Antidepressants are the mainstay for treating depression, but their use is clouded by questions about lasting efficacy. A new study now suggests antidepressants may not improve people's quality of life in the long run, compared to depressed people who don't take this type of medication. That's not to say we shouldn't use them, as these drugs save lives in many instances. But the findings are the latest among a slew of work triggering a rethink of antidepressants; an important project, considering millions of people take them for depression worldwide. The research, led by pharmacoepidemiologist Omar Almohammed of King Saud University, Saudi Arabia, may also help to validate the experiences of folks who feel let down by antidepressants. For some, these meds do little to relieve depression and can have unwanted side effects such as weight gain, insomnia, loss of sex drive, and even withdrawal-like symptoms if they are stopped abruptly. Improving people's overall wellbeing, especially their quality of life, for years and not just a few short months, is "the ultimate goal of therapy," Almohammed and colleagues write in their paper. However, whether antidepressants help achieve this goal is questionable, to say the least. Antidepressants have a checkered history, plagued by undue influence from the pharmaceutical industry that, it turns out, has long suppressed trial data showing antidepressants can be ineffective, inflating the apparent effects of the lucrative drugs. Although this publication bias appears to have diminished in recent years, the fact remains that antidepressants leave many people desperate for better treatments, while the global burden of depression continues to grow. Many studies also compound the problem by not considering the aspects that matter most to patients – such as quality of life. In this latest study, Almohammed and colleagues crunched data from the US Medical Expenditures Panel Survey, a nationwide study that tracks which health services Americans use. Health records showed that on average, between 2005 and 2016, roughly 17 million adults were diagnosed with depression each year, a staggering figure equivalent to the population of the Netherlands or Ecuador. About two-thirds of people in the 11-year dataset were women, reflecting the real-world gender disparities in mental health; nearly 60 percent were treated with antidepressants. Antidepressant use was associated with some improvements in mental, but not physical aspects of quality of life, the analysis found. What that means is people tended to report that their psychological distress and wellbeing improved with antidepressants, but their physical health problems, bodily pain, and lack of vitality often remained. Worryingly, the positive change in some aspects of quality of life seen among those on antidepressants over two years did not differ much from that seen among those not taking the drugs. Doctors and health professionals should consider looping people into psychotherapy or social support sessions before resorting to or when prescribing antidepressants "mainly since there was no persisting impact for these medications" on people's quality of life, the team writes. However, the study did not distinguish between newly diagnosed cases of depression and people who had lived with the mood disorder for years; people were included in the analysis so long as they had a diagnosis of depression and two years of follow-up data. This means it can't rule out the scenario that for some, these drugs had an initial effect before the two-year period observed. The researchers also couldn't control for the severity of depression because this was not recorded in the survey data. Plus, the two study groups also differed somewhat in age, gender, ethnicity, and their experience of poverty. We also can't extrapolate the findings of this US-centric study to everyone, everywhere, but it does fit with mounting evidence from other countries that modern antidepressants are falling short in many ways. That doesn't mean we should do away with antidepressants altogether. Rather, as this study underscores, clinicians might need to rethink how antidepressants are best used and whether or not the drugs deliver meaningful, lasting benefits to people. For example, just last year researchers argued that mental health experts need to revisit to whom and how antidepressants are prescribed, that the drugs should be prescribed for shorter periods of time, and for people with severe depression, not mild symptoms. What's more, pairing antidepressants with support from a psychotherapist seems key to improving people's quality of life, more so than the drugs or talking therapy alone, according to a 2016 meta-analysis of more than 150 randomized, placebo-controlled trials, the gold standard of clinical evidence. "Although we still need our patients with depression to continue using their antidepressant medications, long-term studies evaluating the actual impact for pharmacological and non-pharmacological interventions on these patients' quality of life [are] needed," the team adds. Source
