A new study from Yale University raises additional concerns about the use of antidepressants.
The study pooled and examined data from previous research trials and found that, while the vast majority of depressed people who take medication improved significantly (and much more than if they were given sugar pills), those who do not improve--about 20 percent in this study--actually did worse than they would have on sugar pills.
This stark finding--that a fifth of depressed patients would actually be better off with placebos than real antidepressant pills--means that doctors must be very alert to who is responding to antidepressants and who is not. They need to select antidepressants carefully, matching the likely effects and side effects with a patient's particular symptoms, then change medications within weeks, when indicated for particular patients.
For patients, this study means that they should be telling their doctors when antidepressants seem to be making them feel more anxious or less energized or even sadder, as soon as they have those experiences. Because "riding it out" for eight weeks or longer, in order to "get the therapeutic effect" of particular medications may be unwise. When antidepressants don't seem to be improving things, and instead seem to be making a person's condition worse, other medications or other treatment modalities should be used, instead.
The notion of stopping medicine that seems to be causing trouble, rather than helping, might seem obvious, but some clinicians have traditionally believed that patients need to "ride out" feeling badly on antidepressants, until the therapeutic effects can take hold. This remains a judgment call, but the Yale data makes it plain that looking to alternatives, instead of looking to the future, might be the wiser course.
While it has become commonplace for family physicians and even nurses to prescribe antidepressants, this study also highlights the importance of patients seeking out experts who use psychiatric medications routinely and who have a good reputation for getting good results with them. Prescribing antidepressants is a clinical art, no different than prescribing a regimen of heart medications for folks with cardiac illness. You wouldn't want to rely on me to treat your cardiac arrhythmia and you probably don't want to rely on anyone other than a psychiatrist (and one who has a good deal of experience using both psychotherapy and medications) to treat your major depression.
In my practice, I often change patients' antidepressants relatively quickly, in order to minimize side effects and achieve early reductions in symptoms. I often add medicines that augment the antidepressant's effectiveness, or that target particularly troubling symptoms, like anxiety or sleeplessness. I sometimes use psychopharmacologic strategies to eliminate or reduce side effects. This requires that I be in frequent touch with patients and that I be willing to take action quickly and decisively. It also requires that I listen very carefully to the nuances of what patients tell me about how they are feeling on these powerful medicines.
I always have told people that they should be very active managers of their own psychiatric care. Now, the data is stronger than ever supporting the importance of being willing to speak up and make it clear when something different or something more need be done.