Antidepressants Little Help for Mild, Moderate Depression

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Millions of Americans are taking antidepressants for mild to moderate depression and reaping little to no benefit, according to the results of a new study. Antidepressants do, however, seem to offer substantial benefit for people who have very severe depression.

The results of this new study, which was conducted by researchers at the University of Pennsylvania, Philadelphia, are important for several reasons, not least of which is the fact that many people are likely taking drugs that may cause them harm and offer no benefits.

A recent study conducted in postmenopausal women, for example, found that those who take antidepressants may be at increased risk for stroke and death. The findings came from the Women’s Health Initiative study and showed that postmenopausal women taking antidepressants had a 45 percent increased risk of stroke and a 32 percent higher risk of death compared with women who were not taking antidepressants.

The Food and Drug Administration also requires antidepressant packaging to carry a black box warning regarding the risk of suicide associated with use of the drugs. The FDA required manufacturers to include a black box warning on all antidepressants at the end of 2004. The latest update to the warning came in July 2009, when the FDA proposed that all antidepressant makers include warnings about increased risks of suicidal thinking and behavior in young adults ages 18 to 24 during initial treatment.

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Use of antidepressants has skyrocketed in recent years. A study published in August 2009 in the Archives of General Psychiatry reported that use of antidepressants in the United States doubled between 1996 and 2005: while 6 percent of people (13 million) were prescribed antidepressants in 1996, more than 10 percent, or 27 million, got prescriptions in 2005.

This new University of Pennsylvania study was a meta-analysis, in which researchers analyzed data from six large-scale, placebo-controlled randomized trials. The studies included a total of 718 adult outpatients. The researchers found that the efficacy of antidepressants for treatment of depression varied considerably. Generally, the drug effects “were nonexistent to negligible” among people who had mild, moderate, and even severe symptoms, but that they were significant for patients with very severe symptoms.

What surprised the investigators was the “high level of depression symptom severity that appears to be required for clinically meaningful drug/placebo differences to emerge.” They point out that healthcare professionals, consumers, and policy makers may not know that the effectiveness of antidepressants has been established mainly based on studies that have included only people who have more severe depression.

Therefore, millions of Americans who have mild to moderate depression appear to be taking antidepressants for naught. The authors conclude that “there is little evidence to suggest that they [antidepressants] produce specific pharmacological benefit for the majority of patients with less severe acute depressions.”

SOURCES:
Food and Drug Administration
Fournier JC et al. Journal of the American Medical Association 2010; 303(1): 47-53
Olfson M, Marcus SC. Archives of General Psychiatry 2009 Aug; 66(8): 848-56
Smoller JW et al. Archives of Internal Medicine 2009 Dec 14; 169(22): 2128-39

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