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%.
All depression types are not the same. Major depression, also known as clinical depression, and chronic depression, also known as dysthymia, are the most common types. But there are also other types of depression with unique signs, symptoms, and treatment.
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
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
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.
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
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.