Placebo nearly as good as antidepressants in treating depression ?
Q.A new review suggests that there is little difference between placebo and antidepressants in treating depression in primary care. Antidepressants are being prescribed increasingly for the treatment of depression. But how effective are they?
A.now looks at the evidence on how antidepressants compare with placebo in a primary care setting. After six to eight weeks of treatment, 56 per cent of those on a selective serotonin reuptake inhibitor (SSRI) were improved, as were 60 per cent on a tricylic, an older type of antidepressant. But a comparison showed that 43 per cent and 47 per cent of those on placebo also improved (that is, compared to SSRIs and tricyclics respectively). Maybe this small difference between drug and placebo arises because depression may resolve itself spontaneously without treatment. The study leads to questions as to whether the spending on antidepressants in primary care is really justified for such a small relative benefit. Any depression being treated in a primary care setting is very mild. Otherwise, it's malpractice, IMHO. I would not be surprised to see that most of the ADs prescribed by PCPs were for situational depression, which of course would resolve itself. All this study really shows is that mildly depressed people probably don't need meds. No big news here, except to PCPs who would rather give someone a pill than refer them to a therapist. PCPs are not able to closely monitor patients with any more than the mildest of depression. They do not have the training or skills, even if they had the time. I think that better studies will show that the biggest factor in suicides is inadequate monitoring, not any specific drug. Severe depression is a serious medical condition. It requires a lot of monitoring, and managed care discourages this. This is why people are given prescriptions and sent on their way. This is why they get into trouble and have nowhere to turn. It isn't the drugs, it's the prescribers and lack of follow-up. Mind you, I love my PCP, but we both agree that he is not up to the task of managing my depression. Health care needs more doctors like that.
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