents a person from functioning normally.
- Dysthymic disorder, also called dysthymia, is characterized by long–term (two years or longer) but less severe symptoms that may not disable a person but can prevent one from functioning normally or feeling well.
- Psychotic depression, which occurs when a severe depressive illness is accompanied by some form of psychosis, such as a break with reality, hallucinations, and delusions.
*Meta-analysis can never follow the rules of science, for example being double-blind, controlled, or proposing a way to falsify the theory in question. It is only a statistical examination of scientific studies, not an actual scientific study, itself.
Anybody know something definite on this?
The Archives of General Psychiatry is an good starting point for researching the research.
Some random supporting research on antidepressants.....
Long-term antidepressant efficacy and safety of olanzapine/fluoxetine combination: A 76-week open-label study Conclusions: The olanzapine/fluoxetine combination showed rapid, robust, and sustained improvement in depressive symptoms in patients with MDD, including patients with TRD.
Treating Major Depression in Primary Care Practice Results: Severity of depressive symptoms was reduced more rapidly and more effectively among patients randomized to pharmacotherapy or psychotherapy than among patients assigned to a physician's usual care.
Cognitive Therapy vs Medications in the Treatment of Moderate to Severe Depression Results: The advantage was significant for medication relative to placebo, and at the level of a nonsignificant trend for cognitive therapy relative to placebo.