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Can Antidepressants Work for Me?

A look at the complex mix of factors -- and key questions -- to consider.

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."

Great Expectations

Make no mistake: For many people, antidepressants do work. In fact, they can be life-saving.

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.  

In fact, antidepressants typically don't approach the success rates shown in clinical trials, he says.

"We have known for many, many years that these antidepressants don't have the kinds of response rates in the real world of practice that they have in those clinical trials that are funded by industry or by the government," Mischoulon says.

He notes that in industry-funded studies, "patients are selected very carefully. For example, they don't accept patients that have certain co-existing illnesses or other health problems or other factors that might rule them out," Mischoulon says.

"That doesn't reflect how practice works in the real world. In other words, if I have a patient coming to see me because they have depression, I'm not going to say, ‘Well sir, I'm not going to treat you because you also have diabetes.' That's not how we practice. The fact is, the more comorbidity [co-existing disease] there is, the less likely people are to get well when they're depressed. Depression and medical illnesses and other psychiatric illnesses all interact with each other. For me to see these meta-analyses that show that antidepressants aren't that fantastic, well, this is what I've been observing for years in my practice and so have most of my colleagues," Mischoulon says. 

"Even our best antidepressants work only about half the time," Payne says. And the odds of success drop if the patient doesn't respond to the first drug they try, Payne says.

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