Depression medication – Evidence and usefulness

Depression medication has been widely prescribed since the early days of Prozac (Fluoxetine) and the discovery that depression can be helped by taking a pill. A new study shows that in reality, only those who suffer from severe depression may actually benefit from taking the meds though.

Depression is commonly seen in addiction treatment so I think the topic is relevant for us. But before I explain the details, a little review of depression medication would be useful.

A review of depression medication

The type of medication has gone through some major changes, starting with TCAs and MAOIs and ending up at SSRIs and SNRIs. MAOIs blocked an enzyme from breaking down Serotonin, which increased the levels of this emotion-enhancing neurotransmitter (MDMA, or ecstasy effects Serotonin as well). SSRIs and SNRIs block the recycling of serotonin (SSRI means Selective Serotonin Reuptake Inhibitor) and a broader group of neurotransmitters (SNRI = Serotonin Norepinephrine Reuptake Inhibitor).

The problem with MAOIs was that their side effects were often worse than the depression the patients were suffering. The same side effect problems were also common with TCAs (tricyclic antidepressants) because of the numerous effects they had on many systems in the brain.

MAOIs and TCAs are essentially gone from the U.S. market but are still prescribed in other countries to some extent. SSRIs and NSRIs are the most common drugs for depression treatment here, but there are still major differences between different specific pills.

New study results – Pills good for severe depression

This new meta-analysis (a combined analysis of a bunch of older papers), seems to show that Tofranil (a TCA) and Paxil (a SSRI) are only more effective than a placebo sugar-pill in patients who suffer from severe depression. The problem is that most people who are prescribed anti-depressants today suffer from mild or moderate depression. This brings into question the wide use of the drugs.

It even seems possible that the reason side effects are worse than the depression for some patients is because the depression itself was simply not that severe in the first place and would have been better helped by the use of psychotherapy without medications.

Some limitations of the study

It’s important to realize that this study looked only at two different medications, both of which are known to have a significant problem with negative side-effects. Future studies will most likely cover more of what’s available and since depression and addiction are so closely associated, you can count on me revisiting this again!

Citation:

Jay C. Fournier; Robert J. DeRubeis; Steven D. Hollon; Sona Dimidjian; Jay D. Amsterdam; Richard C. Shelton; Jan Fawcett (2010). Antidepressant Drug Effects and Depression Severity: A Patient-Level Meta-analysis. JAMA, 303(1):47-53.

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