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    Antidepressants: Best for Severe Depression?

    New Analysis Finds 2 Antidepressants Offer Little Benefit for Less Severe Depression

    Effects of Antidepressants: Study Results continued...

    ''The main finding is that the benefit of medication, over and above the placebo, varied as a function of the severity of the depression," he says. "The effect of the medication for the mild, moderate, and even severe fell below this three-point difference that would be clinically significant."

    The analysis suggests that some depressed people do respond to placebo, he says, and that severely depressed people are most likely to benefit from antidepressants.

    Even so, he tells WebMD, individual treatment decisions should be made in consultation with a physician.

    Other Opinions

    The study results are no surprise to Peter Galier, MD, an internal medicine specialist and former chief of staff at Santa Monica--UCLA Medical Center & Orthopaedic Hospital, Santa Monica, Calif.

    ''Much like any other disease process, the more severe the disease or symptoms, the more improvement with treatment," he says.

    But the analysis doesn't give a complete picture of the effects of antidepressants, says Gregory Asnis, MD, a professor of psychiatry at Albert Einstein College of Medicine and director of the anxiety and depression clinic at Montefiore Medical Center in New York, who reviewed the analysis for WebMD.

    "The data is unfortunately skewed to two medications, only one of which [Paxil] is still commonly used," Asnis says.

    And Paxil, he finds, can have more side effects, such as sedation and sexual problems, than some of the other SSRI drugs.

    The finding of greater differences between placebo and medication in only the severely depressed was not a surprise to him, either, he says. However, he says, the studies were short-term (6 to 11 weeks) and the benefit of the medication could have kicked in later.

    Industry Comments

    ''The study contributes to the extensive research that has helped to characterize the role of antidepressants over the years," says Sarah Alspach, a spokeswoman for GlaxoSmithKline, which makes Paxil. "Since its approval by the FDA in 1992, Paxil has helped millions of people battling mental illness lead more productive, happier lives. Antidepressants are an important option, in addition to counseling and lifestyle changes, for treatment of depression."

    A spokesperson for Eli Lilly, which makes the antidepressant Prozac, declined comment on the new analysis.

    In an email, Alan Goldhammer, vice president of scientific and regulatory affairs for the Pharmaceutical Research and Manufacturers of America (PhRMA), says, "This is a matter best addressed by companies whose drugs were studied and the individual physicians who are tasked with making treatment decisions based on which therapies are best suited for treating their patients."

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