Can Antidepressants Work for Me?
A look at the complex mix of factors -- and key questions -- to consider.
Best for Severe Cases?
Even before the JAMA study, psychiatrists have long known that
antidepressants have a bigger effect in severe cases, Payne says. "The fact is
that many different types of medications work better in people who are more
severely affected than in people who are less severely affected," she
For example, someone with very high cholesterol will experience a bigger
drop in levels after taking a cholesterol drug than a person with mildly raised
levels, she says.
"When we're studying something like depression, if you're more severe and
you get better, you see a larger effect from that. So I don't think it implies
that antidepressants don't help patients who are more mildly or moderately
depressed," Payne says.
Reality Check on Antidepressants
The JAMA study aside, it's a fact that many people with depression
don't seek any treatment -- whether it's medication or therapy.
"There is still a tendency, unfortunately, to think that you can get over
depression on your own -- [that] it's just a sign that you're not trying hard
enough, it's a sign of weakness to be depressed -- and people need to get past
that," says Andrew F. Leuchter, MD, a professor in the department of psychiatry
and biobehavioral sciences at UCLA's David Geffen School of Medicine.
Mischoulon is concerned that research, such as the JAMA findings,
might further discourage people. "My concern was that it might lead certain
people to think, ‘Oh, I shouldn't take antidepressants,' " he says.
None of his patients has asked to stop their drugs, Mischoulon says. But "a
lot of patients do ask, ‘What implications do these findings have, especially
for my case?' -- which is perfectly understandable."
Make no mistake: For many people, antidepressants do work. In fact, they can
But Mischoulon also spoke frankly about the failure of antidepressants to
live up to the high expectations of doctors and patients alike. He and the
other two psychiatrists who spoke to WebMD have consulted for pharmaceutical
companies that make antidepressants.
"Antidepressants may not be quite as effective as historically, we've
believed, when we look at the overall response rate, especially compared to
placebo," he says.