Commentary About Study Questioning Anti-Depressants Effectiveness for Mild to Moderate Depression

An article just published in The American Journal of American Medicine (JAMA) questions the efficacy of the use of anti-depressant medications (ADM) with mild to moderate depressions. The article is not an easy read! Here is an abstract from JAMA.

It looked at six studies with randomized control groups. Three of the studies evaluated imipramine (an older anti-depressant) and three evaluated Paxil. The conclusion is that ADM may be no better than placebo for mild to moderate depression. Further, that there was greater change with ADM as the depression was more severe. The authors reported that it has been known for more than 50 years that more severe medical and psychiatric conditions respond to a greater degree than less severe conditions.

It was also reported that FDA studies of ADM study only those with severe depressions, which they correctly report are not the impressions that Pharma's advertising gives us.

One statement in the Abstract is questionable: “Antidepressant medications represent the best established treatment for major depressive disorder.” Studies comparing ADM with several brief psychotherapies show that the latter are equally effective to ADM. Other studies show regular exercise to also be very effective. Further, therapy and exercise have dramatically lower relapse rates.

So what does this mean if you are on ADM? My suggestion is that if it is working, continue it. Don't suddenly stop altogether. Direct your questions and concerns to your prescribing physician. However, be aware that much of what many physicians know about medications, especially newer ones, is given to them by drug representatives.

email reponse to feature on depression by WCPN

This morning, there was a segment on depression treatments on our local public radio station (WCPN). It was 99% about medical (brief reference to exercise at end) treatments, i.e., anti-depressants, deep brain stimulation, etc. This unbalanced and shallow report bothered me enough to email WCPN. Below is the email I sent to them. I am interested in how YOU feel about this.

Your brief report on depression was woefully lacking. One was left with the impression that the only treatments for depression depression are medical. It is clear that Ms. Cuda had little prior knowledge about depression and that her sources were MDs, medical websites, and/or drug companies.

There have been debates in the past that depression was biological OR psychological. For 25 years, most acknowledge it is BOTH. It would be more accurate to describe it as a bio-psycho-social process.

Trauma can alter one's biology. Negative thoughts can also alter one's biology. Turning the negative thoughts around can IMPROVE one's biology. Schwartz showed this about 20 yrs ago with PET scans of those treated for OCD.

I missed ANY reference to brief psychotherapies that have proven at least equally effective as the anti-depressants. There is about 35 yrs of research that prove this. The research with exercise is another 5 to 10 yrs longer.

A good place to get a more balanced understanding of depression is http://www.nimh.nih.gov/health/topics/depression/index.shtml

While a study reported this week questions the efficacy of anti-depressants for mild to moderated depression http://blogs.consumerreports.org/health/2010/01/antidepressants-most-effective-for-severe-depression-best-buy-drugs-for-treating-depression.html do NOT make the mistake that this message is an attack on medications. Rather, it is a criticism for a lack of depth and balance. I expect MUCH better from WCPN.

Mike Miller, PhD
Psychologist

http://drmikemiller.com/depression.html

Are All Anti-depressants created equally?

Historically, it has been reported that the overall effectiveness of the newer and older anti-depressants were all about equally effective, differing in their side effects. A very recent article in The Lancet disputes this, comparing the effectiveness of 12 of the newer anti-depressants for Major Depression in adults. It looked at side effects, as well.

A summary of their findings found the following to be more effective:

Remeron
Lexapro
Effexor
Zoloft

They also reported the following to be less effective:

Cymbalta
Prozac
Luvox
Paxil
Edronax (least efficacious)

Lexapro and Zoloft were found to have significantly fewer discontinuations due to side effects.

This does NOT mean that if you are taking one of medications found to be "less effective" and it is working, that you should change. Nor does it mean if you are taking one of the "more effective" medications and are having difficult side effects, that you need to continue that medication.

Any medication is the Best medication for one person and the Worst for another. It is imperative that you consult and work closely with your prescribing physician.

An earlier post of mine Drugs vs. Therapy (9/5/08) compared the effectiveness of each. Here is a summary:

Many of the studies with depression, even severe depression, show them to be about equally effective. Therapy has been shown to have greater durability, with lower relapse rates following the end of treatment. There are also lower drop-out rates for therapy, due to medication side-effects. It is common practice for people to receive both treatments. One might think this to be more potent than either treatment by themselves. Some studies do support this, but other studies do not.

Best wishes,
Mike

For a Summary of the article: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60046-5/fulltext