“It is the aloneness within us made manifest,” Andrew Solomon wrote in his book The Noonday Demon: An Atlas of Depression, “and it destroys not only connection to others but also the ability to be peacefully alone with oneself.”
Depression is the most common of all mental illnesses, afflicting an estimated 7 percent of the population. More than one in 10 Americans have prescriptions for antidepressants, now among the most widely used of all medications. But some doctors are questioning the efficacy of these drugs in treating depression. And even with new advances in understanding depression, many cases still go undiagnosed and untreated, experts say—especially among older people.
The depression debate
Many researchers now believe that depression is caused by chemical imbalances in the brain. A predisposition to depression is known to run in families, and there’s also evidence that traumas, certain illnesses and childhood abuse can lead to depression later in life.
For all that is known about depression, however, there’s still plenty of debate about how best to diagnose and treat it.
The most recent furor was sparked by a report published in January in the Journal of the American Medical Association. A team led by psychologist Jay Fournier of the University of Pennsylvania, evaluating data from several studies, concluded that antidepressants, despite their popularity, are no more effective than sugar pills for most people with mild or moderate depression. For severe forms of the disease, the pills do help, the scientists acknowledged. Still, they’re far from a cure-all.
Irving Kirsch, professor emeritus at the University of Connecticut and a professor of psychology at the University of Hull in England, who is widely regarded as one of the world’s leading experts on psychiatric drugs and the placebo effect, says this latest study reinforces earlier findings: “Our studies show that placebos are about 80 percent effective, which is exactly how effective antidepressants are in the short term.”
But, he adds, the “placebo effect is very powerful when you’re treating depression. Placebos offer hope. And one of the chief features of depression is a sense of hopelessness, the belief that you’re not going to get better.” Anything that instills a sense of hope, he says, “will at least temporarily help treat depression.”
For researchers, the placebo effect makes evaluating the effectiveness of mood-altering drugs even more complicated. There is no objective test for depression, as there is for high cholesterol or elevated blood pressure. The only way to gauge if antidepressants are working is to ask people how they’re feeling.
Still, plenty of experts—including many psychiatrists—insist that the widely used medications do work. “We know from years of clinical experience that these medications help people who are moderately or severely depressed,” says Gary Small, M.D., professor of psychiatry at the David Geffen School of Medicine at UCLA and director of the UCLA Center on Aging.