There are many popular debates in medicine’s history and one of them is if antidepressants actually work. Even after encountering so many researches has this debate finally come to an end? Recent studies has shown that antidepressants work, but to what extent?
There are many types of antidepressants where some are more effective than the rest. The more depressed someone is, the more likely antidepressants are going to work on them.
Pills and therapies work equally well on most patients with moderate to severe depression, but most people don’t receive proper treatment. The doctors say that just one out of six people get proper treatment in developed countries and one out of 27 in the developing countries. If patients with cancer or heart disease received this level of under-treatment there would be a riot and complaints from the public.
Antidepressants are taken by people in United States the most, than any other country in the world.
Some people debate that the benefit received from these pills is short-lived and side effects may surpass benefits in the long run, while other believes that these pills can be life-changing.
Although there are many studies regarding this debate, it took a long time to settle down. The negative findings mostly outnumbered the positive findings which prolonged publishing the results.
The lancet has published a new study that proves that depression can be treated with antidepressants.
In 2008, a study showed that Food and Drug Administration- FDA approves the antidepressants if there are at least two positive studies that testify the efficacy of antidepressants. Most negative studies are often declined for journal publication and are less likely to be submitted. The study published in 2008 was led by Dr. Kirsch and a few other researchers which was a meta-analysis containing both positive and negative studies, for six new antidepressants approved by FDA.
The finding was that antidepressants were as good as placebos for mild to moderate depression. Which means that it is not true that antidepressants don’t work at all, but for mild to moderate level of depression placebos often work? Kirsch’s data showed that antidepressants are superior to placebos but they work better on moderate to high depression.
Same year, among 74 studies found by the researchers only 3 studies appeared negatively in the literature. The studies were about drugs approved for more than 12,500 patients approved between 1987-2004. Where half of the trials had positive results, other half were negative. All positive results had been published whereas 22 studies with negative trials were never published. 11 of the published studies had initially negative results but they were repacked to appear as positive.
The journal Philosophy, Ethics had a paper by John Ioannidis where he pointed that selected studies are biased to positive results. His argument was that people knew less about long-term side effects and more about the biased data showed by the published studies.
There are some papers which have placed constant doubts about medical research conduct and use of antidepressants like this one- “Effectiveness of Antidepressants: An Evidence Myth Constructed from a Thousand Randomized Trials?” but the past difficulties have been tried to overcome by the recently published paper— “most comprehensive antidepressants study to date”. A group of researchers including Dr. Ioannidis explored published and unpublished trials in medical literature, international registers till starting of 2016. 21 head-to-head and placebo-controlled antidepressants were searched by them that were used for major depression in adults. They used the network meta-analysis technique to examine how efficient the drugs were also how acceptable the treatment was. The good news is that the result of this analysis was that antidepressants were more effective than placebos.
The analysis also pointed the presence of novelty bias in published trials. Newly released antidepressants performed better, slowly losing efficacy and tolerance level over time. The bad news is that the only people with severe depression got the most benefit from antidepressants. Antidepressants start showing improvements in major depression within first two months of treatment.
To get individual level responses on how antidepressants work we need more data. Dr. Ioannidis hopes that future studies will give us improved responses. He is anxious about the media showing us news like “the debate is over”, “antidepressants work” and so on. Even with so many findings on the usability and effects of antidepressant there are more pending questions. If patients and drug companies are interested in the results of antidepressants they need to demand more research.