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Do Antidepressants Work?

Gail Serruya, MD
March 15, 2010

There’s been a lot of buzz in the media recently following an article printed in the January issue of JAMA (Journal of the American Medical Association) showing that antidepressants are no better than placebo (a sugar pill) in alleviating symptoms of mild and moderate depression. The study suggests that antidepressant only work when depression is clinically severe.

However, before contemplating going off of your antidepressant medicine – or deciding not to see a psychiatrist because the meds they prescribe won’t help, there are very important aspects of the study about which one needs to be aware. First of all, there are hundreds of other studies suggesting that antidepressants do work. This particular study was a meta-analysis that examined only 6 out of 100’s of studies, and only looked at 2 antidepressants (Paxil and Imipramine) while there are more than 20 on the market. In addition, it’s important to keep in mind that there is research showing that many patients do not to respond to the first antidepressant they try. Sometimes a patient and doctor need to work together to find the right medication.

What can we learn from this article? One of the most interesting points to me is that the placebo effect is so amazingly powerful. In some studies, as many as 50% of patients taking a placebo report improvements in their depressive symptoms. This finding demonstrates how incredibly powerful our minds can be without medication – the mere belief that things will get better can sometimes make them better. Having hope is crucial to overcoming depression.

Another important point is that antidepressants may be overprescribed by some clinicians. Perhaps a patient comes to a doctor and wants a magic bullet to make life easier and the physician too readily accommodates this request. Physicians and patients need to be certain they are working together to understand the source of a depression instead of throwing a pill at it. For some, talk therapy, couple’s therapy, or lifestyle changes may be the best first step, before trying a medication.

Stopping an antidepressant can lead to a relapse in depression, especially in patients who have had multiple episodes of depression. Also, if not done properly, abruptly stopping antidepressant therapy can result in extremely unpleasant side effects. Please talk to your doctor before deciding on any changes.

In my own clinical experience, and looking at data from numerous other studies, antidepressants can be quite effective in alleviating the dark cloud of depression. Ultimately, more research is needed to help us understand characteristics of those patients who will respond to antidepressants and those who won’t. For now, it is important for doctors and patients to work together to develop an individualized treatment plan that may or may not incorporate antidepressant medication.

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Gail Serruya, MD is a Staff Psychiatrist at CFR’s Wynnewood office and can be reached at 610-642-2648 ext. 7.

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