If you think you need an antidepressant because "things just don't feel like they used to," as a TV ad for the antidepressant Zoloft describes it, you might want to think again. A new study published in the Journal of the American Medical Association finds that the medications work no better than a placebo in those with mild or even moderate symptoms of depression. The drugs are, however, very effective at lifting depression in people with very severe symptoms. "Consumers may not be aware that the efficacy of [these] medications largely has been established on the basis of studies that have included only those individuals with more severe forms of depression," the study authors write.
Unfortunately, primary care physicians who prescribe antidepressants often don't take the time to tease out the very severe cases from the milder ones, says study coauthor Robert DeRubeis, a professor of psychology at University of Pennsylvania. 'Those with severe symptoms typically wake up every morning one to three hours before they want to," he explains, "often wish they were dead, have a marked increase or decrease in their food intake, and a major decrease in their productivity at work if they can get to work at all." Those with milder symptoms, on the other hand, may have some noticeable sleep difficulties (but not every night), have feelings of dread (but not thoughts of suicide), and can still get their work done even when feeling down. Sure, these folks may feel better after taking an antidepressant, but they might have also felt better just going to the doctor to discuss their symptoms, hitting the gym for regular workouts, or making time to socialize with friends.
"A longer life or better life is what you hope for when you take a medication," says Lisa Schwartz, an associate professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice. Before filling that new prescription, she advises, "find out whether this premise is really true or based on a set of assumptions." Most antidepressant trials, DeRubeis says, included only patients with severe or very severe depression, and the beneficial results measured don't apply to those with mild cases. Clearly, medications can be lifesaving for some (the heart disease patient taking a statin to prevent another heart attack) and life-altering for others (that severely depressed person finally able to get out of bed). But you may not need a statin if your cholesterol is just a tad high or an antidepressant if you're feeling down over a bad breakup. How to determine whether to take that oh-so-promising pill? Here are the 5 questions to ask your doctor.