Newsweek Proclaims "Antidepressants Don't Work"
Newsweek's front cover screamed on its February 10, 2010 issue: Antidepressants Don't Work. Writer Sharon Begley is referring to a study published in the Journal of the American Medical Association last month. The study actually found that for patients with mild to moderate depression, placebos - the inactive pills given to some of the study participants - relieved depression about as much as the actual antidepressants did. Patients with severe depression did get more benefit from the antidepressants than from the placebos. That's an important point.
The reason given is that the people taking placebos hoped they were getting the real thing - and that hope begat some improvement, which translated into belief and led to more improvement. Therefore, the researchers felt, there was no way to determine whether people actually taking antidepressants got better for the same reason.
This landmark study clearly casts the effectiveness of antidepressants into doubt for mild to moderate depression, BUT - how many of us have tried one antidepressant after another before finding one that worked? How many of us have had an antidepressant stop working after awhile? Was that because we stopped believing in them?
Back in 1994 when I crashed into paralyzing depression, I was given Prozac. Within a month I was mildly hypomanic (I was not then diagnosed with bipolar disorder). It was a wonderful year! I felt so confident, so much in control, so normal! But as the second year passed, my mood drifted downward again. I didn't stop believing in Prozac before that happened, believe me. Maybe the researchers would say I was in a self-induced state of hypomania based on my expectations that Prozac would work, and my own depressive tendencies finally asserted themselves? Trust me, I didn't just "happen" to have a hypomanic episode at the same time I went on Prozac. Up to that time, I'd been depressed maybe 95% of the time, stable 3%, hypomanic 2%. Well, maybe I'm exaggerating, but that's how it felt. Given that pattern, a year-long hypomanic episode, something that had never happened to me in my entire life, is highly unlikely to have occurred spontaneously just then.
Last year I had a long and deep depressive episode. During that time my psychiatrist tried me on one antidepressant after another, but nothing helped. It got so bad I was considering ECT. Then we gave Paxil a try - and it worked. I don't believe that my depression just "happened" to improve right at that time. Even now, the Paxil is only allowing me to keep my head above water - but I'm better than I was all last summer and fall.
Am I protesting too much because I want to believe in my pills? There's no way to tell. There's no way for my doctor to prescribe a "fake" antidepressant. Begley's article says that psychotherapy is as effective as antidepressants. That hasn't held true for me at all, and the article does admit that psychotherapy is more difficult to come by than pills. In addition, the study only looked at total results. There were undoubtedly some individuals who got no help from antidepressants, and some who did not get better on placebos. And there undoubtedly some with mild to moderate depression who got far more than average relief from antidepressants. Were there also some who significantly improved on placebos? It's too much a blanket statement for me. Is it really right to tell a person whose depression rating went from 22 to 7, for example, that it was all in his head?
I'm no doctor - I live with bipolar disorder as you do. And my feeling is, a major depressive episode is not "mild to moderate" depression. It is severe. And the study did show that antidepressants help severe depression more than placebos do. So I'm not giving up my belief that my current medications are helping me.
Can I say, "Don't trust Newsweek's headlines"? No. That would be just as sloppy and misleading as "Antidepressants Don't Work." Problem is, that one's a sloppy, misleading and scary headline. It gives no hint of the fact that they were proved to work in the cases of the people who most need them.