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 says.
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 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.