Saturday, January 19, 2008

Antidepressants May Not be as Effective as we Think

A report recently published in the New England Journal of Medicine concluded that drug companies may have misrepresented the effectiveness of antidepressant medications by publishing those trials which showed better results and witholding other trials that were not as positive.

In the published reports, the drugs were about 60% more effective than placebo, but when the results of the unpublished reports were included, they were only slightly more effective than placebo in treating depression.

Over the past few years, it seems to me that patients and physicians alike have increasingly tended to rely on antidepressant medication to treat patients with depressed mood. It has even been suggested by some that we have been guilty of "medicalizing" sadness and treating relatively normal down times in life as a clinical illness, depression. But, clearly, depression is a common and serious malady in the practice of every primary care physician and we must always strive to maintain an effective approach to helping patients with this problem.

So, then, how do we take this recent finding and incorporate it into our practice? I think that antidepressants should be used, in most cases, as adjunctive, rather than primary treatment of depression. The medication clearly reduces anxiety, improves sleep, and in many cases, does elevate mood. But, we should all be cautious, especially in light of this insightful finding, about over-reliance on drug treatment. Use of psychotherapy and other forms of counselling, exercise, attention to sleep and nutrition, and addressing alcohol or other substance abuse issues are all examples of important aspects of treatment beyond just putting the patient on antidepressant medication.

If you have depression, are taking an antidepressant, but are not improving, you should strongly consider a return trip to your doctor to request a fresh approach!

Your comments are welcome...

2 comments:

mkr said...

Dr. Smith,
I totally agree with the use of adjunctive methods (psychotherapy and other forms of counselling, exercise, attention to sleep and nutrition, and addressing alcohol or other substance abuse issues) in addition to antidepressants to treat depression.
Thank you for addressing this issue in your post. This is an important topic that patients need to have a more informed understanding.

Joseph A. Banken, MA, PhD said...

Dr. Smith,

I couldn't agree more with what you have said here. As a clinical psychologist treating many patients who have in incomplete response or no therapeutic response to antidepressant medications, I agree that antidepressants should be used, in most cases, as adjunctive, rather than primary treatment of depression. This is not even to mention the side-effects that many of my patients find significantly troubling.

Thanks for the insightful information here.