Thanks for your comment.

It’s not really old news, although I do like the Casablanca reference. The important take-away message is that anti-depressants probably DO work, but only on the most depressed patients. Given the side-effects of these medicines, we should reserve them for the most severely depressed patients, and using Cognitive Behavioral Therapy (CBT) for less severe cases of depression, at least as the first course of treatment.

Andrew

A study just published in JAMA Jan 5, reported that SSRI antidepressants are no better than placebo for most cases of depression. The authors reviewed 30 years of data and concluded that “the benefit of antidepressant medication compared with placebo may be minimal or nonexistent in patients with mild or moderate symptoms”.

Of course, this is old news, and reminds me of the famous scene in 1942 film, Casablanca, where Captain Louis Renault declares, ” I am Shocked, Shocked … to find gambling here….Here is your winnings… Oh thank you.”

For More:
http://jeffreydach.com/2010/01/21/jama-says-ssri-antidepressants-are-placebos-by-jeffrey-dach-md.aspx

Hi Ken,

Thanks for your comment. Let me reply to them in order to clarify some points.

First of all, even though there is a lot of research suggesting that antidepressants do not reliably outperform placebos, for individual patients antidepressants may work well. My own clinical experience suggests that about 1/3 of depressed patients have a good response to antidepressants, 1/3 have a weak response, and the last 1/3 have little or no response.

If they work for you, then I would encourage you to keep doing what you are doing.

In terms of the the severity variable, the researchers used the scores on the Hamilton Depression Rating Scale, with the ranges I mentioned in the article.

The scale is posted HAM-DHERE, if you want to take a look at it.

And certainly depression varies a lot, from day to day, but there is an underlying core to it, which I believe is measurable.

Andrew

I have never heard of a classification of depression based on ‘very, severely or extremely.’ Nor do I know how patients could understand this comparative term, given that one’s own depression is the only one we can experience directly.

Also in my experience, the depression is a variable sensation. A transient or variable mood feeling, not a fixed sensation set at a fixed level. It varies from moment to moment. It can lift like a breath of fresh air and can fall on you like a steel door slamming.

Regards

Ken