Dr. Adams
01-18-2010, 03:45 PM
"Antidepressant medications (ADMs) offer significant benefit in the treatment of the severest depressive symptoms, but the current standard of treatment may have little or no therapeutic benefit over and above placebo in patients with mild to moderate depression — a population which accounts for most cases.
An analysis of 6 randomized, placebo-controlled trials conducted by investigators at the University of Pennsylvania, Philadelphia, indicates that compared with placebo, the magnitude of benefit of ADMs varies with the severity of depressive symptoms.
True drug effects (an advantage of ADM over placebo) were nonexistent to negligible among depressed patients with mild, moderate, and even severe baseline symptoms, whereas they were large for patients with very severe symptoms.
...surprising part of the findings was how severe depression has to be in order to see this clinically meaningful difference emerge between medication and placebo and that the majority of depressed patients presenting for treatment do not fall into that very severe category.
...ADMs are the best established treatment for major depression, there is little evidence demonstrating their efficacy in patients with less severe symptoms because most major clinical trials tend to exclude patients in the mild to moderate range.
...the underlying mechanics that might explain this effect are not clear...the study findings suggest a need for further research to investigate alternative treatment options — including nonpharmacologic approaches — for patients with mild to moderate depression.
...it is premature and potentially hazardous to suggest patients with mild to moderate depressive symptoms discontinue use of their ADMs.
One additional point that may be getting overlooked in the broader messages about this paper is that even placebo treatment helps a great many people, and although we don't fully understand why that is, part of it likely comes from patients taking their symptoms seriously, acting on their concerns, and speaking with mental health professionals.
It raises the question of whether patients with mild to moderate depression should have antidepressant therapy as a first-line approach."
JAMA. 2010;303:47-53.
An analysis of 6 randomized, placebo-controlled trials conducted by investigators at the University of Pennsylvania, Philadelphia, indicates that compared with placebo, the magnitude of benefit of ADMs varies with the severity of depressive symptoms.
True drug effects (an advantage of ADM over placebo) were nonexistent to negligible among depressed patients with mild, moderate, and even severe baseline symptoms, whereas they were large for patients with very severe symptoms.
...surprising part of the findings was how severe depression has to be in order to see this clinically meaningful difference emerge between medication and placebo and that the majority of depressed patients presenting for treatment do not fall into that very severe category.
...ADMs are the best established treatment for major depression, there is little evidence demonstrating their efficacy in patients with less severe symptoms because most major clinical trials tend to exclude patients in the mild to moderate range.
...the underlying mechanics that might explain this effect are not clear...the study findings suggest a need for further research to investigate alternative treatment options — including nonpharmacologic approaches — for patients with mild to moderate depression.
...it is premature and potentially hazardous to suggest patients with mild to moderate depressive symptoms discontinue use of their ADMs.
One additional point that may be getting overlooked in the broader messages about this paper is that even placebo treatment helps a great many people, and although we don't fully understand why that is, part of it likely comes from patients taking their symptoms seriously, acting on their concerns, and speaking with mental health professionals.
It raises the question of whether patients with mild to moderate depression should have antidepressant therapy as a first-line approach."
JAMA. 2010;303:47-53.