At the turn of the 20th century, buying medicine was a risky business. Medicine shows traveled the country, entertaining crowds and hawking pills and potions of dubious origins, known as “patent medicines.” Even the medicines sold in apothecary shops had not been shown to work well or be safe.
The establishment of the Food and Drug Administration and the development of its standards in the course of the 20th century were supposed to put an end to that kind of uncertainty. Now, Americans justifiably believe that their medicines should be safe and effective. In fact, the law calls for the FDA to determine that before it approves any new drug.
How well does this work? A new analysis suggests that modern antidepressants are no better than inactive placebo pills for alleviating mild to moderate depression (Journal of the American Medical Association, Jan. 6, 2010). Yet over 100 million prescriptions are written each year for drugs to ease the blues.
According to the meta-analysis published in JAMA, people with severe depression clearly benefit more from antidepressants than from placebo. The authors conclude, “…efforts should be made to clarify to clinicians and prospective patients that whereas ADM [antidepressant medication] can have a substantial effect with more severe depressions, there is little evidence to suggest that they produce specific pharmacological benefit for the majority of patients with less severe acute depressions.”
Popular antidepressants like Effexor, Lexapro, Paxil or Prozac can cause side effects, however, even in people who may not be getting significant benefit. Moreover, some of these medicines can be difficult to stop, producing withdrawal symptoms such as dizziness, nausea, sweating, chills, loss of appetite or sensations like an electrical shock.
This is not the first study to throw doubt on the value of antidepressants for mild or moderate depression. In 2008, Irving Kirsch, MD, and his colleagues reported that highly successful antidepressants such as Celexa, Effexor, Paxil, Prozac, Serzone and Zoloft hardly worked better than placebos in clinical trials (PLoS Medicine, Feb., 2008). The authors concluded, “the overall effect of new-generation antidepressant medications is below recommended criteria for clinical significance.”
Even before that, a huge government-funded study (STAR*D) revealed that the effectiveness of antidepressant medications was disappointing (New England Journal of Medicine, March 23, 2006). Only one in four patients responded favorably to the first medication prescribed.
Some people really get great benefit from antidepressants. Those who are especially depressed seem to benefit the most.
For the vast majority of people with mild to moderate depression, non-drug approaches such as exercise, talking therapy or controlled light exposure may be helpful. You can learn more about a variety of approaches in our new Guide to Dealing with Depression.
