TUESDAY, January 5, 2010 (Health.com) — For people with milder cases of depression, fake pills may be just as effective as antidepressant drugs, a new study suggests.
The study confirmed that antidepressants are substantially better than fake pills, or placebo, in people with severe depression, but the researchers found “little evidence” that the drugs are more effective than placebo in people with milder depressive symptoms.
The findings don’t mean that antidepressants don’t work—only that most of the drugs’ effectiveness in people with milder depression can be attributed to the placebo effect.
The implications of the study for the everyday treatment of depression may be limited, however, because the researchers looked at just two antidepressants, paroxetine (Paxil) and imipramine (Tofranil), an older antidepressant known as a tricyclic. Newer and more potent antidepressants might have produced a different result, says David Hellerstein, MD, a research psychiatrist at the New York State Psychiatric Institute in New York City who specializes in treating chronic, low-grade depression.
People on antidepressants should not stop taking them based on these new findings, Dr. Hellerstein adds. “Don’t do anything rash, and talk to your doctor if you think this is relevant to you,” he says.
The study, a new analysis of data from previously conducted clinical trials, was led by Jay Fournier at the University of Pennsylvania and was published in the Jan. 6 issue of the Journal of the American Medical Association.
Fournier and his colleagues looked at 2,164 clinical trials of antidepressants in all, but they ultimately excluded all but six from their analysis for a variety of reasons—because they weren’t placebo-controlled or were shorter than six weeks long, for instance.
The researchers found that, on average, the benefits of antidepressants over placebo were “minimal or nonexistent” in people whose depression was less than “very severe” according to American Psychiatric Association guidelines. Even people with “severe” depression—which is one step below “very severe”—did not experience a significant effect from antidepressants compared to placebo, the study reports.
“It’s a very well done paper in a top journal, and they’re raising a serious question,” says Dr. Hellerstein. But, he says, the findings aren’t comprehensive enough to indicate whether doctors should continue to prescribe antidepressants to people with mild or moderate depressive symptoms.
Next page: Not the final word on treatment
