The Antidepressant Debate

In 1990, depression was determined to be the fourth leading cause of the global burden of disease (death and disability caused by an illness) amongst all diseases. By 2020, it is projected to jump to second place.

Antidepressants and psychotherapy are the two firs line treatments for most patients with depression. The Royal College of Psychiatrists (www.rcpsych.ac.uk/info) recommends that psychotherapy is effective in mild and moderate to server depression. However on a practical level, because of a global shortage of trained psychotherapists, and the cost and time involved in psychotherapy, perhaps more than 95% of depressed patients are treated with antidepressants the world over.

In this scenario, when a respected psychologist from the university of Hill, Irving Kirsch (Kirsch et al. 2008) initial severity and antidepressant benefits: a meta analysis of data submitted to the FDA. PLoS Med 5(2) suggests that there seems little evidence to support the prescription of antidepressant medication to any but the most severely depressed patients. How does one reconcile the above piece of research with the daily observation of psychiatrists and patients that many people, who have been low and depressed of months, and sometimes years recover within four to six weeks of taking antidepressant medication?

The answer probably lies in the way psychiatric research is conduced, reported and interpreted. Without going into too much jargon, Kirsch et al calculated an effect size (a statistical measure of how well a drug works) of .32 while another study done by Erick Tumer, an Assistant Professor of Psychiatry at the university of Oregon, USA reported an effect size of .31. Interestingly, Kirsch’s conclusion was that antidepressants don’t work while Turner’s conclusion was that they do!

And this is where the confusion arises in that different studies have reached different conclusions because they have interpreted almost identical results differently. To summaries, as the current knowledge stands, psychotherapy works well in mild to moderate depression, while antidepressants should be used for moderate to severe depression. However, if you have any personal choices for or against drugs or psychotherapy make sure you discuss it with your psychiatrist.

By Dr Syed Ahmer

The writer is Assistant Professor, Department of Psychiatry, Aga Khan University Karachi.