Antidepressant Medication Mostly Benefits Very Severe Depression
Results from a study aiming to estimate the benefit of medication according to the severity of depressive symptoms have concluded only the most severe cases achieve symptom relief. The report, published in the Journal of the American Medical Association (Jan 6th edition) states that, on average, true drug effects are nonexistent to negligible in patients with mild, moderate and even severe baseline symptoms. By contrast, very large effects are seen in patients with very severe symptoms.
Jay C. Fournier, of the Department of Psychology, University of Pennsylvania, and colleagues, reviewed data from January 1980, through March 2009. They focused only on randomized placebo-controlled trials of FDA approved antidepressants for the treatment of minor or major depression. Levels of depression were obtained from scores attained using the Hamilton Depression Rating Scale (HDRS).
The study authors say their findings were not altogether unexpected as several previous studies have shown that severity of symptoms correspond with drug effectiveness. What did surprise them was the high level of depression severity required before clinically meaningful drug/placebo differences to emerge. Furthermore, they wonder to what extent policy makers and those who prescribe antidepressant's, are aware that the efficacy of antidepressant medications has been established only from data with the most severe forms of depression.
The monetary cost of depression runs to billions of dollars a year in medication and lost labor. Many thousands of adults receive no help for depression, and with evidence emerging over the real limitations of antidepressant medication, it suggests a radical rethink is required if depression is to be taken seriously and treated properly.
Fournier, J. C. et al (2010) Antidepressant Drug Effects and Depression Severity. Journal of the American Medical Association. Jan 6, vol 303, No 1. 47-53.