Huge Study says “Anti-Depressants Work”

The biggest ever study of anti-depressants has found that they reduce symptoms of depression and are more effective than placebos. The findings also included the first ever league tables comparing different antidepressants, confirming that they all work, but some less well-known drugs work better than well-known ones like Prozac.

Here’s how the BBC reported it:

Scientists say they have settled one of medicine’s biggest debates after a huge study found that anti-depressants work.

The study, which analysed data from 522 trials involving 116,477 people, found 21 common anti-depressants were all more effective at reducing symptoms of acute depression than dummy pills.

You can read reports on the research here and here and you can access the original paper here.

The research, led by Oxford University, and published in The Lancet, the most prestigious British medical journal, examined 522 trials involving 21 types of anti-depressant medication and 115,000 patients over almost four decades, most of whom had moderate to severe depression.

Importantly, the paper analysed unpublished data held by pharmaceutical companies, and showed that the funding of studies by these companies does not influence the result, thus confirming that the clinical usefulness of these drugs is not affected by pharma-sponsored spin.

The researchers suggest much of the opposition to prescribing of such medications came from an “ideological” standpoint rather than an assessment of the evidence.

Expert Reaction

You can read some of the expert reaction to the research here. Some extracts below:

Lead author Dr Andrea Cipriani said he was “very excited” about the findings, which he said provided a “final answer” to controversy over the effectiveness of the drugs.

Prof Carmine Pariante, Institute of Psychiatry, Psychology and Neuroscience and spokesperson for the Royal College of Psychiatrists, said: “This meta-analysis finally puts to bed the controversy on antidepressants, clearly showing that these drugs do work in lifting mood and helping most people with depression…For the millions of individuals with depression who are taking antidepressants at present, or will need to take antidepressants in the future, it confirms that these drugs are safe and effective.”

Prof Anthony Cleare, Professor of Psychopharmacology and  Affective Disorders, King’s College London, said  the study “puts to bed the idea that antidepressants don’t work – all 21 antidepressants were more effective than placebo at treating depression.”

Prof David Taylor, Professor of Psychopharmacology, King’s College London, said: “This analysis of a huge number of studies of antidepressants confirms that they are much more effective than placebo – itself a powerful treatment in depression. Differences between antidepressants are smaller, although newer drugs tend to be better tolerated.”

Dr James Warner, Reader in Psychiatry, Imperial College London, said: “This rigorous study confirms that antidepressants have an important place in the treatment of depression.”

Some Caveats

Some of the cautions in relation to the report included the following:

• Researchers added that most of the data in the meta-analysis covered eight weeks of treatment, so the findings might not apply to longer-term use.
• They said it did not mean that anti-depressants should always be the first form of treatment.
• Medication should always be considered alongside other options, such as psychological therapies, where these are available.

The Role of Meds

I state my own view on the role of medication in the treatment of depression in Chapter eight of Refresh: Living a Grace-Paced Life in a Burnout Culture. In summary, the main points are:

• Don’t rush to medication.
• Don’t rule it out
• Don’t wait too long to consider it
• Don’t expect rapid results
• Don’t rely on meds alone (the most important point of all)
• Don’t dwell on side-effects
• Don’t obsess about getting off them
• Don’t come off them too quickly
• Don’t be ashamed of them

I’ve summarized and simplified some of the most recent ground-breaking research into depression here, here, and here.

For a simple accessible Christian guide to medications, see Dr. Mike Emblett’s excellent book, Descriptions and Prescriptions.

Postscript

Some of the alarming mental health stats I picked up in my reading about this report include:

• Although 1 in 5 people will suffer a mental health problem this year only one in six patients suffering from depression receive treatment.
• The average age of onset for depression is 14, as diagnosed now, compared to 45 in the 1960s
• The number of young people who talked about suicide during Childline (UK) counselling sessions in 2013/14 rose 116% compared to 2010/11
• Eighty per cent of people stop anti-depressants within a month although beneficial effects normally took at least two months.
• Because of inadequate resources, antidepressants are used more frequently than psychological interventions.