Jan 222010

Paraphrased from Medscape.com

Antidepressant medications offer significant benefit in the treatment of the severest depressive symptoms, but the current standard of treatment may have little or no therapeutic benefit over and above placebo in patients with mild to moderate depression — a population which accounts for most cases.

An analysis of 6 randomized, placebo-controlled trials conducted by investigators at the University of Pennsylvania, Philadelphia, and published in the January edition of the Journal of the American Medical Association indicates that compared with placebo, the magnitude of benefit of antidepressants varies with the severity of depressive symptoms.

“True drug effects (an advantage of antidepressants over placebo) were nonexistent to negligible among depressed patients with mild, moderate, and even severe baseline symptoms, whereas they were large for patients with very severe symptoms,” the investigators, with first author Jay C. Fournier, MA, write.

“I think the most surprising part of the findings was how severe depression has to be in order to see this clinically meaningful difference emerge between medication and placebo and that the majority of depressed patients presenting for treatment do not fall into that very severe category”

According to the authors, although antidepressants are the best established treatment for major depression, there is little evidence demonstrating their efficacy in patients with less severe symptoms because most major clinical trials tend to exclude patients in the mild to moderate range.

In the meantime, he said, it is premature and potentially hazardous to suggest patients with mild to moderate depressive symptoms discontinue use of their antidepressants.

“Treatment decisions need to be made on an individual basis between patients and their doctors,” said Mr. Fournier.  He also pointed out that it is important for depressed patients to take an active role in their own care, regardless of the severity of their symptoms.  “One additional point that may be getting overlooked in the broader messages about this paper is that even placebo treatment helps a great many people, and although we don’t fully understand why that is, part of it likely comes from patients taking their symptoms seriously, acting on their concerns, and speaking with mental health professionals.

“Rather than walking away with the impression that nothing works for mild or moderate depression, I hope patients understand that treating their illness seriously and actively engaging in treatment can be quite beneficial,” he said.

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