THE DETAILS: Researchers at the University of Pennsylvania analyzed the results of six drug trials, which included 718 patients taking medication for depression. The study authors found that the antidepressants studied, paroxetine (sold as Paxil and Serixat) and imipramine (sold under various names, including Antideprin, Deprinol, and Imipramil), were effective only for the most severely depressed patients. For patients with mild to moderate depression, and even some patients in the less-severe portion of the major depression category, medication for depression performed no better than placebo. That is, no better than a sham treatment such as a sugar pill.
With antidepressants in such widespread use, how is it that this phenomenon went unreported until now? In fact, most drug studies are done with severely depressed patients, the group that according to this data is most likely to show improvement with drug therapy. The six trials included in the JAMA article are among the very few that included less-depressed subjects, and thus, could yield a comparison between less and more depressed patients. By focusing on patients who had the most severe forms of depression and getting good results, most of the research done on antidepressants created the perception that all depressed people would benefit from their use.
Next page: What it means.
WHAT IT MEANS: Antidepressant medication is a very useful treatment for severely depressed patients. However, many people who receive these drugs are not in that category. A recent study found that 71 percent of patients seeking outpatient treatment for depression were mildly or moderately, not severely, depressed. Not only, as this study shows, would they not benefit from taking antidepressants, many of these patients would improve with natural interventions that do not carry the risks of drug side effects.
To put it another way, medication is very effective for the right patients. Unfortunately, it is overprescribed for patients with mild to moderate depression, and this study makes it clear that they're not the ones who benefit from antidepressant medicines. Last year in the U.S., 164 million prescriptions for antidepressant medications were written, at a cost of $10 billion. Influences from the pharmaceutical and insurance industries encourage doctors to prescribe, and consumers to take, antidepressants they don’t need. Thanks to direct-to-consumer advertising, patients who don't have the serious depression that responds to drug treatment are essentially asking their doctors to medicate for unhappiness. When these patients are treated only with drugs, they are deprived of the opportunity to get to the root of their issues and make the changes needed for a full and enduring recovery.
Many of the depressed people I work with get better without drugs. They use diet, nutritional supplements, exercise, meditation, and breathing techniques to reduce stress and boost their energy. They learn to become more optimistic, grateful, and forgiving, all of which enhance their mood. They also get involved in mood-enhancing social activities, and make a decision to actively confront their problems. Using these approaches, mildly and moderately depressed people can improve within several weeks without using medication. These strategies are also helpful for those who really are severely depressed. Many of people in that category do overcome depression without drugs, but for some, medication gives them the boost they need to engage in mood-enhancing activities, including psychotherapy. And it is fortunate that drugs are available to help patients who need their help to climb out of depression, and can then make use of other approaches.
Next page: Natural self-care strategies for moderate depression.
Here are some ways to boost your mood and handle depression, and decide if medication is a good option for you:
• If you are experiencing mild to moderate depression, use self-care approaches that address nutrition, exercise, breathing, sleep, meditation, and attitude-shifting to balance and energize your body.
• Consult with your doctor to determine if your depression is coming from an undiagnosed medical condition, such as an underactive thyroid or a vitamin deficiency.
• Take a hard look at your schedule and daily routines. Make whatever changes are needed so you'll be able to engage in pleasant and constructive activities that lift your mood. Especially helpful are stimulating activities with other people. If you're a person who follows a tight schedule, make sure you put these kinds of activities on your calendar along with all your other appointments. Don't just assume you'll do them "when you have time."
• Enjoy the sunshine. For many people with seasonal depression, exposure to sunlight is one of the best ways to boost mood. On cloudy days, using a high-intensity light box can also help. If you can swing it, a week in a warm, sunny climate can work wonders at this time of year.
• Work with a psychotherapist to understand your feelings, change your thinking, solve problems, and engage in mood-enhancing activities. This need not be a commitment to years of deep analysis; you're liable to feel results after some weeks of therapy.
• If your symptoms are severe, prolonged and/or unresponsive to appropriately applied natural approaches, consider medication. Consult with a psychiatrist who specializes in using medication to treat depression and other emotional conditions.
Jeffrey Rossman, PhD, is a Rodale.com advisor and director of life management at Canyon Ranch in Lenox, MA. His column, “Mind-Body-Mood Advisor,” appears weekly on Rodale.com.