Better Depression Treatment Please, Not More of the Same
In previous Shareposts I've expressed some concerns over the effectiveness of SSRI medications such as prozac and I've pointed to recent research by Fournier and colleagues that indicates antidepressant medication mostly benefits very severe depression. I highlight such things because not only is antidepressant medication is the most common method of treatment, but more and more people are suffering with depression. It's important therefore to put our treatments under the spotlight in order to evaluate their true effectiveness and to encourage more and better treatments where these are seen to be lacking.
The Star*D treatment trial for depression was one of the most extensive studies ever undertaken into the treatment of clinical depression. Nearly 3,000 patients across 41 treatment sites across the United States were involved. Yet, after 14 weeks of treatment for depression some 72 per cent of patients still had significant residual symptoms. From what we know of depression even those patients who initially responded well stand a fairly high chance of it returning at a later stage.
The vast majority of people with depression fall into the mild to moderate category. One of the most worrying things to emerge from the Fournier analysis of six large clinical trials was the fact that only the most severely depressed people appear to benefit from the pharmacology of antidepressant medication. Dr. Jonathan Rottenberg, Associate Professor of Psychology at the University of South Florida, neatly sums up the current state of events in his blog:
"Undertreatment of depression is not the real story; the real story is the recalcitrance of depression, even to state-of-the-art treatments. That's the hard truth we should be telling the public."
He's right. While antidepressant medications are certainly better than nothing they can hardly be said to constitute a cure for depression and the sad reality is that their therapeutic credentials are also suspect, except for the most severely depressed individuals.
It's a worrying trend that more and more people are becoming depressed. Encouraging people into treatment is fine but it presupposes that the treatments currently on offer actually work. The current state of play with depression is that people who suffer with it have precious little to turn to in the way of truly effective therapy. One day they might, if we continue to push for greater investment, research, and creative thinking.
Fournier et al. (2010). Antidepressant Drug Effects and Depression Severity: A Patient-Level Meta-analysis JAMA, 303: 47-53.
Rottenberg, J (2010) Charting the Depths. Depression Treatment: We Need Better Not Simply More. Psychology Today. Jan 5th. http://www.psychologytoday.com/blog/charting-the-depths/201001/depression-treatment-we-need-better-not-simply-more