Below is a link to a Stanford Medical School podcast of an interview with Robert DeRubeis, the lead investigator of a meta-analysis which revealed that antidepressants are no better than placebo in many cases of mild, moderate, and even severe depression (essentially, in all but the most severe cases of depression). DeRubeis discusses media coverage of the study, the reactions of primary care physicians, and his interpretation of the study's results.
The results of the study align with my own anecdotal experience. During my most acute depressions--those times when I truly felt like I was losing my mind--the illness responded rapidly and robustly to medication. (These are the two episodes when my HAM-D score was over 30). However, the drugs have done little to treat my milder, residual depression (even if they are still important as a maintenance measure to stave off relapse).
I'm glad that someone is parsing our coarse classification of depression into more exacting categories and examining the effectiveness of medications for those different tranches of the disorder. Experience and common sense suggest that the disorder is heterogeneous and that treatments need to progress beyond a "one size fits all" approach. Patients should be channeling resources to the most effective evidence-based therapies first, not prolonging their pain and wasting resources by starting with unsupported treatments.
I wasn't surprised by the study but I disliked much of its media coverage. (The pic above is from an egregiously irresponsible Newsweek article: Why Antidepressants are No Better Than Placebo). As DeRubeis points out--and as many media outlets failed to mention (or bury as a caveat several paragraphs in)--a mountain of evidence indicates that antidepressants are effective at treating the most severe depressions. His study, however, examined treatment of a wide range of severities.
Antidepressants and mood stabilizers had an enormous effect on my worst episodes and probably saved my life. That doesn't mean they are the right solution for many (even most) patients.
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