Massive Study Reveals We Need Better Therapies Than Antidepressants here’s why

Antidepressants are the mainstay of treatment for depression, but their use is clouded by questions about their lasting effectiveness. A new study now suggests that antidepressants may not improve people’s quality of life in the long term, compared to depressed people who do not take this type of medication.

This does not mean that we should not use them, because these drugs save lives in many cases. But the findings are the latest in a series of works triggering an overhaul of antidepressants; an important project, given millions of people take them for depression around the world.

The research, led by pharmacoepidemiologist Omar Almohammed of King Saud University, Saudi Arabia, may also help validate the experiences of people who feel disappointed with antidepressants. For some, these drugs do little to relieve depression and can have unwanted side effects such as weight gain, insomnia, loss of sex drive, and even withdrawal symptoms if stopped abruptly.

Improving people’s general well-being, especially their quality of life, for years, not just months, is “the ultimate goal of therapy”, Almohammed and his colleagues write in their diary. However, if antidepressants help achieve this goal is debatable, to say the least.

Antidepressants have a checkered history, plagued by undue influence from the pharmaceutical industry, which, it turns out, has long suppressed trial data showing that antidepressants can be ineffective, inflating the apparent effects of lucrative drugs.

Although this publication bias appears to have diminished in recent years, the fact remains that antidepressants are leaving many people desperate for better treatments as the global burden of depression continues to grow.

Many studies also compound the problem by failing to take into account aspects that matter most to patients, such as quality of life.

In this latest study, Almohammed and his colleagues analyzed data from the US Medical Expenditure Survey, a national study that tracks the healthcare services used by Americans.

Health records showed that, on average, between 2005 and 2016, about 17 million adults were diagnosed with depression each year, a staggering figure equivalent to the population of the Netherlands or Ecuador.

About two-thirds of people in the 11-year data set were women, reflecting real gender disparities in mental health; nearly 60 percent were treated with antidepressants.

Use of antidepressants was associated with some improvements in mental, but not physical aspects of quality of life, according to the analysis. This means that people tended to report that their psychological distress and well-being improved with antidepressants, but their physical health problems, body pain and lack of vitality often persisted.

Worryingly, the positive change in some aspects of quality of life observed in those who took antidepressants for two years did not differ much from that observed in those who did not take the drugs.

Physicians and healthcare professionals should consider involving people in psychotherapy or social support sessions before resorting to or prescribing antidepressants ‘primarily because there has been no lingering impact from these medications’ on people’s quality of life, writes the team.

However, the study did not distinguish between newly diagnosed cases of depression and people who had lived with the mood disorder for years; people were included in the analysis as long as they had a diagnosis of depression and two years of follow-up data. This means that he cannot exclude the scenario that for some these drugs had a first effect before the observed two-year period.

The researchers also could not control for the severity of the depression as this was not recorded in the survey data. Additionally, the two study groups also differ somewhat in age, gender, ethnicity, and their experience of poverty.

We also can’t extrapolate the results of this US-centric study to everyone, everywhere, but it fits with growing evidence from other countries that modern antidepressants fall short in many ways.

That doesn’t mean we should completely cut out antidepressants. Rather, as this study points out, clinicians may need to rethink how best to use antidepressants and whether or not the drugs provide meaningful and lasting benefits to people.

For example, last year researchers argued that mental health experts need to rethink who and how antidepressants are prescribed to, that drugs should be prescribed for shorter periods of time and for people with severe depression, not mild symptoms.

What’s more, pairing antidepressants with support from a psychotherapist appears essential for improving people’s quality of life, more so than medication or talk therapy alone, according to a 2016 meta-analysis of more than 150 randomized, controlled trials. by placebo, the gold standard of clinical evidence.

“Although we still need our patients with depression to continue using their antidepressants, long-term studies are evaluating the real impact of pharmacological and non-pharmacological interventions on the quality of life of these patients.” [are] needed,” adds the team.

The study was published in PLOS A.