Sorting out the evidence for antidepressants

In the July 9 New York Times, Dr. Peter Kramer wrote a piece titled, "In Defense of Antidepressants". It seems ironic that such an article is needed, given the substantial evidence that antidepressants have helped millions of people. However, there continues to be a confusing, academic argument about some of the studies of antidepressants.

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Dr. Kramer is a gifted psychiatrist. He achieved national recognition 18 years ago when he wrote the book "Listening to Prozac". He made his patients come to life for the reader. I read the book and was impressed by how many people he had helped to find their way forward by combining sensitive psychotherapy and appropriate use of one of the earliest serotonin reuptake inhibitors, Prozac.

While his recent article takes on a difficult topic, I was pleased that the paper published it. While some of the details are too esoteric for most readers to follow, the balance of evidence clearly demonstrates that antidepressants work. That's also the conclusion of the FDA and is the experience of many people who have recovered from a serious depression.

Of course, as has been discussed at great lengths on this blog, not all antidepressants work for everyone. Additionally, for some of you, the side effects can be intolerable. Despite millions of dollars of research, the process of finding the right antidepressant is still a difficult one.

While some new tools, such as pharmacogenomic testing, make this process somewhat more rational, it's clear that the search for a better antidepressant must continue and that research designed to identify which people will respond to which medication should have a high funding priority from the National Institute of Health.

One type of study that Dr. Kramer discusses is particularly interesting and rarely considered. These are "maintenance studies". In his article, Dr. Kramer refers to a large study of 4,410 patients who initially had a good response to an antidepressant. The study was designed to focus on the question of how long to continue treatment. The study also wanted to examine the possibility that some patients may respond to treatment as a consequence of other factors besides their medication.

In this study, after successful treatment, half of the patients were switched to a placebo and the remainder continued to receive their active antidepressant. The participants didn't know if they were still getting their antidepressant or had been switched to a sugar pill. In many ways, this is a tough study to volunteer to be in. However, the results were clear. About 70 percent of those who were switched to the placebo relapsed, while most who remained on their medication didn't relapse.

This finding strongly suggests that simply believing that you're taking your antidepressant is not sufficient to maintain a good response. This result makes good sense and supports the importance of staying on a medication that's working.

A link to Dr. Kramer's article can be found in the Resources tab above.

Please share your thoughts.

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