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."
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.
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,"
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,"
"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.