Antidepressants Do Work

A major new review of clinical studies confirms that antidepressants are more effective than placebos, illustrating that medication is one of a set of useful intervention tools for mental illness.

The research, which is published this month in the “Lancet,” looked at 522 clinical trials involving more than 116,000 people, and additional information from unpublished data. This data tracked the use of 21 most commonly prescribed antidepressants among adult patients who had been diagnosed with major depressive disorder. The researchers were looking for signs of mood improvement in the population samples and how that compared to the control placebo group.

Essentially, the researchers were seeing if antidepressants actually do anything to help patients with a depression diagnosis.

WHY EMBARK ON THIS ANALYSIS?

There is a deep mistrust over the profitability big pharmaceutical companies can create from drugs that foster dependency. Antidepressants are no different, but there are added concerns.

Treating mental health conditions, while possible, is different than treating relatively more simple physical ailments. What works for one person’s mental illness may not work for another, and antidepressants can carry significant side effects. While those side effects are usually mild, the risk goes up if front line treatments aren’t effective and secondary or combination therapies have to be tried.
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Previously, concerns have been raised that antidepressants may not be as effective as the drug makers claim, and what’s more that they may in fact make some people’s mental health worse. There are some studies that do seem to show this. (The issue of teens taking antidepressants will be explored more below.)

However, as with any scientific question, we have to amass a lot of data and review it impartially in order to get a better picture of what is really going on.

RESEARCH CONFIRMS THAT ANTIDEPRESSANTS DO WORK.

The researchers were able to say with confidence that all antidepressants in the trial improved the mood of patients with major depressive disorder where those patients maintained their course of treatment, and that they worked better than the placebos. However, some drugs did appear to work better than others.

Drugs like Amitriptyline and Mirtazapine registered near the higher end of the scale, while commonly prescribed Fluoxetine (Prozac) and Citalopram were at the lower end. However, all scored better than the placebo.

Lead researcher Dr. Andrea Cipriani is quoted by the BBC as saying: “This study is the final answer to a long-standing controversy about whether anti-depressants work for depression. We found the most commonly prescribed anti-depressants work for moderate to severe depression and I think this is very good news for patients and clinicians.”

This, the researchers say, should help to restore confidence that taking prescription drugs for mental illness, when carefully managed, can form part of an effective treatment or management plan. Antidepressants are designed to work alongside therapies like Cognitive Behavioral Therapy that can help tackle underlying triggers and help patients learn new thought patterns and mood management skills.

Nevertheless, there are still those who say the drugs don’t work.

“BUT MY FRIEND TRIED ANTIDEPRESSANTS AND THEY DIDN’T WORK.”

It is absolutely right to point out that, for some people who have mental health issues (usually at the more severe end), front line antidepressants do not work. Also, some people may not tolerate them well. When we talk about stories like this it is crucial however to acknowledge that anecdotal and isolated stories of bad reactions are not necessarily reflective of the wider public’s health experiences.

It’s also necessary to point out that different drugs in this trial actually do slightly different things, and so even if someone is prescribed a “less effective” antidepressant, there may be a good reason for that. For example, Citalopram targets both anxiety symptoms and depression, meaning it may be a good choice for people tackling these often overlapping conditions, even if it doesn’t improve their depression as effectively as other drugs might.

Also, another consideration is that different underlying conditions may lead to different outcomes for different patients. For example, some recent research demonstrates that antidepressants may not be effective for people living with chronic physical illnesses.

There is also a significant body of evidence to suggest that teenagers should not be given some classes of antidepressants as they may make their symptoms worse, including introducing new problems like anger control issues and, even, suicidal ideation.

All this serves to make clear that antidepressants are not the right fit for everyone, but what this research does support is that antidepressants are working and are helping many people with depression live better lives.

This may help to break down the misinformation surrounding antidepressants even as we continue to look at how and why these drugs are being prescribed to ensure that they are being given to the right people for the right length of time and in ways that support recovery and wellness.

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