Antidepressants may be ineffective, study shows

By: Katie Gill

Posted: 2/3/10

A recent study done by psychologists and researchers at The University of Pennsylvania suggests that placebos may be as effective at treating mild to moderate depression as antidepressants.

The findings, published in the Journal of the American Medical Association, are based on data gathered from six trials. A total of 718 depressed patients were randomly assigned to take either antidepressants or placebos.

Only patients with severe depression showed a notable improvement as a result of taking antidepressants, as opposed to placebos.

Dr. David Abwender, the acting director of the MA psychology program at The College at Brockport, said these findings are not ground-breaking.

"The idea of a serotonin imbalance being the cause of depression is either wrong or only a tiny part of the problem," he said.

According to IMS Health, antidepressants are some of the most-prescribed medications in the U.S. In 2008, more than 164 million prescriptions were dispensed.

The two medicines that were used in the trials were Paxil, an SSRI, and Imipramine, a generic drug in an older class of antidepressants called tricyclics.

SSRIs, or selective serotonin reuptake inhibitors, keep serotonin, a chemical in the brain that effects mood, from reabsorbing into the area that emits it and allows receptors, the areas that catch the chemical, so to speak, to absorb them.

Trycyclics, used less nowadays due to their strong side effects, increase the chemical messengers serotonin and noradrenaline in the brain.

Cheryl Sitchenko, nurse practitioner and assistant director at Brockport's student health center, said SSRIs are the most commonly prescribed antidepressants given to students.

According to the Child and Youth Health Web site, about one in four people suffer depression by age 24, but few seek help.

"This is often due to not understanding depression and being worried about what their friends might think," the site states.

Sitchenko and Abwneder both said people often seek help from their doctor, rather than a counselor or psychiatrist.

"Most people go to their doctors first if there is a problem," she said. "The last thing I want to do is label something right off."

She said most students she prescribes SSRIs to have a positive reaction to the medicine.

Sitchenko said the health center works closely with the school's counseling center to make sure students are correctly diagnosed and treated, after being given their options for treatment.

She said she chooses to start students who are depressed using SSRIs because they are the safest antidepressants, in terms of side effects, and are likely to help students best.

However, both Abwender and Sitchenko said following up with doctors and seeking both medical treatment and psychotherapy is the best way to deal with depression.

Abwender said severe depression is evident, because there are often "clear, objective and observable signs" of a person's depression.

Sitchenko said there is a palpable sense of depression that transfers to the medical professional, which is often a clear indicator of the patient's depression.

"You feel bummed out when you leave the room," she said.

Sitchenko said when depression impacts what a person does and what he or she wants to do with his or her life, it is time to seek treatment, whether medicinal or counseling.

"Treatment is about getting people to learn how to manage their depression," Stichenko said.

Abwender said there is no hard evidence that increasing serotonin levels will solve depression. He said some medications decrease the amount of Serotonin in a person's brain and alleviate his or her depression.

Sitchenko said those medications target other chemicals in the brain, though.

"I think a lot of people expect too much of medications," Abwender said.

To illustrate his point, Abwender said if, in a study, there were 200 participants, 100 would be given antidepressants and 100 would receive placebos.

At the end of the study, 35 people in the placebo group might get better, whereas 50 in the medication group might.

Since both groups are of the same mindset, with some expecting to be helped and some expecting to only receive placebos, their mindsets would, statistically, be the same.

Hence, the 35 who got better without medication would have to be subtracted from the 50 whose depression was alleviated by the medication, because of the equal mindsets of the two groups.

Therefore, only 15 of the 100 who received medication would have likely been cured by the pills.

Both Abwender and Sitchenko said the amount an SSRI works is only, on average, 15 to 20 percent higher than a placebo.

"The people in the experiment are responding to their beliefs or the attention they are receiving from the doctors, not the pill," Abwender said.

He did say, however, pharmacogenetics, a branch of medicine that studies people's genetic makeup to determine which medicines would be most effective in treating them, shows a lot of promise.

Sitchenko agreed, saying "What people believe really has a strong effect on them, but they have to realize medicines can only do so much."

She said a lot of progress has been made with SSRIs.

Abwender said SSRIs have very different molecular structures, so that is why one may not work for someone but another could.

He said the results of drug experiments sometimes get "spun," because it does not make economic sense for the drug industries to admit to the public the small difference between the effects of a placebo and an antidepressant.

"You need to look inside the numbers," Abwender said.