A new meta-analysis published in the Lancet is said to finally answer the question of whether antidepressants are effective for treating major depression. Researchers assessed 522 clinical trials involving 116,477 patients that were conducted in a double-blind, randomized fashion from 1979 to 2016. They found that antidepressants were more effective than placebo over 8 weeks of treatment. Of the 21 available antidepressants, some were more effective than others. Escitalopram, paroxetine, and venlafaxine were among the most effective, while fluoxetine, fluvoxamine, and reboxetine were among the least. Researchers noted that 82% of these 522 trials were at moderate to high risk of bias, something to consider when pharmaceutical companies are funding most of the research and have a clear financial interest in the outcome.
What’s my take? I find the evidence convincing both from the research and my own clinical experience, that antidepressants can be beneficial for people living with moderate to severe depression. In fact, they can be lifesaving. There is no reason to think that there is not a biological component to depression and there should be no stigma associated with their use.
I don’t think, however, that a pill is all that is needed to show up fully in our lives. A diabetic can take insulin or metformin but still would be wise to limit high glycemic load foods and exercise. A statin for hyperlipidemia is only a small piece of improving heart health. I have migraines, and magnesium works great for keeping them at bay. But I also watch my diet, wear sunglasses in bright light, manage my stress, stay hydrated and get enough sleep. If someone is living with depression, whether they choose to take medication or not, there is still much more that can be done to feel better.
Scientific studies have overwhelmingly shown that counseling/psychotherapy leads to long-lasting improvement in depression. There are many struggles we live through in our lives and learning how to reframe them and having someone to talk with can be life-changing and life-saving. Regular physical activity can both protect against and improve depression, as does meditation. Forty-two studies found that St. John’s wort is superior to placebo for milder forms of depression. Studies show that typical “western” diets are associated with a higher incidence of depression when compared to more wholesome diets.
No matter what health issue we are dealing with, medication should only be one step, sometimes a very important step, in improving our lives.