There's been a lot of buzz in recent weeks saying that antidepressants don't work, or that they don't work better than placebos -- or sugar pills. This controversy is not new. Previous studies have suggested that people with mild to moderate depression respond to psychotherapy as well as they do to antidepressant medications. Other studies even suggest that placebo treatments, the power of suggestion coupled with ongoing attention and concern, may work as well as any "active" treatment, whether it is medication or psychotherapy.
We can expect important scientific rebuttals to the celebrated "anti" antidepressant study in the Journal of the American Medical Association (JAMA, January issue) by Fournier and colleagues. I hope those whose lives are affected by depression will read the forthcoming challenges to Fournier's findings, and that journalists will cover what they say, since the conclusions arrived at by him are debatable. More importantly, antidepressants do work, especially for people with severe depression -- who are also at greatest risk for suicide. Aside from this debate I was surprised to read that many regarded the JAMA article as bad news about antidepressants. Bad? Why bad?
The good news I read is that depression is amenable to many interventions, so people have choices: medications, psychotherapy (like cognitive-behavioral therapy, interpersonal therapy, psychodynamic therapy), even for some with mild conditions what used to be called "watchful waiting", which is very different from indifference. Placebos are not just sugar pills -- they are means by which people who are suffering are attended to by trained, caring and attentive individuals -- that sounds a lot like watchful waiting to me.
Depression is terribly common (and far more untreated than it is properly treated -- see my Huffington post article). The fact is that far too few people get diagnosed or receive any treatment. Take a look at another journal article by Gonzalez and colleagues in the January issue of the Archives of General Psychiatry; this report tells the story of those who do not get the care they need, especially people of color.
People with depression, if their condition is recognized and they are helped to engage any one of a variety of effective treatments -- and for some kindly concern, support and hope -- will get better. That sounds like good news to me.
The opinions expressed herein are solely my own as a psychiatrist and public health advocate.
Lloyd I Sederer, MD
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