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Do Antidepressants Work?

Antidepressants have been hailed as miracle drug rock stars and vilified as brain-changing happy pills.  All promotion aside—good or bad—are they effective?  The Savvy Psychologist Dr. Ellen Hendriksen digs though the data.

By
Ellen Hendriksen, PhD,
Episode #008
sad person against wall

Antidepressants Do Work

Let’s poke around in the two previous studies and see what we find.

The first important thing to remember is this: these studies reveal what happens overall, across thousands of people.  And you can’t predict where you as an individual will fall among those thousands.  Response to antidepressants varies by individual. 

To look at it another way, the average credit score is 689, but that doesn’t mean that your credit score is 689.  A lot of factors go into an individual credit score, just like many factors go into whether or not antidepressants may work for you.  Things you can control—like remembering to take them—as well as  things you can’t control—like how quickly your body metabolizes medication, or whether your genetics predispose you to depression—affect how antidepressants might work for you. 

Second, it makes sense that the drugs work better for people with more severe depression.  That’s not actually a surprising finding.  When you’re really sick, there’s more room to improve.  For example, HIV drugs have the biggest potential impact when people start out with really high levels of virus.

Third, antidepressants have been found to work well for mild depression when it is long-lasting—specifically, more than two years of low-grade depression, a condition also known as dysthymia.  In a 2011 study that re-analyzed 17 different studies, 52% percent of people with dysthymia felt better with antidepressants, versus 30% with placebo.   Oddly, antidepressants worked better overall for dysthymia than for depression: great news for people with chronic mild depression.

Fourth, the 2008 Kirsch study re-examined drug trials submitted to the FDA.  Taking an antidepressant as part of an FDA clinical trial is quite different than taking an antidepressant prescribed in real life.

For one thing, the studies were short—4-8 weeks long—whereas most people stay on antidepressants for months or years.  Critics claim that such short trials are insufficient to capture a real-life picture of both improvements and side effects.

Also, mental health drug trials are notoriously difficult to run.  Because there is no lab test or blood work for depression, the data comes from people talking to people.  And people, we know, do pesky things like forget, read into things, like or dislike each other, jump to conclusions, and hold biases — all of which contaminate the data.   Many mental health drug trials fail not because the drug doesn’t work, but because everything is filtered through the telephone game of human communication. 

Finally, the placebo effect is an effect, and it’s a powerful one.  If you feel better, you feel better.  Whether it comes from the ingredients in the medication, the belief that the medication will help, the hope you gain from seeking treatment, the simple passage of time, or some other x-factor, anyone who has ever suffered from depression can tell you that the ultimate goal is simply to feel better.

Should I Take an Antidepressant?

This is an incredibly personal decision, and I will not tell you what to do.  What I will tell you is that if you or someone you love is battling depression, use every tool in the toolbox to fight it.  Depression is serious business—it’s debilitating, miserable, and causes great suffering.  I wouldn’t wish it on anyone. 

The best answer to the question “Do antidepressants work?” seems to be that there may be some groups of people—those with severe depression, those with chronic mild depression, and other groups research hasn’t pinpointed yet—for whom antidepressants work best over a population.  But for you as an individual, science just doesn’t know.  There are some individuals for whom antidepressants are miraculous and some for whom they're just a ball of unpleasant side effects. 

When you're considering antidepressant medication, don’t simply stop at “Should I take them?”  Consider your general practitioner or psychiatrist.  Does he or she listen to you?  Do you feel comfortable?  Search out a qualified provider you like and trust and discuss the issue with them.

And of course, I’d be remiss as a psychologist if I didn’t plug psychotherapy.  There are forms of psychotherapy—most notably cognitive behavioral therapy, or CBT—that work as well as, or better than, medication for depression. 

Finally, many studies show the one-two punch of medication and psychotherapy is the best treatment of all.  At the end of the day, do what works for you, your values, and your life, but definitely do everything in your power to fight depression.

Note: I believe in transparency, so I want to disclose that I work with a company that consults for pharmaceutical companies, including Lundbeck, Roche, and Takeda.  It’s also important for me to say that I’m a psychologist, not a psychiatrist, which means I don’t and can’t prescribe medication.  I do psychotherapy and I do research.  So bury me in research studies and I am as happy as a pig in…well, you know. 

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References

Dobson, K.S. (1989).  A meta-analysis of the efficacy of cognitive therapy for depression. Journal of Consulting and Clinical Psychology, 57, 414-419.

Fournier, J.C., DeRubeis, R.J., Hollon, S.D., Dimidjian, S., Amsterdam, J.D., Shelton, R.C., et al.  (2010).  Antidepressant drug effects and depression severity: a patient-level meta-analysis.  JAMA, 303, 47-53.

Kirsch, I., Deacon, B.J., Huedo-Medina, T.B., Scoboria, A., Moore, T.J. et al.  (2008).  Initial severity and antidepressant benefits: A meta-analysis of data submitted to the Food and Drug Administration. PLoS Medicine, 5, e45.

Levkovitz, Y., Tedeschini, E., Papakostas, G.I. (2011).  Efficacy of antidepressants for dysthymia: a meta-analysis of placebo-controlled randomized trials.  Journal of Clinical Psychiatry, 72, 509-14.

Zhong, W., Maradit-Kremers, H., St. Sauver, J.L., Yawn, B.P., Ebbert, J.O., Roger, V. et al. (2013).  Age and sex patterns of drug prescribing in a defined America population.  Mayo Clinic Proceedings, 88, 697-707.;

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