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1/05/2010

Anti-Depressant medication may not be an effective treatment for mild or moderate symptoms

Almost 7% of the population will suffer from clinical depression in any given year.  For those who seek treatment,  the most common treatment involves a course of anti-depressant medications,  typically prescribed by a general practice physician.

A new study published in the Journal of the American Medical Association finds that the effectiveness of medication varies significantly,  depending on the severity of the depressive symptoms.  Those who suffer from severe or major depression benefit "substantially."  When the depression is mild or moderate,  the medication does not produce an effect that is greater than the benefit obtained by taking a placebo.

This is already in the news and bears comment.

1.  Individuals reading this should not assume that they should suffer in silence or fail to seek help.  If for any reason you think you may be depressed,  take the Psyris Depression Screening  at the Psychology Resource Information System (psyris.com). 

2.  If things in your life are not right,  or if you are not feeling right,  it typically makes sense to see your physician to make certain that you are not suffering from some type of medical or dietary condition.

3.  This new study does not mean that treatment will not be helpful or that you shouldn't try medications.  Until you consult with someone,  it's hard to know if your feelings of depression are severe,  or simply part of the expected ups and downs in life.

4.  As a psychologist,  I would never recommend that someone feeling depressed should simply start taking a pill.  It is well established that psychotherapy is an essential component in the treatment of any mood disorder.  If your physician is telling you that your condition warrants the use of medication,  then it is certainly the case that you should be seeing someone to talk about how you are feeling.  If you need medication,  you also need to talk to a therapist.

This is an important study for a few different reasons.

First,  the fact that the placebo performs as well as the medication in mild and moderate cases reminds us that depression is not simply medical and biological in nature.  It involves thoughts and psychological processes.  It is not just a type of "brain disease."  It has to do with your mind.

Second,  the fact that medication is effective in more severe cases reminds us that depression can involve medical factors as well.  Sometimes medications are necessary.

In general,  what this study confirms is that the treatment should be designed to meet the needs of the specific,  individual patient.  Psychological health care will always be a component of that treatment.

Depression is common and it can be severely disabling.  It is highly treatable.  No one should suffer in silence.  

Take the take the Psyris Depression Screening at the Psychology Resource Information System (psyris.com)!

Update (01/14/2010):   The blowback from the JAMA depression study has started.  Writing in the New York Times,  Richard A. Friedman, M.D. has challenged the findings,  arguing that the question is much more complex.  He says that this new study "does not stand up to the mountain of earlier evidence" showing that medication is effective for a "wide array of depressed patients." 

Some of his points are well taken (e.g.,  the original study only looked at two particular anti-depressants).  Other points are less compelling (e.g.,  he disparages the well established "meta-analysis" method,  or at least how it was used in this case).  His primary point involves an endlessly complex theoretical issue that empirical science has not resolved:  what is the meaning of the placebo effect?

Perhaps most importantly,  in my view,  is that Dr. Friedman gives short shrift to the importance of psychological care in the treatment of what is typically a psychological problem.

Dr. Friedman's final comment was:  "there is no question that the safety and efficacy of antidepressants rest on solid scientific evidence." 

His earlier statement perhaps deserves more attention:  "antidepressants are not panaceas, and their advocates have sometimes been overly optimistic about their efficacy."



Copyright, Paul G. Mattiuzzi, Ph.D.