Consider this: Antidepressants are the most widely prescribed drugs in the United States, with 10 percent of women and 4 percent of men taking them. Yet a new review published Tuesday in the Journal of the American Medical Association finds that some of the most popular drugs actually don't work better than a sugar pill in the majority of these folks. The study did find, however, that the medications do work effectively in those with really bad depression, the kind that completely interferes with the ability to work, feel any pleasure, sleep, eat normally, and engage in the normal routines of life.
What's shocking to me is how many people—especially women—are put on these drugs for mild mood problems that don't fall into the category of truly, utterly "black dog" depression. That's probably the fault of primary-care physicians, who often don't screen properly for depression before writing a prescription. Correct screening involves asking patients a series of questions about their symptoms in order to categorize the condition as mild, moderate, severe, or very severe. To assess the effectiveness of antidepressants in the new review of six studies, researchers relied on the Hamilton Depression Rating Scale, which defines "mild" as a score from 8 to 13, "moderate" as a score from 14 to 18, "severe" as a score from 19 to 22, and "very severe" as a score above 23.
The University of Pennsylvania review, which evaluated a selective serotonin reuptake inhibitor called paroxetine (Paxil) and the tricyclic imipramine (Tofranil), found that the score "needed to achieve a clinically meaningful" difference between a placebo and an antidepressant was 28. In other words, very, very severe depression—which the bulk of antidepressant takers don't have. (The results probably apply to other SSRIs and tricyclics as well.) A 2005 survey cited by the authors found that more than 70 percent of medication users have scores less than 22. I can't help wondering how many folks are suffering the unnecessary side effects of these medications—lethargy, weight gain, loss of libido—when they could be benefiting just as much from a side effect-free sugar pill. Or better yet, from exercise, which has also been shown to be as effective as antidepressants in those with mild depression. [Here's a plan for lifting depression without medication.]
Clearly, though, many people need to be on these drugs. A study out on Monday found that many with truly severe depression aren't getting even the minimal treatment they need. But if you're feeling depressed and considering medication, you should first make sure that your doctor determines the severity of your condition. Find a doctor who's willing to do an assessment like the Hamilton scale, study author Robert DeRubeis advises. You might need to see a psychiatrist since many primary-care doctors aren't willing or able to set aside the 20 minutes to do a little probing.