Mild, moderate and even severe depression may be better treated with alternatives to antidepressant drugs, which help these patients little more than a placebo, researchers said on Tuesday. But for people with the most severe depression, the drugs bring real benefit.
Pooling the data from six studies of two commonly prescribed antidepressants, paroxetine and imipramine, showed that for many patients the drugs worked only slightly better than a placebo.
"They work as well as a placebo," said Robert DeRubeis, a psychologist at the University of Pennsylvania in Philadelphia, who carried out the analysis with colleagues.
Paroxetine is one of the best-known drugs of the selective serotonin reuptake inhibitor (SSRI) class, sold as Paxil by GlaxoSmithKline. Imipramine is an older tricyclic antidepressant, developed in the 1950s.
In the so-called placebo effect, people feel a treatment has helped them even though they are taking inactive sugar pills, DeRubeis explained.
Severe depression did respond to the drugs
In the report, published in the Journal of the American Medical Association and covering nearly 800 patients, the drugs had a clearly stronger effect than the placebo in people diagnosed with very severe depression.
On a depression scale where a score of 24 or more means very severe illness, patients treated with drugs improved by 13 points, against 9 points for those on placebo. But for people whose starting score was 23 or less, the average improvement was 8 points with antidepressants and 7 with placebo.
Doctors and patients "should pause over our data", DeRubeis said in a telephone interview. "Other alternatives should be considered." Exercise has been shown to help reduce depression, as have talking therapies and even self-help.
A GlaxoSmithKline spokeswoman said the report "contributes to the extensive research" on antidepressants, noting that Paxil was approved in the US in 1992 and has helped "millions of people battling mental illness". She added that the studies used in the JAMA analysis were designed differently from those that supported paroxetine's approval, so direct comparisons are difficult.
27 million Americans take antidepressants
At least 27 million Americans take antidepressants, about twice as many as in the mid-1990s, according to a study by researchers at Columbia University and the University of Pennsylvania in the Archives of General Psychiatry.
More than 164 million prescriptions for antidepressants were written in the US in 2008, worth about 10 billion dollars in sales, according to IMS Health. Worldwide sales were twice that.
Important: don't stop or change an antidepressant on your own; talk to your doctor first.
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