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Can Antidepressants Work for Me?

A look at the complex mix of factors -- and key questions -- to consider.
By
WebMD Feature
Reviewed by Louise Chang, MD

How effective are antidepressants? That's a question that many people with depression have asked -- and research suggests that the answers aren't simple.  

It's a question that's relevant to millions. About one in 10 Americans takes an antidepressant, now the most commonly prescribed type of drug in the U.S., according to research published in 2009 in the Archives of General Psychiatry. Much of the surge has happened in the past two decades. From 1996 to 2005, the rate of antidepressant use rose from 5.84% to 10.12%.

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But a report recently published in The Journal of the American Medical Association showed that the drugs work best for very severe cases of depression and have little or no benefit over placebo (inactive pills) in less serious cases.

That report isn't the last word on the topic, but it got plenty of media attention. So much, in fact, that many psychiatrists became concerned that people would misunderstand the findings and possibly dismiss crucial treatment.

But the controversy also creates an opening to get a reality check about the popular drugs' advantages and limitations, experts tell WebMD.

Here's what those experts said -- and the four questions they recommend you consider when deciding if an antidepressant is right for you.

  1. Do you truly have depression?
  2. Are you willing to stick with treatment long-term, including trying more than one drug?
  3. Would counseling help your mild depression, either alone or combined with an antidepressant?
  4. Do you have a good working relationship with your doctor?

Psychiatrists Dissect the Study

The report published in JAMA isn't new research -- it's a pooled analysis of data from six previously published studies. And it only includes two types of antidepressants -- selective serotonin reuptake inhibitors (SSRIs) and older drugs called tricyclics.

In light of those limits, experts interviewed for this story caution against reading too much into the findings.

"This is the kind of study that really gets misinterpreted by the general public. It's always frustrating when that happens," says Jennifer Payne, MD, assistant professor of psychiatry at Johns Hopkins School of Medicine and director of the Women's Mood Disorders Center.

Some other psychiatrists agree. The report is "very limited," says David Mischoulon, MD, PhD, associate professor of psychiatry at Harvard Medical School and director of research at Massachusetts General Hospital's Depression and Clinical Research Program.

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.

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